Journal Description

Gastrointestinal Disorders

Gastrointestinal Disorders is an international, open access, peer-reviewed journal on gastroenterology, published quarterly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions; authors retain copyright.
High Visibility: indexed within Scopus, ESCI (Web of Science), FSTA, and other databases.
Journal Rank: CiteScore - Q2 (Immunology and Microbiology (miscellaneous))
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 21.3 days after submission; acceptance to publication is undertaken in 5.2 days (median values for papers published in this journal in the second half of 2023).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Reliable service: rigorous peer review and professional production.

Impact Factor: 0.7 (2022)

Imprint Information Journal Flyer Open Access ISSN: 2624-5647

Latest Articles

19 pages, 3777 KiB

Open AccessArticle

Prognostic Factors after Hepatectomy for Hepatocellular Carcinoma—The Importance of Pathological Immunophenotyping, the Steatohepatitic Subtype and the Impact of the Hepatic Pedicle Clamping

by Lorrane Viana, Rui Caetano Oliveira, Ricardo Martins, Henrique Alexandrino, Maria Augusta Cipriano and José Guilherme Tralhão

Gastrointest. Disord. 2024, 6(2), 402-420; https://doi.org/10.3390/gidisord6020027 - 15 Apr 2024

Abstract

Introduction: Hepatectomy (HP) is, along with liver transplantation, the only potentially curative treatment for Hepatocellular Carcinoma (HCC). The high prevalence of Metabolic Syndrome (MS) may be causing a shift in the HCC spectrum. Hepatic Pedicle Clamping (HPC), used to reduce perioperative bleeding during HP, has been theorized to increase the risk of recurrence. Cytokeratin 19 (CK19) and glypican-3 (GLP-3) have been identified as markers of worse prognosis in HCC. Materials and Methods: A clinical and pathological review of 59 patients undergoing HP for HCC between 2005 and 2013 was performed. Chronic liver disease was observed in 53 patients (89.8%), with cirrhosis in 54.2% [most frequent etiologies: ethylism (47.5%), HCV (25.4%) and HBV (11.9%)]. MS was in 36% of patients. In addition, 95% of patients had Child–Pugh class A and 5% class B, and there was a median MELD of 8 (6–18). A single nodule was observed in 46 patients (78%) with an average size of 5.4 cm. Microscopic vascular invasion (MiVI) was in 49% of patients and macroscopic (MaVI) in 17. HPC was in 43 patients (74.1%). Statistical analysis was performed with SPSS™ 21.0. Survival tests (Kaplan–Meier, log-rank and Cox regression). Statistical significance was with p < 0.05. Results: Major morbidity in 22% of patients. Mortality in 5.1%. Median overall survival (OS) of 71 months and median disease-free survival (DFS) of 37. In a multivariate analysis: MaVI (p = 0.001), MiVI (p = 0.005) and HCV infection (p = 0.002) were associated with worse OS; MS was associated with better OS (p = 0.001); MaVI (p = 0.000), MiVI (p = 0.035) and HPC (p = 0.012) were associated with worse DFS. CK19+/GLP-3− (p = 0.007) and CK19−/GLP-3+ (p = 0.029) patients were associated with worse DFS and CK19−/GLP-3− (p = 0.031) with better DFS. Discussion/Conclusions: HPC was an independent factor of worse DFS. The ischemia-reperfusion injury (IRI) produced by HPC could promote a more angiogenic and angioinvasive phenotype of tumor cells, resulting in higher recurrence. HCV etiology was associated with worse OS. MS was associated with better OS, highlighting the importance of a hepatectomy in these cases. The combined detection of CK19 and GLP-3 was an independent prognostic factor in HCC patients allowing for the identification of more aggressive tumors. Full article

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22 pages, 2307 KiB

Open AccessReview

Focused Ultrasound as Targeted Therapy for Colorectal Cancer: A Comprehensive Review

by Muhammad Awais Farooqi, Mahnoor Mahnoor, Kaylee Marie Delgado, Wylie Thien-Tam Dahlgren, Chul-Ung Kang and Hafiz Muhammad Umer Farooqi

Gastrointest. Disord. 2024, 6(2), 380-401; https://doi.org/10.3390/gidisord6020026 - 13 Apr 2024

