Search Results (888)

Background: Irritable bowel syndrome (IBS)-like symptoms are common in patients with ulcerative colitis (UC) in sustained clinical and endoscopic remission and are associated with impaired quality of life. Evidence for targeted treatments in this setting remains limited. Objective: To evaluate the efficacy of the multistrain probiotic VSL#3^® in patients with UC in stable remission and IBS-like symptoms. Methods: In this randomized, double-blind, explorative, placebo-controlled trial, adults with UC in stable remission for ≥6 months and Rome IV C1 or C4 symptoms received VSL#3^® 450 billion colony-forming units or placebo twice daily for 8 weeks. The primary endpoint was symptom relief at week 8 assessed by the 5-point Subject’s Global Assessment of Relief scale. Secondary endpoints included Irritable Bowel Syndrome Symptom Severity Scale scores (IBS-SSS), bowel habits, biochemical remission assessed through fecal calprotectin, IBS-QoL, and IBDQ. Results: Fifty-five patients were randomized. The primary endpoint did not differ significantly between groups. Between-group differences in IBS-SSS total score were not statistically significant at week 8; however, numerically greater and directionally consistent reductions in symptom severity and abdominal pain were observed with VSL#3^® across visits, persisting at follow-up. In exploratory subgroup analyses, restricted to patients with higher abdominal pain and bloating scores at baseline, significant intragroup improvements in abdominal pain and bloating were observed with VSL#3^® but not with placebo. Quality of life improvements were numerically greater and more sustained with VSL#3^®. Conclusions: Within the limitations of the small sample size, these results show a signal of benefit in the quality of life of UC patients with IBS-like symptoms and suggest a potential complementary role for VSL#3^® in symptom-oriented management, particularly for abdominal pain and bloating. Larger, adequately powered randomized trials are warranted to confirm these exploratory findings. Full article

Background/Objectives: Cholecystectomy, the surgical removal of the gallbladder, is one of the most commonly performed abdominal surgical procedures worldwide. Emerging evidence suggests that cholecystectomy may contribute to the development of irritable bowel syndrome (IBS). However, the association remains incompletely understood. This systematic review and meta-analysis aimed to evaluate the relationship between cholecystectomy and IBS. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted from database inception to March 2026. Meta-analyses were performed to pool odds ratios (ORs) and prevalence estimates. Heterogeneity, publication bias, and sensitivity analyses were assessed. Results: Seventeen studies involving 3,511,681 participants were included in the systematic review. Eight studies were eligible for the meta-analysis of the association between cholecystectomy and IBS, while twelve studies contributed to the prevalence analysis. No statistically significant difference in the odds of IBS was observed between patients who underwent cholecystectomy and controls (OR = 2.46, 95% CI: 0.97–6.22; p = 0.056; I² = 91.7%). The pooled prevalence of IBS in post-cholecystectomy patients was 21.0% (95% CI: 9.0–42.0), with high heterogeneity (I² ≈ 99%). Sensitivity analyses did not alter the direction of the pooled estimates following sequential omission of individual studies, and no significant publication bias was detected. Conclusions: No statistically significant difference in the pooled odds of IBS was observed between groups, while the pooled prevalence among cholecystectomy patients was approximately 21%, although heterogeneity was substantial. Further research is needed on heterogeneity. Full article

