Abstract: Hepatocellular syndrome represents a pathological process with a broad etiological spectrum, including viral infections, autoimmune diseases, or intoxications. Clinicians must identify the potential cause using both anamnestic data and available paraclinical examinations. We present the case of a 55-year-old female patient, admitted to the Internal Medicine 1 Department at the Clinical County Emergency Hospital Bihor, Oradea, Romania. The patient exhibited nonspecific complaints and insignificant pathological antecedents, but from a biochemical perspective, substantial changes in liver transaminase levels were evident. To establish differential diagnoses, a series of biochemical and immunological tests were performed, along with a thorough medical history. It was concluded that the patient regularly consumes herbal infusions, specifically Laurus Nobilis leaves, commonly known as Bay Laurel. Although this might be easily overlooked at first glance, a closer examination could explain the current clinical picture. In April 2024, a 55-year-old female patient with no history of liver pathology was admitted. She complained of asthenofatigue, anorexia, mixed dyspeptic symptoms, diffuse abdominal pain, and a weight loss of 12 kg. The pathology had insidiously started approximately 3 months prior. On examination, the patient had altered general status, anorexia, and was overweight. Biochemically, elevated liver transaminase values (AST = 196 U/L / ALT = 357 U/L) that continued to rise during hospitalization, despite hepatoprotective treatment. Various paraclinical examinations were performed to exclude other potential causes of hepatic aggression, being excluded ordinary causes. Consequently, a liver biopsy was performed, and the histopathological examination leaned toward a toxic hepatitis etiology. Application of the RUCAM scale yielded a score of 8 points (“probable” HILI). Clinical and biochemical improvement was observed after complete cessation of bay leaf tea consumption. This case highlights the potential hepatotoxicity of commonly used culinary herbs when consumed in large quantities or as concentrated infusions and emphasizes the importance of detailed anamnesis regarding herbal product use.

Abstract: The creation of a specific culture medium for colorectal organoids in 2011 opened a new era in human primary cultures by enabling the indefinite expansion of normal and pathological epithelial organoids. The original formula has been used ever since, with only minor, lab-specific modifications. The goal of culturing organoids from dif-ferent tissues has relied on saving and propagating the pluripotent stem cell. The "magic bullet" and all its subsequent derivatives have pursued this goal. Consequently, agonist and antagonist signals are chronically activated in the organoid medium, forcing organoid cells (as well as any other co-cultured cellular model) into con-strained signaling pathways. This extremely artificial condition is often overlooked in experimental approaches and may bias the results. Furthermore, some molecules in the organoid medium have unpredictable off-target effects that significantly impact the behavior and maturation of certain cell populations. In this short review, we will ex-amine the components of the colorectal organoid medium, describing their activity and necessity for organoid culture. We will also discuss the expected biases in specific experimental settings. While the original organoid medium formula is the gold stand-ard for propagating organoids in vitro, more focused, reliable conditions are necessary for specific organoid-based tests.

Abstract: The duodenal mucosa plays a pivotal role in gastrointestinal physiology through its endocrine cells (ECs), which secrete key regulatory factors including motilin (MLN), somatostatin (SS), and vascular endothelial growth factor (VEGF). Alterations in the expression of these mediators have been implicated in the pathogenesis of irritable bowel syndrome with constipation (IBS-C) and its overlap with functional dyspepsia (FD). In this study, immunohistochemical and morphometric analyses were performed on duodenal retrobulbar part biopsies obtained from patients with IBS-C, IBS-C combined with FD, and healthy controls. The results demonstrated a significant reduction in MLN-secreting ECs, accompanied by increased SS- and VEGF-positive ECs in IBS-C with FD patients compared to other groups. These endocrine alterations were associated with more severe abdominal pain, higher body mass index, and greater anxiety and depression scores. The findings highlight the contribution of duodenal EC dysfunction to impaired motility, visceral hypersensitivity, and low-grade inflammation, supporting the concept of the duodenum as a critical neuroendocrine hub within the gut–brain axis. This study underscores the relevance of MLN, SS, and VEGF as potential biomarkers and therapeutic targets in IBS-C and FD comorbidity.

