Search Results (122)

Objective: This study aimed to evaluate the relationship between the Prognostic Nutritional Index (PNI) and demographic characteristics, presenting complaints, clinical diagnoses, and patient outcomes in patients admitted to the emergency department for gastrointestinal (GI) emergencies. The predictive value of PNI for the clinical course of patients with GI emergencies was investigated. Method: This retrospective cross-sectional study included 583 patients with a diagnosis of GI emergencies in the emergency department of a tertiary university hospital between January 2021 and December 2024. Data such as age, sex, presenting complaints, final diagnosis, and emergency department outcomes (discharge, ward admission, and transfer to intensive care unit) were collected. The PNI value was calculated using serum albumin (g/dL) and total lymphocyte count (/mm³) with the formula PNI = 10 × albumin + 0.005 × lymphocyte. The PNI was calculated based on serum albumin levels and peripheral lymphocyte counts. Results: The mean age of the study group was 63.4 ± 17.4 years, and 52.1% of the patients were female. The number of patients with a PNI value < 38 was significantly higher in the intensive care unit (p < 0.001). PNI values were considerably lower, especially in patients diagnosed with malignancy, cirrhosis, and GI hemorrhage (X² = 71.387; p < 0.001). The PNI was an independent predictor of outcomes in patients with GI emergencies. The mean PNI was significantly higher in discharged patients but significantly lower in patients admitted to the intensive care unit (p < 0.002). The cut-off score for PNI was calculated using the median value, and the cut-off score for PNI was <38. Conclusion: PNI is a powerful biomarker for predicting the clinical severity and prognosis of patients with GI emergencies. Since it can be easily calculated from routine biochemical tests, it can be used as a practical and effective risk stratification tool. The evaluation of PNI, especially for the early detection of critically ill patients at high risk of malnutrition, may contribute to the reduction of morbidity and mortality through the timely initiation of appropriate supportive therapies. Full article

Background: Gastrointestinal tuberculosis (GI TB) is a rare form of extrapulmonary TB that often mimics other conditions, such as Crohn’s disease (CD) or GI malignancies. Conventional diagnostics, like direct microscopy and culture, are often inconclusive or slow, delaying treatment. In Germany, a low-incidence country, GI TB is underrecognized. Rising migration has led to a resurgence of TB cases, increasing the likelihood of encountering extrapulmonary presentations. This study evaluates the performance and utility of various diagnostic tools and proposes a diagnostic approach to reduce delays and avoid unnecessary interventions. Methods: We retrospectively analyzed eight patients suspected of GI TB based on clinical presentation and testing. Two recent cases are described in detail to highlight diagnostic and therapeutic challenges. Results: GI TB was confirmed in five cases (62.5%), and all the patients presented with abdominal complaints, with the majority experiencing systemic symptoms such as weight loss or fever. Histopathology supported the diagnosis in all GI TB cases, while PCR testing was positive in four. Direct microscopy detected acid-fast bacilli in only one case. The remaining patients were diagnosed with latent genital TB, disseminated TB without GI involvement, or were ruled out clinically. Conclusions: GI TB remains a diagnostic challenge that often mimics other conditions, such as CD or malignancy. Early use of histopathology and PCR in patients with a high risk of GI TB is critical for timely diagnosis. In low-incidence settings like Germany, clinicians should maintain high suspicion in at-risk populations (e.g., migrants from areas or immunocompromised patients), especially when symptoms mimic CD or malignancy, to improve outcomes and avoid unnecessary procedures. Full article

