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Introduction: An attempt at medical management is often the initial step in addressing esophageal obstruction from an impacted food bolus. Medical management, however, has limited success and often requires urgent endoscopy. We present a case in which standard medical treatment failed, but a swallowing augmentation maneuver resolved the obstruction. Case Report: A 67-year-old female presented with esophageal obstruction after eating steak. Transfer to higher level of care for endoscopy was initiated; however, the receiving gastroenterologist suggested an “upright posture, chin tuck, double swallow” maneuver. This immediately resolved the patient’s symptoms, and she was discharged home. Conclusion: This case suggests a novel, non-endoscopic technique for esophageal obstruction from food bolus impaction.

Human milk, due to its unique composition, is the optimal standard for infant nutrition. Osteopontin (OPN) is abundant in human milk but not bovine milk. The addition of bovine milk osteopontin (bmOPN) to formula may replicate OPNs concentration and function in human milk. To address safety concerns, we convened an expert panel to assess the adequacy of safety data and physiological roles of dietary bmOPN in infancy. The exposure of breastfed infants to human milk OPN (hmOPN) has been well-characterized and decreases markedly over the first 6 months of lactation. Dietary bmOPN is resistant to gastric and intestinal digestion, absorbed and cleared from circulation within 8-24 h, and represents a small portion (

There is increasing evidence that microbial-based therapies can be useful in people with Parkinson's disease (PD). In this viewpoint, we provide a state-of-the-art review of the clinical and pre-clinical evidence for probiotics and prebiotics in PD. Currently, short-term clinical studies, including double-blind placebo-controlled randomized clinical trials, have demonstrated safety, and efficacy primarily in improving constipation-related symptoms. Pre-clinical studies consistently reported improvements in a range of biological markers and outcomes, including evidence for attenuation of gut dysfunction and neuroprotection. Bacteria from the genus Lactobacillus and Bifidobacterium have been the most frequently studied both in clinical and pre-clinical probiotics studies, while research into prebiotics is still limited and primarily involved resistant starch and fructooligosaccharides. We provide practical suggestions for clinicians on how to advise patients in the clinic regarding these popular treatments, and important caveats to be aware of. Finally, areas for further advancements are highlighted. It is envisaged that in the future, microbial-based therapies may benefit from personalization based on an enhanced understanding of a whole range of host factors and host-microbiome interactions. [ABSTRACT FROM AUTHOR]

Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions.Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated.Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56 years and body-mass index (BMI) was 43 kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint.Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations. [ABSTRACT FROM AUTHOR]

Background: Patients with low socioeconomic status (SES) are disadvantaged in terms of access to health care. A novel metric for SES is the Distressed Communities Index (DCI). This study evaluates the effect of DCI on hospital choice and distance traveled for surgery. Methods: A Florida database was queried for patients with symptomatic cholelithiasis or chronic cholecystitis who underwent an outpatient cholecystectomy between 2016 and 2019. Patients' DCI was compared with hospital ratings, comorbidities, Charlson Comorbidity Index, and distance traveled for surgery. Stepwise logistic regression was used to determine which factors most influenced distance traveled for surgery. Results: There were 54,649 cases-81 open, 52,488 laparoscopic, and 2,080 robotic. There was no difference between surgical approach and patient's DCI group (p = 0.12). Rural patients traveled the farthest for surgery (avg 21.29 miles); urban patients traveled the least (avg 5.84 miles). Patients from distressed areas more often had surgery at one- or two-star hospitals than prosperous patients (61% vs 36.3%). Regression indicated distressed or at-risk areas predicted further travel for rural/small-town patients, while higher hospital ratings predicted further travel for suburban/urban patients. Discussion: Compared to prosperous areas, patients from distressed areas have surgery at lower-rated hospitals, travel further if they live in rural/small-town areas, but travel less if they live in suburban areas. We postulate that farther travel in rural areas may be explained by a lack of health care resources in poor, rural areas, while traveling less in suburban areas may be explained by personal lack of resources for patients with low SES. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBDs) pose an increased risk of gastrointestinal cancer with especially worse prognosis. Cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) improves outcomes in selected patients with colorectal peritoneal metastases. Little published data describes the outcomes of CRS/HIPEC in IBD patients. Methods: We performed a retrospective review of a prospectively maintained CRS/HIPEC database. Outcomes in patients with and without IBD were compared for short-term outcomes such as hospital/intensive care unit stay, blood loss/transfusions, complications, and reoperations. We also examined oncological outcomes including recurrence, overall (OS), and disease-free survival (DFS). Results: We identified 232 patients that underwent CRS/HIPEC for colorectal or small bowel adenocarcinoma, of which 10 were with IBD. Patients with IBD had lower ASA (p=0.005), less hypertension (p=0.033), and 30% small bowel primary compared to none in the non-IBD cohort (p<0.001). Otherwise, demographic and perioperative characteristics were similar between the groups. The median peritoneal cancer index (PCI) was 7 and similar between the cohorts (p=0.422). Extent of organ resections and peritonectomies performed were similar. Complications occurred in 60.3% of patients (21.2% major), similar between the groups (p=0.744 and p=0.444, respectively). Reoperation rate of 27% was similar between groups (p=0.097). The median OS in the IBD cohort was 19.6 vs 53.2 months in the non-IBD cohort (p = 0.056). The median DFS in the IBD cohort was 4.9 vs 9.4 months in the non-IBD cohort (p=0.174). Discussion: Cytoreductive surgery and heated intraperitoneal chemotherapy in patients with IBD has similar complication profile and trended towards poorer oncological outcomes as CRS/HIPEC in non-IBD patients. [ABSTRACT FROM AUTHOR]

AbstractWe conducted a scoping review of peer-reviewed literature published between January 1, 1990 and October 31, 2021, to identify socioeconomic determinants that contribute to higher burden and adverse outcomes in diseases for which self-care is an important modality of treatment and prevention. We identified these diseases using over-the-counter medicines sales data sourced from IQVIA. We searched Ovid Medline, PubMed, and EMBASE databases for articles published in English using inclusion/exclusion criteria. We analyzed articles covering 42 diseases that qualified as cardiovascular disorders (219 studies including ischemic heart disease, myocardial infarction, stroke, and related risk factors such as hypertension, dyslipidemia and atrial fibrillation), nutritional disorders (66 studies including malnutrition which encompasses undernutrition and micronutrient deficiencies, and anemia), digestive disorders (40 studies including gastroesophageal reflux disorder, inflammatory bowel disease, and dyspepsia), allergy disorders (40 studies including asthma and allergic rhinitis), pain disorders (14 studies including lower back pain, knee pain, generalized musculoskeletal pain and headaches), dermatological disorders (23 studies including atopic dermatitis [eczema], occupational dermatosis, and facial dermatitis), respiratory disorders (11 studies including chronic cough, pneumonia, chronic bronchitis, wheezing, and influenza), and gynecological disorders (29 studies including bacterial vaginosis and trichomoniasis vaginosis). We found that lifestyle factors were the commonly reported risk factors, and residential segregation, education, and income were the commonly reported socioeconomic determinants. A closer analysis of income within each disorder revealed that it is more often associated with health conditions that are self-limiting. Although we did not find any discernible relationship between the commonly reported socioeconomic factors and the prevalence of self-medication for the health conditions considered, income plays an important role in the burden and outcomes of conditions that require more self-care compared to those that require less self-care. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. INSPIRE group assessed if machine learning could determine a hemodialysis (HD) patient's 180-day GIB hospitalization risk. Methods: An eXtreme Gradient Boosting (XGBoost) and logistic regression model were developed using an HD dataset in United States (2017–2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤ 180 days before GIB hospitalization were classified as positive observations; others were negative. Models considered 1,303 exposures/covariates. Performance was measured using unseen testing data. Results: Incidence of 180-day GIB hospitalization was 1.18% in HD population (n = 451,579), and 1.12% in testing dataset (n = 38,853). XGBoost showed area under the receiver operating curve (AUROC) = 0.74 (95% confidence interval (CI) 0.72, 0.76) versus logistic regression showed AUROC = 0.68 (95% CI 0.66, 0.71). Sensitivity and specificity were 65.3% (60.9, 69.7) and 68.0% (67.6, 68.5) for XGBoost versus 68.9% (64.7, 73.0) and 57.0% (56.5, 57.5) for logistic regression, respectively. Associations in exposures were consistent for many factors. Both models showed GIB hospitalization risk was associated with older age, disturbances in anemia/iron indices, recent all-cause hospitalizations, and bone mineral metabolism markers. XGBoost showed high importance on outcome prediction for serum 25 hydroxy (25OH) vitamin D levels, while logistic regression showed high importance for parathyroid hormone (PTH) levels. Conclusions: Machine learning can be considered for early detection of GIB event risk in HD. XGBoost outperforms logistic regression, yet both appear suitable. External and prospective validation of these models is needed. Association between bone mineral metabolism markers and GIB events was unexpected and warrants investigation. Trial registration: This retrospective analysis of real-world data was not a prospective clinical trial and registration is not applicable. [ABSTRACT FROM AUTHOR]