Abstract

Traditional cancer treatments have not significantly improved the survival rates for individuals with colorectal cancer. As a result, there is a dire need to explore novel treatment modalities that can target cancer-specific niches, transform cold colorectal tumors into hot ones, and disrupt the tumor niche. Therapeutic focused ultrasound, recognized for its capacity to induce thermal and mechanical impacts on tissue, can potentially eliminate cancer cells and elicit the body’s anticancer reaction by disrupting the tumor microenvironment. This article provides an overview of recent developments in employing therapeutic focused ultrasound (TFUS) to enhance the body’s natural defenses against colorectal cancers. It also discusses studies examining the utility of TFUS in treating colorectal cancer patients and recent research indicating its potential to stimulate the body’s anticancer response in various in vitro and in vivo colorectal cancer models. Furthermore, it explores the therapeutic effects of TFUS on the immune system in colorectal cancers. This article also highlights the safety and effectiveness of TFUS in managing colorectal cancer, providing relief from pain, and potentially improving survival rates. Given the indications that TFUS may bolster the body’s immune response and augment the impacts of TFUS therapy in clinical and preclinical colorectal cancer models, it has the potential to emerge as a pivotal tool in clinical settings. Full article

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12 pages, 1073 KiB

Open AccessReview

Enteric Nervous System Alterations in Inflammatory Bowel Disease: Perspectives and Implications

by Shubhankar Suman

Gastrointest. Disord. 2024, 6(2), 368-379; https://doi.org/10.3390/gidisord6020025 - 28 Mar 2024

Abstract

The enteric nervous system (ENS), consisting of neurons and glial cells, is situated along the gastrointestinal (GI) tract’s wall and plays a crucial role in coordinating digestive processes. Recent research suggests that the optimal functioning of the GI system relies on intricate connections between the ENS, the intestinal epithelium, the immune system, the intestinal microbiome, and the central nervous system (CNS). Inflammatory bowel disease (IBD) encompasses a group of chronic inflammatory disorders, such as Crohn’s disease (CD) and ulcerative colitis (UC), characterized by recurring inflammation and damage to the GI tract. This review explores emerging research in the dynamic field of IBD and sheds light on the potential role of ENS alterations in both the etiology and management of IBD. Specifically, we delve into IBD-induced enteric glial cell (EGC) activation and its implications for persistent enteric gliosis, elucidating how this activation disrupts GI function through alterations in the gut–brain axis (GBA). Additionally, we examine IBD-associated ENS alterations, focusing on EGC senescence and the acquisition of the senescence-associated secretory phenotype (SASP). We highlight the pivotal role of these changes in persistent GI inflammation and the recurrence of IBD. Finally, we discuss potential therapeutic interventions involving senotherapeutic agents, providing insights into potential avenues for managing IBD by targeting ENS-related mechanisms. This approach might represent a potential alternative to managing IBD and advance treatment of this multifaceted disease. Full article

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9 pages, 1166 KiB

Open AccessBrief Report

Bowel Cleansing Preparations Are Associated with Gastroduodenal Lesions

by Anas Khouri, Cesar G. Moreno and Jack A. Di Palma

Gastrointest. Disord. 2024, 6(1), 359-367; https://doi.org/10.3390/gidisord6010024 - 15 Mar 2024

Abstract

Background: During esophagogastroduodenoscopy performed with colonoscopy, gastric and duodenal erythema, erosions, and ulcerations are often observed. This investigation was designed to review the prevalence of gastroduodenal lesions in patients who have undergone wireless capsule endoscopy using standard bowel cleansing preparations, but no endoscopy or sedation. Methods: A retrospective analysis was conducted on patients referred for capsule endoscopy. Records and capsule reports were reviewed for the patient demographics, preparation prescribed, procedural indications, and gastroduodenal findings. The preparations studied included polyethylene glycol lavage (PEG), PEG plus bisacodyl (PEG + bis), bisacodyl (bis), oral sulfate solution (OSS), and no prep. Results: Among the 1236 records, 498 (40.3%) were men and 738 (59.7%) were women. The mean age was 56 years +/− 18 years SD. The percentage of patients with lesions after any bowel preparation was 52.7% for gastric lesions and 23.6% for duodenal lesions. The percentage of patients with gastroduodenal lesions was 58.3% with prep, compared to 38.2% without prep. These findings were statistically significant, with an RR of 1.53 [1.19–1.94] (p-value = 0.00004). This difference was more pronounced in the OSS group RR of 1.65 [1.29–2.1] and bisacodyl group RR of 1.64 [1.25–2.15] compared to the PEG group RR of 0.95 [0.7–1.3]. Conclusions: This study showed that patients undergoing wireless capsule endoscopy who received bowel preparations had a significant increase in gastric and duodenal lesions. Of the preparations studied, OSS was associated with a greater number of gastroduodenal lesions, while PEG was the least associated with lesions, with an occurrence similar to the non-prep group. The clinical significance of these lesions remains undetermined. Endoscopists should be aware that preparations are associated with gastroduodenal lesions to avoid the misinterpretation and misdiagnosis of these lesions. Full article

