Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction

Psycho-gastroenterological profile of an Italian population of children with disorders of gut-brain interaction: A case-control study

BACKGROUND

Disorders of gut-brain interaction (DGBI) are common, but knowledge about their physiopathology is still poor, nor valid tools have been used to evaluate them in childhood.

AIM

To develop a psycho-gastroenterological questionnaire (PGQ) to assess the psycho-gastroenterological profile and social characteristics of a pediatric population with and without DGBI.

METHODS

One hundred and nineteen Italian children (age 11-18) were included: 28 outpatient patients with DGBI (Rome IV criteria) and 91 healthy controls. They filled the PGQ, faces pain scale revised (FPS-R), Bristol stool chart, gastrointestinal symptoms rating scale, state-trait anxiety inventory, Toronto alexithymia scale 20, perceived self-efficacy in the management of negative emotions and expression of positive emotions (APEN-G, APEP-G), irritable bowel syndrome-quality of life questionnaire, school performances, tobacco use, early life events, degree of digitalization.

RESULTS

Compared to controls, patients had more medical examinations (35% of them went to the doctor more than five times), a higher school performance (23% vs 13%, P < 0.05), didn’t use tobacco (never vs 16%, P < 0.05), had early life events (28% vs 1% P < 0.05) and a higher percentage of pain classified as 4 in the FPS-R during the examination (14% vs 7%, P < 0.05).

CONCLUSION

Pediatric outpatients with DGBI had a higher prevalence of early life events, a lower quality of life, more medical examinations rising health care costs, lower anxiety levels.

How do probiotics alleviate constipation? A narrative review of mechanisms

Constipation is a common gastrointestinal condition, which may occur at any age and affects countless people. The search for new treatments for constipation is ongoing as current drug treatments fail to provide fully satisfactory results. In recent years, probiotics have attracted much attention because of their demonstrated therapeutic efficacy and fewer side effects than pharmaceutical products. Many studies attempted to answer the question of how probiotics can alleviate constipation. It has been shown that different probiotic strains can alleviate constipation by different mechanisms. The mechanisms on probiotics in relieving constipation were associated with various aspects, including regulation of the gut microbiota composition, the level of short-chain fatty acids, aquaporin expression levels, neurotransmitters and hormone levels, inflammation, the intestinal environmental metabolic status, neurotrophic factor levels and the body's antioxidant levels. This paper summarizes the perception of the mechanisms on probiotics in relieving constipation and provides some suggestions on new research directions.

Effect of Buspirone on Upper Gastrointestinal Disorders of Gut-Brain Interaction: A Systematic Review and Meta-analysis

Background/Aims

Buspirone shows promise in treating disorders of gut-brain interaction (DGBIs), particularly functional dyspepsia. However, findings have been mixed.

Methods

We systematically searched for prospective studies testing buspirone for any upper gastrointestinal DGBI in 4 databases (Cochrane, PubMed, Scopus, and PsycInfo). The primary outcome was any validated measure of gastrointestinal symptoms. Anxiety, depression and adverse events were secondary outcomes. For randomized controlled trials (RCTs), we performed random-effects meta-analysis of the standardized mean difference (SMD) in post-treatment scores between buspirone and control groups. Risk of bias in RCTs was assessed using the Cochrane Common Mental Disorders Depression Anxiety and Neurosis Group (CCDAN) scale.

Results

Ten studies (n = 283) met inclusion criteria, comprising 5 RCTs, 1 N-of-1 trial, 1 cohort, 1 case series, and 2 case reports. Tolerability of buspirone was good. In meta-analysis, buspirone produced a non-significant improvement in functional dyspepsia/gastroparesis symptoms compared to placebo (SMD = -0.14; 95% CI, -0.44 to 0.17; P = 0.39; I2 = 0%; Nstudies = 3). Of individual symptoms, buspirone improved bloating severity more than placebo (SMD = -0.41; 95% CI, -0.77 to -0.04; P = 0.03; Nstudies = 2) but did not improve post-prandial fullness (P = 0.24, Nstudies = 2) or nausea (P = 0.75, Nstudies = 2). All RCTs included in the meta-analysis were good quality but most treated for only 4 weeks.

Conclusions

We found that buspirone did not improve functional dyspepsia symptoms more than placebo, though studies were small. Buspirone showed benefit for bloating severity, albeit based on few studies. Larger and longer trials of buspirone, targeting more defined groups such as patients with bloating, are warranted.

Bifidobacterium bifidum CCFM1359 alleviates intestinal motility disorders through the BDNF-TrkB pathway

Intestinal motility disorder is characterised by abnormal intestinal motility function, often resulting in symptoms such as diarrhoea and constipation. Probiotics are increasingly recognised as an effective treatment for gastrointestinal disorders, including intestinal motility disorders. In this study, we used senna extract to induce an animal model of intestinal dysfunction characterised by BDNF downregulation. By assessing relevant indicators of intestinal dyskinesia, we found that Bifidobacterium bifidum CCFM1359 effectively alleviated the dyskinesia. However, this alleviating effect was nullified when a TrkB receptor inhibitor was introduced, suggesting that Bifidobacterium bifidum CCFM1359 operates through the BDNF-TrkB pathway. Further analysis revealed that Bifidobacterium bifidum CCFM1359 likely exerts its beneficial effects by regulating intestinal microecology (increasing the relative abundance of Bifidobacterium bifidum and valeric acid content while decreasing Faecalibacterium and butyric acid content), reducing intestinal inflammation (upregulating the anti-inflammatory factor IL-10 and downregulating pro-inflammatory factors TNF-α and IL-1β), and remodelling intestinal nerves (upregulating S100β and the excitatory neurotransmitter ACh, while downregulating the inhibitory neurotransmitter nNOS). This study provides a theoretical basis for using probiotics to alleviate intestinal motility disorders.

Artificial intelligence as a transforming factor in motility disorders-automatic detection of motility patterns in high-resolution anorectal manometry

High-resolution anorectal manometry (HR-ARM) is the gold standard for anorectal functional disorders' evaluation, despite being limited by its accessibility and complex data analysis. The London Protocol and Classification were developed to standardize anorectal motility patterns classification. This proof-of-concept study aims to develop and validate an artificial intelligence model for identification and differentiation of disorders of anal tone and contractility in HR-ARM. A dataset of 701 HR-ARM exams from a tertiary center, classified according to London Classification, was used to develop and test multiple machine learning (ML) algorithms. The exams were divided in a training and testing dataset with a 80/20% ratio. The testing dataset was used for models' evaluation through its accuracy, sensitivity, specificity, positive and negative predictive values and area under the receiving-operating characteristic curve. LGBM Classifier had the best performance, with an accuracy of 87.0% for identifying disorders of anal tone and contractility. Different ML models excelled in distinguishing specific disorders of anal tone and contractility, with accuracy over 90.0%. This is the first worldwide study proving the accuracy of a ML model for differentiation of motility patterns in HR-ARM, demonstrating the value of artificial intelligence models in optimizing HR-ARM availability while reducing interobserver variability and increasing accuracy.

Oral Health Is Associated with Disorders of Gut-Brain Interaction in Adult Women

BACKGROUND

The disorders of gut-brain interaction (DGBI) form a heterogeneous group of gastrointestinal disorders that, to date, have no organic basis. The role of oral health in the development of these disorders has not been explored.

OBJECTIVE

The objective of this study was to examine the relationship between oral health and the DGBI.

METHODS

Data obtained from 166 women with (n = 113) and without fibromyalgia (n = 55) during a prospective observational study conducted in New Zealand during 2022 was evaluated for correlations between oral health measures (WHO oral health questionnaire), and the DGBI (Rome IV survey).

RESULTS

Of the 166 women enrolled in the study, 122 (73.5%) met criteria for at least one DGBI. Women who met criteria for any of the esophageal, gastroduodenal, bowel, and anorectal disorders had significantly lower oral health scores (p < 0.001). For 12 specific DGBI, oral health scores were significantly lower (p < 0.05). Oral health scores were inversely associated with the number of DGBI detected in each participant (ρ = - 0.590, p < 0.001, 95% CI [- 0.69, - 0.48]).

CONCLUSION

The results of this study suggest there is an association between the oral health and the presence, type, and number of DGBIs in women. Further research to examine the nature of this relationship is required.

European Guideline on Chronic Nausea and Vomiting-A UEG and ESNM Consensus for Clinical Management

INTRODUCTION

Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.

METHODS

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.

RESULTS

Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.

CONCLUSION

These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

The Developmental Origins of Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVES

The Developmental Origins of Health and Disease (DOHaD) framework contends that chronic diseases are attributable to behavioral and environmental risks encountered during vital periods of fetal and childhood development. Clinical research investigating irritable bowel syndrome (IBS) largely focuses on adult risk factors, with emerging evidence of epigenetic contributions. Limited work considers potential childhood exposures. This paper applies a life course approach to the study of IBS, exploring the available evidence to ascertain the potential developmental origins of IBS.

METHODS

A systematic literature review was conducted adhering to MOOSE and PRISMA protocols, identifying papers from 1970 through April 2024 examining all IBS risk factors during the prenatal, postnatal, childhood, and adolescent periods. Data were extracted from screened papers and analyzed via meta-analysis using a random effects model.

RESULTS

A total of 27 case-control, cohort, and cross-sectional studies were identified for analysis. The meta-analysis revealed significant childhood risk factors for adult IBS, including family history (pooled OR 2.17, 95% CI 1.89-2.49, p < 0.0001, n = 11) and the occurrence of any childhood trauma event (pooled OR 1.61, 95% CI 1.29-2.01, p < 0.0001, n = 6). Physical and sexual trauma were the strongest trauma predictors. Factors including breastfeeding and Cesarean section were not significant.

