Search Results (130)

Background/Objectives: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal (GI) symptoms. Small intestinal bacterial overgrowth (SIBO) is emerging as a significant GI sequela post-COVID-19 infection. This study aimed to evaluate the prevalence and incidence of SIBO post-COVID-19 infection across different age groups and to identify associated risk factors in a global cohort. Methods: A retrospective study utilized the TriNetX database and included adult patients (≥18 years) diagnosed with SIBO following COVID-19 infection (1 January 2022–30 May 2024). A propensity score matching (1:1) was used to adjust for demographics and SIBO risk factors. Kaplan–Meier survival analysis assessed the SIBO incidence within 12 months. Results: Among 1,660,092 COVID-19 patients and 42,322,017 controls, SIBO was diagnosed in 353 COVID-19 patients without hydrogen breath tests (BT) and 78 with BT, compared to 3368 controls without BT and 871 with BT. Age-specific analysis demonstrated a clear, progressive increase in the SIBO incidence, becoming distinctly significant by 6 months and highest at 12 months post-infection. The highest risks were noted in ages 60–69 (0.011% vs. 0.004%, OR 2.6, p = 0.0003) and 70–79 (0.011% vs. 0.005%, OR 2.0, p = 0.0004), with younger age groups (30–49 years) also showing significantly increased risks. The medication analysis revealed strong associations with chronic opioid, proton pump inhibitor, and antidiarrheal medication. Conclusions: COVID-19 significantly increased the risk of SIBO, particularly within the first 12 months post-infection, across various age groups and, notably, in association with certain chronic medications. Clinical vigilance and targeted management strategies are recommended to mitigate long-term GI consequences. Full article

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by providing durable responses and a favorable safety profile, ushering in a new era of tumor immunotherapy. However, immune-related adverse events (irAEs) remain a significant clinical challenge. Among these, gastrointestinal irAEs, especially immune-related colitis (ir-colitis), can lead to serious complications if not promptly recognized and managed. Here, we present a case of grade 3 ir-colitis induced by the programmed cell death protein 1 (PD-1) inhibitor sintilimab in a 68-year-old woman with endometrial cancer. The patient developed severe acute diarrhea following ICI administration, which progressed despite initial antidiarrheal and antimicrobial treatments. A multidisciplinary team (MDT) involving gastroenterologists, oncologists, a pathologist, and a clinical pharmacist confirmed the diagnosis and implemented high-dose corticosteroid therapy, yielding significant clinical improvement. Importantly, this report highlights the mechanistic link between PD-1 blockade and ir-colitis pathogenesis, focusing on the dysregulation of the mucosal immune environment and its role in triggering colonic injury. In addition to the case description, we provide a comprehensive review of the literature and clinical guidelines, discussing risk factors, diagnostic approaches, therapeutic strategies, and long-term monitoring. By integrating insights from pharmacology, immunology, and clinical practice, this work emphasizes the importance of early detection, patient education, and MDT collaboration for optimizing therapeutic outcomes and advancing the understanding of ir-colitis in the context of ICI therapy. Full article

The genus Bauhinia has over 350 species distributed on different continents of the world. The vast majority of the species in this genus possess interesting biological activities. Also, they are good sources of flavonoids, which are known to elicit excellent pharmacological properties and are well-positioned as potential drug candidates. A literature search was performed with proper consideration of articles published and indexed in PubMed, Scopus, Springer Link, Google Scholar, ScienceDirect, SciFinder, and Medline databases between 1980 and 2023. A total of 164 flavonoids isolated from the genus Bauhinia were reviewed, and biological activities including antidiabetic, anti-cancer, antibacterial, cytotoxicity, antidiarrheal, antioxidant, anti-inflammatory, and anti-cataract were all reported. This study gave a comprehensive review of these flavonoids through detailed classification, structural diversity, and pharmacological activities. Full article

