Neurogastroenterology & Motility

Objectives. To compare the efficacy and safety of invasive sacral neuromodulation (SNM) and noninvasive enteral neuromodulation (ENM) in children with refractory gastrointestinal motility disorders (GMD). Materials and Methods. This prospective interventional trial enrolled pediatric patients with GMD between 2019 and 2024 at a single tertiary referral center. Children with inflammatory bowel disease or mechanical causes of GMD were excluded. Participants received either SNM via an implanted device or ENM via surface electrodes. Stimulation was delivered at 14 Hz, 210 s pulse width, with individualized intensity (median 1.0 mA for SNM; 6.0 mA for ENM). Primary outcomes were abdominal pain, fecal incontinence, defecation frequency, and stool consistency. Treatment success was defined as clinically significant improvement in at least two of these four domains. Quality of life was assessed at baseline and 12 weeks. Safety outcomes were monitored over a 12-month follow-up. Results. Of 70 eligible patients, 48 completed the study (18 SNM; 30 ENM). Diagnoses included Hirschsprung disease, functional constipation, and congenital neuronal malformations. Severe comorbidities were more frequent in the SNM group (45%) than the ENM group (3%; P = .0018). Treatment success was observed in 80% of ENM and 83% of SNM patients (P = 1.00). No significant differences were found between groups for individual outcomes. No major complications occurred. Minor adverse events were comparable (ENM 27% vs SNM 17%; P = .50). Conclusions. Both SNM and ENM are effective and safe options for treating pediatric GMD and may be considered within a multimodal therapeutic approach.

BackgroundChronic gastroduodenal symptoms are challenging to diagnose and treat. Body surface gastric mapping provides non-invasive biomarkers of gastric function, but the requirement of a standard meal for postprandial assessment can be difficult for severely symptomatic patients. AimsTo assess the impact of reduced meal sizes and fasting on body surface gastric mapping metrics to determine clinical interpretability under non-standard nutritional loads. MethodsHealthy controls (n=60) underwent a 4.5-hour Gastric Alimetry test. Three age, sex, and BMI-matched groups (n=20 each) were compared: Standard Meal (482 kCal), Nutrient bar + Water (250 kcal), and Fasted (no meal). Principal Gastric Frequency, Gastric Alimetry Rhythm Index, BMI-Adjusted Amplitude, and fed:fasted Amplitude Ratio were analyzed against normative intervals. ResultsMeal status significantly affected amplitude-based metrics; the Standard Meal group exhibited higher BMI-Adjusted Amplitude (p<0.001) and fed:fasted Amplitude Ratio (p=0.001) than Fasted and Bar + Water groups. Frequency and rhythm-based metrics were resilient; Principal Gastric Frequency (p=0.245) and Gastric Alimetry Rhythm Index (p=0.336) showed no significant differences across conditions. While amplitude deviations were common in the Fasted group (20% fell below the normative range), Gastric Alimetry Rhythm Index and Principal Gastric Frequency remained within normal reference ranges for 95% of participants across all conditions. ConclusionsWhile consuming <50% of the standard meal significantly reduces gastric amplitude, gastric rhythm remains stable. Principal Gastric Frequency and Gastric Alimetry Rhythm Index function as reliable biomarkers of gastric myoelectrical function regardless of nutritional state.

BackgroundProteases and histamine, co-secreted by mast cells and bacteria, sensitize colonic nociceptors and contribute to irritable bowel syndrome (IBS) pain. ObjectiveTo determine whether irreversible proteolytic cleavage of protease-activated receptor-2 (PAR2) and its continued activity in endosomes amplify and sustain otherwise transient pronociceptive actions of histamine receptors (HRs) to cause recurrent pain, the defining symptom of IBS. DesignWe investigated the coexpression of PAR2 and H1R in nociceptors using RNAscope in situ hybridization and assessed the consequences of coactivation using electrophysiological assays of nociceptor sensitization and biophysical measurements of receptor and effector activity. ResultsPAR2 and H1R were coexpressed by human and mouse dorsal root ganglion nociceptors. Intracolonic infusion of fecal supernatants from IBS patients enhanced mechanosensitivity of colonic nociceptors in mice. Antagonists of PAR2 or H1-4R abolished this response. Combined administration of subthreshold concentrations of trypsin and histamine replicated the effects of fecal supernatant and caused hyperexcitability of isolated nociceptors. Pre-activation of PAR2 sensitized histamine-induced hyperexcitability. Endocytosis inhibitors prevented this hypersensitivity, consistent with sustained endosomal signaling of PAR2 and persistent nociceptor hyperexcitability. Trypsin amplified histamine-induced activation of H1R and {beta}-arrestin2 and Gq effectors at the plasmalemma and in endosomes. Conversely, histamine did not sensitize trypsin-induced hyperexcitability of neurons, in line with the inability of histamine to induce sustained nociceptor hypersensitivity. ConclusionsBy amplifying and maintaining the otherwise transient actions of H1R and possibly other pain receptors, persistent PAR2 endosomal signaling makes a dominant contribution to IBS-related colonic pain. Summary boxO_ST_ABSWhat is already known on this topicC_ST_ABSProteases and histamine are increased in IBS patients and cause visceral pain. What this study addsProlonged intracellular PAR2 signaling sensitizes and maintains H1R activity to amplify and maintain pain. How this might affect research, practice or policyAlthough neuroactive factors can act synergistically to amplify and maintain IBS pain, antagonists of dominant receptors (e.g., PAR2) can provide effective treatment.

