Role of baicalin as a potential therapeutic agent in hepatobiliary and gastrointestinal disorders:A review

Baicalin is a natural bioactive compound derived from Scutellaria baicalensis,which is extensively used in traditional Chinese medicine.A literature survey demonstrated the broad spectrum of health benefits of baicalin such as antioxidant,anticancer,anti-inflammatory,antimicrobial,cardio-protective,hepatoprotective,renal protective,and neuroprotective properties.Baicalin is hydrolyzed to its metabolite baicalein by the action of gut microbiota,which is further reconverted to baicalin via phase 2 metabolism in the liver.Many studies have suggested that baicalin exhibits therapeutic potential against several types of hepatic disorders including hepatic fibrosis,xenobiotic-induced liver injury,fatty liver disease,viral hepatitis,cholestasis,ulcerative colitis,hepatocellular and colorectal cancer.During in vitro and in vivo examinations,it has been observed that baicalin showed a protective role against liver and gut-associated abnormalities by modifying several signaling pathways such as nuclear factor-kappa B,transforming growth factor beta 1/SMAD3,sirtuin 1,p38/mitogen-activated protein kinase/Janus kinase,and calcium/calmodulin-dependent protein kinase kinaseβ/adenosine monophosphate-activated protein kinase/acetyl-coenzyme A carboxylase pathways.Furthermore,baicalin also regulates the expression of fibrotic genes such as smooth muscle actin,connective tissue growth factor,β-catenin,and inflammatory cytokines such as interferon gamma,interleukin-6(IL-6),tumor necrosis factor-alpha,and IL-1β,and attenuates the production of apoptotic proteins such as caspase-3,caspase-9 and B-cell lymphoma 2.However,due to its low solubility and poor bioavailability,widespread therapeutic applications of baicalin still remain a challenge.This review summarized the hepatic and gastrointestinal protective attributes of baicalin with an emphasis on the molecular mechanisms that regulate the interaction of baicalin with the gut microbiota.

Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease(IBD).There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing,rather than clinical remission alone.Consequently,the treatment of refractory“functional”gastrointestinal symptoms,often attributed as the aftermath of previous inflammation,has recently become more prominent in quiescent disease.With further expected advances in anti-inflammatory treatments on the horizon,the burden of such symptoms in quiescent disease,which have been relatively neglected,is set to become an even bigger problem.In this article,we highlight the current state of research and understanding in this field,including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms,such as irritable bowel syndrome and functional anorectal and pelvic floor disorders,in patients with quiescent IBD.These disorders are not only highly prevalent in these patients,they are often misdiagnosed,and are difficult to treat,with very few evidence-based therapies.Moreover,they are associated with substantial impairment in quality-of-life,considerable morbidity,and psychological distress.There is therefore an urgent need for a change in emphasis towards earlier recognition,positive diagnosis,and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD.This article also highlights the need for further research to develop much needed evidence-based therapies.

Gastrointestinal disorders in children with autism:Could artificial intelligence help?

Autism is one of the pervasive neurodevelopmental disorders usually associated with many medical comorbidities.Gastrointestinal(GI)disorders are pervasive in children,with a 46%-84%prevalence rate.Children with Autism have an increased frequency of diarrhea,nausea and/or vomiting,gastroesophageal reflux and/or disease,abdominal pain,chronic flatulence due to various factors as food allergies,gastrointestinal dysmotility,irritable bowel syndrome(IBS),and inflammatory bowel diseases(IBD).These GI disorders have a significant negative impact on both the child and his/her family.Artificial intelligence(AI)could help diagnose and manage Autism by improving children's communication,social,and emotional skills for a long time.AI is an effective method to enhance early detection of GI disorders,including GI bleeding,gastroesophageal reflux disease,Coeliac disease,food allergies,IBS,IBD,and rectal polyps.AI can also help personalize the diet for children with Autism by microbiome modification.It can help to provide modified gluten without initiating an immune response.However,AI has many obstacles in treating digestive diseases,especially in children with Autism.We need to do more studies and adopt specific algorithms for children with Autism.In this article,we will highlight the role of AI in helping children with gastrointestinal disorders,with particular emphasis on children with Autism.

