A few studies have demonstrated an association between gastroesophageal reflux disease (GERD) and depression, with some reporting that antidepressants may affect lower esophageal sphincter tone, thus exacerbating reflux. Here, we study the impact of antidepressants in patients with depression on GERD and its complications.

The TriNetX electronic health records network, which involves 70 healthcare organizations in the United States was utilized for this study. Data from patients between January 2015 and January 2025 was used. Patients with depression on tricyclic antidepressant (TCA) only, on selective serotonin reuptake inhibitors (SSRI) only, or on serotonin and norepinephrine reuptake inhibitors (SNRI) only were evaluated. The prevalence of developing a new diagnosis of GERD, erosive esophagitis (EE), esophageal stricture, or Barrett's esophagus (BE) was assessed in each group and compared to a control group of patients with depression on no antidepressants. Adjusted odds ratios (aOR) were used after a 1:1 propensity score matching for age, obesity, male sex, Caucasian race, alcohol use, and tobacco use between comparison groups. A sensitivity analysis evaluating the odds of developing GERD, EE, BE, or esophageal stricture within 1 month, 6 months, 1 year, 3 years, 5 years, and 10 years after initiation of antidepressant was also conducted.

A total of 2,775,955 patients with depression started on an antidepressant. The use of TCA was associated with increased odds of developing GERD (aOR = 1.52, p < 0.01), EE (aOR = 1.47, p < 0.01), and esophageal stricture (aOR = 2.29, p < 0.01). There was no significance with BE (aOR = 1.18, p = 0.226). The use of SSRI was associated with increased odds of GERD (aOR = 1.48, p < 0.01), EE (aOR = 1.46, p < 0.01), BE (aOR = 1.21, p < 0.01), and esophageal stricture (aOR = 1.35, p < 0.01). The use of SNRI was associated with increased risk of GERD (OR = 1.53, p < 0.01), EE (OR = 1.53, p < 0.01), BE (OR = 1.30, p < 0.01), and esophageal stricture (OR = 1.60, p < 0.01).

There is an increased association in developing GERD, EE, BE, and esophageal stricture with TCA, SSRI, and SNRI use. This association increased with prolonged use of medication over 10 years. Further prospective studies are needed to confirm our findings.

Historically, the management of acute uncomplicated diverticulitis was centered on antibiotics. However, modern theories regarding the pathogenesis of diverticulitis have challenged the notion that antibiotics are necessary in all cases. Despite major reform in many societal guidelines, the adoption of non-antibiotic therapy for uncomplicated diverticulitis has been limited, especially in North America. The purpose of this SAGES White Paper was to review the available evidence on antibiotic omission in uncomplicated diverticulitis and to explore methods of safe implementation.

A task force within the SAGES Colorectal Surgery Committee was formed to work on this White Paper. The committee and its leadership approved an outline that would focus on the following topics: (1) Defining the problem with unnecessary antibiotic exposure; (2) Evaluating the evidence on antibiotic omission in uncomplicated diverticulitis; (3) Identifying the appropriate patient for antibiotic omission; (4) Outlining how to counsel patients who are treated without antibiotics; (5) Reviewing methods to safely implement this practice in both the hospital and community setting. These topics were divided up among members of the task force who performed a structured literature search in preparation for their assignments.

Antibiotics are associated with several patient and societal adverse effects, including the rising problem of antimicrobial resistance. Randomized controlled trials have demonstrated no superiority to the routine administration of antibiotics in acute uncomplicated diverticulitis. Appropriate patients for antibiotic omission include those who are immunocompetent, non-septic, and have mild symptoms/disease severity on imaging. Existing frameworks for the safe implementation of new practices can be referenced to help increase adoption of non-antibiotic therapy.

The existing body of evidence supports antibiotic omission in appropriate cases of acute uncomplicated diverticulitis. In order to increase the widespread adoption of this practice, buy-in from key stakeholders (both healthcare professionals and patients) is necessary.

Impaired gut barrier function plays a pivotal role in the pathophysiology of irritable bowel syndrome (IBS), particularly in IBS with diarrhea. Mucoprotectants, such as xyloglucan, gelatin tannate and pea protein tannins, offer a novel therapeutic approach by restoring intestinal permeability and reducing inflammation. This review assesses preclinical and clinical evidence supporting mucoprotectants in IBS with diarrhea management. Preclinical studies indicate their efficacy in reducing intestinal permeability and inflammation, while clinical trials demonstrate improvements in stool consistency, abdominal pain and bloating. Despite these promising results, comparative studies are needed to establish the superiority of specific mucoprotectants and their optimal use in clinical practice.

The aim of this study was to validate and assess the reliability and validity of the Mandarin Chinese version of the Reflux Sign Assessment (RSA) among individuals with and without laryngopharyngeal reflux disease (LPRD).

This study was carried out from May 2023 to August 2024. A total of 202 individuals were enrolled in this study, including 106 with LPRD and 96 without. Multichannel intraluminal impedance-pH was performed to diagnose LPRD. The internal consistency, test-retest reliability, content validity, clinical, sensitivity, and specificity were analyzed, and the cutoff point was determined.

The internal consistency of the Chinese RSA was high, with Cronbach α coefficients for the subscale scores ranged from 0.707 to 0.822; the values for the total score were 0.812. Test-retest reliability was high for the total score (intraclass correlation coefficient (ICC) = 0.953) and the subscales (ICCs = 0.936, 0.895, 0.923). The patient group had significantly higher total scores, subscale scores, and majority item scores than the control group (P < 0.001). The cutoff point for screening between the two groups was 17.5, with a sensitivity of 94.7% and a specificity of 66.7%.

The Chinese RSA is a valid and reliable tool for identifying individuals with probable LPRD. It has good reliability, validity, and sensitivity in the Mandarin Chinese-speaking population.

A contemporary report describing the burden and expenditures of gastrointestinal (GI) diseases can be helpful for policy makers, administrators, and researchers. Using the most recent data, we estimated the burden and costs associated with GI diseases in the United States.

We generated estimates using data from the Rome Foundation Global Epidemiology Study 2017-2018 (symptoms), National Ambulatory Medical Care Survey 2019 and National Hospital Ambulatory Medical Care Survey 2019 (ambulatory visits), Nationwide Emergency Department Sample 2021 (emergency department visits), National Inpatient Sample 2021 (admissions), Kids' Inpatient Database 2019 (admissions), National Program of Cancer Registries 2001-2021 (cancer incidence), National Center for Health Statistics 2001-2021 (cancer mortality), Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research 2021 (non-cancer mortality), MarketScan Commercial Claims and Encounters data 2002-2021 (endoscopy), MarketScan Medicare Supplemental data 2002-2021 (endoscopy), United Network for Organ Sharing Registry 2023 (transplant), Medical Expenditure Panel Survey 2021 (expenditures), and National Institutes of Health (NIH) 2012-2025 (research).