Simple Summary: Intestinal microbiota (the gut microbiome) are important for normal gut function, especially in horses which rely on gut bacteria to break down plant material in the hindgut. Understanding normal microbiota is essential to be able to assess changes that occur during disease or in response to treatments. Post-mortem studies and biopsies have found different populations in the stomach mucosa (lining) compared to feces, but the gastric fluid has not been evaluated. The objective of this study was to describe the gastric fluid microbiome of healthy horses over time, under two housing conditions, and to compare the gastric fluid to fecal microbiome of paired samples. We found that while there were fewer bacteria (taxa) identified in the gastric juice compared to feces, there was a stable population of gastric microbiota which did not vary from week-to-week under either housing condition. There was a significant difference in compositional diversity (the relatedness of taxa present) between housing conditions, with changes in the relative proportions of a few key groups when horses moved from pasture to stable. These findings are important to inform future investigations of the gastric fluid microbiota in horses. Equine gastrointestinal microbial communities vary across the gastrointestinal tract and in response to diet or disease. Understanding the composition and stability of gastric fluid microbiota in healthy horses is a prerequisite to understanding changes associated with the development of disease. The objective of this study was to describe microbial communities in the gastric fluid and feces of healthy horses longitudinally. Horses were maintained on pasture (6 weeks), stabled (5 weeks), then returned to pasture. A consistent forage diet was provided throughout. Native gastric fluid and feces were collected weekly for full-length 16S ribosomal DNA sequencing and microbial profiling analysis. Fewer taxa were identified in the gastric fluid (770) than in the feces (5284). Species richness and diversity were significantly different between sample types (p < 0.001), but not between housing locations (p = 0.3). There was a significant effect of housing and horse on the Bray–Curtis compositional diversity of gastric (p = 0.005; p = 0.009) and fecal (p = 0.001; p = 0.001) microbiota. When horses moved from pasture to stable, the relative proportions of gastric fluid Lactobacillaceae increased and Streptococcaceae decreased, while fecal Firmicutes increased and Bacteriodota decreased. Within each housing condition, there was no significant week-to-week variation in gastric (p = 0.9) or fecal (p = 0.09) microbiota. Overall, these findings support the maintenance of stable gastric and fecal microbial populations under each management condition, providing a basis for further investigation of gastric fluid microbiota in diseases of the foregut. [ABSTRACT FROM AUTHOR]

The present work examines the relationship between aerial spraying and its health impacts on the population living in the banana production areas of Ecuador (the rural sectors of the cantons Milagro and Naranjito, Guayas Province). Objectives: the objectives of this study are to obtain information on sanitation, basic services, and environmental rationality and to interpret the low levels of cholinesterase and prevalent diseases among the population. Methods: the methodology involved a face-to-face questionnaire, the formal authorization of an informed consent document, and venipuncture for cholinesterase tests. The information was processed in the EPI–INFO system 7.2 (statistical software for professionals and researchers dedicated to public health), with the certification of protocols issued by the Bioethics Committee of the Kennedy Hospital Clinic of Ecuador. Results: the results showed that 89.5% of inhabitants do not have access to drinking water, 92.5% do not have a sewage disposal service, 97.50% experience aerial spraying at their homes or workplaces, and 57% have low cholinesterase levels. Additionally, several gastrointestinal, respiratory, neurological, dermatological, and reproductive disorders were detected among the inhabitants. Conclusions: we found that companies in the banana sector have not implemented corporate social responsibility measures. For example, no blood tests are conducted to monitor cholinesterase levels or to track hereditary disorders. Moreover, entities such as the Ministry of Public Health have not taken action to serve this at-risk population. [ABSTRACT FROM AUTHOR]

Background: Consumer facing wearable devices capture significant amounts of biometric data. The primary aim of this study is to determine the accuracy of consumer-facing wearable technology for continuous monitoring compared to standard anesthesia monitoring during endoscopic procedures. Secondary aims were to assess patient and provider perceptions of these devices in clinical settings. Methods: Patients undergoing endoscopy with anesthesia support from June 2021 to June 2022 were provided a smartwatch (Apple Watch Series 7, Apple Inc., Cupertino, CA) and accessories including continuous ECG monitor and pulse oximeter (Qardio Inc., San Francisco, CA) for the duration of their procedure. Vital sign data from the wearable devices was compared to inroom anesthesia monitors. Concordance with anesthesia monitoring was assessed with interclass correlation coefficients (ICC). Surveys were then distributed to patients and clinicians to assess patient and provider preferences regarding the use of the wearable devices during procedures. Results: 292 unique procedures were enrolled with a median anesthesia duration of 34 min (IQR 25--47). High fidelity readings were successfully recorded with wearable devices for heart rate in 279 (95.5%) cases, oxygen in 203 (69.5%), and respiratory rate in 154 (52.7%). ICCs for watch and accessories were 0.54 (95% CI 0.46--0.62) for tachycardia, 0.03 (95% CI 0--0.14) for bradycardia, and 0.33 (0.22--0.43) for oxygen desaturation. Patients generally felt the devices were more accurate (56.3% vs. 20.0% agree, p < 0.001) and more permissible (53.9% vs. 33.3% agree, p < 0.001) to wear during a procedure than providers. Conclusion: Smartwatches perform poorly for continuous data collection compared to gold standard anesthesia monitoring. Refinement in software development is required if these devices are to be used for continuous, intensive vital sign monitoring. [ABSTRACT FROM AUTHOR]

Background/Aims The proposed eosinophilic esophagitis (EoE) endoscopic reference score serves to diagnose and evaluate treatment responses in EoE. Nevertheless, the validated reference score thresholds for diagnosis and treatment response in Asian patients are yet to be established. This study aims to establish these thresholds for the first time among Asian patients with EoE. Methods Patients presenting with ≥ 15 eosinophils/high power field and esophageal dysfunction symptoms between August 2007 and November 2021 were included. Age- and sex-matched non-EoE controls were also enrolled. Baseline characteristics, endoscopic reference score features, and scores were compared between patients and controls. Among patients, endoscopic reference score features and scores, along with peak eosinophil counts, were evaluated both before and after treatment. The optimal threshold was determined based on sensitivity, specificity, and the Youden index. Results Overall, 102 patients were enrolled (74.5% men; mean age, 46.9 years). The mean endoscopic reference score was 2.65 and 0.52 for patients and controls, respectively (P < 0.001). An endoscopic reference score ≥ 2 was identified as the optimal diagnostic threshold for EoE (sensitivity, 0.79; specificity, 0.86; Youden index, 0.66). Post-treatment data regarding endoscopic findings and histology were available for 30 patients. Regarding histologic response, an endoscopic reference score of ≤ 3 demonstrated the optimal threshold (sensitivity, 0.95; specificity, 0.88; Youden index, 0.83). Conclusions The optimal diagnostic and treatment response thresholds were determined to be endoscopic reference scores of ≥ 2 and ≤ 3, respectively. Further studies involving a larger patient cohort are necessary to validate these findings. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cisplatin, a common chemotherapy agent, is well known to cause severe side effects in the gastrointestinal and nervous systems due to its toxic and pro-inflammatory effects. Although pharmacological manipulation of the endocannabinoid system (ECS) can alleviate these side effects, how chemotherapy affects the ECS components in these systems remains poorly understood. Our aim was to evaluate these changes. Methods: Male Wistar rats received cisplatin (5 mg/kg, i.p.) or saline on day 0 (D0). Immediately after, serial X-rays were taken for 24 h (D0). Body weight was recorded (D0, D1, D2 and D7) and behavioural tests were performed on D4. On D7, animals were euthanized, and gastrointestinal tissue, dorsal root ganglia (DRGs) and brain areas were collected. Expression of genes related to the ECS was assessed via Rt-PCR, while LC-MS/MS was used to analyse endocannabinoid and related N-acylethanolamine levels in tissue and plasma. Results: Animals treated with cisplatin showed a reduction in body weight. Cisplatin reduced gastric emptying during D0 and decreased MAGL gene expression in the antrum at D7. Despite cisplatin not causing mechanical or heat sensitivity, we observed ECS alterations in the prefrontal cortex (PFC) and DRGs similar to those seen in other chronic pain conditions, including an increased CB1 gene expression in L4/L5 DRGs and a decreased MAGL expression in PFC. Conclusions: A single dose of cisplatin (5 mg/kg, i.p.), subnoxious, but capable of inducing acute gastrointestinal effects, caused ECS changes in both gastrointestinal and nervous systems. Modulating the ECS could alleviate or potentially prevent chemotherapy-induced toxicity. [ABSTRACT FROM AUTHOR]