Background/Objectives: Gastrointestinal (GI) symptoms, including abdominal pain, bloating, altered stool pattern, dyschezia, and nausea, are frequent in women with endometriosis and may persist despite conventional gynecological treatment. The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP) diet is an established dietary intervention for irritable bowel syndrome. Its endometriosis-specific evidence base remains limited. This systematic review evaluated clinical evidence on the low-FODMAP diet or structured FODMAP restriction for GI symptoms in women with endometriosis. Methods: This systematic review was prospectively registered in PROSPERO (CRD420261388786) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. PubMed/MEDLINE, EBSCOhost, and BASE were searched from inception to 30 April 2026. Eligible reports were clinical studies investigating low-FODMAP diet or structured FODMAP restriction in women with confirmed, clinically diagnosed, imaging-based, or medically reported endometriosis and extractable GI or related clinical outcomes. Risk of bias was assessed with design-specific tools. Due to substantial heterogeneity across studies in design, comparators, and outcome measures, a narrative synthesis was performed. Results: Five clinical reports met the inclusion criteria: one randomized controlled crossover feeding trial, two prospective non-randomized studies, one retrospective audit of prospectively collected clinic data, and one case report. The randomized trial showed greater GI response during a 28-day low-FODMAP feeding period than during a nutritionally matched control diet. Prospective studies reported improvements in selected GI symptoms, constipation, pain, and quality-of-life domains, but interpretation was limited by non-randomized allocation, attrition, and mixed or pooled diet comparisons. The retrospective audit and case report supported clinical plausibility but were hypothesis-generating. Conclusions: The five available studies, though limited in number and design, indicate that a low-FODMAP diet can reduce GI symptoms in women with endometriosis, particularly those with abdominal pain, bloating, constipation, or IBS-like symptoms. Currently, the low-FODMAP diet should be viewed as a potentially useful, dietitian-guided GI symptom intervention for selected patients. Future trials should define responder profiles, assess long-term tolerability and nutritional safety, and determine the added value of reintroduction and personalization beyond short-term restriction. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is among the most prevalent disorders of gut–brain interaction, yet its implications for spine surgery remain poorly characterized. This narrative review examines how IBS influences symptom presentation and postoperative outcomes in spine surgery patients. Methods: We synthesized the neurobiologic, epidemiologic, and perioperative literature linking IBS with musculoskeletal pain, spine-related symptomatology, and surgical outcomes, drawing on spine-specific data where available and on related surgical and chronic-pain populations where it was not. Results: IBS is characterized by central sensitization, impaired descending inhibition, increased temporal summation, autonomic dysregulation, and a high prevalence of psychiatric comorbidity, which manifest as widespread hyperalgesia and symptom amplification that overlap with pain mechanisms common in spine surgery patients. Epidemiologic studies indicate that patients with IBS undergo musculoskeletal and spinal procedures at disproportionately high rates, reflecting both symptom burden and diagnostic uncertainty from viscerosomatic overlap. These same factors have been associated with greater postoperative pain, elevated opioid requirements, slower functional recovery, and reduced satisfaction after spine surgery, although direct IBS-specific spine data remain limited. IBS may also confound preoperative assessment by mimicking radicular, discogenic, or sacroiliac pain. Conclusions: IBS represents an under-recognized potential modifier of symptom localization, perioperative pain trajectories, and functional recovery in spine surgery. Greater awareness of IBS-related nociplastic and psychosocial mechanisms may improve preoperative evaluation, risk stratification, perioperative management, and the design of future outcome studies. Full article

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease characterized by high mortality and marked clinical heterogeneity. A defining yet insufficiently understood feature of IPF is its frequent coexistence with pulmonary and extrapulmonary comorbidities. However, the molecular basis that underlies this multisystem involvement remains unclear. We applied an integrative systems-level framework that combines lung-derived transcriptomic datasets with curated disease–gene associations across major IPF-associated comorbidities. Network organization and functional stratification analyses were used to characterize shared and disease-specific molecular modules, and independent transcriptomic datasets were analyzed to evaluate the consistency of these patterns. These analyses revealed structured molecular convergence between IPF and its comorbidities organized into two interacting biological programs: a lung-enriched fibrotic–mechanical program and a systemically distributed neuroimmune–metabolic program. These programs are interconnected through a shared regulatory interface that includes IL6, AKT1, TGFB1 and STAT3. This organization was consistently observed across independent datasets. IPF emerges from the interaction between pulmonary and systemic regulatory programs rather than isolated lung-restricted mechanisms. This framework provides a basis for understanding disease heterogeneity and comorbidity burden, with potential implications for stratification and therapeutic targeting. Full article

