The gut microbiota plays a crucial role in the manifestation of intestinal dysfunction associated with irritable bowel syndrome (IBS). The mechanosensory Piezo2 has been implicated in the regulation of intestinal function. However, it remains unclear whether Piezo2 is modulated by the gut microbiota, thus contributing to the development of visceral hypersensitivity and gut dysmotility. The study enrolled patients with diarrhea-predominant IBS (IBS-D) alongside healthy controls (HC). Questionnaires, rectal barostat test, and colonoscopy with mucosal biopsy were conducted. Fecal microbiota transplantation (FMT) was performed using samples from HC or IBS-D patients, and interventions with Akkermansia muciniphila or Fusobacterium varium were carried out on colon- or dorsal root ganglion (DRG)- Piezo2 knockdown pseudo-germ-free mice. Visceral sensitivity and intestinal motility were assessed. Piezo2 levels were detected using western blot and immunofluorescence. Fecal 16S rRNA sequencing and cecum untargeted metabolomics analysis, followed by molecular docking predictions of Piezo2, were also performed. The ratio of Piezo2+/5-HT+ cells was lower in IBS-D patients, positively correlated with visceral sensation and intestinal dysbiosis. The mice that received FMT from IBS-D patients exhibited colonic dysmotility and visceral hypersensitivity, along with elevated Piezo2 protein levels in the colon and DRG. Knockdown of Piezo2 in the colon or DRG ameliorated the FMT-induced colonic dysmotility and visceral hypersensitivity. Fecal 16S rRNA sequencing revealed distinct microbiota composition. Notably, Fusobacterium varium, but not Akkermansia muciniphila, induced gut dysmotility and visceral hypersensitivity, effects that could be alleviated by colon or DRG Piezo2 knockdown. Additionally, Fusobacterium varium lead to increased Piezo2 protein levels, as well as elevated levels of indole-3-acetic acid and indole-3-acrylic acid, which were predicted to bind to Piezo2, causing disturbances. Piezo2 can be regulated by gut microbiota and involved in visceral hypersensitivity and colonic dysmotility, with Fusobacterium varium playing a crucial role.

Low-gluten diets (LGD) are also widely followed by people not suffering from coeliac disease. This study compared oats and rice as the main cereal source of an LGD in metabolically challenged volunteers. Volunteers (n = 69) were randomly assigned to an LGD, which was either rich in oats or rice, for 6 weeks. Before and after the intervention, concentrations of total cholesterol, LDL-C, and HDL-C, triacylglycerols, free fatty acids, glucose, and insulin were measured from fasting plasma samples; the volunteers also completed 4-day food and stool records, as well as questionnaires related to perceived gastrointestinal discomfort (Gastrointestinal Symptom Rating Scale) and health (RAND-36). The intervention with oats resulted in a more substantial decrease in LDL-C (pgroup × time = 0.047), more frequently normal type stool (pgroup × time = 0.010), and bowel movements (pgroup × time = 0.038) than rice (group × time interaction). The rice group experienced more constipation symptoms (pgroup × time < 0.001) than the oat group, possibly due to a lower fiber intake (pgroup × time < 0.001). A greater waist circumference decrease was observed with rice than with oats (pgroup × time = 0.022). Our results suggest that oats improve both biochemical markers of cardiometabolic health and perceived gastrointestinal well-being compared to rice, thus being a crucial part of a nutritiously adequate LGD.

There is a need for diagnostic and prognostic biosignatures to improve long-term outcomes in inflammatory bowel disease (IBD). Here, we describe the establishment of the Swedish Inception Cohort in IBD (SIC-IBD) and demonstrate its potential for the identification of such signatures.

Patients aged ≥18 years with gastrointestinal symptoms who were referred to the gastroenterology unit due to suspected IBD at eight Swedish hospitals between November 2011 and March 2021 were eligible for inclusion.

In total, 367 patients with IBD (Crohn's disease, n=142; ulcerative colitis, n=201; IBD-unclassified, n=24) and 168 symptomatic controls were included. In addition, 59 healthy controls without gastrointestinal symptoms were recruited as a second control group. Biospecimens and clinical data were collected at inclusion and in patients with IBD also during follow-up to 10 years. Levels of faecal calprotectin and high-sensitivity C-reactive protein were higher in patients with IBD compared with symptomatic controls and healthy controls. Preliminary results highlight the potential of serum protein signatures and autoantibodies, as well as results from faecal markers, to differentiate between IBD and symptomatic controls in the cohort. During the first year of follow-up, 37% (53/142) of the patients with Crohn's disease, 24% (48/201) with ulcerative colitis and 4% (1/24) with IBD-U experienced an aggressive disease course.

We have established an inception cohort enabling ongoing initiatives to collect and generate clinical data and multi-omics datasets. The cohort will allow analyses for translation into candidate biosignatures to support clinical decision-making in IBD. Additionally, the data will provide insights into mechanisms of disease pathogenesis.

In patients with chronic disorders of the gastrointestinal (GI) system, integral health is disturbed in all dimensions: physical, mental, quality of life, participation, meaningfulness, and daily functioning. In this group, three large subgroups are distinguished: Inflammatory Bowel Diseases (IBD), Hepato-Pancreatico-Biliary diseases (HPB), and NeuroGastroenterology and Motility (NGM) disorders. Our aim was to compare integral health status between these three subgroups. For the NGM group, we focused on patients with documented motility disorders, not on patients with functional GI-disorders. We hypothesized that the NGM group will have lower scores for integral health status compared to the IBD and HPB groups.

A prospective, observational, questionnaire study was performed in patients with chronic GI-system disorders (IBD, HPB, and NGM) attending the Maastricht University Medical Center outpatient department. Validated questionnaires and patient file data were used to quantify six health dimensions.

Data from 416 patients were collected. In all domains, apart from meaningfulness, the NGM group (n = 93) had significantly (0.001 ≤ p ≤ 0.033) lower scores compared to the IBD (n = 174) and HPB (n = 149) groups. From the NGM group, 66% were malnourished, had symptoms of depression (36%) and anxiety (19%), and work participation was lowest (32%). Correlations between intra- and interdimensional parameters were moderate to strong apart from meaningfulness.

Compared to patients with chronic IBD and HPB disorders, patients with NGM disorders have significantly lower scores in five of six dimensions of health: physical and mental well-being, quality of life, daily functioning, and participation.

Psychosocial stress plays a central role in the pathophysiology of disorders of gut-brain interactions (DGBI), including functional dyspepsia (FD) and irritable bowel syndrome (IBS). Brain activity during psychosocial stress in patients with DGBI has not been adequately investigated. In this prospective study, we aimed to explore brain activity during psychosocial stress in patients with DGBI.

Situations in an unmanned room, public space without attention, and public speaking were simulated in a virtual reality (VR) environment. Subjective stress, emotional state, and gastrointestinal (GI) symptoms were assessed using a visual analog scale, the State-Trait Anxiety Inventory, and the GI Symptom Rating Scale, respectively. Electrocardiograms were recorded to evaluate autonomic function. Activity in the prefrontal cortex (PFC) was examined using functional near-infrared spectroscopy (fNIRS).

