Introduction

Defecatory dysfunction (DD) is a common cause of chronic constipation resulting from functional abnormalities or structural pelvic pathologies. Accurate diagnosis requires combining anorectal manometry (ARM), balloon expulsion test (BET), and defecography. This study evaluates the diagnostic utility of these modalities and explores uncertainties in their performance and interpretation.

Aims & Methods

This retrospective study included 325 adult patients assessed for DD between 2020 and 2023. All patients went through ARM, BET in the left lateral position, and defecography. Statistical associations between test outcomes were analyzed to assess diagnostic concordance and significance.

Results

A strong correlation was observed between ARM and defecography, with 65% of patients with normal anal relaxation on ARM achieving normal rectal evacuation on defecography (p < 0.0001). Conversely, patients with paradoxical contraction during ARM demonstrated a higher likelihood of evacuation failure. BET demonstrated high specificity but limited sensitivity in association with relaxation on ARM and evacuation on defecography. BET failure did not demonstrate a significant association with the presence of pelvic floor pathologies.

Conclusion

Combining ARM, BET, and defecography provides a comprehensive framework for diagnosing DD, addressing its functional and structural components. This integrated approach facilitates targeted interventions, ultimately improving clinical outcomes.

References

Chronic constipation is a common disorder with multifactorial pathophysiology, including pelvic floor dysfunction (Bharucha & Lacy, 2020). Symptomatic pelvic floor disorders affect a significant proportion of women (Nygaard et al., 2008). High-resolution anorectal manometry (HRAM) and rectal balloon expulsion tests are critical for diagnosing defecatory disorders (Prichard et al., 2017; Bharucha & Coss-Adame, 2022). Standardized protocols, including the London Classification, have improved the diagnostic accuracy of anorectal functional tests (Carrington et al., 2020; Carrington et al., 2018). Imaging modalities such as magnetic resonance defecography complement functional testing (Reiner et al., 2011; Carter et al., 2020). Variations in body position influence anorectal test results (Su et al., 2019; Wu et al., 2017; Tsunoda et al., 2022; Ratuapli et al., 2013). Comparative studies emphasize the complementary role of manometry, balloon expulsion, and defecography (Blackett et al., 2022; Heinrich et al., 2015). Recent advances suggest HRAM improves detection of specific defecatory mechanisms (Deb et al., 2022; Sharma et al., 2020), supported by international consensus guidelines (Wald et al., 2021; Rao & Tetangco, 2020; Lee & Bharucha, 2016).

Disclosure

no conflict of interest

Introduction

Graves’ disease (GD) and ulcerative colitis (UC) are two distinct autoimmune disorders with increasing evidence of shared pathophysiological mechanisms. While previous epidemiological studies have reported a higher risk of IBD among individuals with GD, the association between GD and UC specifically remains controversial. In particular, the causal direction, genetic liability, and molecular mediators underlying this relationship are not well defined.

Aims & Methods

We conducted a multi-layered investigation to clarify the relationship between GD and UC. First, a large-scale prospective analysis using the UK Biobank cohort was performed to assess the association between GD and subsequent UC risk, with adjustments for demographic, lifestyle, and clinical covariates utilizing COX proportional hazard models. Second, two-sample Mendelian randomization (MR) analyses were conducted using publicly available genome-wide association study (GWAS) datasets to infer potential causal links. Finally, we performed protein mediation analysis integrating plasma proteomic data to identify potential intermediate proteins and pathways mediating the effect of GD on UC.

Results

Observational analysis revealed that patients with GD had a significantly elevated risk of developing UC. Stratified analysis further revealed that this association was more pronounced among male and obese individuals. The association remained significant even after adjusting for key covariates including medication use, psychological disorders, air pollution exposure, and sunlight exposure. Genetic-level analysis using Mendelian randomization confirmed a potential causal relationship between AITD and UC. This association was independently validated in MR sensitivity analyses. Through mediation analysis based on plasma proteomic data, 28 UC-related proteins were identified as potential mediators of the AITD–UC relationship. Among them, proteins such as Arachidonate 15-lipoxygenase B (ALOX15B) were significantly enriched in the high-risk group. Collectively, six pathways likely represent the core signaling axes through which GD promotes UC pathogenesis, highlighting potential targets for mechanistic and therapeutic exploration.

Conclusion

This study provides robust clinical, genetic, and molecular evidence for a link from GD to UC, mediated through specific immunopathogenic proteins and pathways. These findings offer novel insights into shared autoimmunity and may inform biomarker-driven strategies for early identification and targeted prevention of UC in patients with GD.

References

Ferrari SM. The association of other autoimmune diseases in patients with Graves' disease (with or without ophthalmopathy): Review of the literature and report of a large series. Autoimmun Rev. 2019 Mar;18(3):287-292.
Ordás I. Ulcerative colitis. Lancet. 2012 Nov 3;380(9853):1606-19.
Xian W. Graves Disease and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization. J Clin Endocrinol Metab. 2023 Apr 13;108(5):1075-1083.
Burisch J. Incidence of Immune-Mediated Inflammatory Diseases Among Patients With Inflammatory Bowel Diseases in Denmark. Clin Gastroenterol Hepatol. 2019 Dec;17(13):2704-2712.e3.

