Clinical Case Summary

Gastric cancer in the elderly remains underestimated, particularly in regions with high Helicobacter pylori prevalence but low recorded incidence. We present an 86-year-old Colombian woman from a coastal zone classified as low-risk, with a two-year history of dyspepsia, early satiety, weight loss (9 kg), and melena. She had no prior endoscopic evaluations and had only received symptomatic treatment. Upon admission, she exhibited severe anaemia (Hb 6.8 g/dL). Upper endoscopy revealed a Bormann II tumour in the antrum; CT ruled out metastasis. Biopsies confirmed moderately differentiated intestinal-type gastric adenocarcinoma with chronic atrophic gastritis, intestinal metaplasia, and active H. pylori infection. She underwent laparoscopic staging followed by subtotal gastrectomy with Roux-en-Y reconstruction, with a favourable recovery and no early complications. This case underscores the risks of delayed diagnosis in older adults and highlights the need for redefining screening strategies beyond chronological age. It calls for proactive H. pylori eradication in elderly patients, especially in high-prevalence countries with regional cancer disparities. Moreover, it advocates for routine use of histological staging protocols (e.g., OLGA/Sydney) in elderly dyspeptic patients. Despite advanced age, curative surgical intervention remains feasible and beneficial when functional status allows. Public health efforts must address diagnostic inertia and redefine preventive strategies tailored to elderly populations in Latin America.

References

• Choi IJ, Kook MC, Kim YI, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med. 2018;378(12):1085–95.
• Piazuelo MB, Bravo LE, Mera RM, et al. The Colombian Chemoprevention Trial: 20-year follow-up of a cohort of patients with gastric precancerous lesions. Gastroenterology. 2021;160(4):1106–1117.e3.
• Jonaitis P, Kupcinskas J, Gisbert JP, Jonaitis L. Helicobacter pylori eradication treatment in older patients. Drugs Aging. 2024;41(2):141–51.
• Choi IJ, Kook MC, Kim YI, et al. Helicobacter pylori therapy for the prevention of metachronous gastric cancer. N Engl J Med. 2018;378(12):1085–95.
  

Introduction

The densities of stem cells and their progenitors, and enteroendocrine cells are lower in IBS patients than healthy subjects.^1,2 IBS patients also exhibit submucosal low-grade inflammation.³

Aims & Methods

This study investigated the possible mechanisms underlying the effects of FMT in IBS patients included in a previous study from our group that showed high and long-term efficacy. Ninety-three patients who participated in our previous study were investigated: placebo group (24 patients), the groups that received 30g (47patients) or 60g (22 patients) donor`s transplant. The patients underwent sigmoidoscopy with biopsies, provided faecal samples, and completed IBS-symptom severity score (IBS-SSS), Fatigue Assessment Scale (FAS), and IBS Quality of Life questionnaires at the baseline and at 1 month after FMT. Sections from the biopsy samples were immune-stained for Musahi-1 (marker for stem cells and in their early progeny), neurogenin 3 (marker for early endocrine cell progenitors), chromogranin A (general marker for enteroendocrine cells), serotonin, peptide YY (PYY), glucagon-like peptide 1, GLP-1, pancreatic polypeptide, somatostatin, CD 45 (common marker for immune cells), B lymphocytes, T lymphocytes. NK cells, monocytes, macrophages, myeloid cells, and mast cells. The cell densities were quantified by computerized image analysis. Faecal short chain fatty acids (SCFAs) were measured by gas chromatography, and faecal bacteria by 16S rRNA PCR DNA amplification covering variable regions V3–V9.

Results

The densities of Musashi-1, neurogenin 3, chromogranin A, serotonin, PYY, and GLP-1 expressing cells increased significantly following FMT in patients who received 30g, or 60g transplant, but not in the placebo group. The densities of Musashi-1, neurogenin 3, chromogranin A, serotonin, and GLP-1 expressing cells correlated inversely with IBS-SSS total scores (r=-0.4, P<0.0001; r= -0.2, P=0.007; r=- 0.3, P<0.0001; r=-0.2, P=004; r=-0.4, P<0.0001, respectively). The densities of Musashi-1, chromogranin A, and GLP-1 also correlated inversely with FAS total scores (r=-0.2, P=0.01; r= -0.2, P=0.002; r=- 0.3, P=0.0009, respectively). The density of PYY cells did not correlate with either IBS-SSS or FAS scores. The densities of total submucosal immune cells, and mast cells decreased significantly after FMT in patients treated with 30g, or 60g donor´s faeces, but were unchanged in the placebo group. The densities of these cells were correlated positively with IBS-SSS total scores (r=0.4, P<0.0001; r=0.5, P<0.0001, respectively), and the total immune cells correlated with FAS total scores (r=0.3, P=0.0002). The levels of butyric acid increased significantly following FMT in the 30g and 60g treated groups, but not in the placebo group. The faecal levels of butyric acid were inversely correlated with IBS-SSS (r=-04. P<0.0001), and FAS (r=-0.3, P<0.0001) total scores. Among the bacteria that their abundance increased significantly in IBS patients that received FMT were Alistipes, Faecalibacterium prausnitzii, Eubacterium biforme and Lactobacillus spp.

