Diarrhea caused by amoxicillin (A) or amoxicillin-clavulanate (AC) is common in children, and the induced dysbiosis is often characterized by a severe reduction in bifidobacteria. However, bifidobacteria are extremely antibiotic-sensitive, and their co-administration with antibiotics is likely unwise. The B. breve PRL2020 strain is an A- and AC-resistant probiotic. In a multicenter, randomized, controlled, non-profit study, we tested the tolerability and efficacy of the PRL2020 strain when co-administered to children (3-12 years; N = 121) undergoing A or AC therapy, attempting to interpret the results obtained by observing the intestinal microbiota in a subgroup (N = 41) of enrolled children. In children treated with the probiotic, the therapy was well tolerated and the incidence of diarrhea was significantly reduced by approximately 70% (p < 0.01). Considering only children with diarrhea, in the probiotic-treated group the onset was postponed by about 15 h, and the symptom lasted 19 h less. Gut microbiota richness was significantly reduced in both groups, without significant differences between probiotic-treated and control children. At the phylum level, antibiotic treatment was associated with an increase in Proteobacteria and a reduction in Actinobacteria, with larger apparent shifts in the control group. Bifidobacteria, particularly B. breve, decreased in controls and increased in treated subjects (p < 0.05), despite not being among the most abundant taxa contributing to the majority of the microbial community. Finally, although only in a trend-based manner, butyrate-producing bacteria decreased less in probiotic-treated children, whereas an increase in succinate-consuming bacteria was observed in controls. Co-administering the B. breve PRL2020 strain with A or AC in children significantly reduces diarrheal symptoms and antibiotic-related dysbiotic status. New blinded, placebo-controlled studies with a more robust sample size for microbiota analysis will have to confirm our data.

This study aimed to identify the clinical characteristics of systemic lupus erythematosus (SLE) patients with complicated with lupus mesenteric vasculitis (LMV), and to determine the impacts of the first-visit department, the number and duration of digestive system symptoms on disease activity, and imaging features of LMV patients. We expected that our study would keep clinicians across specialties vigilant for SLE-LMV, enabling early diagnosis and prompt treatment, thereby improving prognosis and reducing mortality from this potentially fatal condition. Clinical data of 174 patients with LMV admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2023 were collected and analyzed. The baseline clinical characteristics and laboratory data were analyzed and compared by the first-admission department: either the Rheumatology Department or other departments. In addition, the impact of the numbers and durations of various digestive system symptoms in these patients, as well as laboratory results, disease activity, and imaging findings, was analyzed. The independent-samples t-test and Mann-Whitney U-test were used to compare differences in continuous variables. In contrast, the Kruskal-Wallis test, chi-square test, or Fisher's exact test was used to compare differences in disease activity-related indicators, imaging features, and treatment regimens. A total of 174 patients with an initial diagnosis of LMV were included in this study. Among these patients, 87 (50.0%) had a prior SLE diagnosis, 76 (43.7%) were first diagnosed in the Rheumatology Department, and 36 (20.7%) and 31 (17.8%) were first diagnosed in the Departments of Gastroenterology and Emergency Medicine, respectively. All patients had mild to severe digestive symptoms, including abdominal pain, diarrhea, nausea, vomiting, and abdominal distension. Multiple digestive symptoms occurred in 151 (86.8%) patients. The patients were divided into two groups based on whether they were first diagnosed in the rheumatology department or other departments. The results showed that patients who were not initially diagnosed in the rheumatology department had longer hospital stays and lower disease activity. The patients were further categorized into groups based on the number and time of various digestive symptoms. Compared with those with fewer flares, the proportions of leukopenia, hypocomplementemia, and abdominal effusion were higher in those with frequent LMV recurrences. The white blood cell (WBC) and neutrophil counts in patients with abdominal pain of less than 7 days were higher than those with abdominal pain of more than 7 days. However, statistical analysis did not reveal significant differences among other inflammatory markers and the indices of disease activity. In terms of imaging features obtained by contrast-enhanced CT, a statistical difference was detected in patients with abdominal pain over 7 days compared to those with less than 7 days with respect to thickening of both small and large bowel walls. Due to atypical clinical manifestations of SLE patients with concomitant LMV, only approximately 50% patients were first diagnosed at the Rheumatology Department, with the rest being first diagnosed in other departments, which resulted in delayed diagnosis and treatments, prolonged hospital stay, and potentially, poor prognosis. Evaluation of the impacts of the number and duration of digestive symptom flares on disease activity and imaging features demonstrated that patients with multiple symptoms had more severe radiological findings. Therefore, clinicians, particularly rheumatologists, should keep vigilant when patients have multiple digestive system symptoms and frequent recurrence, as early diagnosis of LMV with prompt and aggressive treatments may improve the prognosis of these patients.