Background: The herbal preparation, STW5‐II, improves upper gastrointestinal symptoms, including abdominal fullness, early satiation, and epigastric pain, in patients with functional dyspepsia, and in preclinical models decreases fundic tone and increases antral contractility. The effects of STW5‐II on esophago‐gastric junction pressure, proximal gastric tone and antropyloroduodenal pressures, disturbances of which may contribute to symptoms associated with disorders of gut–brain interaction, including functional dyspepsia, in humans, have, hitherto, not been evaluated. Methods: STW5‐II or placebo (matched for color, aroma, and alcohol content) were each administered orally, at the recommended dose (20 drops), to healthy male and female volunteers (age: 27 ± 1 years) in a double‐blind, randomized fashion, on two separate occasions, separated by 3–7 days, to evaluate effects on (i) esophago‐gastric junction pressures following a standardized meal using solid‐state high‐resolution manometry (part 1, n = 16), (ii) proximal gastric volume using a barostat (part 2, n = 16), and (iii) antropyloroduodenal pressures assessed by high‐resolution manometry (part 3, n = 18), for 120 min (part 1) or 180 min (parts 2, 3). Key Results: STW5‐II increased maximum intrabag volume (ml; STW5‐II: 340 ± 38, placebo: 251 ± 30; p = 0.007) and intrabag volume between t = 120 and 180 min (p = 0.011), and the motility index of antral pressure waves between t = 60 and 120 min (p = 0.032), but had no effect on esophago‐gastric junction, pyloric, or duodenal pressures. Conclusions & Inferences: STW5‐II has marked region‐specific effects on gastric motility in humans, which may contribute to its therapeutic efficacy in functional dyspepsia. [ABSTRACT FROM AUTHOR]

Background: Narrow band imaging‐magnifying endoscopy (NBI‐ME) is used to identify changes in mucosal or vascular pattern observed on GI endoscopy in real time on the basis of optical image enhancement.It has a significant role in early detection of dysplasia, premalignant, and Malignant lesions along with its depth of invasion. Materials and methods: Upper and lower GI endoscopy performed in 1742 patients who presented with gastrointestinal symptoms at this tertiary center over 5 years out of which 1623 were evaluated with both NBI‐ME and histopathology. Real time endoscopic assessment was performed. Targeted biopsies were taken for comparative analysis. Results: Of the 1742 patients, 119 were excluded from the study. 807 underwent upper GI endoscopy and 816 underwent lower GI endoscopy. Mean age of presentation was 38 +/− 2.7 years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NBI‐ME for neoplastic esophageal lesions were 96.3%, 90.6%, 91.1%, 96.03%, respectively. For Barrett's esophagus it was 95.4%, 90.7%, 86.1%, and 90.7%; For gastric neoplastic lesions the values were 96.1%, 91.04%, 83.8%, and 97.9%. For colorectal it was 96.7%, 91.3%, 88.0%, and 97.7%. Overall sensitivity, specificity, PPV, and NPV of NBI‐ME for neoplastic lesions (both upper and lower GI) were 96.2%, 91.0%, 96.2%, and 97.2%. Of the 1623 patients, 951 received medical management with regular surveillance and 672 patients with high‐grade dysplasia, premalignant, and malignant conditions underwent interventions in form of either endoscopy or surgery. Conclusion: NBI‐ME has a greater role and can be considered as an effective tool in making early diagnosis and guiding optimum treatment. [ABSTRACT FROM AUTHOR]

Gastrointestinal vagal afferents play an important role in communicating food related information from the gut to the brain. This information initiates vago‐vagal reflexes essential for gut functions, including gut motility and secretions. These afferents also play a role in energy homeostasis, signalling the arrival, amount and nutrient composition of a meal to the central nervous system where it is processed ultimately leading to termination of a meal. Vagal afferent responses to food related stimuli demonstrate a high degree of plasticity, responding to short term changes in nutritional demand, such as the fluctuations that occur across a 24‐hr or in response to a fast, as well as long term changes in energy demand, such as occurs during pregnancy. This plasticity is disrupted in disease states, such as obesity or chronic stress where there is hypo‐ and hypersensitivity of these afferents, respectively. Improved understanding of the plasticity of these afferents will enable identification of new treatment options for diseases associated with vagal afferent function. [ABSTRACT FROM AUTHOR]

Although not often discussed, many of the neuromuscular disorders (NMDs) affect the gastrointestinal tract (GIT). Depending on the type of NMD, the prevalence of GIT involvement ranges from <5% (e.g. hereditary neuropathies, myofibrillar myopathies) to 100% (e.g. MNGIE, OPMD). Particularly in NMDs with multisystem affection, involvement of the GIT can dominate the clinical presentation or at least make up a significant part of the clinical picture. The most prominent representatives of NMDs with multisystem involvement are the mitochondrial disorders (MIDs) and the myotonic dystrophies. The best known syndromic MIDs with GIT involvement are MNGIE, MELAS, Leigh, and Pearson syndromes. Among neuropathies, GIT involvement is most commonly found in ALS and GBS. GIT involvement may also be a feature of myasthenia. The clinical manifestations of GIT involvement are diverse and can affect the entire GIT, from the teeth to the rectum, including the liver and pancreas. The most well‐known clinical manifestations of GIT involvement are dysphagia, nausea, vomiting, reflux, hollow organ dysmotility, hepatopathy, diabetes, diarrhea, constipation, and fecal incontinence. Even if treatment can usually only be symptomatic, the therapeutic options are diverse, are often effective, and can significantly and beneficially influence the course of the underlying NMD. [ABSTRACT FROM AUTHOR]

Introduction: During gastric cancer resection, back table dissection (BTD) involves examination and separation of lymph node (LN) packets from the surgical specimen based on LN stations, which are sent to pathology as separately labeled specimens. With potential impact on clinical outcomes, we aimed to explore how BTD affects number of LNs examined. Methods: A retrospective review of a gastric cancer database was performed, including all cases of gastrectomy with D2 lymphadenectomy from January 2009 to March 2022. Back table dissection and conventional groups were compared using Mann-Whitney U and Fisher's exact tests. Multiple linear regression modeling was used to identify potential predictors of number of LN examined. Results: A total of 174 patients were identified: 39 (22%) BTD and 135 (78%) conventional. More patients in the BTD group underwent neoadjuvant chemotherapy (62% vs 29%, P < .05). Compared to the conventional group, the BTD group had a greater number of LNs examined (42 [26-59] vs 21[15-33], median [IQR], P < .001), lower LNpositivity ratio (.01 vs .07, P = .013), and greater number of LNs in patients with BMI >35 (32.5[27.5-39] vs 22[13-27], P = .041). A multiple linear regression model controlling for age, BMI, preoperative N stage, neoadjuvant chemotherapy, surgeon experience, and operative approach identified BTD as a significant positive predictor of number of LN examined (β = 19.7, P = .001). Conclusion: Back table dissection resulted in improved LN yield during gastric cancer resection. As a simple technical addition, BTD helps enhance pathology examination and improve surgeon awareness, which may ultimately translate to improve oncologic outcomes. [ABSTRACT FROM AUTHOR]

