Search Results (471)

Background and objectives: Acute colicky abdominal pain, involving visceral spasms and inflammatory mechanisms, is a common complaint in everyday medical practice. Despite its widespread use, clinical evidence on the fixed-dose combination of pargeverine 10 mg plus lysine clonixinate 125 mg remains limited. The objective of this study was to describe real-world clinical outcomes, safety, and patient-reported experience associated with this combination in routine practice. Materials and methods: This multicenter, observational, non-comparative, real-world study included adult patients with acute colicky abdominal pain of gastrointestinal, urological, or gynecological origin. Pain intensity was assessed using a visual analog scale (VAS) at baseline and at 5 ± 3 days. Secondary outcomes included time to pain relief, satisfaction with treatment, and safety. Associations between pain reduction and patient-reported outcomes were explored. Results: A total of 202 patients were analyzed. Significant pain reduction was observed across all etiologies (p < 0.001), with median VAS reductions ranging from 6 to 9 points (approximately 70% to 90% from baseline). More than 95% of patients reported early improvement, and sustained relief was maintained in more than 96% throughout the study period, regardless of the pain’s origin. Adverse events were infrequent (3%), mild in intensity (primarily transient gastrointestinal symptoms), and did not lead to treatment discontinuation. Conclusions: In real-world clinical practice, the fixed-dose combination of pargeverine and lysine clonixinate was associated with early and sustained, clinically meaningful pain reduction across multiple forms of acute visceral colicky pain, with a favorable safety and tolerability profile, supporting its relevance as a short-term therapeutic option in mild to severe acute pain. Full article

Background: Gastrointestinal (GI) symptoms are common in endurance and ultra-endurance sports and may impair performance or lead to race withdrawal. While nutritional strategies are frequently emphasized, the respective roles of baseline digestive susceptibility and cumulative exercise exposure remain insufficiently characterized. Methods: Two complementary cross-sectional questionnaire-based studies were conducted in endurance athletes. Study 1 included 230 ultra-trail runners and examined determinants of systematic GI symptoms during competition using a composite digestive vulnerability (DV) score reflecting susceptibility indicators. Study 2 included 497 endurance and ultra-endurance athletes from multiple disciplines and investigated multivariable correlates of GI symptoms and GI-related race withdrawal, integrating training-related GI symptoms (proxy of digestive vulnerability), habitual competition duration (≥6 h), sport category and specific digestive symptoms. Logistic regression models were adjusted for age and sex. Results: In Study 1, the DV score was independently associated with systematic GI symptoms during competition (adjusted OR per point = 1.93, 95% CI 1.33–2.80). In Study 2, athletes reporting GI symptoms during training had markedly higher odds of experiencing GI symptoms during competition (adjusted OR = 3.96, 95% CI 2.67–5.87). Habitual exposure to events lasting ≥6 h was independently associated with increased odds of GI-related race withdrawal (adjusted OR = 2.25, 95% CI 1.35–3.78). GI symptoms during competition represented the strongest proximal correlate of withdrawal (adjusted OR = 7.04, 95% CI 4.00–12.30), indicating a sequential relationship between baseline digestive vulnerability, symptom expression during competition and race termination. After adjustment for digestive vulnerability and exercise exposure, no individual nutritional category remained independently associated with GI outcomes. Conclusions: Gastrointestinal symptoms and race withdrawal in endurance athletes were more consistently associated with digestive vulnerability expressed during training and cumulative exercise exposure than with isolated nutritional items. These findings support a vulnerability–exposure framework in which individual digestive susceptibility interacts with prolonged physiological stress during endurance exercise. Identifying athletes with elevated digestive vulnerability during training may represent a practical strategy to improve individualized nutritional preparation and reduce GI-related race interruption. Full article

