Chronic constipation (CC) is a common disorder of gut-brain interaction that markedly impairs quality of life and remains challenging to manage. Despite the availability of laxatives and prosecretory agents, up to half of patients experience suboptimal relief, underscoring the need for complementary, physiology-based nutritional strategies. Nutrients influence intestinal motility through multiple pathways, including enteroendocrine signalling, bile-acid metabolism, microbiota-derived metabolites, and intestinal taste-receptor activation. Integrating these mechanisms into clinical nutrition requires structured approaches that align fiber type, bile flow, microbial modulation, and sensory stimulation with motility phenotype and fermentation tolerance. Among dietary interventions, the most consistent clinical evidence supports the use of soluble fiber (e.g., psyllium), kiwifruit or prunes, and magnesium- or sulfate-rich mineral waters to improve stool frequency and consistency. Other components, such as fermented foods, probiotics, and generic hydration, show variable efficacy and remain supported primarily by physiological or translational data. The SMART (Sensory, Motor, bile Acid and Reflex Tailored) Constipation Diet (SCD) is proposed as a hypothesis-generating dietary framework that integrates fiber optimization, bile stimulation, microbial support, and chrono-nutritional timing into a coherent dietary model. Given the heterogeneity of CC (e.g., functional constipation, IBS-C, defecatory disorders) and the scarcity of phenotype-stratified trials, the SCD should be regarded as a translational concept rather than a validated clinical protocol. Future randomized, controlled studies with hard motility and symptom outcomes are needed to determine whether coordinated, multi-pathway dietary modulation can outperform single-component interventions and advance precision nutrition in CC.

Introduction and aims:Esophageal achalasia (EA) is a rare motility disorder. Symptoms often impair quality of life (QoL) and lead to restrictive, self-managed diets with potential nutritional deficiencies. The study aimed to assess dietary patterns and nutritional status in EA patients. Materials and methods:EA patients, retrospectively recruited from January 2018 to August 2024, filled out a 15-day diary to record ingested food and relative symptoms onset for each meal. Estimated caloric intake and macronutrient composition were compared to those recommended by the Italian Society of Human Nutrition (SINU). EA activity was assessed with Eckardt Symptoms Score (ESS) and QoL with the MD Anderson Dysphagia Inventory (MDADI). Results:Of 44 patients (24M, 20F; 56.9 ± 15.7 years), 79% had active disease (ESS ≥3). The mean daily caloric intake was 1,573 ± 368 kcal/die, significantly lower than the estimated needs (p < 0.0001). Macronutrients distribution was unbalanced with an increase in fats (37.8%), a decrease in carbohydrates (43.2%), and insufficient fiber intake (14 g). The most common symptom-triggering foods were bread, pasta, pizza (50-60%). Additionally, 60% reported worsened symptoms with cold foods, while 53% found relief with hot foods. Conclusion:This study highlights the pivotal role of dietary factors, particularly food consistency and temperature, in the management of EA, supporting the incorporation of individualized dietary counseling into standard EA care.

Background/Objectives: Small intestinal microbial overgrowth (SIMO), including both small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO), is commonly diagnosed using non-invasive breath tests, whose diagnostic performance and criteria remain inconsistent. This study aimed to assess SIMO prevalence using lactulose (LBT) and glucose breath tests (GBT), compare their diagnostic yields for SIBO and IMO, analyze associated gas profiles, clinical features, risk factors, and evaluate the diagnostic accuracy of a simplified fasting methane criterion for IMO. Methods: Cross-sectional study conducted on 564 outpatients (75.7% female) with suspected SIMO. Patients underwent LBT (n = 275), GBT (n = 289), or both (n = 47). Results: SIMO was diagnosed in 26.8% of patients. LBT identified significantly more SIMO than GBT (37.5% vs. 16.6%, p < 0.01), particularly for SIBO (24.4% vs. 4.8%, p < 0.01), while IMO detection was comparable (9.8% vs. 10.7%). Mixed overgrowth (dual SIBO/IMO positivity) showed a borderline trend favoring LBT. Methane peaks occurred significantly earlier than hydrogen in both BTs. Clinical symptoms did not significantly differ between SIMO subtypes or between test-positive and test-negative groups. The simplified fasting methane criterion showed limited diagnostic accuracy for IMO making it inadequate as a standalone diagnostic tool, requiring further validation before clinical implementation. Conclusions: GBT is the more reliable test for SIMO diagnosis due to LBT's lower specificity. Clinical symptoms alone were not predictive of SIMO subtypes, while the different gas profile suggests a distinct spatial distribution of microbial populations with a higher proximal concentration of methanogenic Archaea.