CONCLUSIONS

This study found IBS is strongly predicted by traumatic childhood experiences, as well as having an immediate family member with IBS. These demonstrated environmental and genetic components indicate a potential gene-environment interaction during childhood, suggesting a need for primary research to better understand the developmental origins of IBS.

Fibromyalgia severity and symptoms are associated with the disorders of gut-brain interaction

INTRODUCTION

Fibromyalgia remains an idiopathic common disorder characterised by widespread pain with no universally accepted treatment. Irritable bowel syndrome is prevalent among women living with fibromyalgia. The prevalence of other disorders of gut-brain interaction (DGBI) and associations with fibromyalgia symptoms and severity is unknown.

OBJECTIVES

To evaluate the prevalence of the range of DGBI and associations with the symptoms and severity of fibromyalgia in women.

METHODS

A prospective observational study was conducted in New Zealand in 2022. A comprehensive survey included validated measures to identify DGBI (Rome IV) and items assessing the severity of fibromyalgia and pain symptoms, sleep quality, quality of life, mental health and migraine. Analysis was conducted employing Spearman's rho, Mann-Whitney U, Kruskal-Wallis and chi-square tests.

RESULTS

A total of 111 adult women with fibromyalgia enrolled in the study. Of these, 98 (93%) met the criteria for at least one DGBI, and 67 (68%) satisfied criteria for more than one. All groups of DGBI, and 11 specific DGBI were significantly associated with measures of pain, fibromyalgia severity, sleep problems and migraine (p < 0.05). Severity of pain and symptoms associated with fibromyalgia, including sleep problems, were also significantly associated with the functional bowel disorder severity index.

CONCLUSION

This study demonstrated that the prevalence of DGBI in women with fibromyalgia extends beyond irritable bowel syndrome. Presence of multiple DGBI correlates with pain, severity indices of fibromyalgia and sleep problems. Further research is required to examine the aetiology of DGBI in this population.

SIGNIFICANCE STATEMENT

This observational study has identified important relationships between the broader DGBI, fibromyalgia pain and associated symptoms, particularly migraine and sleep disturbance. Notable correlations between the severity indices of each are demonstrated, suggesting that improvements in one domain may reduce pain and improve overall well-being. These findings highlight the importance of addressing each clinical feature of the condition when supporting patients with fibromyalgia.

Validating Simple Modifications to the Rome IV Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care

BACKGROUND

The Rome IV criteria for irritable bowel syndrome (IBS) may be too restrictive for clinical practice and research.

AIMS

To validate the Rome IV criteria and study the diagnostic performance of simple modifications to them.

METHODS

We collected symptom data from consecutive adults with suspected IBS seen in a single clinic. We used a reference standard to confirm IBS (presence of lower abdominal pain associated with altered stool form or frequency; no evidence of organic gastrointestinal disease after limited investigation). We applied Rome IV criteria, but also two modifications. First, we re-incorporated abdominal discomfort but kept symptom frequency required for both abdominal pain and discomfort to at least 1 day per week. Second, we included only abdominal pain but relaxed symptom frequency back to 3 days per month. We calculated sensitivity, specificity and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), for each diagnostic criterion.

RESULTS

We recruited 170 patients (76.5% female, mean age 37.9 years). Sensitivity and specificity of the Rome IV criteria were 82.1% and 85.1%, respectively; positive and negative LRs were 5.51 (95% CI 2.95-11.3) and 0.21 (95% CI 0.14-0.31), respectively. Modifying the criteria by relaxing the frequency of abdominal pain to 3 days per month led to the best performance [sensitivity 90.2%, specificity 85.1%, positive LR 6.06 (95% CI 3.25-12.2), and negative LR 0.11 (95% CI 0.07-0.19)].

CONCLUSIONS

The Rome IV criteria performed well in diagnosing IBS. A simple modification relaxing the required frequency of abdominal pain improved their performance.

Cannabinoid hyperemesis syndrome in pregnancy: a case series and review

Background

Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic nausea and vomiting in the setting of chronic cannabis use. To date, only 11 cases of CHS in pregnancy have been reported.

Case presentation

We describe two cases of uncontrolled vomiting in pregnancy due to CHS. Case 1 represents a 30-year-old Caucasian woman presenting in the 5th week of gestation with nausea, vomiting and abdominal pain intermittently of 1 week duration. Physical work-up was normal, and symptoms resolved with supportive treatment within 3 days, only to occur again at the 14th week of gestation, and again at the 30th week of gestation. Link between symptom relief and hot bathing led to suspicion for CHS, confirmed with positive cannabis urine toxicology screening. Nausea, vomiting and pain subsided with cannabis cessation, and baby was born healthy at 38 + 5 weeks gestation. Case 2 describes a 28-year-old Caucasian woman presenting in the 16th week of gestation with nausea, vomiting and abdominal pain. Physical examination was normal, and symptoms self-resolved. Two weeks later, in the 18th week of gestation, the patient re-presented to the emergency room with sudden re-occurrence of nausea, vomiting and abdominal pain. Once again, a link between symptom relief and hot bathing was noted on admission. The patient was educated on possible links of chronic cannabis use with CHS symptoms and subsequently relayed extensive (>14 years) cannabis use history. Symptoms resolved with cannabis cessation. Baby was born at 37 weeks gestation, with low birth weight of 2180 g requiring 5 days neonatal intensive care unit (NICU) treatment. Regular follow-up up to 5 months post-partum confirmed no CHS relapse with cannabis cessation.

Conclusion

CHS in pregnancy is likely under-reported, reflective possibly of limited physician and patient awareness of this condition, as well as patient concealment of cannabis use in pregnancy. In cases of severe, cyclic nausea and vomiting in pregnancy unresponsive to typical anti-emetic treatment, comprehensive social history including cannabis use should be sought, and associated hot bathing for symptomatic relief out-ruled.

Acupuncture and electroacupuncture for cyclic vomiting syndrome with tachygastria in an adult: A case report

RATIONALE

Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of acute vomiting lasting <1 week, occurring independently and chronically. Management typically involves lifestyle interventions, supportive care, and preventative medication. In rare cases, CVS persists for decades in adults, requiring a multidisciplinary approach to improve symptoms and quality of life.

PATIENT CONCERNS

A 30-year-old male patient presented with a 7-year history of recurrent nausea and vomiting, which initially began in 2017. The episodes occurred without identifiable triggers such as alcohol or overeating, increasing in frequency from once every 4 months to 2 months. He expressed fear of severe deterioration, impacting his ability to eat freely, work, and enjoy his hobbies.

DIAGNOSES

He was diagnosed with CVS based on the Rome criteria. Cutaneous electrogastrography showed postprandial power decrease and tachygastria.

INTERVENTIONS

Regular acupuncture treatments, including electroacupuncture at ST36 with 3 Hz, were administered twice a week for 3 weeks, followed by weekly sessions for 5 additional weeks.

OUTCOMES

Over 11 treatment sessions across 8 weeks, no nausea or vomiting was observed. The visual analog scale (VAS) score for subjective gastrointestinal discomfort decreased from 67 to 0 after 4 weeks. The Nausea Severity Scale (NSS) score dropped from 14 to 0 after 4 weeks. The Functional Dyspepsia-related QoL score decreased from 16 to 0 after 8 weeks. The Nepean Dyspepsia Index-Korean version decreased from 80 to 8 after 8 weeks. Furthermore, the patient expressed high satisfaction with the treatment, and no adverse events were observed.

LESSONS

Acupuncture offers a significant and safe approach to relieving symptoms and enhancing the quality of life for patients with nausea and vomiting. Although this is a single case report, the findings suggest that acupuncture can improve treatment compliance and manage symptoms in adults with CVS. Further research, including clinical trials, is required to confirm these findings and understand the underlying mechanisms.

Retrospective Study on the Association Between Climate Factors and Infant Colic in Beijing (2021-2022)

Purpose

To assess seasonal variations in infant colic (IC) prevalence and explore the association between climate factors, including temperature, air pollutants, and their interactions, with IC.

Methods

Medical records of 1955 infants aged 0-3 months from October 2021 to September 2022 were analyzed, with IC diagnosed according to Rome IV criteria. Seasonal differences in IC prevalence were compared using chi-square tests. Climate data, including weekly averages of temperature, PM2.5, PM10, NO2, CO, O3, and AQI, along with 1-, 2-, and 4-week lags, were collected via web scraping. Interaction terms between temperature and pollutants (including lagged variables) were created. Variance Inflation Factors (VIF) addressed multicollinearity. Pearson correlation assessed linear relationships, while Generalized Additive Models (GAM) evaluated non-linear associations.

Results

The overall IC prevalence was 38.62%. Demographic analysis showed no significant differences between infants with and without IC. Seasonal analysis revealed significant differences, with the highest IC prevalence in winter. After Bonferroni correction, spring (34.52%) and winter (43.60%) differed significantly (p < 0.0083). Linear correlation analysis indicated weak associations between temperature, pollutants, and their interactions with IC (correlation coefficients: -0.05 to 0.03). GAM confirmed these findings, with individual climate factors explaining only 0.002 of the deviance and their interactions explaining 0.007. No meaningful relationship between climate factors and IC prevalence was identified.

Conclusion

This study identified significant seasonal differences in IC prevalence, with the highest rates observed in winter. However, no significant linear or non-linear associations were found between IC and temperature, air pollutants, or their interactions. These findings underscore the need for future research to explore non-climatic factors.