BackgroundNeurogenic bowel is a major cause of morbidity in patients affected by neural tube defects (NTDs) such as spina bifida, but the underlying reasons for bowel dysfunction are unknown. An absolute requirement for gastrointestinal (GI) motility is the enteric nervous system (ENS) located within the walls of the GI tract. Enteric neurons coalesce into circumferential stripes throughout embryonic and early postnatal development, and this gradual organization of the ENS into enteric neuronal stripes correlates with the emergence of neurogenic GI motility. We hypothesized that NTDs are associated with changes in ENS organization that correlate with specific GI motility defects. MethodsWe used prenatal valproic acid (VPA) exposure as a model for NTDs in embryonic mice. We used immunohistochemistry, high resolution confocal imaging, and ex vivo motility assays to assess enteric neuronal stripes and gastrointestinal motility in embryos with a VPA-induced neural tube defect. Key resultsGI tracts from embryos with a VPA-induced NTD contain blood. Structurally, the enteric neuronal stripes are thinner with a narrower interstripe distance, leading to an increased number of stripes. Functionally, GI motility is abnormal, with increased contraction frequency and increased length of contractile segments. Conclusions and inferencesENS organization and GI motility are disrupted in mouse embryos with a VPA-induced NTD. This has important implications for our understanding of neurogenic bowel in central nervous system diseases such as spina bifida. Key Points- VPA exposure is a reliable model of neural tube defects with variable intralitter susceptibility - Embryos with a VPA-induced neural tube defect have blood in the amniotic sac and within the lumen of the gastrointestinal tract - Enteric nervous system organization is abnormal in the duodenum and jejunum of embryos with a VPA-induced neural tube defect, with thinner enteric neuronal stripes and narrower interstripe distance - Ex vivo gastrointestinal motility is abnormal in the duodenum and jejunum of embryos with a VPA-induced neural tube defect, including increased contraction frequency and increased length of the contractile segment

BackgroundFood-related gastrointestinal (GI) symptoms are highly prevalent in patients with IBS. Although dietary components may trigger symptoms through luminal mechanisms, cognitive expectations may also shape symptom perception within the gut-brain axis. No validated instrument currently exists to measure food-related symptom expectations. Hence, we developed and validated the Food Expectation Questionnaire (FEX-Q). MethodsThe FEX-Q was developed using a stepwise process including focus group interviews and face-to-face validation to ensure content validity. The finalized digital questionnaire presents 44 food images with six items rated on a visual analogue scale (VAS; 0-100), including the core item assessing food-related symptom expectation ("How severe GI symptoms do you expect after eating this food?"). Additional domains assess taste preference, willingness to eat, perceived healthiness, and perceived fat and carbohydrate content. The finalized FEX-Q was administered in a nationwide online validation survey of adults with IBS and non-IBS controls in Sweden. Participants also completed validated questionnaires including GI symptom severity (combined GSRS), psychological distress (HADS), food-related quality of life (FR-QOL), and a screening tool for food avoidance (NIAS). ResultsTwenty adults with IBS and non-IBS controls participated in the face-to-face validation, resulting in a final version of the FEX-Q comprising 44 food images, which were properly identified and provided a range of macronutrient distributions and trigger foods. In the nationwide online study including 134 patients with IBS and 126 non-IBS controls, the FEX-Q demonstrated strong known-groups validity (mean symptom expectation 18.4 in controls vs 50.1 in IBS), strong construct validity (perceived vs actual fat content r=0.78, p<0.001 and carbohydrate content r=0.59, p<0.001), significant convergent validity with GI symptom severity and food-related quality of life, and high internal consistency (split-half reliability Spearman-Brown corrected r=0.88). ConclusionThe FEX-Q can capture individual food-related symptom expectations to distinct food images. This reliable measurement can be useful to reveal the mechanism of food-related symptom expectations and provide clinically relevant insights for personalized dietary management

ObjectiveTo establish a fetal lamb model of complex gastroschisis and characterize the impact on the intestines over time. Summary Background DataGastroschisis is a congenital abdominal wall defect and in its complex form is associated with serious morbidity. Robust large-animal models may help understanding are lacking. MethodsAt gestational day 75, gastroschisis was induced by creating a 1-cm abdominal wall defect reinforced by a silicone ring. Fetuses were assessed either at term or at mid-gestation (13-21 days post-induction). The primary outcome was complex gastroschisis occurrence, defined by bowel stenosis, atresia, volvulus, perforation or necrosis; otherwise classified as simple. At mid-gestation, occurrence was compared between early (13-16 days) and late (17-21 days) intervals. Secondary outcomes included prenatal ultrasound findings, in vivo bowel motility and morphology, ex-vivo bowel contractility, amniotic fluid composition, and histology across complex, simple, and normal groups. ResultsGastroschisis was induced in 32 fetuses. At term (n=14), all survivors (7/14; 50%) had complex gastroschisis, with impaired bowel motility, altered enteric neural contractile responses and smooth muscle remodeling. At mid-gestation (n=18), complex gastroschisis occurred more frequently in the late than in the early group (71% vs. 11%; p=0.035). Mid-gestation gastroschisis fetuses showed greater intra-abdominal bowel dilatation on ultrasound and higher amniotic fluid digestive enzyme levels compared with non-operated littermates, with the greatest dilation observed in complex gastroschisis. ConclusionsThis model consistently reproduces complex gastroschisis in term survivors. After induction, complex gastroschisis occurrence increases with disease duration and is accompanied by structural and functional bowel changes.

