Gastric cancer usually presents late with nonspecific symptoms such as epigastric discomfort, anorexia, weight loss, nausea, anemia, or gastrointestinal bleeding. Initial presentation with osteoporosis-like manifestations and multiple bone metastases in the absence of gastrointestinal symptoms is rare. We report a 59-year-old postmenopausal woman who presented with thoracolumbar back pain after routine activity. Bone mineral density assessment showed osteoporosis, but laboratory evaluation revealed markedly increased bone turnover markers, including alkaline phosphatase, β-CTX, and P1NP. Because these findings were disproportionate to typical primary postmenopausal osteoporosis, secondary osteoporosis and other metabolic bone disorders were further investigated. Whole-body bone scintigraphy, SPECT/CT, and PET/CT demonstrated multiple osteoblastic skeletal lesions suggestive of metastatic disease. Gastrointestinal endoscopy subsequently identified two synchronous primary tumors: a poorly differentiated gastric adenocarcinoma with focal signet-ring cell differentiation and a moderately differentiated sigmoid colon adenocarcinoma. Bone biopsy confirmed metastatic adenocarcinoma of gastrointestinal origin, most likely from the stomach. No definite extraosseous visceral metastases were identified on imaging. This case illustrates that disseminated gastric cancer may rarely present without gastrointestinal symptoms and may initially mimic postmenopausal osteoporosis, particularly when bone pain coexists with markedly elevated bone turnover markers. It also highlights the importance of a multidisciplinary diagnostic approach in patients initially suspected of primary osteoporosis but showing atypical biochemical or imaging findings. Clinicians should remain alert to secondary osteoporosis, including occult malignancy, in such settings.
Background Postoperative ileus is a common complication following abdominal surgeries, leading to delayed recovery, prolonged hospital stay, and increased patient discomfort. Chewing gum, a form of sham feeding, has been proposed as a simple, non-pharmacological intervention to stimulate gastrointestinal motility and hasten postoperative recovery. This study aimed to evaluate the effect of chewing gum on postoperative recovery of gastrointestinal function in patients undergoing abdominal surgery. Methods This single-blinded randomized controlled study included 198 adult patients undergoing elective abdominal surgeries, who were randomly allocated to a chewing gum group (n = 99) or a control group (n = 99). Patients in the intervention group received postoperative chewing gum once fully conscious with intact airway reflexes, while the control group received standard postoperative care. Primary outcomes included the time to passage of first flatus and the appearance of first bowel sound. Secondary outcomes were postoperative nausea and vomiting (PONV), length of hospital stay, and safety outcomes. Time-to-event analyses were performed using Kaplan-Meier curves with log-rank tests, and multivariable logistic regression was used to identify independent predictors of gastrointestinal recovery. Results Baseline demographic and surgical characteristics were comparable between groups. The chewing gum group demonstrated significantly earlier passage of first flatus (197.0 ± 3.6 vs 280.0 ± 6.3 minutes; p < 0.0001) and earlier appearance of first bowel sounds (201.5 ± 3.8 vs 280.0 ± 6.3 minutes; p < 0.0001). These benefits were consistent across surgical approaches and gender subgroups. The incidence and duration of PONV were significantly lower in the chewing gum group, with faster complete remission (126.0 ± 13.5 vs 237.5 ± 13.1 minutes; p < 0.0001). The hospital stay was significantly shorter in the chewing gum group (1.7 ± 1.3 vs 3.1 ± 1.7 days; p < 0.001). On multivariable analysis, chewing gum independently predicted earlier gastrointestinal recovery (OR = 0.29, 95% CI 0.15-0.59; p < 0.001). No intervention-related adverse events were observed. Conclusion Chewing gum significantly accelerates postoperative gastrointestinal recovery, reduces PONV, and shortens hospital stay following abdominal surgery. Given its safety, simplicity, and low cost, chewing gum should be considered a valuable adjunct to standard postoperative care and Enhanced Recovery After Surgery protocols.
