Search Results (364)

The oral–gut microbiota axis is a relatively new field of research. Although most studies have focused separately on the oral and gut microbiota, emerging evidence has highlighted that the two microbiota are interconnected and may influence each other through various mechanisms shaping systemic health. The aim of this review is therefore to provide an overview of the interactions between oral and gut microbiota, and the influence of diet and related metabolites on this axis. Pathogenic oral bacteria, such as Porphyromonas gingivalis and Fusobacterium nucleatum, can migrate to the gut through the enteral route, particularly in individuals with weakened gastrointestinal defenses or conditions like gastroesophageal reflux disease, contributing to disorders like inflammatory bowel disease and colorectal cancer. Bile acids, altered by gut microbes, also play a significant role in modulating these microbiota interactions and inflammatory responses. Oral bacteria can also spread via the bloodstream, promoting systemic inflammation and worsening some conditions like cardiovascular disease. Translocation of microorganisms can also take place from the gut to the oral cavity through fecal–oral transmission, especially within poor sanitary conditions. Some metabolites including short-chain fatty acids, trimethylamine N-oxide, indole and its derivatives, bile acids, and lipopolysaccharides produced by both oral and gut microbes seem to play central roles in mediating oral–gut interactions. The complex interplay between oral and gut microbiota underscores their crucial role in maintaining systemic health and highlights the potential consequences of dysbiosis at both the oral and gastrointestinal level. Some dietary patterns and nutritional compounds including probiotics and prebiotics seem to exert beneficial effects both on oral and gut microbiota eubiosis. A better understanding of these microbial interactions could therefore pave the way for the prevention and management of systemic conditions, improving overall health outcomes. Full article

Background/Objectives: Gastroesophageal reflux disease (GERD) seems to be a common complaint which persists or develops after metabolic bariatric surgery (MBS). Endoscopic evaluation is vital in both the preoperative and postoperative phases to ensure optimal patient outcomes. The aim of this study was to evaluate the prevalence of GERD after MBS in a 10-year follow-up and analyze the endoscopic outcomes. Methods: This retrospective, multicenter study included 368 patients who underwent single bariatric procedure. The data came from five bariatric centers in Poland, part of the BARI-10-POL project. Data on symptoms of GERD, endoscopic findings, demographics, and surgical outcomes were collected for a 10-year follow-up period. Surgical procedures included SG, Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). Results: Of the 305 patients without symptoms of GERD, 12.3% developed de novo GERD postoperatively. There was no statistical significance regarding the new-onset symptoms and the type of MBS (p = 0.074) and the presence of symptoms of GERD and the type of MBS (p = 0.208). However, SG was associated with a significantly lower likelihood of GERD remission after MBS (p = 0.005). Endoscopic evaluation showed abnormal findings in asymptomatic patients in both preoperative (35.8%) and postoperative (14.1%) examinations (p < 0.001). Conclusions: GERD may be a common issue after MBS. One-quarter of patients after MBS may experience symptoms of GERD, regardless of the type of MBS. SG appears to be associated with a higher risk of persistent symptoms of GERD and a lower likelihood of GERD remission after MBS. Asymptomatic patients both before and after MBS may have abnormal findings in gastroscopy. Full article

Polycystic liver disease (PLD) is a rare genetic disorder characterized by the development of >10 fluid-filled cysts in the liver. While PLD can occur in isolation, it is most commonly associated with autosomal dominant polycystic kidney disease, adding complexity to its management. PLD is often asymptomatic but can lead to hepatomegaly, causing symptoms such as abdominal distension, pain and discomfort, early satiety, gastroesophageal reflux, and malnutrition, ultimately affecting patients’ quality of life. Current treatment strategies, including pharmacological and interventional approaches, focus on reducing liver volume and alleviating symptoms. However, management remains largely symptomatic, as no definitive therapies exist to halt cyst progression. Liver transplantation is the only curative option for patients with severe, progressive disease and refractory complications. The EASL guidelines recognize that PLD-related symptoms, primarily due to hepatomegaly, can contribute to involuntary weight loss and recommend assessing symptomatic patients for malnutrition and sarcopenia. Although evidence suggests that patients with PLD may be at risk of malnutrition, original data on the quality and extent of nutritional alterations remain scarce. The potential influence of nutrition on disease progression, symptom burden, and overall well-being is also largely unexplored. Given these knowledge gaps, addressing nutritional challenges, such as early satiety, is essential for optimizing symptom management and maintaining overall nutritional status. This review outlines a possible pathophysiology of malnutrition, specific dietary considerations and recommendations, and weight management in patients with PLD. Additionally, dietary complexities in patients with concurrent renal involvement are discussed, offering a practical framework for clinicians and dietitians in managing this challenging condition. Full article

