Search Results (83)

Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting. Despite increasing awareness, a standardized treatment approach remains lacking in pediatric populations. Lifestyle factors and anxiety are common triggers, yet their systematic management has not been fully incorporated into therapeutic strategies. Objective: To evaluate the effectiveness of lifestyle modifications and selective serotonin reuptake inhibitors (SSRIs) in the management of pediatric CVS and to compare their outcomes with standard cyproheptadine prophylaxis. Methods: This retrospective study included 119 patients aged 1.2–17.5 years who were diagnosed with CVS according to Rome IV criteria between September 2021 and January 2025. Clinical, psychiatric, and lifestyle data were retrieved from the university’s digital medical records. Patients were grouped according to treatment modality: cyproheptadine, SSRI, or acute attack management alone. Treatment success at 12 weeks was defined as complete cessation of vomiting episodes or absence of hospitalization, prolonged attacks, and school/work absenteeism. Results: Anxiety symptoms were present in 78.2% of patients. SSRIs were prescribed to 34 patients with moderate to severe anxiety, all of whom achieved treatment success. Lifestyle adherence was observed in 73.9% and was found to be a predictor of treatment success. Cyproheptadine was administered to 66 patients but did not provide additional benefit over effective lifestyle modification. Six patients discontinued cyproheptadine due to drowsiness or weight gain. Conclusions: Lifestyle interventions significantly improve outcomes in pediatric CVS. SSRIs represent a safe and effective prophylactic option for patients with comorbid anxiety or poor adherence to behavioral recommendations. These findings support the integration of psychosocial and lifestyle-based strategies into standard CVS treatment protocols. Full article

Background and Objectives: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder with diverse subtypes. Recent evidence has suggested a link between vitamin D deficiency and IBS; however, the associations between vitamin D levels, IBS subtypes, and hematological–biochemical parameters remain unclear. The aim of this research was to investigate the associations between vitamin D status, IBS subtypes, and sex, along with their relationships with biochemical and hematological parameters. Materials and Methods: This retrospective study included 240 patients diagnosed with IBS according to the Rome IV criteria at Van Yüzüncü Yıl University Medical Faculty Hospital. The patients were classified as diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or mixed-type (IBS-M). The patients’ serum vitamin D levels and hematological (hemoglobin, white blood cell and platelet counts, and mean corpuscular volume) and biochemical (ferritin, iron, calcium, magnesium, and vitamin B12 levels) parameters were evaluated at baseline and after vitamin D supplementation. Sex-related differences were assessed. Results: Baseline vitamin D levels were low in all IBS subtypes, with no significant differences between the groups. Vitamin D supplementation resulted in a significant increase in serum vitamin D levels across all subtypes (p = 0.001). No significant correlations were identified between vitamin D levels and hematological or biochemical parameters. Sex differences in vitamin D levels were only significant in the IBS-M group, both at baseline and post-treatment (p < 0.05). Conclusions: Vitamin D deficiency is prevalent among all IBS subtypes and significantly improves with supplementation, independently of the subtype. Although no associations were found between vitamin D levels and laboratory parameters, the observed sex differences in patients with IBS-M highlight the need for further research into potential sex-related pathophysiological mechanisms. These findings support the integration of routine vitamin D assessment and supplementation into the clinical management of IBS, especially in patients with the IBS-M subtype and female sex, to potentially improve patient outcomes. Full article