Behçet's disease (BD) is a multiorgan inflammatory vascular disease of unknown etiology, affecting vessels of any size and type. While, gastrointestinal involvement in BD is uncommon, esophageal Behçet's disease (EBD) is rarely reported, especially in the Mediterranean region. To report a case with esophageal stenosis as an initial presentation of BD and compare to reported cases worldwide. A 30-year-old Syrian male presented with dysphagia, odynophagia with weight loss 20 kg. He had a history of recurrent oral ulcers and was otherwise healthy. On examination he appeared pale, dehydrated with normal systemic examination. Blood tests revealed anemia (hemoglobin 10.5 mg/dl), elevated erythrocyte sedimentation rate (ESR) (90 mm/1sthr) and C-reactive protein (CRP)(98 mg/dl)levels. Upper gastrointestinal endoscopy showed mild ulceration with edema and mucosal thickness at the upper sphincter of the esophagus, leading to stenosis. Biopsy showed nonspecific inflammation, without granulomas or signs of malignancy. Percutaneous endoscopic gastrostomy (PEG) tube was placed and during hospitalization he developed genital ulcers and hemoptysis, with chest computed tomography revealing pulmonary vasculitis. The patient was diagnosed with BD, and treated with methylprednisolone and cyclophosphamide, leading to significant improvement. After two months he could swallow normally, and the PEG tube was removed with no recurrence after one year follow-up. He was maintained on azathioprine 100 g/day and prednisolone 7.5 mg/day. BD is a diagnostic challenge due to its diverse manifestations and geographic variations. EBD is rare and can cause disability. Early diagnosis of EBD and appropriate treatment are crucial for improving outcomes. [ABSTRACT FROM AUTHOR]

Simple Summary: Equine colitis, or inflammation of the colon of the domestic horse, can occur rapidly and lead to death within hours to days. It is often associated with severe diarrhea leading to dehydration. There are many different causes of colitis, including infections with bacteria, viruses, and parasites, as well as non-infectious causes. Antimicrobial administration can be associated with the development of infectious colitis, likely because of disrupted intestinal microbiota allowing for the expansion of pathogenic bacteria. Ion channels regulate electrolyte and fluid movement into and out of the colon lumen. These channels can be manipulated by different infectious organisms to drive increased fluid movement into the intestinal lumen. Current treatments for equine colitis are untargeted and largely supportive in nature. In other species, targeting ion channels has emerged as a potential treatment for diarrhea. This may represent a novel avenue for anti-diarrheal therapies in the horse. However, ion channels have not been well studied in the colon of the horse. This review provides an overview of what is known about colonic ion channels and their known or putative role in specific types of equine colitis due to various pathogens. Equine colitis is a devastating disease with a high mortality rate. Infectious pathogens associated with colitis in the adult horse include Clostridioides difficile, Clostridium perfringens, Salmonella spp., Neorickettsia risticii/findlaynesis, and equine coronavirus. Antimicrobial-associated colitis can be associated with the presence of infectious pathogens. Colitis can also be due to non-infectious causes, including non-steroidal anti-inflammatory drug administration, sand ingestion, and infiltrative bowel disease. Current treatments focus on symptomatic treatment (restoring fluid and electrolyte balance, preventing laminitis and sepsis). Intestinal epithelial ion channels are key regulators of electrolyte (especially sodium and chloride) and water movement into the lumen. Dysfunctional ion channels play a key role in the development of diarrhea. Infectious pathogens, including Salmonella spp. and C. difficile, have been shown to regulate ion channels in a variety of ways. In other species, there has been an increased interest in ion channel manipulation as an anti-diarrheal treatment. While targeting ion channels also represents a promising way to manage diarrhea associated with equine colitis, ion channels have not been well studied in the equine colon. This review provides an overview of what is known about colonic ion channels and their known or putative role in specific types of equine colitis due to various pathogens. [ABSTRACT FROM AUTHOR]

This clinical review focuses on the most common presentations of lower gastrointestinal (GI) signs and symptoms, exploring their prevalence, aetiology, clinical presentation, and the importance of thorough history-taking and examination. In addition, it discusses the investigations and management plans. This paper builds upon existing studies that focused on the presentations of upper GI signs, symptoms and management plans. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) tract involvement affects up to 90% of Systemic sclerosis (SSc) patients. The presence of GI symptoms is assessed by the University of California, Los Angeles, and Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT 2.0). Microbial translocation (MT) is reported in SSc patients consequently to increased intestinal permeability due to intestinal damage (ID) and dysbiosis. Aim of this study was to assess circulating levels of LBP and EndoCab IgM (markers of MT), IL-6 (marker of inflammation), I-FABP and Zonulin (markers of ID) in a cohort of SSc patients and healthy controls (HC). Moreover, we aimed to correlate these parameters with severity of GI symptoms. UCLA SCTC GIT 2.0 questionnaire was administered to 60 consecutive SSc patients. Markers of MT, inflammation and ID were evaluated in SSc patients and HC. SSc patients had higher median value of markers of MT, inflammation and ID than HC. The logistic regression analysis showed LBP as the only variable associated with an UCLA total score "moderate-to-very severe" [OR 1.001 (CI 95%: 1.001–1.002), p < 0.001]. The logistic regression analysis showed LBP [OR 1.002 (CI 95%: 1.001–1.003), p < 0.01] and disease duration [OR 1.242 (CI 95%: 1.023–1.506), p < 0.05] as variables associated with UCLA distension/bloating "moderate-to-very severe". The logistic regression analysis showed LBP as the only variable associated with UCLA diarrhea "moderate-to-very severe" [OR 1.002 (CI 95%: 1.001–1.003), p < 0.01]. SSc patients with dysregulation gut mucosal integrity expressed by high levels of MT and ID biomarkers had more severe GI symptoms. [ABSTRACT FROM AUTHOR]

Intestinal parasitic infections (IPIs) remain a significant contributor to morbidity and mortality globally, particularly in developing countries such as Ethiopia. Periodic assessments of IPI prevalence are essential prerequisite for effective control measures. Therefore, this cross‐sectional study is aimed at determining the prevalence of gastrointestinal parasitic infections and associated risk factors among schoolchildren at Wonji Shoa Secondary School, East Shoa Zone, Adama district, Oromia region, Ethiopia, between January and June 2022. A simple random stratified sampling technique was employed to select participants. Sociodemographic and risk factor data were collected using a structured questionnaire. Stool samples were examined to identify parasites. Data were analyzed using SPSS version 20. Descriptive statistics, chi‐square tests, and logistic regression were conducted to assess associations between variables and then the strength of the association. A p value < 0.05 was considered statistically significant. Of the 403 selected students, 330 completed the study that makes 81.89% response success. The overall IPI prevalence was 16.66% (55/330), with a higher prevalence among males (60%, 33/55) than females (40%, 22/55). Five parasite species were identified: two protozoa (Entamoeba histolytica and Giardia lamblia) with a combined prevalence of 9.70% (32/330) and three helminths (Ascaris lumbricoides, Hymenolepis nana, and Taenia spp.) with a combined prevalence of 6.97% (23/330). Cysts were detected in 62.5% of E. histolytica cases (15/24), and eggs were detected in 76.92% of A. lumbricoides cases (10/13). The study revealed a substantial IPI prevalence (16.66%) among the students. This finding underscores the need for effective prevention and control strategies. The predominance of parasitic infections among males is notable requiring further investigation of the factors. The identification of multiple parasite species indicates a complex epidemiological scenario. The presence of protozoan cysts and helminthic eggs highlights the potential for fecal‐oral transmission and the importance of improved sanitation and hygiene practices. [ABSTRACT FROM AUTHOR]

Familial dysautonomia (FD) is a rare sensory and autonomic neuropathy that results from a mutation in the ELP1 gene. Virtually all patients report gastrointestinal (GI) dysfunction and we have recently shown that FD patients have a dysbiotic gut microbiome and altered metabolome. These findings were recapitulated in an FD mouse model and moreover, the FD mice had reduced intestinal motility, as did patients. To understand the cellular basis for impaired GI function in FD, the enteric nervous system (ENS; both female and male mice) from FD mouse models was analyzed during embryonic development and adulthood. We show here that not only is Elp1 required for the normal formation of the ENS, but it is also required in adulthood for the regulation of both neuronal and non-neuronal cells and for target innervation in both the mucosa and in intestinal smooth muscle. In particular, CGRP innervation was significantly reduced as was the number of dopaminergic neurons. Examination of an FD patient's gastric biopsy also revealed reduced and disoriented axons in the mucosa. Finally, using an FD mouse model in which Elp1 was deleted exclusively from neurons, we found significant changes to the colon epithelium including reduced E-cadherin expression, perturbed mucus layer organization, and infiltration of bacteria into the mucosa. The fact that deletion of Elp1 exclusively in neurons is sufficient to alter the intestinal epithelium and perturb the intestinal epithelial barrier highlights a critical role for neurons in regulating GI epithelium homeostasis. [ABSTRACT FROM AUTHOR]

