Search Results (480)

Coffee is one of the most widely consumed beverages globally, with over 60% of Americans drinking it daily. This review examines coffee’s multifaceted impact on health and well-being, drawing on decades of research. Overall, the consensus is that moderate coffee intake is more beneficial than harmful across a wide range of health outcomes. Numerous large-scale, prospective cohort studies from around the world have consistently shown that moderate coffee consumption—typically three to five cups per day—is associated with reduced overall mortality and lower risk of major diseases such as cardiovascular diseases, diabetes, stroke, respiratory conditions, cognitive decline, and potentially several types of cancer, including liver and uterine cancers. Both caffeinated and decaffeinated coffee have shown benefits. The addition of sugar and cream to coffee may attenuate coffee’s positive health effects. Despite historical concerns, coffee consumption is not linked to increased risks of cancer, hypertension, or arrhythmia. However, some concerns remain. For pregnant women, coffee consumption should be limited to lower amounts, such that the daily intake of caffeine does not exceed 200 mg/day. Also, excessive caffeinated coffee intake may cause anxiety or sleep disturbances. Coffee’s health-promoting mechanisms include improved glucose balancing, increased physical activity, increased fat oxidation, improved lung function, and reduced inflammation. Beyond mortality and chronic diseases, coffee consumption affects many aspects of well-being: it supports hydration, boosts mental acuity, enhances physical performance, and may aid bowel recovery after surgery. While the field is well-studied via long-term observational cohorts, future research should focus on randomized controlled trials, Mendelian randomization studies, and granular analyses of coffee types and additives. Full article

This study assessed the seroprevalence of anti-Anisakis simplex antibodies in Norwegian patients with inflammatory bowel disease (IBD), specifically ulcerative colitis (UC) and Crohn’s disease (CD), compared with healthy controls. Associations between anti-A. simplex antibody positivity and clinical or laboratory parameters in IBD were also explored. A total of 86 UC patients, 68 CD patients, and 41 healthy controls were prospectively enrolled from four Norwegian hospitals (2013–2022). Diagnosis and disease activity were established using standard clinical, endoscopic, and biomarker criteria. Serum samples were analyzed for total Ig, IgG, IgM, IgA, and IgE antibodies against A. simplex and Pseudoterranova decipiens using ELISA. Anti-A. simplex IgG seroprevalence was 4.9% in controls and 3.2% in IBD (3.5% UC, 2.9% CD). IgM seroprevalence was 0% in all groups. IgA seroprevalence was higher in IBD (16.2%) than controls (4.9%), with 14.0% in UC and 19.1% in CD. IgE seroprevalence was low across all groups. Smoking correlated with lower antibody levels and higher surgery rates. In UC, higher anti-A. simplex IgG and IgE levels were associated with milder disease and better prognosis. Anti-TNFα and azathioprine treatments were linked to higher anti-A. simplex IgA. Norwegian UC and CD patients had significantly higher anti-A. simplex total Ig and IgA seroprevalence than healthy controls, indicating increased exposure or immune response. Anti-A. simplex IgG and IgE may serve as markers of clinical activity in UC. Further research is warranted to clarify the clinical significance of these findings. Full article