BackgroundThe surgical stress response is a predictable, physician-managed metabolic state triggered by anesthesia and tissue injury, marked by insulin resistance and hypercatabolism that create unique nutritional needs unmet by standard, pre-surgical fasting diets. We developed a multi-nutrient medical food to support perioperative metabolic homeostasis and piloted its safety/tolerability and exploratory outcomes. MethodsIn a single-center pilot trial (n=67) of adults undergoing elective abdominal, cardiac/thoracic, gynecological, or orthopedic surgery, participants were allocated to medical food or no-treatment control. The product was taken twice preoperatively (evening before and 4 h pre-op) with standard care. Primary safety outcomes were adverse events, postoperative nausea/vomiting (PONV), 30-day readmission, and infections. Exploratory outcomes were fasting glucose, HbA1c, electrolytes, cortisol, pre-operative emotional state, and post-operative pain. ResultsAll participants completed the intervention. No product-attributed adverse events occurred. Gastric clearance was achieved within 2 h in all, and there were no 30-day readmissions or infections. PONV occurred in 30.3% vs 35.3% (risk ratio 0.86, 95% CI 0.43-1.71, p=0.796). Post-operative glycemia favored the intervention; at 48 hr the intervention group showed lower glucose (HL -9 mg/dL, g=0.35, p=0.030), while earlier timepoints were nonsignificant. Post-operative magnesium was numerically lower with intervention (4.76 vs 5.10) without statistical significance; other electrolytes and cortisol showed minimal differences. Post-operative pain was 5.33 vs 5.62 (g=0.19, p=0.43). Positive pre-operative emotion was more frequent with intervention (17/33 vs 9/34; risk ratio 1.95, p=0.046). ConclusionThe medical food was safe and well tolerated without increased PONV or readmissions. Preliminary metabolic and emotional signals justify a larger, adequately powered efficacy trial. Clinical Relevancy StatementThis pilot trial demonstrates that a preoperative multi-nutrient medical food was well tolerated and feasible to administer in a routine clinical setting: all participants achieved gastric clearance within 2 hours of the pre-operative dose, with no increase in PONV and no readmissions. Exploratory findings indicate potential benefits that could nutritionally support recovery if confirmed. These results support the feasibility of administering a targeted nutrition intervention shortly before surgery and justify evaluation in a larger efficacy trial. Clinical Trial RegistrationNCT07359222

Chronic constipation is highly prevalent, and cases refractory to treatment are particularly challenging to manage. High-resolution colonic manometry (HRM) is used to further evaluate these patients to identify cases of intrinsic motor dysfunction (underlying myopathy or neuropathy). However, HRM is invasive and resource-intensive, limiting uptake and clinical utility. This study presents Body Surface Colonic Mapping (BSCM), a non-invasive cutaneous electrical recording technique, as a clinical alternative. Simultaneous recordings from HRM (36-channel) and BSCM (8x8 electrode array) were performed in 10 patients with chronic refractory constipation. Lower gut symptom scores were also tracked patients over the duration of the recording. Motility was assessed during meal and bisacodyl challenges. We optimized BSCM signal processing specifically to detect high-amplitude propagating contractions (HAPCs) evoked by bisacodyl. Analysis included time-frequency quantification of motility indices and blinded visual assessment by domain experts to classify the presence or absence of motor responses. BSCM motility indices showed strong correlation with HRM for both meal (r = 0.86) and bisacodyl (r = 0.69) responses. Expert visual analysis yielded concordant classification between BSCM and HRM in the majority (87.5 {+/-} 9.6%) of cases. Furthermore, BSCM identified distinct, patient-specific symptom-motility associations during the meal response. BSCM accurately detects meal- and stimulant-induced increases in colonic motility with high fidelity to invasive HRM. As a non-invasive method that is easy to apply with minimal resource and time requirements, BSCM is well-positioned for clinical translation as a scalable diagnostic tool to elucidate symptom-motility associations and guide personalized management in refractory chronic constipation.