Organoids, characterized by their high physiological attributes, effectively preserve the genetic characteristics, physiological structure, and function of the simulated organs. Since the inception of small intestine organoids, other organoids for organs including the liver, lungs, stomach, and pancreas have subsequently been developed. However, a comprehensive summary and discussion of research findings on gastrointestinal tract (GIT) organoids as disease models and drug screening platforms is currently lacking. Herein, in this review, we address diseases related to GIT organoid simulation and highlight the notable advancements that have been made in drug screening and pharmacokinetics, as well as in disease research and treatment using GIT organoids. Organoids of GIT diseases, including inflammatory bowel disease, irritable bowel syndrome, necrotizing enterocolitis, and Helicobacter pylori infection, have been successfully constructed. These models have facilitated the study of the mechanisms and effects of various drugs, such as metformin, Schisandrin C, and prednisolone, in these diseases. Furthermore, GIT organoids have been used to investigate viruses that elicit GIT reactions, including Norovirus, SARS-CoV-2, and rotavirus. Previous studies by using GIT organoids have shown that dasabuvir, gemcitabine, and imatinib possess the capability to inhibit viral replication. Notably, GIT organoids can mimic GIT responses to therapeutic drugs at the onset of disease. The GIT toxicities of compounds like gefitinib, doxorubicin, and sunset yellow have also been evaluated. Additionally, these organoids are instrumental for the study of immune regulation, post-radiation intestinal epithelial repair, treatment for cystic fibrosis and diabetes, the development of novel drug delivery systems, and research into the GIT microbiome. The recent use of conditioned media as a culture method for replacing recombinant hepatocyte growth factor has significantly reduced the cost associated with human GIT organoid culture. This advancement paves the way for large-scale culture and compound screening of GIT organoids. Despite the ongoing challenges in GIT organoid development (e.g., their inability to exist in pairs, limited cell types, and singular drug exposure mode), these organoids hold considerable potential for drug screening. The use of GIT organoids in this context holds great promises to enhance the precision of medical treatments for patients living with GIT diseases. [ABSTRACT FROM AUTHOR]

Background: Radiotherapy (RT) is effective for cervical cancer but causes late side effects (SE) to nearby organs. These late SE occur more than 3 months after RT and are rated by clinical findings to determine their severity. While imaging studies describe late gastrointestinal (GI) SE, none demonstrate the correlation between the findings and the toxicity grading. In this study, we demonstrated the late GI toxicity prevalence, CT findings, and their correlation. Methods: We retrospectively studied uterine cervical cancer patients treated with RT between 2015 and 2018. Patient characteristics and treatment(s) were obtained from the hospital's databases. Late RTOG/EORTC GI SE and CT images were obtained during the follow-up. Post-RT GI changes were reviewed from CT images using pre-defined criteria. Risk ratios (RR) were calculated for CT findings, and multivariable log binomial regression determined adjusted RRs. Results: This study included 153 patients, with a median age of 57 years (IQR 49–65). The prevalence of ≥ grade 2 RTOG/EORTC late GI SE was 33 (27.5%). CT findings showed 91 patients (59.48%) with enhanced bowel wall (BW) thickening, 3 (1.96%) with bowel obstruction, 7 (4.58%) with bowel perforation, 6 (3.92%) with fistula, 0 (0%) with bowel ischemia, and 0 (0%) with GI bleeding. Adjusted RRs showed that enhanced BW thickening (RR 9.77, 95% CI 2.64–36.07, p = 0.001), bowel obstruction (RR 5.05, 95% CI 2.30–11.09, p < 0.001), and bowel perforation (RR 3.82, 95% CI 1.96–7.44, p < 0.001) associated with higher late GI toxicity grades. Conclusions: Our study shows CT findings correlate with grade 2–4 late GI toxicity. Future research should validate and refine these findings with different imaging and toxicity grading systems to assess their potential predictive value. [ABSTRACT FROM AUTHOR]

Background: Recently, radio‐frequency ablation has been used to modulate slow‐wave activity in the porcine stomach. Gastric ablation is, however, still in its infancy compared to its history in the cardiac field, and electrophysiological studies have been restricted to temperature‐controlled, non‐irrigated ablation. Power‐controlled, irrigated ablation may improve lesion formation at lower catheter‐tip temperatures that produce the desired localized conduction block. Methods and Results: Power‐controlled, irrigated radio‐frequency ablation was performed on the gastric serosal surface of female weaner pigs (n = 5) in vivo. Three combinations of power (10–15 W) and irrigation settings (2–5 mL min−1) were investigated. A total of 12 linear lesions were created (n = 4 for each combination). Slow waves were recorded before and after ablation using high‐resolution electrical mapping. Key Results: Irrigation maintained catheter‐tip temperature below 50°C. Ablation induced a complete conduction block in 8/12 cases (4/4 for 10 W at 2 mL min−1, 1/4 for 10 W at 5 mL min−1, 3/4 for 15 W at 5 mL min−1). Blocks were characterized by a decrease in signal amplitude at the lesion site, along with changes in slow‐wave propagation patterns, where slow waves terminated at and/or rotated around the edge of the lesion. Conclusions and Inferences: Power‐controlled, irrigated ablation can successfully modulate gastric slow‐wave activity at a reduced catheter‐tip temperature compared to temperature‐controlled, non‐irrigated ablation. Reducing the irrigation rate is more effective than increasing power for blocking slow‐wave activity. These benefits suggest that irrigated ablation is a suitable option for further translation into a clinical intervention for gastric electrophysiology disorders. [ABSTRACT FROM AUTHOR]

Background/Aims: Dilation of the tract before stent deployment is a challenging step in endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD). In this study, we examined the effectiveness and safety of a novel spiral dilator, Tornus ES (Asahi Intec), for EUS-PDD. Methods: This was a retrospective, single-arm, observational study at Aichi Cancer Center Hospital. The punctured tract was dilated using a Tornus ES dilator in all EUS-PDD cases. Our primary endpoint was the technical success rate of initial tract dilation. Technical success was defined as successful fistula dilation using a Tornus ES followed by successful stent insertion. Secondary endpoints were procedure times and early adverse events. Results: A total of 12 patients were included between December 2021 and March 2023. EUS-PDD was performed in 11 patients for post-pancreaticoduodenectomy anastomotic strictures and one patient with pancreatitis with duodenal perforation. The technical success rates of stent insertion and fistula dilation using a Tornus ES dilator was 100%. The median procedure time was 24 minutes. No remarkable adverse events related to the procedure were observed, apart from fever, which occurred in 2 patients. Conclusions: Tract dilation in EUS-PDD using a Tornus ES is effective and safe. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) diseases are a major issue in the human digestive system. Therefore, many studies have explored the automatic classification of GI diseases to reduce the burden on clinicians and improve patient outcomes for both diagnosis and treatment purposes. Convolutional neural networks (CNNs) and Vision Transformers (ViTs) in deep learning approaches have become a popular research area for the automatic detection of diseases from medical images. This study evaluated the classification performance of thirteen different CNN models and two different ViT architectures on endoscopic images. The impact of transfer learning parameters on classification performance was also observed. The tests revealed that the classification accuracies of the ViT models were 91.25% and 90.50%, respectively. In contrast, the DenseNet201 architecture, with optimized transfer learning parameters, achieved an accuracy of 93.13%, recall of 93.17%, precision of 93.13%, and an F1 score of 93.11%, making it the most successful model among all the others. Considering the results, it is evident that a well-optimized CNN model achieved better classification performance than the ViT models. [ABSTRACT FROM AUTHOR]

• Gut function and transit change following the initiation of ETI, measured using MRI. • Small bowel transit and small bowel response to food improves after starting ETI. • After 18 months of ETI use, colonic volume reduces. • First imaging study to find changes in gut physiology following ETI initiation. Gastrointestinal (GI) symptoms in cystic fibrosis (CF) are common and disruptive. The effect of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on the GI tract is not fully understood. The aim was to use magnetic resonance imaging (MRI) to determine if elexacaftor/tezacaftor/ivacaftor (ETI) changed GI function and transit. This was an 18 month prospective, longitudinal, observational study. We enrolled 24 people with CF aged 12 years or older to undergo MRI scans before starting ETI and 3, 6, and 18 months after starting ETI. The primary outcome measure was change in oro-caecal transit time (OCTT) at 6 and 18 months. Secondary outcome measures included change in small bowel water content (SBWC), change in the reduction in small bowel water content following a meal (DeltaSBWC) and change in total colonic volume (TCV). A total of 21 participants completed MRI scans at 6 months and 11 completed at 18 months. After 18 months of ETI, median OCTT significantly reduced, from >360 min [IQR 240->360] to 240 min [IQR 180–300] (p = 0.02, Wilcoxon signed-rank). Both SBWC and DeltaSBWC increased after starting ETI. TCV reduced significantly after 18 months (p = 0.005, Friedman). Our findings suggest an improvement in small bowel transit, small bowel response to food and a reduction in colonic volume after starting ETI. These effects may relate to CFTR activation in the small bowel. To our knowledge this is the first study to show a physiological change in GI transit and function in response to CFTR modulator use through imaging studies. [Display omitted] [ABSTRACT FROM AUTHOR]