Abstract: Nutritional management of children with short bowel syndrome (SBS) remains controversial and depends on multiple factors, including age, etiology, time from resection, extent of bowel loss, residual anatomy, bowel continuity, and associated complications. Consequently, recommendations across intestinal rehabilitation centers rely largely on clinical experience rather than evidence from controlled trials. The primary goals of nutritional management in SBS include progressive advancement of enteral nutrition (EN), discontinuation of parenteral nutrition (PN) with subsequent removal of feeding devices, optimization of intestinal adaptation, and ultimately, achievement of enteral autonomy while supporting normal growth and development. This review summarizes the physiological principles of enteral nutrition and provides practical recommendations for advancing the diet in children with SBS, with particular attention to anatomical variations of SBS and postoperative phases after bowel resection. Emerging areas of interest- including the use of blended diets and the role of EN in enhancing intestinal adaptation - are discussed. Finally, the influence of EN on enteral tolerance and intestinal motility is reported.

Abstract:

Background: Gastroscopy remains a cornerstone in diagnosing upper gastrointestinal tract diseases. However, intragastric foam impairs mucosal visualization, potentially reducing early lesion detection rate. Simethicone is widely used as a defoaming agent in clinical practice, yet its efficacy may be influenced by administration methods and timing. Aims: To investigate the effects of body position changes and waiting time after simethicone administration on defoaming efficacy during gastroscopy. Methods: A prospective study was conducted at the Endoscopy center, Hospitol, Macau, Jul–Aug 2024. Patients scheduled for gastroscopy were divided into a control group (supine position) and an experimental group (body position changes). The experimental group was further subdivided into Group A (traditional sequence: right lateral, supine, left lateral positions, each maintained for 5 min) and Group B (modified sequence: right lateral position for 5 min, followed by alternating head-down/head-up positions for 1 min each, then left lateral position for 3–5 min). The control group was additionally stratified by waiting time post-simethicone administration (≤15 min, 16–30 min, ≥31 min). The primary outcome was mucosal clarity score assessed with the KUO score; secondary outcomes included examination time and polyp detection rate. Results: Group B demonstrated significantly better mucosal clarity compared with both the control group and Group A (P<0.001). Among control patients, those examined within 15 minutes post-medication showed superior defoaming efficacy compared with those examined after 31 minutes (P<0.05). Examination times were comparable across groups. No significant association was observed between mucosal clarity and polyp detection rates. Conclusions: Combining optimized body position changes with appropriate timing post-simethicone administration significantly improves mucosal visualization during gastroscopy. This strategy provides a simple, cost-effective approach to enhance diagnostic performance and is recommended for broader clinical application.

Abstract: Acute pancreatitis (AP) is one of the most common gastrointestinal emergencies, with more than 275,000 hospital admissions annually in the United States [2]. While most cases are mild, 15–20% progress to moderately severe or severe disease characterized by systemic inflammation, organ failure, and local complications [1,3]. Overall mortality remains 3–5%, but increases to 20–35% in patients with persistent organ failure requiring intensive care [7].Early assessment remains challenging. Traditional scoring systems (APACHE II, BISAP, Ranson, mCTSI) demonstrate modest accuracy within the first 24 hours [4,11]. Consequently, emerging biomarkers—including IL-6, IL-8, IL-10 [16–17], pentraxin-3 [8], sCD163 [7], NGAL [10], and presepsin—are critical for identifying early severity. Endothelial dysfunction markers including angiopoietin-2 [19], proADM, endocan, and VEGF provide additional predictive value by reflecting microcirculatory failure and shock. Oxidative stress markers such as MDA and GSH depletion correlate with necrosis and multi-organ dysfunction. ICU physiological predictors—vasopressor requirement, rising lactate, Horowitz-index deterioration, and early AKI—remain the strongest bedside indicators of poor outcome [18]. Modern management emphasizes goal-directed fluid therapy, controlled resuscitation with balanced crystalloids, and selective use of CRRT, although no multicenter RCT has yet confirmed its mortality benefit [20]. This review synthesizes classical and novel biomarkers, endothelial and oxidative markers, and ICU predictors to support a modern, precision-based approach to early risk assessment and managementin acute pancreatitis.

Abstract: Metastases to the pancreas (PM), although rare, have been increasingly identified in recent years, especially among high-volume pancreatic centers. They are often asymptomatic and incidentally detected during follow-up examinations, even several years after the treatment of the primary tumor. In this scenario, endoscopic ultrasound (EUS) has emerged as a crucial diagnostic tool for PM, being capable of providing a detailed morphological characterization and safe and effective tissue acquisition for cytohistological examination. The aim of our study was to extensively review the current evidence concerning the role of EUS in the diagnosis of PM, specifically focusing on their morphological features, contrast-enhancement patterns, and tissue acquisition techniques.

