Introduction

STW 5, a herbal medicinal product with well characterized pharmacological action, has been shown in several RTCs to be an effective treatment in disorders of the gut-brain interaction (DGBI) as functional dyspepsia (FD) [1, 2]. The aim of the present study was to examine whether changes in gut microbiota induced in an experimental model of FD could be prevented by STW 5.

Aims & Methods

FD was induced in rats by subjecting them to neonatal maternal separation followed by subjecting them to restraint stress for 90 minutes/day for one week. During that week, one group (8 animals) was treated with the liquid form of STW 5 (5 ml/Kg) and one with its vehicle at the same dose level. Animals were sacrificed 24 h after the last drug administration. Fecal samples were taken from the cecum. Genomic DNA was isolated and changes in selected bacterial phyla and genera were assessed using quantitative Real Time-PCR (qPCR). The main phyla studied under the influence of stress in the model were the Bacteroidetes, Firmicutes, Fusibacterium and Actinobacteria.

Results

FD led to a 50% drop in the Lactobacilli population but to a two-fold rise in Proteobacteria abundance but did not affect significantly the changes in Bacteroidetes. Furthermore, the Methanobrevibacter population was raised more than two-fold while the genomic DNA concentration in Bifidobacterium dropped from ca. 3 ng/g feces to nearly nil.

Conclusion

In general, STW 5 tended to ameliorate and protect against the changes induced by the stress model. The results lend further support to the use of STW 5 in FD and IBS by providing evidence that it acts at least in part through influencing beneficially the changes in intestinal microbiota induced by stress. Taken together, the findings shed more light on mechanisms involved in the therapeutic action of STW 5 in gastro-intestinal disorders.

References

1. Malfertheiner P. STW 5 (Iberogast) Therapy in Gastrointestinal Functional Disorders. Dig Dis. 2017, 35 Suppl 1: 25-29
2. Allescher H-D, Burgell R, Malfertheiner P, Mearin F. Multi-target Treatment for Irritable Bowel Syndrome with STW 5: Pharmacological Modes of Action. Gastrointest Liver Dis. 2020;29: 227-233

Disclosure

OK and HA-K are empolyees of Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany. MTK has been obtaining travel support and speakers fees from Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany.

Introduction

Ehlers–Danlos syndrome (EDS) is a connective tissue disorder characterized by a non-inflammatory nature. Hypermobility EDS (hEDS) accounts for 80–90% of all EDS cases‎^‎1.
Over the past two decades, studies have reported a high prevalence of gastrointestinal (GI) symptoms among hEDS patients, including abdominal pain, bloating, constipation, diarrhea, nausea, vomiting, and reflux disease.

Aims & Methods

To characterize the GI symptoms in patients with hEDS and to explore the potential contribution of functional and anatomical abnormalities to the GI manifestations observed in this population.
We conducted a retrospective cohort study of patients diagnosed with hEDS who were evaluated at both the EDS and Gastroenterology clinics. Eligible patients had a clinical diagnosis of hEDS based on the Brighton criteria. Patients with a documented diagnosis of inflammatory bowel disease (IBD) were excluded. Demographic data, GI symptoms, and results from diagnostic evaluations—including anorectal manometry, balloon expulsion test, defecography, gastric emptying scans, transit studies, and endoscopic procedures—were collected and analyzed.