Pulsed-field ablation (PFA) is an emerging ablative technology that has been used successfully to eliminate cardiac arrhythmias. As a nonthermal technique, it has significant benefits over traditional radiofrequency ablation with improved target tissue specificity and reduced risk of adverse events during cardiac applications. We investigated whether PFA is safe for use in the stomach and whether it could modulate gastric slow waves. Female weaner pigs were fasted overnight before anesthesia was induced using tiletamine hydrochloride (50 mg·mL−1) and zolazepam hydrochloride (50 mg·mL−1) and maintained with propofol (Diprivan 2%, 0.2–0.4 mg·kg−1·min−1). Pulsed-field ablation was performed on their gastric serosa in vivo. Adjacent point lesions (n = 2–4) were used to create a linear injury using bipolar pulsed-field ablation consisting of 40 pulses (10 Hz frequency, 0.1 ms pulse width, 1,000 V amplitude). High-resolution electrical mapping defined baseline and postablation gastric slow-wave patterns. A validated five-point scale was used to evaluate tissue damage in hematoxylin and eosin-stained images. Results indicated that PFA successfully induced complete conduction blocks in all cases, with lesions through the entire thickness of the gastric muscle layers. Consistent postablation slow-wave patterns emerged immediately following ablation and persisted over the study period. Pulsed-field ablation induces rapid conduction blocks as a tool to modulate slow-wave patterns, indicating it may be suitable as an alternative to radiofrequency ablation. NEW & NOTEWORTHY: Results show that pulsed-field ablation can serve as a gastric slow-wave intervention by preventing slow-wave propagation across the lesion site. Stable conduction blocks were established immediately following energy delivery, faster than previous examples of radiofrequency gastric ablation. Pulsed-field ablation may be an alternative for gastric slow-wave intervention, and further functional and posthealing studies are now warranted. [ABSTRACT FROM AUTHOR]

The internal anal sphincter (IAS) functions to maintain continence. Previous studies utilizing mice with cell-specific expression of GCaMP6f revealed two distinct subtypes of intramuscular interstitial cells of Cajal (ICC-IM) with differing Ca2+ activities in the IAS. The present study further examined Ca2+ activity in ICC-IM and its modulation by inhibitory neurotransmission. The spatiotemporal properties of Ca2+ transients in Type II ICC-IM mimicked those of smooth muscle cells (SMCs), indicating their joint participation in the "SIP" syncytium. Electrical field stimulation (EFS; atropine present) abolished localized and whole cell Ca2+ transients in Type I and II ICC-IM. The purinergic antagonist MRS2500 did not abolish EFS responses in either cell type, whereas the nitric oxide synthase (NOS) inhibitor NG-nitro- l -arginine (l -NNA) abolished responses in Type I but not Type II ICC-IM. Combined antagonists abolished EFS responses in Type II ICC-IM. In both ICC-IM subtypes, the ability of EFS to inhibit Ca2+ release was abolished by l -NNA but not MRS2500, suggesting that the nitrergic pathway directly inhibits ICC-IM by blocking Ca2+ release from intracellular stores. Since inositol (1,4,5)-trisphosphate receptor-associated cGMP kinase substrate I (IRAG1) is expressed in ICC-IM, it is possible that it participates in the inhibition of Ca2+ release by nitric oxide. Platelet-derived growth factor receptor α (PDGFRα)+ cells but not ICC-IM expressed P2Y1 receptors (P2Y1R) and small-conductance Ca2+-activated K+ channels (SK3), suggesting that the purinergic pathway indirectly blocks whole cell Ca2+ transients in Type II ICC-IM via PDGFRα+ cells. This study provides the first direct evidence for functional coupling between inhibitory motor neurons and ICC-IM subtypes in the IAS, with contractile inhibition ultimately dependent upon electrical coupling between SMCs, ICC, and PDGFRα+ cells via the SIP syncytium. NEW & NOTEWORTHY: Two intramuscular interstitial cells of Cajal (ICC-IM) subtypes exist within the internal anal sphincter (IAS). This study provides the first evidence for direct coupling between nitrergic motor neurons and both ICC-IM subtypes as well as indirect coupling between purinergic inputs and Type II ICC-IM. The spatiotemporal properties of whole cell Ca2+ transients in Type II ICC-IM mimic those of smooth muscle cells (SMCs), suggesting that ICC-IM modulate the activity of SMCs via their joint participation in a SIP syncytium (SMCs, ICC, and PDGFRα+ cells). Listen to this article's corresponding podcast at https://ajpgi.podbean.com/e/got-guts-the-micro-version-inhibitory-neurotransmission-in-the-internal-anal-sphincter/. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To re-examine the evidence base that underpins the management of nasogastric tube safety in children • To recognise the consequences of delayed or missed feeds in children who receive nasogastric tube feeding • To enhance your understanding of what checks can be used to ensure a nasogastric tube is safe to use. Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube’s position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home. [ABSTRACT FROM AUTHOR]

Objectives: The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>48 h) operative intervention to allow for resuscitation. Methods: A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results: 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P =<.05) with more pneumoperitoneum (76% vs 23%; P =<.05). The early intervention group had a higher mortality (35% vs 15%; P =<.05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P <.05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; P <.05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion: Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: Rett syndrome is a rare neurodevelopmental disorder associated with methyl CpG binding protein 2 (MECP2) gene mutations. We aimed to characterize the long-term nutritional and gastrointestinal course of Rett syndrome in a large national patient population. Methods: We conducted a retrospective cohort study of patients followed during 1991–2021 at a national center for Rett syndrome. The data retrieved included clinical features, laboratory and genetic analyses. Continuous anthropometric measurements were calculated for the closest visit to the median ages: 2.5, 7.5, 12.5 and 17.5 years. Kaplan Meier curves were used to describe the appearance of clinical manifestations during the follow up period. Generalized estimating equation models were used to compare repeated measurements. Results: Included were 141 patients (139 females), the median age at the first visit was 3.2 years (interquartile range [IQR] 2.3–5.7), and the median length of follow-up was 94.5 months (IQR 28.6–153.3). Mean weight, height and BMI Z-scores were -1.09, -1.03 and -0.56, respectively, at median age 2.5 years; and deteriorated to -3.95, -3.01 and -1.19, respectively, at median age 17.5 years (P < 0.001). Gastrointestinal features included constipation (47.5%, 67/141) and chewing/feeding difficulties (20%, 28/141) at presentation; and an additional 47 (33.3%) and 24 (17.0%), respectively, during follow up. Twenty-eight patients (20%) developed aerophagia and 44 (31.2%) gastroesophageal reflux. No relation was found between genetic mutation types and clinical manifestations. GI manifestations were more prevalent in patients with typical form of Rett syndrome. Conclusions: Anthropometric parameters were shown to deteriorate with age, regardless of the specific genetic mutation. Chewing/feeding difficulties, constipation and gastroesophageal reflux are common in Rett patients. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of temporomandibular dysfunction in scleroderma patients according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to correlate it with disease variables. Methods: Temporomandibular dysfunction was evaluated in 75 scleroderma patients and 74 healthy controls using DC/TMD. Gastrointestinal symptoms were evaluated through the University of California Los Angeles (UCLA) score in scleroderma patients. Results: There was no difference of prevalence in temporomandibular dysfunction [30 (40%) vs 30 (40.5%); p > 00.05] between scleroderma patients and healthy controls. Scleroderma patients had a significant reduction in all oral movements compared to healthy controls. Scleroderma patients with temporomandibular dysfunction had a statistically higher score in the UCLA distention/bloating item [1.75 (0.5–2.38) vs 0.75 (0.25–1.75); p < 0.05] than scleroderma patients without temporomandibular dysfunction. Discussion: Temporomandibular dysfunction prevalence between scleroderma patients and healthy controls is similar. In scleroderma patients, temporomandibular dysfunction reduces oral mobility and opening, which worsens distension/bloating. [ABSTRACT FROM AUTHOR]