Background and Objectives: Rectal cancer is a major cause of morbidity and mortality worldwide, and although current therapeutic protocols have improved survival, treatment-related toxicities may significantly affect patients’ daily functioning and emotional well-being. This study aimed to prospectively assess the impact of radiotherapy with concurrent capecitabine on functional and symptomatic outcomes in patients with rectal cancer, with a particular focus on the presence of a stoma and treatment strategy. Materials and Methods: From 165 patients initially assessed, 64 were included in this study after applying eligibility criteria. All received pelvic radiotherapy (50.4 Gy in 28 fractions); 62.5% also received CAPOX chemotherapy. The quality of life was assessed using EORTC QLQ-C30 and QLQ-CR29 questionnaires administered at three time points: before treatment, mid-treatment (day 15), and post-treatment. Results: A statistically significant deterioration was observed in physical, emotional, social, and role functioning over the course of treatment, along with an increase in symptom scores for fatigue, pain, gastrointestinal, and urinary complaints. The presence of a stoma was significantly associated with worse gastrointestinal symptoms and emotional functioning. No significant differences were noted between patients with or without chemotherapy. Despite symptom worsening, global quality-of-life scores remained relatively stable. Conclusions: These findings highlight the complex interplay between treatment toxicity and patient adaptation. The presence of a stoma and other clinical or demographic factors significantly influence patients’ experience during therapy. Integrating routine assessment of functional and symptomatic burden into clinical practice could support individualized interventions aimed at maintaining daily functioning and psychological resilience during treatment. Full article

Background: Fermented foods rich in bioactive compounds have been proposed as potential strategy to combat non-communicable diseases. Among them is kombucha, a beverage fermented from sugared Camellia sinensis tea by a symbiotic culture of bacteria and yeasts (SCOBY). Recently, there has been an increased focus on assessing the actual effect of this beverage on human health. In this manner, this systematic review aimed to gather clinical evidence on the impact of kombucha consumption on human health. Methods: The databases Cochrane CENTRAL, MEDLINE/PubMed, and Embase^® were searched, and the risk of bias tool used was the Critical Appraisal Tools outlined in the Joanna Briggs Institute. This review followed the PRISMA guidelines and was registered on PROSPERO (CRD42024599464). Results: Eight clinical trials were included (two pre- and post-interventions and six randomized controlled trials) with durations ranging from 10 days to 10 weeks. Two studies reported beneficial effects of kombucha on gastrointestinal symptoms, such as reduced intensity of constipation-related complaints. Two trials observed changes in gut microbiota composition, including increased abundance in Bacteroidota, Akkermansiaceae, Saccharomyces, and Weizmannia coagulans, alongside reductions in Ruminococcus, Dorea, and Rhodotorula. Moreover, five clinical trials evaluated glucose metabolism, evidencing inconsistent results, and other studies identified improvements in salivary microbiota composition and serum metabolomic profile. Conclusion: These findings suggest that kombucha consumption may provide health benefits, particularly in alleviating gastrointestinal symptoms, and demonstrates a modest capacity for modulating gut and salivary microbiota, as well as metabolomic profiles. Although the results are promising, the heterogeneity of the studies and the limited number of available clinical trials highlight the need for further robust research to confirm these effects. Full article

Background and Objectives: Helicobacter pylori, classified as a Group I carcinogen, is the main risk factor for gastric cancer, one of the leading causes of cancer mortality globally. Lithuania reports one of the highest gastric cancer rates in Europe, yet recent large-scale epidemiological data on H. pylori prevalence are lacking. This study aimed to assess the current seroprevalence of H. pylori in Lithuanian adults and its associations with sociodemographic, environmental factors, and dyspeptic symptoms. Materials and Methods: A cross-sectional study was conducted between 2020 and 2023 at the Lithuanian University of Health Sciences in Kaunas city. Randomly selected adults aged 25–69 years underwent venous blood sampling for H. pylori IgG antibody testing (Serion ELISA) and completed a questionnaire on demographic–environmental factors and dyspeptic symptoms in the past 30 days. Subjects previously treated for H. pylori were excluded from seroprevalence analysis. Seroprevalence was compared across age groups using χ² and Z-tests with Bonferroni correction. Multivariable logistic regression identified factors associated with H. pylori seropositivity. The selected level of statistical significance was p < 0.05. Results: A total of 1046 adults (mean age 47.2 years, SD = 11.5; 50% males) participated in the study. The overall age-standardized H. pylori seroprevalence was 63.1% (95% CI 60.4–66.7). Seropositivity increased with age, peaking at 80.3% in males aged 55–69. Higher seroprevalence was observed among those with basic education and those lacking access to municipal or heated water during childhood. Regression analysis revealed that male sex, aging, and lower education were significantly associated with H. pylori seropositivity. No significant link was found between H. pylori seroprevalence and gastrointestinal complaints. Conclusions: H. pylori seroprevalence remains high in Lithuanian adults, highlighting the need for ongoing surveillance and consideration of screening strategies. H. pylori infection was linked to sociodemographic and environmental factors but not dyspeptic complaints. Full article