Background: Faecal incontinence (FI) may occur in patients with irritable bowel syndrome (IBS), particularly when loose stool, urgency, reduced warning time, fluctuating bowel habits, or constipation with retention interferes with timely defaecation. However, IBS-related FI should be distinguished from FI caused primarily by structural sphincter injury, neurological disease, advanced frailty, or other organic gastrointestinal disorders. This focused narrative review examines IBS-specific mechanisms and conservative care considerations relevant to FI risk. Methods: This article is a focused narrative review rather than a systematic review, scoping review, clinical guideline, or formal GRADE assessment. PubMed and the Ichushi-Web/Japanese Medical Abstracts Society were searched for studies published from January 2000 to June 2026. Search terms were combined and included irritable bowel syndrome with faecal/fecal incontinence, urgency, diarrhoea/diarrhea, constipation, stool form, bowel diaries, diet, FODMAP, fibre/fiber, pelvic floor rehabilitation, biofeedback, skin care, absorbent products, ultrasound, and conservative management. Studies directly addressing IBS mechanisms or symptom management, FI assessment or conservative FI care, or implementation issues relevant to IBS-related FI were deemed eligible. Results: Direct studies of FI prevention in IBS patients are scarce. The most defensible IBS-specific targets are loose stool, urgency, reduced warning time, alternating bowel habits, constipation with retention or incomplete evacuation, diet- or medication-related triggers, stress-related exacerbation, and toilet access. Broader FI evidence supports supportive measures such as skin protection, absorbent products, pelvic floor rehabilitation, biofeedback, transanal irrigation, and referral, but these measures are not IBS-specific unless they are connected to IBS-related symptom pathways. Synthesis: Evidence was organized into three categories: direct IBS evidence, general FI evidence, and indirect implementation evidence from continence-care settings. No formal certainty ratings or recommendation strengths were assigned; statements are therefore framed as clinical considerations and areas for future study rather than guideline-level recommendations. Conclusions: IBS-related FI should be discussed as a symptom-risk pathway within IBS rather than as FI in general. Available evidence suggests the value of assessing IBS subtype, stool form, urgency, triggers, warning time, and toileting circumstances before applying general FI support. Because direct preventive trials are limited, conclusions should be interpreted as practice-informing clinical considerations rather than firm recommendations. Full article

Irritable bowel syndrome (IBS) and metabolic dysfunction-associated steatotic liver disease (MASLD) are two of the most common gastroenterological conditions worldwide. Traditionally viewed as unrelated, with one serving a canonical functional role and the other a purely metabolic function, these two processes have recently been linked by compelling evidence, challenging their traditional segregation and pointing to a significant, biologically relevant association. This review aims to evaluate the current evidence for a potential causal contribution of IBS to hepatic steatosis, critically examining the proposed pathophysiological mechanisms via the gut–liver axis while acknowledging that the available data are primarily observational. Notably, epidemiological studies demonstrate a 1.4–2.0-fold increased association between IBS and MASLD, independent of obesity and metabolic syndrome, though causality remains to be established. The primary mechanism is increased intestinal permeability (“leaky gut”) leading to endotoxemia, activation of hepatic toll-like receptor 4 (TLR4) receptors, and subsequent de novo lipogenesis. The relationship is bidirectional, with steatosis also worsening gut barrier function. Therefore, we highlight emerging evidence suggesting that irritable bowel syndrome, particularly the diarrhea-predominant subtype (IBS-D), may contribute to hepatic steatosis through plausible biological mechanisms, though direct causal evidence in humans remains limited. Accordingly, routine screening for metabolic dysfunction-associated steatotic liver disease (MASLD) may be warranted in patients with long-standing IBS-D. Full article