Irritable Bowel Syndrome (IBS) is a disorder of gut- brain interaction characterized by recurrent abdominal pain associated with altered bowel habits. The therapeutic options for IBS patients include the use of probiotics. The aim of this study was to assess the effect of a multi-strain probiotic made up by Lactobacillus rhamnosus LR 32, Bifidobacterium lactis BL 04, and Bifidobacterium longum BB 536 (Serobioma, Bromatech s.r.l., Milano, Italy) on an in vitro model of the intestinal epithelial barrier in the presence of mucosal mediators that are released by IBS patients. IBS (n = 28; IBS with predominant diarrhea, IBS-D = 10; IBS with predominant constipation, IBS-C = 9; and IBS with mixed bowel habits, IBS-M = 9) patients, diagnosed according to the Rome IV criteria, and asymptomatic controls (ACs, n = 7) were enrolled. Mucosal mediators that were spontaneously released by colonic biopsies were collected (supernatants). Two doses of Serobioma were tested with/without IBS/AC mediators. RNA was extracted from Caco-2 cells to evaluate the tight junction (TJ) expression. Serobioma (10⁶ CFU/mL) significantly reinforced the Caco-2 monolayer compared to growth medium alone (p < 0.05). IBS supernatants significantly increased Caco-2 paracellular permeability compared to the AC supernatants. The co-incubation of Caco-2 cells with IBS supernatants and Serobioma (10⁶ CFU/mL) avoided the paracellular permeability alterations that were induced by IBS supernatants alone (p < 0.001), and, in particular, IBS-D and IBS-M ones. The co-incubation of Serobioma (10⁶ CFU/mL) and IBS-D supernatants significantly increased ZO-1 expression compared to Caco-2 cells incubated with supernatants alone (p < 0.05), as confirmed via qPCR analyses. Serobioma (10⁶ CFU/mL) counteracts the paracellular permeability changes that are induced by IBS supernatants, in particular IBS-D and IBS-M supernatants, likely modulating ZO-1 expression. Full article

Background/Objectives: There is a limited body of evidence regarding dietary intake in children with inflammatory bowel disease despite increasing research about the nutritional implications in the disease pathogenesis. Functional abdominal pain disorders (FAPDs) are also chronic disorders marked by chronic abdominal pain, currently described with the ROME IV criteria. This study was aimed to investigate the adherence to healthy eating habits in an inflammatory bowel disease pediatric population when compared to a matched population with functional abdominal pain gastrointestinal disorders. Methods: We performed a single centre study focused on dietary patterns in children with IBD and FAPDs between January 2021 and April 2024. Data collected included general information, disease phenotype, and the KIDMED index regarding healthy eating. Results: The final analysis was based on full data from the KIDMED index available for 122 (57 vs. 65) participants. Overall, the average KIDMED score did not vary significantly between the study population, meaning 6.89 ± 2.33 for the IBD group and 7.11 ± 2.67 for FAPDs group, p = 0.34. In the same KIDMED index group, mean values were higher for FAPDs patients, but results differ statistically significant only for “medium” adherence to healthy diet, showing that larger proportion of IBD patients were previously exposed to non-healthy diets: 8.99 vs. 11.1, p = 0.45, 5.02 vs. 6.92, p = 0.05, 2.89 vs. 2.56, p = 0.43, for group 1, 2, and 3, respectively. Conclusions: This study showed in our cohort that overall adherence to a healthy pattern diet is poor prior to diagnosis of different gastrointestinal pathologies in children. Full article

The gut microbiota plays a pivotal role in gastrointestinal inflammation and immune response since changes in microbiota may result in abnormal neurotransmitter expression, inducing changes in gastrointestinal sensory–motor function and leading to symptom onset in irritable bowel syndrome (IBS) patients. The Bifidobacterium adolescentis species has a documented immunomodulatory effect through its ability to produce γ-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the mammalian central nervous system, which is reduced in IBS patients. This is a multicentric, randomized, double-blind, placebo-controlled, parallel-arm trial aimed at evaluating the effectiveness of Bifidobacterium adolescentis PRL2019 in children with IBS. IBS children diagnosed according to Rome IV criteria were enrolled and randomized into two groups to receive one stick containing 20 × 10⁹ colony-forming unit of Bifidobacterium adolescentis PRL2019 (Gabapral, Pontenure, Italy) or an equivalent placebo once a day, in a 1:1 ratio, for 12 weeks. Clinical evaluation of symptoms was performed every four weeks using validated scores. Bowel habit characteristics were assessed using the Bristol Stool Chart (BSC). Seventy-two subjects (mean age 12.2 ± 1.8 years, 30 males) were enrolled and randomized into two groups, each of thirty-six patients. No significant differences were observed between the two groups regarding demographic characteristics, distribution of IBS subtypes, or baseline measures of IBS severity and BSC. The proportion of patients achieving complete remission was significantly higher in the BA Group (19/36; 52.8%) than in the Placebo Group (7/36; 19.4%, p = 0.003, odds ratio [OR] 0.216, 95% confidence interval [CI] 0.075–0.619). Both groups obtained a reduction in Total IBS Symptom Severity Scale (IBS SSS), Pain Intensity Score (PIS), Pain Frequency Score (PFS), and Life Interference Score (LIS) from T0 to T12. However, upon intergroup comparison, only in the BA group did the IBS-SSS (p = 0.001), PIS (p = 0.001), LIS (p = 0.015), and PFS (p = 0.005) significantly improve between T0 and T12. BSC showed a greater representation of normal stools (type 3–4) at the end of treatment in the BA group compared with baseline (25% vs. 58.3%, p = 0.004), especially in patients who presented an IBS–constipation subtype at T0 (44.5% vs. 19.4%, p = 0.02). In our study, Bifidobacterium adolescentis PRL2019 reduces the severity and frequency of symptoms in children with IBS, positively affecting bowel habits in children with the IBS–constipation subtype. Full article