Background/Objectives: We aimed to evaluate the clinical course, demographic characteristics, and risk factors in Polish patients with geographic tongue (GT). Methods: The analysis was based on medical records of 100 patients with GT referred to the outpatient clinic of Poznań University of Medical Sciences (PUMS) from 2013 to 2023. Data regarding age, gender, medical history, habits, subjective complaints, clinical features, localization, histology, and treatment were considered. Results: Patients with GT constituted 11.3% of 887 individuals admitted to the outpatient clinic in the analyzed period. The female-to-male ratio was 52:48. The average age at diagnosis was 51.6 years. Thirteen patients reported smoking, and 2.0% admitted to consuming alcohol excessively. Subjective complaints were reported by 85.0% of patients and mainly included a burning sensation (57.0%), pain (39.0%), xerostomia (22.0%), bleeding (4.0%), and taste disturbance (3.0%), while 15.0% of GT patients were asymptomatic. Comorbidities were found in 76.0% of subjects with GT, and included cardiovascular disorders (37.0%), gastrointestinal and thyroid gland diseases (24.0% and 18.0%), and type II diabetes (15.0%). Psoriasis was observed in one case only. Conclusions: The frequency of GT in a Polish cohort of patients was high and comparable in both genders. The majority of participants reported subjective complaints, and most of the patients were non-smokers. Comorbidities were found in 76.0% of subjects with GT and mainly included cardiovascular and gastrointestinal diseases. GT was often accompanied by other oral conditions, like candidiasis, recurrent aphthous stomatitis, and lichen planus. GT screening should include cardiovascular and gastrointestinal evaluation. Full article

Background: Constipation is one of the most common gastrointestinal complaints among women, with a variety of contributing factors. We aimed to assess the role of colonoscopy in evaluating young women with constipation. Methods: A multi-center, large cohort, retrospective study included all data from colonoscopies performed between 2016 and 2023 in seven endoscopy departments. The indications and findings of the procedures were collected, and findings of young women aged ≤40 y with constipation as an indication were compared to older women and men of the same age groups. Results: The cohort comprised 377,795 patients, including 198,629 (52.6%) females and 179,166 (47.4%) males. In total, 7872 females underwent colonoscopy for constipation and other indications (Cohort 1). In addition, 6852 women were referred for a colonoscopy for constipation only (Cohort 2). In sum, 75% of colonoscopies in women <40 y were normal in both cohorts. In Cohort 1, inflammatory bowel diseases (IBD) were significantly higher in women <40 y with Ulcerative Colitis (UC) (1.2%) and Crohn’s disease (CD) (0.7%), p < 0.001). The rate of IBD was lower but still significant in Cohort 2. In both cohorts, diverticulosis and polyp rates exponentially increased with age >40 y, p < 0.001. Higher rates of diverticulosis and polyps were found among males <40 y in Cohort 1. One case (0.1%) of Colorectal cancer (CRC) was found in <40 y women. Similar IBD and CRC rates were found in males and females of all ages, p > 0.05. Conclusions: The diagnostic yield of colonoscopy for investigating isolated constipation in young females is not significant. Diagnostic work-up should be guided by accurate clinical understanding. Full article