INTRODUCTION:The worldwide increase in acute diverticulitis (AD) prevalence and the resulting growing economic burden on the healthcare system have driven the scientific community towards standardizing a methodological approach to obtain a prompt diagnosis, optimized treatment, and thus containing costs. By the analysis of currently available evidence, this review could provide effective strategies for efficient AD clinical management and highlights possible innovative therapeutic strategies. EVIDENCE ACQUISITION:A systematic literature search was conducted from October 2014 to October 2024 according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. EVIDENCE SYNTHESIS:The accurate collection of the medical history with investigation of preexisting diverticulosis and known AD risk factors, in combination with careful physical examination, permits a direct AD diagnosis but with proper accuracy. The contextual integration of laboratory data and the use of clinical scores may discourage the use of radiology, which, despite this, remains the only available methodology to exclude complications requiring hospitalization. CT scan with intravenous contrast remains the gold standard both for diagnosis and staging. However, the principal purpose is to prevent AD onset and recurrence (primary and secondary prevention) to reduce the health burden. The intervention on modifiable risk factors reduced AD incidence, whereas the currently available therapeutic options, such as non-absorbable antibiotics, probiotics, and mesalazine, have proven disappointing results. Breakthroughs may arise from recent evidence of a pathogenic role of a transmural colonic oxidative imbalance, likely ascribed to chronic ischemia-reperfusion injuries, that could contribute to reduced colonic wall compliance and represent a new possible therapeutic target. CONCLUSIONS:Although progress has been made in the last decade towards more efficient AD management, further efforts are needed to impact its management and healthcare costs efficiently.

Patients’ attitude toward therapy and adherence to treatment are central in determining the long-term outcomes of medical treatment in ulcerative colitis. A complex interplay of differing factors modulates the likelihood of persisting in or discontinuing treatment, including patients’ beliefs and concerns about adverse effects of drugs, as well as the interactions with medical staff. Emotional attitude and expectancies are reflected in the so-called placebo and nocebo effects which influence patients’ choices to adhere to or discontinue treatment. They represent important confounding factors in clinical trials and are amplified when the evaluation relies on patient-reported outcomes more than on objective measurements. The therapeutic gain related to placebo effects is likely also relevant in day-to-day practice, but few data are available. The aim of the present narrative review is to provide critical insight into the adherence to therapy in ulcerative colitis and its interaction with the emotional component of the effects of therapy, resulting in the placebo/nocebo effects. Understanding the mechanisms underlying patient behavior may help identify the most appropriate therapeutic approach and treatment schedule to optimize adherence and outcomes in individual patients with UC.

BACKGROUND:The natural history and pathophysiology of diverticular disease (DD) are still uncertain. An ex-vivo human complicated DD (cDD) model has recently shown a predominant transmural oxidative imbalance. The present study aims to evaluate whether the previously described alterations may precede the symptomatic form of the disease. METHODS:Colonic surgical samples obtained from patients with asymptomatic diverticulosis (DIV), complicated DD, and controls were systematically and detailed morphologically and molecularly analyzed. Therefore, histologic, histomorphometric, immunohistochemical evaluation, and gene and protein expression analysis were performed to characterize colonic muscle changes and evaluate chronic inflammation, oxidative imbalance, and hypoxia. Functional muscle activity was tested on strips and isolated cells in response to contractile and relaxant agents. KEY RESULTS:Compared with controls, DD showed a marketed increase in muscle layer thickness, smooth muscle cell syncytium disarray, and increased interstitial fibrosis; moreover, the observed features were more evident in the cDD group. These changes mainly affected longitudinal muscle and were associated with altered contraction-relaxation dynamics and fibrogenic switch of smooth muscle cells. Chronic lymphoplasmacytic inflammation was primarily evident in the mucosa and spared the muscle. A transmural increase in carbonylated and nitrated proteins, with loss of antioxidant molecules, characterized both stages of DD, suggesting early oxidative stress probably triggered by recurrent ischemic events, more pronounced in cDD, where HIF-1 was detected in both muscle and mucosa. CONCLUSION & INFERENCES:The different DD clinical scenarios are part of a progressive process, with oxidative imbalance representing a new target in the management of DD.

