Bicol University

College of Nursing
Legazpi City

ARTICLE I:
Gastrointestinal Disease News Digest

Gastrointestinal Viruses Surged After Decline During COVID-19

Following the first stay-at-home orders issued in the United States to curb the spread of COVID-19, gastrointestinal
viruses such as norovirus, rotavirus, and adenovirus all but disappeared from California communities and remained at
very low levels for nearly 2 years. The research was published in the Journal of Clinical Microbiology, a journal of the
American Society for Microbiology. Interestingly, these viruses surged back to prepandemic levels in late 2022, said Niaz
Banaei, MD, professor of pathology and medicine (infectious diseases), Stanford University, and medical director of the
Clinical Microbiology Laboratory, Stanford Health Care. “Adenovirus F40/41, the adenovirus strains most frequently
associated with gastroenteritis, actually jumped to levels twofold higher than prepandemic levels.” Dr. Banaei suspects
that the surge in viral infections was enabled by the waning of collective community immunity from lack of exposure
during the pandemic. “Something similar has been described for the surge in respiratory syncytial virus infections in
2022,” he said.

To identify changes in the prevalence of gastrointestinal pathogens, the investigators compared detection rates for
community-acquired gastrointestinal pathogens before, during, and after California’s COVID-related shelter-in-place.
They used a polymerase chain reaction (PCR) panel test called the BioFire FilmArray Gastrointestinal Panel, which tests
for 22 of the most common pathogens that cause diarrhea, and analyzed about 18,000 tests that were taken from January
2018 to December 2022. The motivation for the research was the change in the rate of positives for certain pathogens
during the COVID-19 pandemic, said Dr. Banaei. “It immediately became clear that the pandemic lockdown and shelter-
in-place had created a natural experiment to investigate the transmission dynamics of pathogens causing gastroenteritis.”
The research offers a unique window into the biology of gastrointestinal pathogens, raising some new research questions,
said Dr. Banaei. “Why did some disappear while others persisted unaffected during lockdown? Why are some now
surging to levels we haven’t seen before?” Improved understanding of these phenomena could lead to ways to interrupt
pathogens’ spread, particularly in low- to middle-income countries where gastroenteritis remains a major cause of illness
and death, especially among children. “It may also help us prepare for future unforeseen pandemics,” he added.

Genetics Links in Endometriosis and IBS

University of Queensland (UQ) researchers in Brisbane, Australia, have shown that endometriosis and irritable bowel
syndrome (IBS) share genetic risk factors, explaining why patients with one condition may also have the other. Grant
Montgomery and Sally Mortlock at UQ’s Institute for Molecular Bioscience found a significant relationship between the
risks for endometriosis and common gastrointestinal disorders, such as IBS, peptic ulcer disease, and gastroesophageal
reflux disease (GERD). “This genetic finding supports the clinical observation of an increased incidence of
gastrointestinal disorders in women with endometriosis,” Dr. Montgomery said. “We hope that this study will raise more
awareness about the overlap of these conditions.”

Endometriosis is a severe condition affecting one in seven women that is caused by tissue that resembles the uterine lining
growing outside the uterus. Women with endometriosis are twice as likely to have an IBS diagnosis compared to women
without the disease and 1.4 times more likely to have a diagnosis of GERD. “Sufferers can find it difficult to distinguish
the source of their pain, leading to confusion or misdiagnosis and years of delay in treatment during which time the
endometriosis can progress to more severe disease,” Dr. Montgomery said. “Endometriosis should be considered as a
possible cause if a woman presents to her GP [general practitioner] with abdominal pain and gastrointestinal symptoms.
As our knowledge of risk factors for endometriosis increases, we hope to move closer to understanding how the disease
develops and improve treatments and diagnosis,” he added.

Older Adults With Digestive Diseases Have More Loneliness, Depression

While life expectancy rates for older Americans are rising, nearly 40% of adults report living with a digestive disease of
some kind. “Many people don’t realize that these conditions are very common in ambulatory care,” said Michigan
Medicine gastroenterologist Shirley Ann Cohen-Mekelburg, MD, who specializes in conditions such as inflammatory
bowel disease, Crohn’s disease, and ulcerative colitis. “Ultimately, this creates an excess in healthcare spending in the
U.S. Not only are these conditions debilitating for the millions of people living with them, but they’re also very expensive
to treat.” Dr. Cohen-Mekelburg says that in recent years there has been a greater emphasis among providers in detecting
why so many Americans are developing digestive diseases. However, she notes that current approaches often fail to
consider how things like psychosocial factors contribute to these conditions. “As physicians, it’s important for us to pay
attention to psychosocial factors involved in the lives of our patients, but they often go overlooked,” she said. “These
factors have the potential to significantly impact gastrointestinal health, and they also play a crucial role in the overall
well-being of our patients.” This notion inspired Dr. Cohen-Mekelburg and a team of fellow gastroenterologists and
hepatologists to examine the rates of loneliness, depression, and social isolation in older adults both with and without
digestive diseases. Their findings were published in Clinical Gastroenterology and Hepatology.