Diagnostic classification systems for disorders of gut-brain interaction should include psychological symptoms

BACKGROUND AND AIMS

The group of disorders known as Disorders of Gut Brain Interaction (DGBI) were originally labeled functional GI disorders and were thought to be disorders of the gastrointestinal tract that had several psychological conditions as comorbidities. Despite mounting evidence that psychological morbidity plays an innate role in the etiology and maintenance of DGBI, none of the Rome IV criteria include any measure of psychological symptoms. This study tested the hypothesis that individuals would cluster differently if GI symptoms alone were considered versus GI symptoms combined with measures of psychological symptoms.

METHODS

Data were obtained from the Rome Foundation Global Epidemiology Study measuring Rome IV GI symptoms, psychological measures and demographic characteristics. Latent profile models were used to cluster individuals based on (i) GI symptoms only (GI only) and then (ii) GI and psychological measures (GI + Psych).

KEY RESULTS

Individuals clustering into the same group of individuals whether formed via GI only or GI + Psych, ranged from 96% for a 2-class solution (the most simplistic) to 76% with 6 classes (the parsimonious system) and 59% with twenty-two classes (mimicking Rome IV). The generalisability of this finding between six geographic regions was confirmed with agreement varying between 95%-97% for 2 clusters and 71-79% for 6 classes and 51%-63% for 22 classes. These findings were also consistent between DGBI (range 94% with 2 classes to 50% with 22 classes) and non-DGBI (range 97% with 2 clusters to 65% with 22 classes) groups.

CONCLUSIONS & INFERENCES

Our data suggest that considering psychological as well as gastrointestinal symptoms would lead to a different clustering of individuals in more complex, and accurate, classification systems. For this reason, future work on DGBI classification should consider inclusion of psychological traits.

Multidisciplinary behavioral therapy reduces rumination

BACKGROUND

Behavioral therapy has proved effective as rumination therapy. Our objective was to treat rumination patients using multidisciplinary behavioral therapy aimed at reducing ≥2 of the rumination score.

METHODS

All patients fulfilled Rome IV criteria for rumination and were referred to speech therapy for psychoeducation, diaphragmatic breathing exercises and guided eating, physiotherapy for exercises to relax the thoracic and abdominal muscles, and consultation with the psychologist and the dietitian. Symptoms, depression, anxiety, health-related quality of life (HRQoL), and functional capacity were evaluated by questionnaires (Rome IV, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), 15D, and World Health Organization Disability Assessment Schedule (WHODAS) 2.0) at baseline and at 6-month control. Esophageal manometry was performed at 6-month control.

KEY RESULTS

The study enrolled 11 patients (19-64 years, 10 female). Rumination score: 6.5 (5-8) at baseline, 4.0 (3-5) at the 6-month control, p = 0.005. BDI/8 (6-13), BAI/15 (8-29) at baseline; BDI/7 (4-8), BAI/15 (7-27) at the 6-month control, NS. 15D score: 0.800 at baseline, 0.845 at the 6-month control, NS. WHODAS 2.0 score: 15 (7-33) at baseline, 11 (7-26) at the 6-month control, NS. Rumination could be evoked in manometry in six of nine (67%) patients at 6-month control.

CONCLUSIONS AND INFERENCES

Behavioral multidisciplinary therapy significantly reduces the self-assessed frequency of rumination. These patients have more depression, anxiety and a lower HRQoL compared to the normal population.

Differences in clinical manifestations and the fecal microbiome between irritable bowel syndrome and small intestinal bacterial overgrowth

BACKGROUND

Irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) share similar abdominal symptoms; however, their differentiation remains controversial.

AIMS

To illustrate the differences between the two conditions.

METHODS

Patients and healthy controls completed questionnaires and provided stool samples for analysis.

RESULTS

IBS presented with the most severe symptoms and was specifically characterized by intense abdominal pain and frequent episodes of diarrhea. Patients with IBS displayed more dysregulated taxonomy within the fecal microbiota than SIBO. Opportunistic pathogens, including Lachnoclostridium, Escherichia-Shigella, and Enterobacter were enriched in the IBS group which contributed to increased bacterial pathogenicity and positively correlated with abdominal pain and bloating, meanwhile, Lachnoclostridium and Escherichia-Shigella were found to be associated with metabolites affiliated to bile acids, alcohols and derivatives. Bacteria enriched in SIBO group correlated with constipation. The bacterial co-occurrence network within the SIBO group was the most intricate. Ruminococcaceae Group were defined as core bacteria in SIBO. Differential metabolites affiliated to androstane steroids and phenylacetic acids were associated with core bacteria.

CONCLUSIONS

Our study elucidates the differences between IBS and SIBO in terms of symptoms, microbiota and functions, which provides insights into a better understanding of both diseases and evidence for different treatment strategies.

Association Between Stress, Neuroinflammation, and Irritable Bowel Syndrome: The Positive Effects of Probiotic Therapy

Stress refers to an organism's response to environmental threats in normal condition to maintain homeostasis in the body. In addition, strong inflammatory reactions induced by the hypothalamic-pituitary-adrenal (HPA) axis under stress condition during a long time. Reciprocally, chronic stress can induce the irritable bowel syndrome (IBS) which is a well-known gut disorder thereby play an important role in the promotion and pathophysiology of neuropsychiatric diseases. It has been demonstrated that leaky gut is a hallmark of IBS, leads to the entrance the microbiota into the bloodstream and consequent low-grade systemic inflammation. In the current review, we will discuss the mechanisms by which stress can influence the risk and severity of IBS and its relationship with neuroinflammation. Also, the role of probiotics in IBS co-existing with chronic stress conditions is highlighted.

Unsupervised machine learning highlights the challenges of subtyping disorders of gut-brain interaction

BACKGROUND

Unsupervised machine learning describes a collection of powerful techniques that seek to identify hidden patterns in unlabeled data. These techniques can be broadly categorized into dimension reduction, which transforms and combines the original set of measurements to simplify data, and cluster analysis, which seeks to group subjects based on some measure of similarity. Unsupervised machine learning can be used to explore alternative subtyping of disorders of gut-brain interaction (DGBI) compared to the existing gastrointestinal symptom-based definitions of Rome IV.

PURPOSE

This present review aims to familiarize the reader with fundamental concepts of unsupervised machine learning using accessible definitions and provide a critical summary of their application to the evaluation of DGBI subtyping. By considering the overlap between Rome IV clinical definitions and identified clusters, along with clinical and physiological insights, this paper speculates on the possible implications for DGBI. Also considered are algorithmic developments in the unsupervised machine learning community that may help leverage increasingly available omics data to explore biologically informed definitions. Unsupervised machine learning challenges the modern subtyping of DGBI and, with the necessary clinical validation, has the potential to enhance future iterations of the Rome criteria to identify more homogeneous, diagnosable, and treatable patient populations.

Social Determinants of Health Are Associated with Failed Bowel Management for Children with Anorectal Malformations

INTRODUCTION

 Children with anorectal malformations (ARMs) benefit from bowel management programs (BMPs) to manage constipation or fecal incontinence. We aimed to understand the role of social determinants of health (SDOH) in outcomes following BMPs in this population.

MATERIALS AND METHODS

 A single-institution, institutional review board (IRB) approved, retrospective review was performed in children with ARM who underwent BMP from 2014 to 2021. Clinical, surgical, and SDOH data were collected. Children were stratified as clean or not clean per the Rome IV criteria at the completion of BMP. Descriptive statistics were computed. Categorical variables were analyzed via Fisher's exact tests and continuous variables with Mood's median tests.

RESULTS

 In total, 239 patients who underwent BMP were identified; their median age was 6.62 years (interquartile range [IQR]: 4.78-9.83). Of these, 81 (34%) were not clean after completing BMP. Children with prior history of antegrade enema procedures had a higher rate of failure. Children who held public insurance, lived within driving distance, had unmarried parents, lived with extended family, and lacked formal support systems had a significant association with BMP failure (p < 0.05 for all). Type of ARM, age at repair, type of repair, age at BMP, and type of BMP regimen were not significantly associated with failure.

CONCLUSIONS

 There is a significant correlation of failure of BMPs with several SDOH elements in patients with ARM. Attention to SDOH may help identify high-risk patients in whom additional care may lead improved outcomes following BMP.

Yoga in Pediatric Gastroenterology

PURPOSE OF REVIEW

Pediatric use of yoga as an integrative medicine modality has increased in prevalence over the last several decades. In this article, we review the available evidence for yoga in pediatric gastrointestinal disorders.

RECENT FINDINGS

Evidence supports that in many pediatric disorders of gut brain interaction (DGBI), including irritable bowel syndrome, functional abdominal pain and functional dyspepsia, yoga decreases pain intensity and frequency and increases school attendance. Yoga has been shown to improve health-related quality of life and improve stress management as an effective adjunct to standard medical therapy in pediatric inflammatory bowel disease (IBD). Further studies are needed regarding optimal frequency, duration of practice and evaluation of the impact on IBD disease activity measures. Yoga may benefit pediatric gastroenterology patients with DGBIs and IBD through improving quality of life and reducing pain. Future yoga studies could investigate biomarkers and continued research will help integrate this modality into routine pediatric gastroenterology care.

Transperineal ultrasound evaluation of pelvic floor muscle function in male patients with constipation

OBJECTIVE

To investigate the application of transperineal ultrasound for assessing pelvic floor muscle (PFM) function in male patients with constipation and to evaluate its clinical value.