Background/Objectives: Haloxylon griffithii is a medicinal plant possessing therapeutic effects in disorders associated with the gastrointestinal (GIT) system. This research aims to study the pharmacological activity of Haloxylon griffithii in a multidimensional manner, involving phytochemistry screening and in vitro and in vivo experiments. Methods: The whole dried plant was extracted with 80% methanol and further fractionation using solvents of increasing polarity. GC-MS analysis was performed on the crude extract to discover volatile compounds. The spasmolytic/spasmogenic effect was assessed in isolated rabbit jejunum using spontaneous and K⁺-induced contractions, as well as contractions induced by increasing concentrations of calcium ions in depolarized tissue. Antidiarrheal activity was evaluated in Swiss albino rats/mice (n = 6/group) using castor oil-induced diarrhea and peristaltic index models. In silico ADMET screening was conducted via SwissADME and pkCSM. Results: The GC-MS profiling of H. griffithii revealed the presence of 59 phytochemicals and a rare azulene derivative and constituents, including α-santonin and hexadecanoic acid esters, with favorable pharmacokinetic profiles, as predicted using SwissADME and pkCSM computational tools. The in vitro and in vivo experiments revealed the significant calcium channel blocking activity in non-polar fractions (n-hexane and ethyl acetate), while the polar extracts (ethanolic, aqueous) exhibited cholinergic effects, indicating a dual mode of action. Conclusions: This was a first-time demonstration of both antidiarrheal and smooth muscle-relaxant activity in H. griffithii, supported by GC-MS profiling and pharmacological assay. The findings lend scientific credibility to the traditional use of the plant in community healthcare, while also reinforcing the need for further pharmacological and clinical studies to explore its potential in drug development. Full article

Background: Pancreatic ductal adenocarcinoma (PDAC) presents a challenge due to its poor prognosis. Irreversible electroporation (IRE) shows promise in improving margin clearance and increasing R0 and R1 indirect resection rates. Although IRE is believed to preserve surrounding tissues, this study aimed to assess postoperative refractory diarrhea as a severe complication and challenge the assumption of consistent tissue preservation. Methods: Patients undergoing pancreaticoduodenectomy (PD) with IRE for superior mesenteric artery (SMA) margin accentuation between May 2022 and April 2024 were included. Primary endpoints were diarrhea-related morbidity and mortality; secondary endpoints included R-status, recurrence, and metastases. IRE electrodes were initially positioned circumferentially around the SMA, but this approach was modified to hemi-circumferential placement and applied in six additional patients. Results: All five patients (median age 70, 80% female) in the initial cohort developed secretory diarrhea lasting a median of 6 months (IQR 5–6.5), with a median frequency of 5 stools/day (IQR 5–6.5). Two patients (40%) died due to diarrhea-associated cachexia. In contrast, among the six patients treated with the modified technique, patients’ diarrhea resolved within a median of 8 days (IQR 6–10) without need for opioid or advanced antidiarrheal therapy. Conclusions: Circumferential IRE for SMA margin accentuation may damage the superior mesenteric plexus and induce severe, prolonged diarrhea. Hemi-circumferential application may mitigate this risk. Larger studies are required to validate these findings and optimize the use of IRE in PD. Full article

Short bowel syndrome (SBS) is a malabsorptive condition resulting from reduced functional small intestinal length. SBS is closely related to intestinal failure (IF), defined as the reduction of functional intestinal mass below that which can sustain life, resulting in parenteral nutrition (PN) support for 60 days or greater within a consecutive 74-day period. IF frequently results from intestinal resection necessitated by such diseases as necrotizing enterocolitis in children and Crohn’s disease in adults. Clinical manifestations of IF may include diarrhea, growth failure, bacterial overgrowth, and vitamin deficiencies. Nutritional rehabilitation is the cornerstone of IF management. Surgical interventions are aimed at preserving intestinal length and restoring continuity. Medical management involves individualized enteral and parenteral nutrition therapy, GLP-2 agonists (e.g., teduglutide) that promote mucosal growth, and drugs for symptom management such as antidiarrheals. Experimental therapies such as the use of devices to induce intestinal growth through distraction enterogenesis are under development for the treatment of IF. An interdisciplinary approach involving surgeons, gastroenterologists, dietitians, nurses, and social workers is crucial in the management of these complex patients. Ultimately, a combination of nutritional, medical, and surgical management may be necessary to improve clinical outcomes in patients with IF. Full article

