BACKGROUND:Spirituality may influence coping and quality of life in inflammatory bowel disease (IBD), yet spiritual needs are rarely assessed systematically in routine care. The Spiritual Needs Questionnaire - Extended Version (SpNQ-EV) and the Interpretation of Illness Questionnaire (IIQ) explore spiritual needs and illness meanings but require cross-cultural adaptation and content validation for use in the Italian IBD context. METHODS:This protocol describes a qualitative questionnaire validation study using think-aloud cognitive interviews. Purposive sampling with planned heterogeneity and saturation-based stopping will be used to recruit adult IBD patients and healthcare professionals from two Italian IBD outpatient centers. Participants will complete the Italian versions of the questionnaires while verbalizing their thoughts, followed by retrospective probing guided by Tourangeau's cognitive model and a brief debriefing. Interviews will be audio-recorded, anonymized, and analyzed item-by-item in a matrix using predefined problem codes complemented by inductive coding. Inter-coder reliability will be assessed on a subset of transcripts; AI-assisted coding will be explored using de-identified text under human oversight. RESULTS:As this manuscript represents a research protocol, no empirical results have been generated at this stage. This protocol describes a structured approach to evaluating the content validity of two questionnaires, emphasizing transparency in translation, cognitive testing, and item-revision decision rules. The combined use of concurrent think-aloud and retrospective probing will enable observation of real-time cognitive processes and clarification of ambiguous responses. The inclusion of both patients and healthcare professionals will provide complementary perspectives. The exploratory use of AI-assisted coding may offer efficiencies for segment classification in large item-by-item matrices. CONCLUSIONS:Rigorously adapted and content-validated Italian versions of the SpNQ-EV and IIQ may support both research and clinical practice by providing a shared language for exploring existential and spiritual dimensions of living with IBD, supporting future psychometric validation and implementation of spiritual and interpretation of illness assessment.
BACKGROUND:Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic immune-mediated disorders characterized by a relapsing-remitting course and progressive intestinal damage with a significant impact on patients' quality of life and healthcare system. Traditional care models, based on periodic outpatient checkups, are often insufficient to ensure continuous disease monitoring and timely intervention in the event of a flare-up. In this context, the use of digital health tools represents a potentially innovative strategy to improve clinical and self-management of the disease. The aim of this systematic review is to investigate which digital health tools are currently used to support the management of patients with inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. METHODS:This systematic review was conducted and reported in accordance with the PRISMA 2020 guidelines. Searches of PubMed, CINAHL, Web of Science, Scopus, and the Cochrane Library were made covering literature from 2006 to 2025. RESULTS:Fifteen articles were analyzed, paying attention to the themes of general characteristics, methodological quality, digital health tools utilized, topics of interest of the studies and acceptability and usability. CONCLUSIONS:DHTs are promising tools for managing chronic conditions such as IBD, but require further refinement and adaptation to population-specific needs.
BACKGROUND:Despite its significant psychological burden, long-term psychosocial effects of nurse-led self-management interventions in IBD remain understudied. This study assessed longitudinal changes in psychosocial outcomes following a structured self-management program, and the moderating role of family functioning. METHODS:A single-center, non-randomized, single-arm longitudinal study was conducted in 60 IBD adults in remission who participated in a nurse-led multidisciplinary psychoeducational program in Spain. HRQoL (CCVEII-9), perceived stress (PSS-14), anxiety and depression (HADS), and family functioning (Family APGAR) were assessed at five time points over 12 months. Linear mixed-effects models evaluated temporal changes and moderating role of baseline family functioning. RESULTS:HRQoL improved significantly over 12 months (β=+6.18, 95% CI: 3.53 to 8.82; P<0.001), exceeding a clinically meaningful threshold. Depressive symptoms showed a significant sustained reduction (P=0.036; β=-0.92, 95% CI: -1.66 to -0.19 at 12 months). Perceived stress showed a non-significant decreasing trend (P=0.054), reaching significance at 6 months (β=-1.93, 95% CI: -3.63 to -0.22; P=0.028). Anxiety remained stable (P=0.471). Family functioning moderated trajectories for perceived stress (P=0.004), depression (P<0.001), and anxiety (P<0.001), with a non-significant trend for HRQoL (P=0.056); participants with normal family functioning showed earlier and stronger improvements. CONCLUSIONS:Longitudinal evidence suggests that a nurse-led psychoeducational intervention was associated with sustained improvements in HRQoL and depressive symptoms in IBD. The moderating role of family functioning in outcomes underscores the value of integrating family-sensitive self-management programs into IBD nursing care.