In 2021, GI health care expenditures totaled $111.8 billion. A GI diagnosis or symptom led to 14.5 million emergency department visits and 2.9 million hospital admissions. There were 315,065 new GI cancers diagnosed. GI diseases caused 281,413 deaths. In 2022, an estimated 23.5 million GI endoscopies were performed. In 2023, the NIH supported $3.6 billion for GI research, which represents 7.4% of the NIH budget.

GI diseases are responsible for a considerable and growing burden of health care use and costs. Funding innovative GI science and supporting the practice of GI medicine are critical to meeting the burden of GI illness.

Neuromodulation of cortical brain regions associated with the gut-brain axis may have the potential to modulate gastric function. Previous studies have shown phase-amplitude coupling between the electroencephalogram (EEG) alpha band frequency of the insula (Ins) and gastric slow wave (GSW) activity. This study investigated the first evidence of alpha band EEG-neurofeedback (EEG-NF) training to explore its effects on GSW activity and heart rate variability (HRV).

A randomized crossover design was employed with 20 healthy participants attending two separate sessions [active-training: uptraining left posterior Insula (LPIns) and active-control: uptraining primary visual cortex (PVC Brodmann area 17)] following the baseline recording period. A 5-min water loading test (5WLT) was conducted following the EEG-NF sessions. Finally, a post EEG-NF/5WL period was also recorded. Participants were blinded to the training program, and the sessions were randomized and conducted at least 48 h apart. Electrocardiogram (ECG), EEG, and electrogastrogram (EGG) data were recorded throughout theexperiment. In addition, the duration of successful NF training was also extracted. Correlation analysis was performed to assess the relationships between outcome variables.

Pearson correlation coefficient analysis revealed a significant relationship between the duration of successful NF training and HRV metrics (RMSSD: r = 0.59; p = 0.005, SI: r = -0.59; p = 0.006) in the LPIns training group and EGG-gastric rhythm index (r = -0.40; p = 0.028) in the PVC training group. Moreover, the duration of successful LPIns NF correlated with EEG activity of the infraslow band over the left anterior Ins (r = 0.45; p = 0.043), slow band over the right posterior Ins (r = -0.5; p = 0.022), and beta band over the left (r = 0.44; p = 0.04) and right anterior Ins (r = 0.45; p = 0.04). Significant correlations were also observed between LPIns NF duration and connectivity in the beta and gamma bands between cortical regions of interest.

The alpha band EEG-NF training of LPIns demonstrated significant association with HRV, and EEG (activity and functional connectivity)measures and did not show a negative correlation with Gastric Alimetry Rhythm Index (GA-RI) following the 5WLT as in the PVC training group. These findings underscore the importance of considering the duration of successful NF as an important variable when evaluating NF training efficacy in future studies.

Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction of unknown origin. The aim of this study was to evaluate the global prevalence of this disorder and its associated factors.

Data were collected from nationwide Internet surveys in 26 countries, with subjects evenly distributed by age, sex, and country. The survey included the Rome IV questionnaire and an extensive supplemental questionnaire to evaluate additional factors.

A total of 54,127 participants completed the questionnaire (51% male, mean age 44.3 years). The pooled prevalence of CVS was 0.3% (95% confidence interval [CI] 0.3%-0.4%; n = 187), highest in Brazil (1%, 95% CI 0.6-1.5), and lowest in Japan and Germany (with no subject who fulfilled the criteria for CVS). The mean age of participants with CVS was 36.7 years (SD 13.5), and it was more common in women (56.7% vs 43.5%). Factors independently associated with this syndrome were female sex (odds ratio [OR] 1.52, 95% CI 1.13-2.03), young age (OR 2.57, 95% CI 1.34-4.94, for people between the ages of 18 and 39 years, compared with those older than 65 years), depression (OR 3.14, 95% CI 2.05-4.82, P < 0.001), and anxiety (OR 1.79, 95% CI 1.15-2.78, P < 0.001). Individuals with CVS had impaired quality of life (QoL) (Patient-Reported Outcomes Measurement and Information System 10-item score: physical QoL mean, 12.9 vs 15.5, P < 0.001; mental QoL mean 12.3 vs 14.4, P < 0.001) compared with others.

CVS is a relatively common disorder that has a negative impact on QoL. It is important to raise awareness on this syndrome to avoid underdiagnosis and improve clinical practice.

Irritable bowel syndrome (IBS), a disorder of gut-brain interaction, imposes a significant economic burden because of its high prevalence and the chronic nature of its symptoms. IBS currently has 7 United States Food and Drug Administration-approved treatments. Despite efforts to improve diversity in randomized controlled trials' participation, significant disparities remain in various medical fields; yet, these have not been thoroughly examined within the context of IBS. We aimed to investigate the demographic, socioeconomic, educational, and geographic disparities in IBS drug trials.

We conducted a systematic review of phase 3 randomized controlled trials on United States Food and Drug Administration-approved drugs for the treatment of IBS with constipation and IBS with diarrhea in the United States. Data on participant demographics and trial site locations were extracted and analyzed to identify disparities.

Our analysis included 17 studies encompassing 21 trials with 17,428 participants. Approximately 77.3% of participants were female, with a mean age of 45.4 years. Race was reported in 95% of the trials, but only 35% disclosed ethnicity. White participants constituted the majority at 79.3%. Hispanics accounted for only 5.9%. Counties without trial sites had smaller average population sizes compared with trial and trial-adjacent counties. Socioeconomic indicators such as poverty rates, median household income, educational attainment, and broadband internet access were lower in counties without trial sites, with higher average Area Deprivation Index scores indicating greater deprivation.

The findings highlight significant disparities in IBS trial participation across race, ethnicity, gender, and socioeconomic backgrounds. This raises potential concerns about generalizability of trial outcomes and underscores the need for strategies to enhance inclusivity in clinical research.

The development of novel ingestible sensors can aid physicians and patients in obtaining precise data on the health status of the gut at a local level. This in turn can facilitate earlier and more accurate disease diagnosis, improve the delivery of point-of-care medicine, and allow monitoring of the gastrointestinal (GI) tract status. This Tutorial overviews characteristics of the gut for inexpert readers and reviews emerging chemical sensing technologies for the GI tract from an analytical chemistry viewpoint.