Background: The mixed type of irritable bowel syndrome (IBS-M) is characterized by recurrent constipation and diarrhea. The cause of the variability of these symptoms is not sufficiently understood. The aim of this study was to perform metagenomic and metabolic assessment of the gut microbiome in constipation and diarrheal period of IBS-M. Methods: This study included 30 women, aged 28–47 years old, with the symptoms which aligned with those of IBS-M, according to the Rome IV Criteria. Results: In both periods of the disease, the dysbiosis index (DI), the Shannon diversity index (SDI), the hydrogen–methane and ammonia breath tests, as well as the selected bacterial metabolites (-p-hydroxyphenyl acetic acid (HPA), 3-indoxyl sulfate (Indican, 3-IS)), and hippuric acid (A) in urine, were determined. The dysbiosis index (DI) in the period of constipation was 3.73 ± 0.90 points, and in the diarrheal period it did not change significantly 3.93 ± 0.75 points (p > 0.05). During the diarrheal period, the diversity of bacteria increases from 2.16 ± 0.59 to 2.74 ± 0.50 points on the Shannon dietary index (p < 0.001). The gut microbiome profile also changed, especially during the diarrheal period where an abundance of Bifidobacterium spp. and Lactobacillus spp. decreased significantly. In addition, during this period, the levels of hydrogen and ammonia in breath air increased, while the methane level decreased. The differences also concern the results of urinary metabolites, especially related to hippuric acid and indican. During the diarrheal period, the levels of hydrogen and ammonia ions increased, while the methane level decreased. The differences also concern the results of urinary metabolites, especially related to hippuric acid and indican. Conclusions: In patients with IBS-M, periodic changes in the profile and metabolism of the gut microbiome occur, which coexist with recurrent symptoms such as constipation and diarrhea. Full article

Background: Irritable Bowel Syndrome (IBS) is a complex disorder characterized by altered gut–brain interactions, with gastrointestinal microbiota and metabolic dysregulation playing key roles in its pathophysiology. Identifying specific metabolic alterations within the colonic mucosa may enhance our understanding of IBS and contribute to improved diagnostic and therapeutic approaches. Methods: This cross-sectional study analyzed the metabolomic profiles of colonic mucosal biopsies from 44 IBS patients assessed with ROME IV criteria and 69 healthy controls undergoing colonoscopy. Untargeted metabolomic profiling was conducted using liquid chromatography–mass spectrometry (LC-MS), and differential metabolite analysis was performed via fold-change calculations and machine learning-based classification. Results: IBS patients exhibited distinct mucosal metabolic profiles, with significantly elevated levels of N-acetylneuraminic acid and 1-palmitoylglycerol, suggesting compromised epithelial integrity and increased gut permeability. In contrast, cis-4-hydroxycyclohexanecarboxylic acid, a metabolite associated with protective mucosal functions, was reduced. Random Forest analysis identified these metabolites as key discriminatory features between IBS and control groups, reinforcing their potential role as biomarkers for IBS-related mucosal alterations. Conclusions: Our study highlights the unique metabolomic signatures of IBS at the mucosal level, emphasizing the role of microbial metabolites in disease pathology. These findings may facilitate the development of novel diagnostic tools and targeted therapeutic strategies, advancing personalized management for IBS patients. Full article

