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The integrity of esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD) or GERD-like symptoms is the first mechanism of protection to decrease the sensitivity to gastric reflux and heartburn symptoms. We investigated the protective effects of Poliprotect ® (PPRO), a CE-marked medical device, on esophageal epithelial integrity using in vitro and ex vivo models. In vitro, the protective effects of PPRO were tested on Caco-2 cells. PPRO demonstrated safety and protection against oxidative damage induced by hydrogen peroxide. It also preserved epithelial integrity by maintaining transepithelial electrical resistance (TEER) against damage from calcium removal or bile acid exposure (taurodeoxycholic acid, TDCA). Ex vivo, esophageal biopsies from patients subjected to endoscopy were mounted in Ussing chambers and exposed to damaging agents (HCl or HCl + TDCA). Untreated biopsies (control) showed significant loss of epithelial resistance (up to -33%). In contrast, low concentrations of PPRO (50-100 µg/mL) provided strong protection against these damages ( p < 0.001), even after 60 min of washing. Histological analysis confirmed the barrier-enhancing effect of PPRO. Overall, PPRO effectively protected the esophageal epithelium from damage in both models, suggesting its potential role in alleviating GERD or GERD-like symptoms by strengthening mucosal barriers and reducing epithelial sensitivity to reflux.

Bile Acid Diarrhea (BAD) is a common cause of chronic diarrhea, often accompanied by urgency, occasional fecal incontinence, abdominal pain, and fatigue. A nationwide survey has shown limited awareness of BAD within the Italian medical community, prompting a panel of experts to develop a Position Paper that outlines the most practical and cost-saving diagnostic investigations and treatments for this frequently overlooked condition. The document provides an overview of the epidemiology, pathophysiology, clinical manifestations, and classification of the different types of Bile Acid Diarrhea (BAD). A key focus is the diagnostic approach to identifying and managing the many undiagnosed BAD patients in both primary care and specialized medical settings. Finally, the paper addresses the optimal therapeutic strategies for BAD, including traditional bile acid sequestrants and newer, promising treatments., Competing Interests: Conflict of interest Annibale B.: Alfasigma, Aboca Barbara G.: Aboca, Ab Biotics, Agave, Alfasigma, Ag Pharma, Bayer, Biocodex, Boheringer, Bromatec, Cadigroup, Danone, Diadema, Falk Pharma, Ge Healthcare, Giuliani, Mayoly, Malesci, Monteresearch, Sanofi, Sofar, Yakult Bellini M.: Alfasigma, Diadema, Agave, Ferring, Ag Pharma, Bromatec, Sila, Depofarma Cammarota G.: Aurora Biopharma, Delta Pharma Corazziari E.S.: Aboca spa; Alfa Sigma spa; GE Healthcare; Sofar spa Fries W.: Abbvie, Pfizer, Janssen, Galapagos Portincasa P.: Aboca, Allergosan, Omega Pharma Stanghellini V.: Alfasigma, Bayer, Bromatec, Ge Healthcare Usai Satta P.: Alfasigma Benedetti A declares non-conflict of interest, (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)