Abstract: Background: Although total 25-hydroxyvitamin D (25(OH)D) measurements may not accurately reflect functional vitamin D status, vitamin D deficiency is common in hepatocellular carcinoma (HCC). The contribution of altered vitamin D-binding protein (VDBP) and albumin to impaired bioavailability is poorly characterized in liver cancer. Methods: We measured total, free, and bioavailable 25(OH)D, VDBP, and albumin in 46 HCC patients and 87 healthy controls during winter and summer. Correlations with Child-Pugh score, Barcelona Clinic Liver Cancer (BCLC) stage, and disease aetiology were evaluated. Results: HCC patients exhibited significantly lower VDBP (177.3 ± 237.0 vs. 239.9 ± 141.9 mg/L, p < 0.001) and albumin (35.9 ± 5.4 vs. 48.0 ± 3.9 g/L, p < 0.001) compared to winter controls. Total 25(OH)D was lower in HCC (39.3 ± 22.1 nmol/L) versus summer controls (75.0 ± 22.8 nmol/L, p < 0.001) but comparable to winter controls (p = 0.061). HCC pa-tients lacked seasonal variation in vitamin D fractions, unlike the controls. VDBP nega-tively correlated with free (ρ = -0.606, p < 0.001) and bioavailable 25(OH)D (ρ = -0.541, p < 0.001). Child-Pugh score correlated positively with BCLC stage (ρ = 0.378, p = 0.012) and inversely with albumin (ρ = -0.565, p < 0.001). Conclusions: Free and bioavailable vitamin D are profoundly compromised in HCC, reflecting impaired hepatic synthetic function and systemic inflammation. These fractions may serve as novel metabolic biomarkers superior to total 25(OH)D for assessing vitamin D deficiency and guiding individualized supplementation strategies in patients with liver cancer.

Abstract:

Advances in single-cell and spatial multi-omics technologies have transformed the understanding of neutrophils from short-lived effector cells to highly heterogeneous and transcriptionally plastic immune populations. Within the inflamed intestinal microenvironment, gradients of cytokines, oxygen tension, and microbial metabolites such as short-chain fatty acids dynamically modulate neutrophil differentiation and function, shaping either tissue-protective or tissue-destructive phenotypes. Recent studies highlight the de novo expression of the NADPH oxidase enzyme DUOX2 in intestinal neutrophils as a pivotal mediator of redox signaling. DUOX2-derived reactive oxygen species activate epithelial and immune signaling cascades through NF-κB and p38 MAPK pathways, thereby amplifying inflammation, promoting barrier disruption, and sustaining microbial dysbiosis. Although this oxidative response enhances antimicrobial defense, it concurrently contributes to neutrophil extracellular trap (NET)-driven thrombo-inflammation and chronic tissue injury. Experimental evidence indicates that selective ablation of myeloid DUOX2 attenuates colitis, underscoring its potential as a therapeutic target. Emerging interventions that modulate this axis, including JAK/STAT inhibitors, CXCR2 antagonists, p38/MK2 inhibitors, and butyrate-based metabolic regulators, offer promising avenues to restore neutrophil homeostasis while maintaining host defense. Integrating single-cell transcriptomics, redox proteomics, and advanced imaging approaches will be essential for translating neutrophil plasticity into biomarker-guided and precision-based therapeutic strategies for durable mucosal healing in IBD.

Abstract: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD), is now recognized as the leading cause of chronic liver disease worldwide. MASLD spans a spectrum ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), and is linked to progressive fibrosis and ultimately hepatocellular carcinoma (HCC). Growing evidence implicates cellular senescence (CS) and lipid droplets (LD) dysregulation as key drivers of disease progression, although their interaction remains poorly characterized. This review synthe-sizes current mechanistic insights into how CS and LD regulation affect the transition from steatosis to MASH. Senescent hepatocytes display altered lipid metabolism, includ-ing upregulation of receptors such as cluster of differentiation (CD) 36, enhancing lipid uptake to meet increased energy demands. Initially, elevated free fatty acid influx can ac-tivate peroxisome-proliferator receptor alpha (PPARα), promoting fatty acid oxidation (FAO) as a compensatory response. Over time, persistent cellular senescence (CS) under steatotic conditions leads to mitochondrial dysfunction and suppression of fatty acid ox-idation (FAO), while the senescence-associated secretory phenotype (SASP), largely driven by nuclear factor – kappa B (NF-κB) signaling, promotes chronic hepatic inflammation. A comprehensive understanding of this dynamic crosstalk between CS and lipid metabo-lism could identify novel therapeutic targets to modulate the MASLD progression.