Treatments for metastatic, unresectable, or treatment-resistant gastrointestinal stromal tumors (GIST) include avapritinib, imatinib, regorafenib, ripretinib, and sunitinib. The FDA Adverse Event Reporting System (FAERS) database collects medication-related adverse events (AEs). Reports in the FAERS database from each medication's FDA approval to June 30, 2025 were analyzed. Reports containing other medications or indications outside of GIST treatment were excluded. Avapritinib was associated with fatigue (n = 826, 10.2%), nausea/vomiting (n = 574, 7.1%), eye/facial swelling (n = 631, 7.8%), diarrhea n = 361, 4.5%), peripheral edema (n = 231, 2.5%). Imatinib was associated with nausea/vomiting (n = 677, 4.4%), fatigue (n = 549, 3.6%), anemia (n = 404, 2.6%), abdominal pain (n = 400, 2.6%), and rash (n = 340, 2.2%), hemorrhage (317 AEs, 2.1%). Regorafenib was associated with fatigue (n = 104, 8.6%), palmar-plantar erythrodyesthesia syndrome (n = 66, 5.4%), diarrhea (n = 60, 4.9%). Ripretinib was associated with fatigue (n = 534, 8.4%), alopecia (n = 355, 5.6%), nausea/vomiting (n = 273, 4.3%). Sunitinib was associated with fatigue (n = 420, 6.1%%), nausea/vomiting (n = 284, 4.2%), diarrhea (n = 262, 3.8 %), hemorrhage (n = 149, 2.2%). The FAERS database revealed multiorgan AEs associated with five GIST treatment medications. Novel findings include eye/facial and peripheral edema with avapritinib, palmar-plantar erythrodyesthesia syndrome, headache/migraine, and gait abnormalities across all five medications, pancytopenia with imatinib, and hemorrhage with imatinib and sunitinib. Gastrointestinal stromal tumors (GIST) are connective tissue derive tumors arising throughout the gastrointestinal tract. These tumors can range from benign to malignant lesions with potential for metastatic spread. Treatment of these tumors with medications such as tyrosine kinase inhibitors is standard of care. These medications include avapritinib, imatinib, regorafenib, ripretinib, and sunitinib. While treatment of these tumors can be effective, certain individuals require changing medications based upon response to treatment and/or if they have a specific mutation that makes their GIST tumor resistant to initial therapy. Exposure to GIST treatment has been shown to have various side effect profiles based depending upon the medication utilized. This study analyzed the FAERS database for adverse events reported for five GIST medications: avapritinib, imatinib, regorafenib, ripretinib, and sunitinib. Our study showed adverse events that were most commonly affected gastrointestinal, neuropsychiatric, dermatologic, hematologic, cardiovascular, and ophthalmologic systems. Most importantly, our study reported new potential safety concerns not previously reported including the risk of lower extremity swelling with avapritinib, rashes including palmar-plantar erythrodyesthesia syndrome, and headache/migraine. Balance and coordination abnormalities were reported among patients treated with all five medications. Additional novel findings included bone marrow suppressive effects of imatinib treatment and the risk of bleeding seen among those treated with imatinib and sunitinib.
To characterize clinical features, risk factors, and outcomes of vitamin A deficiency (VAD) among patients with gastrointestinal (GI) and/or hepatobiliary comorbidities. This retrospective study examined patients with GI or hepatobiliary disease who presented with ocular manifestations of VAD. Extracted data included patient demographics, underlying GI or hepatobiliary diagnoses, serum vitamin A levels, ophthalmic symptoms and examination findings, imaging features, and response to vitamin A repletion. 26 eyes from 13 patients were included. The most common systemic comorbidities were fatty liver disease (38.5%), prior gastric bypass surgery (23.1%), and cirrhosis (23.1%). Median serum vitamin A level at diagnosis was 19.1 mcg/dL (range, 2.5-36.1 mcg/dL, reference range 38-72 mcg/dL). Median presenting best visual corrected acuity (BCVA) was 20/50 (logmar 0.44, range, 20/20-light perception). Twenty-two eyes (84.6%) demonstrated anterior segment manifestations of VAD, including four eyes (15.4%) who presented with bilateral corneal ulceration and perforation. Posterior segment findings were present in 16 eyes (61.5%), including subretinal drusenoid deposits, RPE mottling, placoid macular changes, optic neuropathy, and a full-thickness macular hole. All patients reported bilateral vision loss, with 63.6% endorsing nyctalopia. All patients who underwent vitamin A repletion experienced subjective visual improvement and partial or complete resolution of ophthalmic findings, including regression of anterior and posterior segment pathology. Vitamin A deficiency occurs across a wide spectrum of GI and hepatobiliary diseases and is associated with diverse anterior and posterior segment ocular findings, ranging from subtle surface disease to severe, vision-threatening pathology. Visual symptoms and ocular findings improved following vitamin A repletion, highlighting the preventable and reversible nature of this condition when identified early. Given the risk of irreversible ocular sequelae with delayed diagnosis, serum vitamin A assessment with timely repletion should be considered in patients with at-risk gastrointestinal and hepatobiliary conditions. Early identification through multidisciplinary care may prevent avoidable, vision-threatening ocular complications.
