Enterococcus faecalis is an important cause of bacteremia and infective endocarditis, but the portal of entry often remains unclear. Enterococcal endocarditis is potentially fatal and predominantly affects older men in published cohorts. We describe two men, aged 69 and 40 years, who presented with E. faecalis infective endocarditis and gastrointestinal symptoms. The first patient was admitted with fever and ischemic stroke after three months of chronic diarrhea. Transthoracic echocardiography demonstrated a 12.5 × 5.6 mm mitral-valve vegetation. Pelvic magnetic resonance imaging and colonoscopy revealed a stenosing mid-rectal tumor, and biopsy confirmed invasive rectal adenocarcinoma staged as cT4aN2b. The second patient presented with fever, polyarthritis, and bloody diarrhea. Echocardiography showed a 13.2 × 6.5 mm aortic-valve vegetation, while computed tomography and colonoscopy revealed an ulcerated upper rectal mass with histopathological confirmation of mucinous adenocarcinoma. Both isolates were susceptible to vancomycin and gentamicin, and both patients received six weeks of intravenous vancomycin plus gentamicin. Follow-up blood cultures became negative in both cases. In Case 1, C-reactive protein decreased from 359 to 60 mg/L, transient renal dysfunction associated with glomerulonephritis resolved, and neurological recovery after ischemic stroke was partial. In Case 2, C-reactive protein normalized. Follow-up transthoracic echocardiography showed marked improvement after antimicrobial therapy. These cases support targeted colorectal evaluation in selected patients with E. faecalis endocarditis, particularly when gastrointestinal symptoms are present or no alternative portal of entry is identified.

Gallium-68 ([68]Ga) DOTATATE positron emission tomography/computed tomography (PET/CT) has emerged as the gold standard imaging modality for neuroendocrine tumors (NETs). However, false-positive uptake in non-NET pathologies can be a diagnostic dilemma. The authors report a case of a 70-year-old woman presenting with recurrent small bowel obstructions, chronic diarrhea, and progressive weight loss. CT imaging demonstrated high-grade small bowel obstruction with marked bowel wall thickening and confluent mesenteric and retroperitoneal lymphadenopathy that had progressively increased over the prior year, raising clinical suspicion for NET. DOTATATE PET/CT revealed elevated uptake in the terminal ileum, mesenteric and retroperitoneal lymph nodes, and L4 vertebral body, a distribution that was suspicious for metastatic small bowel NET. However, tissue confirmation and correlation with anatomic imaging established 3 concurrent non-NET diagnoses: grade 3A follicular lymphoma, Crohn's disease, and a benign vertebral hemangioma. Simultaneous DOTATATE uptake in multiple distinct entities represents a diagnostic challenge requiring careful correlation of metabolic, anatomic, clinical, and pathologic data.

Chronic diarrhea in pets features high incidence, often causing vitamin B12 deficiency. Probiotics, which can alleviate or even treat chronic diarrhea by improving intestinal microbial balance, have shown promise. Previously, our laboratory isolated a strain of Limosilactobacillus reuteri (CLAB) with vitamin B12-producing capability from canine feces. However, it had suboptimal palatability and insufficient efficacy against chronic diarrhea and vitamin B12 deficiency. In this study, the CLAB was combined with Enterococcus faecalis and Saccharomyces cerevisiae to formulate a compound probiotic paste. The properties of the paste were comprehensively evaluated via a series of experiments including sensory evaluation, pH testing, microbial colony counting, palatability tests, disease activity index scoring, histopathological analysis, biochemical indicator analysis, and RNA quantification. The results demonstrated that the paste exhibited good stability, safety, and favorable palatability in both dogs and cats. Meanwhile, it significantly alleviated chronic diarrhea and vitamin B12 deficiency in mice. Specifically, the high-dose compound probiotic paste decreased myeloperoxidase and malondialdehyde levels in diarrheic mice from approximately 15.9 and 2.5 nmol/mgprot to about 4.2 and 1.7 nmol/mgprot; increased the total antioxidant capacity content and superoxide dismutase activity from approximately 0.5 nmol/mgprot and 1.0 U/mgprot to about 0.6 nmol/mgprot and 1.6 U/mgprot; and downregulated the relative mRNA levels of interleukin-6, interleukin-1β and tumor necrosis factor-α from approximately 2.1, 2.1 and 2.7 to about 1.2, 1.1 and 1.3, respectively. In conclusion, this study supports the potential use of the compound probiotic paste for preventing and treating chronic diarrhea and improving vitamin B12 deficiency in pets.

Radiation enteritis (RE) is the most common complication of pelvic radiotherapy, often manifesting as diarrhea, hematochezia, and tenesmus. In some cases, it progresses to chronic radiation enteritis, leading to intestinal fibrosis and fistula formation, which severely impacts patients'quality of life and prognosis. Current therapeutic strategies for RE include radioprotective agents, surgery, nutritional support, and symptomatic management. However, their efficacy remains limited. The gut microbiota, a complex microbial community residing in the human digestive tract, is closely linked to human health. Numerous studies have identified gut microbiota dysbiosis in the context of RE. This review illustrates the intricate relationship between RE and the gut microbiota, focusing on the underlying mechanisms of their interaction. It also introduces emerging therapeutic strategies targeting the gut microbiota for RE, including engineered probiotics, washed microbiota transplantation (WMT), and ROS-scavenging nanomaterials, offering novel insights for its diagnosis and treatment.