Prevalence of functional gastrointestinal disorders in children with celiac disease on different types of gluten-free diets

BACKGROUND Functional gastrointestinal disorders(FGIDs)are common during the pediatric age.FGIDs are not related to biochemical or structural abnormalities.However,since they have a high prevalence,several studies have evaluated an overlap between FGIDs and organic diseases.Individuals with celiac disease(CD)have been shown to be at an increased risk for functional abdominal pain,even if they adhere well to a gluten-free diet(GFD).Little information is available for the pediatric age group.The aims of our study were to evaluate the prevalence of FGIDS in CD children 1 year after diagnosis and to compare the prevalence of FGIDs in CD children on a GFD with processed foods compared with those on a GFD with natural products.AIM To assess the prevalence of FGIDs in children with CD after 1 year of follow-up and to compare the prevalence of FGIDs in children with CD on a GFD with processed foods and in children on a GFD with natural products.METHODS We recruited pediatric patients aged 1-18 years with a new CD diagnosis.Participants were randomized to two groups:Group A on a GFD with processed foods(diet 1);and group B on a GFD with natural products(diet 2).Clinical monitoring,diet assessment and the questionnaire on pediatric gastrointestinal symptoms-Rome IV version were performed at diagnosis(T0)and after 12 mo of follow-up(T1).Dietary intake was assessed using a 3-d food diary record.Data from the diaries were evaluated using WinFood nutrient analysis software.We assessed the prevalence of FGIDs at T1 and the correlation with the type of GFD.RESULTS We registered 104 CD children,with 55 patients in group A(53.0%)and 49 patients in group B(47.0%).Initially,30 of the 55(54.5%)CD children were symptomatic in group A,while 25 of 49(51.0%)were symptomatic in group B.At T1,in spite of a low or negative serology for CD,FGIDs prevalence was 10/55(18.0%)in group A and 8/49(16.3%)in group B,with no statistically significant difference between the two groups(P=0.780).At T1 the macro-and micronutrient intake was similar across the two groups with no significant differences in nutrient analysis.However,in both groups at T1 we found that a lower prevalence of FGIDs(P=0.055)was associated with an inferior caloric(odds ratio=0.99,95%confidence interval:0.99-1.00)and fat(odds ratio=0.33,95%confidence interval:0.65-0.95)intake.CONCLUSION Our results showed that CD children on a GFD have gastrointestinal symptoms with an elevated prevalence of FGIDs.Our study suggests that developing FGIDs may be linked to caloric intake and percentage of food fat,but it does not change between a GFD with processed foods or a GFD with natural products.However,long-term monitoring is required to evaluate a correlation between FGIDs and various types of GFDs.

Cow’s milk-induced gastrointestinal disorders:From infancy to adulthood

Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders.Cow’s milk protein allergy(CMPA)is the most common food allergy,especially in infancy and childhood,which may persist into adulthood.There are three main types of CMPA;immunoglobulin E(IgE)-mediated CMPA,non-IgEmediated CMPA,and mixed type.CMPA appears before the first birthday in almost all cases.Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis.CMPA(often non-IgE mediated)can present with symptoms of gastroesophageal reflux,eosinophilic esophagitis,hemorrhagic gastritis,food protein-induced protein-losing enteropathy,and food protein-induced enterocolitis syndrome.Most CMPAs are benign and outgrown during childhood.CMPA is not as common in adults as in children,but when present,it is usually severe with a protracted course.Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose.Lactose intolerance has four typical types:Developmental,congenital,primary,and secondary.Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults.They are also common in inflammatory bowel diseases.Milk consumption may have preventive or promoter effects on cancer development.Milk may also become a source of microbial infection in humans,causing a wide array of diseases,and may help increase the prevalence of antimicrobial resistance.This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.

Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Thinking and Strategy on the Diagnosis and Treatment of Functional Gastrointestinal Disorders with Integrative Medicine

The functional gastrointestinal disorders (FGIDs) are a group of diseases mainly manifested as gastrointestinal functional disorders,including 45 kinds of different diseases,such as functional dyspepsia(FD), irritable bowel syndrome (IBS),functional constipation

A Breakthrough Point in Integrative Medical Research:Challenge of Treating Overlapping Symptoms in Functional Gastrointestinal Disorders

Functional gastrointestinal disorders(FGIDs)are common disorders that are characterized by persistent and recurring gastrointestinal symptoms.Many patients with FGIDs have overlapping symptoms,which impaired the quality of life and ability to work of patients,and left a considerable impact on health-care systems and society.Chinese medicines(CMs)are commonly utilized by many patients with FGIDs.This article discusses the current status of diagnosis and treatment of FGIDs,the advantages and characteristics of CM treatment,and how integrated medicine can make a breakthrough in FGIDs diagnosis and treatment.

Role of gastrointestinal health in managing children with autism spectrum disorder

Children with autism spectrum disorders(ASD)or autism are more prone to gastrointestinal(GI)disorders than the general population.These disorders can significantly affect their health,learning,and development due to various factors such as genetics,environment,and behavior.The causes of GI disorders in children with ASD can include gut dysbiosis,immune dysfunction,food sensitivities,digestive enzyme deficiencies,and sensory processing differences.Many studies suggest that numerous children with ASD experience GI problems,and effective management is crucial.Diagnosing autism is typically done through genetic,neurological,functional,and behavioral assessments and observations,while GI tests are not consistently reliable.Some GI tests may increase the risk of developing ASD or exacerbating symptoms.Addressing GI issues in individuals with ASD can improve their overall well-being,leading to better behavior,cognitive function,and educational abilities.Proper management can improve digestion,nutrient absorption,and appetite by relieving physical discomfort and pain.Alleviating GI symptoms can improve sleep patterns,increase energy levels,and contribute to a general sense of well-being,ultimately leading to a better quality of life for the individual and improved family dynamics.The primary goal of GI interventions is to improve nutritional status,reduce symptom severity,promote a balanced mood,and increase patient independence.

Gut microbiota in various childhood disorders:Implication and indications

Gut microbiota has a significant role in gut development,maturation,and immune system differentiation.It exerts considerable effects on the child's physical and mental development.The gut microbiota composition and structure depend on many host and microbial factors.The host factors include age,genetic pool,general health,dietary factors,medication use,the intestine's pH,peristalsis,and transit time,mucus secretions,mucous immunoglobulin,and tissue oxidation-reduction potentials.The microbial factors include nutrient availability,bacterial cooperation or antagonism,and bacterial adhesion.Each part of the gut has its microbiota due to its specific characteristics.The gut microbiota interacts with different body parts,affecting the pathogenesis of many local and systemic diseases.Dysbiosis is a common finding in many childhood disorders such as autism,failure to thrive,nutritional disorders,coeliac disease,Necrotizing Enterocolitis,helicobacter pylori infection,functional gastrointestinal disorders of childhood,inflammatory bowel diseases,and many other gastrointestinal disorders.Dysbiosis is also observed in allergic conditions like atopic dermatitis,allergic rhinitis,and asthma.Dysbiosis can also impact the development and the progression of immune disorders and cardiac disorders,including heart failure.Probiotic supplements could provide some help in managing these disorders.However,we are still in need of more studies.In this narrative review,we will shed some light on the role of microbiota in the development and management of common childhood disorders.

Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults

BACKGROUND Although the association of attention deficit hyperactivity disorder(ADHD)with psychiatric disorders is well known,its association with somatic diseases is unclear.Only few studies have investigated the gastrointestinal(GI)morbidity in adult patients with ADHD.AIM To measure gastrointestinal comorbidity and its burden on healthcare in young adults with ADHD.METHODS The cohort included subjects aged 17-35 years recruited to the Israel Defense Forces in 2007-2013,33380 with ADHD and 355652 without(controls).The groups were compared for functional and inflammatory conditions of the gastrointestinal tract and clinic and specialist visits for gastrointestinal symptoms/disease during service(to 2016).Findings were analyzed by generalized linear models adjusted for background variables.RESULTS Compared to controls,the ADHD group had more diagnoses of functional gastrointestinal disorders(referred to as FGID),namely,dyspepsia[odds ratio(OR):1.48,95%confidence interval(CI):1.40-1.57,P<0.001],chronic constipation(OR:1.64,95%CI:1.48-1.81,P<0.001),and irritable bowel syndrome(OR:1.67,95%CI:1.56-1.80,P<0.001)but not of organic disorders(inflammatory bowel disease,celiac disease).They had more frequent primary care visits for gastrointestinal symptoms[rate ratio(RR):1.25,95%CI:1.24-1.26,P<0.001]and referrals to gastrointestinal specialists(RR:1.96,95%CI:1.88-2.03,P<0.001)and more episodes of recurrent gastrointestinal symptoms(RR:1.29,95%CI:1.21-1.38,P<0.001).Methylphenidate use increased the risk of dyspepsia(OR:1.49,95%CI:1.28-1.73,P<0.001)and constipation(OR:1.42,95%CI:1.09-1.84,P=0.009).CONCLUSION ADHD in young adults is associated with an excess of FGID and increased use of related health services.Research is needed to determine if an integrative approach treating both conditions will benefit these patients and cut costs.

Gastrointestinal symptoms in acromegaly:A case control study

BACKGROUND Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone,which leads to excess secretion of Insulin like growth factor 1 from the liver,causing abnormal soft tissue growth.There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms.Data was collected from patients with a confirmed diagnosis of acromegaly to evaluate the intensity,variety and impact of abdominal symptoms in comparison with a control group who were healthy participants recruited from the local fracture clinic.AIM To evaluate the frequency type and burden of abdominal symptoms in acromegaly in comparison with a control group.METHODS Medical documentation of patients with a diagnosis of acromegaly treated in one tertiary medical centre between 2010 and 2017 has been analysed.Data was collected from patients with confirmed acromegaly,using the Short Form Health Survey(SF36)and Rome IV Diagnostic questionnaire for Functional Gastrointestinal Disorders in Adults(R4DQ)and compared to a sex-and agematched control group,to assess the burden of abdominal symptoms.Microsoft Excel and IBM SPSS v 25 were used for data analysis.RESULTS Fifty patients with acromegaly(24 male and 26 females;age range 23-64 years,mean 43)and 200 controls(96 male and 104 females;age range 18-84,mean 42.4)were recruited.92%(46 out of 50)of patients with acromegaly reported abdominal symptoms and 78%(39 out of 50)had at least one functional gastrointestinal disorder according to the Rome IV diagnostic criteria,compared to 16%of controls(OR>1,P<0.0001).The most commonly reported symptom was constipation(69%acromegaly vs 21%of controls OR>1,P<0.0001,95%CI:4.4–15.8).34 out of 50(68%)respondents met the criteria for functional constipation according to Rome IV.Upper gastrointestinal disorders were also more prevalent in the acromegaly group.There was no statistically significant difference in the prevalence of biliary and anorectal symptoms between the two groups.Patients in acromegaly group scored lower on the mean scores of the eight parameters of SF36 Quality of Life questionnaire(mean scores 60.04 vs 71.23,95%CI:-13.6829 to-8.6971,OR>1,P<0.001)as compared to the control group.CONCLUSION Upper and lower functional gastrointestinal tract disorders(defined by Rome IV diagnostic criteria)are significantly more prevalent in patients with acromegaly compared with healthy age and sex matched controls in our study.Functional constipation is the most commonly reported problem.Poorer quality of life may in part be attributable to the increased prevalence of abdominal symptoms.

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.

