Search Results (746)

Background: Whether the fatal and non-fatal composition of aggregate pancreatitis burden has changed over time remains unclear. We assessed long-term changes in the fatal-to-non-fatal composition of aggregate pancreatitis burden using Global Burden of Disease (GBD) 2023 estimates. Methods: We conducted a systematic descriptive and trend analysis using publicly available estimates from the GBD 2023 Results Tool for incidence, prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) across 204 countries and territories from 1990 to 2023. Because GBD reports pancreatitis as an aggregate cause category, the analysis could not distinguish acute pancreatitis, recurrent acute pancreatitis, chronic pancreatitis, or acute exacerbations of chronic pancreatitis. Primary analyses used age-standardised rates per 100,000 population. Four burden–composition metrics were derived within each location–year stratum: the YLL:YLD ratio, YLD:DALY proportion, deaths-to-incidence ratio, and prevalence-to-incidence ratio. Temporal trends were modelled in R version 4.5, using segmented regression, with up to three joinpoints selected by a Bayesian information criterion. Results: Globally, all six age-standardised native GBD measures declined between 1990 and 2023. The age-standardised incidence rate decreased from 37.62 (95% UI 32.20–43.11) to 32.91 (28.84–37.17) per 100,000, prevalence from 93.78 (69.26–126.25) to 68.92 (52.53–90.32), deaths from 1.76 (1.49–2.16) to 1.40 (1.21–1.66), YLDs from 5.70 (2.75–9.45) to 4.34 (2.18–7.04), YLLs from 55.96 (46.50–69.72) to 43.60 (36.89–53.53), and DALYs from 61.66 (50.62–75.61) to 47.94 (40.57–58.16). However, the fatal-to-non-fatal composition changed little: the global YLL:YLD ratio was 9.82 in 1990 and 10.04 in 2023, while the YLD share of DALYs was 0.092 and 0.091, respectively. Joinpoint modelling showed fluctuation rather than a sustained shift toward disability-dominant burden: the global YLL:YLD ratio was stable until 1998, increased from 1998 to 2002 (annual percent change [APC] 1.38%, 95% CI 0.42 to 2.36), and then declined modestly thereafter (APC −0.13%, −0.20 to −0.06). Burden remained higher in males, whereas females had a greater non-fatal share of total burden (YLD:DALY in 2023: 0.134 vs. 0.073). All sociodemographic index strata remained mortality-dominant in both 1990 and 2023; low-SDI settings had the greatest fatal dominance (YLL:YLD 34.94 in 1990; 24.72 in 2023). Using a descriptive YLD:DALY ≥ 0.50 benchmark, 203 of 204 countries and territories remained below the disability-dominant threshold in both years, no country crossed from below to above this benchmark, and only Georgia moved from above to below the benchmark. Conclusions: Despite declines in global incidence, mortality, and DALY rates, the aggregate GBD pancreatitis burden remained overwhelmingly mortality-dominant from 1990 to 2023. Because GBD pancreatitis combines acute and chronic pancreatitis, this finding should be interpreted as describing the modelled aggregate pancreatitis cause category rather than proving subtype-specific mortality dominance. The intensity of fatal dominance varied by sex, SDI, region, age, and country, but a structural shift toward disability-dominant aggregate burden was not observed. Full article

Type 2 diabetes mellitus (T2DM) is a major global health burden characterized by insulin resistance, progressive pancreatic β-cell dysfunction, and chronic metabolic dysregulation. Marine seaweeds have emerged as a valuable source of bioactive natural products, particularly polyphenols and polysaccharides, with promising potential for diabetes management. This review focuses on three major contributions: first, the structural diversity of seaweed-derived polyphenols and polysaccharides; second, their multi-target mechanisms of glucose regulation; and third, the structure–activity relationships governing their bioactivities. Current evidence shows that these compounds may help manage type 2 diabetes in several ways, including inhibition of α-amylase and α-glucosidase, attenuation of oxidative stress and chronic inflammation, enhancement of insulin secretion and insulin sensitivity, regulation of lipid metabolism, and modulation of gut microbiota. Key structural determinants such as degree of polymerization, hydroxyl group density, sulfation level, molecular weight, and chemical modifications are discussed in relation to their functional properties. By linking chemical structure with biological function, these findings highlight marine seaweeds as a rich reservoir of multi-target therapeutic candidates for T2DM management and provide a scientific basis for their development as functional food ingredients or lead compounds for novel diabetes management drugs. Full article