Irritable bowel syndrome (IBS) is a prevalent disorder of gut–brain interaction, characterized by a substantial symptom burden, impaired quality of life, and increased healthcare use. Despite advances in diagnostic criteria and treatment strategies, many patients feel dismissed, inadequately informed, or uncertain about the nature and meaning of their symptoms; these experiences may undermine trust and reduce engagement with healthcare professionals. The aim of this narrative review is to synthesize clinical and ethical considerations and propose a patient-centered ethical framework for IBS management, positioning communication as a core therapeutic intervention. We highlight how validation, clear and non-stigmatizing explanations, transparency about uncertainty, and recognition of patient values can strengthen the therapeutic alliance, support relational autonomy, and enable shared decision-making. These elements can promote supported self-management and improve adherence to individualized dietary, behavioral, and pharmacologic strategies. In response to the central role of nutrition in IBS care, we further integrate dietary management into the ethical framework, addressing dietary assessment, first-line dietary advice, soluble fiber, the structured low-FODMAP approach, and the risks of excessive or unsupported food restriction. We further discuss how the incorporation of patient-reported outcomes (PROs) can translate patient priorities into measurable outcomes, monitor clinically meaningful changes over time, and reduce discrepancies between clinical assessment and patients’ lived experiences. Finally, we underscore the impact of stigma and uncertainty and provide practical communication approaches to support a stronger therapeutic alliance in IBS care. The integration of ethical communication, PROs, and nutrition-sensitive self-management may improve patient experience, strengthen adherence, and support individualized therapeutic strategies in IBS care. Full article

Chronic overlapping pain conditions (COPCs) refer to a set of chronic pain disorders that frequently co-occur and may involve partially overlapping mechanisms. The U.S. National Institutes of Health currently recognizes ten COPCs: fibromyalgia, painful temporomandibular disorders, chronic low back pain, chronic migraine headache, chronic tension-type headache, irritable bowel syndrome, endometriosis, interstitial cystitis/bladder pain syndrome, vulvodynia, and myalgic encephalomyelitis/chronic fatigue syndrome. When multiple COPCs coexist, they are associated with a disproportionate multimorbidity burden, including greater pain, poorer psychological well-being, functional limitations, disability, fatigue, sleep disturbances, diminished quality of life, and increased healthcare utilization. Despite their impact, COPCs remain under-recognized, underdiagnosed, and undertreated. Combining structured literature searches and citation tracking with narrative syntheses, this review examines comorbid relationships, the burden of multimorbidity, and potentially overlapping nociplastic mechanisms. By adopting a multimorbidity-based perspective rather than a one-disease, one-treatment approach, it highlights barriers to care—including limited clinical awareness, under-recognition of additional COPCs, limited mechanistic understanding, and fragmented care—and proposes integrated strategies emphasizing prevention, systematic screening, mechanism-informed assessment, and coordinated, patient-centered multimodal management. Full article

Background: Small intestine bacterial overgrowth (SIBO) is associated with steatohepatitis (SH) in subjects with metabolic-associated steatotic liver disease (MASLD). The impact of ileocecal valve (ICV) incontinence, a major cause of SIBO in patients with MASLD, remains unknown because of the unmet need for a non-X-ray-dependent diagnosis. Methods: Exploiting water as contrast medium and colonic irrigation via a hydro-colon machine (Clean Colon Srl, Monza, Italy), we developed a new abdominal ultrasound (US) procedure for diagnosing and grading ICV incontinence. In a pilot, observational, feasibility and safety study, we correlated a new ICV incontinence parameter with irritable bowel syndrome (IBS, ROMA IV criteria), serum transaminases (AST, ALT), platelet counts, FIB-4, US liver steatosis and stiffness (LS, measured by Shear Wave and Transient Elastography, SWE and TE). Results: We prospectively studied 32 consecutive subjects with IBS who underwent a pre-colonoscopy colon cleansing after informed consent: 19 males (59%), body mass index (BMI) 26.6 ± 2.6 kg/m², age 57 ± 19 years, 16 (50%) with US liver steatosis. The half-hour (27 min, range 20–35 min) procedure was safe and well tolerated except in two males with prostate hypertrophy. ICV incontinence was graded (after 2500–3000 mL irrigation) according to cecum/right-colon distention with/without (immediate or delayed) reflux into terminal ileum (TI): 0 = cecum distension without TI reflux; 1 = cecum distension with TI reflux; 2 = absence of cecum distension with TI reflux. Cecum/right-colon distention (grade 0 or 1) was perceived by the patients whereas the right colon irrigation with complete ICV incontinence (grade 2) was symptomless. ICV continence associated with LS (p ≤ 0.0001). A histologic diagnosis of non-alcoholic steatohepatitis was confirmed in a 35-year-old obese male with SIBO and LS > 8 kPa (8.7/8.5 kPa by SWE/TE):steatosis (grade S3) with hepatocyte ballooning, lobular inflammation (grade 6/8) without fibrosis (stage 0/4, F0). Conclusions: The new US-based approach provides a feasible, easy-to-perform, mini-invasive tool for the diagnosis and grading of ICV incontinence. Preliminary results prompt prospective studies investigating the impact of ICV incontinence as a possible co-factor of steatohepatitis in patients with MASLD. Full article

