Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions accou...Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.展开更多
Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical ...Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.展开更多
Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease result...Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.展开更多
The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can i...The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.展开更多
There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.Thi...There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.This,in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches.In this context,the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations.This paper also points out the possibility of using adjuvant complementary medicine such as yoga,whose effects have been documented in other diseases like irritable bowel syndrome.A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal,to see whether the extraintestinal symptoms are alleviated.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.展开更多
The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodo...The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.展开更多
BACKGROUND Irritable bowel syndrome(IBS)symptoms are common in patients with inflammatory bowel disease(IBD),with systematic review reporting an overall pooled prevalence of 35-39%in patients with clinical remission.T...BACKGROUND Irritable bowel syndrome(IBS)symptoms are common in patients with inflammatory bowel disease(IBD),with systematic review reporting an overall pooled prevalence of 35-39%in patients with clinical remission.This subset of patients reports a reduced quality of life and increased anxiety and depression.A multistrain probiotic(Symprove™,Symprove Ltd,Farnham,United Kingdom)has been shown to improve overall symptom severity in patients with IBS and is associated with decreased intestinal inflammation in patients with ulcerative colitis(UC),but not in Crohn’s disease(CD).AIM To ascertain whether this multi-strain probiotic would be effective in an IBS/IBD overlap population.METHODS The treatment of symptoms in the absence of inflammation in inflammatory bowel diseases trial was a randomized,double-blind,placebo-controlled trial of a four-strain probiotic Symprove,containing Lactobacillus rhamnosus NCIMB 30174,Lactobacillus plantarum NCIMB 30173,Lactobacillus acidophilus NCIMB 30175 and Enterococcus faecium NCIMB 30176.The duration of the study was 3 months,at the end of which IBS-Symptom Severity Score(IBS-SSS)was repeated.Primary Endpoint was a 100-point reduction in IBS-SSS.RESULTS 61 participants were randomized into the intention-to-treat analysis.45%of patients receiving the active agent achieved the endpoint compared to 33%of those receiving placebo(P=0.42).In UC,50%of patients receiving placebo achieved the endpoint compared to 44%of those receiving the active agent(P=1.00).In CD 45%of those receiving the active agent achieved the endpoint compared to 29%of those receiving placebo(P=0.34).The mean change in IBS-SSS for patients receiving placebo was a reduction of 61 points,compared to a reduction in 90 points for patients receiving active agent(P=0.31).There was no difference between the groups with regard to IBD outcomes.CONCLUSION Probiotics may represent a safe and effective means of addressing the unmet clinical need for symptom relief in patients with overlapping IBS and IBD,especially in those with CD.展开更多
Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecys...Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecystoduodenal fistula.Since the rarity of gallstone ileus is associated with relatively high rates of morbidity and mortality in elderly patients with multiple comorbidities,making an early and accurate diagnosis in emergency settings crucial.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immu...Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patie...BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.展开更多
Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic ...Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.展开更多
Natural phytoconstituents exhibit distinct advantages in the management and prevention of inflammatory bowel disease(IBD),attributed to their robust biological activity,multi-target effects,and elevated safety profile...Natural phytoconstituents exhibit distinct advantages in the management and prevention of inflammatory bowel disease(IBD),attributed to their robust biological activity,multi-target effects,and elevated safety profile.Although promising,the clinical application of phytoconstituents have been impeded by poor water solubility,low oral bioavailability,and inadequate colonic targeting.Recent advancements in nanotechnology has offered prospective avenues for the application of phytoconstituents in the treatment of IBD.A common strategy involves encapsulating or conjugating phytoconstituents with nanocarriers to enhance their stability,prolong intestinal retention,and facilitate targeted delivery to colonic inflammatory tissues.Furthermore,drawing inspiration from the self-assembling nanostructures that emerge during the decoction process of Chinese herbs,a variety of natural active compounds-based nanoassemblies have been developed for the treatment of IBD.They exhibit high drug-loading capacities and surmount the challenges posed by poor water solubility and low bioavailability.Notably,phyto-derived nanovesicles,owing to their unique structure and biological functions,can serve as therapeutic agents or novel delivery vehicles for the treatment of IBD.Consequently,this review provides an extensive overview of emerging phytoconstituent-derived nano-medicines/vesicles for the treatment of IBD,intending to offer novel insights for the clinical management of IBD.展开更多
BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene...BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.展开更多
BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the...BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the Cochrane Library databases were searched from inception to March 2024.Eligible articles included observational studies that reported on outcomes such as mortality,colectomy,hospitalization,intensive care unit(ICU)admission,complication rates,and length of hospital stay in IBD patients with and without CDI.Data were extracted,and a randomeffects model was used to calculate pooled odds ratios(ORs)and mean differences(MDs).RESULTS As shown in the data from 21 studies with 1249158 participants,CDI significantly increased the risk of mortality in IBD patients[pooled OR=4.569,95%confidence intervals(95%CI):2.584 to 8.079].Although the pooled OR for colectomy was 1.409(95%CI:0.922 to 2.155),it was not statistically significant.Similarly,CDI did not impact hospitalization(pooled OR=1.056,95%CI:0.512 to 2.179)and ICU admission outcomes(pooled OR=1.970,95%CI:0.420 to 9.246)of patients with IBD.The rate of complications was comparable in the two groups(pooled OR=0.658,95%CI:0.378 to 1.147).However,CDI was associated with a significantly more extended hospital stay(pooled MD=0.349 days,95%CI:0.002 to 0.696).CONCLUSION CDI is linked to increased mortality and prolonged hospitalization in IBD patients.These results emphasize the need for early detection and appropriate management.Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.展开更多
Inflammatory bowel disease(IBD),encompassing Crohn's disease and ulcerative colitis,is a chronic condition marked by recurring gastrointestinal inflammation.While immune,genetic,and environmental factors are well-...Inflammatory bowel disease(IBD),encompassing Crohn's disease and ulcerative colitis,is a chronic condition marked by recurring gastrointestinal inflammation.While immune,genetic,and environmental factors are well-studied,the gut virome has received less attention.This editorial highlights the work which investigates the gut virome’s role in IBD and its interactions with the bacterial microbiome and host immune system.The gut virome consists of bacteriophages,eukaryotic viruses,and endogenous retroviruses.Among these,Caudovirales bacteriophages are predominant and influence bacterial communities via lysogenic and lytic cycles.Eukaryotic viruses infect host cells directly,while endogenous retroviruses impact gene regulation and immune responses.In IBD,the virome shows distinct alterations,including an increased abundance of Caudovirales phages and reduced Microviridae diversity,suggesting a pro-inflammatory viral environment.Dysbiosis,chronic inflammation,and aberrant immune responses contribute to these changes by disrupting microbial communities and modifying virome composition.Phages affect bacterial dynamics through lysis,lysogeny,and horizontal gene transfer,shaping microbial adaptability and resilience.Understanding these interactions is crucial for identifying novel therapeutic targets and restoring microbial balance in IBD.展开更多
BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to ...BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.展开更多
Inflammatory bowel disease(IBD),a chronic disorder characterized by intestinal inflammation and mucosal damage,includes mainly Crohn’s disease and ulcerative colitis.However,the cause of its onset remains unclear.The...Inflammatory bowel disease(IBD),a chronic disorder characterized by intestinal inflammation and mucosal damage,includes mainly Crohn’s disease and ulcerative colitis.However,the cause of its onset remains unclear.The pathogenesis of IBD is closely related to host genetic susceptibility,disorders of the intestinal flora,damage to the intestinal mucosal barrier,and abnormal intestinal mucosal immunity.On the basis of the progress in research on the structure of the intestinal microbiota involved in IBD,the influence of genetics on the intestinal barrier and intestinal microbiota;the metagenomics,metatranscriptomics,and metabolomics of the intestinal microbiota involved in IBD;and treatments such as probiotics and fecal microbiota transplantation are important for the future treatment of IBD and the development of drugs for effective treatment.展开更多
Inflammatory bowel disease(IBD)is a progressive multifactorial inflammatory disease of the gut.The cause of IBD is yet unknown.Some researchers have shown that genetic factors,environmental factors,and the gut microbi...Inflammatory bowel disease(IBD)is a progressive multifactorial inflammatory disease of the gut.The cause of IBD is yet unknown.Some researchers have shown that genetic factors,environmental factors,and the gut microbiome are significant considerations.Our gut contains gut virome and gut bacteria,which vary among individuals due to some factors.The gut virome is a substantial component of the microbiome.This editorial explores the emerging role of gut virome in IBD.展开更多
文摘Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.