Background: Long-distance running impacts many organ systems. Aside from musculoskeletal and cardiopulmonary events, the gastrointestinal and renal system as well as metabolic homeostasis and electrolyte balance can be affected. A respective medical support strategy enabling rapid diagnosis, triage, and treatment in the context of large sports events is thus of utmost importance. Incidents can be assessed and graded via point-of-care (POC) blood gas analysis (BGA). We thus aimed to evaluate the feasibility and benefits of its use during a large sports event. Methods: All documented patient contacts during the race of the Vienna City Marathon (VCM) 2023 were retrospectively assessed. Additionally, the BGAs conducted in all patients requiring intravenous access were analyzed. Data are presented in a descriptive manner. Results: There were 39,871 participants at the VCM 2023. Of these, 277 (0.7%) required medical support, localized most commonly in the finishing area of the race (n = 239, 86% of all incidents). Fifty-eight (20.9%) patients had to be hospitalized. The most frequent chief complaints were syncope or collapse (24.9%), followed by general pain (20.6%) and trauma (14.8%). Five patients (1.8%) suffered from seizures, and one experienced (0.4%) from spontaneous pneumothorax. Thirty-one patients (11.2%) received venous blood gas analyses, showing mean creatinine levels of 1.82 (±0.517) mg/dL, mean lactate concentrations of 6.03 (±4.5) mmol/L, mean pH of 7.42 (±0.0721), and a mean base excess of −0.72 (±3.72) mmol/L. No cases of hyponatremia occurred in the documented samples. In eight cases (25.8%), sodium concentrations were above 145 mmol/L, with a maximum of 149 mmol/L. No cardiac arrests occurred. Conclusions: The physical exertion during the assessed long-distance running race resulted in numerous contacts with the medical support teams. The use of POC BGA at a large-scale marathon event was shown to be easy and feasible, allowing for more extensive diagnostics on-site. It can be integrated into a medical support strategy and might be beneficial for decision-making regarding patient triage, treatment, hospitalization, or patient discharge. Full article

Background/Objectives: GPT-3.5 and GPT-4 has shown promise in assisting healthcare professionals with clinical questions. However, their performance in real-time clinical scenarios remains underexplored. This study aims to evaluate their precision and reliability compared to board-certified emergency department attendings, highlighting their potential in improving patient care. We hypothesized that board-certified emergency department attendings at Maimonides Medical Center exhibit higher accuracy and reliability than GPT-3.5 and GPT-4 in generating differentials based on history and physical examination for patients presenting to the emergency department. Methods: Real-time patient data from Maimonides Medical Center’s emergency department, collected from 1 January 2023 to 1 March 2023 were analyzed. Demographic details, symptoms, medical history, and discharge diagnoses recorded by emergency room attendings were examined. AI algorithms (ChatGPT-3.5 and GPT-4) generated differential diagnoses, which were compared with those by attending physicians. Accuracy was determined by comparing each rater’s diagnoses with the gold standard discharge diagnosis, calculating the proportion of correctly identified cases. Precision was assessed using Cohen’s kappa coefficient and Intraclass Correlation Coefficient to measure agreement between raters. Results: Mean age of patients was 49.12 years, with 57.3% males and 42.7% females. Chief complaints included fever/sepsis (24.7%), gastrointestinal issues (17.7%), and cardiovascular problems (16.4%). Diagnostic accuracy against discharge diagnoses was highest for ChatGPT-4 (85.5%), followed by ChatGPT-3.5 (84.6%) and ED attendings (83%). Cohen’s kappa demonstrated moderate agreement (0.7) between AI models, with lower agreement observed for ED attendings. Stratified analysis revealed higher accuracy for gastrointestinal complaints with Chat GPT-4 (87.5%) and cardiovascular complaints with Chat GPT-3.5 (81.34%). Conclusions: Our study demonstrates that Chat GPT-4 and GPT-3.5 exhibit comparable diagnostic accuracy to board-certified emergency department attendings, highlighting their potential to aid decision-making in dynamic clinical settings. The stratified analysis revealed comparable reliability and precision of the AI chat bots for cardiovascular complaints which represents a significant proportion of the high-risk patients presenting to the emergency department and provided targeted insights into rater performance within specific medical domains. This study contributes to integrating AI models into medical practice, enhancing efficiency and effectiveness in clinical decision-making. Further research is warranted to explore broader applications of AI in healthcare. Full article