Results

A total of 76 patients with hEDS were included with a median age of 33.7 years. Common comorbidities included endometriosis (43.5%), fibromyalgia (36.8%). Macrophage activation syndrome was diagnosed in 2.6%.
Upper GI symptoms were frequently reported, with heartburn (31.6%), postprandial pain (30.3%), early satiety (25%), epigastric pain unrelated to meals (22.4%), and dysphagia (13.2%) being the most prevalent.
Lower GI complaints were even more common: constipation affected 64.5% of patients, bloating 57.9% and chronic diarrhea 40.8%. Notably, 19.7% experienced both constipation and diarrhea.
Among 32 patients who underwent colonoscopy, 30 had normal findings.
Anorectal manometry revealed hyposensitivity in 54% of constipated patients and hypersensitivity in 54% of diarrhea patients. Squeeze pressure was low in 38% of diarrhea patients. Balloon expulsion failure occurred in ~50% of patients across groups.
Defecography demonstrated a high prevalence of anatomical abnormalities: rectocele (67–78%), enterocele (47–78%), and rectal prolapse (53–78%). Gastroparesis was identified in 45–60% of patients undergoing gastric emptying scans due to lower GI complaints. Prolonged colonic transit was found in 25–50% of those evaluated.

Conclusion

Patients with hEDS commonly experience a broad range of upper and lower GI symptoms, often presenting with multiple overlapping complaints. Functional and structural abnormalities—such as rectal hyposensitivity, pelvic floor dysfunction, rectocele, and enterocele—were frequently identified and may underlie these symptoms. Notably, gastroparesis was prevalent, highlighting the widespread impact of EDS on GI motility. These findings underscore the importance of comprehensive GI assessment in EDS patients, integrating both functional testing and imaging to guide appropriate management.

References

1. Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017 Mar;175(1):48-69. doi: 10.1002/ajmg.c.31538. Epub 2017 Feb 1. PMID: 28145611

Introduction

20-25% of ulcerative colitis (UC) patients will experience at least one episode of acute severe colitis (ASUC). Up to 20% of non-responders to medical treatment will require surgery during the index episode. For approximately one third of the patients, ASUC is the first manifestation of the disease, presenting unique challenges.

Aims & Methods

A single-center, retrospective, cohort study. We included adult patients hospitalized in our gastroenterology department with ASUC. We aim to compare the clinical outcomes between patients with new-onset and established UC.

Results

62 (33.5%) patients had new-onset UC, while 123 (66.5%) had established UC. No significant differences were found in demographic and baseline clinical characteristics of the two groups. Patients with new-onset UC experienced longer hospitalizations (19 ± 22 vs. 12 ± 11 days, P = 0.002), longer delay until receiving rescue therapy [11 days (IQR 6) vs. 6 days (IQR 8), (P = 0.014)] and more severe bacterial infections (16% vs. 4%, P = 0.005) compared with patients with established UC. Histological features of chronicity, including architectural distortion, were more frequently observed in patients with established disease. We found no significant differences in steroid response (P = 0.719), need for rescue therapy (P = 0.522), response to rescue therapy (P = 0.234), colectomy (P = 0.655), mortality (P = 0.516) and hospital readmission (P = 0.929) between groups. After one year, colectomy or death occurred in 13.5% of patients. Independent predictors of adverse outcomes included active smoking, extensive colitis, the need for rescue therapy, and severe bacterial infections — but not new-onset disease.

Conclusion

Major clinical outcomes were similar between patients with new onset and established ASUC. These findings support the efficacy of standardized, protocol-driven management in mitigating risks across both groups.

References

Ordás I, Eckmann L, Talamini M, Baumgart DC, Sandborn WJ. Ulcerative colitis. Lancet. 2012;380(9853):1606-1619. doi:10.1016/S0140-6736(12)60150-0
Hindryckx P, Jairath V, D’Haens G. Acute severe ulcerative colitis: from pathophysiology to clinical management. Nat Rev Gastroenterol Hepatol. 2016;13(11):654–664. doi: 10.1038/nrgastro.2016.116
Dhaliwal J, Tertigas D, Carman N, et al. Outcomes Following Acute Severe Colitis at Initial Presentation: A Multi-centre, Prospective, Paediatric Cohort Study. J Crohns Colitis. 2024;18(2):233-245. doi:10.1093/ecco-jcc/jjad143
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis. 2022;16(2):179-189. doi:10.1093/ecco-jcc/jjab177