Dr. Cohen-Mekelburg noted that the team also “wanted to quantify these numbers with self-reported rates of poor health.
Our research involved analyzing data from 2008 to 2016 from the University of Michigan Health and Retirement Study.
This is a longitudinal panel study that involves a representative sample of approximately 20,000 individuals in the U.S.
who are 50 years and older, as well as their spouses,” she said. “It’s important to note that loneliness refers to the
subjective distressed feeling of being alone or lacking companionship. The correlation between loneliness and depression
is well established.” However, Dr. Cohen-Mekelburg adds that social isolation refers to the “objective physical separation
from other people, which is independent of psychological well-being. “Therefore, there are people who live in isolation
but are well-adapted, not lonely, and report high psychological well-being. But on the other hand, there are also people
who are socially connected, yet suffer from low psychological well-being and loneliness. This, despite having a strong
social network.” Out of a pool of 7,110 participants, the team identified 56% of individuals with a digestive disease and
44% without one. “Overall, 60.4% and 55.6% of respondents with and without digestive diseases reported loneliness,
while 12.7% and 7.5% reported severe depression, and 8.9% and 8.7% reported social isolation, respectively,” said Dr.
Cohen-Mekelburg. “We found that individuals with a digestive disease were more likely to report ‘poor-or-fair’ health
when compared to those without one. And among patients with a digestive disease, loneliness as well as moderate-to-
severe depression were associated with greater odds of self-reporting ‘poor-or-fair’ health.” Dr. Cohen-Mekelburg said
that she hopes these findings eventually empower gastroenterologists to “screen patients for depression and loneliness” in
addition to their physical symptoms. “By doing this, providers can better establish care pathways for mental health
treatment for their patients, which is hugely important,” she said. “Our research shows that gastroenterologists are in a
unique position to help their patients achieve good overall health. If you’re a clinician who also happens to treat older
adults, even better. Being aware of the link between loneliness, depressive symptoms, and digestive diseases can really
benefit your patients from a holistic perspective.”

Early Broccoli Exposure Protects Against Colitis in IBD

High-fiber diets, such as those that include broccoli sprouts or other cruciferous vegetables, may reduce disease symptoms
and improve quality of life in patients with inflammatory bowel disease (IBD), according to a study conducted in mice.
The study was published in mSystems, a journal of the American Society for Microbiology.

In the study, the investigators used a popular interleukin-10-knockout (IL-10-KO) mouse model of Crohn’s disease to
investigate the interactions between mice and their immune systems, as well as the broccoli sprout diet, microbes within
the Crohn’s-afflicted gut, and how those microbes would use an inactive compound in the broccoli sprouts to make an
anti-inflammatory compound in the gut. They also wanted to determine if, and by how much, a diet containing broccoli
sprouts alleviates Crohn’s symptoms, given the anti-inflammatory metabolites innately present in the sprouts. The
researchers used four groups of IL-10-KO mice in the study. In the first round, they had younger mice enrolled at age 4
weeks that ate their standard mouse diet the whole time, as well as mice that ate the mouse food with raw broccoli sprouts
mixed in. In the second round, they had the same two diet groups, but mice were enrolled at age 7 weeks. The researchers
were particularly interested in understanding the development of IBDs in early life, which is why they studied the Crohn’s
mouse models at the juvenile stage (age 4-6 weeks) and at the adolescence stage (age 7-9 weeks) to better understand how
host-diet-microbial community interactions and disease severity differ by age. The mice were fed for 7 days to acclimate
to their respective diets before the researchers triggered symptoms, and the mice stayed on their diets for the following 2
weeks while the disease progressed. To trigger symptoms, new healthy mice that host more microbes were added to the
cage. Since the IL-10-KO mice in the study cannot produce IL-10, their immune systems have trouble tolerating gut
microbiota, and the new microbes in the cage triggered colitis and Crohn’s symptoms. For the next 15 to 16 days after
infection, the researchers regularly weighed the mice and collected fecal samples to assess for signs of colitis
development. At the end of the study, the researchers examined the gut tissues of the euthanized mice and microbial
communities present throughout their intestines, as well as the presence of certain markers of inflammation and broccoli
metabolites in the blood. The researchers wanted to know what types of microbes were living in particular parts of the gut
to understand how the broccoli sprout diet affected microbial biogeography in the Crohn’s models. DNA was extracted
from the intestinal tissue samples collected from the mice and sent for sequencing to identify the bacteria present. Once
the sequencing data were returned, the researchers used bioinformatics software and human ingenuity to study the gut
microbial ecology of mouse models.
“We found many exciting results from this study. First, we show that the mice that ate the broccoli sprout diet had a
greater concentration of an anti-inflammatory metabolite called sulforaphane in their blood. Even though our mice were
immunocompromised and had colitis, this increase in sulforaphane protected them from severe disease symptoms like
weight loss, fecal blood, and diarrhea,” said Lola Holcomb, lead author and a PhD candidate in the Graduate School of
Biomedical Sciences and Engineering at the University of Maine.