Background: The gut–brain axis (GBA) is a bidirectional communication network connecting the central nervous system with the gastrointestinal (GI) tract, influencing both mental and physical health. Recent research has underscored the significant role of diet in modulating this axis, with attention to how specific dietary patterns can impact anxiety and depression, particularly when linked to disorders of gut–brain interaction (DGBIs), like intestinal bowel syndrome (IBS). Aims and Methods: This narrative review examines the effects of specific diet regimens on the GBA and its potential role in managing psychopathology, focusing on anxiety and depression, IBS, and the low-FODMAP diet. We conducted a search on PubMed and MEDLINE by combining the following key terms: “Gut–Brain Axis”, “Irritable Bowel Syndrome”, “Low FODMAP diet”, “Mediterranean Diet”, “Psychopathology”, “Anxiety and Depression”, and “Gut Microbiota”. We applied the following filters: “Clinical Trials”, “Randomized Controlled Trials”, “Reviews”, “Meta-Analyses”, and “Systematic Reviews”. In total, 59 papers were included. Results: Low-FODMAP diet, originally developed to alleviate GI symptoms in IBS, may also positively influence mental health by modulating the GBA and improving the gut microbiota (GM) composition. New insights suggest that combining the low-FODMAP diet with the Mediterranean diet could offer a synergistic effect, enhancing both GI and psychological therapeutic outcomes. Conclusions: Understanding the complex interactions between diet, the GM, and mental health opens new avenues for holistic approaches to managing psychopathology, particularly when linked to GI symptoms.

The deficiency of vitamins, a condition known as “hidden hunger”, causes comprehensive pathological states. Research over the years has identified a relationship between liver diseases and hypovitaminosis or defects in vitamin metabolism. The exact mechanisms remain elusive; however, the crucial involvement of specific vitamins in metabolic functions, alongside the reclassification of liver disease as metabolic dysfunction-associated steatotic liver disease (MASLD), has prompted researchers to investigate the potential cause-effect dynamics between vitamin deficiency and liver disease. Moreover, scientists are increasingly investigating how the deficiency of vitamins might disrupt specific organ crosstalk, potentially contributing to liver disease. Although the concept of a dysmetabolic circuit linking adipose tissue and the liver, leading to liver disease, has been discussed, the possible involvement of vitamin deficiency in this axis is a relatively recent area of study, with numerous critical aspects yet to be fully understood. In this review, we examine research from 2019 to July 2024 focusing on the possible link between liver-adipose tissue crosstalk and vitamin deficiency involved in the onset and progression of non-alcoholic fatty liver disease (NAFLD). Studies report that vitamin deficiency can affect the liver-adipose tissue axis, mainly affecting the regulation of systemic energy balance and inflammation.

The pathophysiology of diverticular disease (DD) is not well outlined. Recent studies performed on the DD human ex vivo model have shown the presence of a predominant transmural oxidative imbalance whose origin remains unknown. Considering the central role of mitochondria in oxidative stress, the present study evaluates their involvement in the alterations of DD clinical phenotypes. Colonic surgical samples of patients with asymptomatic diverticulosis, complicated DD, and controls were analyzed. Electron microscopy, protein expression, and cytofluorimetric analyses were performed to assess the contribution of mitochondrial oxidative stress. Functional muscle activity was tested on cells in response to contractile and relaxant agents. To assess the possibility of reverting oxidative damages, N-acetylcysteine was tested on an in vitro model. Compared with the controls, DD tissues showed a marketed increase in mitochondrial number and fusion accompanied by the altered mitochondrial electron transport chain complexes. In SMCs, the mitochondrial mass increase was accompanied by altered mitochondrial metabolic activity supported by a membrane potential decrease. Ulteriorly, a decrease in antioxidant content and altered contraction–relaxation dynamics reverted by N-acetylcysteine were observed. Therefore, the oxidative stress-driven alterations resulted in mitochondrial impairment. The beneficial effects of antioxidant treatments open new possibilities for tailored therapeutic strategies that have not been tested for this disease.