Overall, 15 healthy controls, 15 patients with IBS, and 15 patients with FD were included. In the public-speaking scenario, subjective stress scores significantly decreased (indicating more stress) and sympathetic nervous activity increased equally among the three groups compared with those in an unmanned scene. Patients with IBS had higher activity in the left ventrolateral prefrontal cortex (VLPFC) and lower activity in the dorsolateral PFC (DLPFC) than those with FD and healthy controls.

Brain activity increased in the VLPFC and decreased in the DLPFC under stressful psychosocial situations created in the VR space in patients with IBS. Thus, the combination of VR and fNIRS is a viable option for evaluating brain activity under psychosocial stress in natural clinical settings.

Common gastrointestinal (GI) symptoms such as abdominal pain, indigestion, and constipation affect a significant portion of the global population and can substantially impair quality of life. Despite these widespread issues, research specifically investigating the effects of walnuts on gut function and GI symptoms remain limited.

This study investigates the effects of walnuts on gastrointestinal symptoms in healthy adults.

An experimental baseline-end study with an equivalent group design was employed.

The experimental group consumed 42 grams of walnuts daily, and their gastrointestinal symptoms were compared with those of a control group that did not consume walnuts over a 3-week period.

Sixty university students were recruited as volunteer subjects, consisting of 30 males and 30 females.

Participants were randomly assigned to either an experimental group or a control group.

The independent variable was walnut consumption, and the dependent variable was gastrointestinal health, assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and a qualitative questionnaire to collect participants' perceived changes in GI symptoms.

A t-test with a p-value of less than 0.05 and verbatim analysis were utilized.

This mixed-methods study provides evidence for the beneficial effects of walnuts in promoting normal digestive function.

The study provides alternative evidence for the beneficial effects of walnuts in promoting normal digestive function.

Beneficial short-chain fatty acids (SCFAs) are produced through intestinal microbial fiber fermentation. Using stable tracer methodology and compartmental modeling, we observed lower SCFA production in older (OAs) than in young adults (YAs) in both an accessible [that is, systemic circulation; whole-body production] and inaccessible [potentially representing intestine absorbing microbially produced SCFAs (U2)] pool.

We now investigated whether fiber supplementation increases SCFA production in OAs and whether concentrations reflect production rate changes.

In this randomized, placebo-controlled, double-blind crossover study, 21 YAs (20-29 y) and 40 OAs (59-87 y) adults were supplemented with inulin or placebo (maltodextrin) for 7 d (final intake: 30 g/d). Before and after interventions, participants collected stool and received an intravenous pulse containing [U-13C]-labeled SCFAs followed by blood draws. We measured plasma tracer enrichments, plasma and fecal concentrations by gas chromatography-mass spectrometry and performed compartmental analysis. Data are mean (95% confidence interval).

Inulin evoked a 44% increase in butyrate production (μmol/min) in the inaccessible pool {YA: 28-44 [+16.2 (4.3, 28.1); P = 0.038], OA: 14-20 [+6.1 (2.2, 9.9); P = 0.011]} and were not different between YAs and OAs. In addition, a 34% increase in propionate production in YA only. We found a 50%-60% increase in fecal acetate, propionate, and butyrate and a 34% increase in plasma butyrate in OA, whereas in YA only 34% increase in fecal acetate. Plasma but not fecal concentrations correlated positively with SCFA production in the inaccessible pool (R2 = 0.20-0.45; P < 0.001).

OAs have a lower SCFA production. Inulin intake increases SCFA production. Tracer pulse approach detects SCFA metabolism changes more sensitively than plasma or fecal concentration measurements (NCT04459156).

BackgroundThe complexity of gastrointestinal (GI) disorders associated with Parkinson's disease (PD) and the significant interactions between GI medications and the dopaminergic axis necessitates expert management. The integrated care model for disorders of the brain-gut interaction (DBGI) has advantages, however, has not been applied in concurrent DBGI and PD.ObjectiveTo test the hypothesis that our Parkinson's Research and Integrated Support Model (PRISM) will reduce symptom severity and improve the quality of life (QOL) in patients with GI symptoms associated with PD.MethodsPatients with refractory GI symptoms referred to the PRISM clinic were evaluated and treated by the integrated efforts of movement disorder specialists, neurogastroenterologists, dietitians, occupational therapists, speech-swallow therapists, and neuroscientists. Patients underwent a battery of GI symptoms and QOL questionnaires and personalized actionable biomarkers (motility testing and swallowing studies). Inflammatory markers and stool tests were collected. An individualized standard of care treatment was established based on the specific DBGI diagnosis uncovered during the PRISM evaluation.Results44 adult PD patients with GI complaints were evaluated. The most common symptoms included constipation (97%), dysphagia (61%), and gastroesophageal reflux (34%). Actionable biomarkers were highly positive revealing esophageal dysmotility (20/21, 95%), slow-transit constipation (40/42, 90%), intestinal methanogen overgrowth (7/8, 87%), gastroparesis (17/20, 85%), oropharyngeal dysphagia (28/44, 63%), and dyssynergic defecation (27/42, 61%). GI symptom severity and QOL significantly improved (p < 0.05) as measured by all questionnaires.ConclusionsMore severely affected patients with Parkinson's treated with the Fixel PRISM approach showed significant improvements in GI symptom frequency, severity, and QOL.

While it has been suggested that alterations in the composition of gut microbial metabolites may play a causative role in the pathophysiology of autism spectrum disorder (ASD), it is not known how gut microbial metabolites are associated with ASD-specific brain alterations. In this cross-sectional, case-control observational study, (i) fecal metabolomics, (ii) task-based functional magnetic resonance imaging (fMRI), and (iii) behavioral assessments were obtained from 43 ASD and 41 neurotypical (NT) children, aged 8-17. The fMRI tasks used socio-emotional and sensory paradigms that commonly reveal strong evoked brain differences in ASD participants. Our results show that fecal levels of specific tryptophan-related metabolites, including kynurenate, were significantly lower in ASD compared to NT, and were associated with: 1) alterations in insular and cingulate cortical activity previously implicated in ASD; and 2) ASD severity and symptoms (e.g., ADOS scores, disgust propensity, and sensory sensitivities). Moreover, activity in the mid-insula and mid-cingulate significantly mediated relationships between the microbial tryptophan metabolites (indolelactate and tryptophan betaine) and ASD severity and disgust sensitivity. Thus, we identify associations between gut microbial tryptophan metabolites, ASD symptoms, and brain activity in humans, particularly in brain regions associated with interoceptive processing.

To evaluate the effects of a nurse-led individualized mHealth nutrition intervention on nutritional status, nutritional intake, cognitive beliefs related to nutritional behavior, weight loss, blood parameters, gastrointestinal symptoms, and quality of life in post-discharged gastric cancer patients following gastrectomy.

This was an assessor-blinded parallel-arm randomized controlled trial with a repeated-measures design.

The participants were recruited from inpatient gastric surgery units of two tertiary hospitals in Guangzhou, China.

A total of 108 patients with gastric cancer who underwent gastrectomy and were scheduled to be discharged to their homes were included.

Participants were randomly allocated to either the intervention or the control group (n = 54 per group). The intervention group received the nurse-led individualized mHealth nutrition intervention in addition to the usual care, whereas the control group received only usual care. The intervention included face-to-face education before discharge, the use of an applet and phone consultations. Baseline data were collected on the day of discharge from the hospital (T0). The patients' nutritional status, cognitive beliefs related to nutritional behavior, nutritional intake, weight loss, blood parameters, gastrointestinal symptoms and quality of life were repeatedly measured at 4-week (T1) and 12-week (T2) after discharge.

