Search Results (413)

Neuropathic pain is difficult to treat as current therapies are often insufficient and provide incomplete relief. However, the mechanisms of chronic nerve injury are poorly addressed. In the present study, we explored the therapeutic effects of natural steroidal saponin diosgenin and its possible spinal mechanisms in a mouse model of chronic constriction injury (CCI)-induced neuropathic pain. C57BL/6 mice underwent CCI and were orally administered diosgenin once daily from three days after surgery. Diosgenin significantly alleviated CCI-induced mechanical allodynia and thermal hyperalgesia and enhanced motor performance in paw withdrawal, open-field, and rotarod tests. These effects were associated with the restoration of mitochondrial homeostasis as evidenced by the increased mitochondrial fusion, decreased fission and activation of NRF2 signaling. Diosgenin also suppressed spinal endoplasmic reticulum (ER) stress, mitochondria apoptotic signaling and the expression of pro-inflammatory cytokines, and pain-related neuropeptides. Mechanistically, the inhibition of spinal NRF2 proteins and the pharmacological induction of ER stress reduced the analgesic effect of diosgenin, highlighting the critical involvement of these pathways in its therapeutic efficacy. Altogether, diosgenin alleviated neuropathic pain in CCI mice that were pharmacologically associated with the restoration of spinal mitochondrial function and ER stress suppression. Therefore, diosgenin could be a promising natural steroidal therapeutic candidate in alleviating neuropathic pain. Full article

Aim: Antibody-drug conjugates (ADCs) are an emerging class of anti-cancer therapies, designed to specifically target cancer cells while minimizing impact on healthy tissues; however, they are associated with a broad spectrum of toxicities. The goal of this paper is to review the current knowledge about ADC-associated oral toxicities with a focus on the oral mucosa. Methods: A literature search of PubMed and Google Scholar from inception through June 2026 was conducted, supplemented by official FDA pharmaceutical drug information. The review encompasses oral mucosal toxicity, dry mouth, xerostomia, and dysgeusia associated with ADCs. Findings were qualitatively assessed and compared with established guidelines for cancer therapy-associated mucositis. Results: ADC-associated oral mucosal toxicity (OMT) presents as erosions or ulcers, often causing moderate to severe pain. OMT typically occurs early in ADC treatment, with high prevalence rates and varying severity, depending on the ADC type, dose, and treatment cycles. ADC-associated dry mouth can worsen OMT, and ADC-associated dysgeusia may complicate oral intake. OMT management involves a multidisciplinary approach, focusing on basic oral care, pain management, and adequate oral intake tailored to severity. Limited evidence is available regarding steroid-based mouthwashes and cryotherapy, and their efficacy is unclear. Severe OMT may require ADC therapy adjustments, such as dose reduction, cycle spacing, or temporary discontinuation. Conclusions: ADC-associated oral toxicities manifest in various tissues. These toxicities may arise from on-target, off-target, or immune-mediated mechanisms. They require a multidisciplinary approach for management. Further research is needed to establish effective protocols for the prevention and treatment of ADC-associated oral toxicities. Full article

Ibuprofen is a widely used non-steroidal anti-inflammatory drug (NSAID) with antipyretic, analgesic, and anti-inflammatory activity; however, its low aqueous solubility limits its dissolution rate and, consequently, its oral bioavailability. This study aimed to develop and physicochemically characterize an ibuprofen-loaded self-nanoemulsifying drug delivery system (SNEDDS) using a Box–Behnken experimental design. Fifteen formulations were prepared and evaluated based on CQAs: cloud point, robustness to dilution, self-emulsification time, droplet size, zeta potential, and polydispersity index (PDI). The experimental responses were subjected to statistical analysis; robustness to dilution as the only response yielding a statistically valid and predictive model within the studied design space, which was used as the sole optimization criterion. The optimal formulation was evaluated and characterized according to previously established CQAs and subjected to thermodynamic stability testing and stress testing over one month. The optimized formulation exhibited rapid self-emulsification, with a self-emulsification time of 37.02 s, a cloud point of 64.87 °C, and high robustness to dilution across different pH conditions and dilution volumes. Moreover, it exhibited a mean droplet size below 157 nm, a zeta potential of −15.43 ± 0.58 mV, and a PDI of 0.251, suggesting adequate colloidal stability and uniformity of the dispersed system. These physicochemical attributes support the potential of the developed system as a platform for further biopharmaceutical evaluation of ibuprofen oral delivery. Full article