BACKGROUND:Remote education is increasingly used to support patient education, but little is known about how patients with a stoma and stomatherapists experience these pathways. This study explored the lived experiences and perceived effectiveness of remote educational interventions in ostomy care. METHODS:We conducted a descriptive phenomenological qualitative study following the COREQ checklist. Purposive sampling included ten adults with a new stoma who completed a remote educational pathway and eight stomatherapists from six Italian hospitals. Audio-recordings of interviews and focus groups were transcribed verbatim. Analysis followed Moustakas' adaptation of the van Kaam method. NVivo supported data management. The study was part of the broader SELF-STOMA project, which investigated whether remote patient education was non-inferior to traditional in-person education. The study was approved by the Roma Tor Vergata Ethics Committee (119/22). RESULTS:Five themes emerged: 1) the multifaceted nature of shame and embarrassment such as webcam exposure, body image, fear of leakage and odors; 2) barriers spanning technical instability, limited digital literacy, loss of physical examination, and privacy concerns; 3) facilitators, including restored autonomy, feeling heard and supported, and logistical advantages such as reduced travel and waiting times; 4) shared perceptions of effectiveness, after initial skepticism, both groups judged remote education practical and useful; and 5) prerequisites for quality and professional training, prior therapeutic relationships, adequate devices. CONCLUSIONS:Remote education is an acceptable, effective complement to in-person ostomy care. To optimize outcomes, programs should address shame, reduce digital barriers, protect privacy, and strengthen staff training and infrastructure. Combining patient and clinician views can guide hybrid models that improve access, continuity, and autonomy.
Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are widely used in psychiatry for mood and anxiety disorders but remain underexplored in chronic gastrointestinal conditions such as inflammatory bowel disease (IBD) and disorders of gut-brain interaction (DGBI). This review synthesizes emerging evidence on their potential therapeutic role, focusing on shared neurobiological and immunometabolic mechanisms within the bidirectional microbiota-gut-brain axis. We reviewed preclinical and clinical studies investigating SSRIs and SNRIs in IBD and DGBI, emphasizing neuroimmune, enteric, and microbial pathways relevant to disease modulation. SSRIs and SNRIs inhibit serotonin (SERT) and norepinephrine (NET) transporters, increasing central 5-HT and NE signaling across corticolimbic and autonomic networks. These effects enhance neuroplasticity and BDNF activity, reduce microglial activation and proinflammatory cytokines, and partially normalize hypothalamic-pituitary-adrenal (HPA) axis reactivity. Peripherally, epithelial, and enteric SERT blockade elevates luminal 5-HT, activating 5-HT3 and 5-HT4 receptors that promote motility, secretion, and sensory modulation. Both classes also enhance vagal antiinflammatory tone and tighten epithelial barrier integrity by suppressing nuclear factor kappa (NF-κB) signaling and increasing interleukin 10 (IL-10). Through integrated central, enteric, and immune actions, SSRIs and SNRIs can influence mood, pain perception, gut motility, and mucosal inflammation, key determinants of symptom burden in IBD and DGBI. SSRIs and SNRIs hold promise as multimodal modulators of the microbiota-gut-brain axis, bridging psychiatric and gastroenterological care. However, mechanistic preclinical studies and rigorously designed, adequately powered randomized trials are needed to define causal pathways, optimal dosing, and patient stratification strategies.