Body Changes Up to 8 Years Ahead of IBD Diagnosis

Researchers at the Francis Crick Institute and Aalborg University in Copenhagen, Denmark, have shown that changes can
be detected in blood tests for up to 8 years before a diagnosis of Crohn’s disease and up to 3 years before a diagnosis of
ulcerative colitis. This means that the beginnings of inflammatory bowel disease start long before symptoms occur and, in
the future, may provide an opportunity for doctors to take preventative action before symptoms begin or prescribe
medication when it will be most effective.

Crohn’s disease and ulcerative colitis are collectively known as IBD. They are incurable conditions that involve excessive
inflammation in the gut, leading to symptoms like abdominal pain and diarrhea. Early diagnosis and treatment are key to
improving outcomes, but nearly a quarter of the 25,000 people diagnosed each year in the UK wait over a year. In their
study published in Cell Reports Medicine, the team used electronic health records from people in Denmark, comparing
20,000 individuals with an IBD diagnosis with controls from 4.6 million people without IBD. It was previously thought
that most people have symptoms for about a year before diagnosis, but significant bowel damage is often seen, suggesting
that changes have been taking place for a lot longer. The researchers confirmed this by looking at 10 years of test results
before diagnosis. They observed changes in a series of minerals, cells in the blood, and markers of inflammation, such as
fecal calprotectin, a molecule released into the gut during inflammation and currently used to determine which people
with bowel symptoms need further investigation. These changes were observed up to 8 years before diagnosis in Crohn’s
disease and 3 years in ulcerative colitis. Importantly, most of the observed changes were subtle and would have appeared
within a normal range for standard blood tests, so these would not have been flagged as a cause for concern. It required a
huge dataset to be able to detect these changes across many different markers. The researchers’ next steps are to
investigate if treatment or prevention has an impact before people exhibit symptoms and whether the findings from this
research could be developed further to predict who will develop IBD. First author Marie Vestergaard, PhD student at the
Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT) at Aalborg University, said, “So many
young people are affected by IBD. Their lives, hopes, and aspirations for the future are turned upside down by a diagnosis
and trying to live with a chronic disease. As a young person myself, it gets me. I am happy that our research might help
predicting who could potentially suffer from IBD and thus start treatment earlier, which would greatly improve their
quality of life.”

Study Examines How the Gut Signals to the Brain

The gut-brain connection is a complicated, two-way signaling cascade that is responsible for keeping the digestive system
working properly, and it can cause problems when it breaks down. A key part of that axis is the colon, which extracts
water and nutrients from food and transports waste out of the body. This crucial organ is implicated in a range of
gastrointestinal conditions, including constipation, diarrhea, pain, and inflammation.