Gastrointestinal diseases (GIDs) are a major global health burden, but traditional endoscopic screening faces limitations due to its invasiveness. Tongue image analysis offers a non‑invasive alternative but is subjective, relying on clinical experience. To address this, we propose a novel computational framework that synergistically integrates clinical prior knowledge with data-driven learning for non-invasive screening via tongue image analysis. Our framework introduces two key innovations: a TransNeXt hybrid backbone to extract comprehensive local and global tongue features, and a Channel Attention Gated Fusion module that performs asymmetric feature recalibration and prior-guided adaptive integration. Evaluated on a multicenter gastrointestinal disease tongue image dataset, our framework demonstrates robust performance, with an SVM classifier achieving an accuracy of 0.874, a Macro-F1 score of 0.879, and an AUC of 0.898. Ablation studies confirm the critical synergy between multimodal feature fusion and data augmentation. This work establishes an effective and objective computational solution for tongue diagnosis, with strong potential for clinical translation as an auxiliary screening tool.
Berotralstat, the first oral plasma kallikrein inhibitor approved for hereditary angioedema (HAE) prophylaxis, may be associated with gastrointestinal (GI) side effects, particularly during the first three months of therapy. Probiotics have been shown to reduce GI disturbances in several conditions. This pilot study described GI tolerability in patients receiving initiation-phase probiotic co-administration alongside berotralstat and explored whether this supportive strategy merits further controlled evaluation. We analyzed 25 adolescents and adults with HAE treated with berotralstat across six Italian centers (December 2023-November 2025). All patients received probiotics during the early treatment phase. Demographic and clinical data, side effects, and monthly HAE attack rates were collected. Severity of complaints was graded using the Common Terminology Criteria for Adverse Events (CTCAE). Participants were 60% females, and the mean age for the cohort was 45 years (range 12-82). The most common probiotics were Lacteol® , Codex® , and Lactoflorene Plus® . GI complaints occurred in 5/25 patients (20%); only 3/25 (12%) experienced GI side effects while receiving probiotics. 2/25 GI complaints occurred after probiotic discontinuation. No serious side effects were reported. Mean monthly attack rate decreased from 2.6 to 0.8 attacks per month, ~3.3-fold reduction from baseline. Probiotic co-administration during early berotralstat therapy was accompanied by a low incidence of GI side effects, while clinical effectiveness was maintained. These preliminary findings support further controlled studies to validate probiotics as a supportive strategy for improving the tolerability of berotralstat.
Studies examining the prognostic significance of uric acid specifically in upper nonvariceal gastrointestinal bleeding (NVUGIB) are limited. We aim to investigate whether uric acid levels have prognostic value in patients diagnosed with NVUGIB. This study was retrospective. Patients aged >18 diagnosed with NVUGIB were included in the study. Patients' demographic data, vital signs, comorbid diseases, results of laboratory parameters, endoscopy findings, transfusion requirements, recurrent bleeding, and outcomes (discharge and death) were recorded. Albumin; International normalized ratio; Mental status; Shock; Age - 65 (AIMS65) score, Rockall, and Glasgow-Blatchford scores were calculated for all patients based on information obtained from patient files. Pearson correlation test, independent samples t-test, and simple linear regression analysis were utilized to examine the relationship between uric acid levels and various measurements. P < 0.05 was considered statistically significant. One hundred and eighty-nine patients, 30.7% of whom were women, were included in the study, and the mean age was 61.67 ± 19.28 years. While the mean uric acid level of discharged patients was 5.6 ± 2.04 mg/dL, the mean uric acid level of deceased patients was 6.81 ± 2.77 mg/dL. Uric acid level had a significant effect on mortality (P = 0.023) according to univariate analysis. There was a positive correlation between uric acid and both the AIMS65 score (P = 0.001) and the Rockall score (P = 0.001), indicating statistical significance. Our study suggests that elevated serum uric acid levels can serve as a valuable factor in preendoscopy risk assessment. Higher uric acid levels are associated with an increased likelihood of mortality.