IntroductionEsophageal atresia is a common congenital anomaly, occurring in 1 in 3,500 live births. The Foker process has revolutionized the treatment of long gap esophageal atresia (LGEA). It is well established that the Foker process causes tension accelerated growth of the esophagus, but what occurs at the molecular level during tension accelerated growth is still unknown. We aimed to create tension accelerated growth in a fetal lamb model of LGEA in order to answer this question. MethodsFollowing IACUC approval, time-dated fetal lambs (108 to 120 days of gestation) underwent thoracic esophagectomy. Both esophageal ends were ligated and sutured together to create an internal pexy under high tension. Lambs were delivered on postoperative day 2 (POD2) (n=7), POD6 (n=9) or term (n=5). The native esophagus collected at model creation served as control tissue. Specimens were bluntly separated into two layers: inner layer (IL) (epithelium, lamina propria, muscularis mucosa, submucosa) and outer layer (OL) (submucosa, muscle layer, adventitia). RNA sequencing (RNAseq), proteomics, immunohistochemistry, western blotting and real-time qRT-PCR were performed on the specimens. Mann-Whitneys or unpaired t-test were used for statistical analyses. Esophageal fibroblast cell lines established from human biopsy specimens were cultured and stimulated with TGF-beta for in vitro studies on collagen expression. Results23 lambs underwent esophagectomy with tension suture placement at 108 to 120 days gestation. Histologic analysis of tension conditioned compared to control esophagus by trichrome staining demonstrated an increase in collagen deposition in tension conditioned esophagus compared to controls. High throughput bulk RNA sequencing and proteomic analysis were performed with a focus on pathways implicated in fibrosis. GSEA analysis of the inner layer demonstrates upregulation of TGFB signaling, extracellular matrix organization, and collagen deposition at all timepoints. Further analysis was performed to evaluate specific collagen subtypes contributing to this profibrotic phenotype, and COL8A1 and COL12A1 were both significantly upregulated in both RNA and proteomic analysis at all timepoints, with Western blotting confirming up regulation in stretched tissue. In order to evaluate the relationship between TGFB signaling and collagen deposition in the esophagus, we stimulated esophageal fibroblasts with TGFB, qRT-PCR was performed to evaluate the expression of COL8A1, COL12A1, and COL6A3. Expression of all three of these collagen subtypes was noted to be significantly upregulated at all timepoints following TGFB stimulation when compared to non-stimulated controls. ConclusionsTension accelerated growth can safely be achieved in a fetal ovine model of long gap esophageal atresia. Additionally, esophageal atresia can be modeled in the ovine fetus as early as 92 days gestation. Our results demonstrate that esophageal tissue subjected to sustained tension undergoes significant profibrotic changes, as evidenced by upregulation of TGFB signaling, alterations in extracellular matrix organization, and increased collagen deposition. While it is well documented that patients with LGEA have an increased risk of post operative esophageal strictures, these findings provide the first in vivo proof of the role of tension in conferring a profibrotic phenotype in the tension-lengthened esophagus.

Background: Jejunal diverticulitis is an uncommon but increasingly recognized cause of acute abdomen. It can present with a range of CT findings, including peridiverticular inflammation, bowel wall thickening, and fecalized small bowel content, with perforation or abscess occurring as complications in roughly 6% of cases. Case reports note varied presentations with jejunal and ileal involvement, treatment ranging from nonoperative management with antibiotics to urgent surgical intervention. Though rare, small bowel diverticulitis, particularly involving the jejunum, can result in significant morbidity, including peritonitis and sepsis, requiring heightened clinical suspicion in elderly or immunocompromised patients. Methods: We conducted a single center retrospective review of patients diagnosed with jejunal diverticulitis in a single academic center's Emergency General Surgery registry between December 2017 and December 2024. Of 42 patients initially identified, 34 had confirmed diagnoses on chart review. Data abstracted included age, sex, imaging modality, presence of perforation, serial physical exams, lab values (CBC, lactate), ICU admission, length of stay (LOS), antibiotic duration, operative status and timing, distance of residence from our institution, disposition after index admission, and readmission within one year. Results: Of the 34 confirmed cases, 24 (71%) were perforated: 2 presented with small bowel obstruction, 16 with abscesses and/or contained perforations, and 1 with both. 19 of the 24 perforated patients required operative intervention: 9 proceeded directly to the OR, 3 on hospital day one, and 2 as late as hospital day six. Among non-operative patients treated with antibiotics alone, the average LOS was 6 days (range: 2-23). Two patients were readmitted within one year: neither had undergone surgery during their index admission and neither were related to their index admission. Overall, three patients died: two during the index admission (both perforated and operated on) and one on readmission. Conclusion: Compared to the 6% complication rate reported in prior literature, our series demonstrates a notably higher rate of perforation (71%) among patients diagnosed with jejunal diverticulitis. Operative intervention was common, though a subset of patients was successfully managed non-operatively with antibiotics. Mortality was limited to patients with significant comorbidities and complex presentations. These findings underscore the heterogeneity in presentation and outcomes and highlight the need for a standardized approach. Development of practice guidelines incorporating clinical, radiographic, and laboratory parameters may improve diagnostic accuracy and guide timely, evidence-based management of this rare but serious condition.