Background: Chronic enteropathy associated with SLCO2A1 (CEAS) is a rare genetic disorder that is prone to misdiagnosis and characterized by significant challenges in achieving an early diagnosis. Current diagnosis relies on clinical manifestation combined with genetic sequencing. This study aimed to evaluate immunohistochemical (IHC) staining for SLCO2A1 protein deficiency as a diagnostic alternative, in addition to clinical pathological features. Method: Ten patients diagnosed with CEAS between January 2018 and August 2024 were enrolled. Clinicodemographic data, endoscopic findings, and treatment history were collected. Whole-exome sequencing identified SLCO2A1 variants. IHC staining for SLCO2A1 protein was performed from small intestine lesions and accessible GI sites. Results: Complete absence of SLCO2A1 protein expression was demonstrated by IHC in 9/10 patients, with significantly reduced expression in 1/10. This protein deficiency was consistently observed not only in the small intestine but also in the gastric antrum, duodenum, and terminal ileum. Genetic analysis revealed 7 novel SLCO2A1 variants among a total of 11 variants. A median diagnostic delay of 15 years (IQR 6–24) was observed. Ileal involvement and hypoalbuminemia (median albumin 28.02 g/L, IQR 22.1–33.0) were present in all patients. Common symptoms included abdominal pain (70%), melena (60%), and ileus (50%). Conclusions: The diagnosis of CEAS has been time-consuming and challenging. Detection of SLCO2A1 protein deficiency via IHC in either the disease-predominant small bowel or accessible non-lesional upper/lower GI mucosa demonstrates high diagnostic sensitivity for CEAS. This method could provide a practical, cost-effective alternative to genetic sequencing, particularly in resource-limited settings, and has the potential to significantly reduce diagnostic delays for this condition. Full article

Diet is a major modifiable determinant of gastrointestinal (GI) health, influencing disease risk and progression through coordinated effects on the gut microbiome, immune regulation, epithelial barrier integrity, oxidative balance, and epigenetic mechanisms. This narrative review synthesizes epidemiological, mechanistic, and clinical evidence from the past decade to examine bidirectional relationships between dietary patterns and seven common GI disorders: celiac disease, irritable bowel syndrome (IBS), Crohn’s disease, ulcerative colitis, Helicobacter pylori-associated gastritis, peptic ulcer disease, and lactose intolerance. Western dietary patterns, characterized by high intake of ultra-processed foods and saturated fats and low fiber consumption, are consistently associated with microbial dysbiosis, impaired barrier function, and enhanced inflammatory signaling. In contrast, Mediterranean and plant-forward dietary patterns show protective associations across multiple GI conditions. Mechanistically, diet influences GI pathophysiology largely through microbiome-derived metabolites, particularly short-chain fatty acids, which regulate epithelial homeostasis, immune tolerance, and inflammatory pathways. Condition-specific dietary strategies remain clinically important. Gluten exclusion is essential in celiac disease, low- fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) approaches provide evidence-based symptom control in IBS, and exclusive enteral nutrition or targeted exclusion diets support remission induction in Crohn’s disease. Selected probiotics and emerging postbiotics may provide adjunctive benefits in specific contexts. Despite growing evidence, dietary research remains limited by methodological heterogeneity and interindividual variability. Precision nutrition approaches integrating microbiome profiling and artificial intelligence represent a promising translational direction. Overall, dietary patterns—rather than isolated nutrients—form the foundation of GI dietary therapy. Full article

Incretin-based pharmacotherapy has rapidly transformed obesity management. However, despite its efficacy, gastrointestinal (GI) adverse events (AEs) are common and represent a major driver of treatment discontinuation. Symptoms such as nausea, vomiting, acid reflux, diarrhea, and constipation, not only impair the quality of life, but also compromise adherence, thereby limiting the real-world effectiveness of these agents. Targeted nutritional strategies may play a pivotal role in mitigating these symptoms and supporting sustained treatment. However, most clinical trials have relied on generalized lifestyle advice combined with hypocaloric dietary prescriptions, with limited integration of structured, mechanism-based nutritional counseling tailored to the physiological actions of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs. Consequently, practical guidance for clinicians and dietitians remains fragmented. The present review synthesizes the available evidence on GI AEs associated with incretin-based therapies and examines whether structured, targeted nutritional management can meaningfully reduce symptom burden. We also outline key monitoring strategies and focus on important clinical aspects for physicians and dietitians, aiming to optimize patient outcomes. In addition, we provide detailed information on the spectrum of GI AEs to guide effective management and limit intolerance. By bridging pharmacology with applied clinical nutrition, we aim to provide a pragmatic framework for improving tolerability, sustaining adherence, and translating trial efficacy into durable real-world effectiveness. Full article