The impact of postoperative and oncologic outcomes between laparoscopic (L) and open (O) surgical approaches for the resection of gastric gastrointestinal stromal tumors (G-GISTs) located in surgically unfavorable regions remains controversial. A retrospective analysis was conducted on 699 patients who underwent primary resection of G-GISTs at surgically unfavorable locations across 14 centers in China between 2001 and 2017. The patients were categorized into L and O surgery groups. To reduce bias due to baseline differences, propensity score matching (PSM) and multivariate Cox proportional hazards models were employed. Postoperative recovery metrics and long-term oncologic outcomes were compared between the matched cohorts. After 1:1 PSM, the L group exhibited a significantly shorter and lower postoperative hospital stay, intraoperative estimated blood loss and postoperative complication rate compared to the O group (all P < .010). Kaplan-Meier survival analysis with log-rank testing revealed no statistically significant differences in overall survival (OS) between the two groups (P = .190). Multivariate Cox proportional hazards analysis further indicated that the L approach was not associated with a significant reduction in mortality risk (hazard ratio [HR]: 1.41; 95% confidence interval [CI]: 0.56-3.60; P = .467). Laparoscopic resection of G-GISTs located at surgically unfavorable sites was associated with improved short-term postoperative outcomes, including reduced blood loss, shorter hospital stays and fewer complications, compared to open surgery, but had comparable long-term oncologic outcomes.
Parents' satisfaction with pediatric care is often measured for single encounters, although families managing chronic conditions accumulate experiences across multiple contacts and settings. We aimed to identify predictors of parents' cumulative satisfaction with prior pediatric care, focusing on health literacy, e-health literacy, Internet and social media use, and perceived stress, while accounting for sociodemographic and illness-related factors. A cross-sectional paper-and-pencil survey was administered to parents of children treated for chronic gastrointestinal diseases in five university gastroenterology centers in Poland. Parental satisfaction was measured with a study-specific, ad hoc 10-item Parental Cumulative Satisfaction with Pediatric Care Scale. Predictors were examined using hierarchical linear regression with four blocks: sociodemographic variables, illness and service-use indicators, perceived stress, and health literacy, e-health literacy, and media-use indicators. Participants were predominantly mothers (82.4%), mean age was 42.0 years (SD = 5.8), and 66.0% cared for a child with inflammatory bowel disease. Mean satisfaction was high (4.9, SD = 0.81). In regression, explained variance increased from R 2 = 0.094 (sociodemographic block) to R 2 = 0.106 (adding illness/service-use), R 2 = 0.154 (adding stress), and R 2 = 0.202 in the full model. In the full model, higher stress predicted lower satisfaction (B = -0.03; 95%CI-0.04 to-0.02), and inadequate HL (vs sufficient) was associated with lower satisfaction (B = -0.64; 95%CI-0.98 to-0.31). Additional independent correlates included low income ≤ 1,500 PLN (B = -0.37; 95%CI-0.61 to-0.12), bachelor's education (B = 0.40; 95%CI 0.09-0.71), being married/partnered (B = -0.34; 95%CI-0.59--0.10), and residence in a city >500,000 (B = -0.25; 95%CI-0.47--0.04). e-Health literacy and media-use indicators were not independently associated. Cumulative parental satisfaction was significantly associated with the level of perceived stress and health literacy, whereas illness and service-use markers and broad indicators of digital engagement showed limited incremental value after adjustment.
