Search Results (142)

Patients undergoing epidermal growth factor receptor inhibitor (EGFRI) therapy frequently experience dermatologic side effects, notably papulopustular rash, which impacts 50–90% of recipients. This rash typically appears on the face, chest, and back within weeks of treatment, resembling acne but stemming from distinct pathophysiological mechanisms, causing significant discomfort and reduced quality of life. Prophylactic measures and symptom-based treatment are recommended, emphasizing patient education, topical agents, and systemic therapies for severe cases. A 41-year-old female with advanced colonic mucinous adenocarcinoma developed severe acneiform rash and pruritus during EGFRI therapy with panitumumab. Initial standard treatment with oral doxycycline was discontinued after two days due to severe gastrointestinal intolerance characterized by intense nausea and dyspepsia. With limited access to dermatological consultation, treatment with rose stem cell-derived exosomes (RSCEs) provided rapid symptom relief. Significant improvement was observed within 24 h, with complete resolution of pruritus and substantial reduction in inflammatory lesions within 72 h. RSCEs demonstrate anti-inflammatory effects through the modulation of pro-inflammatory cytokines including interleukin-6, interleukin-1β, and tumor necrosis factor-α, while promoting fibroblast proliferation and collagen synthesis enhancement. They may represent a possible alternative to corticosteroids, avoiding associated side effects such as skin atrophy, delayed wound healing, and local immunosuppression. This case underscores the potential of innovative treatments like RSCEs in managing EGFRI-induced skin complications when standard therapies are not tolerated, particularly in healthcare systems with limited dermato-oncological resources. Full article

Endometriosis is a chronic, estrogen-dependent inflammatory condition that affects multiple organ systems and significantly impairs the quality of life in women of reproductive age. While conventional hormonal therapies may alleviate symptoms of endometriosis, they are also frequently associated with intolerable side effects. As a result, there is growing interest in complementary, non-invasive strategies to support long-term disease management. This review explores the potential of plant-based diets and personalized nutrition as adjunctive approaches in endometriosis care. Plant-based dietary patterns, which are rich in antioxidants, phytochemicals, dietary fiber, and essential micronutrients, have been shown to reduce systemic inflammation, modulate estrogen activity, and alleviate pelvic pain. Additionally, the use of medicinal plants, such as curcumin and ginger, has demonstrated anti-inflammatory and anti-proliferative effects in preclinical studies. Moreover, identifying and addressing individual food sensitivities, particularly to gluten, dairy, or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, may improve gastrointestinal and inflammatory symptoms in susceptible individuals. Future research should focus on high-quality clinical trials and integrative care models to evaluate the long-term efficacy, safety, and sustainability of these individualized nutritional interventions in the holistic management of endometriosis. Full article

Background/Objectives: The gut microbiota (GM) is pivotal for immune regulation, metabolism, and neurodevelopment. Infants undergoing surgery for congenital gastrointestinal anomalies are especially prone to microbial imbalances, with a paucity of beneficial bacteria (e.g., Bifidobacteria and Bacteroides) and diminished short-chain fatty acid production. Dysbiosis has been associated with severe complications, including necrotizing enterocolitis, sepsis, and feeding intolerance. This narrative review aims to critically examine strategies for microbiota modulation in this high-risk cohort. Methods: An extensive literature analysis was performed to compare the evolution of GM in healthy neonates versus those requiring gastrointestinal surgery, synthetizing strategies to maintain eubiosis, such as early nutritional interventions—particularly the use of human milk—along with antibiotic management and supplementary treatments including probiotics, prebiotics, postbiotics, and lactoferrin. Emerging techniques in metagenomic and metabolomic analysis were also evaluated for their potential to elucidate microbial dynamics in these patients. Results: Neonates undergoing gastrointestinal surgery exhibit significant alterations in microbial communities, characterized by reduced levels of eubiotic bacteria and an overrepresentation of opportunistic pathogens. Early initiation of enteral feeding with human milk and careful antibiotic stewardship are linked to improved microbial balance. Adjunctive therapies, such as the administration of probiotics and lactoferrin, show potential in enhancing gut barrier function and immune modulation, although confirmation through larger-scale studies remains necessary. Conclusions: Modulating the GM emerges as a promising strategy to ameliorate outcome in neonates with congenital gastrointestinal surgical conditions. Future research should focus on the development of standardized therapeutic protocols and the execution of rigorous multicenter trials to validate the efficacy and safety of these interventions. Full article

