Background/Objectives: Transanal irrigation (TAI) is an established bowel-emptying strategy for selected patients with bowel dysfunction, whereas evidence on Colon Hydrotherapy (CHT) in chronic gastrointestinal disorders remains limited. This pilot study characterized patients undergoing CHT within specialist gastroenterological care and prospectively evaluated gastrointestinal and extraintestinal symptoms, lifestyle modifications, concomitant treatments, and safety over 12 months. Methods: Consecutive adults with chronic gastrointestinal disorders, including Irritable Bowel Syndrome (IBS) and IBS-like disorders, underwent CHT within an individualized gastroenterological management pathway. Symptoms were assessed using a 44-item modified Gastrointestinal Symptom Rating Scale at baseline (T0), 7 days after the first CHT session (T1), and 12 months thereafter (T2). Longitudinal changes were analyzed using linear mixed-effects models. Results: Of 81 enrolled patients, 40 completed all assessments. Overall, 38/44 (86.4%) symptoms showed a significant time effect, predominantly between T0 and T1. Significant time effects were observed across gastrointestinal (14/16, 87.5%), general well-being and systemic (11/13, 84.6%), gynecological (5/6, 83.3%), and urological (8/9, 88.9%) domains. At T2, 36/44 (81.8%) symptoms remained significantly improved versus baseline. The greatest gastrointestinal improvements involved bloating, incomplete evacuation, straining, abdominal pain, hard stools, and reduced bowel movements. Fluid intake and alcohol consumption improved, while macrogol and glycerol suppositories use increased. No clinically significant CHT-related adverse events were observed or reported during the 120 documented CHT procedures performed in the 40 participants included in the longitudinal analysis. Among the remaining 41 enrolled participants, no procedure-related complications or problems were reported in routine clinical care, although a reliable total number of procedures and comparable procedure-level safety data were unavailable. Preliminary safety findings are encouraging, although available data do not allow definitive conclusions regarding the procedural safety of CHT. Conclusions: Symptom improvements were observed after 7 days and confirmed over 12 months in patients managed within an individualized, multimodal gastroenterological pathway that included CHT, pharmacological and dietary management, lifestyle modifications, and specialist follow-up. Although the uncontrolled pilot design and limited longitudinal sample preclude definitive conclusions regarding the specific contribution of CHT, the findings support further investigation of its potential role within integrated gastroenterological care. Controlled studies are warranted to confirm these preliminary observations.
Background: Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are considered major causes of cancer-related mortality. Evidence suggests that gut microbiome dysbiosis and the microbial–metabolic axis and its metabolites in hepatic chronic inflammation might be implicated in carcinogenesis in the gut–liver axis. This descriptive systematic review examines the microbial–metabolic axis in hepatobiliary cancer, focusing on patterns of dysbiosis, microbiome-associated metabolites, and the diagnostic or prognostic potential in this field. Methods: This manuscript was developed according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261455009). PubMed, Scopus, Cochrane Library, Web of Science, and Embase were searched. Eligible studies were published medical manuscripts reporting gut (oral/duodenal/fecal) microbiome alterations with links to HCC or CCA. Risk of bias was assessed with Rob 2.0 for the randomized clinical trial study included in this manuscript and ROBINS-I for the non-randomized studies. Ultimately, 13 studies met the inclusion criteria and were included in this qualitative study. Results: In the included studies, patients with HCC or CCA showed altered gut microbial diversity, a depletion of beneficial taxa such as Faecalibacterium and Bifidobacterium, and increased levels of potentially pro-inflammatory genera. Specific signatures such as Alloprevotella and the B.F.R. genera models in CCA were associated with diagnostic performance, with AUCs that frequently exceeded 0.90 in internal validation. Furthermore, circulating and host microbial metabolites, such as methionine, methionine sulfoxide, taurocholic acid, and microbial-derived TMA/TMAO pathway components, were associated with HCC risk. Conclusions: According to our analysis, gut microbiome alterations are associated with HCC and CCA and show promising diagnostic and prognostic potential. The findings are consistent with a possible microbial–metabolic contribution to hepatocarcinogenesis through chronic inflammatory and metabolic pathways. However, most included studies evaluated virus-related liver disease, and direct evidence linking obesity or MASLD-related dysbiosis to hepatobiliary cancer remains limited. Prospective and interventional investigations of metabolic liver disease populations are needed to clarify this axis.
