Gastrointest. Disord., Volume 7, Issue 1 (March 2025) – 25 articles

Background and Aims: Endoscopic clipping is the standard method for mucosotomy closure in per-oral endoscopic myotomy (POEM) and gastric per-oral endoscopic myotomy (G-POEM). Concerns remain regarding potential leaks and long-term complications. This meta-analysis compares the technical success rates and outcomes of endoscopic clipping and suturing for mucosotomy closure in E-POEM/G-POEM. Methods: A systematic search of databases for studies comparing endoscopic clipping and suturing in E-POEM/G-POEM was conducted. The primary outcomes were technical success rates, and the secondary outcomes were cost, procedure time, and complications. Meta-analyses and sensitivity analysis were performed. Results: Three studies with a total of 91 patients were included. The technical success rates were similar between suturing and clipping, with a success rate of 100% (48/48) for suturing and 94.4% (41/43) for clipping (odds ratio 1.03, 95% confidence interval 0.89–1.19, p = 0.50). There was no significant difference in procedure time between the two methods (SMD −0.73; CI: −1.70 to 0.23; p = 0.13). The cost of suturing was higher on average (mean: $1751, range: $873–$2353) compared to clipping (mean: $898, range: $703–$1083), but the difference was not statistically significant (SMD 1.85, CI −5.05 to 1.35, p = 0.25) with high heterogeneity. Complications for clipping and suturing were also comparable. Conclusions: Both endoscopic clipping and suturing achieve successful mucosotomy closure in E-POEM/G-POEM without any significant difference in the cost and the time between the two closure methods. Further investigation with larger, randomized, controlled trials are necessary to determine their roles in routine practice. Full article

Background: Meckel’s diverticulum on the mesenteric side has been reported only as case reports in the literature and presents a diagnostic challenge, with ultimate recognition often taking place intraoperatively. We describe a case series of children with mesenteric Meckel’s diverticulum (MMD) treated at our institution, along with the results of a systematic review of the literature. Methods: Our experience on MMD was analyzed along with a systematic literature review performed according to PRISMA criteria. We identified studies published from 1941 to 2023 from PubMed, EMBASE, SCOPUS, and WOS. Search terms were variations of “Meckel”, “diverticulum”, and “mesenteric”. Inclusion criteria were patients < 18 years of age and articles written in English. Results: A total of three cases of MMD were observed and treated in our hospital. The mean age was 7.6 years. The most common symptoms were rectal bleeding and abdominal pain. Diagnostic workup included ultrasound and both upper and lower endoscopy. Surgery was performed by the laparoscopy-assisted technique. One case had to be reoperated due to postoperative intestinal occlusion. The mean length of hospital stay was 9.3 days. The literature search yielded 795 citations; out of the 590 papers remaining after the exclusion of 205 duplications, only 15 papers matched the inclusion criteria and were included and analyzed. Conclusions: MMD remains a rare and elusive pathology, sharing with its normal counterpart symptoms and signs. In our experience, and in the more recent literature, laparoscopy-assisted surgery appears safe and effective both for final diagnosis and definitive treatment. Full article

Background: Disability and poor quality of life are frequently reported by patients with inflammatory bowel diseases (IBDs). There is an increased interest in the use and development of self-administered questionnaires of patient-reported outcomes including depression symptoms, potentially allowing easier and even remote monitoring of health status and permitting treatment adjustments. Aim: We noticed a significant overlap in some of the parameters evaluated by Beck’s Depression Inventory and the IBD Disk, which led to the idea that the IBD Disk might be a useful and easy-to-use tool to assess the mental state and quality of life of patients with IBD. Our objective was to validate the IBD Disk in measuring depression symptoms, as well as the correlation between IBD Disk scores and patient background and disease activity. Methods: Patients included in this study were asked to complete Beck’s Depression Inventory (BDI) and the IBD Disk. The resulting scores of BDI and IBD Disk were compared and both questionnaires were corelated with the patients’ background and disease activity. Results: Eighty-two patients with IBD, age 43.11 +/− 13.07, 63.4% male, 61.0% with Crohn’s disease and 39.0% with Ulcerative Colitis, were included. The total scores of BDI and IBD Disk significantly correlated (r_s(80) = 0.951, p < 0.001), as well as the overlapping questions. Disease remission was associated with lower total scores in both questionnaires (BDI and IBD Disk) (r_s(80) = 0.559, p < 0.016; r_s(80) = 0.951, p < 0.005, respectively). Conclusions: Our findings suggest that IBD Disk is a useful and easy-to-use tool for screening for depression symptoms and establishing the quality of life of IBD patients. We encourage its routine use in patients during IBD care and follow-up. Full article