Abstract:

Background and Objectives: With more than 1.9 million new cases and 0.9 million deaths in 2020, colorectal cancer (CRC) was the third most common cancer and the second most common cause of cancer mortality worldwide. The adenoma detection rate as a precursor to the formation of CRC is directly related to the degree of bowel preparation for colonoscopy.Materials and Methods: This is a retrospective single-center study on a total number of 4835 colonoscopies performed in a period of 34 months during the global COVID-19 pandemic.The main goal of the research was related to the emergence of differences in cleaning in relation to gender, age, days of preparation, the type of cleaning agent.Results: There is no signification difference between gender. Compared to younger respondents, older respondents had a lower likelihood of having adequate bowel preparation. Compared to PEG, other solutions had a lower probability of adequate bowel preparation.Conclusions: Better cooperation between patients and medical staff is needed, as well as public health campaigns that raise awareness of the importance of good preparation for colonoscopy.

Abstract: Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal discomfort, pain, and altered bowel habits, as well as extraintestinal manifestations such as fatigue, musculoskeletal pain, gastroesophageal reflux, depression, and anxiety. Despite prevalences of approximately 10% in the general population, its fundamental etiopathogenesis remains unclear. Current theories mainly point toward a multifactorial aetiology crediting psychological stress with a prominent role. The paradigms currently embraced for IBS are mainly based on, and emphasize, the gut-brain axis, visceral hypersensitivity, central sensitization, neuroendocrinology, dysbiosis, motility abnormalities, and post-infectious persistent low-grade mucosal inflammation. Yet, they don’t fully explain its diverse clinical presentations nor IBS’s symptomatic overlap with conditions such as fibrositis/fibromyalgia syndrome. Available treatments are mostly symptomatic and provide limited relief, indicating a still major gap in our mechanistic understanding. This paper proposes a hypothesis for IBS etiopathogenesis as an organic disease of the extracellular matrix driven by myofibroblast overactivity in the gut wall and abdominal soft tissue, along with downstream consequences stemming from tissue stiffness. This process is theorized to mechanically compress visceral structures and nerves, impair synchronized organ motility, and induce substrate stiffness-mediated visceral hypersensitivity. In this theoretical framework the extraintestinal manifestations reflect mechanistic overlap with fibromyalgia, which helps unify functional-psychosomatic syndromes as a medical entity with a shared organic mechanism. This mechanism, along with known mechanisms of gut dysbiosis and the gut-brain axis, helps explain “medically unexplained symptoms” of fibromyalgia-type syndromes and offers testable predictions for future research and suggests new avenues for IBS diagnosis and treatment.

Abstract: A key, but frequently underappreciated parallel between alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD), now also termed metabolic dysfunction-associated steatotic liver disease (MASLD), is the delivery of excessive amounts of calories to the liver via the portal circulation: ethanol in the case of ALD, and nutrient-derived substrates in NAFLD/MASLD. A second, equally salient point is the liver’s distinctive dual blood supply. The portal vein provides approximately 80% of hepatic blood flow, delivering deoxygenated but nutrient-rich blood from the gut, while the hepatic artery supplies the remaining 20% yet contributes about half of the organ’s total oxygen requirements. Notably, only the hepatic artery possesses myogenic regulatory capacity that allows it to dynamically adjust flow and thus modulate hepatic oxygenation. A third consideration is that the liver receives approximately 25% of total cardiac output, which means that maintaining a stable hepatic blood supply is essential for cardiovascular homeostasis and survival. To this end, the liver has developed a unique and specialized mechanism, the hepatic artery buffer response (HABR), that stabilizes total hepatic blood flow independently of metabolic fluctuations or needs. However, this prioritization of constant flow means that the hepatic arterial blood supply, even with maximal vasodilatation, cannot always ensure that oxygen delivery matches nutrient demand, especially under conditions of caloric excess. An imbalance between oxygen delivery and nutrient availability— “oxygen-nutrient mismatch”—can lead to tissue hypoxia and liver cell damage. Over four decades ago, Lautt postulated that this kind of imbalance might play a role in the pathogenesis of alcohol-related liver disease (ALD). We have extended this paradigm to non-alcoholic fatty liver disease (NAFLD), now also called MASLD, theorizing that analogous mechanisms may be involved. Comorbidities such as obstructive sleep apnea (OSA) are associated with recurrent episodes of nocturnal hypoxemia. The concomitant presence of intermittent hypoxia and increased nutrient flux may synergistically exacerbate hepatocellular injury, providing a plausible mechanistic explanation for the more rapid progression of MASLD observed in patients with OSA and other conditions associated with hypoxemic episodes. The attenuated association between ALD and metabolic syndrome, compared with MASLD, likely stems from inherent differences in substrate metabolism. Carbohydrates, lipids, and proteins are subject to multiple complex cytosolic metabolic pathways that permit alternative, often non-oxidative, fates in states of metabolic dysfunction. In contrast, hepatic ethanol metabolism proceeds via a more linear, obligate oxidative route, offering limited flexibility. Therapeutic strategies that reduce hepatic caloric overload, increase basal hepatic metabolic rate (for example, with Resmiritom), or enhance hepatic oxygenation (such as through hyperbaric oxygen therapy) represent promising approaches for disease modification.