Expanded multiplex PCR gastrointestinal panels (GIPs) are routinely ordered to diagnose infectious diarrhea. However, recommendations for repeat GIP testing are limited, resulting in variable testing practices. We evaluated the diagnostic yield of repeat GIP testing within 14 days. We conducted a retrospective cohort study of adults (age ≥ 18 years) tested with GIPs across 12 hospitals and outpatient centers (2019-2024). We analyzed the first diarrheal episode per patient, excluding cases with invalid/missing results and C. difficile results. Repeat testing was defined as a GIP completed within 14 days of an index GIP, excluding confirmatory testing using the same stool sample. The primary outcome was diagnostic yield (new pathogen detection), and the secondary outcome was pathogen persistence (same pathogen detection). Among 16,502 patients, 507 (3.1%) underwent repeat GIP testing within 14 days (median interval: 6.3 days; IQR: 2.7-9.8). Only 4.6% [19/415] index-negative patients and 2.2% [2/92] index-positive patients detected new pathogens on repeat testing, with 51% [47/92] index-positive patients demonstrating persistence of at least one pathogen from their initial test. The number needed to test (NNT) to identify one new pathogen was 24 (95% CI: 16-39) tests overall, and 127 (95% CI: 50-455) tests to identify one new pathogen warranting antimicrobial treatment. Most repeat testing (86% [436/507]) was ordered by a different clinician. Repeat GIP testing within 14 days rarely provided new diagnostic information, highlighting the limited utility of early repeat testing. Institutional policies discouraging repeat GIPs within 14 days may improve diagnostic stewardship.
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There has been a growing trend of combining traditional Chinese medicine and Western medicine, but the safety of co-prescribing Salvia miltiorrhiza (Danshen) and anticoagulants remains uncertain. This study aimed to evaluate the bleeding risk following the concurrent prescribing of S. miltiorrhiza and anticoagulants in a real-world setting. A self-controlled case series study was conducted. This study used the Chang Gung Research Database to identify adult patients co-prescribed oral anticoagulants and S. miltiorrhiza, and having records of bleeding events. Bleeding events included any bleeding event (gastrointestinal, intracranial, or urogenital bleeding) and major bleeding events (hemorrhages requiring hospitalization or transfusion). Exposure periods were defined as days of concurrent prescribing of S. miltiorrhiza and anticoagulants, while control periods included days of anticoagulant use without S. miltiorrhiza. Conditional Poisson regression was applied to estimate bleeding risk during exposure periods relative to control periods, and results were presented as adjusted incidence rate ratio (aIRR) and 95% confidence interval (95%CI). Among 525 patients receiving both medications, 146 experienced bleeding events. The risk of any bleeding increased significantly during days 1-14 (aIRR: 3.98; 95% CI: 3.29-4.77) and days 15-28 (aIRR: 3.99; 95% CI: 3.23-4.79) after concurrent prescribing of S. miltiorrhiza and anticoagulants. Elevated risks of gastrointestinal bleeding (aIRR: 3.79; 95% CI: 2.95-4.53) and intracranial hemorrhage (aIRR: 3.59; 95% CI: 2.79-5.03) were observed within the first 14 days. Concurrent use of S. miltiorrhiza and anticoagulants significantly increased bleeding risk, particularly during the first 28 days of coadministration. These findings highlight the need for careful monitoring during the initial period of combined therapy. Concurrent use of Danshen (a Chinese herbal medicine) and anticoagulants may increase bleeding risk Danshen, also known as Salvia miltiorrhiza, is a traditional Chinese medicine that is commonly used for heart and circulation problems. In Taiwan, Danshen is frequently prescribed together with modern Western medications. One group of these medicines, called anticoagulants, are commonly used to prevent blood clots in people with conditions such as atrial fibrillation or heart disease. While anticoagulants are effective, they can increase the risk of bleeding. It has been uncertain whether using Danshen at the same time might make this risk even greater. In this study, we used a large medical records database to investigate the real-world safety of taking Danshen together with anticoagulants. We included 525 adults who were prescribed both treatments and 146 of them had records of bleeding events. To minimize differences between individuals, we applied a self-controlled case series (SCCS) study design, where each patient served as their own control. We found that the risk of bleeding was significantly higher during the first 28 days after patients started taking Danshen with an anticoagulant. The risk was especially high for gastrointestinal and intracranial bleeding. On average, the first bleeding event happened about 16 days after starting combined treatment. Importantly, most patients in our study already had a high baseline risk of bleeding, but even after adjusting for other factors, the increased risk remained clear. These findings suggest that patients who take Danshen alongside anticoagulants should be monitored carefully, particularly during the first few weeks of combined use. This study highlights the need for careful communication about herbal and conventional medicine use.