Background/Objectives: Tegoprazan (TPZ) is a potassium-competitive acid blocker (P-CAB) used to treat conditions such as gastroesophageal reflux disease, peptic ulcer, and Helicobacter pylori infection. It exists in three solid forms: amorphous, Polymorph A, and Polymorph B. This study investigates the molecular basis of polymorph selection, focusing on conformational bias and solvent-mediated phase transformations (SMPTs). Methods: The conformational energy landscapes of two TPZ tautomers were constructed using relaxed torsion scans with the OPLS4 force field and validated by nuclear Overhauser effect (NOE)-based nuclear magnetic resonance (NMR). Hydrogen-bonded dimers were analyzed using DFT-D. Powder X-ray diffraction (PXRD), differential scanning calorimetry (DSC), solubility, and slurry tests were conducted using methanol, acetone, and water. Kinetic profiles were modeled with the Kolmogorov–Johnson–Mehl–Avrami (KJMA) equation. Results: Polymorph A was thermodynamically stable across all analyses. Both amorphous TPZ and Polymorph B converted to A in a solvent-dependent manner. Methanol induced direct A formation, while acetone showed a B → A transition. Crystallization was guided by solution conformers and hydrogen bonding. Conclusions: TPZ polymorph selection is governed by solution-phase conformational preferences, tautomerism, and solvent-mediated hydrogen bonding. DFT-D and NMR analyses showed that protic solvents favor the direct crystallization of stable Polymorph A, while aprotic solvents promote the transient formation of metastable Polymorph B. Elevated temperatures and humidity accelerate polymorphic transitions. This crystal structure prediction (CSP)-independent strategy offers a practical framework for rational polymorph control and the mitigation of disappearing polymorph risks in tautomeric drugs. Full article

Background: Dyspeptic symptoms are very common in the general population, with an estimated prevalence of 14% to 41%, and the majority of patients experience symptoms without an organic cause for them (so-called functional dyspepsia). While the pathophysiology of functional dyspepsia remains elusive, the impact of functional dyspepsia on quality of life is detrimental. The treatment involves a change in lifestyle—a healthy diet and physical activity—in combination with pharmacological treatments. However, currently, there is no standard therapy for this condition, although a nutritional approach appears to be feasible and well accepted by patients. In this context, the intake of some mineral water types might be able to play an important role. Objective: The aim of the present study was to evaluate whether the regular intake of bicarbonate natural mineral water (Aqua Carpatica from source “F2 Păltiniș”) is able to positively influence the symptomatic process of dyspepsia, promoting digestion and improving the quality of life of patients. Methods: The patients enrolled in this open-label study had diagnosis of functional dyspepsia formulated in accordance with the Rome III criteria. During the 4-week study, patients had to ingest tap water at 1.5 L/day (wash-out period: 2 weeks), and in the 2-week subsequent period, they had to ingest alkaline natural mineral water at 1.5 L/day. The primary efficacy endpoint of this study includes a statistically significant improvement (p < 0.05) in the “heartburn”, “regurgitation”, and “dyspepsia” subscales and the total Reflux Disease Questionnaire’s (RDQ) score with respect to the effects of alkaline natural mineral water. As secondary endpoints, we considered statistically significant improvements (p < 0.05) in quality-of-life scores (Psychological General Well-Being Index—Short form; PGWB-S), the patient’s self-assessment of the state of efficiency of their digestion, and their sense of post-prandial fullness, as well as the use of antacids. Results: Forty-five patients were enrolled: all were Caucasian and mostly women (25, 55.6% vs. 20 men, 44.4%), and they were aged between 25 and 75 years (50.6 ± 13.5 years; mean ± SD). The results of this preliminary study show a significant improvement in functional dyspepsia symptoms—as assessed via the RDQ—and an improvement in quality of life—as assessed using the PGWB-S score—after the intake of alkaline natural mineral water. Conclusions: This preliminary study provides clinical evidence for a recommendation of alkaline natural mineral water as a symptomatic treatment of dyspepsia. Full article