Background/Objectives: Sport-related concussion (SRC) elicits multi-systemic symptoms, including nausea, fatigue, and cognitive changes. Gastrointestinal (GI) symptoms are not well captured in current concussion assessments and may be under-recognised in clinical follow-up. GI disturbances may influence intake tolerance and day-to-day fuelling during post-SRC recovery. This study investigated the prevalence and severity of self-reported GI symptoms in Irish athletes after their most recent SRC, examined sex-based patterns, and evaluated the rationale for integrating GI symptom checks into standard concussion tools (e.g., SCAT6) and post-injury monitoring. Methods: An online survey was completed by recreational, competitive, and elite athletes who retrospectively self-reported concussion history, GI symptoms, and bowel function post-SRC and at the time of survey completion (ToSC; 0.03–216 months post-injury). The survey used the Bristol Stool Chart, Rivermead Post-Concussion Symptoms Questionnaire, and validated GI symptom measures. Descriptive statistics and chi-square tests examined timepoint- and sex-based differences. Results: A total of 106 athletes participated (55.7% female; mean age 26.4 ± 7.7 years), of whom 90.6% reported ≥1 GI symptom post-SRC, with greater severity observed for appetite loss, bloating, and abdominal discomfort. Bowel habits shifted bidirectionally for 42.5%, and 26.4% were experiencing ongoing symptoms at ToSC. Conclusions: Self-reported GI symptoms were common and appear under-recognised post-SRC. These findings support greater attention to GI symptom assessment and suggest that brief GI checks and facilitated access to nutrition advice where symptoms persist may be feasible within multidisciplinary, athlete-centred care. Prospective studies are needed to determine clinical relevance and to evaluate nutrition-related strategies. Full article

Background: Persistent gastrointestinal (GI) symptoms are common in adults and are often considered functional conditions. Emerging evidence suggests that gastrointestinal function may be intertwined with systemic metabolic regulation, yet the association between chronic GI symptoms and cardiometabolic risk assessed using routine clinical biomarkers remains insufficiently explored. Methods: In this cross-sectional observational study, 93 adults were consecutively enrolled during routine clinical evaluations. Anthropometric parameters, fasting plasma glucose, glycated hemoglobin (HbA1c), lipid profile, and blood pressure were assessed. Participants were classified as having persistent gastrointestinal symptoms (GI+) or being asymptomatic (GI−) based on symptom duration and clinical documentation. A composite metabolic stress score, derived from routinely available biomarkers, was used to summarize multidimensional cardiometabolic burden. Group comparisons and correlation analyses were performed using non-parametric methods. Results: Participants with persistent gastrointestinal symptoms exhibited higher triglyceride levels, lower HDL-cholesterol concentrations, and higher fasting plasma glucose compared with asymptomatic individuals (all p < 0.05). The composite metabolic stress score was significantly higher in the GI+ group, indicating greater overall cardiometabolic burden, while body mass index and HbA1c did not differ significantly between groups. Conclusions: Persistent gastrointestinal symptoms were associated with an unfavorable cardiometabolic profile characterized by atherogenic dyslipidemia and impaired fasting glycemia. An exploratory composite metabolic stress score based on routine clinical biomarkers effectively summarized this pattern. These findings support the biological plausibility of shared metabolic vulnerability between gastrointestinal symptom burden and cardiometabolic risk and highlight the need for longitudinal and mechanistic studies incorporating objective gastrointestinal and metabolic biomarkers. Full article