Researchers at Harvard Medical School (HMS) have defined five distinct subtypes of sensory neurons in the colon that
carry signals to the brain. In a new study, conducted in mice and published in Cell, the researchers found that some
neurons are dedicated to sensing gentle forces, such as substances moving through the colon, while others sense more
intense ones, such as pain. The researchers say that if confirmed in humans, their findings could help scientists develop
more effective therapies to treat conditions that arise when this colon-brain sensing system goes awry. “Patients often
complain about sensation and pain in the gastrointestinal system, yet we don’t know a lot about the sensory neurons that
innervate the gut and allow us to respond to different stimuli,” said lead author Rachel Wolfson, a research fellow in
neurobiology at HMS and a gastroenterology fellow at Massachusetts General Hospital. David Ginty and scientists in his
laboratory have spent many years studying how sensory neurons in the skin communicate with the brain to form our sense
of touch. They have developed precise genetic tools that label subtypes of sensory neurons and have used these tools to
uncover basic information about the structure, organization, and function of skin-sensing neurons. Yet, even as scientific
knowledge about touch neurons has grown, very little research has focused on understanding the neurons in other parts of
the body, including the gastrointestinal system. “We’ve learned a lot about the neurons that go to the skin, but the
properties of neurons that project to other organs like the colon have remained poorly understood,” said Dr. Ginty, the
Edward R. and Anne G. Lefler Professor of Neurobiology in the Blavatnik Institute at HMS and senior author of the
article. To tackle this understudied area, Dr. Ginty teamed up with Dr. Wolfson, a neurobiologist and clinical expert on
the gastrointestinal system. Dr. Wolfson took genetically labeled mouse models developed in the Ginty laboratory and
repurposed them to study neurons in the colon. She discovered that five subtypes of sensory neurons in the skin are also
found in the colon. However, colon and touch neurons had distinct shapes, and the subtypes of colon neurons also varied
from each other in form. “We know that form underlies function, so the fact that the colon neurons look different from
each other made us think that they have different functions,” Dr. Wolfson said. To investigate function, she stretched the
mice’s colons with a balloon, mimicking naturally occurring distension, and recorded activity in the distinct types of
neurons. Two types responded to gentle forces, similar to the slight stretching that might happen when digested food or
stool moves through the colon. Two other types responded to intense forces, such as more extreme stretching. When Dr.
Wolfson artificially activated these high-force neurons, the mice behaved as if they were in pain. When she removed the
neuron with the highest force threshold, the pain response diminished. Triggering inflammation in the mice caused one of
the pain-sensing neuron subtypes to become even more reactive.

Study Links Chronic Psychological Stress With IBD

For the first time, cells involved with the communication between stress responses in the brain and inflammation in the
gastrointestinal (GI) tract have been identified in animal models, according to findings from the Perelman School of
Medicine at the University of Pennsylvania, published in Cell.

Glial cells, which support neurons, communicate stress signals from the CNS to the semiautonomous nervous system
within the GI tract, called the enteric nervous system (ENS). These psychological stress signals can cause inflammation
and exacerbate symptoms of inflammatory bowel disease (IBD). An estimated 1.6 million Americans have IBD, which
refers to two conditions, Crohn’s disease and ulcerative colitis, characterized by inflammation of the GI tract, and can
cause symptoms such as persistent diarrhea, abdominal pain, and bloody stools. Prolonged inflammation can also lead to
permanent damage to the GI tract. Current treatments consist of anti-inflammatory drugs, immune suppressants, dietary
changes, and steroids. “Clinicians have long observed that chronic stress can worsen IBD symptoms, but until now, no
biological connection has been identified to explain how the digestive system knows when someone is stressed,” said
senior author Christoph Thaiss, PhD, an assistant professor of microbiology. In the study, researchers found that like
humans, mice with IBD developed severe symptoms when stressed. They traced the initial stress response signals to the
adrenal cortex, which releases glucocorticoids—steroid hormones that activate the physiological responses to stress
throughout the body. The researchers found that neurons and glia in the ENS responded to chronically elevated
glucocorticoid levels, suggesting that they are the link between stress perception by the brain and intestinal inflammation.
While glucocorticoids typically have an anti-inflammatory effect in the body, the researchers found that when glia in the
ENS were exposed to the steroid hormones for a prolonged period, such as during chronic stress, they attract white blood
cells to the GI tract that increase inflammation. The researchers also found that when exposed to chronic stress, the
neurons in the ENS in the GI tract stop functioning as they normally do, which can lead to impaired bowel movements
and exacerbated IBD symptoms. Dr. Thaiss and collaborators verified the connection between psychological stress and
IBD symptoms in humans using the UK Biobank and a patient cohort from the IBD Immunology Initiative at Penn
Medicine. They found that in patients with an IBD diagnosis, the level of reported stress correlated with an increased
severity of IBD symptoms. “This finding highlights the importance of psychological evaluations in patients being treated
for IBD, as well as to inform treatment protocols,” said Maayan Levy, PhD, an assistant professor of microbiology and
cosenior author of the study. “One of the most common treatments for IBD flare-ups is steroids, and our research indicates
that in patients with IBD who experience chronic stress, the efficiency of this treatment could be impaired.” Researchers
underscore the opportunity for more research into the biology of enteric glial cells and the role they play in many
regulatory systems within the body, including the communication between the nervous system and the immune system.