Gallstones (GS) are closely associated with obesity. The body mass index (BMI) is the most commonly used index for evaluating obesity. However, BMI does not consider the distribution of adipose tissue and does not differentiate between differences in fat distribution by sex; therefore, BMI only provides a rough indication of overweight status. Relative fat mass (RFM) is an emerging, simple, and low-cost anthropometric index that reflects obesity (particularly abdominal obesity), and is associated with various obesity-related diseases. However, the relationship between the RFM and GS has not yet been explored. Therefore, this study aimed to evaluate the relationship between RFM and the risk of developing GS, the age of patients at the time of their first GS surgery, and to evaluate the predictive value of RFM for the risk of developing GS. Data from the National Health and Nutrition Examination Survey (2017-2020) were used. Logistic regression and dose-response curves were used to analyze the relationship between RFM levels and the prevalence of GS. Multiple linear regression and dose-response curves were used to analyze the relationship between RFM levels and patient age at the time of the first GS surgery. Subgroup analyses further explored the relationship between RFM and age, sex, race, hypertension, and diabetes mellitus. Receiver operating characteristic (ROC) curves were used to analyze the predictive ability of RFM for GS development. Overall, 7978 adults aged ≥ 20 years were included in this study, of whom 828 had a history of GS. After adjusting for potential confounders, each 1-unit increase in RFM was associated with a 9% increase in GS prevalence (odds ratio: 1.09, 95% confidence interval : 1.07, 1.11), with dose-response curves confirming a positive, nonlinear correlation. And the threshold for the effect of RFM on the prevalence of GS was 40.99. Subgroup analyses revealed that the positive correlation between RFM and GS prevalence remained stable in all populations despite subtle differences. The results of the ROC curves suggested that the predictive value of RFM for GS prevalence was superior to that of BMI. In addition, dose-response curves revealed a nonlinear relationship between RFM and patient age at the time of the first GS surgery, and the threshold for the effect of RFM on age at the first GS surgery was 30.99. RFM is closely associated with GS, and in general, higher levels of RFM are associated with a higher risk of GS. RFM is a better predictor of the risk of GS than BMI. Due to the nature of this cross-sectional study, we were unable to determine a causal relationship between the two.

The results of many large randomized clinical trials (RCTs) have transformed clinical practice in gastroesophageal reflux disease (GERD) and esophageal hiatal hernia (HH). However, research waste (i.e., unpublished data, inadequate reporting, or avoidable design limitations) remains a major challenge to evidence-based medicine.

A cross-sectional analysis was conducted to comprehensively review and evaluate RCTs related to GERD and esophageal HH, registered in the ClinicalTrials.gov database between 2003 and 2023. A sample of eligible RCTs was identified by excluding early-stage trials, pediatric studies, and duplicate studies. Publication status was tracked using PubMed and Scopus databases, reporting adequacy was assessed according to the CONSORT guidelines, and design flaws were checked with the help of Cochrane tools. Shortcomings of RCT studies in different regions and intervention types were identified by quantifying RCT conduct, recruitment, reporting adequacy, risk of bias, and guideline citations.

From 2003 to 2023, a total of 182 RCTs were included in the analysis, of which 69.8% (127 trials) were drug-related, and 71.4% of the principal investigators were located in North America and Asia (65 trials [35.7%] in both). Among them, the country with the most RCTs is the United States. RCTs in Asia were under-conducted in "procedure" and "other" types and fewer RCTs were conducted in Europe in "drug" type. RCTs in Oceania and South America were relatively under-conducted in the device and "other." The study revealed that more than 86.7% of RCTs were characterized by at least one type of research waste. Research waste was associated with the size of the RCT, blinded design, and regional healthcare access and quality index.

This study describes for the first time the characteristics of RCTs for GERD and esophageal HH over the past 20 years and the conduct of various types of RCTs at the continental level. It identifies the burden of research waste and shortcomings in the conduct of RCT programs on each continent, which may provide evidence for the development of rational RCTs and the reduction of waste in the future.

Gallstone disease is common in the US and Europe. Gallstones are associated with factors such as age, sex, weight, and serum cholesterol levels. A complex relationship exists between vitamin D levels and cholesterol metabolism. However, the relationship between vitamin D level and gallstones remains unclear. This study aimed to investigate whether gallstones are associated with dietary vitamin D (D2+D3) consumption (VDC) in American adults.

This cross-sectional study used data from people who participated in the National Health and Nutrition Examination Survey between March 2017 and March 2020. Multivariate logistic regression models were used to determine the association between vitamin D intake and the presence of gallstones. Stratified and interaction analyses were performed to determine whether the relationship was stable across different subgroups.

6873 participants were included. VDC (per 1 SD) was positively associated with gallstones in the crude model (OR: 1.11, 95% Confidence Interval (CI): (1.05-1.17); p < 0.001), Further adjustment did not affect the results. When vitamin D was analyzed using quartiles, with increased quartile of VDC, the incidence of gallstones increased, and the OR of Q2 (OR: 1.08, 95% CI: 0.89-1.32, p = 0.436) and Q3 (OR: 1.55, 95% CI: 1.28-1.87, p < 0.001) was higher than that of Q1 in crude model. After adjusting for covariates, there is a positive association between VDC and incidence of gallstones without statistical significance.

VDC was positively associated with the incidence of gallstones, however, further studies are required to gather additional evidence.

Introduction: Diverticular disease, once considered a rare geriatric gastrointestinal condition, has now become a prevalent disorder associated with increased morbidity and healthcare costs. The spectrum of complications from diverticular disease ranges from incidental findings to more serious issues such as bleeding and diverticulitis. Symptomatic diverticular disease represents a significant economic burden in the western world. Diabetes mellitus is a major global health issue. As global aging accelerates, geriatric syndromes such as diabetes mellitus (DM) and diverticular disease (DD) are becoming increasingly prevalent. Understanding their interplay is critical, particularly within the geriatric population. Both conditions are linked to lifestyle, dietary habits, and changes in gut physiology. Additionally, age-related alterations in the gut microbiome and immune system make this association more complex, contributing to morbidity and healthcare burdens in older adults. The primary aim of this review is to provide an update on the association between diabetes mellitus and diverticular disease. Methods: This narrative review explores the association between diabetes mellitus and diverticular disease. Relevant articles were identified by searching major databases. Results: Risk factors for diverticular disease include insulin resistance, diabetes mellitus, smoking, non-alcoholic fatty liver disease, lack of physical activity, a low-fibre diet, and a high-carbohydrate diet. These risk factors are also associated with the development of diabetes mellitus. Major population studies indicate that diabetes can either increase the risk of diverticular disease or have a neutral impact. A complication of diabetes mellitus includes impaired intestinal peristalsis and enteric nervous system dysfunction, which can ultimately lead to the formation of intestinal diverticula. High-calorie foods low in fibre are a staple in the diets of many type 2 diabetes mellitus patients, contributing to gut dysbiosis. A detrimental consequence of dysbiosis is a breach in the protective intestinal barrier, which promotes the development of diverticulosis. Conclusions: Diabetes mellitus may be associated with diverticular disease, and the risk factors that contribute to diabetes mellitus can also be linked to diverticular disease. Further studies are needed to explore the complex relationship between diabetes mellitus and diverticular disease.

Few studies have investigated the association between Life's Essential 8 (LE8) and abnormal bowel health. We aimed to investigate the relationship between LE8 and diarrhea and constipation in the adult population of the United States.