Proton pump inhibitors (PPIs) are widely prescribed medications primarily used to treat gastroesophageal reflux disease, peptic ulcer disease, and upper gastrointestinal bleeding. Despite clear therapeutic benefits in appropriate contexts, widespread overprescribing and extended use without clear indications have prompted significant concerns about associated risks. Accumulating evidence, predominantly from observational studies, suggests that long-term PPI use may lead to complications such as vitamin and mineral deficiencies, increased risks of infections, dysbiosis, renal dysfunction, bone fractures, cardiovascular disease, and certain malignancies. This narrative review not only synthesizes the current evidence surrounding PPI-related harms and existing deprescribing guidelines but also offers a novel perspective on how stewardship principles can be applied to promote responsible PPI prescribing. In particular, we propose a stewardship-oriented deprescribing framework rooted in implementation science, focusing on provider behavior, patient engagement, and health system-level integration. Recognizing these potential harms, evidence-based deprescribing strategies such as tapering, intermittent dosing, and transitions to alternative therapies are critical to mitigate unnecessary patient exposure. Effective implementation of deprescribing requires addressing patient, provider, and institutional barriers through educational initiatives, policy support, and structured monitoring. By promoting judicious PPI prescribing and proactive stewardship practices, clinicians can significantly reduce medication-related harm and improve patient safety. Full article

Background: Up to one-third of patients with gastroesophageal reflux disease (GERD) have persistent symptoms despite proton-pump inhibitor (PPI) therapy. E-Gastryal^® + MgAlg (Aurora Biofarma, Italy) is a mucosal protective agent that enhances barrier function against acid and non-acidic reflux. This study assessed its efficacy in combination with omeprazole versus omeprazole alone and as maintenance therapy. Methods: Patients with symptomatic GERD and Grade A reflux esophagitis confirmed by endoscopy were randomized to receive omeprazole 20 mg plus E-Gastryal^® + MgAlg or omeprazole 20 mg alone. The primary endpoint was the number of rescue medications used over 28 days. Secondary endpoints included symptom relief and quality-of-life assessments using the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Impact Scale (GIS), GERD-Health-Related Quality of Life (GERD-HRQL), and Global Assessment of Performance (IGAP). Results: Ninety-six patients were included. The combination group used significantly fewer rescue medications (mean: 21 vs. 40.9 tablets; p = 0.002). At week 4, the combination group showed greater improvement in RSI, GIS, and GERD-HRQL scores (p < 0.001). Symptom relief was sustained during weeks 5–26 with E-Gastryal^® + MgAlg alone. Conclusions: E-Gastryal^® + MgAlg combined with omeprazole improves symptom control compared to PPI monotherapy. Continued use as maintenance therapy supports its role in long-term GERD management (NCT04130659). Full article

Background and Aims: Gastroesophageal reflux disease (GERD) is the most common esophageal disorder worldwide and a progressive condition leading to Barrett’s esophagus and adenocarcinoma. Continuous medical therapy with proton pump inhibitors fails to restore the antireflux barrier and is unable to relieve symptoms in up to 40% of patients. A tailored and standardized antireflux surgical procedure may increase cure rates and meet patient expectations. Methods and Results: Antireflux surgery aims to reestablish the natural antireflux barrier, which includes the diaphragmatic crura, the lower esophageal sphincter (LES), and the angle of His along with the gastroesophageal flap valve. For decades, the Nissen total fundoplication has been the primary procedure and remains the gold standard for surgical treatment. Alternatives such as Toupet partial fundoplication, Dor partial fundoplication, and the magnetic sphincter augmentation (LINX™) procedure have been developed to mitigate side effects like dysphagia, gas-bloat syndrome, and the inability to belch or vomit. Recent clinical findings regarding a novel procedure, RefluxStop™, indicate that restoring the gastroesophageal flap valve, in conjunction with anterior fundoplication and a silicone device for stabilizing the LES beneath the diaphragm, can achieve lasting reflux control and enhance patient-reported outcomes. Conclusions: The planning of healthcare services and actionable strategies to improve equity and quality of treatment is critical to address the global burden of GERD. Modern laparoscopic surgery for GERD is safe and effective and should be performed in centers offering a complete diagnostic pathway and specific surgical techniques tailored to the individual GERD phenotype. Shared decision-making between the surgeon and the patient is essential for the choice of operation. A personalized approach can offer clinical benefits over total fundoplication and improve patient-reported outcomes. Full article