Background/Objectives: S-adenosylmethionine (SAMe) is a natural compound implicated in the treatment of liver dysfunction. In this systematic review, our objective was to determine the efficacy, safety, and optimal dose of SAMe in liver diseases. Methods: Using the PRISMA methodology, we searched PubMed, CINAHL, and Web of Science using key MeSH search terms. For title/abstract screening, full-text review, and data extraction, two independent researchers reviewed articles, and a third researcher resolved conflicts. Data extraction also included a quality assessment of included articles. Results: Of the 1881 non-duplicated studies, 15 articles focusing on SAMe use in the liver were included. All included studies (n = 15) scored a 4 or 5 out of 5 points on the quality assessment, which indicated high study quality. Overall, SAMe was effective in improving liver-related parameters with few adverse events, which were primarily mild, transient gastrointestinal complaints. Conclusions: The most common doses were SAMe 1000 mg or 1200 mg per day with or without another treatment or natural supplement. Future studies are needed to assess long-term efficacy and safety data of SAMe and the optimal route of administration in liver diseases. Full article

Self-medication without a medical or dental prescription is an action that leads to a significant problems associated with the overuse of medication in Brazil. The inappropriate use of antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs) leads to problems related to microbial agent resistance and gastrointestinal complications. The purpose of this study was to elucidate the patterns of antibiotic and NSAIDs consumption among the adult population of Brazil. The questionnaire was answered by 400 people residing in Brazil who had access to the link in the year 2023. The findings showed that approximately 89.5% of the volunteers had used NSAIDs, and 32.2% had used antibiotics whether or not these medications had been prescribed by doctors or dentists. It was noted that a large proportion of the adverse effects reported by the volunteers involved symptoms related to gastrointestinal complaints. There was a high prevalence of NSAIDs consumption in the studied population, which is consistent with the high frequency of risk of adverse reactions caused by these drugs, particularly in the gastrointestinal tract. In relation to antibiotics, it was observed that the non-prescription consumption of these medications by the population was considered high, reaching one-third of the total number of volunteers who consumed such medications. Full article

We investigated the effects of Lactobacillus paragasseri OLL2716 on gastrointestinal symptoms in healthy adults with gastric complaints. In this randomized, double-blind, placebo-controlled trial, 174 healthy Japanese adults were randomly assigned to an OLL2716 or placebo group, and each group consumed 85 g of yogurt containing L. paragasseri OLL2716 or placebo yogurt daily for 12 weeks. The primary endpoint was the change in gastric symptoms from baseline as per the participants’ questionnaires at 6 and 12 weeks. The secondary endpoints were changes from baseline in the short-form Nepean Dyspepsia Index (SF-NDI), the Gastrointestinal Symptom Rating Scale (GSRS), and the Council on Nutrition Appetite Questionnaire-Japanese (CNAQ-J) scores at 6 and 12 weeks. The primary endpoint data showed that the changes in “epigastric pain” at 6 and 12 weeks were significantly decreased in the OLL2716 group compared with those in the placebo group. Additionally, the changes in “epigastric pain syndrome-like symptoms” were significantly decreased in the OLL2716 group compared with those in the placebo group at 6 weeks. The SF-NDI items that improved at 6 weeks were “irritable, tense, or frustrated”, “enjoyment of eating or drinking”, and “tension”, which are sub-scales related to mental stress. The items “Over-all” in the GSRS and “feeling hungry” in the CNAQ-J significantly improved in the OLL2716 group compared with the placebo group at 12 weeks. The results suggest that regular intake of L. paragasseri OLL2716 may improve both gastric discomfort and mental stress in healthy adults with gastric complaints, such as postprandial fullness or early satiety. Full article