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22 pages, 1394 KiB

Open AccessReview

A Critical Review on In Vitro and Ex Vivo Models of the Intestinal Epithelium of Humans and Monogastric Animals

by Célia Maria Costa, Nelson Mota de Carvalho, Diana Luazi de Oliveira and Ana Raquel Madureira

Gastrointest. Disord. 2024, 6(1), 337-358; https://doi.org/10.3390/gidisord6010023 - 14 Mar 2024

Abstract

Recently, the bioactive potential of several functional ingredients and biomolecules has been evaluated regarding human and animal nutrition. The digestive process from food intake to absorption and metabolism are important events that induce changes in ingredients, which affect their bioactivity. Consequently, there is a need to assess the bioavailability and bioaccessibility of these compounds. The methodology for the simulation of the human gastrointestinal tract has been standardized (INFOGEST protocol), while a gastrointestinal protocol for other animals (e.g., ruminants or broilers) has yet to be established. However, INFOGEST allows us only to predict bioaccessibility, leaving a gap regarding a methodology able to assess bioavailability by mimicking intestinal permeability and absorption. Several approaches—including in vitro, ex vivo, in situ and in vivo methods—can be found in the literature, aiming to tackle transepithelial routes, but leading to different results concerning the bioefficiency of the compounds studied. Therefore, this review aims to assess the current state-of-the-art regarding monogastric intestinal dynamics, absorption, and permeability events. Moreover, it compiled methodologies for simulating intestinal absorption in several biological systems, while reasoning their advantages, disadvantages, applications in ingredient development and the existing gaps. Full article

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25 pages, 1338 KiB

Open AccessReview

Main Disorders of Gastrointestinal Tract in Older People: An Overview

by Antonella Gallo, Simona Pellegrino, Erika Pero, Maria Chiara Agnitelli, Caterina Parlangeli, Francesco Landi and Massimo Montalto

Gastrointest. Disord. 2024, 6(1), 313-336; https://doi.org/10.3390/gidisord6010022 - 10 Mar 2024

Abstract

From a physiological standpoint, aging is a progressive reduction in each organ system’s capacity to maintain homeostasis in the face of illness or stressors. With advancing age, gastrointestinal (GI) symptoms and signs may increase, not only due to the aging processes but also to the superimposed effects of comorbidities, which can badly affect digestive functions (i.e., diabetes, malignancy, etc.) and environmental exposure. In general, gastrointestinal symptoms in older people more often underlie organic pathologies, while GI functional disorders are less frequently diagnosed in this age group. Moreover, gastrointestinal disease can also present in a nuanced and atypical manner, making the diagnostic hypothesis and, consequently, the correct diagnosis and therapy more challenging. In addition, with reference to this age group, the clinical implications of gastrointestinal pathologies can be more severe due to a decreased physiologic reserve, with a higher risk for malnutrition resulting in falls, depression, social isolation, and a deterioration of functional status. In this review, we focused on the most frequent GI tract disorders, highlighting the main age-related changes, their epidemiological, pathophysiological and clinical implications, and any differences with younger patients. Full article

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5 pages, 223 KiB

Open AccessEditorial

Editorial: Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment

by Angharad Vernon-Roberts, Mark Safe and Andrew S. Day

Gastrointest. Disord. 2024, 6(1), 308-312; https://doi.org/10.3390/gidisord6010021 - 08 Mar 2024

Abstract

Functional gastrointestinal disorders (FGIDs) are classified as those with no organic cause and those not attributable to structural or biochemical abnormalities [...] Full article

(This article belongs to the Special Issue Pediatric Functional Gastrointestinal Disorders: Challenges in Diagnosis and Treatment)

16 pages, 2735 KiB

Open AccessArticle

Detection of Ulcerative Colitis Lesions from Weakly Annotated Colonoscopy Videos Using Bounding Boxes

by Safaa Al-Ali, John Chaussard, Sébastien Li-Thiao-Té, Éric Ogier-Denis, Alice Percy-du-Sert, Xavier Treton and Hatem Zaag

Gastrointest. Disord. 2024, 6(1), 292-307; https://doi.org/10.3390/gidisord6010020 - 07 Mar 2024