Background & AimsDiabetes mellitus has been associated with both intestinal barrier dysfunction and peripheral neuropathy leading to increased risk of infection. The mucus layer forms a physical barrier against pathogens and is a critical component of the intestinal barrier that may be impaired in diabetes. This study aimed to assess how diabetes impacts goblet cells (GCs), mucus layer integrity, and innervation in the colon. MethodsFluorescence microscopy was used to investigate GCs, the mucus layer, and innervation in the colon of db/db mice. Custom open-access image analysis pipelines were developed to quantify GC numbers, location and content, mucus thickness, bacterial colonization, and innervation density in intestinal tissue sections. We also treated mice with the clinically used glucagon-like peptide 1 receptor (GLP-1R) agonist liraglutide to assess its capacity to reverse pathological changes to GCs and the mucus layer in a model of established type 2 diabetes (T2DM). ResultsThe mucus layer was significantly thinner in the colon of db/db mice with established diabetes and bacteria more readily colonized the epithelium and crypts. Intercrypt GC numbers were significantly reduced in db/db mice. However, there were significantly more GCs per crypt, and crypts were elongated in the db/db colon. Innervation was reduced in the mucosa and external muscle of the colon, consistent with diabetic neuropathic changes. Liraglutide treatment increased the size of GCs but had no effect on GC numbers, mucus thickness, or innervation in this model of established T2DM. ConclusionsMucus barrier dysfunction and GC hyperplasia is evident in the db/db colon. Increased microbial penetrability through the mucus layer suggests potential implications for the increased risk of gastrointestinal infection in diabetes.

Background & AimsUnchecked inflammation in Eosinophilic esophagitis (EoE) leads to esophageal fibrosis and eventual stricture. Differentiated fibroblasts, termed myofibroblasts, are the main effector cells in fibrosis, responsible for secreting extracellular matrix proteins leading to tissue stiffness. Regulating myofibroblasts has not been explored as a therapeutic possibility in the fibrostenotic esophagus. Herein, we aim to investigate the efficacy of Prostaglandin E2 (PGE2) in dedifferentiation of the EoE myofibroblast. MethodsWe evaluated the efficacy and mechanism of myofibroblast dedifferentiation using fetal esophageal fibroblasts (FEF3), patient-derived fibroblasts, and a murine model of EoE. ResultsFibrosis markers (SMA, FN1, and COL1A1) and contractility of myofibroblasts were significantly decreased by PGE2 via the cAMP pathway. PGE2 treatment decreased nuclear accumulation of phospho-Smad2/3-YAP complex and induced phospho-YAP proteasomal degradation. Transcriptome analyses of FEF3 treated with TGF{beta} or PGE2 revealed that the Integrin1 pathway, and specifically thrombospondin 1 (THBS-1), was significantly upregulated by TGF{beta} and downregulated by PGE2, as supported by pseudo-bulk single-cell RNA-seq of EoE biopsies. THBS-1 was shown to be regulated by PGE2 via the cAMP/YAP pathway, and its knockdown induced myofibroblasts dedifferentiation. In a murine model of EoE, Butaprost, agonist of the E-prostanoid G protein-coupled receptor 2, treatment significantly reduced the expression of THBS-1, SMA, and FN1 along with a decrease in YAP nuclear translocation. Additionally, collagen fiber organization in the lamina propria was markedly reduced. ConclusionPGE2 promotes dedifferentiation of myofibroblasts in EoE via the cAMP/YAP/ THBS-1 pathway. Our data suggest that PGE2 is a promising treatment strategy for EoE with stenosis. What You Need to KnowO_ST_ABSBackground and ContextC_ST_ABSIn Eosinophilic esophagitis, unchecked inflammation and tissue stiffness drives fibroblast differentiation and fibrostenosis of the esophagus, yet targeting myofibroblasts as regulators of extracellular matrix deposition in fibrostenotic disease remains clinically unexplored. New FindingsProstaglandin E2 promotes dedifferentiation of myofibroblasts in eosinophilic esophagitis via the cAMP/YAP pathway, with Thrombospondin-1 identified as a critical YAP regulated target driving fibrostenosis. LimitationsThis study focused on fibroblast-specific mechanisms. The effects of PGE2 on esophageal epithelial differentiation, barrier function, and immune cell recruitment in EoE remain to be determined. Clinical Research RelevanceThis study demonstrates proof-of-concept that pharmacological reversal of established fibrosis is achievable in EoE. PGE2 and its EP2-selective agonists represent translatable therapeutic targets for fibrostenotic EoE--a patient population that remains treatment-refractory to current immunosuppressive approaches. Basic Research RelevanceThe cAMP/YAP/THBS-1 signaling in fibroblasts emerges as a critical therapeutic target for esophageal fibrosis. Importantly, this work demonstrates that terminally differentiated myofibroblasts retain remarkable plasticity and can dedifferentiate--challenging the paradigm that fibrosis is irreversible.

