Stercoral colitis (SC) is a rare inflammatory colitis that occurs due to increased intraluminal pressure from impacted fecal content in the colon. Chronic constipation is the major risk factor for this condition. Delayed diagnosis is associated with high morbidity and mortality, with complications ranging from colonic perforation to intestinal ulcers. Patients usually present with non-specific symptoms, with advanced cases presenting with acute abdomen pain. This condition can be fatal if not recognized early and promptly treated. Early detection can often be difficult in elderly patients with dementia, stroke, or other neurologic disorders that cause altered mental status (AMS). Therefore, AMS in patients with severe constipation should be a substantial reason to consider stercoral colitis as a differential diagnosis. Here, we describe a case of stercoral colitis in a 59-year-old woman with non-verbal cerebral palsy who had acute metabolic encephalopathy from her stercoral colitis and was successfully treated with colonoscopic fecal disimpaction and an aggressive bowel regimen.

Background Eosinophilic ascites (EA) is a rare, under-recognized condition characterized by eosinophil-rich peritoneal fluid, most frequently associated with eosinophilic gastroenteritis (EGE). Its true prevalence is unclear, often misdiagnosed as malignancy, tuberculosis, or cirrhosis. EA typically presents between ages 30 and 50, with slight male predominance. Its clinical importance lies in a favorable response to corticosteroids and the potential for severe complications such as intestinal obstruction if untreated. Objective This review consolidates current knowledge on EA, focusing on its etiology, pathophysiology, diagnostic challenges, and treatment strategies, while highlighting key knowledge gaps. Methods A narrative review was conducted using PubMed, SpringerLink, and Web of Science (2000–2025). Search terms included “eosinophilic ascites,” “eosinophilia,” and “ascitic fluid.” Included studies reported histopathologically confirmed EA with ascitic eosinophilia > 10%, imaging data, and treatment outcomes. Case reports lacking confirmatory paracentesis or biopsy were excluded. Data on demographics, clinical presentation, fluid analysis, imaging, etiology, treatment, and outcomes were extracted independently by two reviewers. Results EA pathogenesis involves IL-5-driven eosinophilic infiltration of the gastrointestinal serosa. Diagnostic features include exudative ascites (protein > 2.5 g/dL) with eosinophilic predominance (60–90%), peripheral eosinophilia (85%), and CT evidence of bowel wall thickening (72%). Corticosteroids (0.5–1 mg/kg/day) achieve remission in 80% within two weeks; anti-IL-5 agents may benefit refractory cases. Significant gaps include absent diagnostic biomarkers and unknown relapse rates. Conclusion EA demands heightened clinical suspicion in eosinophilic ascites. Future priorities include the development of non-invasive diagnostics, trials comparing biologics with steroids, and the exploration of genetic mutations in refractory disease.

The gut microbiota is a dynamic community of bacteria, viruses, fungi, and archaea that plays a pivotal role in regulating host immunity, metabolism, and systemic homeostasis. Dysbiosis, characterized by an imbalance in the microbial composition, is being increasingly recognized as a contributor not only to gastrointestinal cancers but also to extraintestinal malignancies. Mechanistic studies highlight the gut–microbiota–cancer axis, where microbial metabolites such as bile acids, short‐chain fatty acids (SCFAs), and tryptophan derivatives influence genetic, epigenetic, and immune pathways, influencing carcinogenesis. Germ‐free models demonstrate that commensal signals are essential for CD4 ⁺ and CD8 ⁺ T‐cell differentiation, IgA production, and anti‐tumor immunity. Dysbiosis‐induced immune dysregulation is believed to impair immune checkpoint inhibitor (ICI) efficacy, while specific taxa such as Bifidobacterium and Akkermansia have been shown to enhance therapeutic responses. Emerging evidence links gut microbiota to breast cancer via estrogen metabolism “estrobolome” to lung cancer through the gut–lung axis and modulation of ICI responses, to melanoma by shaping systemic T‐cell function and immunotherapy outcomes, and to prostate cancer through androgen receptor signaling and microbial metabolite interactions. These findings underscore the systemic oncogenic and tumor‐suppressive potential of microbial communities. Microbiome‐targeted interventions, including fecal microbiota transplantation (FMT), defined live biotherapeutics, probiotics, prebiotics, dietary modulation, and postbiotic delivery, are being actively investigated to optimize cancer treatment. While early trials have demonstrated feasibility, variability between individuals and methodological challenges remain significant hurdles. Hence, understanding how gut microbes influence extraintestinal cancers could revolutionize diagnostics, risk prediction, and treatment strategies.