文摘Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.
文摘The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.
文摘There is considerable controversy on the role of physical activity in irritable bowel disease(IBD)since published reports are conflicting.It is well known that there is known relapse with specific treatment in IBD.This,in addition to onset of extraintestinal symptoms creates a need to think of alternate approaches.In this context,the current article describes the need of a multi-institutional study with standard protocol of physical activity for documenting its effect on both the primary disease and the extra alimentary manifestations.This paper also points out the possibility of using adjuvant complementary medicine such as yoga,whose effects have been documented in other diseases like irritable bowel syndrome.A third approach could be to focus on the intestinal dysbiosis in IBD and concentrate on research on restoring the microbial flora to normal,to see whether the extraintestinal symptoms are alleviated.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
文摘The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.
文摘BACKGROUND Irritable bowel syndrome(IBS)symptoms are common in patients with inflammatory bowel disease(IBD),with systematic review reporting an overall pooled prevalence of 35-39%in patients with clinical remission.This subset of patients reports a reduced quality of life and increased anxiety and depression.A multistrain probiotic(Symprove™,Symprove Ltd,Farnham,United Kingdom)has been shown to improve overall symptom severity in patients with IBS and is associated with decreased intestinal inflammation in patients with ulcerative colitis(UC),but not in Crohn’s disease(CD).AIM To ascertain whether this multi-strain probiotic would be effective in an IBS/IBD overlap population.METHODS The treatment of symptoms in the absence of inflammation in inflammatory bowel diseases trial was a randomized,double-blind,placebo-controlled trial of a four-strain probiotic Symprove,containing Lactobacillus rhamnosus NCIMB 30174,Lactobacillus plantarum NCIMB 30173,Lactobacillus acidophilus NCIMB 30175 and Enterococcus faecium NCIMB 30176.The duration of the study was 3 months,at the end of which IBS-Symptom Severity Score(IBS-SSS)was repeated.Primary Endpoint was a 100-point reduction in IBS-SSS.RESULTS 61 participants were randomized into the intention-to-treat analysis.45%of patients receiving the active agent achieved the endpoint compared to 33%of those receiving placebo(P=0.42).In UC,50%of patients receiving placebo achieved the endpoint compared to 44%of those receiving the active agent(P=1.00).In CD 45%of those receiving the active agent achieved the endpoint compared to 29%of those receiving placebo(P=0.34).The mean change in IBS-SSS for patients receiving placebo was a reduction of 61 points,compared to a reduction in 90 points for patients receiving active agent(P=0.31).There was no difference between the groups with regard to IBD outcomes.CONCLUSION Probiotics may represent a safe and effective means of addressing the unmet clinical need for symptom relief in patients with overlapping IBS and IBD,especially in those with CD.
基金National Natural Science Foundation of China(81902379)Chenguang Program of Shanghai Education Development Foundation and Shanghai Municipal Education Commission(21CGA20)Cultivation Foundation of Renji Hospital(RJPY-LX-011).
文摘Gallstone ileus is an uncommon but life-threatening form of mechanical small bowel obstruction,[1]especially in elderly female patients.[2]It is caused by large gallstone impaction that enters the bowel via a cholecystoduodenal fistula.Since the rarity of gallstone ileus is associated with relatively high rates of morbidity and mortality in elderly patients with multiple comorbidities,making an early and accurate diagnosis in emergency settings crucial.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.
基金Supported by the China Health Promotion Foundation Young Doctors'Research Foundation for Inflammatory Bowel Disease,the Taishan Scholars Program of Shandong Province,China,No.tsqn202306343National Natural Science Foundation of China,No.82270578.
文摘BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.
文摘Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.