BACKGROUND:Reliable tools to quantify nutrition knowledge are crucial for planning education and prevention. We developed the Questionario delle Conoscenze Alimentari Italiano (QCAI) for Italian adults and assessed its reliability. METHODS:A convenience sample of 165 participants (18-89 years; 70.9% women) completed a self-administered, 69-item questionnaire organized into four content sections (experts' recommendations; nutrient content of foods; healthy choices; meal frequency and labels) plus demographics. Participants completed the questionnaire at baseline (T0) and again after seven days (T1) under identical conditions. Internal consistency was evaluated with Cronbach's alpha (and KR-20 for dichotomous items). Temporal stability was assessed with intraclass correlation coefficients (ICC(2,1)) for section and total scores, Cohen's kappa (κ) for items, and Bland-Altman analysis. RESULTS:Total-scale internal consistency was acceptable (Cronbach's α=0.757 for available items), but domain-level α values were heterogeneous and in some sections low (α: 0.307-0.638), indicating limited coherence of some subscales. Test-retest stability for the total score was moderate (ICC(2,1)=0.62), and 64.29% of items showed at least moderate agreement (κ≥0.40). Age-stratified analyses showed no linear trend in the total score across groups (18-39, 40-59, ≥60; Ptrend=0.26). CONCLUSIONS:QCAI is a low-cost instrument that shows moderate temporal stability and acceptable reliability for the total score in Italian adults. However, the low internal consistency observed in some domains limits the interpretability of section scores and highlights the need for item refinement and formal validation (content, construct, and criterion validity) against established measures before routine clinical or public-health use.
Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, are chronic conditions associated with gastrointestinal inflammation and a wide range of extraintestinal manifestations. While conventional treatments primarily address intestinal inflammation, many patients continue to experience chronic pain, psychological comorbidities, and functional gastrointestinal symptoms, highlighting the need for integrated therapeutic strategies. This narrative review explores the potential of neurofeedback (NFB) as a non-invasive therapeutic approach for managing symptoms frequently observed in IBD, including musculoskeletal pain, anxiety, depression, post-traumatic stress symptoms (PTSS), and gut-brain axis dysfunction. In the absence of direct evidence on neurofeedback in IBD populations, we examined data from clinical trials conducted in conditions that are frequently comorbid with or symptomatically overlap with inflammatory bowel disease, including fibromyalgia, irritable bowel syndrome (IBS), chronic pain syndromes, and affective or trauma-related disorders. We focused on outcomes related to chronic pain, psychological well-being, and gastrointestinal function, examining NFB protocols primarily targeting alpha, theta, and sensorimotor rhythms, which have shown promising results in improving symptom severity and autonomic regulation. These findings support the rationale for investigating NFB as a potential adjunctive therapy in IBD, particularly for patients with residual or refractory extraintestinal symptoms. However, as none of the available studies specifically involve patients with IBD, the evidence base remains indirect. Moreover, current findings are limited by small sample sizes, heterogeneous methodologies, and variable outcome measures in the studied populations, making it difficult to draw definitive conclusions regarding the efficacy of NFB in this context. Future research should include large-scale, randomized controlled trials conducted directly in IBD cohorts, along with protocol standardization and individualized approaches based on neurophysiological profiles. Clarifying the therapeutic potential of NFB in this population could open new avenues for non-pharmacological, patient-tailored interventions within integrative care frameworks.