Abstract

Ulcerative colitis is a chronic disease characterized by bleeding and ulcers in the colon. Disease severity assessment via colonoscopy videos is time-consuming and only focuses on the most severe lesions. Automated detection methods enable fine-grained assessment but depend on the training set quality. To suit the local clinical setup, an internal training dataset containing only rough bounding box annotations around lesions was utilized. Following previous works, we propose to use linear models in suitable color spaces to detect lesions. We introduce an efficient sampling scheme for exploring the set of linear classifiers and removing trivial models i.e., those showing zero false negative or positive ratios. Bounding boxes lead to exaggerated false detection ratios due to mislabeled pixels, especially in the corners, resulting in decreased model accuracy. Therefore, we propose to evaluate the model sensitivity on the annotation level instead of the pixel level. Our sampling strategy can eliminate up to 25% of trivial models. Despite the limited quality of annotations, the detectors achieved better performance in comparison with the state-of-the-art methods. When tested on a small subset of endoscopic images, the best models exhibit low variability. However, the inter-patient model performance was variable suggesting that appearance normalization is critical in this context. Full article

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35 pages, 30758 KiB

Open AccessReview

Mesenchymal Tumors of the Gastrointestinal Tract—Beyond GIST—A Review

by João Martins Gama and Rui Caetano Oliveira

Gastrointest. Disord. 2024, 6(1), 257-291; https://doi.org/10.3390/gidisord6010019 - 04 Mar 2024

Abstract

Sarcomas are rare lesions and encompass a wide variety of entities, depending on their nature. In recent years new entities have been described and new knowledge, especially that provided by molecular studies, has been increasing. This makes it very difficult to be updated with all the described entities, since only some of the centers have the desired ancillary studies for the correct diagnosis. Some lesions are extremely rare and may appear once or twice during the lifetime of a general pathologist. When we refer to sarcomas of the gastrointestinal tract, the gastrointestinal stromal tumor (GIST) is the most well-known lesion that the pathologist will most frequently find in daily practice. This paper aims to comprehensively review the sarcomas associated with the gastrointestinal tract, emphasizing histopathology and going beyond GIST. This review highlights the histopathology of rare types of sarcomas so it may increase awareness of common and rare lesions, prompting an easy and effective diagnosis. Full article

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16 pages, 318 KiB

Open AccessReview

Biologics in Focus: A Comprehensive Review of the Current Biological Therapies for Ulcerative Colitis in the United Arab Emirates (UAE)

by Ahmed El-Sayed, Ceyhun Oztumer, Camellia Richards, Omar-Adam Salim, Mathuri Sivakumar and Laith Alrubaiy

Gastrointest. Disord. 2024, 6(1), 241-256; https://doi.org/10.3390/gidisord6010018 - 01 Mar 2024

Abstract

Background: Ulcerative colitis (UC) is a relapsing–remitting inflammatory condition that has an increasing incidence across the world, including in the Middle East. Biological monoclonal antibody drugs (biologics) have been shown to be advantageous in treating UC. We undertook a review of the currently available biological and small-molecule therapies, with a particular emphasis on those currently licensed in the United Arab Emirates (UAE). Methods: We conducted a literature search for studies on biological therapies using the PubMed, MEDLINE, and Embase databases using a list of keywords that were generated following referral to existing treatment guidelines for UC. Papers looking at biological and small-molecule treatments for UC in adult populations were included. Pediatric, pregnancy, and cost-effectiveness studies were excluded. Results and Discussion: There are currently three classes of biologics (anti-tumor necrosis factors (anti-TNFs), anti-integrins, and anti-interleukins) and one class of small-molecule therapy (Janus kinase (JAK) inhibitor) licensed for UC treatment in the UAE. Within the anti-TNF class, three medications have been approved: infliximab, adalimumab, and golimumab. For JAK inhibitors, there are two: tofacitinib and upadacitinib. There is only one licensed medication in the remaining classes: vedolizumab (anti-integrin) and ustekinumab (anti-interleukin). The length of studies varied from 6–8 weeks for induction studies and 52 weeks for maintenance studies. The studies demonstrated increased efficacy in these medications compared to placebos when clinical response, clinical remission, and other secondary measures such as mucosal healing were assessed following the induction and maintenance phases. Biosimilars of infliximab and adalimumab are also available for treating UC, and their safety and efficacy were compared to their biologic originators. Conclusions: The introduction of biologics has been proven to be beneficial for the treatment of UC. This review summarizes the efficacy and safety of each biological class in the treatment of the disease; however, biological drug registries and further studies are required to offer more insight into the comparative efficacy and safety of these agents. Full article

