Gastrointestinal Disorders

Background and Aims: Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are rare but serious congenital anomalies requiring early surgical intervention. Over the past two decades, minimally invasive surgical (MIS) approaches—particularly thoracoscopic repair—have gained traction, aiming to reduce postoperative morbidity while maintaining surgical efficacy. Objective: This narrative review provides a comprehensive overview of the evolution and current status of MIS techniques for EA/TEF, assessing their clinical outcomes, technical challenges, and implications for patient care. Methods: A structured literature search was conducted to identify clinical studies, reviews, and reports on thoracoscopic, robotic-assisted, and endoscopic approaches to EA/TEF. Emerging adjuncts, including tissue engineering, botulinum toxin use, and magnet-assisted anastomosis, were also reviewed. Results: Thoracoscopic repair has demonstrated comparable anastomotic success rates to open surgery (approximately 85–95%) with significantly reduced rates of musculoskeletal complications, such as scoliosis and chest wall deformities (reported in less than 10% of cases, compared to up to 40% in open approaches). Robotic-assisted and endoscopic-assisted techniques have enabled improved visualization and precision in anatomically challenging cases, although their use remains limited to high-resource centers with specialized expertise. Common postoperative complications include anastomotic stricture (30–50%), gastroesophageal reflux disease (35–70%), and respiratory morbidity, necessitating long-term multidisciplinary follow-up. Recent innovations in simulation-based training and bioengineered adjuncts have facilitated safer MIS adoption in neonates. Conclusions: Minimally invasive techniques have improved the surgical management of EA/TEF, though challenges remain regarding technical complexity, training, and resource availability. Continued innovation and collaborative research are essential for advancing care and ensuring optimal outcomes for affected infants. Full article

Background: Neurologically impaired children often face severe gastroesophageal reflux disease (GERD), feeding difficulties, and related challenges, profoundly impacting their quality of life (QoL) and that of their caregivers. Surgery is often necessary to alleviate symptoms in this population, and the success of surgical treatment, along with the achievement of clinical endpoints, must also consider the impact on QoL. The aim of this study is to evaluate the impact of fundoplication surgery on the QoL of both children and caregivers. Methods: All patients treated between 2010 and 2023 at the Pediatric Surgery Department of San Matteo Hospital in Pavia were included in the study. The modified 1996 O’Neill questionnaire was identified as a suitable model for a QoL survey. QoL assessments included caregiver-reported outcomes using validated questionnaires, focusing on physical, psychological, and social domains. Patients with a follow-up period of less than 12 months were excluded. As a secondary outcome, we evaluated the satisfaction of patients treated after 2020 who received integrated care through a multidisciplinary outpatient clinic. Results: Among the 77 patients, 42 were treated between 2010 and 2021. Of these, 16 participated in pre- and post-operative QoL evaluations, showing significant improvements in GERD resolution, feeding ease, and caregiver stress. From 2020, 35 patients benefited from a multidisciplinary approach; 12 underwent robotic fundoplication. Feeding ease scores improved significantly (mean increase from 37.5 to 84.2; p < 0.001), while caregiver stress scores decreased by 35% (p < 0.01). Conclusions: The combination of surgical and multidisciplinary interventions significantly enhances QoL for SNI children and their families. Integrated care models provide a framework for addressing complex needs and should be prioritized in clinical practice. Full article

Background: Acute mesenteric ischemia (AMI) is a potentially life-threatening condition that requires prompt diagnosis and treatment. The presence of air within the arterial lumen, particularly in the abdomen, is an uncommon finding with varied etiologies. This case report presents a unique instance of AMI with air in the superior mesenteric artery (SMA), highlighting the complexities in diagnosis and management. Case presentation: An 89-year-old male with a history of smoking, hypertension, dyslipidemia, and atrial fibrillation presented with chest pain and underwent coronary angiography for suspected anterior ST-elevation myocardial infarction (STEMI). Following successful thromboaspiration and admission to the coronary care unit, he developed severe abdominal pain. A contrast-enhanced computed tomography (CECT) scan revealed a thromboembolic occlusion in the SMA, along with air filling in the SMA and its branches. An endovascular thrombectomy was performed, but the patient died the next day due to complications related to AMI and metabolic acidosis. Conclusions: This case underscores the challenges in diagnosing and managing AMI, particularly when accompanied by unusual imaging findings such as air within the SMA. The presence of air in the arterial system raises questions about its origin and clinical significance in the context of AMI. Further research is needed to understand the mechanisms and implications of this rare phenomenon, which may have implications for refining diagnostic and therapeutic strategies for AMI. Full article