BACKGROUND:Early-onset gastric cancer (EOGC), diagnosed before age 45, demonstrates distinct clinicopathological features and poorer prognosis. Current screening strategies lack sensitivity in young populations, while Helicobacter pylori (H. pylori) virulence genotypes (e.g., cagA, vacA) remain underutilized in risk stratification. To develop and validate a diagnostic model combining clinical characteristics and H. pylori virulence serological detection of virulence factors to optimize EOGC risk stratification. METHODS:In this multicenter case-control study, 200 histologically confirmed EOGC patients and 600 age-matched controls (non-malignant gastric conditions) were enrolled from LiShui Hospital (2023-2024). Clinical parameters, H. pylori infection status (13C-urea breath test), and virulence genotypes (cagA, vacA; ELISA) were analyzed. Multivariable logistic regression identified independent risk factors, followed by risk score development and internal validation (1000 bootstrap replicates). RESULTS:EOGC patients exhibited higher prevalence of persistent epigastric pain (68.5% vs. 32.1%; P<0.001), significant weight loss (6.2 vs. 2.1 kg; P<0.01), and H. pylori infection (85.0% vs. 52.3%; P<0.001). Virulent genotypes were enriched in EOGC: cagA+ (72.5% vs. 45.6%; P<0.01) and vacA s1/m1 (65.0% vs. 38.2%; P<0.01). The final model included five predictors: persistent pain (adjusted odds ratio [aOR]=2.85, 95% CI:1.92-4.23), cagA+ (aOR=3.12, CI: 2.01-4.85), anemia (Hb<110 g/L; aOR=2.34, CI: 1.56-3.51), thrombocytosis (>300×109/L; aOR=1.98, CI: 1.32-2.96), and weight loss >2.1 kg (aOR=2.57, CI: 1.21-2.73). A score ≥3 indicated high risk, achieving 86.5% sensitivity and 82.3% specificity (AUC=0.89, CI: 0.85-0.93). CONCLUSIONS:This novel model integrates accessible clinical and microbiological markers to stratify EOGC risk with high accuracy, providing a cost-effective tool for prioritizing endoscopic evaluation in young symptomatic individuals.
BACKGROUND:Self-care is increasingly recognized as a key determinant of outcomes in inflammatory bowel disease (IBD), yet its relationship with medication adherence remains inconsistently mapped. This scoping review aimed to explore how self-care-related constructs, including self-efficacy and patient activation are associated with medication adherence. METHODS:A scoping review was conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed, Scopus, Web of Science, and CINAHL were searched using terms related to IBD, self-care or self-management, including self-efficacy, patient activation and medication adherence. Primary studies involving adult outpatients were included. Study selection and data charting were performed by two reviewers, with discrepancies resolved through discussion with a third supervisor. RESULTS:The search identified 699 records; after removing 164 duplicates, 535 records were screened. Eleven full texts were assessed, and five studies were included. Evidence was heterogeneous and included interventional and observational designs. Interventions supporting self-management, such as nurse-led counselling and practical tools, were associated with improved adherence. Telemedicine monitoring improved patient activation but not self-efficacy. Observational evidence suggested that higher self-efficacy and lower regimen complexity were associated with better adherence. CONCLUSIONS:Available evidence suggests that self-care-related constructs, particularly self-efficacy and patient activation, may be associated with medication adherence in IBD outpatients. However, the literature remains limited and heterogeneous. Further theory-informed and adequately powered studies are needed.
BACKGROUND:To investigate the impact of early enteral nutrition on hospital stay in adults with severe acute pancreatitis (SAP). METHODS:Retrospective analysis of clinical data from adult SAP patients admitted between January 2023 and June 2023. Patients were divided into early enteral nutrition (63 cases) and late enteral nutrition (69 cases) groups. General information, admission blood parameters, white blood cell count, CRP levels, and length of hospital stay were compared between the groups. Pearson correlation analysis explored the relationship between timing of enteral nutrition and hospital stay. RESULTS:No significant differences in general information and admission blood parameters between groups. Both groups showed significant decreases in white blood cell count (WBC) and CRP levels following the initiation of enteral nutrition. After enteral nutrition intervention, the early enteral nutrition group had significantly lower WBC and CRP concentration than the late enteral nutrition group. Average length of hospital stay and ICU stay were significantly shorter in the early enteral nutrition group. Correlation analysis showed a positive correlation between timing of enteral nutrition and average length of hospital stay and ICU stay in SAP patients. CONCLUSIONS:Early enteral nutrition has significant advantages over late enteral nutrition in improving inflammatory response and reducing length of hospital stay and ICU stay.