Background and Objectives: Real-world data on anifrolumab in Egyptian patients with moderate-to-severe systemic lupus erythematosus (SLE) remain limited. This study aimed to evaluate the real-world effectiveness and safety of anifrolumab in Egyptian patients with moderate-to-severe SLE. Materials and Methods: This retrospective, multicenter, observational cohort study reviewed the medical records of 80 adults with moderate-to-severe SLE who had received at least 6 doses (≥20 weeks) of intravenous anifrolumab 300 mg every 4 weeks as part of routine clinical care at 13 Egyptian tertiary rheumatology centers; medical record review and data extraction were performed between May and July 2026. Outcomes were assessed at baseline and final follow-up and included disease activity, lupus low disease activity state (LLDAS), glucocorticoid use, flare status, laboratory parameters, and adverse events. Results: Patients were predominantly female (98.8%), with a mean age of 30.4 ± 9.8 years. Disease activity improved, with SLEDAI-2K decreasing from 11 to 4 (p < 0.001), PGA from 2.7 to 0.5 (p < 0.001), LLDAS increasing from 0% to 51.3% (p < 0.001), and flares decreasing from 95.0% to 18.8% (p < 0.001). Glucocorticoid burden also declined, with oral glucocorticoid use falling from 95.0% to 83.8% (p = 0.021), median prednisone dose from 20 mg/day to 5 mg/day (p < 0.001), intravenous methylprednisolone use from 50.0% to 6.3% (p < 0.001), and 63.8% achieving prednisone doses ≤ 7.5 mg/day (p < 0.001). Laboratory improvement included hemoglobin, leukocyte count, lymphocyte count, platelet count, C3, C4, anti-dsDNA, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), while serum creatinine did not change significantly (p = 0.904). No serious adverse events were reported. Conclusions: Anifrolumab was associated with significant short-term improvement in clinical and laboratory disease activity, marked steroid sparing, and reduced flare burden in Egyptian patients with moderate-to-severe SLE, with acceptable short-term tolerability. Full article

Background and Clinical Significance: Collagenous gastritis (CG) is a rare disorder characterized by subepithelial collagen deposition, typically presenting in children with iron deficiency anemia (IDA) and abdominal pain. Its pathogenesis remains unclear, and no standardized treatment exists. Case Presentation: A female patient developed IDA at 4.5 years of age, requiring repeated intravenous iron infusions, and recurrent epigastric pain. CG was diagnosed at 13.5 years, with marked gastric eosinophilia (peak 685 eosinophils/mm²) and subepithelial collagen thickening (103.6 μm). Extensive evaluation excluded alternative causes. Proton pump inhibitor (PPI) therapy failed to meaningfully improve symptoms, endoscopic findings, or histology. A 10-week course of oral systemic corticosteroids resolved abdominal pain and normalized hemoglobin and ferritin levels, but endoscopic abnormalities persisted, histologic improvement was limited, and pain recurred after withdrawal. Dupilumab was initiated as a steroid-sparing, histology-targeted therapy. Over 15 months, the patient remained asymptomatic, hemoglobin and ferritin levels remained normal without intravenous iron or routine oral iron supplementation, and endoscopic abnormalities improved although residual histologic abnormalities persisted. Dupilumab achieved a decrease in gastric eosinophil counts and subepithelial collagen thickness by 41% and 33%, respectively; steroids achieved decreases of 17% and 13%, respectively, and PPIs achieved decreases of 23% and 0.6%, respectively. Conclusions: Dupilumab was associated with sustained clinical and hematologic remission together with gradual endoscopic and histologic improvement in pediatric CG with prominent eosinophilic inflammation. To our knowledge, this is the first reported pediatric case of CG treated with dupilumab. These findings suggest that dupilumab may represent a promising steroid-sparing therapeutic option and support further evaluation in larger case series and controlled studies. Full article