Background/Objectives: The gut microbiota is involved in modulating gastrointestinal function and consequently contributes to the manifestation of functional gastrointestinal disorders (FGIDs). The aim of the study was to analyze the composition of the gut microbiota in infants with functional gastrointestinal disorders (infantile colic, functional constipation, gastroesophageal reflux, functional diarrhea) according to age, environmental factors, and clinical manifestations. Methods: The study involved the clinical and laboratory examination of 134 infants divided into two groups: group I (n = 82) with FGIDs according to Rome IV criteria, divided into four subgroups (infantile colic, functional constipation, gastroesophageal reflux, and functional diarrhea), and group II (n = 52) without FGIDs. To assess the composition of intestinal microbiota, a bacteriological analysis of fecal samples was performed. Results: Infants with functional gastrointestinal disorders presented an imbalance of intestinal microflora, which was characterized by a significant decrease in the main representatives of acidifying flora represented by Lactobacillus, Bifidobacterium, and Enterococcus and high abundance of proteolytic microorganisms from the Enterobacteriaceae family such as Klebsiella species and Escherichia coli. In infants born by cesarean section or artificially fed, the incidence of functional gastrointestinal disorders and intestinal dysbiosis was significantly higher. Conclusions: The imbalance of acidifying and proteolytic microbial composition in the gut could be the key to the occurrence of functional gastrointestinal disorders in the first year of life. Full article

Background/Objectives: Functional constipation (FC) is diagnosed using the Rome IV criteria, which require at least two of seven symptoms for diagnosis. Clinical trials evaluating FC treatments commonly use bowel movement frequency, stool consistency, and fecal incontinence as primary endpoints. However, there is limited data on whether these endpoints accurately represent the symptom distribution in children with FC. This study assessed the frequency of each criterion in a large children’s community sample to determine whether commonly used clinical trial endpoints accurately reflect symptom distribution. Methods: A cross-sectional study of school children aged 8–18 years was conducted across seven Colombian cities. Participants completed the Pediatric Gastrointestinal Symptoms Rome IV Questionnaire (QPGS-IV). The prevalence of FC and the distribution of diagnostic criteria were analyzed, calculating the percentage of each criterion. Results: 6611 children completed the questionnaires. FC was diagnosed in 12.8% of participants, making it the most common disorder of gut–brain interaction. The most reported criteria were fewer than two stools per week (66.1%) and painful bowel movements (65%), while fecal incontinence was uncommon (6.9%). 60.5% of participants met only two criteria, with two or fewer defecations per week and painful bowel movements being the most common combination. Conclusions: This study reveals significant variability in Rome IV criteria prevalence for FC, highlighting disparities between the most common endpoints in clinical trials and symptom distribution in a community-based cohort. Painful bowel movements emerged as a critical diagnostic component but remain underutilized as an endpoint in pediatric trials. These findings suggest the possible need to reassess endpoint selection in clinical trials. Full article

Background/Objectives: Growing evidence highlights the pivotal role of gut dysbiosis in the pathophysiology of irritable bowel syndrome (IBS). Despite this, the identification of an “IBS microbiota signature” remains elusive, primarily due to the influence of genetic, dietary, and environmental factors. To address these confounding variables, it is critical to perform comparative analyses using a control group derived from the same community as the IBS patients. This study aimed to evaluate and contrast the gut microbiota composition of IBS patients with healthy controls. Methods: We compared the gut microbiota from stool samples of 25 IBS patients diagnosed according to the Rome IV criteria, and 110 healthy subjects without acute or chronic diseases and not on continuous medication. The high-throughput sequencing of the V3–V4 regions of the 16S rRNA gene was conducted for microbiota analysis. Results: The IBS gut microbiota was richer but exhibited lower alpha diversity compared to the control group, suggesting simplification and imbalance. A beta diversity analysis revealed overall compositional differences between the two groups. A heat tree analysis highlighted key IBS-associated changes, including a decrease in Firmicutes, mainly due to Clostridia, and an increase in Bacteroidota, driven by an expansion of Bacteroidales families. Differential expression analyses identified important genera within these taxa like Bacteroides, Faecalibacterium, and Blautia, which could serve as microbiota-based biomarkers for IBS. Conclusions: Our results reveal both statistically and clinically significant differences in gut microbiota composition and diversity between IBS patients and healthy controls from the same community. These findings provide a deeper understanding of how alterations in the gut microbiota may contribute to IBS symptoms, offering new insights into the diagnosis and potential treatments. Full article