Compared with the control group, the intervention group showed significant improvement in nutritional status (ꞵ₄ weeks = -1.08, 95 % CI -2.12 to 0.04, p = 0.042; ꞵ₁₂ weeks = -1.52, 95 % CI -2.57 to -0.47, p = 0.005). Improvements were also observed in energy and protein intake, weight loss, and cognitive beliefs related to nutritional behavior, including risk perception, outcome expectancy, self-efficacy, intention, and action plan (p < 0.05). However, no statistically significant differences were observed in coping plan, gastrointestinal symptoms, blood parameters, and quality of life (p > 0.05).

The nurse-led individualized mHealth nutrition intervention was effective for improving the cognitive beliefs related to nutritional behavior, energy and protein intake, and nutritional status, as well as reducing weight loss among post-discharged gastric cancer patients following gastrectomy.

ChiCTR2200064808.

Patient-reported outcome (PRO) measures are essential tools for assessing a patient's subjective experience related to disease and health. PROs measure symptom severity and evaluate treatment efficacy across a range of conditions at a particular point in time. Although PROs focusing on esophageal symptoms and esophageal hypervigilance exist, disease-specific PROs for commonly encountered benign esophageal disorders such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and achalasia are limited. Most GERD-specific PROs fail to address the complete spectrum of GERD presentations and those that provide daily assessment are more suited for research. Similarly, many EoE-specific PROs were designed for clinical trials. Comprehensive instruments incorporating EoE symptoms, as well as endoscopic and histologic features of active inflammation and fibrostenotic changes are needed. The psychometric properties of the Eckardt Score used for achalasia have significant limitations, stemming primarily from the dominance of dysphagia in scoring. Newer achalasia-specific PROs attempt to overcome this by capturing nuanced patient experiences. Broader symptom PROs are often used to assess esophageal symptoms across the spectrum of benign esophageal disorders, including a PRO that assesses esophageal hypervigilance and symptom-specific anxiety. Future efforts should focus on creating user-friendly PROs that comprehensively evaluate not just clinical presentation but also the disease state, which will enhance clinical symptom follow-up, quality of life assessment, and research applications. Assessments of hypervigilance and visceral anxiety will complement these applications as these measures are both a PRO and an important moderator of symptom severity and quality of life.

Current treatment of Parkinson's Disease (PD) remains symptomatic, and disease-modifying approaches are urgently required. A promising approach is to modify intestinal microbiota and key metabolites of bacterial fermentation: short-chain fatty acids (SCFA), which are decreased in PD. A prospective, controlled pilot study (DRKS00034528) was conducted on 11 couples (PD patient plus healthy spouse as control (CO)). Participants followed a 4-week diet rich in dietary fibre, including intake of the prebiotic Lactulose. Gut metagenomes, faecal and urinary metabolites, and clinical characteristics were assessed. The dietary intervention significantly augmented faecal SCFA and increased Bifidobacteria spp., reducing PD-related gastrointestinal symptoms. The pre-existing bacterial dysbiosis in PD (depletion of Blautia, Dorea, Erysipelatoclostridium) persisted. Bacterial metabolite composition in faeces and urine positively changed with the intervention: Brain-relevant gut metabolic functions involved in neuroprotective and antioxidant pathways, including S-adenosyl methionine, glutathione, and inositol, improved in PD. These promising results warrant further investigation in larger cohorts.

Inflammation is central in inflammatory bowel disease (IBD) pathogenesis. Because of diet's pro- and anti-inflammatory properties, multiple observational studies have explored the link between the dietary inflammatory potential and IBD-related outcomes. We aimed to systematically review the literature and provide a comprehensive overview of the dietary inflammatory potential and its association with the development and progression of IBD.

Literature was searched systematically on the 2nd of May 2024 in PubMed, Web of Science, Scopus, Cochrane Library, and Embase to identify the observational studies that explored the link between the dietary inflammatory potential and IBD-related outcomes. A higher dietary inflammatory potential was defined as the ability of a dietary pattern to promote inflammation in the body. Studies were included only if they quantified this using a dietary index, such as the dietary inflammatory index (DII) and the empirical dietary inflammatory pattern (EDIP). Two authors independently performed study selection and data extraction and assessed the risk of bias using the Newcastle-Ottawa scale.

Fourteen of the 165 identified records met the inclusion criteria. Seven investigated the risk of developing IBD, but with mixed results. Nine investigated the progression of IBD, which indicated that a higher dietary inflammatory potential contributed to higher disease activity and associated symptoms.

The evidence suggested that a higher dietary inflammatory potential worsens the condition of IBD patients, while the link with the risk of developing the disease was less clear. To elucidate this, high-quality intervention studies are needed.

Oral glucocorticoid (GC) therapy rapidly and deleteriously affects bone metabolism and blood glucose regulation. The gut microbiota regulates bone metabolism and a prior study found that Limosilactobacillus reuteri ATCC PTA6475 (L. reuteri) reduced bone loss over 12 mo in older women. Mice treated either with broad-spectrum antibiotics or with L. reuteri did not experience GC-induced trabecular bone loss. This proof-of-concept, randomized, double-blind, placebo-controlled trial aimed to investigate if daily supplementation with L. reuteri, compared with placebo, could mitigate or prevent the negative effects of oral GC on bone turnover and blood glucose regulation in healthy young adults. Twenty-one men and 29 women, aged 18-45, were randomized to either placebo or L. reuteri (1 × 1010 CFU/d) treatment for 2 wk, followed by open-label oral prednisolone 25 mg daily for 7 d. Primary outcomes were changes in blood bone status indices (osteocalcin, C-terminal telopeptide cross-links of collagen type-I (CTX), and type-I procollagen intact N-terminal propeptide [PINP]) from baseline to 7 d after starting oral GC. Secondary endpoints included changes in blood glucose levels using continuous glucose monitoring during the same period (ClinicalTrials.gov NCT04767711). Blood samples were collected from participants in the morning after overnight fasting. Forty-six participants completed the 30-d study. The L. reuteri and placebo groups were well balanced in terms of baseline characteristics (age, BMI, sex, dietary intake, and physical activity). No significant differences were found between L. reuteri vs placebo for percent changes in CTX (-0.3 [95%CI -19.2-18.7], p = .98) or PINP (4.2 [-6.3-14.8], p = .43), or in osteocalcin levels (14.2 [-7.8-36.3], p = .21), although the group-to-group difference in osteocalcin was larger. There was no effect of treatment on mean blood glucose (-0.1 [-0.3-0.1] mmol/L, p = .28). In conclusion, we failed to detect a significant effect of L. reuteri supplementation on GC-related adverse effects on bone status indices in this proof-of-concept RCT. Larger studies are needed to identify any potential smaller effects.

The treatment of people with tuberculosis necessitates the administration of both broad-spectrum and narrow-spectrum antibiotics for a minimum duration of six months. Prolonged antibiotic therapy may result in dysregulation of the gut microbiota, potentially influencing the onset and progression of tuberculosis. There is a paucity of studies focus on the characteristics of gut microbiota changes at various time points during tuberculosis treatment. This study aims to elucidate the relationship between the composition of gut microbiota and their stage within anti-tuberculosis therapy.