METHODS

The study included 32 male patients with constipation and 32 healthy controls, all of whom underwent transperineal ultrasound examinations. Measured parameters included the anorectal angle (ARA), levator plate angle (LPA), excursions of the ARA and LPA, and displacements of the bulb of the penis (BP), mid-urethra (MU), urethra-vesical junction (UVJ), and anorectal junction (ARJ) at rest, during maximal voluntary contraction (MVC), and during maximal Valsalva maneuver. Reliability was evaluated in 20 healthy controls using intraclass correlation coefficients (ICCs) and Bland-Altman analysis.

RESULTS

(1) The ICCs for each parameter measured by both the same and different observers were above 0.84, indicating high repeatability. At least 90% of the measurements by the same and different observers fell within the 95% confidence interval (CI). (2) At rest, the ARA in patients with constipation was significantly larger than in healthy men (P < 0.05). During MVC, LPA, the ARA excursion, LPA excursion, BP displacement, UVJ displacement, and ARJ displacement in constipation patients were also significantly larger than in healthy men (P < 0.05). Furthermore, BP displacement, UVJ displacement, and ARA excursion during maximal Valsalva maneuver in constipation patients were significantly larger than in healthy men (P < 0.05). (3) Receiver operating characteristic curve analysis revealed that the following indicators demonstrated area under the curve (AUC) values exceeding 0.75: ARA excursion of MVC, ARA excursion of maximal Valsalva maneuver, resting ARA, and ARJ displacement of MVC, with AUC values of 0.782, 0.778, 0.770, and 0.765, respectively. No significant differences in diagnostic performance were found among these indicators (P > 0.05).

CONCLUSION

 Transperineal ultrasound is a reliable and practical technique for assessing the morphology and function of male PFMs. Parameters such as ARA excursion during MVC, ARA excursion during maximal Valsalva maneuver, resting ARA, and ARJ displacement during MVC are valuable for diagnosing PFM dysfunction in constipated patients.

Economic Evaluations of Non-Pharmacological Interventions for Treating Disorders of Gut-Brain Interaction: A Scoping Review

BACKGROUND AND OBJECTIVES

Disorders of gut-brain interaction are highly prevalent and burdensome conditions for both patients and healthcare systems. Given the limited effectiveness of pharmacotherapy in treating disorders of gut-brain interaction, non-pharmacological interventions are increasingly used; however, the value for money of non-pharmacological treatments is uncertain. This is the first review to assess the economic evaluation evidence of non-pharmacological interventions for disorders of gut-brain interaction.

METHODS

A scoping review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Reporting adhered to ISPOR's good practices for systematic reviews with cost and cost-effectiveness outcomes. Comprehensive searches were performed on 24 October, 2023, and an updated search was run on 18 May, 2024 in PubMed/MEDLINE, Embase, Web of Science, Scopus and the International HTA database, with two reviewers screening studies in parallel. The novel Criteria for Health Economic Quality Evaluation (CHEQUE) framework was used to assess methodological and reporting quality. Reporting quality was further assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022.

RESULTS

Fifteen studies were included. Most studies examined treatments for irritable bowel syndrome. Cognitive behavioural therapy, dietary interventions and sacral neuromodulation were cost effective. Acupuncture and physiotherapy were not. CHEQUE assessment showed 12 studies met at least 70% of the methodological criteria, and 14 studies achieved 70% or more for reporting quality.

CONCLUSIONS

This review highlights gaps in the current evidence base, particularly in the robustness and generalisability of results due to methodological inconsistencies. Future research should incorporate longer follow-ups, comprehensive cost assessments, subgroup analyses, equity considerations and clearer justifications for modelling assumptions.

A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome

Cannabis, derived from Cannabis sativa plants, is a prevalent illicit substance in the United States, containing over 400 chemicals, including 100 cannabinoids, each affecting the body's organs differently upon ingestion. Cannabis hyperemesis syndrome (CHS) is a gut-brain axis disorder characterized by recurring nausea and vomiting intensified by excessive cannabis consumption. CHS often goes undiagnosed due to inconsistent criteria, subjective symptoms, and similarity to cyclical vomiting syndrome (CVS). Understanding the endocannabinoid system (ECS) and its dual response (pro-emetic at higher doses and anti-emetic at lower doses) is crucial in the pathophysiology of CHS. Recent research noted that type 1 cannabinoid receptors in the intestinal nerve plexus exhibit an inhibitory effect on gastrointestinal motility. At the same time, the thermoregulatory function of endocannabinoids might explain compulsive hot bathing in CHS patients. The prevalence of cannabis CHS is expected to rise as legal restrictions on its recreational use decrease in several states. Education and awareness are vital in diagnosing and treating CHS as its prevalence increases. This comprehensive review explores the ECS's involvement, CHS management approaches, and knowledge gaps to enhance understanding of this syndrome.

Chronic constipation: focus on microbiome-targeted therapies with prebiotics, probiotics, and synbiotics

Chronic constipation is a global medical, social, and economic problem due to its negative impact on patients’ quality of life and increased risk of colorectal cancer, cardiovascular and cerebrovascular disorders. The gut microbiota plays an important role in the pathophysiology of constipation through its interplay with the immune system, enteral and central nervous system, representing a promising therapeutic target. Gut dysbiosis in patients with constipation is characterized by reduced relative numbers of bacteria producing lactate (Lactobacillaceae, Bifidobacteriaceae) and butyrate (Lachnospiraceae, Oscillospiraceae), as well as with increased numbers of those producing hydrogen sulfide (Desulfovibrionaceae) and methanogenic archaea (Methanobacteriaceae). The leading pathogenetic mechanism related to intestinal dysbiosis in chronic constipation, can be microbial metabolic abnormalities (metabolic dysbiosis) characterized by altered production of short-chain fatty acid, methane, hydrogen sulfide, tryptophan metabolites and by abnormal bile acid biotransformation. It has been proven that dysbiotic abnormalities of the intestinal microbiome play a role in the pathophysiology of constipation, which allows for the use of prebiotics, probiotics, and synbiotics for effective microbiome-modulating therapy in patients with chronic constipation. The proven role of dysbiotic abnormalities of the intestinal microbiome in the pathophysiology of chronic constipation determines the effectiveness of microbiome-modulating therapy (prebiotics, probiotics, synbiotics) in patients with this syndrome. Inulin is the most studied preboitic; it is a soluble food fiber that markedly contributes to the regulation of intestinal microbiota, stimulates the growth of beneficial bacteria, and production of anti-inflammatory metabolites. Inulin normalized the intestinal function in patients with chronic constipation increasing the stool frequency, softening the stool, and reducing the intestinal transit time. In addition, inulin modulates the immune response and impacts the absorption of minerals, appetite, and satiety. Treatment with probiotics is also associated with reduced intestinal transit time, compared to controls. According to a systematic review and meta-analysis of 30 randomized controlled trials, only Bifidobacterium lactis strains (but not other probiotics) significantly increase stool frequencies in chronic constipation in adults. Clinical studies have shown that the targeted probiotic Bifidobacterium lactis HN019 can significantly increase the stool frequencies in patients with low (≤ 3 per week) stool frequency up to 4.7–5.0 per week, reduce the intestinal transit time and the rate of functional gastroenterological symptoms in adults with constipation. Beyond its clinical effects, Bifidobacterium lactis HN019 leads to beneficial changes in intestinal microbiota, significantly increasing the bifidobacteria and decreasing the enterobacteria numbers. The results of trials confirm the importance of synbiotic correction of dysbiotic microbiota in all patients with constipation to increase stool frequencies and improve fecal consistency, as well as to prevent the chronic disorders associated with constipation. Synbiotics, such as a combination of Bifidobacterium lactis HN019 and inulin, with the properties of both complementary and synergic synbiotic, may have the greatest microbiome-modulating and functional potential to significantly improve clinical outcomes in patients with chronic constipation compared to probiotics or prebiotics used alone.

Efficacy of acupuncture treatment for diarrhea-predominant irritable bowel syndrome with comorbid anxiety and depression: A meta-analysis and systematic review

BACKGROUND

Presently, a diverse range of Western medical interventions are accessible for the management of irritable bowel syndrome with diarrhea (IBS-D) concomitant with comorbid anxiety and depression. However, the concomitant adverse effects have also surfaced, exerting strain on healthcare resources and the socio-economic structure. In recent times, the benefits of acupuncture in the management of IBS-D with coexisting anxiety and depression have become progressively evident. Nevertheless, a paucity of evidence-based medicine exists to substantiate the utilization of acupuncture for the treatment of IBS-D with anxiety and depression. The objective of this study is to examine the effectiveness of acupuncture as an intervention for IBS-D with comorbid anxiety and depression.

METHODS

We searched 7 databases, including the Chinese Journal Full-text Database, Wanfang Academic Journals Full-text Database, VIP Chinese Scientific Journals Full-text Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library, for randomized controlled trials (RCTs) related to acupuncture treatment for IBS with anxiety and depression, published from database inception to August 1, 2023. RevMan 5.4 and Stata 17.0 software were used for meta-analysis of relevant outcome measures.