Abstract: Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive destruction of intrahepatic bile ducts. Autoantibodies, particularly anti-mitochondrial antibodies (AMA) and antinuclear antibodies (ANA), are central to diagnosis, prognosis, and pathogenesis. This review provides a comprehensive overview of classical and emerging autoantibodies associated with PBC, including AMA-M2, anti-gp210, anti-sp100, anti-KLHL12, and anti-RPL30. We discuss their diagnostic significance, pathogenic implications, and potential utility in patient stratification and therapeutic monitoring. Furthermore, we explore the role of microbial factors and environmental triggers in autoantibody generation, highlighting molecular mimicry and gut–liver axis interactions. Advances in autoantibody profiling may pave the way for personalized medicine and improved outcomes in PBC.

Abstract: Background/Objectives: Microbial dysbiosis is implicated with a pathogenic role in both irritable bowel syndrome (IBS) and several dermatological conditions. Yet, few studies have assessed a potential overlapping epidemiologic association. We aimed to assess the 1-year prevalence of common dermatologic conditions following an initial IBS diagnosis and to evaluate the reverse association using reciprocal analyses; Methods: We conducted a retrospective study using TriNetX. Patients aged 18-50 with no history of inflammatory bowel disease, celiac disease or infectious intestinal disease were matched 1:1 to healthy controls by demographics and comorbidities. The primary outcome was the prevalence of acne vulgaris, psoriasis, atopic dermatitis, hidradenitis suppurativa, rosacea, vitiligo, alopecia areata, urticaria, 1-year after IBS diagnosis, measured using Odds Ratios (OR) and 95% confidence intervals. To confirm bidirectionality, reciprocal analyses were performed; Results: Over a 1-year period, IBS patients were less likely to have acne vulgaris (OR: 0.78, CIs: 0.75-0.80) and vitiligo (OR: 0.78, CIs: 0.64-0.95) compared to those without. IBS patients were more likely to have psoriasis (OR: 1.14, CIs: 1.08-1.21), hidradenitis suppurativa (OR: 1.11, CIs: 1.03-1.20), rosacea (OR: 1.10, CIs: 1.03-1.18), and urticaria (OR: 1.27, CIs: 1.21-1.34) compared to healthy controls. No association was found for atopic dermatitis or alopecia areata. In the reciprocal analysis, alopecia areata patients (OR: 0.76, CIs: 0.64-0.90) had a lower prevalence of IBS compared to healthy controls. IBS was shown to occur more frequently in patients with psoriasis (OR: 1.15, CIs: 1.07-1.23), rosacea (OR: 1.23, CIs: 1.15-1.31), and urticaria (OR: 1.06, CIs: 1.01-1.12) compared to healthy controls. No association was seen in patients with acne, atopic dermatitis, hidradenitis suppurativa, and vitiligo; Conclusions: IBS shows a bilateral positive overlapping association with psoriasis, rosacea and urticaria. Hidradenitis suppurativa showed a positive association only among IBS patients, with no reciprocal relationship. Moreover, our findings suggest that acne and vitiligo were inversely associated with IBS, however this was not supported in our reciprocal analysis. Although no association was initially found between IBS and alopecia areata, the reciprocal analysis suggests a potential inverse association. No association was seen with atopic dermatitis bilaterally. Clinicians who treat these disorders should be aware of the potential bidirectional association.