Objectives: This study aimed to describe the epidemiological and clinical characteristics and the potential risk factors associated with Clostridioides difficile infection (CDI) in a high-complexity healthcare center. Methods: This was a retrospective case–control study conducted from 2020 to 2022 with a cohort of participants aged ≥18 years with diarrhea (more than three liquid stools per day), which included a molecular testing request (the FilmArray Gastrointestinal [GI] PCR Panel) in a high-complexity clinic in Santiago de Cali, Colombia. Controls were randomly selected from the same institutional laboratory database at a 2:1 ratio, matched by age and sex, and required to test negative for C. difficile. Patients from other institutions were excluded to avoid exposure misclassification. Results: Our study included 147 participants (49 cases and 98 controls) and found a 22% infection prevalence among those who underwent molecular testing. When comparing CDI cases with controls, significant differences were observed in the univariate analysis: cases showed longer time to symptom resolution, longer post-diagnosis hospital stay, and greater exposure to in-hospital antibiotics for more than 7 days prior to symptom onset (p < 0.05). Among CDI cases, 55% were healthcare-associated and 18% were classified as severe, with an overall 30-day mortality of 15%. In the multivariate logistic regression model, three variables remained significantly associated with CDI: hospital stay longer than 10 days before symptom onset, antibiotic exposure in the previous 90 days, and in-hospital proton pump inhibitor use. Conclusions: CDI can present a wide range of clinical manifestations, so underdiagnosis should be avoided. Identifying risk factors, particularly in patients with hospital-acquired diarrhea, is crucial. Factors such as a hospital stay longer than 10 days before symptom onset and in-hospital exposure to PPIs or antibiotics in the last 90 days were significant in our study. Early recognition of these risk factors may reduce hospital stay, lower the risk of complications, and optimize healthcare resources. Full article

Background: Sodium bicarbonate (SB) supplementation can enhance performance in short, high-intensity movements. However, its effectiveness in team sports such as rugby remains insufficiently explored. Methods: In this double-blind, parallel, controlled trial, 17 male professional rugby players ingested SB (0.3 g/kg) or a placebo 90 min before a high-intensity, rugby-specific training session monitored via GPS. The training session was conducted under real-world conditions to enhance ecological validity. Physical performance (countermovement jump, CMJ), fatigue markers (capillary lactate and ratings of perceived exertion, RPE), and gastrointestinal (GI) symptoms were assessed pre- and post-exercise. Results: No significant pre–post changes were observed in CMJ performance in either group. Lactate concentrations increased from pre- to post-exercise in both groups (both p < 0.001). The SB group showed higher GI symptom severity before, during and after exercise versus placebo, with several symptoms increasing over time solely in the SB group (p < 0.05). RPE increased similarly in both groups (SB: p = 0.012; PLA: p = 0.008). Due to the small sample size, only moderate-to-large within-group effects and very large between-group differences could be detected; therefore, the study was powered to detect moderate-to-large within-group effects but underpowered for detecting between-group differences. Conclusions: Acute SB ingestion at 0.3 g/kg did not result in detectable improvements in performance or fatigue markers during rugby-specific high-intensity training and was associated with a greater incidence of GI discomfort; however, the study was underpowered to detect small between-group differences. This study was registered on 23 May 2025 on ClinicalTrials.gov (NCT07017582). Full article