Small intestinal bacterial overgrowth (SIBO) refers to an abnormal increase in the number of bacteria in the small intestine and is observed in various diseases. SIBO can also develop after long-term use of proton pump inhibitors (drug-induced SIBO), bariatric surgery, gastrectomy, and other surgeries (postoperative SIBO). The aim of this narrative review is to summarize all of the published information on the treatment of SIBO in as much detail as possible and present it separately for each specific disease and intervention associated with SIBO. The most extensively studied drug for the treatment of SIBO is rifaximin. It eliminates SIBO in 63% of cases; however, most studies lack a control group. Small RCTs assessing the effects of this antibiotic on SIBO have reported conflicting results, and a meta-analysis showed no effect. A large RCT is required to verify the results of uncontrolled studies. Neomycin and norfloxacin showed efficacy in the treatment of SIBO in single RCTs, with elimination rates of 20 and 100%, respectively. Ciprofloxacin, rifamycin, metronidazole, and other antibiotics, as well as ursodeoxycholic acid, showed positive effects for the treatment of SIBO, but only in uncontrolled studies or in comparison with rifaximin or other drugs. The reported elimination rates were 54%, 67%, 79%, and 75%, respectively. Eradication therapy for Helicobacter pylori infection eliminated SIBO at a rate of approximately 70%. Probiotics have been tested for treatment of SIBO in various diseases. VSL#3 and Saccharomyces boulardii CNCM I-745 were effective in RCTs, with elimination rates of 58% and 80%, respectively. In conclusion, when selecting SIBO treatment regimens, those that have demonstrated the greatest efficacy for a specific concomitant disease should be preferred, despite the generally low level of evidence supporting these approaches in most cases. Full article

Background: The biliary and pancreatic tract is increasingly recognized as a microbial ecosystem rather than a sterile environment. Dysbiosis contributes to inflammation, bile acid alterations, and carcinogenesis, with distinct microbiota profiles linked to progression from benign to malignant conditions. Clinical factors, including gut–liver axis disruption and biliary stenting, may further exacerbate microbial imbalance. Objective: The objective of this study is to synthesize current evidence and identify knowledge gaps on the role of biliary microbiota in pancreaticobiliary carcinogenesis and its implications for diagnosis, prognosis, and therapy. Methods: This scoping review was conducted following PRISMA-ScR guidelines. A systematic search of PubMed, Web of Science, and Scopus was performed for studies published between January 2015 and December 2025, guided by the PICo framework. Results: Included studies primarily characterized changes in microbiota composition to identify microbial biomarkers associated with pancreaticobiliary diseases. Predictive bioinformatics analyses suggest that dysbiosis may promote carcinogenesis through metabolic and inflammatory pathways. Machine learning approaches identified microbiota-based signatures with potential diagnostic value for precancerous lesions, although discrimination remains limited. Biliary dysbiosis was also associated with outcomes related to biliary stenting, chemoprophylaxis, postoperative complications, and responses to chemotherapy or surgery. Conclusions: Integration of microbiota profiling with predictive bioinformatics and machine learning may improve understanding of pancreaticobiliary carcinogenesis. Identifying microbial and functional biomarkers could enable personalized diagnostic and therapeutic strategies, ultimately improving patient outcomes. Full article