A multi-center, observational prospective cohort study was conducted at four designated hospitals in Jiangsu Province in eastern China. The Gastrointestinal Symptom Rating Scale was employed to evaluate the gastrointestinal discomfort experienced during anti-tuberculosis treatment. Fecal samples were collected at baseline before initiating anti-tuberculosis therapy and at the end of 2 months and 6 months during treatment. Total microbial genomic DNA was extracted and sequenced. Rarefaction curves and alpha diversity indices including observed operational taxonomic units, Chao1 richness and Shannon index were calculated.

From October 2020 to December 2022, a total of 204 people with tuberculosis were diagnosed. Among these, 85 people with tuberculosis provided baseline, 2-month, and 6-month fecal samples. The average age was 41.8 ± 15.193 years, with a gender ratio of 77 males to 8 females. Only 28.2% of the cohort reported being free of gastrointestinal symptoms during anti-tuberculosis treatment. Anti-tuberculosis treatment significantly reduced gut microbiota diversity, with a transient decrease in alpha diversity indices observed after two months. A higher alpha diversity in baseline (Shannon index with mean ± standard deviation (SD) 2.92 ± 0.93 vs. 2.50 ± 0.84, P = 0.0014, inverse Simpson's index with 11.9 ± 8.66 vs. 7.87 ± 6.42, P = 0.0012), compared with people with tuberculosis after 2 months of treatment. No significant differences were identified between 2 months of treatment and at the end of treatment microbiota diversity (Shannon index 2.50 ± 0.84 vs 2.58 ± 0.81, P = 0.55, inverse Simpson's index 7.87 ± 6.42 vs 11.90 ± 8.66, P = 0.43).

Findings from our study show that anti-tuberculosis treatment has profound effects on people with tuberculosis gastrointestinal function and the gut microbiota, particularly during the intensive phase of therapy. After the intensive treatment phase, the gut microbiota has partially recovered, but it is an extremely slow process.

Irritable bowel syndrome (IBS) is a common brain-gut disorder often accompanied by depressive symptoms, with atrophy and hyperactivity of the anterior cingulate gyrus (ACC) being key drivers of both IBS and its psychiatric comorbidities. This study aimed to investigate the functional connectivity (FC) patterns of pregenual ACC (pgACC) and anterior midcingulate cortex (aMCC) in IBS patients with depressive symptoms (DEP-IBS). A whole-brain FC analysis was conducted using pgACC and aMCC as regions of interest in three groups: 28 DEP-IBS patients, 21 IBS patients without depressive symptoms (nDEP-IBS), and 36 matched healthy controls (HCs). Partial correlation and mediation analyses were performed between abnormal FC and clinical symptoms. The ability of aberrant FC to identify IBS and its psychiatric comorbidity was evaluated using receiver operating characteristic (ROC) curve. DEP-IBS patients exhibited increased pgACC-related FC in the left medial prefrontal cortex (mPFC) and aMCC-related FC in the right middle frontal gyrus, angular gyrus and cerebellum, while showing decreased aMCC-related FC in the right precentral gyrus, superior parietal gyrus and precuneus. Both patient groups demonstrated increased FC between aMCC and left dorsolateral prefrontal cortex (dlPFC), effectively distinguishing them from HCs (AUC = 0.755). The FC between pgACC and left mPFC partially mediated the relationship between gastrointestinal and depressive symptoms, effectively distinguishing DEP-IBS from nDEP-IBS patients (AUC = 0.808). Aberrant FC within the emotional arousal network may serve as a neurobiological marker for IBS with comorbid depression. Furthermore, abnormal FC between the aMCC and the dlPFC may underlie the neural mechanism of IBS.

Multiple studies suggest that the EQ-5D may overestimate health-related quality of life (HRQoL) in patients with coeliac disease (CD). We aimed to develop and psychometrically test potentially relevant bolt-on dimensions to improve the measurement performance of the EQ-5D-5L in CD patients.

The development and selection of bolt-ons were informed by a literature review on HRQoL in CD, expert and patient input. A cross-sectional online survey was conducted amongst 312 adult CD patients. Respondents completed the EQ-5D-5L, two condition-specific bolt-ons newly-developed for the present study [dining (DI) and gastrointestinal problems (GI)] and three existing bolt-ons [cognition (CO), sleep (SL) and tiredness (TI)]. The following psychometric properties were tested: ceiling, informativity, convergent and known-group validity, and dimensionality (confirmatory factor analysis).

Adding the TI, SL, GI, DI and CO individual bolt-ons reduced the ceiling of the EQ-5D-5L (39%) to 17%, 23%, 24%, 26% and 37%, respectively. GI excelled with strong convergent validity with the Gastrointestinal Symptom Rating Scale total score (rs=0.71) and improved the discriminatory power for all known-groups. GI was the only bolt-on loading on a different factor from the five core dimensions, whereas the other four bolt-ons loaded onto the same 'psychosocial health' factor as the EQ-5D-5L anxiety/depression dimension.

The DI, GI, SL and TI bolt-ons, especially the GI, enhance the validity of EQ-5D-5L in patients with CD, suggesting their value in capturing important HRQoL aspects potentially missed by the five core dimensions. These bolt-ons can be used in sensitivity analyses supporting health technology assessments and subsequent resource allocation decisions.

After major abdominal surgery, patients may experience significant gastrointestinal dysfunction, including postoperative ileus. Many clinical tools are used to measure this dysfunction, but there is no patient-reported outcome measure (PROM) specific to this group. The aim of this study was to develop a new PROM for this common condition.

A four-stage approach was undertaken. Stage 1 used semi-structured interviews with 29 patients to explore experiences of gastrointestinal recovery and develop a draft questionnaire. Stage 2 solicited feedback from 18 patients and 15 clinical experts on the face validity of the proposed tool using the Questionnaire on Questionnaires (QQ-10). Stage 3 recruited 297 patients to complete the questionnaire. Principal component analysis reduced the items and identified the domain structure. Test-retest reliability and a pilot assessment of responsiveness were assessed in stage 4 in a sample of 100 patients and in a sample of 68 patients respectively.

The interviews generated 26 subthemes across gastrointestinal recovery and general well-being. An initial questionnaire containing 44 items was developed. The QQ-10 demonstrated high value and low burden, supporting face validity. Tests to reduce the items and identify the domain structure resulted in a 15-item questionnaire across four domains (nausea, eating, well-being, and bowels). Test-retest reliability showed intraclass correlation coefficient values ≥0.7 for all domains. Pilot responsiveness was demonstrated through differences in pre- and post-surgical scores.

PRO-diGI is a PROM for gastrointestinal dysfunction after major abdominal surgery that shows good psychometric properties and demonstrates face validity, reliability, and responsiveness. This now needs external validation to facilitate broader implementation.

Visceral hypersensitivity is a hallmark of irritable bowel syndrome (IBS). A putative involvement of the Transient Receptor Potential Ankyrin-1 (TRPA1) cation channel has been suggested by several animal studies. Main objective of this study is to assess location-specific TRPA1 expression in the colonic mucosa and its correlation with symptom severity in IBS patients.