Background/Objectives: In the era of treat-to-target strategies in inflammatory bowel disease (IBD), transmural healing (TH) is gaining recognition as a promising therapeutic goal. TH has been associated with significantly better long-term outcomes, including reduced rates of hospitalization, surgery, and the need for therapy escalation. Cross-sectional imaging techniques, such as intestinal ultrasound (IUS), magnetic resonance imaging (MRI), and computed tomography enterography (CTE), offer a comprehensive, non-invasive means to assess this deeper level of healing. This review explores how TH is currently defined across various imaging modalities and evaluates the feasibility and cost-effectiveness of achieving TH with available therapies. Methods: A literature search was conducted across PubMed, Scopus, and Embase using keywords, including “transmural healing”, “intestinal ultrasonography”, “magnetic resonance imaging”, “computed tomography enterography”, “Crohn’s disease”, “ulcerative colitis”, and “inflammatory bowel disease”. Only English-language studies were considered. Results: Despite growing interest, there is no standardized definition of TH across imaging platforms. Among the modalities, IUS emerges as the most feasible and cost-effective tool, owing to its accessibility, accuracy (sensitivity 62–95.2%, specificity 61.5–100%), and real-time capabilities, though it does have limitations. Current advanced therapies induce TH in roughly 20–40% of patients, with no consistent differences observed between biologics and small molecules. However, TH has only been evaluated as a formal endpoint in a single randomized controlled trial to date. Conclusions: A unified and validated definition of transmural healing is critically needed to harmonize research and guide clinical decision-making. While TH holds promise as a meaningful treatment target linked to improved outcomes, existing therapies often fall short of achieving complete transmural resolution. Further studies are essential to clarify its role and optimize strategies for deep healing in IBD. Full article

Background: Robotic deep inferior epigastric artery perforator (DIEP) flap surgery is a technique used for autologous breast reconstruction to maintain the integrity of the rectus abdominis muscle while also utilizing robotic assistance for flap harvest. This study assesses postoperative outcomes of patients undergoing robotic DIEP flap reconstruction through the measurement of postoperative pain, narcotics use, and antiemetic usage. Methods: A retrospective analysis was performed for patients undergoing robotic DIEP flap breast reconstruction between March 2024 and March 2025. Postoperative pain scores (1–10 scale), narcotics usage (measured in oral morphine equivalents), antiemetic usage, and complications were recorded. Patient outcomes were compared to a control group of 40 patients who had undergone abdominal-based free flap breast reconstruction. Results: Overall, 14 patients underwent robotic DIEP flap breast reconstruction, representing 24 breasts. The average patient age was 56.5 (range: 30–73). Ten patients underwent bilateral breast reconstruction, and four underwent unilateral breast reconstruction. The average length of stay postoperatively was 4.86 days (±1.23 days), and the return of bowel function occurred in 1.29 days (±0.47 days). No patients experienced an unplanned return to the OR or flap failure. Average pain scores on postoperative day 1 (POD1), 2 (POD2), and 3 (POD3) were 4.0 (±0.6), 3.4 (±0.6), and 2.93 (±0.5), respectively. Average antiemetic usage totalled 1.25 doses (±0.25). Average daily OME use was 27.7 (±5.0) for POD1, 25.96 (±6.3) for POD2, and 21.23 (±7.11) for POD3. This averaged to a total hospital OME use of 74.9 (±15.7) per patient. Patients undergoing robotic DIEP flap reconstruction required a significantly lower narcotics dosage, as well as a lower antiemetic dosage, during the first three days postoperatively compared to the control abdominal free flap group. Average pain scores in the robotic DIEP flap reconstruction patient group were also significantly decreased, specifically in POD2 and POD3. Conclusions: The robotic DIEP flap offers advantages in autologous breast reconstruction compared to other abdominal free flap reconstructive methods. In this limited retrospective study, the use of the robotic DIEP flap lowers chances of flap failure and complications, while also improving narcotics use, antiemetic use, and postoperative pain. Full article

Disruption of the microbiota resulting in pathogenicity is known as dysbiosis and is key in the pathogenesis of inflammatory bowel disease [IBD]. The microbiome of patients with IBD is characterized by depletion of commensal bacteria, in particular Bacteroidetes and the Lachnospiraceae subgroup of Firmicutes, and by the concomitant increase in Proteobacteria and the Bacillus subgroup of Firmicutes. These changes reflect a decrease in microbial diversity with a concomitant decrease in health-promoting bacteria like Faecalibacterium and Roseburia. Treatment with biologic agents has changed the natural course of disease, improving patient outcomes. Changes in gut microbiota occur under treatment with biologic agents and act towards reversal of dysbiosis. These changes are more striking in patients achieving remission and specific gut microbiota signatures may be predictive of treatment response and a step towards precision medicine, since, despite advances in medical treatment, some patients are at risk of surgery and subsequent complications such as anastomotic leakage. This review summarizes current available evidence on the interplay of gut microbiota and biologic agents, surgery, and surgical complications in patients with IBD. Full article

