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Background Endoscopic full-thickness resection (EFTR) is an effective and safe technique for nonlifting colorectal lesions. Technical issues or failures with the full-thickness resection device (FTRD) system are reported, but there are no detailed data. The aim of our study was to quantify and classify FTRD technical failures. Methods We performed a retrospective study involving 17 Italian centers with experience in advanced resection techniques and the required devices. Each center shared and classified all prospectively collected consecutive failures during colorectal EFTR using the FTRD from 2018 to 2022. The primary outcome was the technical failure rate and their classification; secondary outcomes included subsequent management, clinical success, and complications. Results Included lesions were mainly recurrent (52 %), with a mean (SD) dimension of 18.4 (7.5) mm. Among 750 EFTRs, failures occurred in 77 patients (35 women; mean [SD] age 69.4 [8.9] years). A classification was proposed: type I, snare noncutting (53 %); type II, clip misdeployment (31 %); and type III, cap misplacement (16 %). Among endoscopic treatments completed, rescue endoscopic mucosal resection was performed in 57 patients (74 %), allowing en bloc and R0 resection in 71 % and 64 %, respectively. The overall adverse event rate was 27.3 %. Pooled estimates for the rates of failure, complications, and rescue endoscopic therapy were similar for low and high volume centers (P = 0.08, P = 0.70, and P = 0.71, respectively). Conclusions Colorectal EFTR with the FTRD is a challenging technique with a non-negligible rate of technical failure and complications. Experience in rescue resection techniques and multidisciplinary management are mandatory in this setting. [ABSTRACT FROM AUTHOR]

Novel impedance-pH parameters, Mean Nocturnal Baseline Impedance (MNBI) and Post-Reflux Swallow-Induced Peristaltic Wave (PSPW) index, have been proposed to improve the gastro-esophageal reflux disease (GERD) diagnostic yield. This study aims to determine the integrity of the esophageal epithelial barrier and chemical clearance using these novel parameters and to correlate them with acid exposure time (AET) and acid clearance time (ACT) in obese patients who are candidates for bariatric surgery (BS). Twenty impedance-pHmetry tracings of patients prior to BS were reviewed. Nine (45%) patients with a conclusive diagnosis of GERD had significantly higher ACT, lower MNBI in the distal esophagus and lower PSPW indexes compared to obese patients without GERD. Moreover, 100% of obese patients with GERD had a pathological ACT compared to obese patients without GERD (p = 0.003). However, the percentage of pathological MNBI and PSPW index did not differ between obese patients with and without GERD. The PSPW index and MNBI of the distal channel significantly correlated with ACT and AET. Further studies are needed to assess the role of time-consuming novel parameters in the routine evaluation of morbidly obese patients candidates for BS. The value of acid clearance time is confirmed as a relevant impedance-pH parameter in these patients. [ABSTRACT FROM AUTHOR]

This observational case–control study evaluated the anterior ocular segment parameters of patients with celiac disease with a Scheimpflug imaging system and compared them with those of a healthy controls group, highlighting potential differences related to the underlying pathogenetic mechanisms of the disease. Seventy celiac patients and 70 healthy subjects were assessed with a comprehensive ophthalmological evaluation, including clinical history, Snellen best-corrected visual acuity, axial length (AL) measurements with IOLMaster, and anterior segment tomographic evaluation with Pentacam HR. The measurements of all keratometry values, astigmatism, steep axis, anterior and posterior Q value (asphericity), pupil diameter, pupil center, corneal apex, the thinnest point, corneal volume, anterior chamber depth from the epithelium, anterior chamber depth from endothelium, anterior chamber volume, and iridocorneal angle were also appraised. The two study groups were comparable and similar for gender, age, and AL, with no statistically significant differences regarding all analyzed tomographic parameters. Thus, ocular anterior segment parameters of celiac patients are not significantly different from those of healthy subjects, suggesting no underlying pathogenetic implications of celiac disease affecting the assessed structures. Nevertheless, a routine ophthalmological examination for all celiac patients should be recommended throughout their lifetimes due to the potential ocular manifestations of the disease. [ABSTRACT FROM AUTHOR]

