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INTRODUCTION:Accurate report of stool form is essential to diagnosis and assessment of treatment response. The modified Bristol Stool Form Scale for Children (mBSFS-C) classifies stool form into 5 types and is reliable and valid. However, a direct comparison of provider's and children's ratings using the mBSFS-C vs the traditional BSFS that uses 7 stool form types has not been done.METHODS:Pediatric gastroenterology providers and children rated the same 35 stool photographs, reflecting diverse stool forms, using both scales. The order of photograph presentation and scale use were randomized. For each photograph, the most common rating (modal rating) was calculated for both scales and study samples. The percentage of child and provider ratings matching their respective modal ratings was determined.RESULTS:Twenty-one providers (21 faculty, 11 fellows, 3 nurse practitioners) and 200 children (mean age 12 ± 3 years) participated. No order effect (mBSFS-C vs BSFS used first) was observed. Of 1,225 provider ratings using the mBSFS-C, 90.0% agreed with the provider's modal ratings vs 77.8% using the BSFS. Of 7,000 child ratings using the mBSFS-C, 84.6% agreed with the children's modal ratings vs 71.8% using the BSFS. Using providers' modal ratings as the reference, all mBSFS-C photograph modal ratings matched between children and providers (35/35 photographs) whereas only 86% (30/35 photographs) matched with the BSFS.DISCUSSION:(i) The mBSFS-C showed greater modal agreement among both providers and children compared with the BSFS, and (ii) provider-child concordance was greater with the mBSFS-C than with the BSFS. Validation in other regions/populations is needed.

Introduction Guidelines recommend starting average‐risk colorectal cancer (CRC) screening at age 45 years, and thereafter repeating screening tests at regular intervals. However, US screening rates are currently suboptimal. This study evaluated adherence to repeat CRC screening with the non‐invasive multi‐target stool DNA (mt‐sDNA) test among US adults. Methods This was a retrospective claims‐based analysis of individuals aged 45–75 years at average risk for CRC who had previously completed the mt‐sDNA test. Individuals received the repeat mt‐sDNA kit based on a point‐of‐care order. The primary outcome was adherence, defined as the return of a kit with a valid result within 1 year. Secondary outcomes included rates of follow‐up colonoscopy. Results The analysis included 352,253 patients. Most patients were female (62.1%), White (60.9%), had no comorbidities (76.5%), and underwent one earlier mt‐sDNA test (98.1%). Overall adherence for repeat screening was 86.2%. In logistic regression analysis, higher household income ( $100,000–$ 200,000: 2.05; 1.49–2.77; >  $200,000: 2.46; 1.75–3.40; both vs. < $ 25,000) and receipt of digital outreach (1.36; 1.33–1.40 vs. no digital communications) were associated with higher adherence to repeat screening. Mean (95% CI) time to a successful result was 35.6 (35.4–35.7) days. Among patients who tested positive, 75.8% underwent colonoscopy. Conclusions In this large real‐world study, adherence to repeat screening with the mt‐sDNA test was high. These findings underscore the effectiveness of the mt‐sDNA test in improving CRC screening adherence.

Constipation is a major issue for 10–20% of the global population. In a double-blind randomized placebo-controlled clinical trial, we aimed to determine a dose-response effect of galacto-oligosaccharides (GOS) on stool characteristics and fecal microbiota in 132 adults with self-reported constipation according to Rome IV criteria (including less than three bowel movements per week). Subjects (94% females, aged: 18–59 years) received either 11 g or 5.5 g of BiotisTM GOS, or a control product, once daily for three weeks. Validated questionnaires were conducted weekly to study primarily stool frequency and secondary stool consistency. At base- and endline, stool samples were taken to study fecal microbiota. A trend towards an increased stool frequency was observed after the intervention with 11 g of GOS compared to control. While during screening everybody was considered constipated, not all subjects (n = 78) had less than three bowel movements per week at baseline. In total, 11 g of GOS increased stool frequency compared to control in subjects with a low stool frequency at baseline (≤3 bowel movements per week) and in self-reported constipated adults 35 years of age or older. A clear dose-response of GOS was seen on fecal Bifidobacterium, and 11 g of GOS significantly increased Anaerostipes hadrus. In conclusion, GOS seems to be a solution to benefit adults with a low stool frequency and middle-aged adults with self-reported constipation.

Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.

Background Constipation seriously affects people’s life quality, and dietary adjustment has been one of the effective methods. Overall dietary quality has been reported to be associated with some diseases, while its association with constipation has not been reported. This study aims to explore the association between overall dietary quality and constipation. Methods A cross-sectional study was designed and data were extracted from National Health and Nutrition Examination Survey (NHANES). Overall dietary quality was assessed by healthy eating index-2015 (HEI-2015), and constipation was defined by either stool consistency or stool frequency. The association between overall dietary quality or components of HEI-2015 and constipation was assessed using logistic regression, with results expressed as odds ratio (OR) and 95% confidence intervals (95%CI). Subgroup analysis was conducted according to age and gender. Results A total of 13,945 participants were eligible, with 1,407 in constipation group and 12,538 in non-constipation group. Results showed that higher adherence to HEI-2015 was associated with reduced odds of constipation (OR: 0.98, 95%CI: 0.98–0.99) after adjusting potential confounders. Further, we found higher intake of total fruits, whole fruits, total vegetables, greens and beans, whole grains, total protein foods, seafood and plant proteins, and higher fatty acids ratio decreased the odds of constipation, while higher intake of sodium increased the odds (all P  < 0.05). We also found negative association between HEI-2015 and constipation in participants with male sex, female sex, age ≥ 65 years, and age < 65 years (all P  < 0.05). Conclusion We found higher adherence to HEI-2015 decreased the odds of constipation, suggesting that increasing HEI-2015 adherence may be one of effective methods to alleviate constipation.

Indirect evidence has determined the possibility that microplastics (MP) induce constipation, although direct scientific proof for constipation induction in animals remains unclear. To investigate whether oral administration of polystyrene (PS)-MP causes constipation, an alteration in the constipation parameters and mechanisms was analyzed in ICR mice, treated with 0.5 μm PS-MP for 2 weeks. Significant alterations in water consumption, stool weight, stool water contents, and stool morphology were detected in MP treated ICR mice, as compared to Vehicle treated group. Also, the gastrointestinal (GI) motility and intestinal length were decreased, while the histopathological structure and cytological structure of the mid colon were remarkably altered in treated mice. Mice exposed to MP also showed a significant decrease in the GI hormone concentration, muscarinic acetylcholine receptors (mAChRs) expression, and their downstream signaling pathway. Subsequent to MP treatment, concentrations of chloride ion and expressions of its channel (CFTR and CIC-2) were decreased, whereas expressions of aquaporin (AQP)3 and 8 for water transportation were downregulated by activation of the mitogen-activated protein kinase (MAPK)/nuclear factor (NF)-κB signaling pathway. These results are the first to suggest that oral administration of PS-MP induces chronic constipation through the dysregulation of GI motility, mucin secretion, and chloride ion and water transportation in the mid colon.

In the United States, colorectal cancer (CRC) is the fourth most common cancer diagnosed among adults and the second leading cause of death from cancer. For this guideline update, the American Cancer Society (ACS) used an existing systematic evidence review of the CRC screening literature and microsimulation modeling analyses, including a new evaluation of the age to begin screening by race and sex and additional modeling that incorporates changes in US CRC incidence. Screening with any one of multiple options is associated with a significant reduction in CRC incidence through the detection and removal of adenomatous polyps and other precancerous lesions and with a reduction in mortality through incidence reduction and early detection of CRC. Results from modeling analyses identified efficient and model‐recommendable strategies that started screening at age 45 years. The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high‐sensitivity stool‐based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation . The recommendation for regular screening in adults aged 50 years and older is a strong recommendation . The ACS recommends (qualified recommendations ) that: 1) average‐risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high‐sensitivity, guaiac‐based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years.