Diarrheal disease is a leading cause of child morbidity and mortality globally, largely resulting from contaminated food and water and exposure to enteric pathogens. Salmonella enterica serovar Typhimurium (STm) is an enteropathogenic bacterium that infects the gastrointestinal tract using diverse strategies that are still being elucidated. Meanwhile, the gut comprises a complex ecosystem known as the microbiome, which is densely inhabited by microbial communities. The microbiome confers colonization resistance against enteropathogenic bacteria, whereas STm can overcome these defenses to establish infection. Here, we review STm infection strategies in the gut, with a particular focus on evidence from mouse models. Understanding STm virulence mechanism and adaptation strategies may inform the development of targeted interventions to prevent and treat gastrointestinal infection.
Gastrointestinal-specific anxiety (GSA) is a critical psychosomatic factor influencing symptom perception and quality of life in disorders of gut-brain interaction (DGBI). The Visceral Sensitivity Index (VSI) is a validated instrument used to assess GSA in DGBI such as irritable bowel syndrome (IBS). However, a culturally adapted and psychometrically validated Chinese version is currently unavailable. This study aimed to develop and comprehensively validate a Chinese version of the VSI (VSI-C). The VSI-C was developed through dual translation, back-translation, cultural adaptation, and pilot testing. Its content validity was assessed by an expert panel. The included DGBI patients completed the VSI-C, the Hospital Anxiety and Depression Scale (HADS), and the Patient Health Questionnaire-15 (PHQ-15). Structural validity was evaluated using exploratory factor analysis (EFA), with the factor model tested by confirmatory factor analysis (CFA) and further corroborated visually via exploratory graph analysis (EGA). Convergent validity was assessed through Pearson correlations with the HADS and PHQ-15. Internal consistency and split-half reliability were evaluated using Cronbach's α and the Spearman-Brown coefficient, respectively. Floor and ceiling effects were analyzed based on score distributions. Finally, receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal clinical cutoff score. A total of 102 DGBI patients were included. The scale demonstrated excellent content validity (S-CVI/Ave = 0.91). EFA identified a stable four-factor structure, which was confirmed by CFA with good model fit (χ2/df = 1.539, RMSEA = 0.073, CFI = 0.910) and visually corroborated by EGA. The VSI-C showed significant positive correlations with HADS-A, HADS-D, and PHQ-15 scores (all p < 0.05), supporting convergent validity. It exhibited good internal consistency (Cronbach's α = 0.861) and split-half reliability (Spearman-Brown coefficient = 0.860). No floor or ceiling effects were observed. The optimal cutoff score was 41.5, with a sensitivity of 67.3% and a specificity of 75.5%. The VSI-C is a reliable, valid, and clinically useful tool for assessing GSA in Chinese DGBI patients. Its implementation facilitates the systematic integration of psychological assessment into clinical management, promoting personalized care within a biopsychosocial framework.
Colonoscopy is a key diagnostic and therapeutic procedure in gastrointestinal practice, although rare complications such as post-colonoscopy appendicitis (PCA) may occur. We report the case of a 61-year-old woman who presented 24 hours after a screening colonoscopy with severe diffuse abdominal pain, fever, nausea, vomiting, and watery diarrhea. The procedure had been complicated by poor bowel preparation, with a Boston Bowel Preparation Score of 1-2-1 (right colon, transverse colon, and left colon, respectively; scores range from 0 to 3 per segment, with 0 indicating an unprepared colon and 3 indicating perfectly clean mucosa). Abdominal computed tomography (CT) revealed phlegmonous acute appendicitis with abscess formation and a calcified fecalith, in a pelvis-projecting appendix with a medial cecal position. An open appendectomy was performed, given the complex intraoperative findings and unfavorable anatomy for laparoscopic access. The patient recovered uneventfully and was discharged the following day. This case highlights the convergence of poor bowel preparation, fecalith impaction, and complicated appendicitis as a mechanistically informative triad and underscores the importance of maintaining a low threshold for CT imaging in patients with new abdominal symptoms following colonoscopy.