Lactose malabsorption (LM) refers to the incomplete absorption of lactose in the small intestine, resulting in the arrival of ingested lactose in the colon, which can give rise to symptoms defined as lactose intolerance (LI). The lactose breath test (LBT), thanks to its low cost, availability, and noninvasiveness, is the most used diagnostic method. However, the LBT is a tedious tool, requiring prolonged involvement of patients, qualified staff, and infrastructure, of which the most time-consuming factor is the frequency and number of breath samples needed. Objectives: To simplify the current LBT methodology, compliant with the current guidelines’ statements, by reducing the test duration or the number of breath samples, without compromising the test’s accuracy. Methods: The results of the standard LBT were compared with two simplified tests: a “shortened” test, lasting three hours, with samples taken every 30 min; and a “five-sample” test, lasting four hours, with samples taken every hour. Patients were stratified into three grades of malabsorption (mild, moderate, severe) based on the amount of gas exhaled. A clinical severity score was introduced to assess the clinical relevance of LI using a specific questionnaire. Results: Among the 543 patients enrolled (F 71.5%, mean age 43.7 ± 17.6 yrs), 60.4% (328/543) tested positive for LM. A total of 70.5% (383/543) presented LI, with 32.1% of those being true intolerants (LI without LM). The shortened test demonstrated an accuracy of 93.9%, with a sensitivity of 89.9% and a false negative rate of 10.1% (33/328). The five-sample test showed higher accuracy and sensitivity than the shortened test (96.5% and 94.2%, respectively; p = 0.03) with a false negative rate of 5.8% (19/328). Of the 19 false negatives in the five-sample test, 95% (18/19) were categorized as mild malabsorbents. No statistical correlation was found between the clinical severity score and LBT results. Conclusions: The five-sample test, involving hourly breath measurements, is a reliable option for simplifying the LBT without significantly reducing the procedure’s sensitivity.

PURPOSE:The aim of the study is to identify CT findings that are predictive of recurrence of acute uncomplicated colonic diverticulitis, to better risk-stratify these patients for whom guidelines recommend a conservative outpatient treatment and to determine the appropriate management with an improvement of health costs. MATERIALS AND METHODS:Over the past year, 33 patients enrolled in an outpatient integrated care pathway (PDTA) for uncomplicated acute diverticulitis with 1-year follow-up period, without recurrence, and 33 patients referred to Emergency Department for a recurrent acute diverticulitis were included. Images of admission CT were reviewed by two radiologists and the imaging features were analyzed and compared with Chi-square and Student t tests. Univariate and multivariate Cox regression models were employed to identify parameters that significantly predicted recurrence in 1-year follow-up period and establish cutoff and recurrence-free rates. The maximally selected rank statistics (MSRS) were used to identify the optimal wall thickening cutoff for the prediction of recurrence. RESULTS:Patients with recurrence showed a greater mean parietal thickness compared to the group without recurrence (16 mm vs. 11.5 mm; HR 1.25, p < 0.001) and more evidence of grade 4 of peridiverticular inflammation (40% vs. 12%, p = 0.009, HR 3.44). 12-month recurrence-free rates progressively decrease with increasing thickness and inflammation. In multivariate analysis, only parietal thickness maintained its predictive power with an optimal cutpoint > 15 mm that causes a sixfold increased risk of recurrence (HR 6.22; 95% CI, 3.05-12.67; p < 0.001). Beyond thickness and peridiverticular inflammation, predictive value of early recurrence within 90 days from the 1st episode resulted also an Hinchey Ib on admission CT. CONCLUSIONS:The maximum wall thickening and the grade of peridiverticular inflammation can be considered as predictive factors of recurrence and may be helpful in selecting patients for a tailored treatment to prevent the risk of recurrence.