Introduction. Many pharmacological properties of dipyridamole (DIP) are associated with its ability to inhibit phosphodiesterases (PDEs). Actually, DIP has interesting properties like antiviral for influenza, SARS-2 COVID-19, and herpesviruses. Our research aimed to design and synthesize the dynamic combinatorial DIP derivatives with more pronounced inhibiting properties in relation to PDE and to carry out the HPLC analysis of the resulting combinatorial derivatives of DIP. This study is aimed at investigating the effect of the dynamic derivative of dipyridamole (DDD) on intestinal dysbiosis syndrome in mice caused by streptomycin against the background of cyclophosphamide-induced cellular immunodeficiency. Materials and methods. For the synthesis of a dynamic combinatorial derivative of dipyridamole, we used a molecular dynamic method for drug design and combinatorial acylation of dipyridamole by succinic and acetic anhydride in different molar ranges of acylation agents. Combinatorial derivatives were analyzed using gradient HPLC with a UV detector. Also, derivatives established the inhibition ability for phosphodiesterase by the spectrophotometric method. Also, we used an in vivo mouse model with immunodeficiency caused by cyclophosphamide for pharmacological study. Results and discussion. Molecular modeling suggests that 18 different dipyridamole derivatives can self-assemble into a stable supramolecular structure with lower total energy. Specific combinatorial molar ratios of the synthesis components were necessary to create a new supramolecular compound with enhanced pharmacological properties. The inhibition of phosphodiesterase in such a dynamic combinatorial derivative already appeared at a concentration of 0.05 μM. In mice with colitis caused by streptomycin treatment, the administration of DDD per os resulted in an antidiarrheal effect and prevention of the animals’ weight loss. Given the cyclophosphamide-induced immunosuppression and streptomycin-associated diarrhea, immunity was completely restored only under the action of DDD. Conclusions. The most effective dipyridamole derivative for phosphodiesterase inhibition was formed only if the number of different derivatives in solution was maximum and consisted of all 18 molecules. With other quantities of modifiers, there was no qualitative change in the inhibitory activity of the combinatorial mixture against phosphodiesterase. According to all parameters, DDD has been proven to be more effective than the pure dipyridamole reference product. Full article

Medicinal plants represent promising sources for the treatment of gastrointestinal disorders because of their abundance in bioactive compounds with therapeutic properties. Throughout history, various plant species have been used to alleviate digestive ailments, and studies have revealed the presence of metabolites with anti-inflammatory, antibacterial, antiviral, antiparasitic, antidiarrheal, antioxidant, and anticancer activities. The secondary metabolites responsible for these properties include alkaloids, terpenoids, and phenolic compounds, with the latter, particularly flavonoids, being the most associated with their bioactivities. Gastrointestinal diseases, such as gastritis, peptic ulcers, gastroesophageal reflux disease, inflammatory bowel disease, irritable bowel syndrome, and gastrointestinal cancer, are caused primarily by bacteria, parasites, viruses, and the consumption of raw or undercooked foods. These conditions significantly impact human health, necessitating the development of safer and more effective therapeutic alternatives. After an extensive literature review, several plant species with widespread use in the treatment of these disorders were identified, including Matricaria chamomilla, Mentha spicata, Melissa officinalis, Artemisia ludoviciana, Flourensia cernua, Phoradendron californicum, and Turnera difusa. This study revealed that the analyzed plants are rich in bioactive compounds, which confer their medicinal properties. However, many other plants commonly used to treat digestive disorders have been scarcely studied, highlighting the need for further research. Full article

Lactic acid bacteria play a crucial role in maintaining the health of the host’s gut microbiota. In this study, the anti-inflammatory properties of Limosilactobacillus reuteri LR20-6 and Lacticplantibacillus plantarum L272 were evaluated using a mouse model of diarrhea induced by Escherichia coli. We also investigated their effects on gut microbiota regulation. The results indicated that both Lacticplantibacillus plantarum and Limosilactobacillus reuteri could reduce inflammation by inhibiting the expression of inflammatory factors IL-6 and TNF-α and blocking the MyD88 and NF-kB/p65 signaling pathways. Additionally, after intervention with these strains, the relative abundance of Lactobacillus was significantly increased. This suggested that Lacticplantibacillus plantarum and Limosilactobacillus reuteri could mitigate the severity of E. coli-induced diarrhea and enhance the abundance of beneficial probiotics in the gut of animals. Full article