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care. Full article

Background/Objectives: Systemic sclerosis (SSc) patients frequently develop osteoporosis; however, vertebral fracture risk factors remain poorly characterized. This study identifies general and SSc-specific predictors of vertebral fractures in SSc patients undergoing osteoporosis evaluation. Methods: This multicenter cross-sectional study enrolled consecutive SSc patients meeting ACR/EULAR 2013 criteria with suspected osteoporosis. Data included demographics, disease characteristics, bone density (DXA), and vertebral imaging. Stepwise logistic regression analyzed fracture associations (p ≤ 0.05 significant). Results: The majority of 103 enrolled patients were female and all were post-menopausal. The prevalence of osteoporosis was 52.4%, that of vertebral fractures was 38.8%, and that of osteopenia was 28.1%. General risk factor analysis identified family history of fragility fractures (OR 11.8, p = 0.008) and vertebral T-scores (OR 0.6, p = 0.049) as significant predictors. When adding SSc-specific factors, only family history (OR 13.8, p = 0.03) and gastrointestinal (GI) involvement (OR 4.8, p = 0.05) remained significant. Conclusions: Vertebral fractures in SSc patients are strongly linked to a family history of fractures. The suggestive association with GI involvement may imply a significant role for malabsorption-related metabolic impairment. Prioritizing bone density screening in SSc patients with GI symptoms may enable earlier intervention and reduce fracture risk. Full article

Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent restriction or avoidance of food intake leading to clinically significant nutritional, medical, and/or psychosocial consequences, without associated body-image disturbance. Although historically described in pediatric populations, ARFID is increasingly recognized in adults, particularly among patients with gastrointestinal (GI) disorders. Emerging data demonstrate a strong bidirectional relationship between ARFID and GI disease—especially disorders of gut–brain interaction—where fear of GI symptoms commonly drives restrictive eating, and chronic undernutrition may worsen GI motility, visceral sensitivity, and symptom severity, reinforcing a self-perpetuating cycle. Despite growing recognition of ARFID in adult gastroenterology patients, evidence guiding nutritional management and the use of nutrition support therapies in this population remains limited. This narrative review synthesizes the current literature on the epidemiology, clinical features, and nutritional consequences of ARFID in adults with GI disease, with a focus on screening and diagnostic considerations relevant to GI clinicians and principles of multidisciplinary management. Particular attention is given to the role of nutrition support therapies, including oral nutritional supplementation, enteral nutrition, and parenteral nutrition. While oral strategies are foundational to nutritional rehabilitation, available evidence supporting enteral or parenteral nutrition in adults with ARFID is sparse and largely extrapolated from pediatric or retrospective studies. Expert guidelines caution against routine or prolonged use of invasive nutrition support due to risks of reinforcing food avoidance, medical complications, and poor long-term outcomes, recommending their use only in carefully selected, medically necessary, and time-limited circumstances. Overall, ARFID represents an underrecognized but clinically significant contributor to malnutrition and symptom burden in adult patients with GI disorders, underscoring the need for routine screening, individualized multidisciplinary care, and high-quality prospective research to inform evidence-based treatment guidelines. Full article

Background: The widespread use of antithrombotic therapies increases bleeding risk, particularly in patients with a high bleeding risk (HBR). Although proton pump inhibitors are recommended for lowering the risk of upper gastrointestinal (UGI) bleeding, the optimal agent and dosage remain uncertain. This study evaluated the efficacy and safety of low-dose rabeprazole (LORA, 5 mg) in reducing the incidence of GI-related adverse events in HBR patients receiving chronic antithrombotic therapy. Methods: This was a prospective, multicenter, interventional study that enrolled 909 South Korean patients receiving long-term antithrombotic therapy with HBR features including age ≥70 years, dual antiplatelet therapy, combined antithrombotic regimens, and prior GI bleeding. The primary endpoint was the incidence of significant GI events, including overt/occult bleeding and symptomatic peptic ulcer disease (PUD). Secondary endpoints included study drug discontinuation owing to GI adverse events, composite cardiovascular events, and all-cause mortality. Results: No patients had significant UGI bleeding or symptomatic PUD. The median adherence rate was 92.0% (interquartile range [IQR], 87.0–95.0). Drug discontinuation owing to GI symptoms occurred in 32 patients (3.52%) at a median of 81 days (IQR, 36–119 days). GI-related adverse events were reported in 3.96%, with diarrhea, epigastric discomfort, and constipation being the most common. Non-GI bleeding and cardiovascular composite events occurred in 0.33% (n = 3) each, with all-cause mortality at 0.55% (n = 5). Conclusions: Low-dose rabeprazole was associated with reduced GI complications in patients receiving chronic antithrombotic therapy, with a favorable safety profile and high adherence. Further studies with larger and broader populations are required to confirm these findings. Full article

