The phenomenon that meal ingestion immediately increases colonic motility was at first referred to as the "gastrocolic reflex", but later changed to the "gastrocolonic response" because of the possible involvement of humoral mediators. This review aims to describe the various mechanisms providing stimuli that alter the gastrocolonic response by dividing it into 'cephalic', 'gastric', and 'intestinal' phases, just as the process of gastric acid secretion after feeding, for a better understanding of the gastrocolonic response. The gastrocolonic response occurs within minutes after feeding and continues for 30-120 min. Fat must be an important component of the ingested meal to induce the gastrocolonic response, but the role of carbohydrates and amino acids remains unclear. The cephalic phase of the gastrocolonic response exists, but the mechanism, including the role of brain-gut peptide ghrelin, remains largely undetermined. Mechanoreceptors and nociceptors of vagal afferents are involved in the gastric phase of GCR. Chemoreceptors in the duodenum play a role in the intestinal phase of GCR. The GCR was not observed in the extrinsically denervated colonic segment. Thus, the involvement of neural factors has been shown in all three "cephalic", "gastric", and "intestinal" phases of the gastrocolonic response. There has been no definitive evidence to show the involvement of humoral factors, but the humoral mechanism cannot be dismissed. The GCR was abnormal or diminished in patients with chronic constipation and diabetes mellitus. These results indicate that neural pathways, rather than humoral pathways, are important mediators of the gastrocolonic response.

Constipation is a common gastrointestinal disorder, which impairs the quality of life. This study investigated the ameliorative effects of 6'-sialyllactose (6'-SL) in a loperamide-induced murine model of constipation and associated depressive-like behaviors. Constipation was induced in mice by loperamide and subsequently treated by administering 6'-SL at doses of 100 or 300 mg per kg body weight for 14 days. The ameliorative effects of 6'-SL were evaluated through defecation-related parameters, histopathological and immunohistochemical analyses of colonic and hippocampal tissues, biochemical assays, behavioral tests, gut microbiota analysis, and short-chain fatty acid (SCFA) levels. The results showed that 6'-SL alleviated loperamide-induced constipation by improving defecation-related parameters, colonic histopathology, gastrointestinal neurotransmitter levels, and AQP3 and SCF/c-Kit levels. Moreover, 6'-SL ameliorated constipation-associated depressive-like behaviors and hippocampal alterations while modulating the gut microbiota composition and increasing the SCFA levels. Spearman's correlation analysis suggested that the alleviation of constipation and depressive-like behaviors may be associated with alterations in the gut microbiota and SCFA levels upon 6'-SL intervention. These results provide a theoretical and practical basis for developing functional foods and biomedical products based on 6'-SL.

Hypothyroidism is associated with multiple gastrointestinal manifestations, ranging from mild constipation to rare life-threatening complications such as paralytic ileus and intestinal pseudo-obstruction. We report a case of a 41-year-old male patient with severe autoimmune hypothyroidism presenting with persistent abdominal distension and subacute intestinal obstruction secondary to fecaloma and colonic ileus. The diagnosis was initially obscured by concomitant diabetic ketoacidosis (DKA) and electrolyte disturbances. Despite resolution of DKA and multiple bowel decompression procedures, gastrointestinal symptoms persisted until hypothyroidism was recognised and treated with levothyroxine. This case highlights the importance of considering endocrine causes, particularly severe hypothyroidism, in patients with unexplained intestinal dysmotility and bowel obstruction.

Amyand's hernia is a rare condition characterized by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not be inflamed. We present the case of a 43-year-old male with a 3-year history of right inguinal hernia who presented to the emergency department with acute enlargement of the hernia sac and associated discomfort. A contrast-enhanced computed tomography scan of the abdomen and pelvis revealed a right inguinal hernia containing an inflamed appendix, consistent with acute appendicitis, with periappendiceal stranding but no abscess formation. The patient denied recent trauma or bowel habit changes, though he reported chronic constipation. This report highlights the importance of imaging in diagnosing rare hernia contents and discusses the management controversies associated with Amyand's hernia.