Background and aim: Bariatric surgery (BS) is a pillar for the treatment of morbid obesity and its related comorbidities. However, it might be associated with long-term deficiencies and absorption issues. Adherence to micronutrient supplementation is a crucial aspect in the management of these patients. Aim: The aim of the present survey was to evaluate the adherence to micronutrient supplementation in a cohort of Italian patients submitted to BS (BS patients) and to identify predictors of adherence using a self-administered, anonymous, internet-based instrument. Methods: Patients who underwent BS over the last decade in a single center were invited to participate to a self-administered, anonymous, internet-based survey consisting of a 23 items structured questionnaire evaluating: a. demographic information b. Bariatric procedures performed; c. Indication to BS; d. Lapse of time since last BS, e. Frequency of follow up visits post-surgery, f. Perception of well-being post BS; g. Adherence to micronutrient supplementation; h. Changes in their quality of life and self-esteem. Results: We received an automatic notification of delivery from 1100 out of 1600 BS patients and 290 (81.4% female, mean age 39.5 ± 10.1 years) completed the questionnaire. The main reported bariatric procedures were: Sleeve Gastrectomy (59%), Roux-en-Y Gastric Bypass (31%) and Adjustable Gastric Banding (7.2%). Only 33.1% of the sample acknowledged to have taken all recommended medication regularly. BS patients who underwent malabsorptive procedures and had their last follow up visit more than 5 years earlier, had a higher risk of being nonadherent to micronutrient supplementation. Conversely, BS patients in their forties seemed more likely to adhere to treatment recommendations. Losing more weight was the only independent risk factors for nonadherence to micronutrient supplementation, independently from patient’s perception of wellbeing. Conclusion: After BS, several clinical and psychosocial factors might predict nonadherence to micronutrient supplementation. [ABSTRACT FROM AUTHOR]

Background Oral lichen planus (OLP) and hyposalivation have been reported as extrahepatic manifestations of hepatitis C virus (HCV) infection. Our study evaluated the effect of direct antiviral agents (DAAs) on OLP and hyposalivation in convicts with chronic hepatitis C, examining patients before, during and after the antiviral treatment period with direct acting antiviral agents (DAAs). Methods We screened 198 inmates for the presence of the HCV antibody. Patients found to be positive underwent a quantitative HCV-RNA test and HCV genotype typing, as well as an oral cavity examination using a scoring system for OLP (REU score) and the clinical oral dryness score (CODS). Subsequently, all patients underwent DAA therapy and a systematic physical examination of the oral cavity at 1, 3 and 6 months from the beginning of treatment. Results Fifty patients (25.25%) had a positive HCV-RNA test. At baseline, OLP was detected in 4 patients (8%), with a mean REU score of 10.13±4, and different degrees of hyposalivation were seen in 17 patients (34%), with a mean CODS score of 4.71±1.72. Six months after the start of DAA therapy, we observed resolution of OLP in 3 patients (75%) and improvement in the remaining subject with a significantly lower mean REU score (2±4). Hyposalivation disappeared in 5 patients, improved in 10, and remained unchanged in 2 patients with a significantly lower mean CODS score (0.06±0.24). Conclusion This study demonstrated the effectiveness of DAAs in the treatment of OLP and hyposalivation. [ABSTRACT FROM AUTHOR]

Introduction: Celiac disease (CeD) diagnosis has worldwide shared protocols. Conversely, follow-up of patients is still an object of study. Gluten immunogenic peptide detection in the urine (GIP) appears to be a new and efficient method for dietary gluten control of patients. The present study aims to assess the clinical usefulness of the GIP point-of-care urine test in the follow-up of symptomatic and asymptomatic patients with CeD before and during the COVID-19 lockdown in Italy. Methods: Thirty adult CeD patients on a gluten-free diet (GFD) were enrolled before and during the COVID-19 lockdown through follow-up visits or remote consultation. Patients underwent anthropometrical evaluation, dietetic interview, and State-Trait Anxiety Inventory (STAI). Then, two groups were formed: symptomatic and worried about gluten contamination. Each patient received 5 GIP point-of-care tests to perform a maximum of 5 times in the following 5 weeks in case of symptoms or anxiety state due to hypothesized gluten contamination. Results: Sixteen symptomatic patients and 14 patients with concerns related to gluten contamination were included. There were no differences in age, BMI, compliance to GFD and GIP positive tests between the two groups. Worried group showed a borderline higher level of anxiety than symptomatic group (p = 0.06), with a significant minor percentage of patients reporting "no or low anxiety" (14.3% vs 50% p = 0.03). The symptomatic patients showed a higher rate of diarrhea than worried group (25% vs 0%, p = 0.04). Gluten in urine samples was globally found in 8 out of 30 cases (26.6%). Conclusion: The GIP test is a tool that can be used as a point of care test to assess adequate compliance with GFD and reassure symptomatic CeD patients from the feeling of anxiety for gluten contamination, especially during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. Methods: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re‐assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self‐administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. Key Results: The intensity‐frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1–1.7]), waterbrash (OR 1.3 [1.0–1.7]), epigastric burning (OR 1.3 [1.0–1.6]), and abdominal pain (OR 1.6 [1.0–2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. Conclusions and Inferences: During the COVID‐19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them. [ABSTRACT FROM AUTHOR]