Background: Functional dyspepsia (FD) is a common functional gastrointestinal disorder characterized by chronic digestive symptoms without identifiable structural abnormalities. FD affects approximately 8–46% of the population, leading to significant socioeconomic burdens due to reduced quality of life and productivity. Traditional medicine utilizes differential diagnosis through comprehensive examinations, which include observing and questioning, abdominal examination, and pulse diagnosis for functional gastrointestinal disorders. However, challenges persist in the standardization and objectivity of diagnostic protocols. Methods: This study aims to develop an artificial intelligence-based algorithm to predict identified patterns in patients with functional dyspepsia by integrating brain–body bio-signals, including brain activity measured by functional near-infrared spectroscopy, pulse wave, skin conductance response, and electrocardiography. We will conduct an observational cross-sectional study comprising 100 patients diagnosed according to the Rome IV criteria, collecting bio-signal data alongside differential diagnoses performed by licensed Korean medicine doctors. The study protocol was reviewed and approved by the Institutional Review Board of Kyung Hee University Hospital at Gangdong on 25 January 2024 (IRB no. KHNMCOH 2023-12-003-003) and was registered in the Korean Clinical Trial Registry (KCT0009275). Results: By creating AI algorithms based on bio-signals and integrating them into clinical practice, the objectivity and reliability of traditional diagnostics are expected to be enhanced. Conclusions: The integration of bio-signal analysis into the diagnostic process for patients with FD will improve clinical practices and support the broader acceptance of traditional-medicine diagnostic processes in healthcare. Full article

Background/Objectives: Functional gastrointestinal disorders (FGIDs) affect children’s daily activities and overall performance due to gastrointestinal symptoms. This study assesses the prevalence and types of FGIDs in children living in Jeddah City and its countryside. It also examines factors that contribute to the incidence of these disorders and their impact on children’s lifestyles. Methods: This cross-sectional study was conducted among 285 mothers of preschool children enrolled in kindergartens during the academic year 2020–2021. The Rome IV Diagnostic Questionnaire was sent out online through kindergartens to be filled out by the children’s mothers. The questionnaire assessed the prevalence of FGIDs subjectively through symptoms and their frequency. Results: Among the 285 participants, 9% (n = 27) fit the diagnostic criteria for FGIDs. Common FGIDs included functional constipation, 3.5% (n = 10); postprandial distress syndrome, 2.4% (n = 7); functional abdominal pain—not otherwise specified, 1% (n = 3); and functional epigastric pain, 0.7% (n = 2). Significant risk factors for developing FGIDs among the children in the sample included being a preterm baby (p < 0.01), being previously diagnosed with a gastrointestinal condition (p < 0.010), having a family history of diarrhea or nausea and vomiting (p < 0.001 and p < 0.01, respectively), skipping lunch at kindergarten (p < 0.01), and having pre-existing food allergies (p < 0.01). Conclusions: FGIDs were prevalent among 9% of children in Jeddah City and its countryside. Functional constipation was the most common disorder. Factors associated with FGIDs in children included preterm birth, being previously diagnosed with a GI condition, a family history of gastrointestinal conditions, irregular eating habits, and food allergies. Full article