Background: The perspective of inflammatory bowel disease (IBD) has changed radically since the first decade of the 21st century, and the formerly monolithic components of IBD, ulcerative colitis (UC), and Crohn’s disease (CD) have undergone a fundamental convergence, with realization that there is likely an element of shared pathogenesis. The ground shift began with genomic revelation but with the current emergence of the innate immune system (InImS) as a key player, allowing for improved understanding of the associations between the immune underpinnings of IBD. Methods: Using unique ferritin/fecal p87 (FERAD) or using colonoscopic effluent as denominator (FEREFF) and other ratios to test this hypothesis, we prospectively enrolled 2185 patients with increased risk of colorectal cancer, of whom 31 had UC and 18 CD, with 2136 controls and brought to bear in a convenient measure for the InImS, the FERAD ratio. The FERAD, FEREFF, and NLR ratios have been shown to be effective measures of the InImS in COVID-19 and various cancers. p87 is expressed in gut Paneth cells known to modulate the microbiome by secretion of alpha-defensins, a natural antibiotic. Other related parameters were also evaluated. Results: There was no significant difference between the FERAD ratio in UC and CD. However, differences between IBD entities and controls were substantial. Conclusions: InImS settings in IBD are similar between CD and UC. p87 tissue immunohistochemistry (IHC) is also shared. Other InImS markers, such as the absolute neutrophil/lymphocyte ratio, are also confluent between the two IBD forms. Full article

Background: Helicobacter pylori infection, overweight, and obesity are global health concerns. This bacterium is involved in the pathophysiology of chronic gastritis and gastric cancer. Additionally, overweight and obesity, associated with unhealthy eating habits and sedentary lifestyles, cause alterations in the gut microbiota that facilitate gastric colonization by Helicobacter pylori. Moreover, individuals with obesity tend to consume low-quality foods due to episodes of anxiety and exhibit elevated insulin levels, which may promote the development of gastric neoplasms. Studies conducted in Latin America have found that over 50% of participants are infected with Helicobacter pylori, a situation similar to that reported in Ecuador, where the prevalence of overweight and obesity in individuals aged 19 to 59 years reached 64.58% in 2018. Both health issues are influenced by the high consumption of processed foods or those prepared under inadequate hygiene conditions. Methods: In this context, this research aimed to correlate the body composition of university students with the prevalence of Helicobacter pylori. An observational, cross-sectional, and descriptive study was conducted with 57 Nursing, Medicine, and Psychology students from Universidad Indoamérica, Ambato campus, during 2024. Fecal samples were analyzed to detect the presence of the bacterium, and anthropometric measurements were taken to establish a possible relationship between these parameters. Results: Of the 57 students who participated, 54.39% tested positive for Helicobacter pylori. However, the presence of the bacteria did not show any relationship with body composition parameters such as fat mass, lean mass, BMI, weight, height, or age. Conclusions: The study found no evidence of a connection between Helicobacter pylori infection and anthropometric parameters in this university population. However, the high incidence of infections highlights the importance of promoting the consumption of safe food and ensuring timely diagnosis and treatment. Full article

Background: Cystic artery bleeding (CAB) is a rare but potentially life-threatening condition. Its etiologies span iatrogenic trauma, inflammatory diseases, and trauma, often presenting variably as hemoperitoneum, upper gastrointestinal bleeding, or hemorrhagic shock. The clinical heterogeneity of CAB complicates its diagnosis, necessitating a high index of suspicion and reliance on imaging modalities, particularly computed tomography (CT), for accurate identification of bleeding sources and differentiation from other causes of abdominal pain. Methods: This pictorial essay highlights key imaging findings in CAB and pseudoaneurysms, emphasizing the role of ultrasound, CT, and digital subtraction angiography (DSA) in diagnosis and management planning. Additionally, a systematic review of transcatheter arterial embolization (TAE) is presented, consolidating data from 64 studies encompassing 90 patients. Results: The review evaluates patient demographics, etiologies, clinical presentations, and procedural outcomes, underscoring TAE’s high efficacy and safety as a first-line treatment. Conclusions: The findings reinforce the importance of early diagnosis and tailored intervention strategies to optimize outcomes in CAB management. Full article