Patient: Male, 77-year-old Final. Diagnosis: Enterocolic fistula. Symptoms: Diarrhea • pain and guarding of the abdomen • weight loss. Medication: -- Clinical. Procedure: Colonoscopy with colon biopsy. Specialty: Gastroenterology and Hepatology. Objective: Unusual clinical course. Background: Endoscopic full-thickness resection represents an innovative procedure, used in selected patients that allows lesions en-bloc resection with an integral wall specimen available for histopathological definition. Bleeding and perforation are known to be the most frequent procedure-related adverse events. We report a case of enterocolonic fistula as complication of an endoscopic full-thickness resection. Case Report: A 77-year-old male, with a personal history of right-hemicolectomy for a colonic adenocarcinoma presented to our department for a routine colonoscopy that showed the presence of a 25 mm lateral spreading tumor localized at about 50 cm from the anal margin. A full-thickness resection of the lateral spreading tumor using the over-the-scope clip device was performed. After 4 weeks, because of abdominal pain, weight loss, diarrhea, and signs of malnutrition, the patient underwent a new colonoscopy showing hyperemic mucosa with ulcerations in all colonic segments and, at the site of the previous endoscopic full-thickness resection, an orifice of an entero-colonic fistula. The histological definition was suggestive for ulcerative proctocolitis and confirmed the presence of small bowel mucosa at fistula orifice. An intussusception at the level of fistula with consequent intestinal obstruction caused a worsening of clinical conditions and finally the patient death for a septic peritonitis. Conclusions: Full thickness resection represents an innovative tool for en-bloc resection of gastrointestinal tumoral lesion, but procedural complications and limitations must be considered before performing this procedure. [ABSTRACT FROM AUTHOR]

Nuclear fusion power plants require electron cyclotron (EC) heating and current drive (H&CD) systems for plasma heating and stabilization. High-power microwave beams between 1 and 2 MW generated by gyrotrons propagate in a dedicated waveguide transmission system to reach the plasma at specific locations. Key components in this transmission system are the chemical vapor deposition diamond windows on both the torus and gyrotron sides of the reactor as they allow transmission of high-power beams while acting as confinement and/or vacuum boundaries. Diamond windows consist of a polycrystalline diamond disk integrated in a metallic housing. In the conventional configuration, there is one disk perpendicular to the beam propagation direction. A steering mechanism is then used to deploy the fixed frequency beam at different locations in the plasma. This is, for instance, the configuration used in the ITER EC H&CD system. Movable parts close to the plasma will be problematic for the lifetime of launchers in future fusion reactors like the DEMOnstration nuclear fusion reactor (DEMO) because of the higher heat loads and neutron fluxes. Therefore, one of the alternative concepts is to deploy the beams directly at the desired resonant magnetic flux surface by frequency tuning gyrotrons. In this case, diamond windows able to work in a given frequency range, like the diamond Brewster-angle window, are required. It is an elegant and compact broadband window solution with the disk inclined at the Brewster angle with respect to the beam direction. This paper shows the development and the current state of different diamond window concepts including the design, the numerical analyses, and application of standard construction nuclear codes and of a specific qualification program. [ABSTRACT FROM AUTHOR]