This cross-sectional study, based on population data, used information from the National Health and Nutrition Examination Survey conducted between 2005 and 2010. Diarrhea and constipation were classified based on Bristol Stool Form Scale and stool frequency. LE8 score is composed of 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 health factors (body mass index, blood lipids, blood glucose, and blood pressure) and is classified into low (0-49), moderate (50-79), and high (80-100) cardiovascular health groups. Weighted logistic regression and restricted cubic splines were used to analyze the relationship between the LE8 score and abnormal bowel health.

The study comprised 12,369 participants aged 20 years or older, among whom 1,279 (9.7%) had constipation and 1,097 (7.6%) had diarrhea. After adjusting for potential confounders, we observed negative associations between LE8 scores and diarrhea (odds ratio: 0.60, 95% confidence interval: 0.39-0.93), whereas the association between LE8 scores and constipation was not statistically significant (odds ratio: 0.82, 95% confidence interval: 0.59-1.13). In addition, health behavior scores and health factor scores were associated with constipation.

Higher LE8 levels are associated with a lower incidence of diarrhea, but not constipation.

Gut microbiota has been recognized as an extrahepatic manifestation of gastro-esophageal reflux disease (GERD) in observational studies. However, the directionality and causality of the association and whether cytokines act as a mediator remain unclear. We aim to estimate the casual relationship between gut microbiota, inflammatory cytokines and GERD using a 2-sample Mendelian randomization method. Gut microbiota, cytokines, and GERD were identified using summary data from the genome-wide association studies and the FinnGen consortium. The primary method for causal estimation was the inverse-variance weighted approach, complemented by a range of sensitivity analyses aimed at assessing heterogeneity, horizontal pleiotropy, and the robustness of the findings. Furthermore, mediation analysis was conducted to evaluate the association between gut microbiota and GERD, with 5 cytokines, and to calculate the mediated proportions. We found 3 positive and 3 negative causal associations observed between genetic predisposition in gut microbiota and GERD. Additionally, 2 positive and 3 negative causal associations were identified between cytokines and GERD. Our analysis unveiled that TNF-related apoptosis-inducing ligand levels (TRAIL) mediated the causal relationships between the genera Family XIII UCG001 and Senegalimassilia, and GERD. We identified causal effects between 6 bacterial traits, 5 inflammatory cytokines, and GERD. Notably, we furnished causal evidence linking TRAIL levels to a substantial proportion of the risk attributed to genus Family XIII UCG001 and genus Senegalimassilia, thereby mediating the risk of GERD. These findings offer novel avenues for therapeutic interventions targeting individuals with GERD.

Arm circumference (AC) is a measure of nutritional status and an indicator of the risk of developing diseases, such as metabolic disorders. However, its relationship with the prevalence of gallstone disease (GS), a metabolic disorder, is unknown. Consequently, this research sought to investigate the relationship between AC and the prevalence of GS among the general adult population in America.

Participant data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 cycle. GS was defined based on self-reported medical history. AC was measured following standardized protocols as the primary exposure variable. Multivariable logistic regression models were employed to assess the association between AC and GS. Dose-response relationships were evaluated using generalized additive models with smoothed curve fitting, and subgroup analyses were conducted to explore effect modification by key covariates such as age, sex, race, hypertension, diabetes, and body mass index.

Overall, a total of 8,081 participants were included in this study, with 849 reporting a history of GS. After accounting for potential confounders, we discovered that each centimeter increase in AC was linked to an 8% rise in the prevalence of GS (Odd ratio = 1.08, 95% confidence interval: 1.07-1.10). Dose-response curves demonstrated a positive linear relationship between AC and the prevalence of GS, which, according to the results of the subgroup analyses, was consistent in the vast majority of subgroups, although there were subtle differences.

AC exhibited a linear and positive association with the prevalence of GS. Although a causal relationship between AC and the prevalence of GS could not be established, our study provides strong new support for the potential role of AC in the health assessments of adult populations.

Neurogastroenterology and motility disorders are complex gastrointestinal conditions that are prevalent worldwide, particularly affecting women and younger individuals. These conditions significantly impact the quality of life of people suffering from them. There is increasing evidence linking these disorders to cirrhosis, with a higher prevalence compared to the general population. However, the link between neurogastroenterology and motility disorders and cirrhosis remains unclear due to undefined mechanisms. In addition, managing these conditions in cirrhosis is often limited by the adverse effects of drugs commonly used for these disorders, presenting a significant clinical challenge in the routine management of patients with cirrhosis. This review delves into this connection, exploring potential pathophysiological links and clinical interventions between neurogastroenterology disorders and cirrhosis.

The neutrophil percentage to albumin ratio (NPAR) is an emerging, costimulatory indicator of inflammation that is associated with a variety of diseases, such as non-alcoholic fatty liver disease, liver fibrosis, stroke, and cardiovascular disease. However, the relationship between NPAR and gallstones (GS) has not yet been explored. Therefore, this study aimed to evaluate the association of the NPAR with the odds of GS and the age of patients at the time of their first GS surgery.

Participants were selected from the National Health and Nutrition Examination Survey (NHANES) in the United States, a nationally representative survey. Logistic regression analysis and dose-response curve were performed to analyze the relationship between NPAR and the prevalence of GS. Multiple linear regression analysis and dose-response curve were used to analyze the association between NPAR and the age of patients at the time of their first GS surgery. Subgroup analyses further explored the relationships between NPAR and age, sex, race, body mass index, hypertension, and diabetes.

In total, 7805 adults aged > 20 years were included in this study, of whom 838 had a history of GS. After adjusting for all potential confounders, each 1-unit increase in NPAR was found to be associated with a 4% increase in the prevalence of GS (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.02, 1.07) and an advancement in the age of the patient at the time of the first GS surgery by 0.35 years (β = - 0.35, 95% CI: - 0.68, - 0.02). Dose-response curves further confirmed that NPAR was positively associated with the prevalence of GS and negatively associated with the age of patients at the time of their first GS surgery. The results of the subgroup analyses suggested that after adjusting for all potential confounders, the positive association of NPAR with the prevalence of GS was more pronounced in the 40-59-year-old (OR: 1.07, 95% CI: 1.02, 1.12), male (OR: 1.07, 95% CI: 1.02, 1.12), non-Hispanic Black (OR: 1.06, 95% CI: 1.01, 1.12), non-hypertensive (OR: 1.06, 95% CI: 1.02, 1.10), and non-diabetic populations (OR=: 1.05, 95% CI: 1.02, 1.08).

The higher the NPAR, the higher the prevalence of GS, and the earlier the age of the patient at the time of the first GS surgery. Due to the nature of cross-sectional study, it is not possible to determine a causal relationship between them.

Based on triglyceride, body mass index (BMI), alanine aminotransferase/ aspartate aminotransferase ratio, fasting blood glucose, the ZJU index is proven to be a novel and effective parameter for screening NAFLD in Chinese. This study aims to evaluate the correlation between ZJU values and the risk of developing gallstones.