Background/Objectives: Cancer incidence and mortality are key epidemiological indicators for evaluating the long-term biological effects of chronic low-dose radiation exposure. The aim of this study was to assess the incidence, structure, and relative risk of digestive tract cancers (ICD-10 C15–C26) among populations exposed and not exposed from uranium waste storage site in North Kazakhstan over a 10-year period (2014–2023). Methods: A retrospective population-based analysis was conducted using national cancer registry data, including data for residents of Stepnogorsk and nearby settlements (exposed group) and Akkol (control group). Results: A total of 588 cases were identified, including 465 in the exposed group and 123 in the control group. The mean age at diagnosis was similar (~65 years), and most cases were diagnosed at advanced stages (III–IV: ~58–60%). The leading cancer types were colorectal (38–40%) and stomach (29–31%) in both groups. The incidence rates were comparable (85.27 vs. 87.40 per 100,000), with an overall relative risk (RR) of 0.98 (95% confidence interval [CI]: 0.80–1.19), indicating no significant difference. Site-specific analysis showed no significant variation for esophageal, stomach, or colorectal cancers. A higher, but not statistically significant, risk was observed for pancreatic cancer (RR = 1.61; 95% CI: 0.90–2.89). Temporal analysis demonstrated similar trends in both populations, with incidence rates decreasing from 91.37 to 79.08 per 100,000 in the exposed group and from 97.40 to 78.13 per 100,000 in the control group between 2014–2018 and 2019–2023. Conclusions: Overall, digestive tract cancer incidence and structure were comparable between groups, with no statistically significant increase in the exposed population. Full article

Oxidative stress is a central component of type 1 diabetes (T1D) pathophysiology, contributing to pancreatic β-cell vulnerability and the development of chronic complications. Current therapeutic strategies are primarily focused on glycemic control and do not directly address underlying redox imbalance. Dietary polyphenols, a structurally diverse class of plant-derived compounds, have been investigated for their antioxidant and cytoprotective properties, yet their role in T1D has not been systematically defined. This systematic review evaluates the effects of polyphenols on oxidative stress and glycemic parameters in preclinical models of T1D. Across studies, polyphenols were consistently associated with attenuation of oxidative stress, as evidenced by reductions in lipid peroxidation and reactive oxygen and nitrogen species, along with restoration of endogenous antioxidant defenses, including superoxide dismutase, catalase, and glutathione. These effects were frequently linked to modulation of redox-sensitive signaling pathways, particularly Nrf2-dependent mechanisms. In contrast, glycemic outcomes were heterogeneous and influenced by compound-specific and experimental factors. Modulation of oxidative stress markers was often observed independently of changes in glycemic parameters, suggesting a primary redox-mediated mode of action. These findings provide a mechanistic rationale for prioritizing oxidative-stress-focused endpoints in future translational studies and support the evaluation of polyphenols as adjunctive strategies targeting redox imbalance in T1D. Full article

Type 2 diabetes (T2D) is a multifactorial metabolic disorder characterized by chronic hyperglycemia, insulin resistance, and progressive β-cell dysfunction. Chronic hyperglycemia in T2D causes multi-organ and systemic damage, leading to a wide range of complications, including cardiovascular disease and metabolic dysfunction-associated steatotic liver disease (MASLD). Brown seaweeds are increasingly recognized as promising marine-derived functional foods because they contain structurally unique bioactive compounds, including fucoidan, alginate, phlorotannins, and fucoxanthin. A growing body of evidence suggests that these compounds influence glucose homeostasis through multiple mechanisms, including improvement of pancreatic β-cell function, regulation of gut-mediated metabolic processes, and modulation of glucose metabolism and insulin signaling in the liver, adipose tissue, and skeletal muscle, and attenuation of chronic inflammation and oxidative stress. Brown seaweed-derived bioactive compounds have also been reported to improve abnormal lipid metabolism, a key pathological process implicated in metabolic disorders associated with T2D, including MASLD. This review provides an overview of the antidiabetic potential of brown seaweeds, with a particular focus on the mechanisms of action of their major bioactive compounds, including fucoidan, alginate, phlorotannins, and fucoxanthin. Full article