Background/Objectives: Exercise is increasingly recognized as a modulator of host–microbiome interactions, yet its role in irritable bowel syndrome (IBS) remains poorly characterized. Methods: In this prospective, single-arm, before-and-after interventional study, we used an integrated multi-omics approach based on metataxonomics and metabolomics to assess the effects of a structured 12-week moderate aerobic exercise program in 80 patients with mild-to-moderate IBS, stratified by Global Physical Capacity Score (GPCS). Biochemical and inflammatory markers have been gathered. Results: Exercise did not alter overall microbial diversity but selectively enriched short-chain fatty acid (SCFA)-producing taxa and remodeled the volatile organic compound (VOC) profile toward a more efficient metabolic state. Notably, conventional biochemical and inflammatory markers failed to distinguish response subgroups, whereas GPCS stratification revealed distinct microbial and metabolomic trajectories. Individuals with higher baseline physical capacity had higher acetate levels and lower levels of VOCs associated with dysbiosis and oxidative stress. Conclusions: Our results suggest that baseline physical capacity is a primary determinant of the microbiome’s responsiveness to exercise, challenging the reliance on static biochemical profiling. Despite the lack of a control group and the exploratory nature of some metabolomic signals, this study provides a framework for precision exercise interventions in IBS. Our work identifies GPCS as a clinically relevant stratification tool. The full trial protocol is registered on ClinicalTrials.gov under the identifier NCT05453084. Full article

The gut microbiota is increasingly examined as a therapeutic target because it contributes to epithelial barrier integrity, microbial metabolite production, bile acid transformation, immune regulation, and communication between the gut and distant organs. This structured narrative review synthesizes evidence on microbiota involvement in metabolic, gastrointestinal, hepatic, cancer, and neuroimmune conditions, including MASLD/MASH, inflammatory bowel disease, irritable bowel syndrome, obesity, type 2 diabetes, hypertension, colorectal cancer, Parkinson’s disease, and autism spectrum disorder. Across these conditions, microbiome findings are biologically plausible but heterogeneous. Many associations are shaped by diet, geography, medication exposure, host genetics, disease stage, sampling methods, and analytical pipelines. Microbial alterations should therefore be interpreted as context-dependent signals and candidate modifiers rather than universal causal markers. Conventional microbiota targeted strategies include diet, physical activity, prebiotics, probiotics, synbiotics, postbiotics, and fecal microbiota transplantation. These approaches are clinically familiar, but their effects are often broad, host specific, strain dependent, and difficult to assign to one mechanism. Fecal microbiota transplantation has the clearest clinical role in recurrent Clostridioides difficile infection, while evidence for most other indications remains inconsistent. Engineered microbial therapeutics offer greater experimental precision through signal sensing, payload delivery, metabolic modulation, and genetic circuit design. However, most evidence remains preclinical or early translational. Progress requires stronger human trials, standardized methods, mechanistic validation, safety monitoring, ecological containment, transparent reporting, and proportionate regulation. Full article

The consumption of functional foods, especially enriched by probiotics, is appreciated by a growing group of consumers. In this comprehensive review, the comparison of food probiotics’ health advantages between adult healthy women and healthy men was demonstrated with the aim of indicating the target group of consumers. Based on clinical studies and meta-analyses, in the context of sex differences, the impact of functional foods with probiotics on selected disease development and disease course, as well as on the potential health benefits, was discussed. Significantly population-related and most common health abnormalities, such as obesity, metabolic disorders, hypertension, irritable bowel syndrome, and functional gastrointestinal disorders, were analysed. There is a sex-dependent variety of gut microorganisms, and a greater diversity of the gut microbiome is found in women. The major differences between men and women considered in the study included higher prevalence of irritable bowel syndrome and obesity in women, a different lipid profile, and different age-related hypertension occurrence in both groups. Life expectancy has also been taken into account. According to the statistical data, women live longer, experience more health problems in the course of life, and therefore will probably more frequently seek functional food. In general, consumption of functional foods should be supported and recommended for the entire population. The open questions that need to be clarified are if the sex-dependent strategy is justified for choosing specified functional foods and probiotic strains. Full article