Purpose of Review: Irritable bowel syndrome is a common disorder of gut-brain interaction characterized by chronic abdominal pain and altered bowel habits in the absence of structural pathology. Its pathophysiology reflects a complex interplay between the central nervous system, enteric nervous system, microbiota, immune signaling, epithelial barrier dysfunction etc. Despite advances in the understanding of the mechanisms causing IBS, the diagnosis of IBS remains primarily symptom-based, necessitating the use of objective tools to improve diagnostic precision and personalized management. This review synthesizes highlights existing literature on IBS biomarkers, including inflammatory markers (cytokines, C-reactive protein), microbial signatures (gut microbiota composition, anti-CdtB and anti-vinculin antibodies), metabolic indicators (bile acids, short-chain fatty acids), and markers of intestinal permeability (zonulin) to assess their applications in the diagnosis and management of IBS. We also examined emerging multi-omics technologies that identify the complex patterns linking the gut, the brain and the microbiota. Early research focusing on single biomarkers demonstrated limited diagnostic utility due to the heterogeneous and multifactorial nature of IBS. Recent advances support the development of composite, mechanism-based biomarker panels that integrate multiple biological domains, offering improved representation of underlying pathophysiological processes. Summary: These developments mark a shift from a single-marker approach toward multidimensional biomarker strategies. This narrative review synthesizes current evidence and proposes a framework for integrating biomarkers into clinical practice. Biomarkers are best utilized following a positive symptom-based diagnosis and exclusion of alarm features, to stratify patients into biologically relevant subtypes and guide targeted therapy. This supports a transition from exclusion-based diagnosis of IBS towards a positive and more precise one.

Endoscopic retrograde cholangiopancreatography (ERCP), introduced in 1968, remains the gold standard for managing pancreatobiliary disorders, achieving success rates of nearly 95% in patients with normal anatomy. However, modern surgical interventions, such as Roux-en-Y gastric bypass (RYGB), hepaticojejunostomy, pancreaticoduodenectomy (Whipple procedure), and Billroth II gastrectomy, result in surgically altered anatomies (SAA), complicating biliary interventions due to anatomical distortions, including long afferent limbs and sharp intestinal angulations. Device-assisted enteroscopy-based ERCP (DAE-ERCP), including double-balloon, single-balloon, and spiral enteroscopy, has improved access in SAA, especially RYGB patients, with technical success rates as high as 95%; however, it remains technically demanding and time-intensive. Laparoscopy-assisted ERCP demonstrates a higher technical success rate (>95%), but carries increased invasiveness, prolonged procedure times, and higher adverse event rates, limiting its routine use. Endoscopic ultrasound-guided biliary drainage, comprising rendezvous technique, transmural drainage such as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), and antegrade interventions, has emerged as a reliable alternative, showing superior technical success and lower complication rates compared with percutaneous transhepatic biliary drainage. Specifically, EUS-guided transmural techniques (HGS, CDS) offer effective internal drainage in anatomies where conventional approaches fail. The recently developed EUS-directed transgastric ERCP procedure, utilizing lumen-apposing metal stents to create temporary gastro-gastric or jejuno-gastric fistulas, has revolutionized biliary interventions in RYGB, achieving high technical and clinical success rates. Novel and hybrid approaches, including magnetic compression anastomosis, artificial intelligence-assisted navigation, and biodegradable stents, continue to enhance therapeutic possibilities, underscoring an evolving multidisciplinary landscape for biliary interventions in surgically altered anatomy.