Simple Summary: In this retrospective study, three dogs and three cats were selected from the database of the Chonnam National University Teaching Hospital from February 2017 to June 2019. The inclusion criteria for the selection of patients were as follows: (1) clinical data including age, sex, breed, clinical signs, histology, fine-needle aspiration, or fluid centesis were available and (2) intraluminal CEUS was performed; CEUS findings helped confirm the diagnosis. Each patient underwent physical examination, blood tests, radiography, and conventional ultrasonography. Intraluminal CEUS was performed using contrast agents, including SonoVue, agitated saline, saline, or a combination for GI hydrosonography in two patients and sono-cystourethrography in four patients. GI hydrosonography could assess the anatomic relationship between the mass and gastric lumen after administration of a mixture of 0.1 mL SonoVue and 30 mL/kg water in case 1 and could dilate the colonic lumen to detect the thickened wall using saline infusion in case 2. Upon sono-cystourethrography, communication between the urinary tract and prostatic cyst was clearly visualized in case 3, and narrowing of the urethral lumen secondary to prostatomegaly could be ruled out in case 4 with pyogranulomatous prostitis using agitated saline. The saline or agitated saline is appropriate for filling the lumen and improving the acoustic window for GI hydrosonography. Intraluminal CEUS examinations helped to assess the patency of the lumen, evaluate the extent of luminal dilation, rule out luminal narrowing, determine the presence of a mass within the lumen, and identify rupture sites. Administering intraluminal fluid can improve the acoustic window for the visualization of the lumen and wall layers in the cavitary organs. Microbubbles in ultrasound contrast agents can also be used for intracavitary applications to enhance visualization of the lesion in human patients. However, there was no literature extending the clinical application of intraluminal contrast-enhanced ultrasonography (CEUS) to patients with naturally occurring diseases in veterinary medicine. This case series aims to describe the detailed application and diagnostic value of intraluminal CEUS in six clinical cases with naturally occurring gastrointestinal (GI) and urinary tract diseases. [ABSTRACT FROM AUTHOR]

Background and Aim: Helicobacter pylori plays an important role in causing digestive diseases. The purpose of this study is to investigate Helicobacter pylori in COVID‐19 patients with and without gastrointestinal symptoms. Methods: In this case–control study, all patients with COVID‐19 admitted to Imam Khomeini Hospital in Jiroft city in 2021 were convenience sampled and divided into two homogeneous groups. Ninety‐five patients with COVID‐19, who presented with gastrointestinal symptoms, were included in the case group, while 95 patients with COVID‐19 without gastrointestinal symptoms were included in the control group. Noninvasive diagnostic methods, including serology and stool antigen tests, were used to identify Helicobacter pylori in the studied patients. Results: Fifty‐three people (55.8%) from the case group had Helicobacter pylori, and 48 (50.5%) from the control group had Helicobacter pylori. Among the 53 people from the case group, 27 (50.9%) were men and 26 (49.1%) were women. Nineteen people (35.8%) were taking pantoprazole, 10 people (18.8%) were taking nonsteroidal anti‐inflammatory drugs, 20 people (37.7%) were taking narcotics, and 7 people (13.2%) had peptic ulcer. Seven people (13.2%) had an H2 blocker, and 21 people had an underlying disease. A significant relationship between infection with Helicobacter pylori and the use of pantoprazole, nonsteroidal anti‐inflammatory drugs, narcotics, peptic ulcer, underlying disease, and H2 blocker in COVID‐19 patients with gastrointestinal symptoms and without gastrointestinal symptoms was present (P‐value < 0.05). Conclusion: The prevalence of Helicobacter pylori infection in patients with COVID‐19, who have gastrointestinal symptoms, is high and should be considered as a treatment criterion for people infected with COVID‐19. [ABSTRACT FROM AUTHOR]

Purpose: Treatment of metastatic pancreatic neuroendocrine tumors (pancNETs), particularly grade 2 (G2) and grade 3 (G3), often presents a dilemma in choosing from multiple similarly efficacious therapies. Data on targeted therapies for these tumor types is limited, and this report presents BRAF-targeted therapy as a therapeutic option for metastatic pancNET G3. Methods: This is a case report of a patient with G3 pancNET metastatic to the liver, lung, lymph node, and scalp (soft tissue) treated with dabrafenib/trametinib (D/T) in the presence of a BRAF V600E mutation detected in tumor tissue. Results: This patient has demonstrated an ongoing partial response to therapy at all involved sites for nearly 15 months with minimal side effects attributable to D/T. Conclusion: Dabrafenib/trametinib therapy for BRAF-mutated metastatic pancNETs provides a novel treatment option and, especially in the G3 setting, should be considered a first-line option. Tumor testing for actionable mutations should be undertaken at the time of diagnosis and/or progression to identify novel therapeutic avenues in these rare tumors. [ABSTRACT FROM AUTHOR]

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) and caffeine-containing beverages are widely consumed but their impact on gastrointestinal (GI) health requires further investigation. This cross-sectional study investigated the relationship between NSAIDs use, caffeinated drink consumption, and the prevalence of self-reported GI symptoms in a Jordanian subpopulation. Methods: An online survey was administered to 400 Jordanian individuals aged 18–65 years. Data on sociodemographics, NSAIDs use, caffeine consumption, peptic ulcer disease (PUD) history, and GI symptoms were collected. Contingency tables were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between exposures and outcomes. Results: The prevalence of self-reported PUD-related GI symptoms was 6.0%. NSAID users had higher odds of PUD (OR = 2.431) and related GI symptoms, including abdominal pain (OR = 4.688, p < 0.001) and discomfort (OR = 8.068, p < 0.001). Caffeine consumption was associated with self-reported burning stomach pain (OR = 14.104, p < 0.001), fullness (OR = 8.304, p = 0.010), and bloating (OR = 8.304, p = 0.010). Coffee, tea, soft drinks, and energy drinks were associated with increased odds of various GI symptoms (ORs 2.018-12.715, p < 0.05). Conclusions: NSAIDs use and caffeine consumption were independently associated with the increased prevalence of self-reported PUD and related GI symptoms. Despite the lack of adjustment for necessary confounders, our findings highlight the importance of considering the potential GI effects of NSAIDs and caffeine. Public health strategies promoting their safe use may help reduce the burden of GI disorders. [ABSTRACT FROM AUTHOR]

ImportancePropofol sedation is widely used for endoscopic procedures, but it poses risks of hemodynamic and respiratory depression. The addition of esketamine as an adjuvant may reduce propofol requirements and associated adverse events.ObjectiveTo evaluate the effects of low-dose esketamine added to propofol-based sedation on desaturation and hypotension during same-visit bidirectional endoscopy.Design, setting, and participantsThis multicenter, double-blind, placebo-controlled randomized clinical trial assessed patients from 3 teaching hospitals in China who were scheduled for same-visit bidirectional endoscopy between February 8 and November 30, 2022, and randomly assigned to receive esketamine or normal saline (placebo).InterventionsAfter induction of sedation with 0.1 μg/kg of sufentanil and 0.5 mg/kg of propofol, patients in the esketamine group received 0.15 mg/kg of intravenous esketamine, whereas patients in the placebo group received an equivalent volume of saline. Sedation was achieved through propofol titration.Main outcomes and measuresThe primary outcome was the composite of desaturation and hypotension during the procedures. Secondary outcomes included desaturation, hypotension, propofol requirements, postprocedure pain and fatigue, nausea or vomiting, dizziness or headache, hallucination or nightmare, endoscopist satisfaction, and patient satisfaction.ResultsAmong the 663 initially enrolled patients, 660 completed the study (median [IQR] age, 48 [36-57] years; 355 [53.8%] female), with 331 randomized to the esketamine group and 329 to the placebo group. The administration of esketamine compared with placebo significantly reduced the incidence of the composite outcome of desaturation and hypotension (8.2% vs 21.0%; difference, -12.8 percentage points; odds ratio [OR], 0.34; 95% CI, 0.21-0.54; P