Terminalia bellirica (Gaertn) Roxb. and Terminalia chebula Retz. are significant botanicals in ancient Ayurvedic medicine. They are renowned for their therapeutic properties, notably in addressing gastrointestinal (GI) diseases. These plants have undergone thorough examination related to their antibacterial, anti-inflammatory, and antioxidant properties, which make them highly efficient natural treatments for controlling gastrointestinal infections. The current research demonstrated the antibacterial efficacy of fruit extracts of Terminalia bellirica and Terminalia chebula against Bacillus cereus, Shigella sonnei, Shigella flexneri, and Salmonella typhimurium. We performed disc diffusion and liquid microdilution experiments to evaluate the antibacterial efficacy. All extracts of Terminalia bellirica and Terminalia chebula showed good antibacterial effects against B. cereus and S. flexneri. The minimum inhibitory concentration (MIC) values ranged from 94 µg/mL to 556 µg/mL. The methanolic extracts from both plants also showed noteworthy antibacterial activity against S. sonnei and S. typhimurium, with MIC values of 755 µg/mL for both. Fractional inhibitory concentration studies revealed additive interactions between some conventional antibiotics and the plant extracts when used concurrently. Liquid chromatography–mass spectrometry (LC-MS) analyses revealed that the T. bellirica and T. chebula extracts contained various tannins including methyl gallate, propyl gallate, gallic acid, and ellagic acid. Lethality assays conducted using Artemia franciscana Kellogg nauplii indicated that all the plant extracts are non-toxic. The antibacterial properties and absence of toxicity in T. bellirica and T. chebula fruit extracts indicate their potential for antibiotic development, warranting additional mechanistic and phytochemical studies. Full article

Hagenia abyssinica (HA) is a monotypic tree species used as traditional medicine against various diseases and conditions in African countries. HA is also a multipurpose plant used for furniture, fuel wood, soil fertility management, and rainwater conservation, along with medicinal usage. In different in vitro, in vivo, ex vivo, and human studies, the potential of HA for different pharmacological properties, including anti-parasite, antibacterial, antifungal, antispasmodic, anticancer, anti-diabetes, antidiarrheal, wound healing, antioxidant, and anti-inflammatory activities were observed. Antioxidant and anti-inflammation properties of HA may be the primary reason for the multi-pharmacological activities of HA. Initial toxicity studies and the presence of various phytochemicals, especially flavonoids, also support the therapeutic potential of HA. The diverse medicinal properties of the plant have different challenges to overcome for its development. Limited studies to decipher the molecular mechanism behind the pharmacological activity restrict the utilization of the complete potential of HA as therapeutics. Still, the compilation of phytochemical, pharmacological activities, and target pathways of HA is missing in the literature. The current review not only compiles the pharmacological activities and phytochemicals but also highlights the gaps and proposes the future direction to develop HA as a candidate against important diseases. Full article

For thousands of years, Vachellia nilotica has been widely used as an herbal medicine to treat some diseases and symptoms, including respiratory, gastrointestinal and urogenital ailments. The present study was adapted to document and assemble existing information about V. nilotica and its evidence-based ethnopharmacological activities, with brief reviews on the description, geographical distribution, ecology, medical uses and phytochemistry. A literature review and information up to 2024 was performed in various scientific databases, including PubMed, Science Direct and Google Scholar. The keywords were “Acacia nilotica”, “Botany”, “ecology”, “Traditional uses”, “Phytochemistry”, “Polyphenols”, “Molecular docking”, “Ethnopharmacological activities” and “toxicity”, among others. V. nilotica has a wide range of uses, with low toxicity, reported in different countries. It can be infused into oils or tea or incorporated into paste, poultice and biscuits, used as an emollient, antidiarrheal, astringent and as an antidote for bite poisons. Glucose and lipid-lowering, anti-inflammatory, analgesic, antipyretic, antioxidant, antihypertensive, antibacterial, antifungal, antiviral and anthelmintic activities are the most prominent. Over 150 chemical components have been identified from V. nilotica that could be associated with its potential actions. Quercetin, rutin, kaempferol, naringenin, catechin, epicatechin, gallic acid, ellagic acid, lupeol and niloticane are its main active constituents. From the research data, and despite the fact that human clinical trials and detailed methodological studies are scarce, V. nilotica has shown wide-ranging activities, though the most robust evidence is related to the treatment of microbial infections, diarrhea, wound and ulcer healing and for topical application. More pharmacological and toxicological studies are required to further elucidate the mechanisms of action, potential side effects, and optimal dosages for these treatments. Additionally, more clinical trials are needed to validate these traditional uses in human populations and to ensure the safety and efficacy of V. nilotica for these applications. This article offers an overview of therapeutic applications by utilizing traditional uses and recent findings on phytochemical studies, and clinical and pharmacological research. Full article