Biopsies were obtained from the sigmoid of 30 IBS patients (Rome III; median age 39.0 years, 80 % female) and 23 healthy controls (median age 22.7 years, 43.5 % female). Additional biopsies of the proximal colon were obtained in 24 IBS patients. TRPA1 expression levels were measured in duplicate by quantitative reverse-transcriptase-polymerase-chain-reaction, normalized to GAPDH, and assessed as relative mRNA values using the -2ΔCt method. In IBS patients, symptoms were assessed and correlated with TRPA1 expression.

Relative TRPA1 expression in the sigmoid was significantly higher in IBS patients compared to healthy controls (P < 0.001). Within IBS patients TRPA1 expression of sigmoid biopsies was significantly higher compared to proximal colon samples (p < 0.001). No significant correlation was found between TRPA1 expression in sigmoid or proximal colon samples and the symptom severity (abdominal discomfort, abdominal pain and bloating).

These findings suggest a potential role for the TRPA1 related pathway as a target for IBS treatment in the future. Since there was no correlation found in the current exploratory study between TRPA1 expression and symptom severity, further research towards the clinical relevance of the increased TRPA1 expression in IBS-patients along with its location-specific expression is warranted.

ObjectivesThis study examines the safety and efficacy of a fecal transplant alternative, Microbial Ecosystem Therapeutic-2 (MET-2), in improving symptoms of depression. The primary objective of this study is to assess changes in depressive symptoms before, during, and after administration of MET-2 in comparison to placebo. Mood-related symptoms such as anxiety and anhedonia, gastrointestinal symptoms, and safety of the therapeutic were also assessed using both self-report and clinician-rated measures.MethodsTwenty-nine participants (n = 29) experiencing a major depressive episode were recruited from the Kingston and Toronto areas. Participants orally consumed MET-2, an encapsulated microbial therapeutic containing 40 different strains of bacteria, or placebo alternative, once daily for 6 weeks with a 2-week follow-up. Participants underwent a series of clinical assessments used to measure mood, anxiety, and gastrointestinal symptoms.ResultsThere was a significant improvement in depressive symptomology over time as determined by Montgomery-Åsberg Depression Rating Scale scores (p < 0.0001); however there was no significant difference between placebo and MET-2 groups (p = 0.338). No serious adverse events were reported. The findings of this study are the first to provide evidence for the role of oral microbial therapeutics, such as MET-2, as treatment for symptoms of depression.ConclusionsThough there are positive trends suggesting a greater improvement in depressive symptomology among the MET-2 group compared to the placebo group, a larger sample size is needed for more conclusive results. Clinicaltrials.gov NCT04602715.

Background: While the low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet, low FODMAP diet (LFD) has demonstrated effectiveness in managing irritable bowel syndrome (IBS) symptoms, little is known about sex-specific responses to this dietary intervention. Aim: This study evaluates the role of sex differences in symptom improvement following a dietitian-led, group education session on the LFD for IBS patients. Methods: A total of 305 patients, including 249 with a diagnosis of IBS and 56 classified as having suspected IBS, were enrolled in this study (79.7% female). Patients attended two group education sessions on the LFD. Primary outcomes were measured using the IBS Symptom Severity Score (IBS-SSS) and the Global Symptom Question (GSQ). Secondary outcomes included stool frequency, stool consistency and individual symptoms assessed by the Gastrointestinal Symptom Rating Scale. Statistical analyses were performed to compare baseline and follow-up data within and between sexes. Results: Both male and female patients experienced significant reductions in IBS-SSS scores and improvements in GSQ satisfactory relief, stool frequency, stool consistency and individual gastrointestinal (GI) symptoms following the LFD (p < 0.05). There were no significant between-sex differences in the extent of symptom relief (p > 0.05). Conclusion: The study found no significant sex-based differences in symptom reduction or GI relief following the intervention. These findings suggest that, despite differing symptom profiles and IBS prevalence, both male and female patients achieve similar relief with the LFD group education.

Background and Objectives: Neuropeptide Y (NPY) family peptides and dipeptidyl peptidase-4 (DPP-4) are involved in gastrointestinal regulation and may contribute to obesity and type 2 diabetes mellitus (T2DM) pathophysiology. This study investigates their expression in jejunal muscular tissue and associations with gastrointestinal symptoms in patients with obesity, with (OB+/DM+) and without T2DM (OB+/DM-). Materials and Methods: This cross-sectional study includes forty-four patients undergoing laparoscopic Roux-en-Y gastric bypass divided based on T2DM status. Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and jejunal tissue samples were analyzed for DPP-4, NPY, peptide YY (PYY), and pancreatic polypeptide (PP) mRNA and protein levels. Results: DPP-4, NPY, PYY, and PP gene expression in jejunal muscular tissue was similar between groups. In the OB+/DM+ group, PP protein was higher, while DPP-4 and PYY were lower compared to the OB+/DM- group. Significant positive correlations between DPP-4 and NPY, PYY, and PP were found in the OB+/DM- group, while only DPP-4 and PYY correlated in the OB+/DM+ group. Gastrointestinal symptoms in the OB+/DM- group showed positive correlations with PP (abdominal pain), DPP-4 (indigestion), and NPY (constipation). Conclusions: The study demonstrates significant differences in DPP-4, PYY, and PP protein expression between patients with obesity, with or without T2DM. Peptide correlations with gastrointestinal symptoms in non-diabetic patients suggest distinct regulatory mechanisms, warranting further research.

Globally, master's and doctoral students, especially pregraduate students, are under great pressure. Probiotics are emerging as a promising intervention to improve mental health via gut-brain axis.

The aim of this study was to explore the impact of Lacticaseibacillus paracasei K56 supplementation on perceived stress among pregraduate students.

We conducted a double-blind, randomized, placebo-controlled trial in 120 healthy master's and doctoral students who faced graduation. Participants were randomly assigned to either probiotics (containing Lacticaseibacillus paracasei K56 6 × 1010 CFU / d) or placebo group for 2 weeks intervention. The main outcome was perceived stress assessed using Cohen's Perceived Stress Scale-10 (PSS-10). The secondary outcomes were stress, depression, and anxiety assessed by Depression, Anxiety and Stress Scales (DASS), gastrointestinal symptoms, and sleep evaluated by corresponding scales. These outcomes were assessed at baseline, 1, and 2 weeks. Pre- and post-treatment serum biomarkers, gut microbiota composition and metabolites were also detected.

There was no difference in changes of PSS-10 scores from baseline to 2 weeks between the K56 groups and the placebo [mean (standard error): -1.68 (0.48) vs. -0.39 (0.46), p = 0.055]. Furthermore, the K56 group exhibited superior reductions in both stress [-2.15 (0.38) vs. -0.96 (0.49), p = 0.035] and anxiety symptoms [-1.54 (0.32) vs. 0.53 (0.43), p = 0.003] via DASS compared with the placebo group. Additionally, those receiving K56 also experienced improved sleep quality (p = 0.010) and elevated levels of serotonin (5-HT) (p = 0.038) compare to placebo group. Moreover, taking probiotics K56 could modulate the pressure-induced changes in gut microbiota composition, particularly by increasing the beneficial bacteria (Lacticaseibacillus and Lacticaseibacillus paracasei), while suppressing suspected pathogenic bacteria (Shieglla and Escherichia_coli). Metabolomic analysis revealed an increased in metabolites, especially butyric acid in the K56 group (p = 0.035). Notably, there was a significant negative correlation between relative abundance of lactobacillus and stress-related symptoms, whereas butyric acid showed a significant positive correlation with lactobacillus abundance level.