The pancreas is an organ with two functions: endocrine and exocrine. The proper functioning of the pancreas depends on many factors. One of these is trace elements—precise control of trace element homeostasis is important for both the endocrine and exocrine parts. This review provides a comprehensive summary of current knowledge regarding the role of trace elements: iron (Fe), copper (Cu), cobalt (Co), iodine (I), manganese (Mn), zinc (Zn), silver (Ag), cadmium (Cd), mercury (Hg), lead (Pb), and selenium (Se) in pancreatic physiology and their influence on the pathogenesis of key diseases of this organ, such as diabetes (DM), acute (AP) and chronic pancreatitis (CP), autoimmune pancreatitis (AIP), and pancreatic cancer (PC). Trace elements, including Fe, Cu, Zn, Se, and Mn, play a fundamental role in maintaining endocrine and exocrine homeostasis, participating in insulin synthesis, stabilizing digestive enzymes, and the functioning of antioxidant systems. It has been demonstrated that disturbances in their concentrations lead to the activation of pathological molecular pathways, including oxidative stress, chronic inflammation, and beta-cell apoptosis. In the context of diabetes, excess Fe promotes ferroptosis, whilst exposure to heavy metals such as Cd, Pb, and Hg induces insulin resistance and pancreatic islet dysfunction. In the course of pancreatitis, elements such as Zn and Se exhibit protective potential by stabilizing tissue barriers, whereas toxic metals impair ion transport, exacerbating fibrotic processes. Furthermore, analysis of available data indicates a significant association between heavy metal accumulation and pancreatic carcinogenesis, driven by DNA damage and oncogene modulation. Understanding pancreatic metallomics opens new prospects for early diagnosis, environmental prevention, and the development of targeted therapeutic strategies that restore the body’s micronutrient balance. Full article

Background: Spleen-preserving (SP) distal pancreatectomy (DP) with splenic vessels resection (SVR) (Warsaw procedure, WP) is an option for the treatment of tumors with low malignant potential. The reverse blood flow through the short gastric arteries (SGA) explains the preservation of the spleen after SVR, but leaves the source of the blood supply to the SGAs hidden. The types of blood supply to the spleen after WP and their incidence have not been previously described, nor has the significance of these types for locally advanced pancreatic head cancer (LAPHC) surgery been determined. Aim: To determine the main types of spleen blood supply after WP, and to assess the feasibility and safety of splenic artery (SA) rotation for the organ-preserving surgery of LAPHC. Methods: Retrospective analyses of demographic and perioperative data, including CT scans, overall (OS) and progression-free (PFS) survival after 71 SP DP SVR and 41 SP SVR pancreaticoduodenectomies (PD) and total pancreatectomies (TP) for LAPHC (2007–2025). Results: In 134 SP procedures, SA was resected in 115 cases (71DP, 9 TP, 3 central, and 32 PD). Indications for surgery were MCN (41), IPMN (14), CSA (3), NEN (25), SPPN (8), PHDAC (40), sarcoma (1), autoimmune (1), and calculous chronic pancreatitis (1). There were no deaths or ischemia-related splenectomies. Morbidity—31% (n23); Dindo–Clavien (D-C) > 3b-2.8%; POPF-grade B-n7 (10.6%); splenic infarctions on CT after SVR-n18 (23%), one symptomatic. CT revealed three types of arterial blood supply to the spleen after SPDP SVR: left gastric artery (LGA) type (n50, 70, 5%), gastro-epyploic arcade (GEA) type (n9, 12, 5%), and an intermediate type (n12, 17%). Spleen- and pancreas tail-preserving SVR pancreatectomies for LAPHC (n41) were accompanied by rotation of the SA to substitute resected SMA (n19) and CHA (n15) for 26 Whipples and 8TPs. There were no ischemic complications. D-C > 3–19.5%. Median OS and PFS for PDAC were 35 and 21 months for 29.5 months median follow-up. Conclusions: Despite the preservation of blood flow through all potential sources of splenic blood supply following resection of the splenic artery, the main collaterals supplying the spleen after WP are LGA branches (~90%). This knowledge, with strict adherence to the developed criteria, allows for the safe preservation of the spleen, pancreatic tail, and stomach during pancreatectomies with SA resection, including its rotation for the substitution of the SMA and CHA in LAPHC. Full article