Differentiating inflammatory bowel disease (IBD) from diarrhea-predominant irritable bowel syndrome (IBS-D) remains a major clinical challenge due to overlapping symptoms and the limited specificity of single biomarkers. A reliable, non-invasive multimarker approach is needed to improve diagnostic accuracy and reduce unnecessary endoscopic procedures. To evaluate the diagnostic performance of serum interleukin-17A (IL-17A), neutrophil-to-albumin ratio (NAR), and fecal calprotectin (FCP), individually and in combination, for discriminating IBD from IBS-D and healthy controls in Egyptian patients. In this case–control study, 300 participants (100 with IBD, 100 with IBS-D, and 100 healthy controls) were enrolled. Serum IL-17A, NAR, and FCP were measured, and subgroup analysis was performed for infected and non-infected IBS-D patients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, with optimal cutoffs determined by the Youden index. A combined biomarker model was constructed using logistic regression. All biomarkers demonstrated a significant stepwise increase from healthy controls to IBS-D and IBD (p < 0.001). IL-17A, NAR, and FCP were elevated in IBS-D compared with controls, indicating low-grade inflammation, but were highest in IBD. No significant differences were observed between infected and non-infected IBS-D patients. Among individual markers, NAR showed the highest diagnostic accuracy (AUC = 0.923), followed by FCP (AUC = 0.884) and IL-17A (AUC = 0.859). The combined model significantly improved performance (AUC = 0.973), achieving 89% sensitivity and 96% specificity. IBS-D is associated with measurable systemic and intestinal inflammation independent of infection status. The combined biomarker model integrating IL-17A, neutrophil–albumin ratio, and fecal calprotectin demonstrated promising discriminatory performance for differentiating IBD from IBS-D. These findings suggest the potential applicability of combined non-invasive biomarkers in future diagnostic stratification approaches. However, the model was developed and evaluated within a single cohort, and external validation in independent populations is required before future potential clinical application. A multimarker diagnostic panel integrating IL-17A, neutrophil–albumin ratio, and fecal calprotectin demonstrated promising diagnostic performance for differentiating inflammatory bowel disease from IBS-D. The combined model may contribute to future diagnostic stratification strategies in patients with chronic diarrhea. However, these findings were derived from a single cohort and require validation in independent populations before broader clinical application. Full article

Irritable bowel syndrome (IBS) is a common disorder of gut–brain interaction (DGBI) of multifactorial genesis. Studies consistently show a disrupted intestinal barrier with increased permeability in IBS patients, regardless of subtype. This allows facultative pathogenic bacteria to translocate into underlying body tissue and to initiate or exacerbate IBS symptoms. Protecting the intestinal barrier is therefore a primary therapeutic target. Bifidobacterium bifidum MIMBb75 has proven its efficacy in IBS both in its viable and heat-inactivated forms. Its efficacy is thought to be mediated by the physical adhesion of B. bifidum MIMBb75 to intestinal epithelial cells, thereby protecting the intestinal barrier. In the present study, we show—using a Caco-2 model—that this strain-specific adhesion is facilitated by the high cell surface hydrophobicity of B. bifidum MIMBb75, which is retained following heat inactivation. In line with these adhesive properties, both viable and heat-inactivated B. bifidum MIMBb75 protect the epithelial barrier, as indicated by an increased transepithelial electrical resistance in Caco-2 monolayers. Together, these findings strongly support a physical mode of action in which both viable and heat-inactivated B. bifidum MIMBb75 adhere to the epithelial surface and act, figuratively, as a protective plaster on the epithelial barrier. Full article