Synchronous colorectal cancer (SCRC) is characterized by the simultaneous occurrence of two or more primary colorectal malignancies, diagnosed either preoperatively, intraoperatively, or within six months postoperatively. The rare prevalence of SCRC makes it an uncommon scenario among colorectal malignancies. Since the majority of SCRC patients have been reported to have two concurrent malignancies, triple synchronous malignancies are extremely rare. We report the case of a 65-year-old male individual presenting with a history of abdominal pain, anemia, anorexia, and unintentional weight loss. He was diagnosed with synchronous colorectal cancer with three distinct tumors: two located in the splenic flexure and sigmoid colon, respectively, and another in the rectum that caused partial obstruction. This case highlights the importance of intraoperative evaluation and an appropriate choice of surgical intervention in colorectal cancer. The early identification and proper management of multiple colorectal cancers remain essential for better survival rates. Full article

The most common anorectal disorders are fecal incontinence, functional anorectal pain, and functional defecation disorders. They are often presented by overlapping symptoms with various degrees of severity. Therefore, a personalized approach to the patient is crucial for diagnosing and determining the prognosis of the disease. Biofeedback training is appropriate to consider when the motoric function disorder is known, the patient could learn voluntary control of response, and this could further lead to an improvement in the condition. Biofeedback is recommended for short-term and long-term treatment of constipation in adults and fecal incontinence in adults. It could also be considered for treatment of specific cases of anorectal pain. As office biofeedback is often time-consuming and comes with a substantially high cost, there is an emerging trend of home biofeedback administration. However, only a few significant studies have been published on this new approach. Although comprehensive data are needed to evaluate the proper strategy and development of various treatment protocols for different types of defecation disorders, home biofeedback therapy offers a potentially effective tool in the personalized treatment of defecation disorders. Full article

Background/Objectives: Oropharyngeal dysphagia (OD) is a prevalent symptom in patients with neuromuscular diseases (NMDs) and increases the risk of aspiration and malnutrition. Malnutrition is frequent in these patients and is not only related to dysphagia, but also generates a vicious circle that may result in worsening muscle atrophy and weakness. Texture modification is required to ensure safe and efficient swallowing. This study evaluates the acceptability of a ready-to-mix oral nutritional supplement (ONS) containing high-quality protein and a xanthan-based thickener in patients with OD and NMDs. Methods: This cross-sectional study includes adult patients with NMDs and OD who received a xanthan gum-based protein ONS. Patients completed a questionnaire to rate their satisfaction with the ONS. Results: Seventy-two patients were included (median age = 56 years; 51% were males). The percentage of patients with moderate-to-severe OD who rated the taste, consistency, and product quality as acceptable-to-very-satisfactory (score 3–5) were 76%, 80%, and 84%, respectively. After three months, 93% of patients continued consuming the ONS. Conclusions: Our findings support that the use of protein xanthan gum-based ONS can be as a palatable and an effective nutritional intervention, given their high satisfaction and acceptance rates among patients with NMDs and OD. Full article

Gastroesophageal reflux disease (GERD) is a common chronic gastrointestinal disorder that greatly influences patients’ quality of life and represents a growing public health concern. Characterized by typical and atypical symptoms, GERD encompasses a range of clinical phenotypes and is associated with complications such as erosive esophagitis and Barrett’s esophagus. This review intends to provide a thorough overview of current scientific knowledge on the etiological factors, risk determinants, and pathophysiology of GERD, while exploring diagnostic challenges and therapeutic approaches. Proton pump inhibitors (PPIs) remain the mainstay of medical therapy; however, concerns regarding their long-term safety have encouraged interest in adjunctive and alternative strategies. Emerging pharmacological agents, plant-based treatments, and integrative approaches rooted in traditional medicine offer promising modalities for enhanced management. Additionally, dietary and lifestyle modifications such as weight control, meal timing, and avoidance of trigger foods, are essential components of effective care. A multidisciplinary framework incorporating pharmacological, nutritional, and behavioral strategies is emphasized as the most reliable path toward personalized and sustainable GERD management. This review further aims to synthesize current therapeutic modalities and evolving perspectives in the treatment of GERD. Full article

