Background and Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.

Plasma Oncostatin M (OSM) has been proposed as a biomarker of disease activity in ulcerative colitis (UC). We evaluated OSM’s relationship with clinical, endoscopic, and histological activity across two follow-up visits, compared with fecal calprotectin (FC). One hundred UC patients were assessed at Visit 1 (baseline) and Visit 2 (12 months) for clinical (partial Mayo score), endoscopic (Mayo Endoscopic Score), and histological (Nancy Histological Index) activity, alongside plasma OSM, FC, CRP, and fibrinogen; 30 healthy controls were included for comparison. Given the marked right-skewness of OSM and FC, associations were assessed using both Pearson and Spearman correlations, and logistic regression effect sizes are reported as odds ratios per doubling of biomarker concentration (log2 scale). OSM correlated significantly with all activity measures at both visits, most strongly with histological activity (r = 0.521–0.602), but weakly or not with CRP/fibrinogen. OSM was significantly elevated versus controls at both visits (p < 0.001) and declined significantly with treatment response (Δ = −89.06 vs. +0.50 in controls, p = 0.006). FC was the dominant predictor of clinical (AUC = 0.788) and endoscopic (AUC = 0.926) remission at Visit 2, with OSM contributing little independent value; however, for histological remission, both baseline OSM and ΔOSM were independent, complementary correlates (OR = 8.43 and 9.64 per doubling, respectively; p < 0.001 for both), yielding the strongest model overall (AUC = 0.949). OSM’s discriminative accuracy improved markedly from Visit 1 to Visit 2 for endoscopic (AUC 0.695 → 0.897) and histological (AUC 0.738 → 0.927) activity. Across two follow-up assessments, OSM consistently reflected UC activity, with its strongest and most independent signal for histological inflammation, both as a concurrent correlate and—more modestly—as a genuine prospective marker independent of baseline treatment exposure. OSM’s incremental value over FC was most apparent for histological status and for stringent (MES 0) endoscopic remission, but not for conventional clinical or endoscopic remission thresholds.

Background: Less than 1% of all colorectal cancers (CRCs) are primary colorectal signet-ring cell carcinomas (SRCCs), which represent an uncommon and aggressive histological subtype. Given their subtle onset and rapid progression, these are often diagnosed in an advanced stage, and can be distinguished by the presence of mucin-producing signet-ring cells. Synchronous colonic metastases at initial diagnosis are rather uncommon. Case presentation: We report the case of a 65-year-old male patient who underwent a routine colonoscopy following a positive fecal immunochemical test (FIT). The patient had no remarkable medical history and was asymptomatic. A 3 cm semi-pedunculated polyp and several smaller depressed lesions, 2 cm maximum in diameter, were observed in the descending colon during the colonoscopy. Multiple biopsies were obtained. The lesions were found to be SRCC according to histopathological examination. There was no sign of extra-colonic metastases on the computed tomography (CT). The patient was referred for extensive hemicolectomy, regional lymphadenectomy, and adjuvant chemotherapy. Conclusions: This article provides a thorough literature review on this uncommon presentation and discussion regarding the current understanding of the pathogenesis, clinical manifestations, and management strategies of SRCC. This case highlights the importance of routine screening in detecting aggressive malignancies like SRCC in asymptomatic individuals. Early identification through colonoscopy can lead to timely intervention, potentially improving prognosis.