The data from the National Health and Nutrition Examination Survey (NHANES) database during the period from 2017 to 2020 were analyzed in this cross-sectional study. And 6155 participants were included to assess the correlation between the ZJU index and the formation of gallstones through multivariate logistic regression, receiver operating characteristic (ROC) curve, subgroup analysis, and restricted cubic spline regression (RCS) analyses.

In this population-based study, 6155 participants aged 18 years and older were included, among which, 671 had gallstones. Logistic regression and RCS regression analyses indicated a significant positive non-linearly correlation between the ZJU index and the prevalence of gallstones (OR = 1.044, 95% CI: 1.032, 1.056), with an inflection point of 40.6. Subgroup analysis further revealed a stronger correlation between the risk of developing gallstones and the ZJU index in females. ROC analysis indicated that the ZJU index (AUC = 0.653) can serve as a more robust predictor for developing gallstones compared to traditional indices, with a sensitivity of 55.9%, a specificity of 67.1% and a cutoff of 43.4.

This study provides evidence that elevated the ZJU index is correlated with an increased risk of developing gallstones.

Previous studies have indicated a potential association between gut microbiota and diverticular disease. However, the precise nature of this relationship remains unclear. In light of this, we decided to use a bidirectional two-sample Mendelian randomization (MR) study to investigate the causal relationship between gut microbiota and intestinal diverticular disease in greater depth.

To investigate the potential causal relationship between gut microbiota and intestinal diverticular disease, we conducted a two-sample MR study in a European ancestry. Genetic instrumental variables for gut microbiota were obtained from a genome-wide association study (GWAS) involving 5,959 participants. Summary statistics for intestinal diverticular disease were sourced from the IEU Open GWAS project, which included data from 5,193 cases and 457,740 controls. The analysis was primarily conducted using the inverse variance weighted method, with additional sensitivity analyses to assess the robustness of the findings.

With regard to the findings, 11 microbial taxa were identified as having a potential causal relationship with intestinal diverticular disease. Specifically, the microbial taxa Caryophanales, Paenibacillaceae, Herbinix, Turicibacter, Turicibacteraceae, and Staphylococcus fleurettii were found to be positively associated with the risk of developing intestinal diverticular disease, while Chromatiales, Arcobacter, Herbidospora, Ligilactobacillus ruminis, and Megamonas funiformis were found to be negatively associated with the risk. Further reverse MR analysis did not reveal a reverse causal effect between these microbial taxa and intestinal diverticular disease.

Our MR analyses revealed a potential causal relationship between certain gut microbiota and intestinal diverticular disease, which may provide new directions for future intestinal diverticular disease prevention and treatment strategies.

Irritable bowel syndrome (IBS) is a highly prevalent and debilitating disorder of gut-brain interaction (DGBI) affecting millions globally. It imposes a significant burden on healthcare systems and is a leading cause of workplace absenteeism. IBS is classified into several subtypes based on predominant presenting symptoms, including IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D), with each requiring targeted approaches to treatment. Some treatments, such as psychotherapy, dietary intervention, and medications like tricyclic antidepressants, are nonspecific and recommended for managing IBS symptoms across all subtypes. In contrast, therapies like secretagogues for IBS-C and eluxadoline or rifaximin for IBS-D are subtype-specific. However, many IBS treatments carry conditional recommendations and are based on low-certainty evidence, emphasizing the need for further research to expand the available treatment options. This review compares the latest IBS management guidelines from the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), British Society of Gastroenterology (BSG), and European Society for Neurogastroenterology and Motility (ESNM). Pharmacologic and non-pharmacologic therapies, including established and emerging interventions, will be explored to provide a comprehensive guide to management.

Aquaporins (AQPs) are transmembrane proteins permeable to water and a series of small solutes. AQPs play a key role in pathways of hepatobiliary secretion at the level of the liver, bile ducts, and gallbladder. AQP8 and -9 are pivotal in facilitating the osmotic water movement of hepatic bile, which is composed of 95% water. In the biliary tract, AQP1 and -4 are involved in the rearrangement of bile composition by mechanisms of reabsorption/secretion of water. In the gallbladder, AQP1 and -8 are also involved in trans-epithelial bidirectional water flow with the ultimate goal of bile concentration. Pathophysiologically, AQPs have been indicated as players in several hepatobiliary disorders, including cholestatic diseases and cholesterol cholelithiasis. Research on AQP function and the modulation of AQP expression is in progress, with the identification of potent and homolog-specific compounds modulating the expression or inhibiting these membrane channels with promising pharmacological developments. This review summarizes the contribution of AQPs in physiological and pathophysiological stages related to hepatobiliary function.

Each year, more than 1 million ambulatory patient visits occur for diverticular disease, with nearly 75% of these patients seen in outpatient clinics. Although diverticulitis historically had been considered a disease of the older adult, it has become increasingly prevalent among the younger population. Likewise, in the past, antibiotics were considered first-line treatment for uncomplicated diverticulitis (Hinchey classification 0 and Ia); however, two large clinical trials compared treatment with antibiotics versus without antibiotics in uncomplicated cases of the disease and found no significant difference in patient outcomes. Based on these findings, first-line management now constitutes clear-liquid diet along with bowel rest for resolution of symptoms in these patients. Proper management with lifestyle modifications can help prevent complications and improve outcomes for patients with this condition; patient education is therefore critical.

Gastroesophageal reflux disease (GERD) is a frequent digestive disorder that presents with a broad spectrum of symptoms. Global consensus on which patients should be selected for anti-reflux surgery is lacking.

This evidence-based review will analyze current indications for anti-reflux surgery, outcomes of the operation, and potential side effects.

Treatment of GERD has three main purposes: control symptoms, improve quality of life, and prevent potential serious complications such as bleeding, esophageal stenosis, Barrett's esophagus, and esophageal adenocarcinoma. Although medical therapy is effective in the majority of patients, some might require anti-reflux surgery in order to achieve these goals. Adequate patient selection for anti-reflux surgery is critical to obtain optimal outcomes. Most patients undergoing a fundoplication have adequate long-term symptomatic relief. However, potential side effects of anti-reflux surgery should also be discussed with patients to help manage expectations from the operation.

Inflammatory responses and lipid metabolism make vital impacts on the development of gallstones. This study investigated the relationship between gallstone disease (GSD) and the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) in American patients with gallstones.

The data analyzed were sourced from the 2017-2020 National Health and Nutrition Examination Survey (NHANES) and comprised of participants with complete data on GSD and NHR. The relationship between NHR and GSD was evaluated with weighted multivariable logistic regression analysis. Additionally, subset analyses, interaction tests, smoothed curve fitting, and threshold effect analyses were conducted.