Hematochezia has a broad differential, including nonsteroidal anti-inflammatory drug (NSAID)-induced, infectious, and inflammatory colitis. Colonoscopy with biopsy is primarily used to evaluate suspected colitis or inflammatory bowel disease (IBD) in patients with hematochezia, rather than to diagnose all causes of hematochezia. While the inflammatory bowel disease serology, genetics, and inflammation (IBD-SGI) blood panel test has been studied and marketed by laboratories, it is not widely implemented in routine clinical practice due to the restriction of current clinical guidelines, lack of FDA clearance/approval, and limited medical insurance coverage. Thus, we report a case of the utility of the IBD-SGI panel in the evaluation of atypical ulcerative colitis (UC) with active NSAID use. A 39-year-old man with hematochezia, diarrhea, and chronic high-dose NSAID use developed anemia, elevated fecal calprotectin, and endoscopic evidence of inflammation. Biopsies by colonoscopy showed focal colitis with features suggestive of both NSAID injury and IBD. To provide additional diagnostic support in this challenging case, an IBD-SGI blood panel was used. When interpreted with the patient's clinical presentation, elevated fecal calprotectin level, colonoscopic findings, and histopathologic features, the panel results supported a diagnosis of UC. Based on the overall clinic-pathological assessment, including continuous circumferential inflammation on colonoscopy and histopathologic evidence of chronic IBD, the patient was diagnosed with UC and treatment with vedolizumab was initiated. Anemia attributed to hematochezia was also managed. At the three-month follow-up, the patient had resumed his daily activities and returned to work. In the setting of overlapping features of UC and possible NSAID-associated colitis, the IBD-SGI panel provided adjunctive diagnostic information. This case highlights the panel's potential value as a supportive tool when endoscopic biopsy findings are inconclusive and multiple possible etiologies coexist.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with increasing global incidence, lacking specific targeted drugs. Green banana resistant starch (RS) has been shown to possess antioxidant effects and alleviate gastric ulcers and diarrhea, suggesting its potential therapeutic value for UC. However, its specific efficacy and mechanism of action remain unclear. In a dextran sulfate sodium-induced mouse model of UC, this study demonstrated that RS attenuates inflammatory responses and oxidative stress, preserves intestinal barrier function, and enriches beneficial commensals including Muribaculaceae, with a concomitant increase in propionate (PA) production. Its protective effects were microbiota-dependent, as shown in pseudo-germ-free mice. PA activated GPR43, triggering the SP1 pathway to suppress HDAC1 expression. Reduced HDAC1 increased HIF-1α acetylation, upregulating tight junction proteins (ZO-1, Occludin) and MUC2 while inhibiting NFκB/NLRP3 signaling and improving oxidative markers. PA supplementation mimicked RS benefits, whereas an HDAC activator counteracted them, thereby highlighting the central role of the HDAC1/HIF-1α axis. These results establish the mechanistic basis by which RS-derived propionate targets the HDAC1/HIF-1α axis against colitis, highlighting the potential of RS as a gut microbiota-targeting nutraceutical for UC management.

Background Celiac disease is a chronic immune-mediated enteropathy triggered by gluten in genetically susceptible individuals. Its presentation is variable and may range from classic malabsorptive symptoms to atypical or extraintestinal manifestations. Iron deficiency anemia (IDA) is a common extraintestinal presentation and may occur without gastrointestinal symptoms, which can delay diagnosis. Objective To determine the hospital-based proportion of celiac disease among patients with iron deficiency anemia at Cheikh Khalifa International University Hospital, Casablanca, Morocco, and to describe their clinical, biological, serological, and histological characteristics. Methods We conducted a retrospective, descriptive, single-center study of patients with IDA followed in the Department of Medical Hematology between January 2020 and September 2025. Among 635 patients with IDA, 97 underwent anti-tissue transglutaminase IgA (anti-tTG IgA) testing, and 40 underwent duodenal biopsy based on clinical suspicion. Celiac disease was confirmed by positive anti-tTG IgA serology and compatible duodenal histology. One patient with strongly positive serology and normal histology was classified as having potential celiac disease according to the Oslo definitions. Data were collected retrospectively from medical records and hospital databases. Results Among the 635 patients with IDA, 97 underwent serological testing, of whom 18 were positive, while 40 underwent duodenal biopsy. Seventeen patients had biopsy-confirmed celiac disease, and one additional patient was classified as having potential celiac disease, resulting in an 18-patient celiac disease spectrum cohort and a crude hospital-based proportion of 2.83%. This figure reflects selective, clinically driven testing and should not be extrapolated to the general population or to unselected patients with IDA. All 18 patients were female, with a mean age of 29.9 years. Asthenia was reported in all patients, and intestinal discomfort was the most frequent digestive symptom (83.3%). Weight loss, chronic diarrhea, and steatorrhea were reported in 66.6%, 44.4%, and 27.7% of patients, respectively. Extra-intestinal manifestations included arthralgia (38.9%), bone pain (27.7%), oral aphthous ulcers (11.1%), amenorrhea (22.2%), and recurrent miscarriage (16.7%). Mean hemoglobin was 9.9 ± 1.4 g/dL, and 94.4% of patients had ferritin levels below 15 ng/mL. Among the nine patients assessed for micronutrient status, folate and vitamin D deficiencies were found in 44.4% and 66.7%, respectively. Anti-tTG IgA was positive in all 18 patients, and Marsh III lesions were found in 66.6% of cases. Gastritis and Helicobacter pylori infection were each identified in approximately half of the patients who underwent upper endoscopy. All patients started a gluten-free diet; 12 received oral iron supplementation, and six received intravenous iron. Conclusion Celiac disease may be an underrecognized cause of iron deficiency anemia in this single-center hospital cohort, particularly among young women. Celiac serology should be considered in the evaluation of unexplained or persistent IDA, including in patients without overt gastrointestinal symptoms, to facilitate earlier diagnosis and appropriate nutritional management.