Disclosure

The authors declare no conflicts of interest.

Introduction

The impact of antral preservation versus antral resection in sleeve gastrectomy remains a subject of debate due to its potential effects on weight loss, metabolic outcomes, and gastrointestinal function. This meta-analysis aims to provide a comparative assessment of these surgical techniques.

Aims & Methods

The Meta-Analysis aims to provide a comprehensive analysis between ​these two surgical techniques.
A systematic review and meta-analysis were conducted using 10 studies published between 2014 and 2025 that compared sleeve gastrectomy with antral preservation versus antral resection. The primary outcomes included excess weight loss (EWL) at different time points, while secondary outcomes assessed metabolic parameters (C-peptide, GLP-1, HbA1c), gastric emptying, gastroesophageal reflux disease (GERD), and resolution of comorbidities.

Results

A total of 10 studies were included. Patients undergoing antral resection exhibited greater excess weight loss at 6 and 12 months (MD: -4.50, 95% CI: -5.98 to -3.02; MD: -6.11, 95% CI: -7.74 to -4.47, respectively; p<0.00001), though the difference diminished by 24 months (MD: -3.37, 95% CI: -7.04 to 0.30; p=0.07). No significant differences were observed in overall GERD incidence (RR: 1.00, 95% CI: 0.75–1.33) or complications (RR: 1.00, 95% CI: 0.74–1.42). Metabolic outcomes showed marginal differences, with C-peptide (SMD: 0.02, 95% CI: -0.38 to 0.42) and GLP-1 (SMD: -0.22, 95% CI: -0.90 to 0.47) exhibiting minimal changes between groups.

Conclusion

Antral resection in sleeve gastrectomy is associated with superior short-term weight loss, but long-term differences remain inconclusive. Metabolic outcomes and postoperative complications appear comparable between techniques. Further randomized controlled trials with extended follow-up are warranted to refine surgical recommendations.

References

Disclosure

The author(s) declare no conflict of interest

Introduction

​​​​​Parenteral nutrition (PN) is necessary to overcome malnutrition in hospitalized patients with acute or chronic intestinal failure, but is associated with complications. Physicians often lack knowledge in clinical nutrition, which makes clinical decision support tools recommended for prescribing PN. ¹

Aims & Methods

This study evaluated the impact of the OLIVE TREE (Offering guidance and Learning to prescribers to Initiate parenteral nutrition using a Validated Electronic decision TREE), a decision tree integrated into the prescribing software at University Hospital Leuven, Belgium, on prescribing behavior and safety.² Two cohorts were compared: 63 patients who received OLIVE TREE-guided PN initiation and 63 who did not. The primary outcome, assessed in the first cohort, was the proportion of patients for whom the OLIVE TREE impacted prescribing behavior. An impact was defined as a different PN regimen that was prescribed after using the OLIVE TREE compared with before using the OLIVE TREE (i.e. for the first question of the OLIVE TREE, the prescriber had to indicate which PN regimen he/she would initiate). Secondary outcomes included changes in initial PN regimens, time to regimen change, mortality, PN-related complications (hyperglycemia, liver dysfunction, fluid overload, catheter-related thrombosis, central line associated bloodstream infection and PN-related intensive care transfer) and weight evolution between PN initiation and discontinuation and between PN initiation and discharge.

Results

An impact on prescribing behavior was observed in 33 of 63 patients (52.4%; 95% CI 39.4-65.1; p < 0.001), resulting in providing more calories (27.0%), less calories (9.5%) and more refeeding protocols (6.3%). Initial PN regimens were altered in 54.0% of both cohorts, with a median time to change of six days (p = 0.820). No significant differences were found in mortality (1.6% and 3.2%; p = 0.747), complications (31.9% and 48.1%; p = 0.284), weight change between PN initiation and discontinuation (-0.5kg [-3.2-0.5] and -0.6kg [-2.5-1.2]; p = 0.317) or weight evolution between PN initiation and discharge (-1.4kg [-3.6-0.2] and -1.3kg [-2.75-0.3]; p = 0.541) between the OLIVE TREE and non-OLIVE TREE cohort.

Conclusion

The OLIVE TREE significantly impacted prescribing behavior, without leading to earlier or more frequent PN regimen changes, increased complications or different weight evolutions.

References

1 1 Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft MD, et al. A.S.P.E.N. parenteral nutrition safety consensus recommendations. JPEN J Parenter Enteral Nutr. 2014;38(3):296-333.
2 Van den Broucke E et al. Offering Guidance and Learning to Prescribers to Initiate Parenteral Nutrition using a Validated Electronic Decision TREE (OLIVE TREE). J Med Syst. 2022;46(8):56.