This study suggested the potential benefits of K56 supplementation in alleviating stress and significant effect in reducing anxiety and insomnia among master's and doctoral students, which may be attributed to K56-induced changes in microbial composition and butanoate metabolism.

Chictr.org.cn, identifier ChiCTR2300078447.

Many patients with ulcerative colitis report ongoing diarrhoea even when their disease is stable and in remission.

MODULATE was a pragmatic, multicentre, seamless, adaptive, phase 2/3 open-label, parallel-group, multiarm multistage randomised controlled trial.

People aged over 18 years with stable ulcerative colitis who had diarrhoea, recruited from secondary care sites in the United Kingdom.

The control arm consisted of modified first-line dietary advice given to all patients with irritable bowel syndrome; the first interventional arm was amitriptyline, a tricyclic antidepressant, which at low doses slows colonic transit; the second intervention was loperamide, an antidiarrhoeal drug also thought to slow colonic transit; the third was ondansetron, an antiemetic thought to slow colonic transit; and the fourth was a diet low in fermentable oligo-, di-, and mono-saccharides and polyols, which is thought to reduce bloating and gas within the small intestine. All patients randomised to an interventional arm were to receive treatment for 6 months.

Phase 2: Improvement in diarrhoea measured using the Gastrointestinal Symptom Rating Scale-irritable bowel syndrome questionnaire at 8 weeks post randomisation: improvement defined as those reporting minor discomfort from diarrhoea or less (scoring ≤ 2 on the diarrhoea subscale).

Phases 2 and 3: Measured at both 8 weeks and 6 months: Improvement in diarrhoea measured using the Gastrointestinal Symptom Rating Scale-irritable bowel syndrome. Blood for C-reactive protein, stool for faecal calprotectin at 6 months only, reviewing case notes for escalation of medical therapy for ulcerative colitis. Anxiety and depression, via the Hospital Anxiety and Depression Scale.

The MODULATE trial opened in December 2021 and closed in January 2023. Of the eight secondary care sites that completed contracting, only four opened to recruitment during this time, and one person was randomised. Trial timelines coincided with the start of the COVID-19 pandemic, causing substantial delays and, ultimately, its early closure. During this time, the trial underwent two major redesign phases, enabling a fully remote participant pathway incorporating electronic consent, remote data capture, posted blood and stool sample kits for eligibility screening, delivery of the dietary intervention via telephone or video call platform, postage of trial investigational medicinal products directly to participants' homes and all trial follow-up appointments conducted via telephone. The second phase of redesign pushed the trial towards a fully decentralised model. However, this stage was not implemented due to the decision to close the trial early.

The study was unable to recruit the necessary sample size, preventing the trial from progressing. The trial met with several challenges. The Trial Steering Committee's root cause analysis concluded that the pandemic was the leading factor in trial closure, especially regarding our ability to recruit both sites and participants.

Although the trial closed early and with insufficient participants to proceed with full statistical analysis, lessons were learnt that could potentially inform future remote trial design and decentralised participant pathways.

MODULATE was a commissioned call in response to a priority question identified by people living with ulcerative colitis. The question remains important and unanswered; trials to address it are needed. Given the recruitment difficulties we experienced, consideration should be given to conducting these in both primary and secondary care.

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/33/03.

Various oral manifestations are associated with coeliac disease in children, whereas data on adults are scarce. Moreover, possible individual factors predisposing to these manifestations remain unresolved. The aim of this study was to investigate these issues in a large cohort of adult coeliac disease patients both at diagnosis and while on gluten-free diet (GFD).

This population-based study involved 873 adult patients with coeliac disease and 563 non-coeliac controls. Patients and controls were interviewed and structured questionnaires were used to assess the severity of gastrointestinal symptoms and quality of life at the time of the study. All participants were systematically asked about oral manifestations, including dental enamel defects, recurrent aphthous ulceration and glossodynia. Coeliac disease-related data were collected from medical records. Possible individual factors associated with oral manifestations were studied using logistic regression analysis.

Dental enamel defects were more common among patients than among non-coeliac controls (27% vs. 4%, p < 0.001). Prior to the coeliac disease diagnosis, 56% of the patients had experienced recurrent aphthous ulceration and GFD brought relief to 69% of them. While on GFD, coeliac disease patients had higher prevalence of recurrent aphthous ulceration than did the controls (17% vs. 13%, p = 0.040), but this significance disappeared after adjusting for gender. Glossodynia on GFD was more prevalent in the coeliac cohort than in the controls (14% vs 6%, p < 0.001). Oral manifestations at diagnosis and on GFD were associated with the presence of abdominal symptoms at the time of coeliac disease diagnosis, long diagnostic delay and female gender. At the time of the study, patients with oral symptoms had more severe gastrointestinal symptoms and poorer quality of life than those without these symptoms.

Oral manifestations were more prevalent, at diagnosis and on GFD, in patients with coeliac disease than in the controls, and they were associated with long diagnostic delay, abdominal symptoms, female gender and impaired quality of life. A GFD was shown beneficial in relieving recurrent aphthous ulcerations in patients with coeliac disease.

Recent studies show that the increase in breath hydrogen (BH2) and symptoms after ingestion of inulin are reduced by coadministering psyllium (PI).

To determine if slowing delivery of inulin to the colon by administering it in divided doses would mimic the effect of PI. Primary endpoint was the BH2 area under the curve AUC0-24 h. Secondary endpoints included BH2 AUC0-6 h, 6-12 h, and 12-24 h. Exploratory endpoints included the correlation of BH2 AUC0-24 h with dietary fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) intake and in vitro fermentation results.

A total of 17 healthy adults were randomly assigned to a single-blind, 3-arm, crossover trial. All consumed 20 g inulin (I) powder dissolved in 500 mL water and mixed with either 20 g maltodextrin (control) or 20 g PI consumed as a single dose or 20 g inulin given in divided doses (DDI), 62.5 mL every 45 min over 6 h. Twenty-four-hour BH2, dietary FODMAP intake, stool microbiota, and gas production in vitro were measured. Responders were defined as those whose AUC0-24 h BH2 was reduced by PI, whereas nonresponders showed no reduction.

Compared with control, PI did not reduce mean BH2 AUC0-24 h, whereas DDI increased it, P < 0.0002. DDI and PI both significantly reduced BH2 AUC0-6 h compared with the control, P < 0.0001. However, subsequently, DDI significantly increased BH2 from 6 to 12 h (P < 0.0001) and overnight (12-24 h) (P < 0.0001), whereas PI did so only overnight (P = 0.0002). Nonresponders showed greater release of arabinose during in vitro fermentation and higher abundance of 2 species, Clostridium spp. AM22_11AC and Phocaeicola dorei, which also correlated with BH2 production on PI. Dietary FODMAP intake tended to correlate inversely with BH2 AUC0-24 h (r = -0.42, P = 0.09) and correlated with microbiome community composition.

DDI, like PI, reduces early BH2 production. PI acts by delaying transit to the colon but not reducing colonic fermentation over 24 h. Dietary FODMAP intake correlates with BH2 response to inulin and the microbiome. This trial was registered at www.

gov as NCT05619341.