Among the 7894 participants analyzed in this study, the prevalence of GSD was 10.98%, and the average NHR value was 3.41 ± 0.06. The fully adjusted multivariable logistic regression results demonstrated an obvious positive association between NHR and the likelihood of GSD (OR = 1.09, 95% CI: 1.01, 1.16; P = 0.0197). Consistency of this association was confirmed through subset analyses and interaction tests across various subgroups, including those categorized by smoking status and asthma. Furthermore, smoothed curve fitting and threshold effect analyses revealed a nonlinear relationship with a threshold of 2.86.

NHR shows a positive relationship to an increased likelihood of GSD among Americans. It can act as an easy and cost-effective tool for the early detection and management of individuals at risk for GSD.

Cardiovascular illness and gallstones are closely related. Our goal was to determine whether gallstones and the updated LE8 score, which measures cardiovascular health among US adults, are related.

3,570 adults participated in the 2017-2018 National Health and Nutrition Examination Survey, which provided the data for our study. Based on the criterion provided by the American Association for Cardiovascular Health (AHA), LE8 score (range 0-100) was calculated and classified as low (0-49), moderate (50-79), and high (80-100) cardiovascular health. Gallstones were derived from the questionnaire. Multivariate logistic modeling explored the independent relationship between LE8 score and gallstones.

There was a negative correlation between LE8 score and gallstones. Specifically, the odds of gallstones dropped by 15% for each 10-unit increase in LE8 score (OR = 0.85; 95% CI, 0.77-0.94). Smooth curve fitting detected a saturation effect between LE8 score and gallstones, with a minimum threshold of 66.25 points associated with both. There was a noticeably stronger inverse relationship between gallstones and LE8 score in those under 60 years of age and not taking antihypertensive or lipid-lowering drugs.

Lower LE8 scores may be a potential risk factor for the development of gallstones and could also be a target for risk assessment and intervention.

Disorders of gut-brain interaction (DGBI) are symptom-based disorders categorized by anatomic location but have high overlap and heterogeneity. Viewing DGBI symptoms on a spectrum (i.e. dimensionally) rather than categorically may better inform interventions to accommodate complex clinical presentations. We aimed to evaluate symptom networks to identify how DGBI symptoms interact.

We used the Rome IV Diagnostic Questionnaire continuously/ordinally scored items collected from the Rome Foundation Global Epidemiology Study. We excluded participants who reported ≥1 organic/structural gastrointestinal disorder(s). We sought to (1) identify core symptoms in the DGBI symptom networks, (2) identify bridge pathways between Rome IV diagnostic categories (esophageal, bowel, gastroduodenal, anorectal), and (3) explore how symptoms group together into communities.

Of 54,127 adults, 20,229 met criteria for at least one DGBI (age mean = 42.2 ± 15.5; 57% female). General abdominal pain and epigastric pain were the core symptoms in the DGBI symptom network (i.e., had the strongest connections to other symptoms). Pain symptoms emerged as bridge pathways across existing DGBI diagnostic anatomic location (i.e., abdominal pain connected to chest pain, epigastric pain, rectal pain). Without a priori category definitions, exploratory network community analysis showed that symptoms grouped together into "pain," "gastroduodenal," and "constipation," rather than into groups by anatomic location.

Our findings suggest pain symptoms are central and serve as a key connection to other symptoms, crosscutting anatomic location. Future longitudinal research is needed to test symptom network relations longitudinally and investigate whether targeting pain symptoms (rather than anatomic- or disorder-specific symptoms) has clinical impact.

The purpose of this narrative review is to evaluate the implementation of robotic surgery in hiatal hernia and crural repair, based on the existing literature and to compare this approach to other established techniques.

We performed a non- systematic literature search of PubMed and MEDLINE on February 25, 2024 for papers published to date focusing on the surgical repair of hiatal hernias using the robotic platform. After eliminating publications based on eligibility criteria, 13 studies were selected for analysis.

Robotic surgery is increasingly utilized in hiatal hernia repair due to its enhanced ergonomics and superior visualization capabilities. Operative times vary, with some studies indicating longer durations for robotic surgery (e.g., Giovannetti et al. demonstrated median operative time of 196 min for robotic compared to 145 min for laparoscopic) while others report shorter times (e.g., Lang F et al. demonstrated 88 min for robotic versus 102 min for laparoscopic). Recurrence rates between robotic and laparoscopic repairs are comparable, with reported recurrence rates of 1.8% for robotic and 1.2% for laparoscopic approaches by Benedix et al. Robotic surgery offers potential advantages, including reduced intraoperative blood loss (e.g., Giovannetti et al. mentioned median blood loss of 20 ml for robotic versus 50 ml for laparoscopic). The length of hospital stay and postoperative complication rates also vary, with some studies suggesting shorter stays and fewer complications for robotic surgery as surgeons become more proficient. Soliman et al. reported a statistically significant reduction in complication rates with robotic surgery (6.3% versus 19.2%).

Robotic surgery presents promising results regarding the length of hospital stay, conversion rate to open surgery and postoperative complication rates when compared to laparoscopy based on the existing literature. Despite the lack of striking differences, robotic hiatal hernia repair is a valid and evolving approach.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) and caffeine-containing beverages are widely consumed but their impact on gastrointestinal (GI) health requires further investigation. This cross-sectional study investigated the relationship between NSAIDs use, caffeinated drink consumption, and the prevalence of self-reported GI symptoms in a Jordanian subpopulation. Methods: An online survey was administered to 400 Jordanian individuals aged 18-65 years. Data on sociodemographics, NSAIDs use, caffeine consumption, peptic ulcer disease (PUD) history, and GI symptoms were collected. Contingency tables were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between exposures and outcomes. Results: The prevalence of self-reported PUD-related GI symptoms was 6.0%. NSAID users had higher odds of PUD (OR = 2.431) and related GI symptoms, including abdominal pain (OR = 4.688, p < 0.001) and discomfort (OR = 8.068, p < 0.001). Caffeine consumption was associated with self-reported burning stomach pain (OR = 14.104, p < 0.001), fullness (OR = 8.304, p = 0.010), and bloating (OR = 8.304, p = 0.010). Coffee, tea, soft drinks, and energy drinks were associated with increased odds of various GI symptoms (ORs 2.018-12.715, p < 0.05). Conclusions: NSAIDs use and caffeine consumption were independently associated with the increased prevalence of self-reported PUD and related GI symptoms. Despite the lack of adjustment for necessary confounders, our findings highlight the importance of considering the potential GI effects of NSAIDs and caffeine. Public health strategies promoting their safe use may help reduce the burden of GI disorders.