Background/Objective: Women after cesarean delivery (CD) may feel discomfort and pain until the gastrointestinal (GI) activation. Standard care approaches following an elective cesarean delivery often fail to address the needs of patients. Nurses care for women after CD, managing their symptoms and promoting GI activity to prevent ileus. Randomized controlled trials (RCTs) have shown that gum chewing is an effective method compared to standard care. Additionally, pilot RCTs have found Paula method exercises to be beneficial in comparison to standard care. This study aims to compare the time of first flatus and first defecation between the Paula method group and the gum-chewing group in women after an elective CD. Methods: A randomized controlled trial was conducted with 90 women; forty-four women were randomized to the Paula method exercises, and forty-six to gum chewing. Both groups received standard care. The primary outcomes were the time to the passage of the first flatus and the time to the first defecation from the delivery. Results: There was no significant difference between groups in time to flatus or time to defecation, yet there was a median 8.2 h shortening of time to flatus in the Paula group (19.7 h [IQR 15.7–28.3] in the Paula group versus 27.9 h [IQR 17.6–38.2] in the gum-chewing group). In an exploratory analysis of the first 16 h post-cesarean delivery, the gum-chewing group showed a shorter time to passage of the first flatus compared to the Paula group. Conclusions: Gum chewing is recommended as part of the current guidelines to enhance recovery after surgery, yet it is not suitable for all. While the Paula method appears safe and demonstrates promise, definitive conclusions require validation from larger, adequately powered trials. Full article

Background/Objectives: Oral health-related quality of life (OHRQoL) is a complex topic, encompassing the medical, functional and psychosocial aspects of well-being, especially in the context of systemic conditions that can trigger oral cavity impairment. While this subject has been extensively investigated in adults, evidence remains limited in pediatric populations, particularly in children with leukemia who are at high risk for oral complications related to the disease itself and its treatment. Moreover, children and parent perceptions of oral health are essential for guiding preventive and personalized therapeutic strategies, yet they are poorly explored in this clinical context. The objective of this study was to assess OHRQoL in children with leukemia and gingival inflammation, and compare it with that of children without this systemic condition. Methods: This observational, cross-sectional, case–control study was conducted on 99 subjects, divided into two groups: the study group n = 49 leukemia subjects and the control group n = 50 subjects without oncologic pathology. Clinical examination of all subjects was performed and oral health status was evaluated using Oral Health Index-Simplified (OHI-S) and Gingival Index (GI). Parents filled out a personalized exploratory questionnaire, adapted after established scales, designed to capture the child’s perceived impact of certain leukemia-related gingivo-periodontal alterations, including pain, ulcerations, gingival bleeding and xerostomia. Data were analyzed using descriptive statistics, Pearson’s Chi-square test and comparative graphical analyses (IBM SPSS Statistics 26). Results: Children with leukemia reported higher frequencies of xerostomia, ulcerations and gingival bleeding compared to children in the control group, with xerostomia showing a suggestive association to gingival inflammation. Oral hygiene status of children in the leukemia group was generally better among children receiving parental assistance during brushing or those practicing dental flossing. Comparative graphical analyses showed differences in symptom reporting and oral hygiene support between groups. Conclusions: The results suggest that xerostomia seemed to align with gingival inflammation in children with leukemia, while parental assistance and dental flossing seemed to be associated with better oral hygiene status. Our findings also support the need for developing standardized, disease-oriented scales of evaluating OHRQoL, as well as individualized oral care and continuous monitoring in order to improve oral health-related quality of life in this vulnerable pediatric population. Full article