Background/Objectives: Natural compounds represent novel promising alternative treatments for functional gastrointestinal disorders. This multicenter, double-blind, randomized, placebo-controlled, crossover study aimed to evaluate the efficacy and safety of xyloglucan, pea protein, and chia seed powder (XP + CS) in irritable bowel syndrome with constipation (IBS-C). Methods: Sixty patients received twice-daily XP + CS or placebo for 28 days. Following a 28-day washout period, patients switched to the alternative treatment for another 28 days. Efficacy was evaluated using the Bristol Stool Form Scale; a seven-point Likert scale for abdominal pain, bloating, and discomfort; a Visual Analogue Scale for IBS symptom severity; the quality of life (QoL)-IBS questionnaire; Sickness Impact Profile (SIP) score; and serum zonulin concentrations. Adverse events were monitored throughout the study. Results: Compared to the placebo, XP + CS significantly improved stool consistency (p = 0.04 and p < 0.001 at days 15 and 28, respectively), IBS symptoms (p < 0.001 at day 15), QoL (p < 0.001 from day 15 on), and nearly all SIP domains (p < 0.001 at all time-points). Additionally, XP + CS treatment restored serum zonulin concentrations to within normal ranges by day 15. No serious adverse events were reported. Conclusions: This study provides evidence supporting the efficacy and safety of XP + CS in managing IBS-C symptoms. Full article

Background/Objectives: Individuals with Crohn’s disease often experience challenges at work and are confronted with the decision of whether to disclose their health status in their workplace. This study explores the disclosure of Crohn’s disease in the workplace and the factors influencing their choices among individuals in Greece. Methods: The study examined how demographic characteristics affected the disclosure of a non-visible disability, the reasons behind the disclosure, and the associated experiences. Results: The sample consisted of 152 individuals with Crohn’s disease. Although 52.6% of participants had disclosed their condition, the results show that factors like health benefits, the impact of COVID-19, and necessary workplace accommodations influenced disclosure decisions. On the other hand, 47.3% chose not to disclose their condition, the predominant reason being the fear of being fired or not being hired. Conclusions: The findings imply that workplace cultures and policies that foster inclusive, supportive environments are necessary to allow employees with non-visible disabilities to request the accommodations they require without worrying about the consequences. Future research could focus on a deeper understanding of the disclosure issues for people with Crohn’s disease and other non-visible disabilities. Full article

Background/Objective: Hirschsprung-associated enterocolitis (HAEC) can occur before and after surgery, increasing the complication rates, hospital stay, and treatment costs. This study aims to determine the incidence of preoperative and postoperative Hirschsprung-associated enterocolitis HAEC and the related risk factors. Methods: This study is a prospective cohort study of Hirschsprung’s disease patients under 16 years of age at two Children’s Hospitals in Ho Chi Minh City, Vietnam from December 2022 to June 2024. The postoperative follow-up is 12 months. Results: We enrolled 84 pediatric patients, with a male-to-female ratio of 5.4/1 and an average age of 7.2 ± 1.07 months. Of the patients, 25% had preoperative enterocolitis at the time of admission. Statistical analysis revealed that risk factors for preoperative enterocolitis at admission included a history of enterocolitis (p = 0.024), low weight in hospital (p = 0.001), and lack of preoperative treatment (p = 0.01). Postoperative enterocolitis occurred in 14 patients (16.7%) at an average of 4.03 months postoperatively. Multiple logistic regression of postoperative enterocolitis was associated with a history of preoperative enterocolitis (p < 0.001), anastomotic stricture (p = 0.002), and the length of the aganglionic segment (p = 0.031). No statistically significant association was found between the surgical method and the risk of postoperative enterocolitis. Conclusions: A history of preoperative enterocolitis, low weight, and anastomotic stricture are significant risk factors for postoperative enterocolitis in patients with Hirschsprung’s disease. Therefore, preoperative medical treatment is recommended for the patients who have not yet undergone a definitive surgical procedure. Full article