Pentadesma butyracea is a medicinal plant of which bark decoctions are used in traditional medicine for the treatment of diarrhea symptoms in Gabon. The aim of the present work was to perform phytochemical and pharmacological analyses of decoctions of P. butyracea bark. In a principal approach, spectrophotometric analyses were used to quantify phenolic compounds, followed by liquid chromatography coupled to mass spectrometry analysis that allowed the identification of flavanone–flavone dimers as the main metabolites. Pharmacological analyses showed the absence of toxicity, thus confirming the safety of use of this decoction in traditional medicine. The antioxidant activity of the bark decoctions was demonstrated to depend on their phenolic contents. The decoction of stem barks harvested during the rainy season also induced a dose-dependent relaxation of isolated ileum fragments from Wistar rats. In addition, the antidiarrheal activity of P. butyracea barks was investigated against castor oil-induced diarrhea. The oral administration of different concentrations of this decoction led to a decrease in wet stools, indicating an antidiarrheal effect at the doses that were used. These results encourage the deepening of bio-guided research on P. butyracea bark decoctions in order to propose standard traditional medical treatments. Full article

Background: Community pharmacists are frequently approached by patients seeking health advice for minor ailments, particularly for common childhood diseases like diarrhea. Globally, approximately two million children under five years of age die each year due to diarrhea, which remains a significant health concern, especially in developing countries. Objectives: The purpose of this study was to assess the skills of community pharmacists in addressing and prescribing for simple viral diarrhea in children. Methods: A hundred community pharmacies were visited by simulated clients following a standard scenario of inquiring about simple childhood diarrhea. Subsequently, they filled out a standardized form after each visit to assess the skills of the community pharmacists. Results: It was found that 98% of the pharmacists were males. Approximately 80% of them inquired about the child’s age, while only 29% asked about the presence of fever. Around 2–6% of them only asked about the stool nature, child’s feeding behavior, and family symptoms. Around 10% of them suggested a potential bacterial origin, and 24% recommended the use of antibiotics. Only 43% of the community pharmacists suggested the use of oral rehydration solution, while 15–56% recommended using antidiarrheals, anti-emetics, and spasmolytics. The mean knowledge score of the pharmacists was 9.06 out of 17. Conclusions: The results indicated a relatively low level of knowledge about managing simple viral childhood diarrhea, which may reflect a similar level of knowledge about dealing with minor ailments in general. Full article

To evaluate the phytobiotic effect of Anacardium occidentale leaf powder (AOLP) on growth performance, diarrhea incidence, blood biochemistry, and intestinal traits, seventy-two weaned piglets were randomly distributed into four groups (six replicates/group and three pigs/replicate) for 28 days, receiving a control diet (T0) or being supplemented with 5 (T1), 10 (T2), or 15 (T3) g/kg of AOLP. The diets did not affect the growth performance (p > 0.05); however, the AOLP groups had a decreased diarrhea incidence and malondialdehyde concentration (p < 0.05; 28 days). However, the AOLP groups had increased immunoglobulins (G and M) and villus heights (p < 0.05) in the duodenum. Likewise, T3 improved the number of goblet cells in the villi and the whole intestine (p < 0.01), the Mucin2 area in the jejunum and ileum (p < 0.05), occludin gene expression in the jejunum (p < 0.01), and acetic and valeric acid production (p < 0.05). Microbial diversity at the genus level was not different (p > 0.05); however, T3 increased the abundance of the Lactobacillus genus. These findings suggest that dietary supplementation with AOLP improved intestinal health by increasing antioxidant, immune, anti-inflammatory, and antidiarrheal activity in the weaned piglets. Full article