Cognitive impairment is among the most common non-motor symptoms in parkinsonism and Parkinson's disease, ranging from subjective complaints to dementia. Although several predictive factors have been described, their prognostic relevance remains uncertain. This study aimed to examine the predictive association between clinical features and the risk of dementia and determine the incidence of dementia in a population-based cohort of incident Parkinsonism cases. Patients with parkinsonism onset between 1991 and 2020 were identified using the Rochester Epidemiology Project records-linkage system. Subjects with cognitive impairment preceding motor symptoms onset or concomitant Alzheimer's disease were excluded. Diagnoses of dementia and mild cognitive impairment were established using neuropsychological testing or brief cognitive screening. Development of dementia was assessed using a Cox proportional hazards regression model. Associations between dementia and each risk factor were individually estimated in adjusted Cox models. All risk factors were also included in a least absolute shrinkage and selection operator penalized multivariable Cox model. A total of 1104 patients were included: 153 (13.9%) developed mild cognitive impairment, and 543 (49.2%) developed dementia during follow-up. The cumulative incidence of dementia was 30.3% at 5 years, 48.6% at 10 years, 61.4% at 15 years and 69.3% at 20 years, indicating that a considerable portion of patients remained free of dementia after a prolonged follow-up. The majority of patients with dementia were males (61.5%), and older age at disease onset was associated with risk of dementia (hazard ratio [HR] = 1.32, P < 0.001 per 5-year increment). In the penalized model, dementia risk was significantly higher among individuals presenting with impaired postural reflexes (HR = 1.26, P = 0.014), consistent with a poorer prognosis in akinetic-rigid-predominant parkinsonism. Eye movement abnormalities, including reduced ocular range of motion (HR = 1.86, P < 0.001) and smooth pursuit alterations (HR = 1.34, P = 0.024), were also associated with dementia. Non-motor symptoms, including rapid eye movement sleep behaviour disorder (HR = 1.51, P < 0.001), orthostatic hypotension (HR = 1.30, P = 0.009) and constipation (HR = 1.24, P = 0.022), were linked to dementia risk, supporting a potential involvement of non-dopaminergic and central autonomic pathways in cognitive decline. These findings were largely confirmed in the Parkinson's disease/Parkinson's disease with dementia group, in which 77 (13.5%) developed mild cognitive impairment and 249 (43.5%) developed dementia. Among these patients, smooth pursuit alterations, reduced ocular range of motion, orthostatic hypotension and constipation were associated with dementia.

Thalassaemia is a major public health concern in Eastern India, with many children requiring lifelong blood transfusions. Thalidomide, known for its immunomodulatory properties, has shown promise in reducing transfusion needs by increasing fetal hemoglobin production.The safety and efficacy of thalidomide was evaluated in 404 patients aged 2 to 18 years, diagnosed with beta thalassaemia major or intermedia.Mean age was 8.4 years with 54.5 % cases being male. Majority of the patients were Beta thalassaemia major (54.8%). Mean Haemoglobin ± SE at baseline was 6.435 ± 0.092, with a significant increase in haemoglobin levels from 6.435 ± 0.092 at baseline to 8.157 ± 0.069 at the 12 months (p < 0.001). The mean number of transfusions decreased from 1.261 ± 0.051 at 3 months to 1.108 ± 0.074 at 12 months (p < 0.001). The mean spleen size decreased from 3.712 ± 0.087 at baseline to 2.242 ± 0.068 at 12 months (p < 0.001). The mean ferritin level decreased from 1947 ng/mL at baseline to 1554 ng/mL at 12 months (p < 0.001). This decline in ferritin reflects both reduced transfusion requirements and improvement in iron overload. Total bilirubin levels also showed a significant downward trend over 12 months (p < 0.001). At the end of 12 months, 30.7% of the responses were excellent, 52.5% were good, 13.3% were partial and rest 3.5% were no response. Side effects were reported in 62.6% of the patients, out of which most common was constipation (51%).Thalidomide significantly benefits transfusion-dependent thalassaemia patients, with a high proportion showing excellent or good response.