Background: The administration of direct oral anticoagulants to older adults requires careful risk stratification against a backdrop of polypharmacy and age-related renal function decline. The role of single nucleotide polymorphisms in cytochrome P450 genes and efflux transporters in this context remains a clinically understudied issue. This study aimed to investigate the association of ABCB1, CYP3A4, and CYP3A5 allelic variants with the safety of rivaroxaban therapy in geriatric patients with non-valvular atrial fibrillation (AF). Materials and Methods: This prospective cohort study consecutively enrolled 94 patients (mean age 83.2 ± 9.2 years). Rivaroxaban trough plasma concentrations ($C_{min,ss}$ ) were quantified using a validated high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) assay. Real-time polymerase chain reaction was utilized for the molecular genetic profiling of the ABCB1 (rs1045642, rs2032582), CYP3A4*22 (rs35599367), and CYP3A5*3 (rs776746) loci. Comorbidity severity and the spectrum of drug–drug interactions were evaluated as additional predictors. Results: Clinically relevant hemorrhagic complications were documented in 36.2% (n = 34) of the monitored patients. A significant association was established between the homozygous CC genotype at the ABCB1 rs1045642 locus and increased bleeding propensity (odds ratio [OR] 2.42; 95% CI: 1.02–5.74; p = 0.042), whereas the alternative TT variant was associated with a pronounced protective effect. No statistically significant correlations were identified for biotransformation isoenzyme markers (CYP3A4*22, CYP3A5*3). Anticoagulant metrics were comparably distributed across groups and showed no dependence on genetic status. The leading non-genetic factors associated with hemorrhage were advanced age (p < 0.0001), progressive glomerular filtration rate decline (CKD stages 3b–4; p = 0.0009), and pharmacokinetic/pharmacodynamic interference from the co-administration of amiodarone (OR 3.61), non-steroidal anti-inflammatory drugs, and antiplatelet agents. The validated HAS-BLED score demonstrated no predictive power within the comorbid conditions of this cohort (p = 0.052). Conclusions: The ABCB1 rs1045642 (C3435T) polymorphism is associated with the occurrence of hemorrhagic events. Implementing pharmacogenetic testing of the P-glycoprotein transporter combined with a rigorous audit of renal excretory function and concomitant therapy management may optimize the safety profile of rivaroxaban in geriatric practice. These findings warrant confirmation in a larger cohort. Full article

Background: Premenstrual disorders (PMDs), including premenstrual syndrome and premenstrual dysphoric disorder, are common conditions that may substantially affect adolescents’ physical and psychological well-being. However, their presentation and management during adolescence are complicated by reproductive-axis maturation, overlap with other medical conditions, and limited adolescent-specific evidence. This review aimed to provide an interdisciplinary perspective on PMDs in adolescents, integrating biological, psychological, developmental, clinical, and sociocultural aspects. Methods: A structured narrative review was conducted. Publications addressing the neuroendocrine and developmental mechanisms, clinical manifestations, psychosocial consequences, diagnosis, and treatment of PMDs were considered, with adolescent-specific evidence prioritized where available. Results: Current evidence suggests that PMDs are associated with altered sensitivity to physiological ovarian steroid fluctuations and their neuroactive effects rather than abnormal circulating hormone concentrations alone. In adolescents, PMDs may present with diverse somatic, affective, cognitive, and behavioral symptoms and are associated with impaired quality of life, school functioning, interpersonal relationships, and psychological well-being. Diagnostic assessment remains challenging because symptoms may overlap with normal pubertal changes and psychiatric disorders. Prospective monitoring of symptom cyclicity and functional impairment is therefore essential. Pharmacological treatments, particularly selective serotonin reuptake inhibitors and selected combined oral contraceptives, represent important therapeutic options, while psychological, lifestyle, physical activity, and physiotherapeutic interventions may provide additional benefits. However, most treatment evidence is derived from adult populations. Conclusions: PMDs in adolescents should be conceptualized as multidimensional conditions requiring an interdisciplinary approach integrating gynecological, psychiatric, psychological, endocrinological, primary care, and lifestyle perspectives. Greater recognition and developmentally appropriate assessment may facilitate earlier diagnosis and individualized management. Further prospective, adolescent-specific research is needed to clarify the biological and psychosocial determinants of PMDs and establish evidence-based strategies for their multidisciplinary management. Full article

