Dysfunctional Gallbladder Disorder (DGBD) and Sphincter of Oddi Disorder (SOD) are possible causes of abdominal pain, biliary obstruction, and acute pancreatitis, and are often invoked when a structural etiology is not obvious. Diagnosis was traditionally based on gallbladder scintigraphy and sphincter of Oddi manometry, both of which have fallen out of favor and are no longer part of the Rome diagnostic criteria. For DGBD, the presence of typical biliary pain and persistence of symptoms despite watchful waiting, and for SOD, objective evidence of biliary obstruction and pancreatitis are now central to the diagnosis. With growing recognition that these disorders have traditionally been over-diagnosed and their treatments - which are risky - have been overused, the approach to cholecystectomy and endoscopic retrograde cholangiopancreatography has become progressively more restrictive. This trend continues in Rome V, although predictors of response to therapy, especially for biliary and pancreatic SOD, are desperately needed.

Rome V provides updated criteria for pediatric disorders of gut-brain interaction (DGBI), replacing age-based subdivisions with a classification based on regions and symptom patterns: abdominal pain disorders, defecation and anorectal disorders, and discomfort disorders. New entities were introduced including biliary pain syndrome, centrally mediated abdominal pain syndrome, functional abdominal bloating, and proctalgia fugax. The term "infantile colic" has been replaced with "infant distress syndrome." Existing criteria for irritable bowel syndrome, functional constipation, and nonretentive fecal incontinence were revised to improve diagnostic clarity and reflect current clinical understanding. Rome V also acknowledges that DGBIs may coexist with other conditions producing gastrointestinal symptoms. These updates are intended to support a more consistent diagnostic framework and guide appropriate management strategies for children and adolescents.

The digestive tract plays a key role in maintaining homeostasis and the general well-being of the human body via complex physiological functions. These gastrointestinal functions include motility; mixing of ingesta with pancreatic, biliary, and enteric secretions; absorption of digested nutrients; and disposal of undigested residues. Such processes usually occur without conscious perception. However, about 30-40% of the general population complain of digestive symptoms, often triggered by meal intake. Most of these people will be labelled as having a disorder of gut-brain interaction (DGBI). The pathophysiology of DGBI is complex, and not only involves bidirectional dysregulation of gut-brain interaction (via the gut-brain axis) but also microbial dysbiosis within the gut, altered mucosal immune function, increased epithelial barrier permeability, visceral hypersensitivity, and abnormal gastrointestinal motility. In this article, normal physiology and pathophysiology of GI function, and processes underlying symptom generation are reviewed. This article provides a thorough appraisal of symptom profiles, pathogenesis and functional tests of the wide array of DGBI.

Symptoms that can be attributed to the gastroduodenal area are classified into five categories: (1) Functional Dyspepsia, with two subcategories that can overlap: Postprandial Distress Syndrome, with meal-induced symptoms of postprandial fullness or early satiation and Epigastric Pain Syndrome, with epigastric pain or burning that does not occur exclusively postprandially; (2) Nausea and Vomiting Disorders, which include three subcategories: chronic nausea and vomiting syndrome; cyclic vomiting syndrome; and cannabinoid hyperemesis syndrome; (3) Excessive Belching Disorders, defined as audible escapes of air from the esophagus or the stomach and classified into 2 subcategories depending on the origin of the refluxed gas: gastric or supragastric belching; (4) Inability to Belch Syndrome, a new category defined by the self-reported inability to belch; and (5) rumination syndrome, defined by the repetitive, effortless regurgitation of recently ingested food into the mouth followed by the reswallowing or expulsion of the food bolus.