Abstract: Inflammatory bowel diseases include Crohn's disease (CD) and ulcerative colitis (UC). These diseases are characterised by periods of exacerbated inflammation of the gastrointestinal mucosa, interspersed with periods of remission. Current pharmacological interventions are only partially effective. There is a need for effective dietary therapies and interventions involving plant substances that can alleviate the course of this dis-ease. This study aimed to determine the effects of a 28-day dietary intervention involving a 3% solution of chemically pure, low-molar-mass oat beta-glucan (OBG) in patients diagnosed with de novo UC. Similar-aged men and women were compared. The OBG was isolated and prepared for consumption as a sterile aqueous suspension. This solution had previously been evaluated for in vitro toxicity using 3D intestinal co-cultures comprising Caco-2, HT29-MTX and THP-1 cells. Before and after the dietary intervention, endoscopic colon examinations were performed, and blood haematological, biochemical and immunological parameters, as well as stool calprotectin concentrations, were analysed. The Disease Activity Index (DAI), endoscopic Mayo score, the Lichtiger Colitis Activity Index (LCAI) and the neutrophil-to-lymphocyte ratio (NLR) were also determined. Following dietary intervention, the Mayo score, DAI index, faecal calprotectin levels, and indices of peripheral blood white cells, CRP, and proinflammatory cytokine concentrations were decreased. The obtained results demonstrated the beneficial effect of dietary intervention with OBG in accelerating the achievement of clinical remission in patients with UC.

Abstract:

Background: In pediatric celiac disease (CD), intestinal malabsorption and the restrictive nature of a gluten-free diet (GFD) frequently result in persistent macro- and micronutrient imbalances, despite histological remission. The present review evaluates the evidence on nutritional adequacy of the GFD, identifies common deficiencies, and considers biomarker strategies and dietary recommendations to optimize growth and metabolic health. Methods: A narrative review of the literature was conducted, focusing on studies of nutrient intake, product composition of gluten-free foods, biomarker assessment, and clinical outcomes in children with CD. Both macronutrient (protein, fat, carbohydrate, fiber) and micronutrient (iron, vitamin D, calcium, B-vitamins, zinc, magnesium) domains were included. Results: Children with CD on long-term GFD demonstrate higher intake of lipids (especially saturated fat) and simple carbohydrates, alongside consistently low intake of dietary fiber and key micronutrients. Gluten-free products often exhibit lower protein content, higher glycemic index, and reduced fortification compared to gluten-containing equivalents. Biomarkers including prealbumin, ferritin, 25-hydroxyvitamin D, and inflammatory mediators aid in early detection of malnutrition. Nutritional deficits contribute to impaired linear growth, delayed puberty and increased metabolic risk. Conclusions: Nutritional adequacy of the GFD cannot be assumed in children with CD. Routine monitoring using standardized biomarker panels, combined with personalized dietary counselling and improved formulation and fortification of gluten-free products, is essential to mitigate long-term adverse outcomes. Future work should advance precision nutrition approaches and public-health initiatives to optimize dietary quality in this vulnerable population.

Abstract: Background/Objectives: High-quality bowel preparation is essential for the diagnostic accuracy of colonoscopy, which remains the gold standard for colorectal cancer screening. Aims: In our study, we aimed to compare the efficacy and tolerability of three bowel preparation regimens—Moviprep with Donat Mg, Plenvu, and Plenvu with Donat Mg—commonly used in clinical practice in Slovenia. Methods: We conducted a randomized, multicenter, prospective study across three Slovenian gastroenterology centers. A total of 300 patients undergoing elective colonoscopy were randomly assigned to one of the three bowel preparation groups. Bowel cleanliness was evaluated using the Boston Bowel Preparation Scale, and lesion detection was assessed using polyp detection rate (PDR) and adenoma detection rate (ADR). Patients also completed a questionnaire assessing adverse effects, overall tolerability, and willingness to repeat the same regimen. Statistical analyses included ANOVA, chi-square, Kruskal-Wallis, and t-tests. Results: All three regimens achieved high bowel preparation adequacy (≥95%), with no statistically significant differences in total BBPS scores, PDR, or ADR. Adverse effects were mild and comparable between groups, with thirst and bloating being the most frequently reported symptoms. Patient satisfaction and willingness to repeat the preparation were high across all regimens, with no significant differences. Conclusions: Moviprep with Donat Mg, Plenvu, and Plenvu with Donat Mg are all effective, safe, and well-tolerated bowel preparation regimens. Each achieved a high level of bowel cleanliness and lesion detection, exceeding ESGE minimum standards. Their comparable efficacy and tolerability support their interchangeable use in routine colonoscopy practice.