The increasing complexity and difficulty of surgical procedures have led to a rise in medical errors within clinical settings in recent years. Gastrointestinal diseases, in particular, present significant medical challenges and impose substantial economic burdens, underscoring the urgent need for experiential, high-fidelity gastrointestinal surgical training tools. This study leverages patient-specific computed tomography (CT) and magnetic resonance imaging (MRI) data, combined with 3D printed manufacturing, to develop hydrogel organ models with tunable performance and tissue-mimicking softness. These properties are achieved by regulating the freeze-thaw cycles, cross-linking agents, and the concentration of incorporated antibacterial nanoparticles in DN hydrogels. Through the application of indirect 3D printing and the "sacrificial material method", we successfully fabricate organ tissues such as the stomach, intestines, and blood vessels with high precision. In ex vivo surgical training demonstrations, these tissue-like soft hydrogels provide an effective platform for preoperative simulation and surgical training in digestive surgery, accommodating various surgical procedures and accurately simulating intraoperative bleeding. The development of advanced bionic organ models with specific and tunable characteristics based on DN hydrogels is poised to significantly advance surgical training, medical device testing, and the reform of medical education.

Gastric Alimetry™ (Alimetry, New Zealand) is a new clinical test for gastroduodenal disorders involving simultaneous body surface gastric electrical mapping and validated symptom profiling. Studies have demonstrated a range of distinct pathophysiological profiles, and a classification scheme is now required. We used Gastric Alimetry spectral and symptom profiles to develop a mechanism-based test classification scheme, then assessed correlations with symptom severity, psychometrics, and quality of life.

We performed a multicenter prospective cohort study of patients meeting the Rome IV criteria for functional dyspepsia and chronic nausea and vomiting syndromes. Patients underwent Gastric Alimetry profiling, and a standardized digital classification framework was devised and applied to separate patients into those with a) abnormal spectral analyses (ie aberrant gastric frequencies, amplitudes, and rhythms); and normal spectral analyses with b) symptoms correlated to gastric amplitude (subgroups: sensorimotor, postgastric, and activity-relieved), and c) symptoms independent of gastric amplitude (subgroups: continuous, meal-relieved, meal-induced).

Two hundred ten patients were included (80% female, median age 37), of whom 169 met the criteria for chronic nausea and vomiting syndromes and 206 met the criteria for functional dyspepsia (79% meeting both criteria). Overall, 83% were phenotyped using the novel scheme, with 79/210 (37.6%) classified as having a spectral abnormality. Of the remainder, the most common phenotypes were "continuous pattern" (37, 17.6%), "meal-induced pattern" (28, 13.3%), and "sensorimotor pattern" (15, 7.1%). Symptom patterns independent of gastric amplitude were more strongly correlated with depression and anxiety (Patient Health Questionnaire 2: exp(β) 2.38, P = .024, State-Trait Anxiety Inventory Short-Form score: exp(β) 1.21, P = .021).

A mechanistic classification scheme for assessing gastroduodenal disorders is presented. Classified phenotypes showed independent relationships with symptom severity, quality of life, and psychological measures. The scheme is now being applied clinically and in research studies.

The chronic digestive condition gallstones is quite common around the world, the development of which is closely related to oxidative stress, inflammatory response and abnormalities of lipid metabolism. In the last few years, as a novel biomarker of lipid metabolism, the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) has garnered significant interest. However, its relationship with gallstones has not been studied yet.

3,772 people, all under 50, were included in this study, and their full data came from the National Health and Nutrition Examination Survey (NHANES) database for the years 2017-2020. Information on gallstones was obtained through self-reported questionnaires. Smoothed curve fitting multifactorial logistic regression was utilized to evaluate the connection of NHHR with gallstone formation incidence. Subsequently, subgroup analysis and interaction tests were applied. Finally, to create a prediction model, logistic regression and feature screening by last absolute shrinkage and selection operator (LASSO) were used. The resulting model was displayed using a nomogram.

In multivariate logistic regression that accounted for all factors, there was a 77% increase in the likelihood of gallstones for every unit rise in lnNHHR (OR 1.77 [CI 1.11-2.83]). Following NHHR stratification, the Q4 NHHR level was substantially more linked to the risk of gallstones than the Q1 level (OR 1.86 [CI 1.04-3.32]). This correlation was stronger in women, people under 35, smokers, abstainers from alcohol, non-Hispanic White people, those with excessively high cholesterol, people with COPD, and people without diabetes. After feature screening, a predictive model and visualized nomogram for gallstones were constructed with an AUC of 0.785 (CI 0.745-0.819), which was assessed by DCA to be clinically important.

In the group of people ≤ 50 years of age, elevated NHHR levels were substantially linked to a higher incidence of gallstones. This correlation was stronger in several specific groups such as females, under 35 years of age, smokers, and so on. Predictive models constructed using the NHHR have potential clinical value in assessing gallstone formation.

Prior research suggests polyunsaturated fatty acids (PUFA) may prevent gallstones, but evidence on saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) is limited. This study aims to explore the associations between fatty acids and gallstones using a large sample of American population and Mendelian randomization (MR) methods.

The cross-sectional study involved 6,629 participants from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Logistic regression and restricted cubic spline (RCS) analysis were conducted after stratifying by gender subgroups. Two-sample MR analysis was used to explore the causal relationship between fatty acids and gallstones without confounding factors.

In females, higher SFA intake was positively associated with gallstone risk, while higher intake of n-3 and n-6 PUFA was negatively associated. No significant associations were found in males. No nonlinear correlations were found in any group by RCS analysis. MR analysis indicated that SFA, n-3, and n-6 PUFA could reduce gallstone risk.

The influence of dietary fatty acid composition on gallstone development differs by gender, providing insights into dietary prevention and treatment of gallstones.

The intestinal barrier plays a crucial role in homeostasis by both facilitating the absorption of nutrients and fluids and providing a tight shield to prevent the invasion by either pathogen or commensal microorganisms. Intestinal barrier malfunction is associated with systemic inflammation, oxidative stress, and decreased insulin sensitivity, which may lead to the dysregulation of other tissues. Therefore, a deeper understanding of physiological aspects related to an enhanced barrier function is of significant scientific and clinical relevance. The naked mole-rat has many unusual biological features, including attenuated colonic neuron sensitivity to acid and bradykinin and resistance to chemical-induced intestinal damage. However, insight into their intestinal barrier physiology is scarce. Here, we observed notable macroscopic and microscopic differences in intestinal tissue structure between naked mole-rats and mice. Moreover, naked mole-rats showed increased number of larger goblet cells and elevated mucus content. In measuring gut permeability, naked mole-rats showed reduced permeability compared with mice, measured as transepithelial electrical resistance, especially in ileum. Furthermore, intestinal ion secretion induced by serotonin, bradykinin, histamine, and capsaicin was significantly reduced in naked mole-rats compared with mice, despite the expression of receptors for all these agonists. In addition, naked mole-rats exhibited reduced prosecretory responses to the nonselective adenylate cyclase activator forskolin. Collectively, these findings indicate that naked mole-rats possess a robust and hard-to-penetrate gastrointestinal barrier that is resistant to environmental and endogenous irritants. Naked mole-rats may therefore provide valuable insights into the physiology of the intestinal barrier and set the stage for the development of innovative and effective therapies.NEW & NOTEWORTHY This is the first study to characterize the intestinal function of naked mole-rats. We found that these animals show a robust gut tissue structure, displaying thicker intestinal layers, longer villi, and larger crypts. Naked mole-rats showed more and larger goblet cells, with increased mucus content. Intestinal permeability, especially in the ileum, was substantially lower than that of mice. Finally, naked mole-rats showed reduced intestinal anion secretion in response to serotonin, bradykinin, histamine, capsaicin, and forskolin.