Conclusion

Stem cells, enteroendocrine progenitor, serotonin, and GLP-1cells, as well as low-grade inflammation appear to play a significant role in IBS symptom manifestation and that FMT effect most probably is due to restoring the abnormality in them. The present observations suggest potential new treatments for IBS such as transplantation of epithelial organoids containing stem cells, GLP-1 agonist, low-dose anti-inflammatory drugs, pharmacological drugs to control mast cell function³, and sodium butyrate.

References

1-El-Salhy M. Possible role of intestinal stem cells in the pathophysiology of irritable bowel syndrome. World J Gastroenterol 2020;26:1427-1438.
2-El-Salhy M, Hausken T, Gilja OH, et al. The possible role of gastrointestinal endocrine cells in the pathophysiology of irritable bowel syndrome. Expert Rev Gastroenterol Hepatol 2017;11:139-148.
3-Barbara G, Stanghellini V, De Giorgio R, et al. Functional gastrointestinal disorders and mast cells: implications for therapy. Neurogastroenterol Motil 2006;18:6-17.

Disclosure

Nothing to disclose

Introduction

Studies have shown that adults with irritable bowel syndrome (IBS) may be associated with anxiety, mood disorders, chronic headache, and other neuropsychiatric conditions. This growing body of evidence can allude to a possible bidirectional gut-brain connection. While adolescence is the age when both IBS and neuropsychiatric illnesses often first manifest, this population remains under-studied.

Aims & Methods

We aim to assess the association between the presence of irritable bowel syndrome (IBS) and neurologic and psychiatric disorders in a nationwide cohort of adolescents. This cross-sectional study included all adolescents aged 16-21 who underwent mandatory medical evaluations as part of their conscription between 2000-2021. All individuals completed comprehensive medical interviews. Suspected diagnoses prompted referral to board-certified specialists for confirmation and severity grading based on predefined criteria. IBS was diagnosed according to the Rome II-IV criteria by a certified gastroenterologist.
Neurologic disorders included attention-deficit/hyperactivity disorder [ADHD], epilepsy, chronic headache, sleep disorders. Psychiatric disorders included psychotic, personality, general anxiety disorder [GAD], non-combat post-traumatic stress disorder [PTSD], mood, dissociative, and eating disorders. Each diagnosis was classified by severity (mild, moderate, severe). Unadjusted and multivariate-adjusted logistic regression models were fitted to estimate odds ratios (ORs) for associations with IBS. The adjusted models were accounted for age, sex, intelligence score, body mass index (BMI), socioeconomic status (SES), education, country of origin, and any concurrent neuropsychiatric diagnoses.

Results

The study included 1,561,717 adolescents (666,442 [42%] women, mean age 17.4 ± 1.4 years), of whom 7,230 (0.46%) were diagnosed with IBS (4,778 mild; 1,948 moderate; 504 severe). Neurologic disorders were present in 1,661 (23.0%) and 143,348 (9.2%) of those with and without IBS, respectively. The respective numbers of people with psychiatric disorders were 773 (10.7%) and 49,889 (3.2%). In multivariable adjusted models, those with IBS were more likely to have chronic headache (aOR 4.7, 95% CI: 4.4-5.1), GAD (aOR 3.6, 95% CI: 3.2-3.9), eating disorders (aOR 2.6, 95% CI: 1.9-3.5), mood disorders (aOR 2.5, 95% CI: 2.1-3.1), personality disorders (aOR 2.5, 95% CI: 2.1-2.9), and dissociative disorders (aOR 19.1, 95% CI: 12.5-28.9). Patients with severe IBS (n=504) were independently associated with the presence of at least one severe neurologic (aOR 2.9, 95% CI: 1.2-7.1) or psychiatric disorder (aOR 3.8, 95% CI: 2.6-5.4).