Reference: Gastrointestinal Disease News Digest. (2023, December 19). Uspharmacist.

https://www.uspharmacist.com/article/gastrointestinal-disease-news-digest
 Bicol University
College of Nursing
Legazpi City

ARTICLE II:
Emerging trends in gastrointestinal disease management: A comprehensive review

Gastrointestinal diseases affect millions of people worldwide, posing significant challenges to healthcare systems and
patients' quality of life. Over the years, medical advancements and research have led to the emergence of innovative
trends in the management of gastrointestinal diseases. This comprehensive review aims to explore the cutting-edge
developments and novel approaches that have revolutionized the field of gastrointestinal disease management. From
advanced diagnostic techniques to personalized treatment options, this review will delve into the most promising
strategies that are transforming the landscape of gastroenterology [1].

One of the most significant emerging trends in the field of gastroenterology is precision medicine, which tailors treatment
plans based on individual patient characteristics. This approach takes into account genetic, environmental, and lifestyle
factors to optimize treatment outcomes. With the advent of high-throughput sequencing technologies, genetic profiling
has become more accessible, enabling healthcare professionals to identify genetic markers associated with specific
gastrointestinal diseases. Consequently, personalized therapies are being developed, offering patients targeted
interventions that aim to maximize efficacy while minimizing side effects. Precision medicine has already shown
promising results in conditions such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and colorectal
cancer, setting the stage for a new era of patient-centric care [2].

Artificial Intelligence (AI) and Machine Learning (ML) have rapidly transformed various industries, including healthcare.
In gastroenterology, these technologies are being harnessed to analyze vast amounts of medical data, aid in accurate
diagnosis, and predict disease progression. AI-powered imaging techniques have shown exceptional accuracy in
identifying gastrointestinal lesions and polyps, making them valuable tools in early detection and prevention of
gastrointestinal cancers. Moreover, ML algorithms can analyze patient data to predict disease outcomes, allowing
clinicians to intervene proactively and tailor treatment plans accordingly. As AI continues to evolve, it holds the potential
to revolutionize gastrointestinal disease management by enhancing diagnostic precision and patient care [3].

Traditional surgical interventions for gastrointestinal diseases often come with significant risks and extended recovery
periods. However, the field of gastroenterology has witnessed remarkable progress in minimally invasive procedures and
endoscopic innovations. Endoscopic techniques, such as endoscopic mucosal resection and endoscopic submucosal
dissection, have become standard in the treatment of earlystage gastrointestinal cancers. Additionally, the development of
advanced endoscopic imaging technologies, such as confocal laser endomicroscopy and virtual chromoendoscopy,
enables more accurate visualization of lesions and early detection of pathology. These minimally invasive approaches
offer patients shorter hospital stays, faster recovery times, and reduced morbidity, representing a paradigm shift in
gastrointestinal disease management [4].

The gut microbiota plays a crucial role in maintaining gastrointestinal health and influencing various disease processes.
Recent research has highlighted the potential of microbiota modulation as a therapeutic strategy for managing
gastrointestinal disorders. Probiotics and prebiotics are being extensively studied for their ability to promote a healthy gut
microbial balance and alleviate symptoms associated with conditions such as irritable bowel syndrome and inflammatory
bowel disease. Moreover, Fecal Microbiota Transplantation (FMT) has emerged as a groundbreaking treatment option,
particularly for recurrent Clostridioides difficile infection. By transplanting fecal matter from a healthy donor to a patient,
FMT aims to restore the gut microbiota's balance and eradicate pathogenic bacteria. As research in this field progresses,
microbiota modulation holds significant promise for the future of gastrointestinal disease management [5].

Conclusion: The management of gastrointestinal diseases is rapidly evolving, driven by emerging trends that promise to
revolutionize patient care. Precision medicine, powered by genetic profiling and personalized therapies, holds immense
potential for tailoring treatment plans to individual patients. Artificial intelligence and machine learning are reshaping
diagnosis and prognosis, leading to more accurate and timely interventions. Minimally invasive procedures and
endoscopic innovations are transforming surgical interventions, offering patients improved outcomes and faster recovery.
Microbiota modulation and FMT present novel avenues for managing gastrointestinal disorders by targeting the gut
microbiota. Finally, telemedicine and remote patient monitoring are revolutionizing healthcare delivery, increasing access
to care and empowering patients to actively participate in their own treatment. As these trends continue to advance, the
future of gastrointestinal disease management looks promising, with the potential for improved outcomes and enhanced
quality of life for patients worldwide.

Reference: Daperno A. Emerging trends in gastrointestinal disease management: A comprehensive review. Arch Dig
Disord. 2023; 5(4):152. www.alliedacademies.org. https://doi.org/10.35841/aaadd-5.4.152