11 pages, 1615 KiB

Open AccessArticle

Prospective Visual Inspection of the Ventrum of Tongue (VIVOT) Vasculature Predicts the Presence of Esophageal Varices

by Martin Tobi, Monina Pascua, Rebecca Rodriguez, Yu-Xiao Yang, John Lieb, Douglas Weinstein and David E. Kaplan

Gastrointest. Disord. 2024, 6(1), 230-240; https://doi.org/10.3390/gidisord6010017 - 26 Feb 2024

Abstract

Venous collateral shunting of blood from the splanchnic to systemic venous systems due to portal hypertension increases the pressure in the ventral lingual venous bed. We hypothesized that the appearance of sublingual varices evaluated by pre-endoscopy/bedside visual inspection of ventrum of tongue (VIVOT) might predict the presence of esophageal varices (EVs). Methods: To test this hypothesis, we prospectively enrolled patients with cirrhosis (CP) referred for EV screening for assessment of lingual vasculature after informed consent. Non-cirrhosis control patients were also enrolled. Methods: VIVOT was scored based on the presence of vessels > 2 mm and/or serpiginous veins. VIVOT scores were then correlated with endoscopic findings. Results: A total of 59 patients with cirrhosis (Group 1) were enrolled, as were 62 patients without cirrhosis (Group 2). Group 1 consisted of 100% male patients with mean age 59.5 ± 5.4 years; 39.0% were African American (AA). Group 2 consisted of 86% male patients, 59.0 ± 13 years and 53% AA. Among Group 1 patients, varices were present in 29% (16 esophageal and 3 gastric). There were no demographic differences among Group 1 patients with or without varices. Positive VIVOT scores were associated with EVs on endoscopy in 11 of 16 patients (sensitivity 68.75%). Positive VIVOT findings were present in 8 of 40 patients without EVs (specificity 80%). False-positive VIVOT scores were present in 6 of 62 non-cirrhotic controls. Overall, the positive predictive value among patients with cirrhosis was 59% with a negative predictive value of 84%. Conclusions: VIVOT has modest values in predicting EVs and should not be used alone to stratify patients for endoscopic evaluation when elastography and laboratory tests are available; however, its use in resource-limited settings to identify high-risk patients may be considered. Full article

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16 pages, 898 KiB

Open AccessReview

Diabetic Gastroparesis: Navigating Pathophysiology and Nutritional Interventions

by Alfredo Caturano, Massimiliano Cavallo, Davide Nilo, Gaetano Vaudo, Vincenzo Russo, Raffaele Galiero, Luca Rinaldi, Raffaele Marfella, Marcellino Monda, Giovanni Luca and Ferdinando Carlo Sasso

Gastrointest. Disord. 2024, 6(1), 214-229; https://doi.org/10.3390/gidisord6010016 - 22 Feb 2024

Abstract

Diabetic gastroparesis (DGP) delays gastric emptying in diabetes patients, notably impacting those with type 1 and long-standing type 2 diabetes. Symptoms include early satiety, fullness, appetite loss, bloating, abdominal pain, and vomiting, arising from slow stomach-to-intestine food movement. DGP’s unpredictable nature complicates diagnosis and blood glucose management, leading to severe complications like dehydration, malnutrition, and bezoar formation. Understanding DGP’s mechanisms is crucial for effective management. Vagal dysfunction, disturbances in the interstitial cells of Cajal, reduced neural nitric oxide synthase, and increased oxidative stress contribute to the complex pathophysiology. Accurate diagnosis demands a comprehensive approach, utilizing tools like gastric scintigraphy and the Gastric Emptying Breath Test. Considering the complex relationship between DGP and glycemia, managing blood glucose levels becomes paramount. Nutritional interventions, tailored to each patient, address malnutrition risks, emphasizing smaller, more frequent meals and liquid consistency. DGP’s complex nature necessitates collaborative efforts for enhanced diagnostic strategies, improved pathophysiological understanding, and compassionate management approaches. This comprehensive approach offers hope for a future where individuals with DGP can experience improved well-being and quality of life. Full article

(This article belongs to the Special Issue Feature Papers in Gastrointestinal Disorders in 2023-2024)