BACKGROUND:This investigation was to assess the association between endothelial activation and stress index (EASIX) levels and mortality risk in hepatitis B virus (HBV)-infected patients. METHODS:This retrospective study analyzed HBV-infected adults from the National Health and Nutrition Examination Survey database. Weighted univariate and multivariate Cox regression models analyzed the relationship between EASIX and all-cause mortality. Kaplan-Meier curves and restricted cubic spline curves supplemented these findings, while the concordance index (C-index) assessed EASIX's predictive accuracy. RESULTS:The analysis comprised 3468 patients. The analysis revealed that elevated EASIX levels correlated with higher all-cause mortality risk in HBV patients (continuous: hazard ratio [HR] 1.07, 95% CI: 1.02-1.12; categorical: HR=1.52, 95% CI: 1.17-1.99). Patients with higher EASIX levels had a lower probability of survival (P<0.05). A nonlinear correlation was found between elevated EASIX scores and poorer survival outcomes (P<0.05). EASIX showed moderate predictive accuracy, with C-index values of 0.646 (95% CI: 0.611-0.680). CONCLUSIONS:EASIX performed a moderate discriminative ability for mortality risk in HBV-infected patients, suggesting a complementary prognostic value with conventional liver fibrosis indices and established scores.
BACKGROUND: Gastrointestinal endoscopy is an increasingly complex clinical environment in which nurses play a pivotal role throughout the patient pathway. Although international guidelines and curricula clearly define the expected competencies of endoscopy nurses, their competence profile has not been consistently described across healthcare settings, particularly from the nurses' own perspective and across both technical and non-technical items. The aim of this study is to describe the self-perceived competence of nurses working in digestive endoscopy units and to explore its association with individual and organizational factors. METHODS: A nationwide multicenter cross-sectional survey was conducted among nurses employed in digestive endoscopy units across Italy. Data were collected through an anonymous online questionnaire developed by expert endoscopy nurses based on international guidelines and consensus documents. Self-perceived competence was assessed across ten technical and non-technical items using five-point Likert scales, along with a global self-classification of competence level. RESULTS: A total of 250 nurses participated. Most respondents self-identified as Competent (45.2%) or Expert (39.2%). Mean competence scores across items were moderate and showed limited variability. Non-technical items were rated slightly higher than technical items (P<0.001), although the absolute difference was small. Years of experience in digestive endoscopy were weakly but significantly associated with specialist technical skills and teamwork/leadership, whereas total professional experience and coordination experience were not. CONCLUSIONS: Endoscopy nurses perceive themselves as generally competent across technical and non-technical items; however, competence levels remain moderate, and associations with experience, education, and organizational factors are modest. These findings support the need for structured, competency-based assessment and training approaches beyond seniority or exposure alone.
BACKGROUND:Fecal microbiota transplantation (FMT) has gained popularity over the last years. So far, conflicting data regarding the effect on disorders of gut-brain interaction (DGBI) exist. In this study we aimed to access current knowledge and attitude towards potential FMT of DGBI patients. METHODS:A survey on attitudes toward FMT was conducted in DGBI patients. Patients answered questions anonymously before and after having read a brief information sheet on FMT. Data were collected prospectively in 2017-2018 and in 2022-2023. RESULTS:In total, 387 patients completed the survey. Forty percent of patients had heard about FMT prior to underlying survey. Prior to a brief information regarding FMT, 38% of patients would have agreed to FMT, while 50% were undecided and 12% would have declined. After a brief information sheet on FMT, decisions significantly changed to 63%, 26% and 11% respectively (P<0.001). The decision of patients to undergo FMT remained unchanged between 2017 and 2022. Type of DGBI and disease severity are significantly associated with treatment decisions (P=0.005). CONCLUSIONS:This survey demonstrates great interest of DGBI patients in potential FMT, especially after being informed on details of the procedure. Bearing in mind that in the future FMT may be a clearer option in the treatment of certain DGBIs, patient education will be an important factor.