Background: The relationship between gut microbiota and metabolic health has garnered significant attention in recent years. In this study, we aim to explore the intricate link between gut microbiota and metabolic outcomes, with a focus on lifestyle factors such as smoking, diet, and living environment. Materials and Methods: We investigated the gut microbiota and metabolic profiles of adult patients with type 2 diabetes, all receiving metformin therapy, to assess how lifestyle factors impact metabolic health. Key metabolic parameters and body composition indices were measured, alongside gut microbiota composition. Results: Our cohort included 30 patients, and we identified significant associations between smoking and adverse body composition changes, as well as dietary patterns favoring plant-based foods correlating with improved metabolic outcomes. Urban participants displayed distinct microbiota profiles and metabolic markers compared to their rural counterparts, highlighting the potential influence of environmental factors. Conclusions: The current data does not directly demonstrate a causal link between metformin usage and specific changes in gut microbiota composition. These findings align with the existing literature while providing novel insights into specific population dynamics. Future research should focus on longitudinal studies and interventions targeting the gut microbiota to further unravel its therapeutic potential. Full article

Background/Objectives: This study aimed to identify molecular variants associated with the progression of gastric precancerous lesions in a follow-up study conducted on patients from Southwestern Colombia. Methods: Whole-exome sequencing (WES) was performed on patients enrolled in the Colombian chemoprevention trial, who were classified into two groups—progression and regression—based on changes in the severity of their gastric precancerous lesions over 16 years of follow-up. The bioinformatics pipeline included steps for quality control, mapping, variant calling, filtering, and annotation. Associations between molecular variants and lesion progression were analyzed using Fisher’s exact test and the Cochran–Armitage trend test. Additionally, functional impact and pathway enrichment analyses were performed for variants that showed significant associations. Results: Thirty-eight molecular variants from thirty-seven participants were associated with the progression of gastric precancerous lesions. These variants were found in tumor suppressor genes like CDKN2A and CDK4, which are involved in cell cycle regulation and apoptosis. Additionally, variants were identified in extracellular matrix regulators such as COL23A1, LAMA2, and TNR. Other noteworthy findings included variants in FLT1, which is linked to VEGF signaling in angiogenesis, and APOB, which is involved in modulating inflammatory responses. Furthermore, alterations in genes associated with the hemostatic system, such as FGA and F5, underscored the connection between hemostasis and carcinogenesis. Conclusions: This exploratory analysis highlighted some molecular variants that may affect the function, structure, and expression of key proteins involved in cancer development, contributing to the progression of gastric precancerous lesions. Full article

Background: The increasing availability of gastrointestinal (GI) interventions has raised the need to treat luminal defects. Endoscopic suturing (ES) is a minimally invasive technique that is used for a wide range of indications. This retrospective cohort study aimed to evaluate the performance of ES in treating upper GI defects. Materials and Methods: Data from a tertiary centre were collected for patients undergoing ES to treat upper GI defects. The primary outcome was long-term outcomes, defined as the successful sutures deployment. Secondary outcomes included technical success, immediate clinical success (confirmation of closure at the time of the procedure), recurrence, and complications. Descriptive statistics and x² test were used to calculate the rates of the outcomes and assess any link between independent variables and results. Results: Forty-two procedures were performed on 25 patients between 2018 and 2023. The mean age was 55 (±16.2) years, and 56% were female. The long-term clinical success rate was 69.6% (16/23), the technical success rate was 88.1% (37/42), and the immediate clinical success rate was 91.9% (34/37), with only two (4.8%) adverse events. The overall recurrence rate was 61.8% (21/34). Technical success was higher in the esophagus (92.3%), and stomach (100%) (p = 0.002), and immediate clinical success was more likely in patients with leaks (88.9%) or fistula (95.2%) compared to perforation (50%; p = 0.005). Conclusions: ES demonstrated high rates of technical and immediate clinical success for defect closure in the upper GI tract, with low rates of complications. The benefit is most prominently seen among patients with leaks and fistulas in the stomach and esophagus. Full article

Microbiome dysbiosis—an imbalance in gut microbial communities—has emerged as a critical factor in the pathogenesis of neurological disorders, particularly Alzheimer’s and Parkinson’s diseases. This review examines the role of gut microbiota in neurodegeneration, emphasizing how dysbiosis disrupts gut–brain communication through mechanisms such as impaired gut permeability, systemic inflammation, and neuroinflammation. The gastrointestinal and central nervous systems interact bidirectionally, with microbial metabolites like short-chain fatty acids playing a pivotal role in maintaining gut and brain health. Dysbiotic shifts in microbial composition can compromise the blood–brain barrier, enabling inflammatory molecules to alter brain biochemistry and potentially accelerate neurodegenerative processes. Additionally, this review explores therapeutic strategies—including probiotics, prebiotics, and dietary modifications—designed to restore microbial balance, reduce neuroinflammation, and slow disease progression. Further research is essential to refine microbiome-targeted therapies and fully elucidate their potential in managing neurodegenerative diseases. Full article