RESULTS

This study included a total of 16 RCTs, involving 1305 IBS-D patients (691 in the experimental group and 614 in the control group). The meta-analysis results showed that compared to oral medication, acupuncture therapy improved HAMD scores (MD = 0.88, 95% CI = [0.68, 1.07], P < .00001), HAMA scores (MD = 2.32, 95% CI = [1.70, 2.93], P < .00001), self-rating anxiety scale scores (MD = 11.67, 95% CI = [10.85, 12.49], P < .00001), SDS scores (MD = 9.84, 95% CI = [8.52, 11.16], P < .00001), IBS-SSS scores (MD = 37.48, 95% CI = [12.17, 62.78], P = .004), overall response rate (MD = 1.27, 95% CI = [1.20, 1.35], P < .00001), and relapse rate (MD = 0.27, 95% CI = [0.16, 0.47], P < .00001) in patients with IBS-D comorbid with anxiety and depression.

CONCLUSION

Acupuncture treatment has a definite and beneficial effect on IBS-D patients with comorbid anxiety and depression.

The Value of PHQ-9 and GAD-7 for Screening Emotional Disorders in IBS-D and the Specificity of the Gut Flora Associated with Emotional Comorbidity: Preliminary Findings

Background

To identify irritable bowel syndrome with diarrhea (IBS-D) combined with anxiety and/or depression through a psychological screening tool and to further explore the relationships between patients with comorbidities and gut microbiota.

Methods

The GAD-7, SAS, PHQ-9 and SDS were administered to evaluate anxiety and depression. Faeces were subsequently collected from 44 patients with emotional disorders (IBS-EDs), 22 patients without emotional disorders (IBS-nEDs) and 18 healthy controls (HCs) via 16S rRNA sequencing, depending on the participants' wishes. The differences in gut microbiota among different groups were analysed. Spearman analysis was conducted at the genus level and was based on psychological assessment scores. Patients with IBS-D were recruited from December 2020 to November 2022.

Results

This study included 124 outpatients with IBS-D. According to the GAD-7 and SAS scores, 40.3% and 19.3% of the participants, respectively, had anxiety (P < 0.05). Similarly, a significantly greater percentage of participants had depression according to the PHQ-9 than according to the SDS (61.3% vs 33.1%) (P < 0.05). Overall, approximately 66.1% of the participants had emotional disorders (anxiety and/or depression) according to the GAD-7 and PHQ-9. Correlation analysis revealed that the abundances of Eubacterium_hallii_group, Monoglobus and Lachnoclostridium were closely related to the PHQ-9 scores and that the abundances of Subdoligranulum and Holdemanella were closely related to the GAD-7 scores.

Conclusion

In comparison to the SAS and SDS, both the GAD-7 and PHQ-9 identified a greater number of individuals with emotional disorders within the IBS-D population. Furthermore, our findings demonstrated that Lachnoclostridium is not only a biomarker for IBS-ED patients but also that its abundance changes are related to PHQ-9 scores, which may provide insights for further brain gut investigations.

Clinical factors influencing patency capsule excretion and confirmation in patients with intestinal patency

INTRODUCTION

The PillCam™ patency capsule is useful in preventing capsule endoscope retention; however, visual confirmation of patency capsule excretion is challenging for many patients.

OBJECTIVE

We investigated the factors related to the patency capsule remaining in the colon after 33 h and the factors hindering the visual confirmation of its excretion.

METHODS

We retrospectively analyzed 498 patients with intestinal patency who underwent patency capsule examination. Patients were categorized into the "excretion group" and "colon group," depending on whether the capsule was excreted or remained in the colon after 33 h, respectively. Patients were further classified into self-confirmed and unself-confirmed groups within the excretion group. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with the colon and unself-confirmed groups.

RESULTS

Overall, 49% of patients visually confirmed capsule excretion within 33 h, whereas 51% did not and required radiological examination. Among those without capsule excretion, 34% of patients had a detectable capsule in the colon, whereas 16% had no detectable capsule. In the excretion group, 75% and 25% of patients were self-confirmed and unself-confirmed, respectively. Female sex, inpatient status, constipation, and capsule in the colon during the previous examination were the independent factors associated with the colon group. Male sex and younger age were the independent factors associated with the unself-confirmed group.

CONCLUSIONS

Our findings highlight the need for new approaches to facilitate patency capsule excretion to avoid radiation exposure, especially in females, inpatients, those with constipation, and capsule remaining in the colon on the previous examination.

Medical Comorbidities, Nutritional Markers, and Cardiovascular Risk Markers in Youth With ARFID

OBJECTIVE

Avoidant/restrictive food intake disorder (ARFID) is common among populations with nutrition-related medical conditions. Less is known about the medical comorbidity/complication frequencies in youth with ARFID. We evaluated the medical comorbidities and metabolic/nutritional markers among female and male youth with full/subthreshold ARFID across the weight spectrum compared with healthy controls (HC).

METHOD

In youth with full/subthreshold ARFID (n = 100; 49% female) and HC (n = 58; 78% female), we assessed self-reported medical comorbidities via clinician interview and explored abnormalities in metabolic (lipid panel and high-sensitive C-reactive protein [hs-CRP]) and nutritional (25[OH] vitamin D, vitamin B12, and folate) markers.

RESULTS

Youth with ARFID, compared with HC, were over 10 times as likely to have self-reported gastrointestinal conditions (37% vs. 3%; OR = 21.2; 95% CI = 6.2-112.1) and over two times as likely to have self-reported immune-mediated conditions (42% vs. 24%; OR = 2.3; 95% CI = 1.1-4.9). ARFID, compared with HC, had a four to five times higher frequency of elevated triglycerides (28% vs. 12%; OR = 4.0; 95% CI = 1.7-10.5) and hs-CRP (17% vs. 4%; OR = 5.0; 95% CI = 1.4-27.0) levels.

DISCUSSION

Self-reported gastrointestinal and certain immune comorbidities were common in ARFID, suggestive of possible bidirectional risk/maintenance factors. Elevated cardiovascular risk markers in ARFID may be a consequence of limited dietary variety marked by high carbohydrate and sugar intake.

Positive Outcomes of Supplementation with Lecithin-Based Delivery Formulation of Curcuma longa and Boswellia serrata in IBS Subjects with Small Bowel Dysbiosis

BACKGROUND

Small bowel dysbiosis (SBD) is a frequent finding in subjects with irritable bowel syndrome (IBS). The sunflower lecithin (phytosome) formulation of Curcuma longa and Boswellia serrata demonstrated beneficial effects on intestinal microbiota. This study aimed to evaluate the impact of a lecithin-based delivery formulation of Curcuma longa and Boswellia serrata extracts (CUBO) on SBD in IBS subjects.

SUBJECTS

Forty-nine adult subjects with IBS and SBD were randomly supplemented for 30 days with CUBO and a low-FODMAP diet (LFD) (intervention) or with LFD and placebo (control group).

RESULTS

The intervention group showed a significant reduction in urinary indican (p < 0.001), which was the marker of SBD, and of abdominal bloating (p < 0.001) and abdominal pain (p < 0.001). The pre-post control group analysis did not evidence significant differences. The comparison between the two groups (net effect in intervention minus control subjects) showed that the changes differ significantly for urinary indican p < 0.001 (-42.88; 95% CI: -62.04 to -23.72), abdominal bloating p < 0.001 (-1.50; 95% CI: -1.93 to -1.07), and abdominal pain p < 0.001 (-2.37; 95% CI: -3.61 to -1.13) and for the global assessment of efficacy (p < 0.001). The efficacy was 20% greater in males than in females.

CONCLUSIONS

In IBS subjects, the intervention with CUBO and LFD shows a significantly higher reduction in SBD, abdominal pain, and bloating compared to LFD and placebo. Additional research is needed to confirm these data.

Rikkunshito improves anorexia through ghrelin- and orexin-dependent activation of the brain hypothalamus and mesolimbic dopaminergic pathway in rats

BACKGROUND

Rikkunshito (RKT), a traditional Japanese medicine, can relieve epigastric discomfort and anorexia in patients with functional dyspepsia. RKT enhances the orexigenic hormone, ghrelin. Ghrelin regulates food motivation by stimulating the appetite control center in the hypothalamus and the brain mesolimbic dopaminergic pathway (MDPW). However, the effect of RKT on MDPW remains unclear. Here, we aimed to investigate the central neural mechanisms underlying the orexigenic effects of RKT, focusing on the MDPW.

METHODS

We examined the effects of RKT on food intake and neuronal c-Fos expression in restraint stress- and cholecystokinin octapeptide-induced anorexia in male rats.

KEY RESULTS

RKT treatment significantly restored stress- and cholecystokinin octapeptide-induced decreased food intake. RKT increased c-Fos expression in the ventral tegmental area (VTA), especially in tyrosine hydroxylase-immunoreactive neurons, and nucleus accumbens (NAc). The effects of RKT were suppressed by the ghrelin receptor antagonist [D-Lys3]-GHRP-6. RKT increased the number of c-Fos/orexin-double-positive neurons in the lateral hypothalamus (LH), which project to the VTA. The orexin receptor antagonist, SB334867, suppressed RKT-induced increase in food intake and c-Fos expression in the LH, VTA, and NAc. RKT increased c-Fos expression in the arcuate nucleus and nucleus of the solitary tract of the medulla, which was inhibited by [D-Lys3]-GHRP-6.

CONCLUSIONS & INFERENCES

RKT may restore appetite in subjects with anorexia through ghrelin- and orexin-dependent activation of neurons regulating the brain appetite control network, including the hypothalamus and MDPW.

The prevalence of small intestine bacterial overgrowth in irritable bowel syndrome is much higher with lactulose than glucose breath test: Results of a retrospective monocentric study

BACKGROUND

Glucose (GBT) and lactulose (LBT) breath tests have been recommended for the diagnosis of small intestinal bacterial overgrowth (SIBO). LBT may yield a higher prevalence of SIBO diagnosis, because of its limited small bowel absorption, and therefore colonic fermentation. The aim of this retrospective study was to confirm this hypothesis, in irritable bowel syndrome patients (IBS).