The ITER torus diamond window unit is part of the electron cyclotron (EC) upper launcher (UL) used to direct high power microwave beams generated by the gyrotrons into the plasma for heating and current drive (H&CD) applications. The UL consists of an assembly of ex-vessel waveguides (WGs) and an in-vessel port plug (PP). The diamond window units form vacuum and confinement boundaries between the torus volume and the transmission lines (TLs) which guide beams between 1 and 1.5 MW at 170 GHz from the gyrotrons to the launcher. There are eight window units attached to the assembly of the WGs, one unit for each WG. The design strategy of the unit is to have a very rigid outer frame able to withstand the potential external loads acting on the unit while thin copper cuffs brazed to the diamond disk allow indirect cooling of the disk to remove the EC power absorption during the beam transmission. The load combination given by the stringent ITER seismic level 2 (SL-2) event occurring during baking of the torus vessel is the design driver for the outer frame of the unit. In fact, the assembly of the WGs is connected from one side to the ceiling of the ITER port cell area by a support frame and to the UL PP from the other side. Movements of the torus vessel due to baking, seismic and plasma disruption events, result in forces and moments acting on the units. Furthermore, during a seismic event, the unit is subject to additional loads induced by the oscillation of the support frame attached to the ceiling. An outer frame surrounding the window unit is thus required to ensure the structural integrity and the confinement function of the unit. This paper shows how the design of the window unit was assessed and optimized by finite element method (FEM) analyses. A specific methodology was developed to carry out the analyses with respect to the seismic and baking loads. At Karlsruhe Institute of Technology (KIT), FABRY-PEROT resonators measure the loss tangent of the diamond disk and it is then used as input to the computational fluid dynamics and FEM analyses aiming to assess the design. The impact of the FEM analyses on the design of the window unit is discussed also together with the manufacturing aspects of the unit. [ABSTRACT FROM AUTHOR]

We, herein, describe a patient with a choledochal polyp who underwent IDC followed by macrobiopsy using an IDC retrieval snare. A cholangioscopy-guided cold macrobiopsy of the choledochal polyp was successfully performed using an IDC snare (Spyglass retrieval snare) and the specimen was collected for histopathological examination (Fig. [Extracted from the article]

The former lesion was treated with radiation therapy, but the second lesion could not be treated owing to close proximity to the bladder (Fig. 1 Computed tomography (CT) and endoscopic ultrasound (EUS) images. a CT image showing the recurrent pelvic lesion adjacent to the bladder. b EUS image of the recurrent pelvic lesion adjacent, but a few centimeters distant, from the bladder. c EUS image of the pelvic lesion with the radiofrequency ablation needle inside, surrounded by hyperechoic haloes due to tumor ablation, with tissue necrosis. d Contrast-enhanced EUS evaluation after lesion ablation, showing complete lack of contrast uptake. The 19 G RFA needle was inserted into the lesion and radiofrequency current was administered at 50 W until increase of impedance on the RFA generator (Fig. [Extracted from the article]

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) followed by intracholecystic lithotripsy was offered as a minimally invasive treatment alternative to surgery and scheduled for 2 weeks later. Elective endoscopic gallbladder treatment has been described previously in five relatively young patients with a mean age of 50 years and giant gallstones, who rejected surgery and desired gallbladder preservation [2]. With an aging population, the number of elderly frail individuals at high surgical risk and gallstone disease requiring surgical intervention is expected to increase [3], and elective endoscopic gallbladder treatment may be a valid alternative treatment option in such patients. [Extracted from the article]

The electron cyclotron (EC) heating and current drive (H&CD) system developed for the ITER is made of 12 sets of high-voltage power supplies feeding 24 gyrotrons connected through 24 transmission lines (TL), to five launchers, four located in upper ports and one at the equatorial level. Nearly all procurements are in-kind, following general ITER philosophy, and will come from Europe, India, Japan, Russia and the USA. The full system is designed to couple to the plasma 20 MW among the 24 MW generated power, at the frequency of 170 GHz, for various physics applications such as plasma start-up, central H&CD and magnetohydrodynamic (MHD) activity control. The design takes present day technology and extends toward high-power continuous operation, which represents a large step forward as compared to the present state of the art. The ITER EC system will be a stepping stone to future EC systems for DEMO and beyond. The development of the EC system is facing significant challenges, which includes not only an advanced microwave system but also compliance with stringent requirements associated with nuclear safety as ITER became the first fusion device licensed as basic nuclear installations as of 9 November 2012. Since the conceptual design of the EC system was established in 2007, the EC system has progressed to a preliminary design stage in 2012 and is now moving forward toward a final design. [ABSTRACT FROM AUTHOR]