Conclusion

In this large nationwide cohort, adolescents with IBS were more likely to have several tested neurologic and psychiatric disorders, compared to those without IBS. Longitudinal studies are needed to explore the directionality and long-term implications of these associations.

Introduction

Irritable bowel syndrome (IBS) has a profound impact on health-related quality of life. Increasing evidence suggests psychological factors have a large impact in the development and course of IBS, and in particular quality of life, with large individual heterogeneity. This observational study aims to investigate the influence of personality traits using the Big Five Inventory (BFI) and examine their associations with abdominal pain, general and gastrointestinal-specific anxiety, and quality of life in patients with IBS.

Aims & Methods

Data from a large observational study in patients with IBS (Rome III criteria) was used, in which patients completed questionnaires with regards to personality traits (BFI-44), symptom severity, general anxiety, GI-specific anxiety, and quality of life. Multivariable regression models and a network correlation analysis were used to determine underlying associations.

Results

194 patients were included for analysis (74.7% female, mean age 51.36 years). There was a positive association of neuroticism to GI-specific anxiety (B 7.234, P = 0.040) and general anxiety (B 0.954, P = 0.040) with a strong negative association to mental quality of life (B – 3.576, P = 0.007). In addition, a strong negative association of agreeableness to mental quality of life was found (B – 4.266, P = 0.001). Although there were no significant associations of personality traits to abdominal pain, positive associations were found regarding general anxiety (B 6.304, p < 0.001) and GI-specific anxiety (B 0.034, P <0.001) of abdominal pain. There were no associations found with regards to the other personality traits openness, conscientiousness or extroversion.

Conclusion

IBS patients with a higher level of neuroticism were more likely to experience higher levels of GI-specific and general anxiety. The trait neuroticism and/or agreeableness was more likely to have a significant lower mental quality of life in IBS. These findings emphasize the contribution of personality traits in the pathophysiology and course of IBS, pleading for a more personalized approach in patient management.

Introduction

While the mechanistic background to functional bowel disorders, including irritable bowel syndrome (IBS) is insufficiently understood, there is growing evidence that cytokine imbalance and inflammation may contribute to IBS pathogenesis.

Aims & Methods

We undertook a comprehensive investigation of serum cytokine profiles in individuals with functional bowel disorders (IBS n=164, functional constipation n=6, functional diarrhea n=3) and healthy controls (n=31), mapping their associations with clinical symptoms (GSRS-IBS, HAD), the gut microbiome (whole-metagenome sequencing of fecal samples), colonic mucosal responses (bulk RNA sequencing of sigmoid biopsies), intestinal physiological parameters, and the serum metabolome (liquid chromatography-mass spectrometry). Serum levels of IFN-γ, IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-13, TNF-α, IL-17A and CXCL10 were measured with Meso Scale Discovery (MSD) multiplex immunoassay kits.

Results

While cytokine levels did not differ significantly between persons with functional bowel disorders and healthy individuals, CXCL10 was reduced in participants with predominant diarrhea (IBS-D and functional diarrhea, p=0.01), whereas IL-12p70 was increased in predominant constipation (IBS-C and functional constipation, p=0.03), compared to healthy controls. Within both the full study cohort and participants with functional bowel disorders, IL-12p70 levels correlated with oroanal transit time (rho 0.20 and 0.19, p=0.007 and 0.01, respectively), and were inversely associated with fecal short-chain fatty acids (p=0.006, 0.01 and 0.03 for acetate, propionate and butyrate, respectively), as well as with the abundance of several butyrate-producing species. By contrast, IL-12p70 levels were positively associated with mucus-resident species (e.g., from the Akkermansia and Victivallis genera), with metabolites potentially derived from the degradation of mucosal carbohydrates, and with a distinct T helper 1 type response in colonic biopsies. Moreover, IL-12p70 levels correlated with anxiety (rho 0.17, p=0.03) in participants with functional bowel disorders.

Conclusion

Systemic cytokine profiles did not discriminate persons with functional bowel disorders from healthy individuals, but participants with predominant constipation and diarrhea exhibited distinct cytokine profiles. Alteration of systemic cytokines, notably IL-12p70, may result from disrupted mucosal barrier integrity and host-microbe homeostasis, and contribute to extraintestinal symptoms in a subset of individuals with functional bowel disorders.