Gastrointestinal effects of Artemisia absinthium Linn. based on traditional Persian medicine and new studies

One of the most extensively used herbs in traditional Persian medicine (TPM) used in the treatment ofgastrointestinal (GI) disorders, is the plant Artemisia absinthium Linn. (AAL). It also has a wide range of activitiessuch as analgesic and anti-inflammatory, anti-oxidant, anti-fungal, and anti-bacterial activities, hepatoprotective,and neuroprotective activities in addition to having gastroprotective effects. This article is a review comparingTPM resources with new medicines. This review investigates this herb in major TPM sources and strives toextrapolate the exact function it serves in the digestive tract and compares the collected information on the functionof AAL with information found in new medical resource databases such as ISI, Pubmed, Scopus, Google Scholar,and Scientific Information Database. AAL from the Asteraceae family of TPM, known as Afsentin, was used in thetreatment of GI weaknesses, stomach pains, swellings, intestinal parasites, diarrhea, and vomiting. AAL increasedappetite, so it was used for insect repellents and insecticide. Recent studies have indicated that the effects of thisplant improved the symptoms of Crohn's disease and played a role in reducing inflammatory factors. It also hasstrong anti-parasitic, anti-insect, hepatoprotective, and antioxidant effects. Given the widespread use of AAL as atraditional medicine currently in use in different countries, particularly in the treatment of GI diseases, furtherclinical studies that focus on the therapeutic qualities of this plant are required in the future.

Gastrointestinal tract post-transplant lymphoproliferative disorder after liver transplantation

To the Editor:Post-transplant lymphoproliferative disorder（PTLD）is a rare and potentially fatal complication occurring after all types of solid organ transplantation.;PTLD accounts for 20%of all de novo post-transplant tumors.;The most important risk factors for PTLD are prolonged intense immunosuppression and Epstein-Barr virus（EBV）

Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period:A population-based study

BACKGROUND Psychosocial and physical trauma are known risk factors for irritable bowel syndrome(IBS),including in war veterans,whereas war exposure in civilians is unclear.Nicaragua experienced two wars,1970-1990:The Sandinistas Revolution(1970s)and The Contra War(1980s).Our aim was to investigate the role of exposure to war trauma in the subsequent development of IBS in the context of an established health surveillance system(11000 households).AIM To investigate in a civilian population the relationship between exposure to war trauma and events and the subsequent development of IBS in the context of an established public health and demographic surveillance system in western Nicaragua.METHODS We conducted a nested population-based,cross-sectional study focused on functional gastrointestinal disorders based on Rome II criteria.1617 adults were randomly selected.The Spanish Rome II Modular Questionnaire and Harvard Trauma Questionnaire were validated in Nicaragua.War exposure was assessed with 10 measures of direct and indirect war trauma and post-war effects.Multiple exposures were defined by≥3 measures.RESULTS The prevalence of IBS was 15.2%[Female(F)17.1%,Male(M)12.0%],war exposure 19.3%(F 9.3%,M 36.7%),and post-traumatic stress disorder(PTSD)5.6%(F 6.4%,M 4.3%).Significant associations with IBS in the civilian population were observed(adjusted by gender,age,socioeconomic status,education):physical and psychological abuse[adjusted odds ratio(aOR):2.25;95%confidence interval:1.1-4.5],witnessed execution(aOR:2.4;1.1-5.2),family member death(aOR:2.2;1.2-4.2),and multiple exposures(aOR:2.7;1.4-5.1).PTSD was independently associated with IBS(aOR:2.6;1.2-5.7).CONCLUSION An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS.Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.

To explore acupuncture therapy for post-stroke gastrointestinal dysfunction based on gut microbiota

The occurrence of post-stroke gastrointestinal disorder(PSGD)is closely related to gut microbiota.Acupuncture has a positive effect on PSGD.However,it is not completely clear how acupuncture can mediate the regulation of gut microbiota in the treatment of PSGD.In this paper,the relationship between PSGD risk factors and gut microbiota,the relationship between gut microbiota and PSGD,the regulation of gut microbiota and metabolites by acupuncture,and the application research progress of acupuncture in regulating PSGD were reviewed to explore the mechanism of gut microbiota in the treatment of PSGD.We found that acupuncture can improve intestinal mucosal permeability,increase the number of beneficial bacteria such as Bifidobacterium and Lactobacillus,and increase serum 5-hydroxytryptamine(5-HT)and short chain fatty acids(SCFAs)to relieve gastrointestinal symptoms and improve PSGD.