Abstract Background Gastrointestinal bleeding (GIB) is a clinical challenge in kidney failure. INSPIRE group assessed if machine learning could determine a hemodialysis (HD) patient’s 180-day GIB hospitalization risk. Methods An eXtreme Gradient Boosting (XGBoost) and logistic regression model were developed using an HD dataset in United States (2017–2020). Patient data was randomly split (50% training, 30% validation, and 20% testing). HD treatments ≤ 180 days before GIB hospitalization were classified as positive observations; others were negative. Models considered 1,303 exposures/covariates. Performance was measured using unseen testing data. Results Incidence of 180-day GIB hospitalization was 1.18% in HD population (n = 451,579), and 1.12% in testing dataset (n = 38,853). XGBoost showed area under the receiver operating curve (AUROC) = 0.74 (95% confidence interval (CI) 0.72, 0.76) versus logistic regression showed AUROC = 0.68 (95% CI 0.66, 0.71). Sensitivity and specificity were 65.3% (60.9, 69.7) and 68.0% (67.6, 68.5) for XGBoost versus 68.9% (64.7, 73.0) and 57.0% (56.5, 57.5) for logistic regression, respectively. Associations in exposures were consistent for many factors. Both models showed GIB hospitalization risk was associated with older age, disturbances in anemia/iron indices, recent all-cause hospitalizations, and bone mineral metabolism markers. XGBoost showed high importance on outcome prediction for serum 25 hydroxy (25OH) vitamin D levels, while logistic regression showed high importance for parathyroid hormone (PTH) levels. Conclusions Machine learning can be considered for early detection of GIB event risk in HD. XGBoost outperforms logistic regression, yet both appear suitable. External and prospective validation of these models is needed. Association between bone mineral metabolism markers and GIB events was unexpected and warrants investigation. Trial registration This retrospective analysis of real-world data was not a prospective clinical trial and registration is not applicable. Graphical Abstract

Abstract Background Radiotherapy (RT) is effective for cervical cancer but causes late side effects (SE) to nearby organs. These late SE occur more than 3 months after RT and are rated by clinical findings to determine their severity. While imaging studies describe late gastrointestinal (GI) SE, none demonstrate the correlation between the findings and the toxicity grading. In this study, we demonstrated the late GI toxicity prevalence, CT findings, and their correlation. Methods We retrospectively studied uterine cervical cancer patients treated with RT between 2015 and 2018. Patient characteristics and treatment(s) were obtained from the hospital’s databases. Late RTOG/EORTC GI SE and CT images were obtained during the follow-up. Post-RT GI changes were reviewed from CT images using pre-defined criteria. Risk ratios (RR) were calculated for CT findings, and multivariable log binomial regression determined adjusted RRs. Results This study included 153 patients, with a median age of 57 years (IQR 49–65). The prevalence of ≥ grade 2 RTOG/EORTC late GI SE was 33 (27.5%). CT findings showed 91 patients (59.48%) with enhanced bowel wall (BW) thickening, 3 (1.96%) with bowel obstruction, 7 (4.58%) with bowel perforation, 6 (3.92%) with fistula, 0 (0%) with bowel ischemia, and 0 (0%) with GI bleeding. Adjusted RRs showed that enhanced BW thickening (RR 9.77, 95% CI 2.64–36.07, p = 0.001), bowel obstruction (RR 5.05, 95% CI 2.30–11.09, p

Background: Langerhans cell histiocytosis (LCH) has a variable presentation. Gastrointestinal involvement is rare and portends a poor prognosis in LCH. Case report: Herein, we describe the presentation, progression, management, and outcome of an 11-month-old female infant with LCH. The patient presented with severe acute malnutrition, hepatosplenomegaly, and gastrointestinal involvement in the form of persistent vomiting. She was managed with chemotherapy initially and subsequently developed complete duodenal narrowing. She underwent Kimura's duodenojejunostomy and improved. Hence, chemotherapy was restarted. Two months later, she developed features of intestinal obstruction with intraoperative findings of ileal gangrene requiring adhesiolysis, ileal resection, and ileostomy. Subsequently, she succumbed to sepsis. Conclusion: This case report aims to highlight the atypical gastrointestinal manifestations of LCH and the challenges faced in managing such a case.

BACKGROUND: Duodenal neuroendocrine tumors (dNETs) are rare, and their management is not well-defined. National Comprehensive Cancer Network (NCCN) guidelines recommend surgical resection of large dNETs (> 2 cm) and endoscopic resection of small tumors ( 3 cm. Kaplan-Meier and multivariable Cox proportional hazards models were used for survival analysis. RESULTS: The study included 465 patients, with 124 (26.7%) undergoing surgical resection. The average age was 61.9 years, and tumor sizes ranged from 0.1 to 10.5 cm. Endoscopic resection had 40.5% of tumors between 0 and 0.5 cm, while surgery had only 21% (p

Total neoadjuvant treatment (TNT) for rectal cancer is becoming an accepted treatment paradigm and is changing the landscape of this disease, wherein up to 50% of patients who undergo TNT are able to avoid surgery. This places new demands on the radiologist in terms of interpreting degrees of response to treatment. This primer summarizes the Watch-and-Wait approach and the role of imaging, with illustrative atlas-like examples as an educational guide for radiologists. We present a brief literature summary of the evolution of rectal cancer treatment, with a focus on magnetic resonance imaging (MRI) assessment of response. We also discuss recommended guidelines and standards. We outline the common TNT approach entering mainstream practice. A heuristic and algorithmic approach to MRI interpretation is also offered. To illustrate management and common scenarios, we arranged the illustrative figures as follows: (I) Clinical complete response (cCR) achieved at the immediate post-TNT decision point scan time; (II) cCR achieved at some point during surveillance, later than the first post-TNT MRI; (III) near clinical complete response (nCR); (IV) incomplete clinical response (iCR); (V) discordant findings between MRI and endoscopy where MRI is falsely positive, even at follow-up; (VI) discordant cases where MRI seems to be falsely positive but is proven truly positive on follow-up endoscopy; (VII) cases where MRI is falsely negative; (VIII) regrowth of tumor in the primary tumor bed; (IX) regrowth outside the primary tumor bed; and (X) challenging scenarios, i.e., mucinous cases. This primer is offered to achieve its intended goal of educating radiologists on how to interpret MRI in patients with rectal cancer undergoing treatment using a TNT-type treatment paradigm and a Watch-and-Wait approach.

The food industry is faced with a significant challenge in maintaining the viability and stability of probiotics during processing and in model food. Encapsulation technology offers a promising solution to this issue. This study was aimed to investigate the effect of Sodium Alginate (SA) and arabinoxylan (AX) composite encapsulation on the viability & stability of Lactobacillus rhamnosus GG. The AX was extracted from maize and characterized, and then the SA-AX composite was used to encapsulate the probiotics. The resulting microbeads were analyzed for their morphological, molecular, and physicochemical properties. The MAX-SA microbeads demonstrated the highest efficiency at 97.9 ± 0.6%, followed by MAX at 95 ± 1.5% and SA at 92 ± 1.4%. The FTIR spectra revealed specific functional groups in the samples. The MAX-SA and MSA matrices had a dispersed structure, while the MAX matrix had a smooth microstructure. The microcapsules had an average size ranging from 718 ± 2 mm to 734 ± 2 mm. The viability of the encapsulated probiotics was assessed under storage conditions, simulated gastrointestinal conditions, and model food. Encapsulated probiotics showed higher viability than free probiotics in simulated gastrointestinal conditions, and pineapple juice fortified with encapsulated probiotics showed a higher probiotic count. Overall, the study found that MAX-SA was the most effective in maintaining probiotic viability under stressed conditions.

Abstracts:Background: Food allergy is an increasing health problem in children. Previous studies have reported conflicting results about the diagnostic value of atopy patch test (APT) in food allergies.Objectives: To investigate the accuracy of APT in identifying non-IgE-mediated gastrointestinal food allergy to pasteurized cow's milk, heated cow's milk, white and yolk egg, soy, wheat, walnut, sesame, pistachio, almond, peanut, date and cumin which are popular food ingredients in Iran.Methods: This study was performed on children with GI allergic problems who did not improve after at least 4 weeks of cow's milk protein elimination. Atopic patch test (APT) was performed and the elimination diet was considered according to APT results and after resolving symptoms, introduction of each accused food was done sequentially. Results: 53 children under 7 years old with mean age of 19.6 months underwent APT and the results were verified by open oral food challenge. Sensitivity in the rage of 59%-95%, specifity of 80.7-92.8, positive predictive values of 75-96.4 and negative predictive value of 23-80.7% were calculated depending on the type of food. Compared to the heated raw cow's milk, the pasteurized/homogenized cow's milk reaction was significant. Conclusion: APT can be included in the diagnostic workup of non-IgE-mediated GI allergy because it's safe and has great accuracy. However, several aspects require further investigation especially to enable the standardization of the technique. We should be aware of allegenicity of our foods due to processing and geographic region.