Αlpha-Glucosidase Inhibitors (AGIs) are a class of oral antidiabetic agents that effectively control postprandial hyperglycemia by delaying carbohydrate digestion and absorption in the small intestine through the inhibition of the α-glucosidase enzyme, representing a therapeutic strategy to manage postprandial hyperglycemia in Type 2 Diabetes Mellitus (T2DM). Although synthetic AGIs such as acarbose are clinically effective, their use is often limited by gastrointestinal side effects. A systematic literature search was performed across PubMed, ScienceDirect, and Google Scholar for studies published between 2000 and 2025. Keywords included "α-glucosidase inhibitors," "natural compounds," "flavonoids," "tannins," "xanthones," "coumarins," "sugar mimics," and "marine-derived compounds." Peer-reviewed original research and review articles in English were included, while conference abstracts, unpublished data, and non-peer-reviewed literature were excluded. Natural AGIs, including flavonoids, xanthones, tannins, coumarins, sugar mimics, and marine bromophenols, provide structurally diverse scaffolds with significant α-glucosidase inhibitory activity. These compounds exhibit competitive, non-competitive, or mixed-type inhibition depending on their structure and experimental conditions. Despite promising in vitro results, most natural AGIs face challenges such as poor bioavailability, metabolic instability, and limited clinical validation. Natural AGIs derived from diverse natural compounds demonstrate promising potential for managing postprandial hyperglycemia in T2DM, although their clinical application remains limited due to challenges related to bioavailability and insufficient clinical validation. Natural α-glucosidase inhibitors represent a potentially safer alternative to synthetic drugs for postprandial hyperglycemia management. Comprehensive in vivo pharmacokinetic and toxicity studies, along with mechanistic investigations and clinical trials, are necessary to evaluate their therapeutic potential in T2DM.
The Gut-Brain Axis (GBA) has a complex role in chronic neuroinflammation, which is increasingly connected to neurodegenerative diseases (NDDs) such as Multiple Sclerosis (MS), Parkinson's Disease (PD), and Alzheimer's Disease (AD). Through neuronal, endocrine, and immunological pathways, the GBA enables twoway communication between the gastrointestinal tract and the central nervous system. According to recent research, the pathophysiology of neuroinflammatory responses in NDDs may be significantly influenced by gut dysbiosis, increased intestinal permeability, and modified microbial metabolites, such as Short-Chain Fatty Acids (SCFAs) and polyphenols. This study summarizes preclinical and clinical data supporting several anti- inflammatory approaches targeting GBA. Probiotics and fecal microbiota transplantation are two examples of microbiota-based treatments that have demonstrated promise in reducing neuroinflammatory responses and enhancing cognitive performance. Mediterranean and polyphenol-rich diets are among the dietary therapies that show promise in modifying the composition of microorganisms, lowering pro-inflammatory signaling, and enhancing neuroprotection. Through microbiota regulation, pharmacological substances such as curcumin, resveratrol, and SCFA mimetics also have anti-neuroinflammatory benefits. However, a number of translational challenges still exist, including limitations in animal models, a lack of standardized therapies, and inter-individual microbiome heterogeneity. In order to provide precise, GBA-targeted therapies, future views place a strong emphasis on integrating multi-omics, artificial intelligence, and personalized medicine. This study highlights a new therapeutic approach to treating neurodegeneration by examining the translational potential of anti- inflammatory therapies targeting GBA. It also emphasizes the necessity of strong clinical studies to confirm these findings.