Metabolic bone disease (MBD) is a known complication of short bowel syndrome (SBS), with a high prevalence in both pediatric and adult populations. MBD includes various conditions that disrupt skeletal homeostasis, such as rickets, osteomalacia, and osteoporosis. The pathogenesis of MBD is multifactorial, regardless of the underlying cause of SBS. When MBD is suspected, it is important to conduct laboratory evaluations to guide proper diagnosis and treatment. Dual-energy X-ray absorptiometry (DXA) is the preferred imaging modality for assessing MBD in routine clinical care. Early and accurate diagnosis and treatment of MBD in pediatric patients with SBS are essential to support growth and development and prevent fractures and metabolic complications. Using the best evidence available, this article aims to review the pathophysiology, diagnosis, and current management of MBD in pediatric patients with SBS. Full article

Introduction: Pelvic cancers present significant health challenges and often require aggressive treatment strategies. Pelvic exenteration, which involves the resection of multiple pelvic organs, is currently the only curative option for advanced or recurrent pelvic malignancies. Due to its extensive nature, it carries a high risk for postoperative complications and extended hospital stays. Current evidence suggest that improved preoperative fitness is associated with better postoperative outcomes. This study explored the relationship between preoperative self-reported physical activity levels and surgical outcomes following pelvic exenteration. Methods: This retrospective cohort study included consecutive adult patients undergoing pelvic exenteration at Royal Prince Alfred Hospital between May 2017 and December 2023. Eligible participants completed the International Physical Activity Questionnaire—Short Form (IPAQ-SF) preoperatively. Primary outcomes included postoperative morbidity, length of hospital stay, and survival. Univariate and multivariate logistic regression analyses explored the association between preoperative physical activity and postoperative outcomes. Results: A total of 256 participants were included, of which 115 (44.9%) were classified as active. Active patients experienced fewer postoperative complications (p = 0.047) and shorter hospital stays (p = 0.007), compared to inactive participants. There was no significant association between preoperative physical activity levels and survival outcomes (p = 0.749). Younger age, preoperative physical activity level, and advanced primary malignancy were significantly associated with fewer complications and shorter hospital stays. Conclusions: Higher levels of preoperative physical activity is associated with fewer postoperative complications and shorter hospital stays in patients undergoing pelvic exenteration. These findings support the potential benefits of incorporating prehabilitation programs to improve surgical outcomes and reduce healthcare costs. Full article

Introduction: Primary colorectal lymphoma (PCL) is a very rare disease with limited information regarding its macroscopic features. This retrospective descriptive study aims to identify the macroscopic characteristics of PCL and explore treatment trends and outcomes with respect to histopathologic subtypes. Methods: This IRB-approved study from a large academic medical center identified 66 patients with colorectal lymphoma from 1998 to 2022 from a tumor registry. Thirty-four patients met the inclusion criteria of having PCL with available endoscopic data. The macroscopic features of each lesion were identified. Treatment trends and outcomes were examined at the patient level. Data were described using frequency and percentages for categorical characteristics and the median and interquatile range (IQR) for continuous outcomes. Results: A total of 77 PCL lesions were identified. Most were identified on screening or surveillance colonoscopies or colonoscopies performed after abnormal imaging (61.8%). Diffuse large B cell lymphoma (DLBCL) had the highest prevalence (N = 24), followed by follicular lymphoma (n = 21), mantle cell (n = 16), mucosa-associated lymphoid tissue (MALT) (n = 14), then Burkitt’s (n = 2). More mantle cell (93.8%) and follicular (90.5%) lymphomas were sessile. More MALT lymphomas were ulcerated (71.4%). A higher proportion of follicular (76.2%) and mantle cell (71.4%) lymphomas were diminutive (≤5 mm). More MALT (78.6%), DLBCL (75.0%), and Burkitt’s (100%) were large (≥20 mm). More lesions were found in the sigmoid colon (26.0%), followed by the rectum (22.1%), transverse colon (18.2%), cecum (18.2%), descending colon (10.4%), and ascending colon (5.2%). Overall, most underwent immunotherapy (61.3%) and did not have radiation therapy (81.3%), endoscopic resection (75.0%), and surgery (68.8%). Patients with DLBCL demonstrated higher rates of chemotherapy (70.6%), immunotherapy (87.5%), and remission after intervention (52.9%). Conclusions: Primary colorectal lymphomas display distinct macroscopic features and appear in different locations depending on the histopathologic subtype. Most cases are identified at early stages on screening colonoscopies and demonstrate a 75% two-year survival rate. Full article