The digestion of A1 β-casein present in conventional milk releases β-casomorphin-7 (βCM-7), a bioactive peptide with potential implications for gastrointestinal and neurological health. A scoping review was performed to respond to the following research question: What are the health effects of consuming milk containing the A1 β-casein variant compared to the exclusive consumption of the A2 variant in humans? The evidence collected in this review of human studies with different populations (i.e., children, middle-aged adults, athletes) suggests that the consumption of milk containing A1 β-casein may negatively influence gut health by altering microbial composition, reducing intestinal motility, and increasing colonic fermentation, leading to elevated gas production and altered short-chain fatty acid (SCFA) profiles. The release of βCM-7 upon digestion can also compromise intestinal-barrier integrity, which may exacerbate symptoms of lactose intolerance, irritable bowel syndrome (IBS), or other allergy-related sensitivities. Its ability to cross the blood–brain barrier raises concerns about potential neurological effects. In contrast, milk containing exclusively A2 β-casein is associated with improved gastrointestinal outcomes, including the enhanced abundance of beneficial bacteria such as Bifidobacterium spp. and reduced inflammatory markers. Full article

Background/Objectives: Diamine oxidase (DAO) deficiency can lead to excessive histamine absorption at the intestinal level, triggering symptoms that affect the gastrointestinal, neurological, dermatological, respiratory, circulatory, and musculoskeletal systems. This condition, known as histamine intolerance, is more prevalent in women. While serum DAO levels have been observed to increase during pregnancy in healthy women, there is a lack of in-depth studies evaluating the relationship between pregnancy, DAO activity, and histamine intolerance symptoms. This is the first study to assess serum DAO activity before, during, and after pregnancy, as well as the evolution of histamine intolerance symptoms in women diagnosed with this condition. Due to low histamine, diets are quite restrictive, no dietary intervention was considered for pregnant women. Methods: This prospective observational study used an assessment questionnaire to evaluate the presence or absence of histamine-related symptoms in 30 adult women with histamine intolerance before, during, and after pregnancy. Serum DAO activity was also measured at the three time points. Results: Nearly all women (27 out of 30) experienced symptom improvement during pregnancy (p < 0.001). Specifically, at least 77% of women reported a marked reduction in flatulence, bloating, headache, rhinorrhea, flushing, pruritus, hypotonia, or muscle pain. Concurrently, the DAO activity significantly increased 11-fold from the baseline, coinciding with symptom relief. At two months postpartum, symptoms tended to reappear, accompanied by a significant decrease in DAO activity in all participants. Conclusions: This first-of-its-kind observational study demonstrates an improvement in histamine intolerance symptoms and an increase in serum DAO activity during pregnancy. The pronounced symptom relief suggests that restrictive diets, such as low-histamine diets, may not be necessary during pregnancy. Further research is required to confirm these novel findings. Full article

Background and Objectives: Military capability may be reduced in hot environments with individuals at risk of exertional heat stroke (EHS). Heat tolerance testing (HTT) can be used to indicate readiness to return to duty following EHS. HTT traditionally relies on rectal core temperature (T_re) assessment via a rectal probe. This study investigated the use of gastrointestinal core temperature (T_gi) as an alternative to T_re during HTT. A secondary aim was to compare physiological factors between heat-tolerant and heat-intolerant trials. Materials and Methods: Australian Defence Force personnel undergoing HTT following known or suspected heat stroke volunteered (n = 23 cases participating in 26 trials) along with 14 controls with no known heat illness history. Confusion matrices enabled comparison of HTT outcome based on T_gi and T_re. The validity of T_gi compared to T_re during HTT was assessed using correlation and bias. Comparisons between heat-tolerant and intolerant trials were performed using non-parametric tests. Results: Although T_gi correlated closely with T_re (Spearman’s rank correlation $\rho$ = 0.893; median bias 0.2 °C) there was no consistent pattern in the differences between measures. Importantly, the two measures only agreed on heat tolerance outcome in 80% of trials with T_gi failing to detect heat intolerance identified by T_re in 6 of 8 trials. If T_gi was relied upon for diagnostic outcome, return to duty may occur before full recovery. None of the assessed covariates were related to the difference between T_re and T_gi. In addition, resting heart rate and systolic blood pressure were significantly lower and body surface area to mass ratio significantly higher in heat-tolerant compared to intolerant trials. Conclusions: It is not recommended to rely on T_gi instead of T_re during HTT. Resting heart rate and systolic blood pressure findings point to the importance of aerobic exercise in conveying heat tolerance along with body composition. Full article