Background & AimsFood-related adverse reactions are frequently reported by patients with inflammatory bowel disease (IBD), but the underlying mechanisms are poorly understood. We investigated how intestinal inflammation and the microbiota contribute to the development of adverse food reactions. MethodsWe sensitized mice to different foods (dairy and gluten) after intestinal inflammation (chemically- and hapten-induced models), and then re-exposure to the sensitized foods through diet enrichment. To study whether inflamed microbiota facilitates adverse food reactions, we employed gnotobiotic models and bacterial supplementation experiments. We assessed markers of intestinal inflammation and sensitization, clinical responses, RNA transcripts, and microbiota composition and function. In a translational approach, we recruited IBD patients in remission and healthy controls, recorded self-reported food intolerances and clinical responses to triggering foods, and feces for gut microbiota analyses were collected. ResultsIntestinal inflammation facilitates food sensitization by disrupting microbial antigen metabolism, recruiting mast cells to the colon, and promoting mucosal IgE production. In gnotobiotic models, inflammation-driven depletion of colonic bacteria involved in food digestion contributed to food sensitization. Upon re-exposure to triggering foods, sensitized mice experienced visceral pain and low-grade inflammation through mast-cell mediated mechanisms, which also worsened experimental colitis. Supplementation with depleted bacteria or treatment with mast cell stabilizers attenuated food-driven responses. In IBD patients, self-reported food intolerances were common and associated with microbial disruption and depletion of food-metabolizing bacteria. ConclusionMicrobial metabolism of foods is disrupted after intestinal inflammation. This facilitates food sensitization, through colonic mast cell-mediated immune responses, which may explain the high number of adverse food reactions reported by IBD patients. WHAT YOU NEED TO KNOWO_ST_ABSBackground and contextC_ST_ABSPatients with inflammatory bowel disease (IBD) frequently report adverse food reactions, but the underlying mechanisms are not well understood. New findingsIntestinal inflammation promotes food sensitization by depleting bacteria that degrade food triggers. IBD patients in remission with food intolerances show reduced microbial diversity and loss of bacteria involved in digesting food triggers. LimitationsWe used chemically- and hapten-induced mouse models in this study due to the importance of monitoring inflammation onset. Food-driven immune reactions in the mucosa of IBD patients were not performed. Clinical research relevanceImpaired microbial food metabolism is linked to adverse food reactions in IBD. Microbiome-based therapies, such as probiotics capable of degrading dairy or gluten, should be considered for IBD patients with food intolerances. Basic research relevanceWe identified a novel mechanism in which microbial disruption caused by intestinal inflammation leads to adverse food reactions and worsened colitis in preclinical models. Restoring the microbial capacity to digest trigger foods reverses these effects. Lay AbstractIntestinal inflammation facilitates sensitization to gluten and dairy proteins by depleting microbes that digest them, contributing to the increase in adverse food reactions among IBD patients.

Background: Irritable bowel syndrome (IBS) is characterized by heterogeneous symptom trajectories and high treatment discontinuation rates. Traditional analyses examine longitudinal outcomes and time-to-event endpoints separately, potentially missing informative dropout and the association between symptom dynamics and treatment persistence. Objective: To jointly model patient-reported IBS symptom trajectories and time-to-treatment discontinuation using shared random effects, characterizing the association between individual symptom dynamics and treatment persistence in a large Canadian prospective cohort. Methods: We analyzed 2,847 adults with Rome IV diagnosed IBS enrolled in the Canadian Gut Project (2018 to 2024) across 14 gastroenterology centres in Alberta, British Columbia, and Ontario. The longitudinal submodel used linear mixed-effects regression for the IBS Severity Scoring System (IBS-SSS) measured at baseline and months 3, 6, 12, 18, and 24. The survival submodel used a Weibull proportional hazards model for time-to-treatment discontinuation. The joint model linked both processes through shared random effects (random intercept and slope), estimated via maximum likelihood with adaptive Gauss-Hermite quadrature (15 nodes). We conducted sensitivity analyses using Bayesian estimation, alternative association structures (current value, time-dependent slopes), and multiple imputation for intermittent missingness. Results: Mean baseline IBS-SSS was 298.4 (SD 72.1). Over 24 months, 1,042 participants (36.6%) discontinued treatment. The longitudinal submodel revealed a mean IBS-SSS decline of -8.7 points/month (95% CI: -10.2, -7.1) with substantial between-person heterogeneity in both intercepts (STD = 4,218.3) and slopes (STD = 12.4). The association parameter linking the shared random intercept to the hazard of discontinuation was = 0.0034 (95% CI: 0.0021, 0.0047; p < 0.001), indicating that each 10-point increase in individual-specific baseline severity increased the hazard of discontinuation by 3.5%. The shared slope association parameter was 2 = -0.187 (95% CI: -0.264, -0.110; p < 0.001), demonstrating that individuals with steeper symptom improvement had lower discontinuation hazards. IBS-D subtype (HR = 1.41; 95% CI: 1.18, 1.69), concurrent anxiety (HR = 1.28; 95% CI: 1.09, 1.50), and social media health information use (HR = 0.82; 95% CI: 0.71, 0.95) were significant predictors in the survival submodel. Conclusion: Joint longitudinal-survival modelling reveals that IBS symptom trajectories and treatment discontinuation are dynamically linked through individual-level latent processes. Higher baseline severity and slower improvement trajectories significantly predict earlier discontinuation. These findings support personalized treatment monitoring approaches that use real-time symptom trajectory data to identify patients at risk of discontinuation.