Background: Surgery in periampullary cancers (PAC) is associated with high morbimortality rates. There are multiple scores used to predict surgical risk. This study aims to identify a possible correlation between POSSUM, P-POSSUM, E-PASS, and mE-PASS scores and morbimortality in patients operated on for PAC. Methods: POSSUM, P-POSSUM, E-PASS, and mE-PASS were calculated for patients operated for PAC in Hospital de Braga between 1 January 2011 and 31 August 2021. The calibration and discrimination of scores were analyzed by comparing the predicted mortality and morbidity with the observed one and by evaluating the Receiver Operating Characteristic (ROC) curve, respectively. Results: The study included 58 patients. The most frequent location was the ampulla of Vater (AVC) (43.10%), and the most frequent stage was IIb (48.28%). The postoperative mortality and morbidity observed at 30 days were 3.45% and 37.93%, respectively. P-POSSUM (O:E 0.45), POSSUM (O:E 0.16), and E-PASS (O:E 0.03) overestimated mortality, and mE-PASS underestimated it (O:E 1.89). In most subgroups, both POSSUM scores showed the best calibration. CRS and E-PASS showed the highest discriminative ability for mortality (AUC 0.982). In the pancreatic head carcinoma subgroup, the SSS showed better calibration for morbidity. The operative score had the best discrimination for the CAV subgroup (AUC 0.767) and for stage IIb (AUC 0.900). No scale showed discriminative ability in overall morbidity. Conclusions: POSSUM and P-POSSUM obtained the best calibration regarding subgroup mortality. E-PASS and CRS showed the highest discrimination for mortality, and the operative score showed the greatest discrimination for morbidity in the subgroups. Full article

The purpose of this study was to propose a new diagnostic approach using ultrasound imaging equipment. Many patients suffer from constipation, and medical professionals have difficulty providing treatment and care. The prevalence of constipation increases with age, and this condition strongly impacts the quality of life. Herein, a new diagnostic approach using ultrasound imaging equipment was examined. The study design was a narrative review, and the authors discussed existing knowledge, challenges, and prospects based on previous research. References were obtained by searching PubMed and Centralblatt für die gesammte Medicine. Most of the papers were published in English. Papers with scientific knowledge that has already been published in academic journals were extracted from these documents. No restrictions were placed on the publication date, sample size, study design, or age of subjects, and only published papers reporting scientific knowledge and consensus were cited. As a result, we suggest that this approach classifies the state of fecal retention in the rectum into three patterns. If ultrasound imaging indicates that the rectum is free of feces, there is no need to administer an enema. If hard stool is found, dissection can be performed to prevent complications such as severe intestinal perforation due to subsequent administration of laxatives. If ultrasound imaging reveals normal stool in the rectum, inducing defecation with suppositories may enable treatment for constipation. Full article

Background: Chronic constipation is a well-recognized complication which is caused by hard and/or infrequent defecation. According to estimates, constipation presents as a chronic illness affecting 16% of adults globally, who deal with insufficient bowel movements that cause discomfort, bloating, or a sensation of incomplete bowel. Objectives: This review looks at the many local and systemic factors that contribute to the pathogenesis of the causative, including dietary habits, genetic factors, colon function and absorption, social and economic factors, lifestyle, and biological and drug factors. Results: Appropriate diagnostic and management modalities are the cornerstone in the management of patients with chronic constipation. However, there are still controversies regarding the timing of these diagnostic and management approaches. This condition is common and reduces the quality of life of patients and represents a burden on any healthcare system. In clinical practice, it remains problematic, as physicians are most of the time indecisive on which therapy to administer and at what time. Conclusions: Constipation management is a new topic that was introduced over a decade ago and the purpose of this study is to shed some light onto the practice, problems and modern day techniques that can be used to treat constipation in patients, primarily through behavioural, conservative, medical, and surgical means. Additionally, this particular management is to be used in conjunction with an algorithm designed to enhance and support clinical practice. Full article