Ehlers-Danlos Syndromes (EDS) and Generalized Hypermobility Spectrum disorders (G-HSD) are a group of genetic, connective multi-systemic disorders that can affect the musculoskeletal, gastrointestinal, cardiovascular, and respiratory systems. Respiratory manifestations in EDS/G-HSD can contribute to decrements in health-related quality of life (HRQL); however, these relationships have not been previously characterized. We aimed to review the association of respiratory manifestations with the physical, psychological, and social domains of HRQL in EDS/G-HSD. A comprehensive search was conducted using Ovid Medline, Embase, and CINAHL with the following terms: “Ehlers-Danlos Syndrome”, “Hypermobility Spectrum Disorders”, and “Quality of Life”. Selected studies in English that investigated the relationship between respiratory manifestations and HRQL domains in EDS/G-HSD were included in this narrative review from inception to March 2024. Twelve studies described the physical, psychological, or social domains of HRQL relating to respiratory manifestations. Dyspnea, wheezing, and expiratory flow limitations were associated with limitations in physical function and exercise intolerance. Respiratory manifestations were associated with increased fatigue, pain, anxiety, kinesiophobia, and deconditioning. This review highlights the consequences that respiratory manifestations have on the physical domains of HRQL, through limitations on physical activity and exercise. Future studies should aim to identify the impact that respiratory manifestations have on the psychosocial domains of HRQL and develop disease-specific patient-reported measures to evaluate these relationships. Full article

Background: Previous research indicates that gastrointestinal discomfort from milk consumption may be attributable to A1 β-casein, rather than lactose intolerance alone. A2 milk (free of A1 β-casein) consumption may result in fewer symptoms compared to conventional milk containing both A1/A2 β-casein. Objective: In this five-week, double-blind, double-crossover study, we assessed the physiological responses to doses escalating in volume of lactose-free conventional milk (Lactaid), A2 milk, and lactose-free A2 milk in fluid milk-avoiding participants. Methods: Each milk type was consumed over three separate weeks with three increasing doses across five days per week, >one week washout. Gastrointestinal symptoms, blood glucose, and breath gases were monitored for twenty-four, two-, and three-hours post-consumption, respectively. Sensory evaluation was completed for each sample. Results: Fifty-three participants consented and were randomized, with forty-eight participants completing the study. Overall, symptoms were minimal. On Days 1 and 3, lower ratings of bloating and flatulence were observed in A2 compared to lactose-free A2. Breath hydrogen responses reflected lactose content, but were higher in lactose-free A2 than Lactaid on Day 5. Thirty-three participants were deemed lactose-intolerant and had higher fasting and average breath hydrogen for all samples. The only symptom corresponding to the increase in breath hydrogen among these participants was flatulence after A2 consumption. Surprisingly, flatulence was apparently higher for lactose-tolerant individuals when consuming Lactaid compared to A2. Conclusions: These findings suggest that adults who avoid conventional fluid milk consumption may experience minimal GI discomfort from lactose-free and/or A1-free milks. Full article

Background/Objectives: Nutritional support is a critical yet challenging aspect of care for pediatric patients requiring extracorporeal membrane oxygenation (ECMO). Malnutrition is prevalent in this population and is associated with worse clinical outcomes. This review synthesizes current evidence on nutritional strategies for pediatric ECMO patients, emphasizing assessment methods, feeding routes, challenges, and clinical outcomes. Methods: A literature review was conducted using PubMed, Scopus, and Web of Science to identify relevant studies published between January 2010 and 2025. Keywords included “pediatric ECMO”, “nutrition”, “enteral feeding”, and “parenteral nutrition”. Studies addressing nutritional assessment, enteral and parenteral feeding practices, and their impact on clinical outcomes were included. Results: Malnutrition is a significant risk factor for morbidity and mortality in ECMO patients, yet nutritional support remains highly variable. While enteral nutrition (EN) is preferred, feeding intolerance and gastrointestinal dysfunction often necessitate parenteral nutrition (PN). Early EN initiation, even at trophic levels, is associated with improved gut integrity and outcomes. However, achieving full nutritional goals enterally remains a challenge, particularly in neonates. PN remains essential in cases of feeding intolerance but is linked to hepatic dysfunction and metabolic imbalances. Conclusions: Optimizing nutritional support in pediatric ECMO patients requires individualized assessment and a structured approach to enteral and parenteral feeding. Further research is needed to establish standardized feeding protocols and determine the optimal timing and composition of nutritional support to improve outcomes. Full article