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12 pages, 1243 KiB

Open AccessArticle

An Evaluation of the Efficacy and Safety of TAMIXAM^®, Based on Hyaluronic Acid and Tamarind Seed Extract, for Esophageal Mucosal Protection from Acid Insult

by Marisa Francesca Motta, Giuseppe Pulitano, Antonino Bagnulo, Giampaolo Buriani, Umberto Di Maio, Fabio Amone, Vincenzo Nobile and Rocco Malivindi

Gastrointest. Disord. 2024, 6(1), 202-213; https://doi.org/10.3390/gidisord6010015 - 18 Feb 2024

Abstract

TAMIXAM^® is a novel technology that combines hyaluronic acid and tamarind seed extract in its formulation. It is designed to protect the esophageal mucosa by creating a barrier through its filmogenic properties. The aim of this study is to evaluate the safety and efficacy of this technology through mucoadhesion tests, a cell viability assay, TEER measurements, and morphological analysis on reconstructed esophageal mucosa exposed to 10% hydrochloric acid before and after treatment. The mucoadhesion test highlighted the synergistic bioadhesive effect of the technology’s components. Cell viability assays revealed the substantial mucoprotective and barrier effects of the technology, preserving tissue viability when applied before exposure to acid insult. A morphological analysis illustrated TAMIXAM^®’s efficacy in countering acid-induced damage, reducing erosion, necrosis, and tissue degeneration compared to the positive control, both pre- and post-acid insult. An evaluation of epithelial integrity through TEER measurements indicated a minimal reduction in tissues treated with the invention before acid exposure, demonstrating its ability to maintain epithelial integrity in the presence of an acid insult. However, this effect was less pronounced in tissues treated with the technology after the acid insult, implying a potential partial recovery of epithelial integrity. Furthermore, comprehensive in vitro and in vivo studies supported the safety profile of the invention. In conclusion, TAMIXAM^® emerged as a compelling solution, providing enhanced mechanical action to maintain epithelial balance and shield the esophageal mucosa from acid-induced damage. Full article

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11 pages, 464 KiB

Open AccessArticle

Investigating the Role of Gastrointestinal-Specific Anxiety and Perceived Disability in the Adjustment to Inflammatory Bowel Disease

by Angela Seaman and Nuno Ferreira

Gastrointest. Disord. 2024, 6(1), 191-201; https://doi.org/10.3390/gidisord6010014 - 17 Feb 2024

Abstract

In this study, an exploratory model was tested to investigate the mediating role of gastrointestinal-specific anxiety and perceived disability in the relation between disease activity and the outcomes of quality of life and depression in patients with inflammatory bowel disease (IBD). In a cross-sectional design, data from an online survey of patients with IBD (over the age of 16) recruited through a UK-based IBD charity were used to test a model of serial mediation. Measures targeted disease activity (self-reported), gastrointestinal-specific anxiety (Visceral Sensitivity Index), perceived disability (Perceived Disability Scale), IBD-specific quality of life (UK Inflammatory Bowel Disease Questionnaire), and depression (Depression subscale of the Depression, Anxiety, and Stress Scale). The theoretical model was investigated using model 6 of the PROCESS macro for SPSS. Bootstrapped 95% confidence intervals were constructed for each estimate A total of 320 participants provided valid responses to the survey. Gastrointestinal-specific anxiety and perceived disability were found to serially mediate the relationship between disease activity and quality of life (95%CI = −0.80 to −0.19) and disease activity and depression (95%CI = 0.13 to 0.59). Findings suggested that the effect of multiple psychosocial variables in the experience of people living with IBD and its respective outcomes should be taken into account when planning treatment. The theoretical and clinical implications of these findings are discussed. Full article

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11 pages, 549 KiB

Open AccessReview

Metabolic Endoscopy: Should Gastroenterologists Be Treating Type 2 Diabetes?

by Benjamin Charles Norton, Apostolis Papaefthymiou, Andrea Telese, Ritwika Mallik, Alberto Murino, Gavin Johnson, Charles Murray, Janine Makaronidis and Rehan Haidry

Gastrointest. Disord. 2024, 6(1), 180-190; https://doi.org/10.3390/gidisord6010013 - 15 Feb 2024