Superior mesenteric artery syndrome (SMAS) is an uncommon cause of proximal intestinal obstruction caused by compression of the third portion of the duodenum between the SMA and the abdominal aorta. We report the case of a 17-year-old boy with a 2-year history of recurrent nausea, vomiting, epigastric pain, early satiety, postprandial fullness, and progressive abdominal distension, followed by recent clinical deterioration. Despite repeated non-diagnostic investigations and empirical dietary and pharmacological treatment, symptoms persisted. Contrast-enhanced computed tomography established the diagnosis by demonstrating a markedly reduced aortomesenteric angle of approximately 10° and an aortomesenteric distance of 5.5 mm, associated with severe gastric and proximal duodenal dilatation. The patient was treated conservatively with nasogastric decompression and nutritional support. Nasogastric tube placement resulted in marked gastric decompression, with substantial improvement in abdominal distension, epigastric discomfort, early satiety, and vomiting, allowing surgical intervention to be deferred during the acute phase. Follow-up showed no further acute obstructive deterioration; however, the absence of meaningful weight gain over the subsequent six months indicated persistence of the chronic nutritional component of SMAS and the need for continued dietary rehabilitation and close monitoring. This case highlights the diagnostic difficulty of SMAS in adolescents with chronic, treatment-refractory upper gastrointestinal symptoms and emphasizes that resolution of acute obstruction should not be equated with definitive correction of the underlying disease process. Early recognition, conservative stabilization, nutritional optimization, and longitudinal reassessment are essential to prevent delayed diagnosis and guide timely escalation to surgery when conservative treatment is insufficient.

Bouveret syndrome is a rare form of gallstone ileus characterized by the formation of a cholecystoenteric fistula and subsequent gallstone migration into the gastrointestinal tract, resulting in gastric outlet obstruction. Diagnostic criteria consist of clinical evidence (persistent non-bilious vomiting, nausea, epigastric pain) paired with imaging (CT abdomen showing ectopic gallstone, gastric outlet obstruction, cholecystoenteric fistula) and endoscopy. Current expert consensus recommends initial endoscopic stone removal as first-line therapy to avoid techniques associated with higher morbidity and mortality. This review focuses on identifying recurrent findings in clinical and stone-related factors observed in endoscopic failure to determine any features that may guide initial therapy selection. This systematic review analyzed 30 published case reports with 31 patients, consisting of only patient-level clinical data from studies in English. Data was extracted via full-text review, organized into comparative tables, and analyzed for common patterns in symptoms, diagnostic techniques, and stone size in failed endoscopic and successful endoscopic cases. Patients ranged in age from 31 to 92 years and were predominantly female. Therapeutic endoscopic management was attempted initially in 21 cases, with successful extraction in 7 cases. The remaining 14 cases required conversion to open surgical intervention. The mean stone size did not differ substantially between successful and failed endoscopic cases. In this review, stone size did not successfully predict endoscopic success. Bouveret syndrome is a challenging condition to both diagnose and manage, with a high rate of endoscopic failure. Minimally invasive approaches in endoscopy and lithotripsy are appropriate initial strategies in selected patients; however, a substantial proportion ultimately require more open surgical intervention. Consideration of open surgical management may be warranted in patients with more severe obstruction or advanced disease, highlighting the importance of individualized treatment and standardized reporting.

Superior mesenteric artery syndrome (SMAS) is a rare cause of upper gastrointestinal obstruction caused by compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery, usually due to rapid weight loss or an anatomical predisposition that reduces the retroperitoneal fat pad between these vessels. Its symptoms often mimic more common gastrointestinal disorders, which can delay diagnosis, making cross-sectional imaging, particularly computed tomography (CT), essential for identifying a reduced aortomesenteric angle and distance with proximal duodenal dilatation. We report the case of a 17-year-old female patient who presented with persistent nausea, vomiting, and inability to tolerate oral intake despite extensive gastroenterological evaluation; upper gastrointestinal endoscopy and magnetic resonance cholangiopancreatography were unremarkable, but CT subsequently demonstrated an aortomesenteric angle of approximately 17° and a distance of approximately 7 mm with proximal duodenal dilatation, consistent with SMAS. She was managed conservatively with nutritional optimisation and supportive therapy. This case highlights the diagnostic challenge of SMAS and underscores the importance of considering it in patients with unexplained persistent vomiting, as early recognition and appropriate imaging are crucial to prevent prolonged morbidity and unnecessary investigations.

Tirzepatide is a glucagon-like peptide-1 receptor (GLP-1R) agonist and glucose-dependent insulinotropic polypeptide receptor (GIPR) agonist that is used for diabetes mellitus and weight loss. Common adverse effects include gastrointestinal symptoms such as nausea and vomiting, pancreatitis, and acute kidney injury. Hypercalcemia is rarely reported in the literature and has previously been reported in patients taking GLP-1R agonists with concomitant thiazide diuretic or exogenous calcium supplement. We report a 70-year-old female with obstructive sleep apnea started on tirzepatide three months prior to presentation, osteoporosis on calcium supplements, and obesity, who developed nausea and vomiting. She was found to have symptomatic moderate hypercalcemia with hypokalemia, metabolic alkalosis, and acute kidney injury that corrected after intravenous hydration. No prior literature describes hypercalcemia from tirzepatide use and calcium supplementation. The mechanism most likely involves tirzepatide's effect on bone turnover and concomitant increased absorption from calcium supplement ingestion. Clinicians need to closely monitor patients' electrolytes, especially calcium, when initiating patients on tirzepatide. Further research is warranted to reveal tirzepatide's mechanism regarding calcium metabolism.