Upper gastrointestinal Disorders of Gut-Brain Interaction (DGBI) present from infancy through adolescence. The Rome V criteria have expanded to include DGBI of the esophagus, disorders of air-transit and feeding disorders as well as rumination syndrome, cyclic vomiting, chronic nausea syndrome and functional dyspepsia. This expansion provides a diagnostic framework for patients presenting with chest and throat pain, feeding difficulties, belching, pain with eating, nausea and vomiting. Given the advances in impedance technology and high-resolution manometry, testing plays a greater role in these diagnostic criteria than they have in past Rome iterations. This harmony between symptoms and testing results in more precision in therapeutic approaches that are critically multidisciplinary. The ability to assign new, positive diagnoses across the upper gastrointestinal tract offers new opportunities for pediatric-focused therapeutic trials.

Bowel Disorders (BDs), previously termed functional bowel disorders, are highly prevalent disorders worldwide. These disorders affect individuals across all demographic and socioeconomic groups and have substantial economic, in addition to a significantly reducing quality of life. Since the Rome IV publication in 2016 research in the basic and clinical sciences has provided new insights in epidemiology, etiology, pathophysiology, diagnosis, and treatment of BDs, creating the need to revise the diagnostic framework of BDs. This article presents the updated Rome V classification of BDs in 6 distinct categories: irritable bowel syndrome, chronic constipation, functional diarrhea, functional abdominal bloating, unclassified BD and opioid-induced constipation. Each disorder is defined, followed by sections on epidemiology, rationale for changes from prior criteria, clinical evaluation, pathophysiology and treatment. It is in hope that the Rome V BD Committee will assist clinicians and researchers in improving diagnosis, patient care and scientific endeavors of these common and burdensome disorders.

Irritable bowel syndrome (IBS) is a common medical condition characterized by different phenotypes. Diarrhea is usually prevalent in IBS patients, but constipation and meteorism are also common. Pharmacological therapies do not modify the IBS natural history. Thus, food supplements are used in clinical practice. The present Italian educational activity investigated the characteristics of IBS patients and compared the attitudes of gastroenterologists (GEs) and general practitioners (GPs).

FI adversely affects nearly every aspect of daily life. Patients often avoid telling symptoms, and physicians may neglect to inquire about FI symptoms. This study aims to audit the point prevalence of FI, and risk factors among participants older than 50 years old.

The lack of data on the relationship between dysphagia and major esophageal motility disorders (MEMDs) in the United Arab Emirates (UAE) has presented challenges for clinical management of dysphagia. This study aims to describe the characteristics of patients with dysphagia and MEMDs.

Our study aims to establish and validate a scoring framework based on hemodynamic parameters in patients with acute pancreatitis (AP), and to evaluate its clinical predictive performance and significance in guiding fluid resuscitation.

Fibrolamellar carcinoma (FLC) is a rare liver cancer affecting young adults without underlying cirrhosis. Although almost all FLC patients share an immunogenic DNAJB1-PRKACA fusion oncogene, endogenous antitumor immunity and clinical response to immunotherapy are limited. We hypothesized that the lack of response to immunotherapy is mediated by both T-cell exclusion and intratumoral immunosuppression.

Unresectable advanced pancreatic ductal adenocarcinoma (PDAC) typically requires systematic chemotherapy, but it remains unclear how this treatment remodels tumor cell plasticity and the tumor microenvironment (TME) to influence clinical outcomes.

Low anterior resection syndrome (LARS) affects up to 80% of patients following sphincter-preserving rectal surgery, profoundly impacting quality of life. Transanal irrigation (TAI) has emerged as a promising therapeutic intervention; however, the current evidence remains heterogeneous regarding its effectiveness, adherence, and optimal delivery methods. The specific contribution of nursing support in TAI implementation has not yet been systematically evaluated.

Despite their substantial global health impact, there has been no systematic and comprehensive evaluation of the epidemiological patterns and risk factors of pancreatitis and pancreatic cancer worldwide. This study aimed to quantify and compare epidemic indicators and their changing trends by sex, age group, and socio-demographic status from 1990 to 2019.