Abstract

Type 2 diabetes (T2D) is one of the most significant and fast-growing health challenges of the 21st century. Despite the variety of available glucose-lowering agents, many patients do not attain or maintain adequate glycaemic control. Bariatric surgery demonstrates a profound anti-diabetic effect, which is almost immediate and weight-loss independent. The significant improvement in diabetes after bariatric surgery together with the endoscopic accessibility of the duodenum has led to the development of new metabolic endoscopic procedures that capitalise on the importance of the proximal small bowel in glycaemic control. Clinical trials have shown a clear efficacy signal, and now, several devices are undergoing evaluation as primary T2D treatments. Establishing where these procedures fit into the treatment algorithms for T2D and how they can be combined with modern pharmacotherapies is needed in a rapidly changing landscape. Ultimately, through metabolic endoscopy, gastroenterologists are on the cusp of providing safe and effective treatments for the multidisciplinary management of T2D. Full article

16 pages, 1177 KiB

Open AccessReview

The Influence of Ultra-Processed Food on Colorectal Cancer: A Systematic Review

by Rocío Caceres-Matos, Aurora Castro-Méndez, Marina García Domínguez, Daniel Pabón-Carrasco and Manuel Pabón-Carrasco

Gastrointest. Disord. 2024, 6(1), 164-179; https://doi.org/10.3390/gidisord6010012 - 08 Feb 2024

Abstract

Colorectal cancer (CRC) is a disease characterised by the development of malignant tumours in the colon or rectum; it is considered the most common cancer in women, and up to 50% of cases can be prevented with a healthy lifestyle. Nutritional habits are related to its appearance, and the current trend of an increased consumption of ultra-processed foods (UPFs) has led to a surge in the incidence of CRC in recent years. This systematic review aims to evaluate, based on scientific evidence, the role of UPF in the incidence of CRC. The PubMed, Scopus, CINAHL, and Web of Science databases were reviewed, and a total of 24 scientific articles were selected according to the inclusion and exclusion criteria of this review (studies from the past 5 years and observational studies in English). The conclusions of this study point to an association between UPF-based diets and the appearance of CRC, which is promoted by the harmful effects of the consumption of high levels of sugar, fat, red meat, and additives. These dietary habits, coupled with a sedentary lifestyle and obesity, further increase the incidence of CRC. Full article

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12 pages, 525 KiB

Open AccessArticle

A Multiparametric Method Improves the Serological Characterization of Inflammatory Bowel Diseases: Preliminary Results from a Multicenter Eastern Europe Study

by Nikola Panic, Marco Marino, Goran Hauser, Silvia Jacobsen, Francesco Curcio, Francesco Meroi, Adriana Cifù, Eleonora Castagnaviz, Cinzia Pistis, Giovanni Terrosu, Milutin Bulajic, Salvatore Francesco Vadalà di Prampero, Dino Tarabar, Irena Krznaric-Zrnic, Gordana Kovacevic, Ivan Ranković and Martina Fabris

Gastrointest. Disord. 2024, 6(1), 152-163; https://doi.org/10.3390/gidisord6010011 - 29 Jan 2024

Abstract

The serological support for early diagnosis and differential diagnosis of inflammatory bowel diseases (IBDs) is actually very limited. In this study, we evaluated the performance of a promising multiparametric method including either well-established and newly developed biomarkers. We conducted a multicenter cross-sectional study at the Gastroenterology Units of Udine (Italy), Rijeka (Croatia) and Belgrade (Serbia). Sera was collected from IBD patients, and autoantibody profiles were determined using a mosaic cell and tissue-based indirect immunofluorescence (IIF) method simultaneously investigating anti-saccharomyces cerevisiae antibodies (ASCAs), anti-atypical perinuclear neutrophilic antibodies (P-ANCAs), anti-pancreatic antigens antibodies (PABs) and anti-goblet cells antibodies (GAB). The study finally enrolled 156 patients with IBD: 100 affected by Crohn’s disease (CD) and 56 by ulcerative colitis (UC). Twenty age-sex matched blood donors (BDs) were included as controls. PAB (anti-CUZD1 and/or anti-GP2 antibodies) were present in 24 CD patients versus none of the UC patients or BDs (24% sensitivity, 100% specificity). As regards CD patients, combined positivity of PAB and ASCA (sensitivity 84%, specificity 71.4%) performed better than ASCA alone. Colon involvement (87.5% vs. 60.5%; p = 0.014), deep mucosal lesions (58.3% vs. 25.0%; p = 0.002) and need for biologic therapies (79.2% vs. 46.1%; p = 0.005) were significantly more prevalent in PAB-positive than in PAB-negative CD patients. Multivariate analysis identified PAB positivity (OR = 3.67; 95%CI = 1.29–10.46) and anti-CUZD1 in particular (OR = 3.54; 95%CI = 1.08–11.63) as significant risk factors for deep mucosal lesion development in CD. A multiparametric diagnostic approach appears very useful to better characterize IBD patients. PABs, whether isolated or combined with other autoantibodies, may support differential diagnosis but above all facilitate the selection of CD patients at risk for more severe disease. Full article