Background/Objectives: Abdominal tumors can trigger acute, life-threatening complications, needing urgent care. Though often slow-growing, they may present suddenly with obstruction, bleeding, or organ compression. This article explores diagnostic challenges in such emergencies and presents a rare case of a giant mesenteric cyst. Methods: A PubMed search was conducted to review abdominal tumors in emergencies, focusing on mesenteric cysts. Results: A 37-year-old woman with no significant history presented with two weeks of diffuse abdominal pain and distension. Labs showed mild inflammation and low malignancy risk. Imaging revealed a large cystic mass compressing abdominal organs. Surgery found a 35 × 15 cm cyst from the mesenteric root extending into the pelvis and behind the stomach. Conclusions: Mesenteric cysts are rare with vague symptoms, needing high suspicion for diagnosis. Imaging helps, but large cysts often require surgery. Complete removal prevents recurrence, and bowel resection may be needed if vital structures are involved. Careful planning, teamwork, and follow-up ensure success. Full article

Background/Objectives: A 2-year-old male presented to the emergency department (ED) with vomiting and abdominal discomfort following ingestion of multiple magnets from a sibling’s bracelet. This case highlights the risks associated with magnet ingestion and the need for coordinated multidisciplinary care and public health intervention. Methods: Radiographs revealed magnets in the oropharynx, stomach, and small bowel. Emergency physicians coordinated care with otolaryngology, gastroenterology, and general surgery. Results: Laryngoscopy successfully removed two magnets from the uvula, and endoscopy retrieved 30 magnets from the stomach. General surgery performed a diagnostic laparoscopy, identifying residual magnets in the colon. Gastroenterology attempted a colonoscopy but was unable to retrieve magnets due to formed stool, leading to bowel preparation and serial imaging. The patient eventually passed 12 magnets per rectum without surgical intervention. Conclusions: This case emphasizes the importance of multidisciplinary collaboration in managing magnet ingestion, a preventable cause of serious gastrointestinal injury. Recent studies highlight the increasing incidence and severity of such cases due to accessibility and inadequate regulation. These findings underscore the need for public awareness and adherence to management protocols to mitigate morbidity and mortality in pediatric patients. Full article

Background & Aims: treat-to-target approach is essential for improving outcomes in inflammatory bowel disease (IBD). This study aimed to assess real-world achievement in objective monitoring (clinical, biomarker, and endoscopic assessments) and the correlation between patient-reported outcomes (PROs) and treatment targets. Methods: This retrospective study included consecutive IBD patients from January 2020 to December 2024. Disease activity was assessed using the Harvey-Bradshaw Index (HBI), partial Mayo score, PRO2, and PRO3, along with C-reactive protein (CRP) levels and endoscopic scores (SES-CD, MES). Clinical outcomes were evaluated at baseline, 1 year, and 2 years. Results: Among 112 IBD patients (55% with CD, median age at diagnosis: 45.2 years), clinical remission rates at baseline, 1 year, and 2 years were; CD: 75.8%, 70.0%, and 55.8%; UC: 84.0%, 79.5%, and 81.4%. CRP normalization rates at the same time points were; CD: 54.8%, 41.7%, and 63.8% UC: 78.0%, 70.5%, and 81.8%. Endoscopic remission rates were; CD: 58.1%, 50.0%, and 50.0%, UC: 71.4%, 64.5%, and 51.7% Flare-ups were more frequent in CD than in UC (32% vs. 20%), with an 8.1% rate of IBD-related surgery. In CD, PRO2 and PRO3 strongly correlated with clinical remission (AUC = 0.885 and 0.881), moderately with biomarkers (AUC = 0.737 and 0.755), and modestly with endoscopic remission (AUC = 0.695 and 0.685). In UC, PRO2 showed a strong correlation with clinical remission (AUC = 0.972) and moderate correlations with biomarkers (AUC = 0.653) and endoscopy (AUC = 0.783). Conclusions: Clinical remission was more frequent in UC than in CD. PROs showed a strong correlation with clinical remission but only moderate associations with biomarkers and endoscopic remission in both CD and UC. Full article