Irritable bowel syndrome (IBS) increases the risk of depression and damages the body, but there is no ideal treatment. However, aberrant expression of miRNAs in gastrointestinal diseases holds promise for the treatment of IBS. The aim of this study was to investigate how miR-149-5p regulates IBS by affecting the function of colonic mucosal epithelial cells. We examined miR-149-5p and IGF2BP1 levels in colonic tissue from clinical patients. The mice model of IBS was established by acetic acid (AA) enema, and NCM460 was induced using LPS in order to establish a cellular model. Measurement of fecal weight and water content in mice evaluated the model. miR-149-5p, IGF2BP1, IL-1β, and IL-6 levels were detected by qRT-PCR. The targeting relationship between miR-149-5p and IGF2BP1 was detected by dual-luciferase reporter gene assay, and cell proliferation was examined by CCK-8. Elisa was used to detect D-LA concentration. miR-149-5p levels were up-regulated in the colon of patients with IBS, whereas the opposite was true for IGF2BP1 levels. AA enemas exacerbated the degree of diarrhea in mice, but diarrhea and inflammation were less severe in miR-149-5p-/- mice. miR-149-5p negatively regulates IGF2BP1. IGF2BP1 partially reversed the enhanced proliferation and inflammatory suppression of NCM460 cells caused by silencing miR-149-5p. Inhibition of miR-149-5p protects colonic mucosal epithelial cells and alleviates IBS by negatively regulating IGF2BP1.
Intermediate-risk gastrointestinal stromal tumor (GIST) patients exhibit marked prognostic heterogeneity. The traditional NIH risk classification often results in undertreatment of latent high-risk patients and overtreatment of truly low-risk ones. This study aimed to develop an interpretable machine learning model integrating hematologic inflammatory markers to achieve precise risk re-stratification and optimize adjuvant therapy strategies for intermediate-risk patients. Primary GIST patients were retrospectively enrolled. LASSO regression was applied to select key features from eight inflammatory markers (including NLR, PLR, and SII). A random survival forest model was then constructed, followed by 5-fold cross-validation. SHAP values were used to interpret feature contributions, and Kaplan-Meier survival analysis was conducted to evaluate stratification performance. LASSO regression identified seven inflammatory markers, among which PLR, SII, and PIV were the top three key variables. The optimal random survival forest model (five-feature model) achieved an AUC of 0.777, with an internally validated mean AUC of 0.782 (95% CI: 0.679-0.878) and an out-of-bag (OOB) error of 0.124. SHAP analysis revealed that PLR, NLR, and PAR were the major contributors to model prediction. The model effectively stratified intermediate-risk patients into "intermediate-high-risk" and "intermediate-low-risk" subgroups with significantly different survival outcomes (p<0.0001). This study represents the first construction of an interpretable predictive model integrating blood-based inflammatory markers with machine learning algorithms. The model accurately identifies occult high-risk individuals among patients with intermediate-risk GIST, thereby providing exploratory evidence and a foundation for hypothesis generation for future individualized management strategies.
Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) pose significant global health challenges with high mortality risks. Adverse drug reactions (ADRs) further complicate treatment, impacting patient adherence and outcomes. In India, the DOTS strategy under the Revised National Tuberculosis Control Programme has been widely implemented, yet TB management is hindered by limited patient awareness, socioeconomic constraints, and gaps in healthcare provider training. This study assesses the incidence of ADRs and their impact on treatment outcomes at a tertiary care hospital in Delhi. A cross-sectional study was conducted using retrospective medical record reviews of MDR-TB and XDR-TB patients (aged ≥18 years) registered at a university hospital in Delhi from January 2017 to August 2021. Data on ADRs and treatment outcomes were extracted from outpatient records for analysis. Of 213 enrolled patients, 183 were analyzed, with 72.6% experiencing at least one ADR. Males had a higher ADR incidence (58%) than females (42%). The most common ADRs were gastrointestinal disorders (21.8%), eye disorders (14.3%), and musculoskeletal disorders (14.3%), primarily linked to pyrazinamide, ethambutol, and ethionamide. Serious ADRs occurred in 17.4% of cases. Gastrointestinal disorders, particularly nausea and vomiting, emerged as the most commonly reported ADRs. These findings emphasize the importance of early identification of high-risk patients and the need for close monitoring throughout anti-TB treatment to support adherence and improve outcomes. This study adds valuable evidence to strengthen pharmacovigilance efforts and inform the optimization of MDR/XDR-TB treatment protocols within India's public healthcare system.