(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice)

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9 pages, 236 KiB

Open AccessStudy Protocol

Developing a Core Outcome Set for Cytoreductive Surgery for Colorectal Cancer with Peritoneal Metastases: A Mixed-Method Study Protocol

by Pratik Raichurkar, Kilian Brown, Nabila Ansari, Cherry Koh, Nima Ahmadi, Michael Solomon, Brendan Moran and Daniel Steffens

Gastrointest. Disord. 2024, 6(1), 143-151; https://doi.org/10.3390/gidisord6010010 - 18 Jan 2024

Abstract

As the number of centres offering cytoreductive surgery (CRS) for colorectal cancer with peritoneal metastases (CPMs) is increasing worldwide, research is focused on establishing better patient selection and ensuring that new techniques have positive impacts on survival. However, high-impact comparative research in this field is limited by the heterogeneity of outcome measurement and reporting. Additionally, as there are comparatively few randomised controlled trials reporting comprehensive patient-reported outcomes, it is possible that key stakeholders such as patients and carers are underrepresented in the current literature. A core outcome set (COS) for CRS with or without intraperitoneal chemotherapy for the treatment of CPMs, supported by clinicians and patients, will promote homogenous comparison across trials and optimise the utility of research findings. We have established a comprehensive protocol based on the Core Outcome Measures in Effectiveness Trials (COMETs) method to facilitate this. A systematic review will identify all the outcomes reported in the literature, whereas a semi-structured interview will identify outcomes considered important by patients and carers. The identified outcomes will populate an international Delhi survey, distributed to patients, carers, surgeons, oncologists, nurses, and allied health clinicians. Outcomes reaching international consensus of importance will be further discussed in a face-to-face workshop between patients, carers, and clinicians. This process will inform the development of a final COS for CRS for patients with CPMs. Full article

12 pages, 3448 KiB

Open AccessReview

Endoscopic Management of Gastric Disruptions

by Veeral M. Oza and Truptesh H. Kothari

Gastrointest. Disord. 2024, 6(1), 131-142; https://doi.org/10.3390/gidisord6010009 - 11 Jan 2024

Abstract

Gastric perforations and leaks are significant complications that can arise from various gastrointestinal disorders and surgical interventions. Over the past decade, endoscopic techniques have emerged as an effective method for managing these conditions. Furthermore, as endoscopic resection techniques have grown in popularity, the risk of acute and delayed perforations has also grown. This review aims to provide an in-depth analysis of the endoscopic management strategies employed in the management of gastric perforations and leaks. We will discuss the etiology, diagnostic modalities, and various endoscopic techniques utilized, as well as emerging trends in endoscopic management. Our attempt in writing this review paper is to educate and guide clinicians in making informed decisions when faced with gastric perforations and leaks. Full article

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17 pages, 581 KiB

Open AccessSystematic Review

Probiotic Interventions in Coeliac Disease: A Systematic Review with a Focus on Cardiovascular Risk

by Lorretta Olu Fagbemi, Carlo Soldaini, Adele Costabile, Sofia Kolida, Carolina Ciacci and Yvonne Jeanes

Gastrointest. Disord. 2024, 6(1), 114-130; https://doi.org/10.3390/gidisord6010008 - 10 Jan 2024

Abstract

People with coeliac disease (CD) have a higher risk of developing cardiovascular disease (CVD), potentially due to inflammation. Probiotics can influence CVD risk through several mechanisms including modifying inflammation. We performed a systematic review of probiotic interventions in people with CD. In total, 4 databases were systematically searched for studies published up to March 2023. All outcomes, inclusive of any cardiovascular risk factors, were collated and reported. We screened 8084 articles and 11 publications reporting on 7 RCTs and 2 non-RCTs met the inclusion criteria for qualitative analysis. In total, 1 RCT and both non-RCTs were considered to have a high risk of bias. There was large heterogeneity between the studies and adherence to a gluten-free diet was only measured in two studies. No specific outcomes related to cardiovascular risk were reported. Two studies reported a significant reduction on serum TNF-α in children over time after probiotic supplementation. One study reported no significant change in intestinal permeability over a 3-week intervention. Currently there is insufficient evidence to advocate a positive impact of probiotics on inflammation in CD, due, in part, to the limited data on adherence to the gluten-free diet and active disease. Full article

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