BackgroundUrbanisation has been associated with a decline in the diversity of the gut microbiome that could potentially limit access to functionally robust probiotic strains. In contrast, traditional tribal populations represent underexplored reservoirs of diverse microbiota with unique metabolic capabilities. In this study, isolated and functionally characterised culturable probiotic bacteria from the gut microbiomes of individuals from the Mulluvadi tribal community (Tamil Nadu, India), with a focus on their inferred postbiotic-producing potential.MethodsA total of 112 microbial isolates were obtained from the stool samples of 25 healthy individuals, from which 13 representative bacterial strains were shortlisted by sequential screening based on phenotypic and functional criteria. These isolates were evaluated for tolerance to gastrointestinal stress conditions (pH, bile salts, NaCl, and temperature), cell surface hydrophobicity, auto-aggregation, safety attributes, and functional properties, including antibacterial activity, exopolysaccharide production, protease activity, biofilm formation, and short-chain fatty acid (SCFA) production.ResultsThe 13 isolates, mainly comprising Lactiplantibacillus plantarum and Lacticaseibacillus rhamnosus, exhibited >70% survival under simulated gastric and biliary conditions, high levels of hydrophobicity (60%–80%), strong inhibition of pathogens (12–25 mm), significant production of SCFAs, high levels of protease activity (15–20 mm clearance), and marked membrane stabilising effects of human red blood cells (65%–82%). All isolates were non-haemolytic, negative for DNase production, and displayed safety profiles consistent with those of probiotics. In particular, L. plantarum and Heyndrickxia coagulans were identified as the most functionally potent strains.ConclusionProbiotic isolates from the gut microbiomes of a tribal population show remarkable postbiotic-producing capacity and potential functional relevance. These strains are promising candidates for further investigations toward the development of postbiotic-based functional formulations; however, their efficacies must be first established in animal and clinical trials and validated through additional in vivo and clinical studies for gut dysbiosis and other related disorders.

ObjectiveInflammatory bowel disease (IBD) is a multifactorial immune-mediated inflammatory disease of the intestine, comprising Crohn’s disease and ulcerative colitis. By characterising metabolites in faeces, combined with faecal metagenomics, host genetics and clinical characteristics, we aimed to unravel metabolic alterations in IBD.DesignWe measured 1684 different faecal metabolites and 8 short-chain and branched-chain fatty acids in stool samples of 424 patients with IBD and 255 non-IBD controls. Regression analyses were used to compare concentrations of metabolites between cases and controls and determine the relationship between metabolites and each participant’s lifestyle, clinical characteristics and gut microbiota composition. Moreover, genome-wide association analysis was conducted on faecal metabolite levels.ResultsWe identified over 300 molecules that were differentially abundant in the faeces of patients with IBD. The ratio between a sphingolipid and L-urobilin could discriminate between IBD and non-IBD samples (AUC=0.85). We found changes in the bile acid pool in patients with dysbiotic microbial communities and a strong association between faecal metabolome and gut microbiota. For example, the abundance of Ruminococcus gnavus was positively associated with tryptamine levels. In addition, we found 158 associations between metabolites and dietary patterns, and polymorphisms near NAT2 strongly associated with coffee metabolism.ConclusionIn this large-scale analysis, we identified alterations in the metabolome of patients with IBD that are independent of commonly overlooked confounders such as diet and surgical history. Considering the influence of the microbiome on faecal metabolites, our results pave the way for future interventions targeting intestinal inflammation.

Purpose of Review Biliary atresia is a serious neonatal liver disease due to obstructed bile ducts that has better outcomes when detected and treated in the first 30–45 days of life. This review examines different methods to screen newborns for biliary atresia as well as discusses observations from ongoing screening programs implemented in parts of the United States. Recent Findings Screening strategies for biliary atresia include detecting persistent jaundice, examining stool color, testing fractionated bilirubin levels, or measuring bile acid levels from dried blood spot cards. The stool color card program is the most widely used screening strategy worldwide. An alternative approach under investigation in the United States measures fractionated bilirubin levels, which are abnormal in newborns with biliary atresia. Fractionated bilirubin screening programs require laboratories to derive reference ranges, nurseries to implement universal testing, and healthcare systems to develop infrastructure that identifies and acts upon abnormal results. Summary Biliary atresia meets the disease-specific criteria for newborn screening. Current studies focus on developing a strategy which also meets all test-specific criteria. Such a strategy, if implemented uniformly, has the potential to accelerate treatment and reduce biliary atresia’s large liver transplant burden.