METHODS

Among a cohort of 995 patients who underwent GBT or LBT, 287 with typical IBS according to Rome IV criteria, without past digestive surgery or significant medical comorbidities, were included.

RESULTS

155 IBS patients underwent GBT, and 132 LBT (71% women, mean age 45±15, mean BMI: 22.6±4.3 kg/m2). There were no difference between both groups in terms of demographics, IBS type and severity of symptoms. The prevalence of SIBO according to LBT was 47%, versus 4.5% only with GBT (p<0.001). The prevalence of methane values ≥ 10 ppm were similar in both groups (34%).

CONCLUSION

LBT is very frequently positive in IBS patients, as compared to GBT. The 2 tests are thus not interchangeable for the diagnosis of SIBO. Furthermore, the positivity of both tests was not correlated with symptoms, which may indicate a poor clinical interest of these tests in IBS.

Effect of sex on chronic stress induced alterations in hindbrain catecholaminergic system and autonomic dysfunction resulting in gastrointestinal dysmotility

It has been reported that the clinical symptoms of functional dyspepsia (FD) exacerbate upon stress while the gender-related factors have been incompletely understood. This study aims to investigate the role of sex in chronic heterotypic stress (CHS)-induced autonomic and gastric motor dysfunction. For CHS, the rats were exposed to the combination of different stressors for 7 consecutive days. Subsequently, electrocardiography was recorded in anesthetized rats to evaluate heart rate variability (HRV) for the determination of autonomic outflow and sympathovagal balance. Solid gastric emptying (GE) was measured in control and CHS-loaded male and female rats. The immunoreactivities of catecholaminergic cell marker tyrosine hydroxylase (TH), choline acetyltransferase (ChAT), corticotropin releasing factor (CRF), and estrogen receptor (ER-α/β) were evaluated in medullary and pontine brainstem sections by immunohistochemistry. Compared with the controls, CHS significantly delayed GE in males but not in females. There was no significant sex-related difference in parasympathetic indicator HF under either control or CHS conditions. Sympathetic indicator LF was significantly higher in control females compared to the males. The higher sympathetic output in females was found to be attenuated upon CHS; in contrast, the elevated sympathetic output was detected in CHS-loaded males. No sex- or stress-related effect was observed on ChAT immunoreactivity in the dorsal motor nucleus of N.vagus (DMV). In males, greater number of TH-ir cells was observed in the caudal locus coeruleus (LC), while they were more densely detected in the rostral LC of females. Regardless of sex, CHS elevated immunoreactivity of TH throughout the LC. Under basal conditions, greater number of TH-ir cells was detected in the rostral ventrolateral medulla (RVLM) of females. In contrast, CHS remarkably increased the number of TH-ir cells in the RVLM of males which was found to be decreased in females. There was no sex-related alteration in TH immunoreactivity in the nucleus tractus solitarius (NTS) of control rats, while CHS affected both sexes in a similar manner. Compared with females, CRF immunoreactivity was prominently observed in control males, while both of which were stimulated by CHS. ER-α/β was found to be co-expressed with TH in the NTS and LC which exhibit no alteration related to either sex or stress status. These results indicate a sexual dimorphism in the catecholaminergic and the CRF system in brainstem which might be involved in the CHS-induced autonomic and visceral dysfunction occurred in males.

2-Ethylhexyl diphenyl phosphate aggravates colitis-induced neuroinflammation and behavioral abnormalities by inhibiting the PI3K-AKT-NF-κB and Wnt/GSK3β signaling pathways

2-Ethylhexyl diphenyl phosphate (EHDPHP), a widely used organophosphorus flame retardant (OPFR), is ubiquitous in daily life because of its extensive application in plastic production. EHDPHPs, which are only superficially applied and not chemically bonded to products, are released into the environment, posing potential health risks. With increasing environmental concentrations, EHDPHP is a growing threat, particularly to individuals with preexisting health conditions who are more susceptible to environmental pollutants. This study examined the effects of EHDPHP exposure in a colitis model, reflecting a rising chronic health issue, by assessing changes in neuroinflammation and neurobehavioral abnormalities. Healthy and dextran sulfate sodium (DSS)-induced colitis C57BL/6 J mice were treated with either 0.2 % Tween or EHDPHP solution (10 mg/kg body weight/day) for 28 days. The study revealed significant increases in the serum and expression levels of TNFα and IL-1β, accompanied by depressive and anxiety-like behaviors. Coexposure to EHDPHP and DSS exacerbated these neurobehavioral impairments. RNA sequencing confirmed that EHDPHP triggered inflammation via the PI3K-Akt-NF-κB and Wnt/GSK3β signaling pathways, as confirmed by Western blot analysis. These findings suggest that EHDPHP aggravates colitis-induced neuroinflammation and neurobehavioral abnormalities, highlighting the harmful impact of EHDPHP, particularly in individuals with preexisting inflammatory conditions.

Serum Exosomal MicroRNAs as Potential Biomarkers for Centrally Mediated Abdominal Pain Syndrome

Centrally mediated abdominal pain syndrome (CAPS) has generated a heavy disease burden worldwide. This study aimed to explore the serum exosomal microRNAs (miRNAs) as potential diagnostic biomarkers for CAPS. From September 2022 to October 2023, 97 patients with CAPS and 96 healthy subjects were enrolled. Differentially expressed serum exosomal miRNAs between patients with CAPS and healthy controls were identified by high-throughput sequencing and quantitative real-time polymerase chain reaction. The receiver operating characteristic curves and multivariate logistic regression analysis were used to evaluate the diagnostic value of the serum exosomal miRNAs. MiR-6850-5p, miR-194-5p, miR-199a-3p, and miR-4525 were significantly downregulated in serum exomes of CAPS patients compared with healthy controls, which yielded the area under curve (AUC) values of .914 (95% confidence interval (CI), .873-.954), .767 (95% CI, .695-.839), .617 (95% CI, .527-.708), and .561 (95% CI, .465-.656), respectively, to distinguish CAPS patients from healthy subjects. And AUC of the integration of the above 4 miRNAs was .931 (95% CI, .896-.966). Multivariate logistic regression indicated that hsa-miR-6850-5p (odds ratio (OR) = .046, P < .001), anxiety (OR = 7.670, P = .025), and depression (OR = 22.967, P = .008) were the independent predictors of CAPS. Serum exosomal miR-6850-5p is a promising diagnostic biomarker for CAPS. PERSPECTIVE: This study may be the first to explore serum exosomal miRNAs as new diagnostic biomarkers for CAPS, and the findings may help clinicians to access comprehensive understanding and accurate diagnosis of CAPS.

Interplay of yoga, physical activity, and probiotics in irritable bowel syndrome management: A double-blind randomized study

OBJECTIVES

This study aimed to explore the synergistic impact of online yoga, mindfulness practices, and probiotics on irritable bowel syndrome (IBS) by evaluating changes in physical fitness, mental health, and gut microbiota composition.

DESIGN, SETTING AND INTERVENTIONS

The six-week randomized, double-blinded, placebo-controlled trial included 31 IBS patients categorized into three groups: online yoga with probiotics (EP), online yoga with a placebo (EC), and probiotics only (P). Assessments involved physical fitness tests, subjective questionnaires (IBS-QOL, BSRS-5), and gut microbiome analysis.

MAIN OUTCOME MEASURES

Participants self-collected stool samples and were given a set of questionnaires at baseline and after six weeks of intervention. Their symptoms were measured by changes in the gut microbiota, physical fitness and quality of life, and psychological well-being.

RESULTS

The EP group demonstrated improved cardiovascular endurance (P < 0.001) and a significant reduction in Klebsiella bacterial strains (P < 0.05). Both the EP and EC groups exhibited significantly decreased IBS-QOL scores (P < 0.001 and P < 0.05, respectively), indicating enhanced quality of life. While BSRS-5 scores decreased in both groups, the reduction was statistically insignificant.

CONCLUSION

Integrating online yoga, mindfulness practices, and probiotics demonstrated comprehensive benefits for IBS patients. This intervention improved physical fitness and mental well-being and positively influenced gut microbiota composition. The study highlights the potential of this multifaceted approach in managing IBS symptoms and enhancing overall health, emphasizing the relevance of the gut-muscle-brain axis in understanding and addressing IBS complexities.

TRIAL REGISTRATION

Taiwanese Registry of Institutional Review Board IRBHP210009/CH11000259.

Molecular Mechanisms Underlying Loss of Vascular and Epithelial Integrity in Irritable Bowel Syndrome

BACKGROUND & AIMS

The pathophysiology of irritable bowel syndrome (IBS) is multifactorial and includes epithelial barrier dysfunction, a key element at the interface between the gut lumen and the deeper intestinal layers. Beneath the epithelial barrier there is the vascular one representing the last barrier to avoid luminal antigen dissemination The aims of this study were to correlate morpho-functional aspects of epithelial and vascular barriers with symptom perception in IBS.

METHODS

Seventy-eight healthy subjects (controls) and 223 patients with IBS were enrolled in the study and phenotyped according to validated questionnaires. Sugar test was used to evaluate in vivo permeability. Immunohistochemistry, western blot, and electron microscopy were used to characterize the vascular barrier. Vascular permeability was evaluated by assessing the mucosal expression of plasmalemma vesicle-associated protein-1 and vascular endothelial cadherin. Caco-2 or human umbilical vein endothelial cell monolayers were incubated with soluble mediators released by mucosal biopsies to highlight the mechanisms involved in permeability alteration. Correlation analyses have been performed among experimental and clinical data.