BackgroundSkeletal muscle in wasting conditions often exhibits a common set of phenotypes that include atrophy, mitochondrial respiratory dysfunction, and fragmentation of the acetylcholine receptor (AChR) cluster at the endplate. Mitochondria are frequently implicated in driving muscle pathology in these conditions, although which aspects of mitochondrial function are most relevant is poorly understood. MethodsTo address this gap, we focused on mitochondrial permeability transition (mPT), a well-established pathological mechanism in ischemia-reperfusion injury and neurodegeneration but poorly studied in skeletal muscle. We performed a broad assessment of the consequences of mPT in skeletal muscle, focusing on features that are common in wasting conditions. We then tested whether tumor-host factors could promote mPT and compared differentially expressed genes (DEGs) with mPT and a mouse model of pancreatic cancer cachexia. ResultsInducing mPT in mouse skeletal muscle bundles in a Ca2+ retention capacity assay progressively altered mitochondrial morphology, beginning with cristae swirling and condensation, progressing to mitochondrial cristae displacement, and culminating in breach of the outer mitochondrial membrane; features that are common in wasting conditions. Inducing mPT with Bz423 in single mouse muscle fibers increased mROS and Caspase 3 (Casp3) activity and was prevented by inhibitors of mPT, mROS or Casp3. Incubating single muscle fibers with Bz423 for 24 h reduced fiber diameter by [~]20% which was prevented by inhibiting mPT, mROS, or Casp3. Inducing mPT caused a complex I-specific mitochondrial respiratory impairment and increased co-localization of lysosomes with mitochondria. Inducing mPT also fragmented the AChR cluster at the muscle endplate and was prevented by inhibiting mPT or Casp3. The Ca2+ threshold for mPT and mitochondrial calcein colocalization were reduced by pancreatic tumor-conditioned media in skeletal muscle or C2C12 myoblasts, respectively, and these effects were counteracted by mPT inhibition or cyclophilin D knockout. Finally, there was significant overlap between the transcriptome of mPT and that seen in diaphragm muscle in a mouse model of pancreatic cancer cachexia, particularly during the muscle wasting phase. ConclusionsWe conclude that inducing mPT in skeletal muscle recapitulates muscle phenotypes common with muscle wasting conditions like cachexia. Furthermore, mPT is engaged by tumor-host factors and had significant overlap with DEGs seen during the muscle wasting phase in a mouse model of pancreatic cancer cachexia, warranting further investigation of mPT as a therapeutic target.

BackgroundAnorexia nervosa (AN) remains difficult to treat, partly due to co-occurring mental health challenges and gastrointestinal symptoms. Emerging research suggests that individuals with AN exhibit gut microbiota dysbiosis and dysregulation in the gut-brain axis (GBA). However, research examining the role of gut microbiota as a potential driver of AN-related pathologies remains limited. The Norwegian Microbiota Study in Anorexia Nervosa (NORMA) will therefore investigate gut microbiota and its interaction with the GBA in AN. MethodsNORMA is a collaboration between the Norwegian University of Life Sciences and seven Norwegian specialized eating disorder inpatient treatment units, consisting of three work packages (WP): a clinical observational trial (WP1), in vitro fermentation experiments (WP2), and animal experiments (WP3). In WP1, 90 patients with AN (age 16-50, BMI<18.5) admitted for treatment and 90 healthy controls (HCs, age 16-50, BMI 18.5-27) will be recruited. Data on mental and physical health, dietary intake, and blood and fecal samples for biomarker and microbiota analyses will be collected at baseline, 6 and 12 weeks after start of treatment for AN patients and once for HCs. Outcomes will be compared between groups, and longitudinal effects of standard treatment examined within the AN group. In WP2, fecal microorganisms from patients and HCs will be grown in vitro to assess influence of prebiotics. In WP3, mice will receive fecal microbiota from AN and HC donors to determine if and how AN-related microbiota affects AN-relevant phenotypes. ConclusionNORMA is pioneering in its integration of clinical, in vitro, and animal studies, providing the most comprehensive gut microbiota study of AN so far. By investigating the role of gut microbiota in AN and effects of standardized treatment on gut microbiota composition, this study aims to inform the development of innovative therapeutic strategies and ultimately improve treatment outcomes and life quality for individuals with AN. Trial registrationNORMA is a registered clinical trial: clinicaltrials.gov as NCT06144905.

BackgroundFood allergies have become a major public health concern in Western countries due to their rising prevalence. The microbiota is increasingly recognized as a key factor in their pathogenesis. Using V3-V4 16S rRNA amplicon sequencing, our group previously reported alterations in the oral microbiota of children with food allergies compared to controls. Given growing awareness of biases associated with relative-abundance analyses in 16S rRNA studies, we re-analyzed the salivary DNA samples from our earlier work. MethodsTotal bacterial loads were quantified by qPCR using universal 16S rRNA primers, enabling the estimation of absolute abundances for each taxon in each sample.These data were then used to reassess key microbial community features and to directly compare conclusions derived from absolute versus relative abundance approaches. ResultsAllergic children exhibited a marked reduction in salivary bacterial load, a feature not detected in the original relative-abundance analysis. Incorporating absolute abundances also partially reshaped the previously defined taxonomic pictures. Similar distortions affected functional predictions, such as Short Chain Fatty Acids (SCFA)-producing capacity. ConclusionsOur data confirm that variations of the bacterial load across samples hinder efforts to associate microbiota features and disease phenotypes. We identify reduced oral bacterial load as a previously unrecognized characteristic of children with food allergies. This observation aligns with reports in other immune-mediated disorders, suggesting that overall microbiota depletion may represent a defining and potentially diagnostically feature of disease-associated ecosystems.