BACKGROUND:Autoimmune atrophic gastritis causes achlorhydria, which may predispose to gastrointestinal microbial overgrowth (MO). We sought to evaluate the association between autoimmune atrophic gastritis and MO. METHODS:From a database of patients at our institution who had undergone MO testing (via intestinal aspirate culture or glucose or lactulose hydrogen/methane breath testing), we identified patients with autoimmune atrophic gastritis via ICD codes. We then confirmed that these patients had a histologically confirmed diagnosis. Finally we queried the electronic health record to identify patients with non-atrophic chronic gastritis who had undergone MO testing. RESULTS:We identified 52 patients with autoimmune atrophic gastritis who underwent aspirate culture; 48 (92.3%) met criteria for small intestinal bacterial overgrowth (SIBO) at a threshold of ≥103 CFU/mL, and 39 (75%) at ≥105 CFU/mL. Among patients who had multiple aspirates, 83.3% had recurrent SIBO. Among 24 patients who underwent breath testing, 11 (45.8%) tested positive, primarily reflecting intestinal methanogen overgrowth. A notable discordance was observed among seven patients who underwent both testing modalities, with five patients having a positive culture but negative breath test. Finally, comparing MO results from patients with autoimmune atrophic gastritis to those with non-atrophic chronic gastritis identified significantly higher test positivity in autoimmune atrophic gastritis (75% vs. 34.3% at ≥105 CFU/mL, P<0.00001; 92.3% vs. 65%, P=0.000043), but not for breath tests (45.8% vs. 30.3%, P=0.106). CONCLUSIONS:MO is common among symptomatic patients with autoimmune atrophic gastritis, and intestinal aspirate culture identifies more positive cases than breath testing in this population. Findings are subject to selection bias and the inherent constraints of both MO testing modalities, and require confirmation with prospective studies.
BACKGROUND:Serrated polyps account for up to 30% of colorectal cancer cases and are linked to interval cancers. Due to their clinical relevance and frequent underdiagnosis, this study evaluated the epidemiological profile, endoscopic and histopathological characteristics, and subtypes of serrated polyps, including those occurring synchronously with conventional adenomas. METHODS:This cross-sectional observational study reviewed medical records of patients undergoing colorectal lesion resection at a Therapeutic Endoscopy Center in southern Brazil between 2013 and 2018. Variables analyzed included age, sex, serrated polyp subtype and size, anatomical location, and presence of synchronous conventional adenomas. RESULTS:A total of 222 patients were included (65.3% female), with a mean age of 60.6 years. Among 431 resected lesions, 329 were serrated polyps: 144 traditional serrated adenomas (TSAs), 126 sessile serrated lesions and 59 hyperplastic polyps. Age was significantly associated with TSA occurrence, with a 3% increase in likelihood per additional year. The mean number of polyps per patient was 1.94, and ~70% measured 10-20 mm. Most TSAs (80%) were located in the right colon. Serrated polyps coexisting with synchronous adenomas represented 24% of cases, with TSAs being the most frequent subtype; no significant differences in age or sex were observed in this subgroup. CONCLUSIONS:These findings highlight the predominance of TSAs, their right-sided colon predilection, and association with increasing age. Synchronous adenomas were present in approximately one-quarter of patients, emphasizing the importance of careful detection and characterization of serrated polyps in clinical practice.
BACKGROUND:The use of mesalamine for the treatment of ulcerative colitis (UC) is common, and may rarely cause nephrotoxicity. One of the clinical signs of nephropathy is hematuria or dark urine. We aimed to evaluate the effect of hypochlorous acid (HA) found in household bleach on the color of urine among pediatric UC subjects treated with mesalamine. METHODS:This was a prospective case-control study. We obtained fresh urine samples from UC subjects in remission and with intact kidney function. A urinalysis was used to rule out hematuria or signs of infection. We noted the color of the urine before and after adding 1mL of HA to each sample. RESULTS:Our study included 17 UC subjects, of them 14 (82%) were females with a median age of 17 years (IQR 14.5-17.5 years). Nine (53%) of subjects were on mesalamine therapy with a median daily dose of 64 mg/kg, while eight (47%) received other therapies (three infliximab, three adalimumab, one vedolizumab, one ustekinumab). Initial urine color of all samples was between transparent and dark-yellow. All subjects taking mesalamine had an immediate and notable change of urine color to brown compared to none of the subjects treated with other drugs (P=0.0001). This phenomenon was unaffected by the initial urine color, daily dose taken or time from last mesalamine dose. CONCLUSIONS:Urine of mesalamine users turns brown when exposed to HA, which may cause unnecessary alarm among such patients. Likewise, awareness of this benign phenomenon may help avoid needless alarm and testing.