Metabolic syndrome came to the attention of the scientific community several decades ago, and its definition has undergone multiple changes over time. It is currently defined by the coexistence of hypertension, central obesity, dyslipidemia, and impaired glucose metabolism, with insulin resistance, chronic inflammation, and oxidative stress representing important underlying pathophysiological mechanisms. The latter two processes are major promoters of the onset and progression of atherosclerosis. In parallel, many individuals develop metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called non-alcoholic fatty liver disease (NAFLD). Growing evidence indicates that MASLD may interact bidirectionally with cardiovascular, renal, and metabolic dysfunction and may contribute to cardiometabolic risk. These observations have prompted proposals for a broader cardio–reno–hepato–metabolic axis. However, MASLD is not currently included in the established cardiovascular-kidney-metabolic (CKM) definition or staging system, and its incorporation remains an evolving conceptual extension. Prediabetes is a reversible condition characterized by abnormal glucose levels that do not meet the diagnostic criteria for diabetes. The American Diabetes Association defines prediabetes as glycated hemoglobin (HbA1c) = 5.7–6.4%, fasting plasma glucose = 100–125 mg/dL, or two-hour plasma glucose during an oral glucose tolerance test = 140–199 mg/dL. This comprehensive review examines traditional and genetic risk determinants, shared pathophysiological mechanisms, diagnostic strategies, clinical manifestations, emerging phenotypes, circulating microRNAs as non-invasive biomarkers, complications, and the principal therapeutic strategies, including diet, exercise, and pharmacotherapy. Particular attention is given to the recent approvals of resmetirom and semaglutide for metabolic dysfunction-associated steatohepatitis and to the expanding roles of sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists and non-steroidal mineralocorticoid receptor antagonists. Cardiovascular, renal, metabolic, and hepatic disorders are frequently present in the same patient. Other individuals may develop this high-risk cluster over time. The aim of this article is to define the interplay between different metabolic conditions and to outline the best approach to diagnosis, monitoring, and effective integrated therapy. Full article

Conjunctival lymphoma classically appears as a painless salmon-pink subepithelial infiltrate, but its indolent forms can closely imitate inflammatory ocular surface disease and delay diagnosis, particularly when an uncommon subtype such as small lymphocytic lymphoma presents bilaterally and in isolation. A woman in her early fifties presented with one month of left ocular discomfort and sectoral redness, and slit-lamp examination revealed two multilobulated hyperaemic bulbar conjunctival nodules, clinically indistinguishable from nodular episcleritis. Topical corticosteroids and a topical non-steroidal anti-inflammatory drug relieved the ocular discomfort and hyperaemia, but the nodules regressed only partially and at no point resolved. This dissociation between symptomatic relief and persistence of the lesions was, in retrospect, the earliest argument against a purely inflammatory process. The initial work-up pointed toward inflammatory and granulomatous causes: elevated serum angiotensin-converting enzyme and lysozyme raised the possibility of sarcoidosis, although thoracic computed tomography, bronchoscopy and a first conjunctival biopsy performed without a lymphoma-directed panel were unrevealing, showing only reactive lymphoid hyperplasia. Approximately one year later, recurrent and now bilateral disease prompted a repeat biopsy with directed immunohistochemistry, which demonstrated a CD20-positive small B-cell infiltrate co-expressing CD5 and CD23 with negative cyclin D1 and CD10, consistent with chronic lymphocytic leukaemia/small lymphocytic lymphoma. Systemic staging with ¹⁸F-FDG PET/CT and bone marrow biopsy revealed no definite extra-conjunctival disease. After multidisciplinary review of observation, local radiotherapy and surgical excision, systemic therapy was preferred given the bilateral, recurrent and symptomatic course, and oral ibrutinib 420 mg once daily achieved complete clinical regression at three months and a sustained ocular response at two years, with indefinite haematological and ophthalmological surveillance planned. Full article

