Opioid-induced nausea and vomiting (OINV) in patients with cancer imposes a substantial clinical burden and may compromise adherence to opioid therapy. Naldemedine, a peripheral μ-opioid receptor antagonist, is currently approved for the treatment of opioid-induced constipation. Recent evidence suggests similar benefits for the treatment of OINV. This study aims to evaluate the preventive effect of naldemedine on OINV in patients with cancer pain initiating opioid analgesics.

Encopresis is a common disorder of childhood that accounts for about one in four referrals to pediatric gastroenterology clinics (Culbert & Banez, 2007). Encopresis involves the repeated passage of feces into inappropriate places. Encopresis with constipation and overflow incontinence (retentive encopresis) accounts for more than 80% of pediatric encopresis cases. Despite its prevalence, the literature on the etiology and treatment of retentive encopresis is underdeveloped and has seen little innovation over the past half-century. While classical and operant conditioning mechanisms have long been implicated in the onset and maintenance of retentive encopresis, a comprehensive, transdiagnostic conceptualization has been lacking. This paper reviews the predominant model of retentive encopresis and proposes a novel framework grounded in inhibitory learning theory. Given the mechanistic similarities between anxiety disorders and retentive encopresis, this paper will propose that inhibitory learning theory should be utilized to optimize and innovate behavioral interventions for retentive encopresis, leading to more effective treatments.

Abdominal bloating, distension, excessive gas, abdominal pain, diarrhea and constipation are common symptoms that may arise from carbohydrate malabsorption, carbohydrate intolerance, small intestinal bacterial overgrowth (SIBO), intestinal methanogen overgrowth (IMO), or disorders of gut-brain interaction. Hydrogen- and methane-based breath tests are safe, noninvasive, inexpensive and widely used, but differences in indications, patient preparation, test performance and interpretation can lead to inconsistent diagnoses and management. At the recommendation of the Israeli Gastroenterology Association, a multidisciplinary panel of adult and pediatric gastroenterologists, neurogastroenterologists, dietitians, clinical nutrition specialists and heads of gastrointestinal laboratories reviewed the literature and reached consensus during 8 meetings. This guideline provides practical standards for breath testing in adults and children. The panel recommends simultaneous measurement of hydrogen and methane, structured symptom recording during testing, standardized pretest preparation, and cautious interpretation in settings that alter anatomy or orocecal transit time. Lactulose is recommended as the preferred substrate for SIBO/IMO testing, with glucose as an acceptable alternative. Carbohydrate malabsorption should be distinguished from intolerance by the presence or absence of typical symptoms during the test. The guideline also defines suspected hypersensitivity and highlights methane production as a cause of false-negative hydrogen-based carbohydrate tests. These recommendations are intended to harmonize breath test practice and reporting, and to support rational, test-directed treatment in adult and pediatric patients.

Anxiety, depressive symptoms, sleep disorders, and chronic constipation frequently co-occur and collectively impose a substantial clinical burden. Although these conditions may involve partially overlapping neural, endocrine, immune, and metabolic processes, their shared pathophysiological basis has not been fully established. This narrative review examines the potential role of the microbiota-gut-brain axis in linking affective symptoms, sleep disturbances, and chronic constipation. Evidence from human observational studies, Mendelian randomization analyses, animal models, and preliminary interventional studies suggests that alterations in gut microbial composition and function may contribute to these clinical associations through microbial metabolites, immune signaling, neuroendocrine regulation, and neural pathways. The review also summarizes microbiota-targeted interventions, including probiotics, prebiotics, dietary modification, and fecal microbiota transplantation. However, substantial heterogeneity in study populations, microbial findings, experimental methods, and intervention protocols limits causal interpretation and clinical generalization. A more rigorous distinction among associative, mechanistic, genetic, and interventional evidence is therefore required when evaluating the therapeutic potential of microbiota-based strategies.

Irritable bowel syndrome with constipation (IBS-C) is a common pediatric disorder of gut - brain interaction (DGBI) characterized by constipation-related bowel dysfunction and recurrent abdominal pain. Despite multimodal management, pharmacologic options specifically evaluated for pediatric IBS-C have historically been absent. Linaclotide, a guanylate cyclase-C agonist with local intestinal activity, has emerged as a mechanism-based therapy for this phenotype.