Abstract: Background/Objectives: Microbial dysbiosis is implicated with a pathogenic role in both irritable bowel syndrome (IBS) and several dermatological conditions. Yet, few studies have assessed a potential overlapping epidemiologic association. We aimed to assess the 1-year prevalence of common dermatologic conditions following an initial IBS diagnosis and to evaluate the reverse association using reciprocal analyses; Methods: We conducted a retrospective study using TriNetX. Patients aged 18-50 with no history of inflammatory bowel disease, celiac disease or infectious intestinal disease were matched 1:1 to healthy controls by demographics and comorbidities. The primary outcome was the prevalence of acne vulgaris, psoriasis, atopic dermatitis, hidradenitis suppurativa, rosacea, vitiligo, alopecia areata, urticaria, 1-year after IBS diagnosis, measured using Odds Ratios (OR) and 95% confidence intervals. To confirm bidirectionality, reciprocal analyses were performed; Results: Over a 1-year period, IBS patients were less likely to have acne vulgaris (OR: 0.78, CIs: 0.75-0.80) and vitiligo (OR: 0.78, CIs: 0.64-0.95) compared to those without. IBS pa-tients were more likely to have psoriasis (OR: 1.14, CIs: 1.08-1.21), hidradenitis suppurativa (OR: 1.11, CIs: 1.03-1.20), rosacea (OR: 1.10, CIs: 1.03-1.18), and urticaria (OR: 1.27, CIs: 1.21-1.34) com-pared to healthy controls. No association was found for atopic dermatitis or alopecia areata. In the reciprocal analysis, alopecia areata patients (OR: 0.76, CIs: 0.64-0.90) had a lower prevalence of IBS compared to healthy controls. IBS was shown to occur more frequently in patients with psoriasis (OR: 1.15, CIs: 1.07-1.23), rosacea (OR: 1.23, CIs: 1.15-1.31), and urticaria (OR: 1.06, CIs: 1.01-1.12) compared to healthy controls. No association was seen in patients with acne, atopic dermatitis, hidradenitis suppurativa, and vitiligo; Conclusions: IBS shows a bilateral positive overlapping association with psoriasis, rosacea and urticaria. Hidradenitis suppurativa showed a positive association only among IBS patients, with no reciprocal relationship. Moreover, our findings suggest that acne and vitiligo were inversely associated with IBS, however this was not supported in our reciprocal analysis. Although no association was initially found between IBS and alopecia areata, the reciprocal analysis suggests a potential inverse association. No association was seen with atopic dermatitis bilaterally. Clinicians who treat these disorders should be aware of the potential bidirectional association.

Abstract:

Background/Objectives: Ultrasonography (US) is a non-invasive and repeatable examination for evaluating chronic constipation. However, only few studies have investigated drug therapy decisions based on rectal US results. To date, the efficacy and safety of elobixibat have not been evaluated using rectal US classification in patients with chronic constipation. This study aimed to evaluate the efficacy and safety of elobixibat in patients with chronic constipation classified as “no fecal retention” by rectal US. Methods: We retrospectively analyzed 32 patients with chronic constipation who underwent rectal US and received elobixibat (10 mg/day) between May 2019 and December 2024. Patients were classified into four groups according to rectal US findings: no fecal retention, fecal retention without hard stools, fecal retention with hard stools, and gas retention. The primary endpoint was the response rate of spontaneous bowel movements (SBMs) within 3 days after starting elobixibat in the “no fecal retention” group. Results: Among 18 patients in the “no fecal retention” group, 94.4% achieved SBMs within 3 days after elobixibat administration, indicating a favorable response. Adverse events included abdominal distension and abdominal pain, each observed in one patient (3.1%). Conclusions: Elobixibat was effective and well tolerated in patients with chronic constipation classified by rectal US findings.