RESULTS

The intestinal epithelial barrier was compromised in patients with IBS throughout the gastrointestinal tract. IBS-soluble mediators increased Caco-2 permeability via a downregulation of tight junction gene expression. Blood vessel density and vascular permeability were increased in the IBS colonic mucosa. IBS mucosal mediators increased permeability in human umbilical vein endothelial cell monolayers through the activation of protease-activated receptor-2 and histone deacetylase 11, resulting in vascular endothelial cadherin downregulation. Permeability changes correlated with intestinal and behavioral symptoms and health-related quality of life of patients with IBS.

CONCLUSIONS

Epithelial and vascular barriers are compromised in patients with IBS and contribute to clinical manifestations.

Slow gut transit increases the risk of Alzheimer's disease: An integrated study of the bi-national cohort in South Korea and Japan and Alzheimer's disease model mice

INTRODUCTION

Although the association between Alzheimer's disease (AD) and constipation is controversial, its causality and underlying mechanisms remain unknown.

OBJECTIVES

To investigate the potential association between slow gut transit and AD using epidemiological data and a murine model.

METHODS

We conducted a bi-national cohort study in South Korea (discovery cohort, N=3,130,193) and Japan (validation cohort, N=4,379,285) during the pre-observation period to determine the previous diagnostic history (2009-2010) and the follow-up period (2011-2021). To evaluate the causality, we induced slow gut transit using loperamide in 5xFAD transgenic mice. Changes in amyloid-beta (Aβ) and other markers were examined using ELISA, qRT-PCR, RNA-seq, and behavioral tests.

RESULTS

Constipation was associated with an increased risk of AD in the discovery cohort (hazard ratio, 2.04; 95% confidence interval [CI], 2.01-2.07) and the validation cohort (hazard ratio; 2.82; 95% CI, 2.61-3.05). We found that loperamide induced slower gut transit in 5xFAD mice, increased Aβ and microglia levels in the brain, increased transcription of genes related to norepinephrine secretion and immune responses, and decreased the transcription of defense against bacteria in the colonic tissue.

CONCLUSION

Impaired gut transit may contribute to AD pathogenesis via the gut-brain axis, thus suggesting a cyclical relationship between intestinal barrier disruption and Aβ accumulation in the brain. We propose that gut transit or motility may be a modifiable lifestyle factor in the prevention of AD, and further clinical investigations are warranted.

Positive affect longitudinally buffers the negative effect of health anxiety on gastrointestinal symptoms

People with significant health anxiety may experience brain-gut dysregulation, leading to increased visceral sensitivity and greater gastrointestinal (GI) symptoms. Positive affect (PA), on the other hand, may serve as a protective characteristic, buffering the negative impact of health anxiety on GI symptoms. This study investigated interrelationships between health anxiety, PA, and GI symptoms. Longitudinal data were collected on health anxiety, PA, and GI symptoms via an online survey from 861 adults at two timepoints, 4 weeks apart. Regression models were conducted to examine the moderating effect of PA at baseline on future GI symptoms. Greater health anxiety at baseline predicted GI symptoms at follow-up, whereas higher levels of PA predicted reduced GI symptoms at follow-up. Post hoc testing revealed that PA significantly moderated the relationship between health anxiety and GI symptoms over time, such that higher levels of PA attenuated the effect of health anxiety on belly pain, nausea and vomiting, and reflux at follow-up. This study provides preliminary evidence PA may buffer the negative impact of health anxiety on GI symptoms. Future studies should explore whether the promotion of PA through interventions similarly attenuates health related anxiety's impact on GI symptoms.

Assessing gastrointestinal symptoms in people with autism: Applying a new measure based on the Rome IV criteria

BACKGROUND

People with autism spectrum disorder (ASD) often struggle with gastrointestinal symptoms, implicating alterations of the gut-microbiota-brain axis, which has also been linked to sensory reactivity, pain, and gastro-intestinal symptoms in ASD. To better understand the prevalence and impact of gastrointestinal symptoms among individuals with ASD, a measure is needed that adhere to the Rome IV criteria of gastrointestinal symptoms and is applicable to individuals with ASD. The Gastrointestinal Symptom Severity Scale (GSSS) is a new assessment tool designed to match this need.

METHODS

In a diverse sample of 265 individuals with ASD (mean age = 9.44, SD = 4.99), we examined the psychometric properties of the GSSS, the prevalence of gastrointestinal symptoms and associations with ASD traits, sensory sensitivity, repetitive behaviors, and pain.

RESULTS

A unidimensional factor structure of the GSSS was confirmed and the measure showed good internal consistency, adequate test-retest reliability and strong convergent validity. Around a third of the participants evidenced clear difficulties with gastrointestinal symptoms and gastrointestinal symptoms were strongly associated with more pronounced ASD traits, sensory reactivity, and repetitive behaviors.

CONCLUSIONS

The GSSS shows promise as a useful measure to analyze the prevalence, severity, and impact of gastro-intestinal symptoms in individuals with ASD.

Causal relationships between psychological disorders and functional gastrointestinal disorders: a bidirectional two-sample Mendelian randomization study

BACKGROUND AND AIMS

Observational studies have shown bidirectional associations between psychological disorders (e.g. depression and anxiety) and functional gastrointestinal disorders. However, whether the relationships are causal is uncertain. Here, we used a bidirectional two-sample Mendelian randomization method to investigate the association between psychological disorders and functional gastrointestinal disorders (FGIDs).

METHODS

We obtained genome-wide association study summary statistics for two common psychological disorders: depression (170 756 cases) and anxiety (31 977 cases), as well as for three common FGIDs: functional dyspepsia with 6666 cases, constipation with 26 919 cases, and irritable bowel syndrome (IBS) with 7053 cases. These summary statistics were retrieved from several publicly available genome-wide association study databases. The inverse variance weighted method was used as the main Mendelian randomization method.

RESULTS

Inverse variance weighted Mendelian randomization analyses showed statistically significant associations between genetically predicted depression and risk of functional dyspepsia [odds ratio (OR): 1.40, 95% confidence interval (CI): 1.08-1.82], constipation (OR: 1.28, 95% CI: 1.13-1.44), and IBS (OR: 1.51, 95% CI: 1.37-1.67). Genetically predicted anxiety was associated with a higher risk of IBS (OR: 1.13, 95% CI: 1.10-1.17) instead of functional dyspepsia and constipation. In addition, genetically predicted IBS instead of functional dyspepsia and constipation was associated with a higher risk of depression (OR: 1.33, 95% CI: 1.12-1.57) and anxiety (OR: 2.05, 95% CI: 1.05-4.03).

CONCLUSION

Depression is a causal risk factor for three common FGIDs. A bidirectional causal relationship between IBS and anxiety or depression was also identified.

Silent Struggles Within: Alexithymia Unveiled in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis

Background/Aims

In recent years, the presence of alexithymia in patients with irritable bowel syndrome (IBS) has gained more attention, and several studies have evaluated this relationship. However, no clear conclusion has been reported yet. Therefore, we conducted a systematic review and meta-analysis to better understand the association between IBS and alexithymia.

Methods

We performed a systematic search on the medical databases PubMed, EMBASE, and Scopus using predefined keywords to identify observational studies assessing the association between IBS and alexithymia. The included studies diagnosed IBS using the Rome criteria, and alexithymia was evaluated using the 20-item Toronto Alexithymia Scale (TAS-20) score. We used The Newcastle-Ottawa Scale to evaluate the quality of included studies. The primary summary outcome was the mean difference in TAS-20 scores.

Results

We included 7 studies involving 1,513 individuals in our qualitative analysis, with 6 of them included in our quantitative analysis. All studies were considered to be of satisfactory quality according to the Newcastle-Ottawa Scale criteria. We found significantly higher TAS-20 scores in IBS patients compared to controls (8.063 [95% CI, 2.554-13.572]). However, no significant mean difference in TAS-20 scores was observed in IBS vs inflammatory bowel disease patients (0.884 [95% CI -2.536-4.304]).

Conclusions

We demonstrated that IBS is associated with an increased risk of developing alexithymia. However, our study did not show a significant difference in TAS-20 scores between patients with IBS compared to inflammatory bowel disease.

Is domestic violence during COVID-19 in lactating women related to infantile colic? An important question

BACKGROUND

Psychosocial factors such as maternal stress in lactating women were shown to be related to an increased risk of infantile colic because the infants can be affected through breast milk. Therefore, domestic violence against lactating mothers can be effective on the infants' health. It is also demonstrated that domestic violence against women has increased following the COVID-19 pandemic and quarantine. Therefore, this study aims to assess the relationship between domestic violence against breastfeeding women during COVID-19 and the incidence of infantile colic.

METHODS

This was a case-control study that was conducted on 356 lactating mothers who attended Bentolhoda Hospital in Bojnoord-Iran from November 2021 to August 2022. The participants were exclusively breastfeeding mothers who were under 6 months infants. Mothers with and without infantile colic infants were considered the case and control groups, respectively. Two questionnaires were used for data collection including a demographic questionnaire, and a questionnaire to assess domestic violence against women during the quarantine period of Corona pandemic. The data was analyzed using SPSS-V22 and Pearson Spearman correlation and linear regression tests.