Background/Objectives: Gastric cancer is a major global health concern and a leading cause of cancer-related death. While surgical resection remains the cornerstone of curative treatment, postoperative morbidity and mortality are significant issues. This study aimed to identify factors associated with postoperative morbidity and mortality in patients undergoing laparoscopic gastrectomy for gastric adenocarcinoma. Results: The median age was 73 years. Eighteen total gastrectomies (15%) and eighty-eight subtotal gastrectomies (66.6%) were performed. Major complications (Clavien-Dindo ≥ III) occurred in 22.3% of patients, and the hospital mortality rate was 7.5%. Independent predictors of morbidity included anemia (OR 2.49, p = 0.047), extended lymphadenectomy (OR 5.09, p = 0.002), and conversion to open surgery (OR 9.40, p = 0.031). Coagulopathy was a significant predictor of mortality (OR 5.01, p = 0.049). Methods: A retrospective, single-center observational study was conducted on 120 patients who underwent laparoscopic surgery between January 2004 and December 2022. Preoperative assessments included endoscopy, imaging, and staging according to the TNM classification. Risk factors were analyzed using univariate and multivariate logistic regression. Conclusions: Laparoscopic gastrectomy is a technically challenging procedure with substantial risks of morbidity and mortality. Identifying modifiable risk factors, such as anemia and coagulopathy, provides opportunities for improved outcomes through preoperative prehabilitation and optimized patient selection. Full article

Background/Objectives: The gut–liver axis is bidirectional and influences the body’s homeostasis. Pathologies such as metabolic dysfunction-associated steatotic liver (MASL) can have detrimental effects on the human microbiome, with multiple systemic effects. Furthermore, the geographical particularities of the intestinal microbiome may influence liver disease. The study’s outcome was to identify dysbiosis in a group of patients with MASL from the western region of Romania. Methods: The NGS shotgun genomic sequencing (WGS metagenomics) method was used to identify bacteria in fecal samples. The data were analyzed using IBM SPSS Statistics software [version 29.0.2.0 (20)]. Results: Out of the 122 MASL patients included in the study, 43 (35.24%) exhibited low alpha diversity. In the subgroup with a normal biodiversity index, approximately half were identified with a Firmicutes/Bacteroidetes ratio below the lower reference value, while the remaining patients presented dysbiosis based on decreased concentrations of Proteobacteria and Prevotella, considered among the most relevant species supporting dysbiosis. A higher prevalence of Prevotella species (15.99 ± 13.65%) was identified in the study cohort. Conclusions: The present study demonstrates that patients with MASL from the western region of Romania exhibit criteria for intestinal dysbiosis, namely reduced bacterial diversity, along with significant alterations in populations of Firmicutes, Bacteroidetes, Proteobacteria, and Prevotella. Together, these findings suggest a possible influence of geo-cultural factors on the intestinal microbiome, highlighting the need for regionally adapted therapeutic interventions to support liver health. Full article

Despite many advances in the management of patients with colorectal cancer, this malignancy remains the second leading cause of cancer death worldwide. One of the keys to improve the prognosis of these patients is diagnosis in early stages, making them eligible for curative surgical treatment. Cutaneous paraneoplastic syndromes can enhance the diagnostic management of these patients. The time elapsed from the appearance of skin lesions to the appearance of the first digestive symptoms can reach up to a decade. Thus, comprehensive paraclinical evaluation and the monitoring of patients with specific skin lesions play an important role in detecting an underlying cancer. Given these findings, it is imperative to increase the awareness of cutaneous paraneoplastic syndromes among patients and medical professionals. Additionally, the investigation of the mechanisms that elucidate this pathogenic link has the potential to result in the identification of novel therapeutic targets. Full article

The human microbiome, a complex ecosystem of microorganisms residing in and on the body, plays a pivotal role in the regulation of a wide range of physiological processes, including digestion, immune responses, and metabolic functions. In recent years, the rapidly growing field of microbiome-driven therapeutics has garnered significant attention owing to its potential to revolutionize healthcare. This review explores the evolving landscape of microbiome-based therapies, with a particular focus on the gut microbiome and its implications for both gut health and precision medicine. We highlight recent advances in understanding how microbial communities influence disease pathogenesis and treatment outcomes, spanning conditions such as inflammatory bowel disease (IBD), metabolic disorders, neurological diseases, and even cancer. This article also discusses emerging therapeutic strategies, including probiotics, prebiotics, fecal microbiota transplantation (FMT), and microbial-based drugs, as well as the challenges associated with their clinical implementation. Additionally, we examined how the integration of microbiome profiling and metagenomic data is advancing the field of precision medicine, paving the way for personalized and effective treatments. This review serves as a comprehensive resource that synthesizes current knowledge, identifies key gaps in microbiome research, and offers insights into the future direction of microbiome-driven therapeutics, thus providing a valuable framework for clinicians, researchers, and policymakers seeking to harness the potential of microbiomes to advance personalized healthcare solutions. Full article