The past decade has witnessed a tremendous profusion of data on the luminal contents of the gastrointestinal tract and their interactions with the host, many of which have been implicated in the pathophysiology of Disorders of Gut-Brain Interaction (DGBI). The role of food in DGBI-related symptoms has attracted much attention and while many alterations in gut microbiome composition have been described, the multitude of factors that confound study design and interpretation in DGBI has precluded the discovery of a specific microbial "signature". The complexities of the gut barrier, its immune and enteroendocrine systems, so critical to the transmission of signals from lumen to host, continue to be revealed. Along the way, concepts such as the microbiome-gut-brain axis have emerged to explain symptom generation in DGBI, forming the basis for novel diagnostic approaches and therapeutic interventions. Taken together, recent research findings have renewed interest in luminal and enteric phenomena in DGBI.

We identify three centrally mediated disorders of gastrointestinal pain in the context of epidemiology, pathophysiology, clinical evaluation and treatment, including pharmacotherapy, brain-gut behavioral therapy and neuromodulation, with emphasis on the importance of a physician-patient relationship. Centrally mediated abdominal pain syndrome is characterized by chronic continuous abdominal pain. It has two main categories: Category A, where the pain occurs without association with physiological events, while in Category B, there is a variable association of pain with physiological events. It is thought to be predominantly a result of central sensitization with altered processing of visceral pain by spinal and brain networks rather than heightened peripheral afferent nerve excitability. Abdominal migraine is newly recognized in adults with paroxysmal, stereotypical episodes of intense abdominal pain. Narcotic bowel syndrome/opioid-induced gastrointestinal hyperalgesia is characterized by the paradoxical development of, or increases in, abdominal pain associated with continuous or increasing dosages of opioids.

Chimeric antigen receptor (CAR) T cells have shown great potential in hematological cancers, but lack efficacy in solid tumors, highlighting the need for novel strategies. Stimulator of interferon genes (STING) activation was shown to inflame the tumor microenvironment, but combination of STING agonists and CAR-T cells might be limited by detrimental outcomes of T cell-intrinsic STING activation. In this study, we evaluated the potential of combining STING agonists and CAR-T cells in the context of pancreatic cancer METHODS: We assessed the synergy of CRISPR-Cas9-edited CAR-T cells and the STING agonist diABZI within a T cell exhaustion model in vitro and both xenograft and syngeneic mouse models in vivo.

The variability of pancreatic vasculature, especially the dorsal pancreatic artery (DPA), increase surgical difficulty and may elevate the risk of intra- and postoperative bleeding. This study aimed to establish a precise preoperative vascular assessment protocol for pancreatic surgery, summarize DPA variant patterns, and evaluate their impact on pancreatic surgery-related bleeding.

Current indicators lack the precision required to accurately predict the PM(peritoneal metastasis) of gastric cancer (GC). The accurate prediction of GC with PM and the implementation of targeted therapeutic strategies hold substantial clinical significance. This study aimed to evaluate the prognostic value of galectin-1 expression and peritoneal fibrosis in predicting PM in GC patients. Immunohistochemical and Masson's trichrome staining were conducted on GC tissues and peritoneal tissues from 125 patients who underwent radical gastrectomy. The correlations among galectin-1 expression in GC tissues, peritoneal fibrosis, and PM were analyzed. Univariate and multivariate regression analyses were performed, incorporating clinicopathological parameters, to assess predictors of PM of GC. Both univariate and multivariate analyses revealed significant correlations among pathological Tumor (pT) stage, galectin-1 expression, peritoneal fibrosis, and PM. Patients with pathological pT3-4 stage GC, who had high galectin-1 expression and who were positive for peritoneal fibrosis had a greater risk of PM after pairwise superposition. This study represents the first to systematically elucidate that galectin-1 expression in GC tissues and peritoneal fibrosis are independent predictors of the risk of PM in patients with GC. These two indicators coordinate with pT stage, and the combination of these two indicators increases their predictive accuracy.