基金supported by the National Natural Science Foundation of China(Nos.82273824,31670359 and 82372111)the Liao Ning Revitalization Talents Program(No.XLYC 1905019)。
文摘Natural phytoconstituents exhibit distinct advantages in the management and prevention of inflammatory bowel disease(IBD),attributed to their robust biological activity,multi-target effects,and elevated safety profile.Although promising,the clinical application of phytoconstituents have been impeded by poor water solubility,low oral bioavailability,and inadequate colonic targeting.Recent advancements in nanotechnology has offered prospective avenues for the application of phytoconstituents in the treatment of IBD.A common strategy involves encapsulating or conjugating phytoconstituents with nanocarriers to enhance their stability,prolong intestinal retention,and facilitate targeted delivery to colonic inflammatory tissues.Furthermore,drawing inspiration from the self-assembling nanostructures that emerge during the decoction process of Chinese herbs,a variety of natural active compounds-based nanoassemblies have been developed for the treatment of IBD.They exhibit high drug-loading capacities and surmount the challenges posed by poor water solubility and low bioavailability.Notably,phyto-derived nanovesicles,owing to their unique structure and biological functions,can serve as therapeutic agents or novel delivery vehicles for the treatment of IBD.Consequently,this review provides an extensive overview of emerging phytoconstituent-derived nano-medicines/vesicles for the treatment of IBD,intending to offer novel insights for the clinical management of IBD.
基金Supported by Jiaxing Science and Technology Projects,No.2023AD31041。
文摘BACKGROUND Colonoscopic polypectomy is a crucial procedure for the prevention and treatment of colorectal cancer,with its success and safety largely dependent on the quality of bowel preparation.Currently,polyethylene glycol electrolyte solution remains the standard method for bowel preparation,but its use may cause patient discomfort and incomplete cleansing.AIM To evaluate impact of enhanced and conventional bowel preparation protocols on the outcomes of colonoscopic polypectomy.METHODS This retrospective cohort study collected data from 130 patients who underwent colonoscopic polypectomy between March 2023 and June 2024.Patients were divided into the conventional bowel preparation group(n=65)and enhanced bowel preparation group(n=65).Primary outcome measures included Boston Bowel Preparation Scale(BBPS)scores,procedure-related parameters,complication rates,and prognosis.Statistical analysis was performed using SPSS version 25.0,with P<0.05 indicating statistical significance.RESULTS The enhanced group demonstrated significant advantages over the conventional group,with higher BBPS total scores(4.2±0.7 vs 3.1±0.8,P<0.001),higher onetime complete resection rates(95.4%vs 83.1%,P=0.01),shorter operative times(23.1±4.8 vs 25.4±5.2 min,P=0.03),and lesser intraoperative blood loss(18.2±4.5 vs 20.3±5.1 mL,P=0.04).Total complication rates were significantly lower(5.9%vs 16.9%,P=0.05),particularly for bleeding(1.5%vs 16.9%,P=0.01)and infection(1.5%vs 7.7%,P=0.04).The enhanced group also showed lower 6-month recurrence rates(3.1%vs 10.8%,P=0.05)and higher patient satisfaction(87.7%vs 76.9%,P=0.04)than did the conventional group.CONCLUSION The enhanced bowel preparation protocol demonstrates significant advantages,particularly in improving surgical outcomes,reducing complications,and increasing patient satisfaction,underscoring its importance of its application during colonoscopic polypectomy.
文摘BACKGROUND Clostridium difficile infection(CDI)is common in patients with inflammatory bowel disease(IBD).AIM To assess the association of CDI with clinical outcomes of IBD.METHODS PubMed,EMBASE,Web of Science,and the Cochrane Library databases were searched from inception to March 2024.Eligible articles included observational studies that reported on outcomes such as mortality,colectomy,hospitalization,intensive care unit(ICU)admission,complication rates,and length of hospital stay in IBD patients with and without CDI.Data were extracted,and a randomeffects model was used to calculate pooled odds ratios(ORs)and mean differences(MDs).RESULTS As shown in the data from 21 studies with 1249158 participants,CDI significantly increased the risk of mortality in IBD patients[pooled OR=4.569,95%confidence intervals(95%CI):2.584 to 8.079].Although the pooled OR for colectomy was 1.409(95%CI:0.922 to 2.155),it was not statistically significant.Similarly,CDI did not impact hospitalization(pooled OR=1.056,95%CI:0.512 to 2.179)and ICU admission outcomes(pooled OR=1.970,95%CI:0.420 to 9.246)of patients with IBD.The rate of complications was comparable in the two groups(pooled OR=0.658,95%CI:0.378 to 1.147).However,CDI was associated with a significantly more extended hospital stay(pooled MD=0.349 days,95%CI:0.002 to 0.696).CONCLUSION CDI is linked to increased mortality and prolonged hospitalization in IBD patients.These results emphasize the need for early detection and appropriate management.Implementing routine CDI screening during IBD flare-ups and stringent infection control measures could mitigate severe complications and reduce the healthcare burden.