Helicobacter pylori (H.p.) is a Gram-negative bacterium endowed with gastric tropism. H.p. infection is widely spread throughout the world, accounting for various pathologies, such as peptic ulcer, gastric cancer, mucosa-associated lymphoid tissue lymphoma, and extra-gastric manifestations. This bacterium possesses several virulence factors, e.g., lipopolysaccharides (LPS), the toxins CagA and VacA, and adhesins, which elicit a robust immune response during the initial phase of the infection. Of note, the lipid A moiety of the LPS exhibits a lower endotoxic potency than that of other LPSs, thus facilitating infection through a mechanism of immune escape. H.p. colonization of the gastric mucosa induces an initial protective immune response with innate immune cells, e.g., neutrophils, monocytes, and macrophages, which engulf and kill bacteria. Moreover, the same cells, along with gastric epithelial cells, secrete cytokines and chemokines, which recruit T cells [T helper (h)1 and Th17 cells] to the site of infection, thus leading to H.p. eradication. In a large subset of individuals, the perturbation of such an immune equilibrium leads to a harmful response, with an expansion of T regulatory (TREG) cells, which suppress the protective immune response. In fact, TREG cells, via the production of interleukin (IL)-10, downregulate Th1- and Th17-related cytokines, thus allowing H.p. survival and the perpetuation of inflammation. As far as the humoral immune response is concerned, B cells, upon H.p. stimulation, produce autoreactive antibodies, and IgG anti-Le^x antibodies are harmful to the gastric mucosa. In this review, the structure and function of H.p. antigenic components and immune mechanisms elicited by this bacterium will be described in relation to gastric damage. Full article

Nociplastic pain, commonly observed in conditions such as Fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome, arises from altered central pain processing and involves complex mechanisms, including interactions between the gut–brain axis and immune dysregulation. Conventional therapies often fail to address this type of pain effectively, leading to interest in alternative approaches such as fecal microbiota transplantation. This technique has been proposed to restore gut microbial balance and modulate systemic inflammation, neuroinflammation, and neurotransmitter signaling. This systematic review, conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and registered in the International Prospective Register of Systematic Reviews (CRD42024611939), evaluated 13 studies with n = 409 participants, including clinical trials, case reports, and retrospective analyses. A quality assessment was performed using appraisal tools such as Cochrane RoB 2, ROBINS-I, NOS, and CARE. The results suggest that fecal microbiota transplantation may reduce pain intensity and improve fatigue and quality of life, particularly in patients with Fibromyalgia and irritable bowel syndrome. However, outcomes for Chronic Fatigue Syndrome and psoriatic arthritis were inconsistent and limited by methodological flaws, small sample sizes, and variability in protocols and donor selection. Although adverse events were minimal, the current evidence is insufficient to support widespread clinical use. High-quality, standardized studies are needed to confirm the efficacy of fecal microbiota transplantation. Until then, its application should remain experimental and interpreted with caution. Full article