Dr. Wang et al. analyzed 38 returned surveys sent to their irritable bowel syndrome (IBS) patients early in the pandemic. We would like to thank Dr. Wang and colleagues for their interest in our study focused on the effects of perceived stress and anxiety due to COVID-19 lockdown on symptoms in functional gastrointestinal disorders (FGID) patients. Finally, COVID-19 outbreak has severely tested our health system, making us neglect various categories of patients such as those suffering functional GI symptoms. [Extracted from the article]

Objectives: The diagnosis of vestibular neurolabyrinthitis is based on the sudden appearance of vertigo that lasts for hours or days without associated cochlear or central nervous system signs or symptoms. The advent of the video head impulse test, cervical vestibular evoked myogenic potential testing, and ocular vestibular evoked myogenic potential testing has provided interesting clinical evidence for evaluating and monitoring the damage to specific compartments of the vestibular apparatus. These various methods of testing individual end-organ functions may have a clinical impact on the vestibular vvorkup of neurolabyrinthitis. Methods: This report describes 3 patients with acute vestibular neurolabyrinthitis in whom caloric tests, cervical vestibular evoked myogenic potentials, ocular vestibular evoked myogenic potentials, and the video head impulse test led to a suspicion of peripheral vestibular deficits of the lateral or superior semicircular canal ampulla or ampullary nerves. Results: In our patients, the examination results (normal hearing, absence of responses on caloric testing, and bilateral preservation of cervical and ocular vestibular evoked myogenic potentials) disclosed an acute partial superior vestibular neurolabyrinthitis. Conclusions: To our knowledge, these are the first reported cases in which selective damage to the lateral and superior semicircular canals and their nerves caused by neurolabyrinthitis was demonstrated clinically. Our clinical results indicate that the damage can be selective for specific vestibular end organs. [ABSTRACT FROM AUTHOR]

Objectives: We analyzed the behavior of preoperative and postoperative vestibular evoked myogenic potentials (VEMPs) and vestibular evoked periocular potentials (VEPPs) in 3 patients who had vestibular schwannoma and underwent modified translabyrinthine surgery. Methods: We compared VEMPs and VEPPs, measured with both air-conducted (AC) and bone-conducted (BC) stimulations. Vestibular evoked potentials were measured both in the immediate postoperative period and some months later. Results: At the immediate postoperative examination, VEPPs were preserved in all 3 patients with both AC and BC stimulations. The VEMPs showed stable or improved parameters in 2 of our patients and were absent in the third patient. At the follow-up examination, VEMPs did not show any significant change with respect to the previous evaluation. In contrast, VEPPs were absent in 2 of our patients with AC stimulation and in 1 patient with BC stimulation. Conclusions: Our results seem to indicate a greater stability and reproducibility of VEMPs compared with VEPPs. In 1 patient, who had a schwannoma of the inferior vestibular nerve, the preservation of VEPPs and the absence of VEMPs in the immediate postoperative period confirm that the saccule represents the origin of VEMPs. Furthermore, these results suggest that not only the saccule, but also the utriculus, could be implicated in the origin of VEPPs. [ABSTRACT FROM AUTHOR]

Benign paroxysmal positional vertigo is probably the most common cause of vertigo. It is characterized by acute short-lived episodes of severe vertigo in association with change in the position of the head. This condition is benign, and after the repositioning procedure, the cure rate is between 70 to 80%. Numerous studies describe the association between vertigo and social handicap and emotional disturbance. In our study, we report for the first time the level of anxiety and social consequences, tested with the Hamilton anxiety scale and vertigo handicap questionnaire, in a group of patients who had suffered only from positional vertigo and were clinically cured when the questionnaires and test were administered. The important role played by psychological factors in maintaining or increasing the social consequences and perception of vertigo is revealed in this study. [ABSTRACT FROM AUTHOR]