Background/Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in children with acute or chronic pancreatitis, or following pancreatic trauma, is technically demanding and may be associated with an increased risk of complications. Evidence on technical success and complication rates in preadolescent children is limited. This study aimed to evaluate the short- and long-term outcomes of ERCP with pancreatic stenting in children with pancreatic conditions. Methods: In this retrospective single-center cohort study, consecutive patients aged ≤12 years who underwent ERCP with pancreatic stenting for acute or chronic pancreatic diseases or pancreatic trauma were included. Demographic, clinical, and procedural data were collected, and complications and clinical response, were assessed. Results: A total of 20 patients (mean age 7 years, range 2–12; 45% female) underwent 62 ERCP procedures for pancreatic indications. Nine patients (45%) had a known genetic mutation. Post-ERCP pancreatitis occurred in 2 procedures (3.2%), and bleeding in 1 procedure (1.6%). No perforations or procedure-related mortality were observed. Technical success was achieved in 57/62 procedures (91.9%), with associated improvement in symptoms, pain, or inflammatory markers. Conclusions: In this pilot study from Sweden, ERCP with pancreatic stenting appears to be a feasible therapeutic option in pre-teen children with pancreatic diseases, with a good technical success rate and relatively low complication rates. Further studies are warranted to better define long-term outcomes in this population. Full article

Diabetes mellitus (DM), particularly Type 2 DM (T2DM), is increasingly recognized as both a risk factor and an early manifestation of pancreatic ductal adenocarcinoma (PDAC), yet the molecular mechanisms bridging these conditions remain poorly understood. There is growing evidence that chronic metabolic stress in diabetes induces persistent cellular reprogramming and metabolic memory through stable post-translational and epigenetic alterations, independent of conventional insulin resistance, obesity, and inflammatory pathways. We aim to elucidate how hyperglycaemia and metabolic overload contribute to the accumulation of major intermediates, such as acetyl-CoA, Uridine diphosphate N-acetylglucosamine (UDP-GlcNAc), and reactive oxygen species, which induce broad changes in post-translational modifications in diabetes-induced PDAC. A comprehensive literature search was conducted using electronic databases, including PubMed, Scopus, and Web of Science databases, to retrieve studies published between 2005 and 2025. This review synthesizes current understanding of post-translational modifications (PTM) dynamics in diabetes-associated PDAC, with emphasis on their role in modulating oncogenic pathways such as KRAS-MAPK and PI3K-AKT. We introduce the concept of PTM remodeling, wherein transient metabolic perturbations become persistently stabilized, contributing to metabolic memory and tumor initiation. In addition, we examine how PTM-driven alterations influence the pancreatic tumor microenvironment, including stromal activation, immune evasion, and metabolic crosstalk, reinforcing a bidirectional link between tumor progression and systemic metabolic dysfunction. Furthermore, emerging therapeutic strategies targeting PTM-regulating enzymes, metabolic substrates, and signaling nodes are discussed as potential approaches to disrupt this axis. Collectively, precision targeting of PTM-mediated metabolic reprogramming represents a promising framework for early intervention and therapeutic development in PDAC associated with diabetes. Full article

