Irritable bowel syndrome (IBS) is a common, chronic functional gastrointestinal disorder affecting the large intestine, and presents as abdominal pain and/or discomfort, bloating, gas retention, diarrhea, and constipation. IBS impairs quality-of-life and requires long-term management. In 2016, the Rome Foundation introduced new IBS diagnostic criteria (the Rome IV criteria), and also revised the diagnostic algorithms for, and the multidimensional clinical profile (MDCP) of, functional gastrointestinal disorders. The IBS MDCP includes clinical data, the extent to which normal daily activities are affected, and psychosocial and physiological measures. The criteria seek to aid physicians in choosing appropriate treatment for IBS patients. Herein, we seek to provide evidence- based practical information on IBS and functional diarrhea. We review the new Rome diagnostic IV criteria, the MDCP, and the various IBS treatment options. We suggest that, in clinical practice, combination therapies may be useful to treat patients with IBS of various grades.
Abdominal Pain ; Constipation ; Diarrhea* ; Gastrointestinal Diseases ; Humans ; Intestine, Large ; Irritable Bowel Syndrome*

Non-celiac gluten sensitivity (NCGS) is a term that is used to describe individuals who are not affected by celiac disease or wheat allergy, yet they have intestinal and/or extra-intestinal symptoms related to gluten ingestion with improvement of their symptoms upon withdrawing gluten from their diet. Gluten-related disorder groups are manifested by symptoms of gastrointestinal tract disorders, as well as hematological dermatological endocrinological, gynecological, rheumatological and nervous system symptoms. It is believed that NCGS represents heterogeneous groups with different subgroups characterized by different etiologies, clinical histories and clinical courses. There also appears to be an overlap between NCGS and irritable bowel syndrome (IBS). There is a need for establishing strict criteria for diagnosing NCGS. The absence of validated biomarkers remains a significant limitation for research studies on NCGS. New evidence shows that a gluten-free diet may be beneficial for some patients with gastrointestinal symptoms, such as those symptoms commonly found in patients with IBS. Further studies about NCGS are needed.
Abdominal Pain ; Biomarkers ; Celiac Disease ; Diarrhea ; Diet ; Diet, Gluten-Free ; Eating ; Gastrointestinal Diseases ; Gastrointestinal Tract ; Glutens ; Humans ; Irritable Bowel Syndrome ; Nervous System ; Wheat Hypersensitivity

No abstract available.
Colitis* ; Eosinophils*

No abstract available.
Duodenum ; Dyspepsia

Constipation is a frequent symptom in patients with chronic kidney disease (CKD). This review outlines the mechanisms and management of constipation in patients with CKD from a physician’s perspective. Common causes of constipation in patients with CKD include concomitant medications, low dietary fiber intake, water-restricted diet, lack of physical activity, altered gut microbiota, and reduced gastrointestinal motility. Constipation has a negative impact on overall health, and, in particular, the presence of constipation has been associated with worsening kidney function and increased risk of developing advanced stages of CKD. Although lifestyle and dietary modifications may not always be practical for patients with CKD, they are recommended because they are beneficial as they lower mortality in patients with CKD. The use of laxatives containing magnesium salts, bulking agents, and osmotic laxatives may have insufficient efficacy and may be associated with adverse effects. In contrast, lactulose and lubiprostone have been shown to exhibit reno-protective effects. Linaclotide and plecanatide have very limited systemic absorption and appear safe in patients with CKD. Tenapanor reduces paracellular intestinal phosphate absorption in addition to blocking sodium uptake by enterocytes, and provides additional benefit in patients patients with CKD who have hyperphosphatemia and constipation. Prucalopride leads to improvements in bowel function and constipation-related symptoms in cases in which response to conventional laxatives are inadequate. However, the dose of prucalopride should be reduced to 1 mg once daily for patients with CKD. In conclusion, there are important advances on the impact and treatment of constipation in patients with CKD.