Background and aim Probiotics have been linked to improved gastrointestinal health and essential nutrient absorption. This study aimed to assess the impact of Bacillus clausii(Shouchella clausii) UBBC-07 plus whey protein supplementation on the bioavailability of circulating essential amino acids (EAAs) in physically active young adults.  Methods In this double-blind, randomized, controlled trial, 70 physically active male participants (21.46±3.19 years) were instructed to ingest either a probiotic supplement containing two billion colony-forming unit (CFU) Bacillus clausii UBBC-07 + 20 g of whey protein or a control supplement containing placebo + 20 g of whey protein once daily for 60 days. All the participants followed a supervised exercise protocol. The circulating amino acid levels were determined using a high-performance liquid chromatography with fluorescence detection (HPLC-FLD) assay and compared using the student's t-test and a repeated measures analysis of variance (ANOVA). Results After 60 days, a significant improvement in the probiotic group was observed compared to the control group in terms of total levels of circulating EAAs (mean change: 258 pmol/μl, 95% CI: 161.5-354.4 vs. 76.4 pmol/μl, 95% CI: 16.5-136.4; p=0.002) and branched-chain amino acids or BCAAs (mean change: 144.2 pmol/μl, 95% CI: 89-199.3 vs. 37.5 pmol/μl, 95% CI: 7.3-67.8; p=0.001) as well as levels of isoleucine (p=0.003), leucine (p>0.001), and valine (p=0.001). Total plasma free amino acids (PFAAs) were also increased in the probiotic group (p<0.001). The improvement in the one-repetition maximum (RM) leg press was higher in the probiotic group as compared to the control group (mean change: 20.46 kg, 95% CI: 14.73-26.19 vs. 14.09 kg, 95% CI: 8.44, 19.73; p=0.045). A trend towards improvement in deadlift and vertical jump was also observed in the former group. No probiotic-mediated gastrointestinal upsets and respiratory symptoms or any other adverse events were observed. Conclusion A significant improvement in circulating EAA levels in the probiotic group suggests an enhancement of protein absorption with Bacillus clausii UBBC-07 supplementation. The effect of BCAAs, which enhance muscle strength, is evident in the significant improvement in leg press and a trend towards improvement in deadlift and vertical jump in the probiotic group. This has positive implications for individuals involved in sports activities.

Linerixibat, an ileal bile acid transporter (IBAT) inhibitor, is being evaluated for the treatment of pruritus in primary biliary cholangitis (PBC). Diarrhea is commonly reported with this drug class as IBAT inhibition redirects bile acids (BA) to the colon. Serum 7-alpha-hydroxy-4-cholesten-3-one (C4) measurement is a validated method to identify BA diarrhea. To inform dose selection, we characterized the relationship between linerixibat dose, C4 levels, and patient-reported bother on the gastrointestinal symptom rating scale (GSRS) diarrhea question. A kinetic-pharmacodynamic model was developed using data from five Phase 1/2 trials, to describe the effect of linerixibat dose (1-180 mg) and regimen (once/twice daily) on C4 concentrations over time. GSRS data from patients with PBC and pruritus in the Phase 2b GLIMMER study (NCT02966834) were used to develop a proportional odds model to predict the probability of a score of 1-7 (no-very severe discomfort) to the question "Have you been bothered by diarrhea during the past week?" in relation to linerixibat dose. The two models were linked to describe the linerixibat dose-C4-diarrhea bother relationship. Models were validated using graphical and numerical assessment and visual predictive checks. Linerixibat caused dose-dependent increases in C4 until saturation (~180 mg total daily dose). Increased C4 concentrations trended with increased GSRS diarrhea scores. Simulations demonstrated increases in moderate-to-very severe (≥ 4) diarrhea scores with increasing linerixibat dose. Increases in patient-reported diarrhea scores were linerixibat dose-dependent. Selecting an optimal dose that maximizes linerixibat's ability to improve pruritus while minimizing patient-reported diarrhea bother is important to support treatment adherence.

Introduction The biotransformation of minerals through glycosylation by microorganisms, such as yeast or probiotics, can produce nutrients bound to a food matrix, potentially enhancing their bioavailability. This study aimed to compare the absorption kinetics of iron bound to a glycoprotein matrix (GPM) with those of ferrous bisglycinate chelate (FBC) and ferrous fumarate (FF). Methods In a double-blind, crossover design, 17 participants ingested 11 mg of iron in one of three forms: GPM (Pharmachem Innovation, Kearny, NJ, USA), FBC (Ferrochel®, Balchem Corp., Montvale, NJ, USA), or FF (FerroPharma Chemicals Ltd, Hungary). Blood samples were collected at baseline and 30-, 60-, 90-, 120-, 180-, 240-, 300-, 360-, 420-, and 480-minutes post-ingestion. Water intake was standardized throughout the protocol, and an iron-free snack was provided at four hours post-ingestion. Pharmacokinetic analysis was performed, with key outcome variables including the incremental area under the concentration vs. time curve (iAUC), maximum concentration (Cmax), and time to maximum concentration (Tmax). The a priori significance level was set at p < 0.05. Results Linear mixed-effects models indicated statistically significant effects of the GPM condition for both raw iron concentrations and changes from baseline (p = 0.03). On average, participants had iron concentrations that were 27.1 mcg/dL (95% CI: 2.8 to 51.4) higher after consuming GPM iron compared to the FF reference condition. Changes in iron concentrations from the baseline were 16.6 mcg/dL (95% CI: 1.5 to 31.7) higher after GPM consumption compared to FF. In contrast, iron concentrations and changes in iron levels after FBC consumption did not significantly differ from those observed with FF. Significant effects of time were also observed in both linear mixed-effects models. When expressed as percentage changes from baseline, iron concentrations in the GPM condition were 9.4% to 35.0% higher than FF and 5.9% to 32.6% higher than FBC. Pharmacokinetic analysis revealed a significant effect of condition on the iAUC (p = 0.047), but no significant effects for Cmax (p = 0.15) or Tmax (p = 0.81). Post hoc tests for the iAUC indicated a trend (p = 0.07) for a difference between the GPM and FBC conditions, but no significant differences between GPM and FF (p = 0.17) or FBC and FF (p = 0.75). Conclusion These findings suggest that iron bound to a glycoprotein matrix can improve absorption kinetics without any associated side effects. This data could have important implications for addressing iron deficiency or absorption disorders in a variety of populations.

During the COVID-19 pandemic, dietary habits in the population changed and sometimes deviated from healthy eating patterns, such as the Mediterranean diet. Based on reports on the quality of the diet of respondents to studies conducted at the beginning of the pandemic, it could be concluded that these new dietary habits are unfavorable for a good prognosis and the course of any disease and its severity of symptoms. This study decided to confront these assumptions with the results of people who had COVID-19. Background/Objectives: This study aimed to assess the associations between dietary patterns and the occurrence of hospitalization and gastrointestinal disorders among patients diagnosed with COVID-19. Methods: This study included 550 respondents who completed a survey up to 8 months after being diagnosed with COVID-19. The survey included 62 items from the FFQ-6®, GSRS, PAC-SYM and FACT-G7 standardized questionnaires. Results: Two dietary patterns (DPs) were identified: 'Processed high fat/sugar/salt/meat/dairy/potatoes' and 'Semi-vegetarian'. Higher adherence to the 'Processed' DP was associated with higher odds of hospitalization due to COVID-19, a more severe course of the disease, and the highest intensity of gastrointestinal symptoms. Higher adherence to the 'Semi-vegetarian' DP was associated with lower odds of hospitalization due to COVID-19, a less severe course of the disease, and the lowest intensity of gastrointestinal symptoms. Conclusions: This study showed a strong harmful effect of high adherence to a processed dietary pattern on an increased incidence of hospitalization and gastrointestinal disorders among northwestern Polish adults during the COVID-19 pandemic, emphasizing the importance of a healthy diet.