Background/Objectives: Contemporary data on active Helicobacter pylori infection among young adults in Albania are limited. This study estimated Urea Breath Test (UBT)-detected prevalence among university students and described awareness, self-reported knowledge, gastrointestinal symptoms, and previous healthcare engagement. Methods: A cross-sectional study during 2023–2025 combined questionnaire data and interpretable UBT results from 390 consenting students aged ≥18 years in academic years I–IV in Korçë, Albania. The questionnaire underwent cultural adaptation, expert assessment, and pilot testing. Prevalence was reported with a Wilson 95% confidence interval (CI); questionnaire percentages used item-specific valid-response denominators. Results: UBT was positive in 107/390 students, giving a prevalence of 27.4% (95% CI 23.2–32.1%). Women comprised 321/390 (82.3%) participants. Overall, 209/385 (54.3%) had heard of H. pylori, 155/353 (43.9%) reported knowing associated diseases, and 152/363 (41.9%) reported knowing a transmission mode. School and health professionals were the leading reported information sources. Previous testing was reported by 21/388 (5.4%), stomach problems by 77/377 (20.4%), and gastric ulcer by 6/369 (1.6%). The highest proportions of moderate-or-greater symptoms involved bloating sensation (54/378, 14.3%), abdominal distension (54/380, 14.2%), and general abdominal complaints (49/382, 12.8%). Among six previously treated respondents with complete follow-up information, none reported post-treatment retesting. Extreme-case sensitivity estimates among 420 consenting students ranged from 25.5% to 32.6%. Conclusions: Approximately one in four tested students had evidence of current H. pylori infection, while self-reported knowledge and previous testing were limited. The findings support targeted university health education, access to clinically appropriate testing, and continuity through treatment and confirmation of eradication. Representative studies are needed before extrapolating to the broader population or adopting universal student screening.
Background: Gastrointestinal (GI) involvement is increasingly recognised in paediatric SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C), but severe GI bleeding remains rare. Its pathogenesis in this setting is multifactorial: direct viral injury, hyperinflammatory microvascular damage, treatment-related mucosal injury, and coagulopathy may all contribute, and the relative role of each is often difficult to disentangle. Case Presentation: A previously healthy 12-year-old boy underwent appendectomy for perforated appendicitis with peritonitis. On postoperative Day 1, he developed high fever and was found to be SARS-CoV-2 PCR-positive; SARS-CoV-2 IgM and IgG were also positive. He met the positive clinical elements of the CDC 2023 case definition for MIS-C (persistent fever, multisystem involvement—gastrointestinal, hepatic, haematological, and markedly elevated inflammatory markers), although perforated appendicitis with peritonitis is a sufficient alternative explanation and the diagnosis cannot be regarded as secure (see Discussion). Treatment included broad-spectrum antibiotics (meropenem, amikacin, metronidazole), methylprednisolone 2 mg/kg/day, and intravenous immunoglobulin (IVIG) 2 g/kg. On Day 4 in the paediatric intensive care unit (PICU), the patient developed sudden haematemesis with fresh blood through the nasogastric tube and haemodynamic collapse. Coagulation studies revealed prolonged INR (1.6) and reduced prothrombin activity (42%). The patient was stabilised with packed red blood cells, fresh frozen plasma, and intravenous vitamin K. Fibrogastroscopy demonstrated diffuse mucosal bleeding without ulcers or anatomical defects; histology showed mucosal hyperaemia, mixed basal inflammation with intraepithelial lymphocytes, and small erosions. Melena persisted for several days. The child recovered fully and was discharged after 20 days with substantially improved but not fully normalised laboratory values (residual mild anaemia, Hb 110 g/L, and elevated CRP 32.7 mg/L and D-dimer 5.88 mg/L). Conclusions: Severe upper GI bleeding is a rare but life-threatening event in children with severe SARS-CoV-2 infection and MIS-C. In our case, several mechanisms may have acted in combination, although none could be confirmed individually: possible direct viral enterocyte injury via ACE-2 receptors, hyperinflammatory microangiopathy, high-dose corticosteroid-related mucosal injury, possible broad-spectrum antibiotic-associated vitamin K deficiency, and postoperative critical-illness stress. Their relative contributions cannot be determined from a single retrospective case. Bleeding occurred despite continuous PPI prophylaxis, suggesting that PPI cover alone is insufficient when multiple risk factors coexist; the clinical implication is that risk-factor-based (rather than universal) PPI prophylaxis, together with monitoring of vitamin K-dependent coagulation, should be considered in critically ill children receiving high-dose corticosteroids and prolonged broad-spectrum antibiotics.
Background/Objective: The standard first-line treatment for advanced or recurrent gastric cancer (AGC) includes chemotherapy combined with an immune checkpoint inhibitor or zolbetuximab, but delivering fluoropyrimidine-platinum chemotherapy at standard doses can be difficult in elderly patients. Method: We retrospectively collected clinical data from 70 patients aged 70 years or older with AGC who received first-line chemotherapy plus nivolumab between July 2017 and December 2024. Patients who started treatment without dose reduction were classified as the normal group, whereas those who received a reduced starting dose of fluoropyrimidine and/or platinum were classified as the reduced group. Results: Fifty patients were assigned to the reduced group and 20 to the normal group. The reduced group was older, more frequently received SOX, and more often had PD-L1 combined positive scores ≥ 1. Objective response rate, disease control rate, progression-free survival, and overall survival did not differ significantly between the groups. In contrast, grade ≥ 3 adverse events and any-grade infections were more frequent in the normal group. Conclusions: These findings suggest that reduced-dose chemotherapy plus nivolumab may be an effective and less toxic first-line option for elderly patients with AGC.