There is evidence of perturbed microbial and host processes in the gastrointestinal tract of individuals with functional gastrointestinal disorders (FGID) compared to healthy controls. The faecal metabolome provides insight into the metabolic processes localised to the intestinal tract, while the plasma metabolome highlights the overall perturbances of host and/or microbial responses. This study profiled the faecal (n = 221) and plasma (n = 206) metabolomes of individuals with functional constipation (FC), constipation-predominant irritable bowel syndrome (IBS-C), functional diarrhoea (FD), diarrhoea-predominant IBS (IBS-D) and healthy controls (identified using the Rome Criteria IV) using multimodal LC-MS technologies. Discriminant analysis separated patients with the ‘all constipation’ group (FC and IBS-C) from the healthy control group and ‘all diarrhoea’ group (FD and IBS-D) from the healthy control group in both sample types. In plasma, almost all multimodal metabolite analyses separated the ‘all constipation’ or ‘all diarrhoea’ group from the healthy controls, and the IBS-C or IBS-D group from the healthy control group. Plasma phospholipids and metabolites linked to several amino acid and nucleoside pathways differed (p < 0.05) between healthy controls and IBS-C. In contrast, metabolites involved in bile acid and amino acid metabolism were the key differentiating classes in the plasma of subjects with IBS-D from healthy controls. Faecal lipids, particularly ceramides, diglycerides, and triglycerides, varied (p < 0.05) between healthy controls and the ‘all constipation’ group and between healthy controls and ‘all diarrhoea’ group. The faecal and plasma metabolomes showed perturbations between constipation, diarrhoea and healthy control groups that may reflect processes and mechanisms linked to FGIDs. Full article

Background: Functional bowel disorders (FBDs) have detrimental effects on young adults, but the risk factors were not fully explored. This study aimed to investigate the prevalence and potential risk factors of FBDs in college freshmen, including, in particular, the association between passive smoking and the risk and symptoms of FBDs. Methods: A cross-sectional study was conducted in September 2019 in freshmen of Huazhong University of Science and Technology with a random cluster sampling method. Validated questionnaires were voluntarily completed by participants. Rome IV criteria were applied for the diagnosis of FBDs. Univariate analysis and multivariate logistic regression analysis (Model 1: unadjusted; Model 2: adjusted for age and sex; Model 3: adjusted for age, sex, intake frequency of coffee and juice, regular exercise, total sedentary time, sleep quality, interpersonal relationship, and SLSI scores) were performed to determine the potential risk factors of FBDs. Results: A total of 3074 participants were included in this study, among whom 236 college freshmen were diagnosed with FBDs. There was a positive relationship between passive smoking and the risk of FBDs (crude odds ratio [OR] = 2.084, 95% confidence interval [CI]: 1.480, 2.936, Model 1; adjusted OR = 1.825, 95%CI: 1.245, 2.675, Model 3). Moreover, the symptoms of hard stool, exertion, and sensation of obstruction in defecation were more frequent in passive smokers than non-passive smokers among FBD patients. Meanwhile, diarrhea was comparable between passive smokers and non-passive smokers among FBD patients. Conclusions: In the present study, around 7.68% of college freshmen were found to have FBDs. Passive smoking was positively associated with the risk of FBDs. Furthermore, passive smoking was significantly associated with constipation-related symptoms rather than diarrhea among FBD patients. Full article

Background: Irritable bowel syndrome (IBS) is a common yet debilitating disorder of gut–brain interaction, characterized by gut–brain axis dysregulation, visceral hypersensitivity, and other comorbidities. Obesity has been hypothesized to be a risk factor linked to IBS, albeit evidence remains conflicting. Given the growing global prevalence of obesity and IBS, we performed a meta-analysis examining their purported association. Methods: Embase, MEDLINE, and the Cochrane Library were searched to identify studies reporting the prevalence and odds ratios (ORs) of IBS according to BMI categories. Random effects meta-analyses were used for the primary analysis. Results: From 1713 articles, 27 studies were included. Our findings showed that using study-defined categories for overweight, obese, and normal BMI, the odds of the diagnosis of IBS were not associated with overweight (OR 1.02; 95% CI 0.89 to 1.17; p = 0.772) or obese BMI (OR 1.11; 95% CI 0.91 to 1.37; p = 0.309). The meta-analysis of study-reported adjusted odds ratios of IBS among individuals living with overweight or obesity also did not yield significant results. Further sensitivity analysis by the Rome criteria demonstrated a statistically significant association between obese BMI and IBS in studies using the Rome IV criteria (OR 1.59; 95% CI 1.13 to 2.23; p < 0.01), with significant subgroup difference between studies using the Rome II, Rome III, and Rome IV criteria. Further sensitivity analysis using the different cut-off values and subgroup analysis by geographical territory did not yield significant associations. Conclusions: In summary, excess body weight may not be a primary driver of IBS risk. Future research should focus on longitudinal studies that account for changes in weight and other lifestyle factors, as well as detailed mechanistic investigations. Full article