Background/Objectives: Pancreatic cancer is a common gastrointestinal cancer with high risk of mortality. Currently, the therapeutic strategies for pancreatic cancers are surgery, chemotherapy, and radiotherapy, none of which are effective treatments. Ferroptosis is a new form of cell death that is iron (Fe)-dependent and characterized by lipid peroxidation, which is a new approach for treatment of pancreatic cancer. Therefore, this study was dedicated to investigating the effect of erastin and Ras-selective lethal small molecule 3 (RLS3) as ferroptosis inducers as well as focusing on the antioxidant effects of two natural products, curcumin and (−)-epigallocatechin-3-gallate (EGCG), against ferroptosis. Methods: PANC1 cells were treated with 20 μmol/L curcumin or EGCG and then exposed to 20 μmol/L erastin. Cell viability was detected by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay, Reactive Oxygen Species (ROS) were measured by dihydrodichlorofluorescein (H2DCF) cell-permeant probe, Fe levels were determined by inductively coupled plasma mass spectrometry (ICP-MS), and glutathione (GSH), lipid peroxidation, Western blot, and mRNA were assayed with commercially available kits. Results: Curcumin and EGCG enhanced cell viability in erastin-treated PANC1 cells in a dose-and time-dependent manner. Erastin-treated PANC1 cells exhibited the elevated levels of GSH depletion, ROS productions, and lipid peroxidation while curcumin reversed the erastin-induced ferroptotic effects. The treatment of erastin-induced PANC1 cells with curcumin increased the GPX4 mRNA gene and protein levels. Also, curcumin decreased the FTH1 mRNA gene levels as a strong Fe chelator. Conclusions: In conclusion, this study shows that erastin can be potentially a therapeutic strategy for treatment of cancer cells. Additionally, curcumin might play an antioxidant role at the specific concentrations, potentially mitigating ferroptosis in cells. Full article

Objective: The regulation of food intake is disturbed in obesity, possibly resulting from alterations in gut peptide secretion. We hypothesize that obesity is associated with attenuated systemic and tissue concentrations of the gut peptides PYY and GLP-1. Methods: A prospective single-center study in which we included 13 individuals with obesity (BMI 39.5 ± 2.8 kg/m²) and 11 lean individuals as controls (BMI 20.7 ± 1.2 kg/m²) matched for age and gender. We measured: (1) tissue concentrations and mRNA expression of GLP-1 and PYY in ileal and colonic biopsies taken during routine colonoscopy and (2) plasma concentrations of PYY and GLP-1 in response to a meal in the same group. Results: Plasma GLP-1 and PYY responses did not differ between individuals with obesity and lean controls. Neither were tissue concentrations and mRNA expression of both peptides different between both groups. Conclusions: Systemic and local PYY and GLP-1 concentrations in individuals with obesity do not differ from those in lean subjects. Full article

Background: The rise in bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB), has added complexity to diagnostic evaluations in post-transplant patients. Case Presentation: We present a rare case of metastatic jejunal adenocarcinoma in the biliopancreatic limb of a patient with a history of RYGB, diagnosed three months after simultaneous liver–kidney transplantation. Despite multiple advanced imaging modalities, the primary malignancy eluded detection during pre-transplant evaluation. The patient developed progressive anemia and persistent liver enzyme elevation, which led to a comprehensive diagnostic workup. After failed initial endoscopic and radiological attempts, a multifaceted approach combining PET-CT, targeted open liver biopsy, and repeat endoscopy via a G-tube site enabled the discovery of a 5 cm partially obstructing jejunal mass. Histopathological analysis confirmed moderately differentiated adenocarcinoma. Conclusions: This case underscores the challenges in diagnosing gastrointestinal malignancies in patients with altered anatomy, particularly following RYGB. It highlights the need for modified cancer screening protocols before organ transplantation, especially for those with complex post-surgical gastrointestinal anatomy, to prevent the development of metastatic disease post-transplant. Further research is warranted to refine screening strategies and improve early malignancy detection in this high-risk population. Full article

Hereditary polyposis syndromes are rare but potentially devastating conditions which require multidisciplinary care from an early age. Societal guidelines, which ideally combine expert opinions and medical evidence, serve as the framework for disease diagnosis, surveillance and treatment. However, there is a significant underrepresentation of pediatric gastroenterology input in guideline formulation, and additionally, recommendations can vary significantly between societies, which can have a moderate-to-high clinical impact on patient care. This paper aims to summarize key differences in management based on societal guidelines and identify some of the factors which may contribute to divergence in care in hereditary polyposis syndromes in pediatric patients. The authors review the literature underlying the divergence in recommendations and attempt to reconcile these differences with a closer consideration of the pediatric population, considering the available evidence. This review highlights the need to harmonize recommendations across subspecialties and professional societies and sheds light on the significant underrepresentation of pediatric gastroenterology input in guideline formulation. Given the poor-quality evidence underlying many societal guidelines and the lack of pediatric gastroenterology representation in guideline formulation in these rare syndromes, there is a need for collaborative, multicenter, registry-based studies to refine and improve care standards. Full article