Background and AimsAvoidance of symptom-related situations is common in chronic gastrointestinal (GI) conditions, contributing to greater symptom severity, psychological distress, and reduced quality of life. However, no validated measure exists to comprehensively assess GI-specific avoidance. We developed and validated the GI-specific Avoidance Scale (GIAS), a self-report instrument measuring behavioral and cognitive avoidance specific to GI symptoms. MethodsFollowing literature review and multidisciplinary input, an initial pool of 58 items was generated and refined through expert and patient ratings, yielding 37 items. A sample of 102 adults (mean age 40.8 years) with medically diagnosed GI conditions completed the GIAS and validated measures of avoidance, psychological flexibility, illness shame, GI symptoms, distress, and quality of life. Exploratory factor analysis was used to determine factor structure. Internal consistency, convergent validity, incremental validity, and mediation analyses were conducted. ResultsFactor analysis supported a 20-item, three-factor solution: General Avoidance, Food Avoidance, and Intimacy/Body Exposure Avoidance. Internal consistency was excellent for the total scale ( = .94) and good-to-excellent for subscales ( = .82-.94). GIAS scores correlated positively with illness shame, GI symptoms, and distress, and negatively with psychological flexibility, self-compassion, and quality of life. GIAS showed incremental validity over a general illness avoidance measure (IBAS) in predicting GI symptoms and anxiety. Moreover, mediation models suggested that GI-specific avoidance partially mediates bidirectional associations between GI symptoms and psychological distress. ConclusionsThe GIAS is a novel, psychometrically robust, and multidimensional self-report questionnaire of GI-specific avoidance. It holds potential for clinical assessment, treatment planning, and evaluation of intervention mechanisms in GI populations.

Background/ObjectivesGlucagon-Like Peptide-1 (GLP-1) is a key incretin hormone that regulates glucose homeostasis and energy metabolism. Impaired GLP-1 signaling contributes to the development of obesity, metabolic syndrome, and type 2 diabetes. Emerging evidence indicates that gut microbiota-derived components can influence GLP-1 secretion, highlighting the therapeutic potential of microbial modulators. Akkermansia muciniphila, a next-generation probiotic associated with improved metabolic health, remains underexplored for its capacity to stimulate GLP-1 release. This study aimed to investigate the GLP-1- stimulatory effects of live and pasteurized (dead) A. muciniphila strains in human enteroendocrine cells. MethodsHuman enteroendocrine L-cells (NCI-H716) were treated with varying doses of live and dead A. muciniphila from Vidya Herbss proprietary VHAKM strain and a commercially available marketed strain (dead form). Following incubation, GLP-1 levels were quantified from culture supernatants using enzyme-linked immunosorbent assay (ELISA). Comparative analyses assessed differences in GLP-1 secretion between strains and treatment forms. ResultsBoth live and pasteurized VHAKM strains significantly increased GLP-1 secretion compared to untreated controls. The live VHAKM strain exhibited higher GLP-1 stimulatory activity than its pasteurized counterpart and the marketed strain. The results suggest a strain-specific and viability-dependent modulation of GLP-1 secretion in human L-cells. ConclusionsThis study demonstrates that A. muciniphila VHAKM enhances GLP-1 secretion in a strain- and form-dependent manner, with live cells showing superior efficacy. These findings provide foundational insights for developing microbiome-targeted interventions to boost endogenous GLP-1 levels and improve metabolic health outcomes.

AimThe mammalian tracheal epithelium is composed by different cell types unevenly distributed along the proximal-distal axis. Nevertheless, variations in expression and function of ion channels and transporters participating in fluid absorption and secretion had never been studied separately in proximal and distal sections of the mouse trachea. In this work, we aim to characterize basal and stimulated absorption and secretion of fluid obtained from proximal and distal trachea from the same animal. MethodsUssing chamber experiments were performed using a custom-made tissue slider that allowed the mounting small tracheal sections, where response to agonists and blockers was recorded. The role of the NKCC1 co-transporter was studied using the Slc12a2-/- mouse. A genetically tomato-induced mouse model was used to assess co-expression of NKCC1 and ASCL3 by immunofluorescence. Animals were instilled with different interleukins (ILs) to determine changes in absorption, secretion and mucus properties. ResultsProximal trachea didnt participate in sodium absorption but exhibited higher cAMP- and succinate-induced anion secretion than the distal section. NBCe1-dependent bicarbonate and TMEM16A-driven chloride secretion was significantly higher in the distal section. NKCC1+ cells were found in the submucosal glands (SMGs) and abundant patches of NKCC1+ cells in the distal region. Isolated NKCC1+ cells co-expressing ASCL3 were also detected. ILs treatment changed the electrophysiological properties of the distal but not the proximal trachea. ConclusionsOur experiments determined that the mouse trachea organizes its functions differentially in the proximal and distal sections, based in the functional distribution of channels, transporters and receptors. While the distal trachea drastically changed its responses to agonists inducing anion secretion the proximal trachea was unperturbed by the action of ILs.