Background/Objectives: Food hypersensitivity remains an understudied and overlooked subject globally. It is characterized by adverse reactions to dietary substances, potentially triggered by various mechanisms. Food allergy, a subset of food hypersensitivity, denotes an immune response to food proteins categorized into immunoglobulin IgE-mediated or non-IgE-mediated reactions. Conversely, food intolerance, another facet of food hypersensitivity, refers to non-immunological reactions, in which the human body cannot properly digest certain foods or components, leading to gastrointestinal discomfort and other non-immune-related symptoms. The main objective of this study was to determine and differentiate the differences, characteristics, and types of food hypersensitivity. Methods: This study involved a comprehensive review of key research from 1990 onward, including review articles, prospective studies, nested case–control studies, and meta-analyses. Results: Recognizing these differences is essential for healthcare professionals to ensure accurate diagnosis, effective management, and improved patient outcomes, while also aiding dietitians in providing optimal nutritional and dietary guidance. Conclusions: there are big differences between the main characteristics, such as symptoms, complications, and treatments between allergies, and food intolerances. Commonly reported trigger foods include cow milk, gluten, eggs, nuts, and seafood. Full article

Objective: The objective was to evaluate the impact of perioperative immunonutrition (IN) on postoperative complications in patients undergoing radical cystectomy (RC) for bladder cancer (BC). Methods: A prospective case series of 19 patients treated with perioperative IN between October 2022 and July 2023 was conducted. Patients received preoperative IN based on nutritional risk and postoperative IN with gradual recovery of normal feeding. The inclusion criteria encompassed clinically node-negative patients without metastatic disease. The outcomes were assessed using Clavien–Dindo classification and included infectious complications, wound healing disorders, ileus, anemia, genitourinary issues, recovery time, and compliance with the nutritional regimen. Results: Sixteen patients (84.2%) experienced complications. Most were low-grade (CD 1–2), with no CD > 3a. Wound disorders affected 10.5% and anemia requiring transfusion occurred in 47.4% of patients, infectious complications were reported in 26.3%, and ileus in 36.8%. The median time to first flatus was 2 days (IQR 2–3), while resumption of oral feeding occurred after 4 days (IQR 2–5), like mobilization (IQR 2–5). The median hospital stay was 14 days (IQR 11–18). Compliance with IN was 78.9%, with gastrointestinal intolerance being the primary cause of discontinuation. Conclusions: Patients with RC undergoing perioperative IN showed low rates of high-grade complications and promising results in bowel function recovery and infection rates. Further randomized controlled trials are required to validate these results. Full article

Enteral nutrition (EN) has been reported to have some physiological importance for critically ill patients. However, the advantage of EN over parenteral nutrition remains controversial in recent paradigms. To maximize the benefits and efficiency of EN, implementing measures based on comprehensive evidence is essential. Here, we systematically reviewed EN-related studies and integrated them into the best and most up-to-date EN practices. We extracted studies from 13 systematic reviews during the development of Japanese Critical Care Nutrition Guidelines, summarizing findings on the assessment of enteral feeding intolerance (EFI), the timing of EN, formula composition and nutrients, and method of administration in critically ill adult patients. Multifaceted EFI assessment may be needed in patients for high-risk patients. Early EN may reduce infectious complications, and initiating EN even earlier may offer an additional advantage. High protein intake (≥1.2 g/kg/day) could maintain muscle mass and physical function without increasing gastrointestinal complications. Probiotics, prebiotics, and synbiotics may serve as beneficial options for preventing infection and gastrointestinal complications, although their efficacy depends on the strains, types, and combinations used. For patients with EFI, post-pyloric feeding could be an effective approach, while intermittent feeding may be a safer approach. Both methods should be utilized to achieve nutritional targets. Integrating these nutritional interventions into EN strategies may help maximize their effectiveness and minimize complications. However, careful consideration regarding timing, dosage, nutrient selection, administration methods, and patient selection is required. Full article