Diabetes mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The most common types—type 1 and type 2 diabetes—have different etiologies and pathophysiological mechanisms. Type 1 diabetes (T1DM) results from autoimmune destruction of the insulin-producing pancreatic β-cells, leading to the development of absolute insulin deficiency, whereas in type 2 diabetes (T2DM), impaired carbohydrate metabolism is primarily caused by insulin resistance and relative insulin deficiency. Current diagnostic criteria do not allow for the detection of the disease at the preclinical stage. MicroRNA (miRNA) influences post-translational regulation of gene expression by inhibiting mRNA translation and also promotes mRNA degradation. The aim of this review is to summarize current evidence on the role of microRNAs in the pathogenesis of T1DM and T2DM and to evaluate their potential as early diagnostic biomarkers and therapeutic targets. It is demonstrated that T1DM and T2DM exhibit altered expression of specific microRNAs involved in β-cell apoptosis, autoimmune inflammation, and insulin signaling. In T1DM, key miRNAs include miR-21, miR-25, miR-146a, and miR-375, which reflect β-cell destruction and the autoimmune process. In T2DM, critical roles are played by miR-9, miR-29, miR-34a, miR-103/107, miR-126, miR-143, and miR-375, which regulate insulin secretion, lipid metabolism, and tissue insulin sensitivity. Particular attention is given to microRNAs whose expression changes several years before clinical disease onset (miR-15a, miR-126, miR-375), offering opportunities for early diagnosis. Data are presented on circulating miRNAs in stable biological fluids (blood, urine). It should be emphasized, however, that the proposed microRNA panel currently represents only a potential diagnostic tool. This panel requires further validation and confirmation by clinicians in large-scale prospective studies and does not yet claim to be ready for routine clinical use. Nevertheless, the development of such a universal microRNA panel, followed by thorough clinical evaluation, has promising biomedical potential, which will not only allow for the diagnosis of diabetes at an early stage but also identify new therapeutic targets for personalized medicine. Full article

The pancreatic pseudocyst is a collection of pancreatic fluid surrounded by a non-epithelialized wall comprising granulation tissue and fibrosis, occurring in approximately 10% of patients diagnosed with acute pancreatitis and in 20–38% of those with chronic pancreatitis. Most pseudocysts are situated in the pancreatic head and pancreatic body, but about 20% develop in extrapancreatic locations. We present the case of a 46-year-old male patient diagnosed with chronic alcohol pancreatitis with acute exacerbation, who developed a large pancreatic pseudocyst with subcapsular location in the right hepatic lobe; this was successfully treated by laparoscopic surgical drainage, with no postoperative complications and no recurrence of the pseudocyst. The computed tomography scan and postoperative biochemical analysis of the intracystic fluid played a key role in establishing the diagnosis of this rare condition. An intrahepatic pancreatic pseudocyst is a rare location for pancreatic pseudocysts, but one located in the right hepatic lobe is extremely rare. The treatment of intrahepatic pancreatic pseudocysts may be conservative, though endoscopic, percutaneous, or surgical drainage may be necessary. The presence of symptoms, signs of extrinsic compression, or complications require drainage of the pseudocyst. The “take-away” lesson learned from this case: surgical treatment for pancreatic pseudocysts located subcapsularly in the liver may be considered when they are very large, or when minimally invasive treatment has not been effective. Full article

Chronic pancreatitis (CP) is a fibro-inflammatory condition defined by permanent anatomical changes in the pancreas. The causes of CP are described by the TIGAR-O classification system: toxin-related, idiopathic, genetic mutations, autoimmune disorders, episodes of recurrent acute pancreatitis, and obstructions. Pain is multifactorial in nature, and common psychopathological consequences of CP, including depression and anxiety, complicate the clinical picture of chronic pancreatitis. As a result, the quality of life of patients with CP is decreased. This review describes the pathophysiology of pain and its relationship to underlying psychological consequences, with a focus on a long-term, holistic management approach. Strategies that combine physical and psychological management align with SDG 3 (Good Health and Well-being). CP predominantly affects patients from low socioeconomic backgrounds due to disparities in medical care, underscoring the relevance of achieving SDG 10 (Reduced Inequalities). This review emphasizes the importance of targeted research in developing a holistic care model for CP that aligns with the SDGs. Full article

Diabetes mellitus is a chronic and progressive metabolic disorder associated with abnormal blood glucose levels. The term involves several diseases with different pathophysiology mechanisms and treatment strategies. Stem cell-based treatments represent an emerging strategy for patients with diabetes mellitus with severe pancreatic insufficiency and poor glycemic control. Over the last 20 years, researchers have investigated mesenchymal stem cell infusion and the transplantation of stem cell-derived β cells and islet tissues. This review aims to comprehensively discuss the latest advances in the field of stem cell use in diabetes, including clinical studies and preclinical experiments aiming at improving the efficacy and safety of stem cell use. Full article