Background/Objectives: Carbon-ion radiotherapy (CIRT) is a promising treatment option for unresectable locally recurrent rectal cancer (LRRC). However, CIRT is contraindicated in cases where recurrent tumors are attached to the intestine. To address this limitation, we developed a novel treatment strategy involving curative-dose CIRT to recurrent tumors, including the adjacent intestine, without dose constraints, followed by surgical resection of the irradiated intestine. This study aimed to assess the feasibility of this approach. Methods: Patients were eligible for this study if the distance between the unresectable recurrent tumor and the adjacent intestines was less than 3 mm. Between 2019 and 2023, twelve patients were enrolled. CIRT was administered at curative doses of 70.4 or 73.6 Gy (relative biologic effectiveness (RBE)), including the adjacent intestines, without dose constraints. Surgical resection was not intended to excise the tumor itself, but was performed solely to remove the irradiated intestines. Irradiated intestine resection was planned within eight weeks after the completion of CIRT. Results: All patients completed the scheduled treatment course. The median interval between completing CIRT and surgery was 4 (3–8) weeks. No patients experienced acute AEs related to CIRT. Regarding late AEs, two patients developed Grade I sciatic neuralgia, and one patient developed Grade III neuralgia. We considered this symptom, which later resulted in a limp in his left leg, acceptable because this patient could ambulate with assistance. Clavien–Dindo Grade III postoperative complications occurred in one patient. The median follow-up duration was 40 (20–60) months. One patient was diagnosed with in-field recurrence, and three patients were diagnosed with out-of-field recurrence. These patients received reirradiation with CIRT. Four patients experienced lung recurrence, and one patient died from rectal-cancer-specific causes. Conclusions: This novel treatment strategy may provide favorable outcomes for patients with unresectable LRRC. This approach can be applied to the currently accepted indications for CIRT, and we believe that CIRT is a feasible treatment option for future patients. Full article

In this review, we summarize current insights into the treatment of functional constipation (FC) in children. Constipation is a global issue in the pediatric population, with a prevalence of approximately 9.5%. Initial management involves a combination of non-pharmacological and pharmacological interventions. However, a significant number of children continue to experience therapy-resistant FC despite optimal non-pharmacological and pharmacological treatments. While studies on novel pharmacological options in children are limited, adult trials have shown promising results. New agents such as lubiprostone, prucalopride, linaclotide, and plecanatide have demonstrated improved outcomes compared to placebo or conventional therapies, particularly in increasing spontaneous bowel movements. Neurostimulation presents an additional treatment modality. Posterior tibial nerve stimulation appears to be a promising new option, offering high treatment satisfaction and a favorable safety profile with a low rate of severe adverse events. For children who do not respond to optimal conservative therapy, the impact on quality of life can be substantial. In such cases, surgical interventions may be considered, including intrasphincteric botulinum toxin injections, antegrade continence enema surgery, and, in severe cases, colonic resection or a diverting ostomy. The choice of surgical treatment remains a subject of ongoing debate. Therapy-resistant FC in children is a complex and impactful condition. An individualized, stepwise approach is essential, with surgical options such as colonic resection reserved as a last resort. Full article