Premenstrual disorder (PMD), which includes premenstrual syndrome and premenstrual dysphoric disorder, has a complex pathogenesis and may be closely related to emotional cognition and memory. However, the mechanisms underlying these associations remain unclear. Therefore, this study used machine learning to explore the roles of various factors that are not typically considered risk-factors for PMD.

A predictive model for PMD was constructed using a dataset of questionnaire responses and heartrate variability data collected from 60 participants during their follicular and luteal phases. Based on the Japanese version of the Premenstrual Symptom Screening Tool, the binary objective variable (PMD status) was defined as "PMD" for moderate-to-severe premenstrual syndrome and premenstrual dysphoric disorder and other conditions as "non-PMD." The contribution of each feature to the predictive model was assessed using the Shapley Additive exPlanations (SHAP) model-interpretation framework.

Of the 58 participants (providing 117 data points), 17 (34 data points) were in the PMD group and 41 (83 data points) were in the non-PMD group. The area under the receiver operating characteristic curve was 0.90 (95% confidence interval: 0.82-0.98). Among the top 20 features with the highest SHAP values, six were associated with maternal bonding. Four of the six mother-related characteristics were associated with overprotection.

Based on these findings, parental bonding experiences, including maternal overprotection, may be associated with the presence of PMD.

To explore neural similarities and differences between visceral and somatic pain by comparing spontaneous brain activity in patients with chronic temporomandibular disorder (TMD) and irritable bowel syndrome (IBS).

Twenty eight IBS patients, 21 TMD patients, and 28 healthy controls (HC) underwent resting-state fMRI and behavioral assessments. The correlations between fMRI metrics such as the amplitude of low-frequency fluctuations (ALFF), regional homogeneity (ReHo), functional connectivity (FC), and clinical manifestations were further analyzed.

Compared with HC, both patient groups demonstrated increased ALFF in right parahippocampal gyrus (PHG), insula, medial superior frontal gyrus (SFGmed), precentral gyrus (PreCG), and increased ReHo in right SFGmed and left supplementary motor area (SMA). Compared with IBS patients, TMD patients exhibited reduced ALFF in right SFGmed and insula, increased ALFF in right PHG and PreCG, decreased ReHo in right SFGmed and left lingual gyrus, and increased ReHo in left SMA. Both patient groups exhibited enhanced right PHG-related FC in left precuneus and right cingulate gyrus, and right insula-related FC in left superior temporal gyrus and right paracentral lobule. Specifically, IBS patients showed higher FC between right PHG and orbitofrontal cortex than TMD patients, which was negatively correlated with mood and gastrointestinal symptoms. Mediation analysis revealed that pain in TMD and gastrointestinal symptoms in IBS mediated these relationships.

Visceral and somatic pain share abnormal activity in multiple brain networks. Abnormalities in affective region present potential neuroimaging markers for pain disorders, with depression in somatic pain linked to pain intensity and in visceral pain to gastrointestinal symptoms.

Pain, poor quality of life (QOL) and gastrointestinal (GI) symptoms are commonly experienced by individuals with endometriosis. Although diet and nutrition supplements are frequently used to manage endometriosis-related symptoms, there is limited understanding of the breadth and quality of research in this field. Our aim was to undertake a scoping review of diet and nutrition supplement intervention studies in people with endometriosis, diagnosed by ultrasound or surgery.

MEDLINE Complete, Embase, CINAHL and PsycINFO databases were searched for articles published in English from database inception to November 2024. Quality was assessed by two reviewers independently using the Joanna Briggs Institute appraisal tools. In total, 5130 publications were screened and 13 were included.

Among these, five evaluated the effect of diet intervention, one evaluated the effect of a combined diet-supplement intervention and seven evaluated the effect of a nutrition supplement in endometriosis. Overall, there were seven randomised controlled trials (RCTs) (n = 1 diet intervention, n = 6 nutrition supplement), two nonrandomised controlled studies (n = 1 diet intervention, n = 1 combined diet-supplement) and four uncontrolled studies (n = 3 diet intervention, n = 1 nutrition supplement). On the basis of evidence from the RCTs, the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet improved QOL and GI symptoms, whereas garlic supplements and combination trace element supplements may be beneficial for improving reduced pain symptoms related to endometriosis. The quality of most included studies was poor. Adherence to the interventions was only measured in five studies and only one diet study measured baseline diet.

High-quality RCTs of diet and nutrition supplement interventions are needed to progress the understanding of whether they should be integrated into the clinical management of endometriosis.

Prebiotic dietary fiber (PDF) may reduce feelings of stress or improve mood in healthy individuals. Yet gut intervention studies that focus on mood in daily life are lacking and few studies include extensive biological sample analyses to gain mechanistic insights. As part of a larger randomized placebo-controlled crossover study including healthy individuals, we explored the effects of 12 weeks of PDF (acacia gum and carrot powder) on everyday mood, as measured with ecological momentary assessment (EMA). Microbiome composition and levels of microbial metabolites, endocrine, and inflammatory markers were determined prior to and after both intervention phases. Fifty-four participants completed the study. The intervention significantly increased daily positive affect (PA) and reduced daily negative affect (NA) in female but not male participants. The intervention-induced reduction in NA was associated with an increase in microbial diversity in female participants. The intervention did not significantly affect levels of fecal short chain fatty acids, cortisol, and inflammatory markers. This is one of the first studies to show that a dietary fiber intervention can positively alter mood as it is experienced in everyday life. Overall, our findings may stimulate more targeted gut-microbiome interventions and detection of its mental health effects in real life.

The dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), called the low-FODMAP diet (LFD), is frequently used to manage irritable bowel syndrome (IBS). This service evaluation aimed to assess the long-term effectiveness of the LFD in managing IBS symptoms and whether symptom response and dietary adherence to the LFD were associated.

This observational service evaluation collected data via questionnaires during clinical dietetic appointments for IBS management. Symptom severity was reported at baseline, short term (following FODMAP restriction) and long term (following FODMAP reintroduction). Additional data that captured experiences following the LFD were collected at long-term follow-up.

Of 184 patients, 14% reported satisfactory relief from global symptoms at baseline, which increased to 69% at short-term follow-up and 57% at long-term follow-up (p < 0.001). The most notable improvements in individual symptoms between baseline and long-term follow-up were abdominal bloating (72% baseline, 48% long term, p < 0.001), abdominal pain (61% baseline, 30% long term, p < 0.001) and flatulence (71% baseline, 40% long term, p < 0.001). High adherence with the LFD at short-term follow-up was not associated with long-term symptom improvement, but there was an association between long-term adherence and global symptom severity (p = 0.032). Completion of FODMAP reintroduction as per protocol was associated with long-term symptom improvement (p = 0.049).

The LFD is an effective treatment for managing IBS symptoms in the long term, particularly, when the diet is adhered to and reintroduction is completed as per dietetic education. Further randomised-controlled trials are required to explore the cause-and-effect relationship between LFD and IBS symptom management.