Should gastroenterologists prescribe cannabis? The highs, the lows and the unknowns

Cannabis,commonly known as marijuana,is a drug extracted from the Cannabis plant known for its psychotropic and medicinal properties.It has been used for healing purposes during ancient times,although its psychoactive components led to its restricted use in medicine.Nonetheless,cannabis is found to have modulatory effects on the endocannabinoid system exhibiting its medicinal role in the gastrointestinal(GI)system.Emerging animal and human studies demonstrate the influential effects of cannabis on a variety of GI diseases including inflammatory bowel disease,motility disorders and GI malignancies.It also has a regulatory role in GI symptoms including nausea and vomiting,anorexia,weight gain,abdominal pain,among others.However,both its acute and chronic use can lead to undesirable side effects such as dependency and addiction,cognitive impairment and cannabinoid hyperemesis syndrome.We will discuss the role of cannabis in the GI system as well as dosing strategies to help guide gastroenterologists to assess its efficacy and provide patient counseling before prescription of medical marijuana.

Associations between irritable bowel syndrome and non-alcoholic fatty liver disease:A systematic review

BACKGROUND Irritable bowel syndrome(IBS)is associated with obesity and metabolic syndrome.IBS and non-alcoholic fatty liver disease(NAFLD)are highly prevalent entities worldwide and may share similar mechanisms including gut dysbiosis,impaired intestinal mucosal barrier and immune system activation.AIM To systematically review their association according to the Preferred Reporting Items for Systemic Review and Meta-analyses guidelines.METHODS PubMed,EMBASE and Cochrane Database of Systematic Reviews were searched for relevant papers.Manual searches were also performed.RESULTS Six studies were included.Both IBS and NAFLD subjects had significantly more metabolic risk factors like hypertension,obesity,dyslipidaemia and diabetes.Our review showed that 23.2%to 29.4%of NAFLD patients had IBS.IBS was significantly higher in NAFLD patients compared with patients without NAFLD(23.2%vs 12.5%,P<0.01).A higher proportion of IBS patients had NAFLD(65.8%to 74.0%).IBS patients were three times more likely to have NAFLD compared with non-IBS patients(P<0.001).Two studies showed a significant correlation between the severity of IBS and NAFLD.The proportion of NAFLD subjects with IBS increased with NAFLD severity.CONCLUSION Further prospective studies are warranted to evaluate the relationship and shared pathways between IBS and NAFLD,potentially leading to the development of future therapeutics.

Exposure to Hyaluronan and Radon-Containing Water during the Treatment of Periodontal Pockets

Hyaluronic acid (HA) preparations have emerged as pivotal components in contemporary dentistry, gaining widespread recognition for their multifaceted roles in various biological functions. Extensive literature underscores the significance of HA in maintaining tissue water balance, fostering cell proliferation, promoting rapid cell migration, influencing cell differentiation during organism development, and facilitating tissue regeneration. Notably, HA’s interactions with cell surface receptors contribute to the viscosity of synovial fluid, activate the immune system, and enhance cartilage elasticity. Beyond these established functions, HA has also been investigated for its potential involvement in determining and studying the hormetic effects of radon water, adding a novel dimension to its applications in dental research. A thorough exploration of existing studies reveals a nuanced understanding of how HA interventions impact the outcomes of dental procedures. The comprehensive scope of these investigations allows for a more accurate assessment of the potential effectiveness of specific interventions and provides valuable insights into post-procedural prognoses for individual patients. This synthesis of literature serves as the foundation for elucidating the intricate interplay between HA, radon exposure, and their relevance in modern dental practices.