Background: Single-Anastomosis Duodenoileostomy with Sleeve Gastrectomy (SADI-S) has been reported as both a safe and effective surgical procedure. However, these findings have not been directly compared to those of more established and less complex procedures, such as Sleeve Gastrectomy (SG), which remains the most commonly performed technique in Metabolic and Bariatric Surgery (MBS). Objective: This study aimed to assess and contrast the intraoperative and postoperative outcomes between patients who underwent SADI-S and those who underwent SG. Methods: A systematic review and meta-analysis were performed and registered under PROSPERO with the ID CRD42024532504. A comprehensive search strategy was executed on 15 April 2024, covering PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Science Direct from the first reports to March 2024. The search strategy incorporated relevant keywords, including: “SADI-S” OR “Single Anastomosis Duodenal-Ileal bypass” and “Sleeve Gastrectomy”. We included studies comparing adult patients (≥18 years old) undergoing SADI-S and SG, reporting at least one clinical outcome of interest. Results: Five studies published between 2019 and 2023, comprising 3593 patients, were included. Of these, 461 patients (12.8%) underwent SADI-S, while 3132 (87.2%) underwent SG. The mean patient age was 42.96 years, with 89.6% female participants. Patients undergoing SADI-S had a significantly higher Body Mass Index (BMI) than those undergoing SG (Mean: 49.73 ± 8.10 vs. 45.64 ± 7.84; Mean Difference [MD]: 3.83, 95% CI: 0.52–7.14; p = 0.02) and an increased risk of hypertension (OR: 1.38, 95% CI: 1.04–1.84; p = 0.03). SADI-S also resulted in longer operative times (125.63 ± 51.91 min vs. 49.67 ± 26.07 min; MD: 65.97 min, 95% CI: 61.71–70.25; p < 0.001) and length of hospital stay (2.30 ± 2.76 days vs. 1.21 ± 0.81 days; MD: 1.03 days, 95% CI: 0.70–1.37; p < 0.001). Moreover, patients who underwent SADI-S demonstrated a significantly higher risk of postoperative complications, such as readmissions and reinterventions (OR: 3.17, 95% CI: 2.15–4.67; p < 0.001), and experienced greater excess weight loss (MD: 12.42%, 95% CI: 0.92–23.92; p = 0.03). No significant differences were observed between the groups regarding age, sex, or the prevalence of obstructive sleep apnea (OSA). Conclusions: SADI-S appears to be a promising surgical technique for facilitating substantial weight loss in individuals with severe obesity. Given the higher risk of postoperative complications associated with SADI-S, careful evaluation and personalized decision-making for patient selection and education are essential to optimize clinical and safety outcomes. Full article

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide. While screening tools such as the fecal immunochemical test (FIT) aid in early detection, they do not provide insights into individual risk factors or strategies for primary prevention. This study aimed to develop and internally validate an interpretable machine learning-based model that estimates an individual’s probability of developing CRC using readily available clinical and lifestyle factors. Methods: We analyzed data from 154,887 adults, aged 55–74 years, who participated in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. A risk prediction model was built using the Light Gradient Boosting Machine (LightGBM) algorithm. To translate these findings into clinical practice, we implemented the model into a risk estimator that categorizes individuals as average, increased, or high risk, highlighting modifiable risk factors to support patient–clinician discussions on lifestyle changes. Results: The LightGBM model incorporated 12 predictive variables, with age, weight, and smoking history identified as the strongest CRC risk factors, while heart medication use appeared to have a potentially protective effect. The model achieved an area under the receiver operating characteristic curve (AUROC) of 0.726 (95% confidence interval [CI]: 0.698–0.753), correctly distinguishing high-risk from average-risk individuals 73 out of 100 times. Conclusions: Our findings suggest that this model could support clinicians and individuals considering screening by guiding informed decision making and facilitating patient–clinician discussions on CRC prevention through personalized lifestyle modifications. However, before clinical implementation, external validation is needed to ensure its reliability across diverse populations and confirm its effectiveness in real-world healthcare settings. Full article

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