Background: There is controversy regarding whether using fiber-enriched formula affects the incidence of diarrhea among enterally fed patients in our setting. Also, there is a lack of clinical studies about enterally fed patients’ tolerance for feeding and the incidence of diarrhea among patients in the Middle East. This study aimed to assess fiber enrichment’s efficacy in reducing post-enteral feeding bowel intolerance in non-critically ill patients. Methods: This was a prospective cohort study of 55 fiber-free (FF) and 119 fiber-enriched (FE) tube-fed adult patients admitted for five or more days with medical or surgical conditions. Data on patients’ demographics, antibiotics and laxative medications, and gastrointestinal complications were collected. Absolute risk reduction (ARR), relative risk reduction (RRR), and relative risks (RR) were calculated to assess the efficacy of fiber enrichment in reducing post-enteral feeding bowel intolerance. Statistical significance was set at p ≤ 0.05. Results: The rate of diarrhea dropped from 54.5% for FF to 29% for FE groups, with an ARR of 25.1% (95% CI 24.6–25.6, p < 0.001) and an RRR of 64.1%, and RR was 0.54, reflecting a reduction in the rate of diarrhea by 46% after fiber enrichment. The rate of significant weight loss dropped from 45.5% without enrichment to only 26.9% with enrichment, with an ARR of 18.6% (95% CI: 18.0–19.2, p < 0.001) and RRR of 40.9%, and RR was 0.59, reflecting a 41% reduction in significant weight loss after fiber enrichment. After adjusting for some potential confounders, FF formula was a significant predictor of diarrhea (OR = 3.04, 95% CI 1.49–6.19, p = 0.002) and significant weight loss (OR = 2.37, 95% CI 1.16–4.84, p = 0.018) in tube feeding, while antibiotic intake was also a significant predictor of only diarrhea (OR = 2.68, 95% CI 1.12–6.38, p = 0.026). Conclusions: This study demonstrated the beneficial effect of fiber supplementation in minimizing diarrhea in hospitalized patients receiving tube feeding. Antibiotic usage must be scrutinized and stopped if possible. Overall, the study provides compelling evidence supporting fiber-enriched enteral feeding, though further discussion on potential confounders and clinical applications would enhance its impact. Further, well-designed RCTs are needed to prove the efficacy of fiber-enriched feeds used in enteral tube feeding in non-critically ill patients. Full article

Celiac disease (CeD), also known as gluten enteropathy, is an immune-mediated inflammatory enteropathy triggered by intolerance to gluten. It presents with a spectrum of symptoms, including both gastrointestinal and extraintestinal manifestations, as well as neurological symptoms. A review of the literature indicates that 10–22% of patients with CeD present with neurological symptoms. The objective of this study is to assess the influence of a gluten-free diet (GFD) on brain bioelectrical activity and neurological symptoms in children with CeD. Methods: The study was conducted using a multidisciplinary approach, encompassing a comprehensive array of clinical data gathered alongside laboratory test results, questionnaires, and electroencephalogram (EEG) assessments. The study population included 85 children: 18 newly diagnosed cases of CeD patients (NDC), subsequently reassessed after 6 months on a GFD as a celiac disease on diet (CDD); 27 CeD patients on a GFD for over 12 months (CDD2); and 40 healthy individuals in the comparison group (CG). Results: It was observed that over half of the NDC group exhibited neurological symptoms, particularly headaches. Following a six-month period on a GFD, there was a notable reduction in symptom severity. In comparison to the CG, the NDC patient group exhibited a higher prevalence of abnormalities in EEG recordings (p = 0.032), including focal sharp waves or slow waves. Conclusions: The results demonstrate that a GFD has a positive impact on the neurological condition of children with CeD. The clinical improvements correspond with EEG normalization, which supports the hypothesis that dietary intervention plays a role in mitigating CeD-associated neurological dysfunction. Full article

Background/Objectives: Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between ileus and mechanical obstruction but expose patients to radiation, add cost, and may lead to unnecessary work up. The aim of this study was to determine how often KUBs led to a change in treatment after PSF in patients with NMS. Methods: A retrospective review was conducted of NMS patients with ≥2-year follow-up treated with PSF between January 2014 and December 2019 at a tertiary pediatric hospital. Results: Of the 133 patients (age 13.7, SD 2.6 years; preoperative curve magnitude 82.8, SD 23.0 degrees; follow-up 44.7, SD 15.4 months), 22.6% (30/133) underwent KUB imaging due to abdominal pain, distension, or delayed return of bowel function. In total, 93.3% (28/30) of the KUB imaging was consistent with ileus. One KUB study resulted in a gastroenterology consultation and bowel cleanout, and one raised concerns regarding possible pneumatosis of the colon, prompting a pediatric surgery consultation and exploratory laparotomy which was unremarkable. Conclusions: KUBs were performed in nearly 25% of NMS patients during the acute postoperative period, but rarely provided useful diagnostic information leading to changes in management. In the presence of postoperative abdominal distension, feeding intolerance, and delayed return of bowel function, we advocate for continuing conservative measures until bowel function returns, reserving abdominal radiographs for patients with a worsening exam despite bowel rest or additional causes for concern. Full article