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Background Fatigue is a debilitating and highly relevant symptom in patients with inflammatory bowel disease (IBD). However, awareness of fatigue and treatment options remains limited. This study was aimed at elucidating the influence of disease activity and common complications (pain, anemia, depression, anxiety and quality of life) on fatigue in patients with IBD to identify potential interventional targets for treating physicians. Methods A cross-sectional survey including five questionnaires (HADS, Fatigue Assessment Scale, McGill Pain Questionnaire, IBDQ and general well-being) was performed on patients with IBD ( n  = 250) at a university IBD clinic. Additionally, demographic data, laboratory data, IBD history, treatment and current disease activity (Harvey-Bradshaw Index, partial Mayo Score, calprotectin and CRP) were recorded. Results A total of 189 patients were analyzed (59.8% with Crohn’s disease (CD) and 40.2% with ulcerative colitis (UC)). A total of 51.3% were fatigued, and 12.2% were extremely fatigued. Multiple factors showed significant correlations in univariate analysis. Multivariate analysis revealed that fatigue was correlated with depression (CD, p  = 0.002; UC, p  = 0.02), diminished quality of life (CD, p  = 0.015), female sex (CD, p  = 0.015) and younger age (UC, p  = 0.024), whereas the influence of anemia or disease activity was non-significant. Conclusions Fatigue is burdensome and highly prevalent in patients with active and inactive IBD. Considerations for fatigue treatment, beyond targeting inflammation and anemia, should include investigation of underlying sub-clinical depression.

In a phase 2 proof-of-concept trial, patients with celiac disease controlled on a gluten-free diet were assigned to one of three dose levels of ZED1227 (a selective transglutaminase 2 inhibitor) or placebo. Patients were challenged with 3 g of gluten daily for 6 weeks. Comparison of duodenal-biopsy samples between baseline and 6 weeks showed that ZED1227 attenuated gluten-induced mucosal damage.

In a previous cross-sectional study using the tablet-based Oxford Cognitive Screen-Plus (OCS-Plus), deficits in delayed memory, attention, and executive functioning were identified in working-age patients with post-COVID-19 syndrome (PCS) following infection in 2020 or early 2021. Initial assessment occurred approximately five months after infection. To examine short-term longitudinal trajectories, patients were reassessed several months later. Eighty-one patients with PCS (mean age 46.6 years, 64% female) completed OCS-Plus assessments at baseline and after a median follow-up of 4.4 months. Cognitive change was analysed using Wilcoxon signed-rank tests and equivalence testing (± 1 SD of reference scores) to assess clinical relevance. Associations between cognitive change and changes in depression and fatigue were examined using bootstrap-corrected multiple regression. No significant change in cognitive performance was observed between baseline and follow-up across any cognitive domain (all p  > 0.3). Equivalence testing indicated that observed differences fell within predefined bounds of clinical insignificance (all p  < 0.01). Changes in depressive symptoms and fatigue were not associated with changes in cognitive performance. Across the observed follow-up period, domain-level cognitive performance remained stable, with no evidence of short-term spontaneous improvement. These findings suggest short-term longitudinal stability of cognitive impairments in PCS within the limits of screening-based assessment and the follow-up interval studied, supporting the value of continued cognitive monitoring in affected individuals.

Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4–4% and has severe impact on morbidity and mortality. An estimated 10–20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens. Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient. First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.

Like other infections, a SARS-CoV-2 infection can also trigger Post-Acute Infection Syndromes (PAIS), which often progress into myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS, characterized by post-exercise malaise (PEM), is a severe multisystemic disease for which specific diagnostic markers or therapeutic concepts have not been established. Despite numerous indications of post-infectious neurological, immunological, endocrinal, and metabolic deviations, the exact causes and pathophysiology remain unclear. To date, there is a paucity of data, that changes in the composition and function of the gastrointestinal microbiota have emerged as a potential influencing variable associated with immunological and inflammatory pathways, shifts in ME/CFS. It is postulated that this dysbiosis may lead to intestinal barrier dysfunction, translocation of microbial components with increased oxidative stress, and the development or progression of ME/CFS. In this review, we detailed discuss the findings regarding alterations in the gastrointestinal microbiota and its microbial mediators in ME/CFS. When viewed critically, there is currently no evidence indicating causality between changes in the microbiota and the development of ME/CFS. Most studies describe associations within poorly defined patient populations, often combining various clinical presentations, such as irritable bowel syndrome and fatigue associated with ME/CFS. Nevertheless, drawing on analogies with other gastrointestinal diseases, there is potential to develop strategies aimed at modulating the gut microbiota and/or its metabolites as potential treatments for ME/CFS and other PAIS. These strategies should be further investigated in clinical trials.

Purpose Despite the wide range of medical and interventional therapy options available, some patients with Crohn’s disease (CD) need an ileostomy or colostomy. The aim of this study was to identify clinical, surgical and drug-related predictors of successful stoma reversal in CD patients. Methods A retrospective medical record analysis of surgical department logs, hospital discharge letters and patient reports from outpatient departments was performed for all CD patients who underwent a first ostomy surgery. Results Our study analysed a total of 149 patients (76 women, 73 men, median age at first stoma of 34 years after a median CD duration of 9 years), with a median follow-up of 78.4 (IQR 88.6) months after first ostomy surgery. Of these patients, 73 (49%) underwent stoma reversal after a median of 11.7 months (IQR 15.7 months) of whom 17 (23.3%) needed a second stoma. In multivariant analysis, Montreal A1 classification (HR 2.07; 95% confidence interval 1.23–3.47; p  = 0.006), a primary laparotomy (HR 2.30; 95% confidence interval 1.20–4.41; p  = 0.012) and the absence of perianal/rectal CD activity (HR 3.00; 95% confidence interval 1.86–4.86; p  < 0.001) emerged as independent predictors of a shorter time to stoma reversal. Introduction or switch of biological therapy after first stoma was not associated with successful reversal of the stoma (OR 4.6 95% confidence interval 1.45–14.66; p  = 0.01). Laboratory parameters had no influence. Conclusion Clinical and surgical features—rather than medication or laboratory findings—were found to be predictors of successful stoma reversal in CD patients. Future studies focusing on the definition of a Standard Operation Procedure for emergency and elective CD surgery are warranted.