Esophageal carcinosarcoma is a rare malignant esophageal neoplasm consisting of both carcinomatous and sarcomatous elements, with an incidence of 0.5%. There have been only a few case reports of carcinosarcoma and squamous cell carcinoma coexisting in the esophagus. However, all of these are cases of synchronous or metachronous development of carcinosarcoma after chemoradiotherapy in patients of esophageal squamous cell carcinoma. A 53-year-old man underwent esophagogastroduodenoscopy because of chest pain for several months. Endoscopic examination revealed a huge pedunculated esophageal polypoid mass. Endoscopic submucosal dissection (ESD) was performed and histopathologic examination confirmed spindle cell carcinoma (carcinosarcoma). He refused additional esophagectomy. After 21 months, third follow-up endoscopy showed poorly-demarcated flat, faint discolored lesions at different location from the previous ESD site and endoscopic biopsies confirmed squamous cell carcinoma. To the best of our knowledge, this is the first case of metachronous development of esophageal squamous cell carcinoma in a patient with esophageal carcinosarcoma.
Antineoplastic Agents/therapeutic use ; Carcinoma, Squamous Cell/*diagnosis/drug therapy/pathology ; Carcinosarcoma/*diagnosis/drug therapy/pathology ; Cisplatin/therapeutic use ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Esophageal Neoplasms/*diagnosis/drug therapy/pathology ; Fluorouracil/therapeutic use ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; S100 Proteins/metabolism ; Tomography, X-Ray Computed ; Tumor Suppressor Protein p53/metabolism

Perivascular epithelioid cell tumors (PEComas) are unusual mesenchymal neoplasms composed of histologically and immunohistochemically distinct perivascular epithelioid cells (PECs). Although PEComas have the potential to behave in a malignant fashion, malignant PEComas arising from the retroperitoneum are extremely rare. A 68-year-old woman presented with a painful palpable mass in her left upper abdomen. Computed tomography of the abdomen showed a 9 cm sized heterogeneous mass in left para-aortic space and multiple hypervascular nodules in the liver. 18F-fludeoxyglucose-PET/CT showed multifocal hypermetabolic lesions in retroperitoneum, liver, and skeletal bones. Percutaneous needle biopsies were done on the retroperitoneal and hepatic mass. Both specimens were positive for human melanoma black-45 (HMB-45) on histological and immunohistochemical staining which was compatible with PEComas. Herein, we report a rare case of retroperitoneal PEComa with multiple metastases involving liver and bone at initial diagnosis that exhibited aggressive behavior and resulted in a devastating prognosis.
Aged ; Bone Neoplasms/pathology/radiography/secondary ; Female ; Fluorodeoxyglucose F18 ; Humans ; Liver Neoplasms/pathology/radiography/secondary ; Perivascular Epithelioid Cell Neoplasms/*diagnosis/pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Liver cirrhosis is commonly associated with bleeding complications due to portal hypertension or coagulopathy. Spontaneous muscle hematoma is a rare but potentially lethal complication of liver cirrhosis. Here we report three cases of spontaneous muscle hematoma diagnosed in patients with alcoholic liver cirrhosis. All three patients died due to recurrent bleeding and liver failure although they had undergone repeated transcatheter arterial embolization of the actively bleeding vessels. We reviewed 14 cases of spontaneous muscle hematoma that were associated with liver cirrhosis, including our cases, and found that the mortality rate was 86%, despite early diagnosis and treatment. Cirrhosis-associated spontaneous muscle hematoma occurred more frequently in patients with alcoholic liver cirrhosis, who accounted for -93% of cases. Thus, spontaneous muscle hematoma should be considered a life-threatening complication in patients with alcoholic liver cirrhosis, and abstinence from alcohol may help to prevent the occurrence of this deadly condition.
Alcoholics* ; Early Diagnosis ; Fibrosis ; Hematoma* ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic* ; Liver Failure ; Mortality