Background: Laparoscopic antireflux surgery (LARS) is widely used to treat gastroesophageal reflux disease (GERD). Iatrogenic gastroesophageal injuries, when recognized intraoperatively, can be managed without major consequences, whereas undetected injuries presenting as postoperative leaks are associated with high morbidity and mortality. Despite their complexity, research on post-LARS leaks is scant. We aim to describe the diagnosis and management of such injuries at a tertiary referral center. Methods: We describe a single-center case series of patients referred for gastroesophageal perforations after LARS. Patients were identified through the personal records of surgeons at our institution. A narrative literature review was conducted to summarize publications on the topic. Results: Five patients (four female [80%]; median age, 73 years [IQR, 67–74]) were included. The median time between LARS and clinical presentation was 2 (IQR, 1–8) days (range 1–15 days). The most frequent symptoms were shortness of breath (all five patients) and pain (three [60%] patients). All patients presented with hypoxia, and four (80%) patients presented with sepsis. Two (40%) patients underwent primary repair, and three (60%) required limited esophagogastrectomy without immediate reconstruction. All patients required both thoracic and abdominal exploration, and all of them experienced significant postoperative complications (Clavien–Dindo ≥ 3). The median hospital stay was 58 days (IQR, 34–59). At a median follow-up of 14 months (IQR, 6–28), all patients were alive. Conclusions: Although infrequent, gastroesophageal perforation after LARS often requires complex surgical interventions and prolonged hospital stays. Additional efforts should focus on prevention and early recognition. Full article

Gastroesophageal reflux disease (GERD) is associated with inflammatory and neoplastic changes in the esophageal epithelium. Despite widespread PPI use, esophageal adenocarcinoma (EAC) incidence continues to rise, implicating non-acidic reflux components such as pepsin in disease progression. We performed transcriptomic profiling to assess pepsin-induced changes and the protective effect of amprenavir in vitro. Het-1A (normal) and BAR-T (Barrett’s) cells (n = 3) were treated at pH 7.0 with pepsin and/or 10 μM amprenavir for 1 h. RNA-seq identified DEGs (FDR ≤ 0.05, |log₂FC| ≥ 0.375), and Ingenuity Pathway Analysis revealed enriched pathways. Pepsin exposure altered mitochondrial function, oxidative phosphorylation, epithelial integrity, signaling, and inflammatory pathways in both cell lines. Amprenavir attenuated these transcriptomic perturbations, preserving mitochondrial and stress-response pathways. Notably, BAR-T cells exhibited heightened activation of wound-healing and epithelial repair pathways, whereas Het-1A cells showed greater mitochondrial and systemic stress pathway alterations. Pepsin drives transcriptomic dysregulation in esophageal epithelial cells under non-acidic conditions, and amprenavir shows potential to counteract peptic injury. Further studies are needed to validate these findings and explore amprenavir’s therapeutic utility in GERD management and EAC prevention. Full article

Background: A low-FODMAP diet is considered as a potential supportive treatment approach in some gastrointestinal disorders. The aim of this study was to systematically review the literature for randomized controlled trials assessing the efficacy of the low-FODMAP diet on the severity of gastrointestinal symptoms and quality of life in patients with gastrointestinal disorders. Methods: This review was conducted in accordance with CASP tool and PRISMA guidelines. A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of fourteen randomized controlled trials. Results: Ten studies examined the effect of the low-FODMAP diet in patients with irritable bowel syndrome (IBS), three with inflammatory bowel disease (IBD), and one with symptomatic proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD). All interventions compared the low-FODMAP diet with another diet and lasted from 3 to 12 weeks. Most studies on IBS showed significant improvements in abdominal pain, bloating, and quality of life compared to control diets. In IBD, improvements were mainly observed in functional gastrointestinal symptoms, while no clear benefit was demonstrated in GERD. Heterogeneity in study designs, intervention durations, comparator diets, and outcome measures limited the ability to conduct a meta-analysis. Conclusions: Although a low-FODMAP diet may reduce symptoms in selected individuals, it is not universally necessary. Importantly, the diet’s restrictive nature and potential long-term effects—such as nutritional deficiencies and alterations in gut microbiota—highlight the need for clinical supervision by dietitians with expertise in gastrointestinal disorders. Furthermore, in some cases, symptom improvement may be achievable through less restrictive changes, such as improving food hygiene and reducing intake of processed or high-sugar foods. Further high-quality randomized controlled trials with standardized endpoints and longer follow-up are needed to clarify the efficacy and safety of the low-FODMAP diet across various gastrointestinal conditions. Full article

Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with IP between 2018 and 2025. Sociodemographic and clinical data were collected. A blinded pathologist assessed the presence and severity of inflammation within the IP. Results: Nine patients (median age, 12 years; range, 6–14 years) were included, with 78% beingmale. Cervical esophageal symptoms were identified in 67%, primarily dysphagia and gastroesophageal reflux disease-related complaints, although concomitant conditions such as eosinophilic esophagitis were frequently present. Three patients had symptoms potentially attributable to IP (33%). Endoscopic examination revealed characteristic well-demarcated salmon-red plaques in all patients, with multiple lesions observed in three cases. Histology confirmed gastric heterotopia with varying degrees of chronic inflammation in all cases. A potential association was observed between the severity of gastritis in the stomach, the severity of inflammation in the IP, and the presence of H. pylori, with 75% of patients with moderate-to-severe IP inflammation also exhibiting gastric H. pylori-associated gastritis. All patients except one received proton pump inhibitors, and symptoms improved in all cases. Conclusions: A thorough and targeted examination of the cervical esophagus significantly increased IP detection at our center, with most cases (89%) being diagnosed in the last 12 months. While mostly asymptomatic and incidental, IP can be symptomatic. In this case, series, we found a possible association between the severity of inflammation in the IP, the severity of gastritis, and the presence of H. pylori. Further studies are needed to define the clinical significance of pediatric IP and optimal management. Full article

Gastroesophageal reflux disease (GERD) is a widespread condition that requires reliable and non-invasive diagnostic methods to minimize patient discomfort. This study presents a radiofrequency spectrophotometry sensor specifically designed to detect esophageal liquid flow and ionicity in real time without disrupting the patient’s daily life. The sensor operates by measuring dielectric properties and ionic conductivity through the thoracic plexus, eliminating the need for invasive probes or prolonged monitoring. A study conducted on 49 participants demonstrated the sensor’s ability to differentiate between various liquid media and identify beta dispersion relaxation as a biomarker for esophageal tissue damage, a key indicator of GERD progression. Additionally, alpha dispersion conductivity effectively distinguished reflux episodes, proving the sensor’s high sensitivity. Unlike traditional diagnostic techniques such as endoscopy or pH monitoring, this radiofrequency spectrophotometry sensor enables continuous, real-time reflux detection, allowing patients to maintain a normal lifestyle during assessment. The results validate its potential as an innovative alternative for GERD diagnosis and monitoring, with future research focused on clinical validation, optimization, and integration into long-term patient monitoring systems. Full article

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

In recent years, there has been a growing recognition within the medical community that idiopathic pulmonary fibrosis (IPF) cannot be effectively managed through a singular focus on the disease itself. Instead, a dual approach is essential, one that not only aims to prolong survival by targeting the underlying pathological mechanisms of IPF but also addresses the numerous comorbidities that frequently complicate the clinical picture for affected individuals. This narrative review seeks to provide a detailed and comprehensive exploration of the various comorbid conditions associated with IPF, which may include cardiovascular disease (CVD), lung cancer (LC), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and anxiety/depression, among others. By understanding the interplay between these comorbidities and IPF, healthcare providers can better tailor treatment regimens to meet the holistic needs of patients. Furthermore, this review delves into both current management strategies and emerging therapeutic approaches for these comorbidities, emphasizing the importance of interdisciplinary collaboration in clinical practice. By synthesizing the latest research and clinical insights, this review aims to enhance awareness and understanding of the complexities surrounding IPF management, ultimately guiding clinicians in developing more effective, individualized care plans that address not only the fibrotic lung disease but also the broader spectrum of health challenges faced by patients. Through this comprehensive overview, we hope to contribute to the ongoing dialogue about improving quality of life and survival rates for individuals living with IPF. Full article