BACKGROUND:Current treatment strategies for symptomatic uncomplicated diverticular disease (SUDD) remain controversial. Nutraceuticals could be potential adjuvant treatments to reduce symptoms and improve Quality of Life (QoL). METHODS:A retrospective analysis of data collected in a real-world clinical setting was performed on SUDD patients with persistent diarrheal symptoms following rifaximin therapy. A synbiotic anti-inflammatory dietary supplement (SADS), containing Lactobacillus rhamnosus GG, Hericium erinaceus, berberine, quercetin, palmitoylethanolamide, and Undaria, was administered daily for one month to evaluate its effectiveness in reducing these symptoms. Outcome measures included daily bowel movement frequency, Abdominal Pain Score, treatment satisfaction, and fecal calprotectin levels, and were evaluated at baseline (T0) and after one month (T1). RESULTS:Data from 54 SUDD patients (mean age: 53.2±11.3 years) were collected. Daily bowel movements significantly decreased after SADS treatment (T1) compared to T0 (2.18±0.8 vs. 3.8±0.7; P<0.001). Abdominal Pain Score also improved significantly (2.59±1.2 vs. 5.81±1.0; P<0.001), with 88.9% of patients reporting moderate-to-high treatment satisfaction. Calprotectin levels decreased significantly following SADS treatment (P<0.001), with positive test results reducing from 100% at T0 to 65% at T1, while negative results increased from 0% to 35%. Significant negative correlations were observed between treatment satisfaction and both abdominal pain scores (r=-0.742; P<0.001) and daily bowel movement frequency (r=-0.516; P<0.001). CONCLUSIONS:This SADS could be considered as a supportive treatment for SUDD patients, potentially alleviating symptoms and improving QoL. Further prospective clinical trials are required to confirm these observations.
INTRODUCTION:Post-pancreatectomy diabetes (type 3c diabetes) is a frequent consequence of pancreatic cancer surgery and is characterized by extreme glycemic variability, high risk of severe hypoglycemia, and a substantial impact on quality of life and nursing workload. Technological solutions such as continuous glucose monitoring (CGM) and closed-loop insulin delivery may help address these challenges. EVIDENCE ACQUISITION:We conducted a systematic review according to the Cochrane Handbook 6.5 and PRISMA 2020 guidelines, with prospective registration on PROSPERO (CRD420251117523). PubMed, Embase, CINAHL, Scopus, and the Cochrane Library were searched from 2006 to October 2025 for primary studies evaluating automated or semi-automated glucose control systems in adults with diabetes secondary to pancreatic resection for malignancy. Risk of bias was assessed with RoB 2.0 and ROBINS-I; certainty of evidence was rated using the GRADE approach. EVIDENCE SYNTHESIS:Four studies (three randomized trials and one prospective time-motion simulation; N.=66) met the inclusion criteria. Fully closed-loop systems increased time in range to 77.7±4.6% versus 41.1±19.5% with standard care and virtually eliminated severe hypoglycemia. A bihormonal artificial pancreas increased euglycemia from 54% to 78% and reduced time below range to 0%. A hybrid closed-loop system maintained improved glycemic control over long-term follow-up, while a simulation study estimated a 67% reduction in nursing workload for major surgery. Overall certainty of evidence ranged from very low for continuous metrics (TIR, TBR) to moderate for prevention of severe hypoglycemia. CONCLUSIONS:Automated glucose control systems improve peri- and postoperative glycemic stability in post-pancreatectomy diabetes and may substantially reduce nursing workload. Structured training, institutional protocols, and multicenter studies with larger samples and longer follow-up are needed to confirm clinical effectiveness, cost-efficiency, and implementation strategies.