Pelvic floor dysfunction (PFD) is one of the most significant postoperative consequences in gynecological surgery, leading to impaired bowel function, structural alteration, and reduced quality of life. The conventional technique using fluoroscopic defecography and perineal ultrasonography provides an incomplete assessment of multi-compartment defects and post-surgical changes. Magnetic resonance defecography (MRD) represents a valuable alternative imaging method in the assessment of PFD following gynecological surgery, increasing diagnostic accuracy and enabling personalized treatment planning. MRD achieves high-resolution multi-compartmental assessment of the pelvic floor in dynamic states. Particularly, it is able to detect postoperative complications such as mesh retraction, organ prolapse, and fistula formation, not visible to other modalities. This narrative review discusses the role of MRD in diagnosing PFD and its advantages in detecting functional and anatomical changes following gynecological surgery. This review also examined the ability of MRD to demonstrate surgical changes and its contribution to possible standardization in clinical practice. Full article

Background/Objectives: Continuous epidural analgesia (CEA) is commonly used to manage postoperative pain in young infants. However, it can impair bladder function, leading to postoperative urinary retention (POUR) and necessitating Foley catheter placement, which carries a risk of urinary tract infection (UTI). Limited research exists on the frequency of POUR and UTIs and factors influencing optimal Foley catheter management in this population. Methods: A retrospective chart analysis conducted at UPMC Children’s Hospital of Pittsburgh included 103 infants who had surgery with CEA. The patients were assigned to Group A (Foley catheter removed before epidural discontinuation), Group B (Foley catheter removed after epidural discontinuation), and Group C (no Foley catheter placement). Data collected included demographics, details regarding urinary complications, epidural analgesia, pain management, and Foley catheter management. Results: The median/IQR age was 8 weeks (0.71–13.29), and the weight was 3.01 (2.55–3.52) kg. POURs occurred shortly after surgery in two (1.9%) infants with no initial Foley catheter placement (p = 0.101). Two (1.9%) infants in Group B developed a UTI (p = 0.327). A total of 10 (9.7%) (Groups A and B) had a preexisting urologic condition (p = 0.040). Common surgeries included exploratory laparotomy with bowel resection (34%) and stoma closure (28.2%). The epidural catheter was discontinued on postoperative day 3 (median) (p = 0.587). Total opioid administration, median/IQR (MME mg/kg), was significantly higher in Group B (1.7/0.6–3.8) and Group A (0.7/0.3–1.8) compared to Group C (0.6/0.3–1.1) (p = 0.029). Conclusions: No POUR occurred when the Foley catheter was removed before the epidural was discontinued. UTIs occurred when the Foley catheter remained after epidural discontinuation. Our findings highlight the importance of individualized assessment for urinary catheter placement and early removal in young infants receiving CEA. Full article

Background/Objectives: Bowel resection may be necessary during cytoreductive surgery (CS) in advanced epithelial ovarian cancer to achieve complete tumor removal. However, concerns about increased perioperative risks and unclear survival benefits have led to ongoing debate. This study aimed to evaluate the impact of bowel resection on perioperative mortality and overall survival (OS) in patients undergoing CS. Methods: We retrospectively reviewed 127 patients with FIGO stage IIB–IV epithelial ovarian cancer who underwent primary or interval CS between 2007 and 2021. Patients were stratified based on the performance of bowel resection. Clinical, surgical, and survival data were analyzed using Kaplan–Meier survival analysis and Cox proportional hazards modeling. Primary outcomes were 90-day mortality and OS. Results: Bowel resection was performed in 58 patients (46%) with more extensive disease and poorer ECOG performance scores. Although the resection group had increased perioperative risks (e.g., higher transfusion rates and ICU use), OS was similar between groups (log-rank p = 0.122). Multivariate analysis identified that increasing age (HR = 1.042, p = 0.005) was independently associated with poorer OS, whereas lymph node dissection (HR = 0.450, p = 0.003) and undergoing primary CS (HR = 0.540, p = 0.047) were associated with improved survival. Bowel resection was not independently associated with OS. Conclusions: Bowel resection does not adversely affect OS when optimal cytoreduction is achieved. Although it increases perioperative complexity, it can be safely incorporated into CS in selected patients. These findings support its use as part of an individualized surgical strategy for advanced ovarian cancer. Full article