文摘Inflammatory bowel disease(IBD),encompassing Crohn's disease and ulcerative colitis,is a chronic condition marked by recurring gastrointestinal inflammation.While immune,genetic,and environmental factors are well-studied,the gut virome has received less attention.This editorial highlights the work which investigates the gut virome’s role in IBD and its interactions with the bacterial microbiome and host immune system.The gut virome consists of bacteriophages,eukaryotic viruses,and endogenous retroviruses.Among these,Caudovirales bacteriophages are predominant and influence bacterial communities via lysogenic and lytic cycles.Eukaryotic viruses infect host cells directly,while endogenous retroviruses impact gene regulation and immune responses.In IBD,the virome shows distinct alterations,including an increased abundance of Caudovirales phages and reduced Microviridae diversity,suggesting a pro-inflammatory viral environment.Dysbiosis,chronic inflammation,and aberrant immune responses contribute to these changes by disrupting microbial communities and modifying virome composition.Phages affect bacterial dynamics through lysis,lysogeny,and horizontal gene transfer,shaping microbial adaptability and resilience.Understanding these interactions is crucial for identifying novel therapeutic targets and restoring microbial balance in IBD.
文摘BACKGROUND Intestinal obstruction(IO)in pregnancy,though rare(1:1500-1:66000),carries high maternal(6%-10%)and fetal mortality(26%).Adhesions from prior surgery are the leading cause.Diagnosis is often delayed due to symptom overlap with nor-mal pregnancy,increasing risks of perforation and sepsis.CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation,feculent vomiting,and abdominal distension.She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma.The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings.Interventions included conservative measures(nasogastric tube decompression,enemas)followed by emergency laparotomy with bowel resec-tion/anastomosis.Despite surgical management,the patient succumbed to septic shock.CONCLUSION High clinical suspicion,expedited cross-sectional imaging(computed tomogra-phy/Magnetic resonance imaging),and emergent surgery are critical to reduce mortality.
基金Supported by the National Natural Science Foundation of China,No.82574996Shaanxi Province Traditional Chinese Medicine Research and Innovation Talent Plan Project,No.TZKN-CXRC-16+3 种基金Project of Shaanxi Administration of Traditional Chinese Medicine,No.SZYKJCYC-2025-JC-010Shaanxi Province Key Research and Development Plan Project-Social Development Field,No.2025SF-YBXM-498the“Nursery Cultivation Plan”Project of Shaanxi Provincial Academy of Chinese Medicine and Shaanxi Provincial Hospital of Traditional Chinese Medicine,No.2025-04the Fifth Batch of Outstanding Clinical Talents in Traditional Chinese Medicine Project of Shaanxi Province.
文摘Inflammatory bowel disease(IBD),a chronic disorder characterized by intestinal inflammation and mucosal damage,includes mainly Crohn’s disease and ulcerative colitis.However,the cause of its onset remains unclear.The pathogenesis of IBD is closely related to host genetic susceptibility,disorders of the intestinal flora,damage to the intestinal mucosal barrier,and abnormal intestinal mucosal immunity.On the basis of the progress in research on the structure of the intestinal microbiota involved in IBD,the influence of genetics on the intestinal barrier and intestinal microbiota;the metagenomics,metatranscriptomics,and metabolomics of the intestinal microbiota involved in IBD;and treatments such as probiotics and fecal microbiota transplantation are important for the future treatment of IBD and the development of drugs for effective treatment.
文摘Inflammatory bowel disease(IBD)is a progressive multifactorial inflammatory disease of the gut.The cause of IBD is yet unknown.Some researchers have shown that genetic factors,environmental factors,and the gut microbiome are significant considerations.Our gut contains gut virome and gut bacteria,which vary among individuals due to some factors.The gut virome is a substantial component of the microbiome.This editorial explores the emerging role of gut virome in IBD.