In our experience some patients subjected to stapedotomy presented vestibular symptoms characterized by brief episodes of vertigo that only lasted 10 to 20 seconds, accompanied by rapid paroxysmal nystagmus similar to that found in benign paroxysmal positional vertigo (BPPV). For this study, 141 otosclerotic patients were enroled and underwent stapedotomy following the Fisch and Dillier's technique. Twelve out (8.5%) of all the patients under study complained of post-operative vertigo and the physical examination of the positional nystagmus confirmed the presence of paroxymal positional vertigo. The percentage seems particularly high and does not agree with the data reported in literature. The onset of the vestibular symptoms appeared between the 5th and 21st day after surgery. To our knowledge, this is the first prospective study existing in literature on the incidence of BPPV after surgery of the stapes. It must also be stressed that the patient should be informed beforehand during the consultation phase of the possibility of post-stapedotomy BPPV together with the other causes of post-operative vertigo. [ABSTRACT FROM AUTHOR]

The present investigation was specifically designed to evaluate the ability of the glycerol test combined with pure tone audiometry, distortion-product otoacoustic emissions (DPOAEs), and vestibular evoked myogenic potentials (VEMPs) to diagnose endolymphatic hydrops early and to identify cases that may evolve toward Meniere's disease. This investigation consisted of 29 consecutive patients with mild dizziness or vertigo who received no treatment. Each patient underwent glycerol testing measured with conventional pure tone audiometry and with both DPOAEs and VEMPs. It is interesting to note that in 7 and 8 of the 29 cases, the VEMPs and DPOAHs, respectively, showed an improvement after glycerol administration that had not been shown on traditional audiometry. A further element worthy of consideration emerges from an analysis of the VEMP results compared to the DPOAE results that divided the patients into 4 groups. The first group had a postglycerol improvement with both methods, which would seem to suggest hydrops in both the anterior and posterior parts of the labyrinth. In the second and third groups, there was an improvement only either with VEMPs or DPOAEs. and this finding seems to indicate that only one endolymphatic compartment might be involved. In the last group, all patients had a positive glycerol test with positive DPOAEs on one side and with positive VEMPs on the other. Although endolymphatic hydrops can only be proven after death, a combination of VEMPs and DPOAEs with the glycerol test may permit early diagnosis of endolymphatic hydrops. These results clearly imply that these methods should be permanently included in the diagnostic protocol of patients with vestibuiar and audiological symptoms. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) causes not only severe illness but also detrimental effects associated with the lockdown measures. The present study aimed to evaluate reported lifestyle changes in a cohort of adults in Italy, including physical exercise, food choices, and psychological wellbeing, after two months of lockdown. Methods: A web survey on social media (Facebook and LinkedIn) of 32 multiple-choice questions aiming to evaluate the impact of the national COVID-19 lockdown in a sample of Italian adults. Results: We received 1378 complete responses (women 68.3%, mean age 39.5 ± 12.5 years). The percentage of participants reporting regular exercise decreased during lockdown (52 vs. 56.5%). The vast majority of people continued to consume the three traditional meals per day, but the consumption of meat, fish, and eggs significantly decreased. Women reported more frequent anxiety, sadness, fear, and feelings of insecurity than men. The factors predicting the worst outcome during the lockdown were being a woman, low education and income, gastrointestinal diseases. Conclusion: The lockdown has had a limited impact on food choices and physical exercise in Italian adults of our series, since most of them made an effort to improve their lifestyle. However, women with gastrointestinal diseases reported more frequent negative feelings and poor adaptation to the lockdown. [ABSTRACT FROM AUTHOR]

Eating disorders (ED) are frequently associated with a wide range of psychiatric or somatic comorbidities. The most relevant ED are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorders (BED). Patients with ED exhibit both upper and lower gastrointestinal (GI) symptoms. Evidence of alterations throughout the GI tract in ED will be analyzed given the role of the GI tract in food intake and its regulation. It remains a matter of debate whether GI disorders are inherent manifestations of ED or the results of malnutrition occurring from ED. Moreover, recent clinical studies have highlighted the growing role of intestinal microbiota in the pathogenesis of ED, making it possible to hypothesize a modulation of intestinal microbiota as a co-adjuvant to standard therapy. The aim of this review is to analyze the link between ED and GI diseases and to present, where known, the potential key factors underlying these conditions. Conclusions: The presence of GI disorders should be investigated in patients with ED. Screening for ED should also be encouraged in individuals seeking treatment for unexplained GI complaints to better address therapeutic issues that surround these difficult medical conditions. [ABSTRACT FROM AUTHOR]