Gastrointestinal symptoms, including reflux, bloating, dyspepsia, stomach pain, and altered bowel patterns, are commonly reported in individuals with severe obesity and may significantly impact quality of life. Background/Objectives: Curcumin, a bioactive compound found in turmeric (Curcuma longa L.), possesses anti-inflammatory and antioxidant properties and has been investigated for its potential role in gastrointestinal health. However, its effects in individuals with severe obesity remain unclear. Methods: This double-blind, placebo-controlled clinical trial aimed to evaluate the effect of curcumin supplementation on gastrointestinal symptoms in women with severe obesity. Thirty-one women with a body mass index (BMI) ≥ 40 kg/m² undergoing bariatric surgery were randomized to receive either 1500 mg of curcumin (98.75%) or a placebo (1500 mg corn starch) daily for 13 weeks. Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS), and stool consistency was assessed using the Bristol Stool Scale. Anthropometric measurements were also collected. Results: Participants had an average age of 33.1 ± 8 years and a BMI of 45.6 ± 3.31 kg/m². No differences were observed between groups at baseline. At the end of the study, the curcumin group showed a significant reduction in the GSRS’s total score compared to the placebo group (p = 0.002), with improvements in eructation (p = 0.011) and constipation (p = 0.007). Additionally, the curcumin group showed reduced BMI (p = 0.019) and neck circumference (p = 0.042). Conclusions: These findings suggest that curcumin supplementation may alleviate some gastrointestinal symptoms and improve anthropometric measures in women with severe obesity, providing a potential dietary strategy. Full article

Background/Objectives: Patients with inflammatory bowel disease (IBD), whether affected by Crohn’s disease (CD) or ulcerative colitis (UC), are burdened by disability and a reduced quality of life. The individual’s regular participation in daily working life is a key factor among its determinants. This work aims to quantify work absenteeism in patients with IBD, profiling it concerning specific demographic variables, the degree of disease activity, and the level of self-reported anxious symptoms. Methods: A cross-sectional observational study targeted patients with a known diagnosis of IBD with disease activity no greater than moderate who were either employed or engaged in regular student activities. Participants were administered the Beck Anxiety Inventory (BAI) for the assessment of anxious symptoms, the Patient-Reported Outcome 2 (PRO-2) for evaluating IBD disease activity, and the Health and Work Performance Questionnaire (HPQ) short form for the analysis of work absenteeism, measured both as absolute and relative over two time frames (the last 7 days and the last 4 weeks). Within the HPQ, Likert scale (0–10) questions were administered to assess self-perceived work productivity. Results: A total of 300 patients were included [median age 43.5 years, IBD (UC 55.7%, CD 44.3%, sex (males 54%, females 46%)], recording absolute absenteeism of 56 (36–76) and 2 (−8–20) hours lost over 4 weeks and 7 days, respectively. The factors associated with worse absolute and relative absenteeism (both at 7-days and 4-weeks) were having CD (p < 0.001), having previous surgery (p < 0.05), and, exclusively in the 4-week assessment, being female (p < 0.05) and a smoker (p < 0.05). The BAI demonstrated a moderate correlation with 4-week absolute absenteeism (ρ = 0.374, p < 0.001), progressively increasing with anxiety severity. Additionally, the BAI was an independent predictor of a 25% work productivity loss over 4 weeks (aOR: 1.1, 95% CI 1.06–1.142, β = 0.096, p < 0.001). Disease activity measured based on PRO-2 strongly correlated with 4-week (ρ = 0.53, p < 0.001) and 7-day (ρ = 0.47, p < 0.001) absolute absenteeism. Conclusions: In conclusion, work absenteeism in IBD patients may be driven by the IBD phenotype, sex, anxiety, and disease activity. Improving these parameters could enhance productivity. Full article