Traditional anthropometric measures, including body mass index (BMI), are insufficient for evaluating gallstone risk. This study investigated the association between novel anthropometric indices and gallstone risk among 6,848 participants from the National Health and Nutrition Examination Survey in the United States.

Measures calculated included weight (WT), BMI, waist circumference (WC), waist-to-height ratio (WtHR), conicity index (CI), A Body Shape Index (ABSI), Body Roundness Index (BRI), Abdominal Volume Index (AVI), and Weight-adjusted Waist Index (WWI). Logistic regression and smooth curve fitting assessed the relationships between these indices and gallstones, complemented by receiver operating characteristic (ROC) curve analysis to evaluate their discriminative power.

The results indicated significant differences between study groups, with a positive and independent correlation identified between gallstones and all measures except ABSI. Specifically, per 1 SD increase in WC, WT, BMI, WtHR, and AVI was associated with a 57%, 59%, 52%, 53%, and 53% increased risk of gallstones, respectively. Dose-response analysis confirmed a positive correlation between these indices and gallstone risk. ROC analysis highlighted WtHR and BRI as having superior discriminative abilities (AUC = 0.6703). Further, among participants with a BMI < 30 kg/m2, elevated levels of WT, WtHR, CI, BRI, and WWI significantly increased the risk of gallstones (P < 0.001). Likewise, elevated BMI heightened the risk at low levels of WT, WC, WtHR, BRI, AVI, and CI (P < 0.001).

This study supports the positive association between various anthropometric indicators and gallstones, recommending that newer anthropometric indices be considered more extensively to enhance gallstone prevention and treatment strategies.

Objective This study evaluated trends and racial disparities in hospitalization, clinical outcomes, and resource utilization for diverticular disease (DD) between 2017 and 2020. Methods We performed a retrospective analysis using the NIS database from 1 January 2017 to 31 December 2020 to study hospitalizations for DD (CCSR code: DIG013). Our primary outcomes were hospitalization rates, all-cause mortality, total charges, and length of stay. Secondary outcomes included in-hospital complications and discharge status. Outcomes were stratified by race and ethnicity (White, Black, Hispanic, Asian or Pacific Islanders and Native Americans). Data were weighted and adjusted for clustering, stratification, and other relevant factors. The normality of the continuous data distribution was confirmed using Kolmogorov-Smirnov, and descriptive statistics were used to summarize variables. Demographic characteristics were compared using χ² and Student's t-test, with significance set at P<0.05. We used stepwise multivariable logistic regression to estimate adjusted odds ratios for study outcomes by race and ethnicity, controlling for demographic and clinical factors and correcting for multicollinearity. Missing data were treated with multiple imputations, trend analyses were performed using Jonckheere-Terpstra tests, and costs were adjusted for inflation using the GDP price index. Analyses were conducted with Stata 17MP. Results A total of 1,266,539 hospitalizations for DD were included for analysis. Approximately 953,220 (75.3%) were White patients and 313,319 (24.7) did not belong to the White race. A total of 747,868 (59%) were women compared to 518,671 (41%) men. Compared to patients who were not of the White race, White patients were younger (63.5 vs. 66.8 years; p<0.001). Hospitalizations for DD increased by 1.2% from 323,764 to 327,770 hospitalizations (2017-2019) and decreased by 11.8% from 327,770 to 289,245 admissions in 2020. Mortality rates were higher among White patients than in those not of the White race (16,205 (1.7%) vs 5,013 (1.6%)). However, no significant difference was observed in mortality odds between both sets of patients (aOR, 0.953; 95% CI 0.881-1.032; P=0.237). Mortality rates showed an uptrend over the study period (4,850 (1.5%) in 2017 to 5,630 (1.9%) in 2020; Ptrend<0.001). DD accounted for 7,016,718 hospital days, 2,102,749 procedures, and US$ 6.8 billion in hospital costs. Mean hospital costs increased from US$54,705 to US$72,564 over the study period (P<0.000). Patients who were not of the White race incurred higher mean hospital charges than White patients ($67,635 ± $6,700 vs $59,103 ± $3,850; P<0.001). Black race correlated with lower odds of bowel perforation, routine home discharge, and bowel resection (P<0.001). Conclusion During the study period, hospitalization and mortality rates and resource utilization for DD increased. Patients from other races incurred higher hospital costs than White patients. White Americans were more likely to be discharged to skilled nursing, intermediate care, and other facilities. Additionally, White patients were less likely to develop bowel abscesses compared to patients who were not White. Compared to White American patients, Black patients had fewer DD hospitalizations complicated by bowel perforations or requiring bowel resections. In contrast, DD admissions among Hispanic patients were more likely to require bowel resections than those among White American patients.

Many diagnostic tests for gastroduodenal symptoms, such as gastric emptying scintigraphy (GES), gastric emptying breath tests (GEBT), and electrogastrography (EGG) show variable intra-individual reproducibility over time. This study investigated the short- and long-term reproducibility of body surface gastric mapping (BSGM), a non-invasive test for assessing gastric function, in controls and patients with chronic gastroduodenal disorders.

Participants completed three standardized BSGM tests using Gastric Alimetry® (Alimetry, New Zealand). The test encompassed a fasting baseline (30 min), a 482 kCal standard meal, and a 4 h postprandial recording. The first two tests were >6 months apart and the last occurred ~1 week after the second test, to evaluate long and short-term reproducibility.

Fourteen patients with upper gastrointestinal symptoms and 14 healthy controls were recruited. There were no significant differences in any BSGM metrics between the tests at short and long term (all p > 0.180). Lin's concordance correlation coefficients (CCC) for the primary metrics were high, ranging from 0.58 to 0.96, with intra-individual coefficients of variance (CVintra) ranging from 0.2% to 1.9%. Reproducibility was higher, and intra-individual variation lower, than in previous studies of GES (CCC = 0.54-0.83, CVintra = 3%-77%), GEBT (CVintra = 8%-11%), and EGG (CVintra = 3%-78%).

BSGM spectral metrics demonstrate high reproducibility and low intra-individual variation at both short and long term, with superior results to comparable tests. The high reproducibility of Gastric Alimetry supports its role as a diagnostic aid for gastric dysfunction and a reliable tool for evaluating treatment outcomes and disease progression over time.