Gulf War Illness (GWI) is a debilitating condition marked by chronic fatigue, cognitive problems, pain, and gastrointestinal (GI) complaints in veterans who were deployed to the 1990–1991 Gulf War. Fatigue, GI complaints, and other chronic symptoms continue to persist more than 30 years post-deployment. Several potential mechanisms for the persistent illness have been identified and our prior pilot study linked an altered gut microbiome with the disorder. This study further validates and builds on our prior preliminary findings of host gut microbiome dysbiosis in veterans with GWI. Using stool samples and Multidimensional Fatigue Inventory (MFI) data from 89 GW veteran participants (63 GWI cases and 26 controls) from the Boston biorepository, recruitment, and integrative network (BBRAIN) for Gulf War Illness, we found that the host gut bacterial signature of veterans with GWI showed significantly different Bray–Curtis beta diversity than control veterans. Specifically, a higher Firmicutes to Bacteroidetes ratio, decrease in Akkermansia sp., Bacteroides thetaiotamicron, Bacteroides fragilis, and Lachnospiraceae genera and increase in Blautia, Streptococcus, Klebsiella, and Clostridium genera, that are associated with gut, immune, and brain health, were shown. Further, using MaAsLin and Boruta algorithms, Coprococcus and Eisenbergiella were identified as important predictors of GWI with an area under the curve ROC predictive value of 74.8%. Higher self-reported MFI scores in veterans with GWI were also significantly associated with an altered gut bacterial diversity and species abundance of Lachnospiraceae and Blautia. These results suggest potential therapeutic targets for veterans with GWI that target the gut microbiome and specific symptoms of the illness. Full article

Background: Disorders of gut–brain interaction are chronic or recurrent symptoms originating in the gastrointestinal tract that cannot be substantiated by the results of standard clinical tests, such as radiologic studies, morphologies, or endoscopic examination. The diagnosis of these disorders is mainly based on symptoms and the standardized Rome IV criteria. These criteria classify functional disorders of the gastrointestinal tract according to anatomical location and define each disorder according to a set of symptoms. Methods: This study was conducted between October 2021 and February 2022. Participants in the study were patients of a gastroenterology outpatient clinic with a functional disease diagnosed by a gastroenterologist. A questionnaire was used to conduct the study, with questions regarding perceived functional discomforts of the gastrointestinal tract, dietary changes to alleviate discomforts, and frequency of consumption of various food groups. Results: Based on the study, statistical significance was demonstrated between the gender of the respondents and the severity of gastrointestinal complaints after the consumption of legumes and alcohol. The analysis performed confirmed the correlation between the age of the respondents and the severity of complaints when consuming raw vegetables and fruits, brassica vegetables, legumes, fried products, and spicy products. There was also a significant correlation between the body mass index (BMI) of the respondents and the severity of complaints after alcohol consumption. Conclusions: The results identify abdominal pain, bloating, and constipation as the most commonly reported gastrointestinal symptoms among participants. The association between the consumption of certain foods, such as milk and dairy products, as well as fried and fatty foods, and the severity of disorders of gut–brain interaction symptoms was confirmed. Despite this, the majority of respondents did not eliminate any food products to alleviate the discomfort. Full article

Bothersome gastrointestinal (GI) signs/symptoms, including abdominal pain, distension, nausea, and flatulence, are common in children. A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) is frequently recommended for children with GI symptoms. Currently, there are no studies on the effect of FODMAPs in healthy schoolchildren. In this cross-sectional study, schoolchildren reported an association between FODMAPs and GI symptoms through a standardized questionnaire and images of 20 common staples known to be rich in FODMAPs. A total of 208 schoolchildren aged 8–18 years old participated. A proportion of 38.0% of children reported GI symptoms, with abdominal pain (33%) being the most common complaint followed by abdominal distension (24%) and nausea (23%). The majority of children who reported intolerances to FODMAP-containing foods were intolerant to less than two food groups (76%). While vegetables and legumes (26%), particularly black beans (11%) and onions (7%), emerged as the most common group of triggers, milk (12%) stood out as the single food most frequently associated with GI symptoms. In conclusion, there was a high prevalence of FODMAPs intolerance among schoolchildren. Larger studies are recommended to confirm these findings and to inform possible dietary interventions to reduce the effect of FODMAPs on schoolchildren. Full article