RESULTS

The results showed that women in the case group had a significantly higher score for "sexual violence and restraint" than women in the control group [0.59 ± 0.34 versus 0.62 ± 0.25 (Mean ± SD), respectively] (P < 0.05). The chance of infantile colic was higher among the infants of mothers who experienced domestic violence, but it was not statistically significant (OR = 1.236, P = 0.573). Significant relationships were found between the infantile colic and the history of abortion (OR = 1.430, P = 0.028) and cesarean section (OR = 1.723, P = 0.044).

CONCLUSION

Domestic violence during pregnancy can potentially increase infant colic through breast milk. Although our findings need more investigation, it can be recommended to plan the direction of screening for domestic violence and providing the necessary care and counseling to the parents in perinatal care services to prevent infantile colic and improve the infant's health.

Frequency of detection of dyssynergic defecation in patients with overlap syndrome of functional disorders of the digestive organs associated with constipation

Introduction. The presence of dyssynergic defecation in a cohort of patients with overlap syndrome of functional disorders is poorly studied.

Aim. To assess the motor function and sensitivity parameters of the anorectal zone, to identify dyssynergic defecation and to analyze the frequency of correlation in patients with overlap syndrome of functional gastrointestinal disorders associated with constipation.

Materials and methods. A one-stage examination was conducted in four parallel groups. The study included 100 patients aged 30 to 40 years with the following diagnoses: constipation-p redominance irritable bowel syndrome (IBS-C) (group 1), IBS-C combined with functional dyspepsia (group 2), IBS-C combined with functional biliary disorder (group 3) and healthy volunteers (group 0). All patients underwent a balloon expulsion test and high-resolution anorectal manometry to determine the presence of dyssynergic defecation.

Results. Based on the analysis of parameters according to anorectal manometry data, dyssynergic defecation was not detected in group 0, in group 1 dyssynergic defecation was detected in 8 people – 32.0% (95% CI 12.3–51.6), in group 2 – in 14 people – 56.0% (95% CI 35.0–76.9), in group 3 – in 16 people – 64.0% (95% CI 43.7–84.2). A negative evacuation test was detected in 8 (32%) patients in group 1, in 14 (56%) patients in group 2, and in 17 (68%) patients in group 3, which confirmed the presence of dyssynergic defecation.

Conclusions. This study demonstrated the presence of dyssynergic defecation in three groups of subjects, more often with a combination of irritable bowel syndrome with predominant constipation with functional dyspepsia, and most often with a functional disorder of the gallbladder.

Associations of thyroid hormones with chronic diarrhea and constipation in euthyroid individuals

Background

Abnormalities in thyroid function affect bowel health. However, the relationships between thyroid hormone concentrations and the risk of developing chronic diarrhea and constipation remain unclear. Thus, the aim of this study was to investigate the relationships between thyroid hormone concentrations and the risk of developing chronic diarrhea and constipation in euthyroid US adults.

Methods

The data for this population-based study were taken from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 datasets. The relationships between thyroid hormone concentrations and the risk of developing chronic diarrhea and constipation were examined via multivariate regression. Smoothed curve fitting and threshold effects analysis were used to test for nonlinear relationships and inflection points.

Results

This study involved 4999 participants ranging in age from 20 to 80 years. Multivariate logistic regression analysis revealed a significant positive correlation between FT3 concentrations and the risk of developing chronic diarrhea [1.37 (1.00, 1.88), P=0.049]. Multivariate linear regression analysis revealed a significant positive correlation between FT3 concentrations and the number of bowel movements [0.84 (0.39, 1.28), P<0.001]. Using smoothed curve fitting and the two-stage regression model, we found a nonlinear relationship between FT4 concentrations and chronic diarrhea, with a breakpoint of 0.79 ng/dl.

Conclusions

There were associations between thyroid hormone concentrations and abnormal bowel habits, particularly between FT3 concentrations and the risk of developing chronic diarrhea. A higher FT3 level was associated with an increased risk of developing chronic diarrhea and more frequent bowel movements. To validate our results, further large-scale prospective studies are needed.

Mast cell modulation: A novel therapeutic strategy for abdominal pain in irritable bowel syndrome

Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders characterized by recurrent abdominal pain and an altered defecation pattern. Chronic abdominal pain represents the hallmark IBS symptom and is reported to have the most bothersome impact on the patient's quality of life. Unfortunately, effective therapeutic strategies reducing abdominal pain are lacking, mainly attributed to a limited understanding of the contributing mechanisms. In the past few years, exciting new insights have pointed out that altered communication between gut immune cells and pain-sensing nerves acts as a hallmark driver of IBS-related abdominal pain. In this review, we aim to summarize our current knowledge on altered neuro-immune crosstalk as the main driver of altered pain signaling, with a specific focus on altered mast cell functioning herein, and highlight the relevance of targeting mast cell-mediated mechanisms as a novel therapeutic strategy for chronic abdominal pain in IBS patients.

Impact of Enteric Nervous Cells on Irritable Bowel Syndrome: Potential Treatment Options

Irritable bowel syndrome (IBS) is a condition that significantly impacts the lifestyle, health, and habits of numerous individuals worldwide. Its diagnosis and classification are based on the Rome criteria, updated periodically to reflect new research findings in this field. IBS can be classified into different types based on symptoms, each with distinct treatment approaches and some differences in their pathophysiology. The exact pathological background of IBS remains unclear, with many aspects still unknown. Recent research developments suggest that disorders in the brain-gut-microbiota axis are key contributors to the symptoms and severity of IBS. The central nervous system (CNS) interacts bidirectionally with intestinal processes within the lumen and the intestinal wall, with the autonomic nervous system, particularly the vagus nerve, playing an important role. However, the enteric nervous system (ENS) is also crucial in the pathophysiological pathway of IBS. The apeline-corticotropin-releasing factor (CRF)-toll-like receptor 4 (TLR4) signaling route via enteric glia and serotonin production in enteroendocrine cells at the enteric barrier are among the most well-understood new findings that affect IBS through the ENS. Additionally, the microbiota regulates neuronal signals, modifying enteric function by altering the number of enteric bacteria and other mechanisms. Given the limited therapeutic options currently available, it is essential to identify new treatment targets, with the brain-gut axis, particularly the enteric nervous system, being a promising focus. This study aims to delineate the molecular mechanisms that induce IBS and to suggest potential targets for future research and treatment of this potentially debilitating disease.

Chronic nausea and vomiting syndrome and impact on quality of life

INTRODUCTION AND AIM

Chronic nausea and vomiting syndrome is a disorder of gut-brain interaction that affects the productive-age population. Our aim was to determine the association of this disorder with quality of life, workplace performance, and socioeconomic impact related to gastrointestinal health.

METHODS

A cross-sectional study on a Mexican population was conducted. The patients were classified as having chronic nausea and vomiting syndrome or other disorders of gut-brain interaction. A comparative analysis of quality of life, workplace productivity, annual medical consultations, and digestive health-related expenses was carried out, applying a logistic regression model.

RESULTS

One thousand patients were included, 79.2% of whom met the criteria for a disorder of gut-brain interaction. Of the 792 patients, 10.3% presented with chronic nausea and vomiting syndrome. Said syndrome was associated with a negative impact on usual activities (OR 4.34, 95% CI 1.90-9.30, p ≤ 0.001), pain/discomfort (OR 2.09, 95% CI 1.31-3.33, p ≤ 0.001), anxiety/depression (OR 2.08, 95% CI 1.30-3.40, p ≤ 0.001), workplace presenteeism (OR 3.96, 95% CI 2.47-6.44, p ≤ 0.001), and workplace absenteeism (OR 2.54, 95% CI 1.52-4.16, p ≤ 0.001). There was also a higher number of annual medical consultations for digestive health (p = 0.013), without generating a greater annual expense due to digestive health (p = 0.08).

CONCLUSIONS

Chronic nausea and vomiting syndrome produces a negative impact on quality of life, which could be secondary to its symptomatology or its association with anxiety and depression.

Intestinal Inflammation and Permeability in Patients Recovered from SARS-CoV-2 Infection

INTRODUCTION

Different works suggest a close link between long COVID gastrointestinal (GI) manifestations and the post-infection disorders of gut-brain interaction (PI-DGBIs). However, the actual mechanisms underlying long-term GI sequelae are still not clear. Our study was aimed to assess both intestinal inflammation and permeability among subjects recovered from SARS-CoV-2 infection and their eventual correlation with long-term GI sequelae.

METHODS

Eighty-six subjects attending the post-COVID service and recovered from SARS-CoV-2 infection for 6 months were investigated for long COVID manifestations. Those subjects complaining of long-term GI symptoms were further evaluated by Rome IV questionnaire to assess PI-DGBIs. Intestinal inflammation (by fecal calprotectin, FC) and permeability (by serum and fecal levels of zonulin) were evaluated in all subjects. The Hospital Anxiety and Depression Scale (HADS) and the Gastrointestinal Quality of Life Index (GIQLI) questionnaires were further provided to all participants.

RESULTS

Thirty-seven subjects (43%) complained of long-term GI symptoms, while 49 subjects (57%) did not. Thirty-three subjects fulfilled Rome IV criteria for PI-DGBIs. FC values resulted higher in those subjects who did not complain GI symptoms (p = 0.03), although remaining quite close to the normal range. No significant differences were shown regarding the assessment of intestinal permeability. By GIQLI, long-term GI sequelae were inversely correlated with quality of life (p = 0.009).

CONCLUSION

Long COVID GI complaints unlikely recognize underlying local inflammatory mechanisms. Since the healthcare, economic, and social burden of post-COVID DGBIs, a deeper understanding of this emerging condition should be encouraged to improve management of the affected subjects.