Background: Portulaca oleracea L. (POL) has anti-inflammatory and immunomodulatory activities, but its mechanism against atopic dermatitis (AD) remains incompletely understood. Methods: 2,4-dinitrofluorobenzene (DNFB)-induced AD mice were treated orally with POL or dexamethasone for 14 days. We evaluated skin lesions, scratchizng, serum IgE, histopathology, inflammatory cytokines, skin-barrier genes, JAK/STAT phosphorylation, and fecal metabolites. Results: POL alleviated skin lesions and pruritus, reduced serum IgE concentrations, attenuated epidermal hyperplasia and inflammatory-cell and mast-cell infiltration, and restored keratinocyte architecture. It decreased IL-4, IL-13, and IL-31 expression, increased filaggrin and loricrin expression, and inhibited JAK1, STAT1, and STAT3 phosphorylation. Untargeted metabolomics showed that POL mainly regulated unsaturated fatty acid and steroid hormone biosynthesis and restored levels of anti-inflammatory and antiallergic metabolites, including (±)18-HEPE, docosahexaenoyl ethanolamide, and dehydroepiandrosterone. Conclusions: These findings indicate that POL ameliorates AD by suppressing Th2 inflammation through JAK1/STAT3 signaling, correcting lipid-metabolic disturbances, and restoring skin barrier integrity. Full article

Background: Pemphigus is a rare group of autoimmune blistering diseases characterized by autoantibody-mediated loss of keratinocyte adhesion, resulting in intraepithelial blister formation involving the skin and mucous membranes. Pemphigus Vulgaris (PV) is the most common type of pemphigus, which usually presents in adulthood and has a prevalence rate of about 2.83 cases per million person years worldwide. The prevalence rate in children and adolescents is relatively uncommon; however, it accounts for about 1.4 to 3.7 percent of all cases of pemphigus vulgaris reported worldwide. The involvement of oral cavity is clinically significant since it can present prior to the disease or as its predominant feature. Hence, this narrative review seeks to review literature on pemphigus with involvement of oral cavity in children and adolescents. Objective: The objective of this study was to review the current literature regarding epidemiology, pathogenesis, clinical presentation, diagnosis, histopathological characteristics, treatment, and outcomes of pemphigus with oral involvement in children and adolescents. Materials and Methods: A literature search was conducted using the PubMed/MEDLINE, Scopus, and Cochrane Library databases to identify relevant studies published between 2015 and 2026. The search strategy included terms related to pemphigus, pediatric patients, and oral manifestations. Articles involving patients younger than 18 years of age with oral involvement were screened according to predefined inclusion criteria. Following database screening, duplicate removal, and full-text assessment, 25 studies comprising a total of 51 patients with documented oral or orofacial involvement were included in the final review. Results: Pemphigus vulgaris was the predominant subtype, with oral lesions representing the initial or sole manifestation in the majority of patients. The gingiva, mucosa, tongue, lip, and palate were the most common affected areas in the mouth. The lesions in these areas usually appeared as painful erosion, ulcers, and desquamative gingivitis. Histopathology with the presence of acantholysis in the suprabasal area and direct immunofluorescence was the most definitive test for diagnosis. Systemic corticosteroids were the mainstay of treatment in conjunction with steroid sparing agents in some cases, with good results in difficult cases using rituximab. Overall, most patients achieved partial or complete clinical remission following appropriate treatment, although relapses were occasionally reported. Conclusions: Pemphigus in children and adolescents is rarely encountered; however, it should be included as a differential diagnosis of erosive/ulcerative lesions. Early identification, diagnosis, and treatment through a collaborative approach from dental practitioners are critical. Further research is required at multiple centers to gain a better understanding of the disease and to develop evidence-based guidelines for diagnosis and treatment of pediatric patients. Full article

Canine urothelial carcinoma (UC) is commonly managed with non-steroidal anti-inflammatory drugs (NSAIDs), alone or combined with cytotoxic chemotherapy. Evidence supporting subcutaneous keyhole limpet hemocyanin (KLH) in canine UC is lacking. We describe two client-owned dogs with presumptive lower urinary tract UC managed with NSAIDs, KLH, and selenium after cytotoxic chemotherapy was declined. Case 1 was an 11-year-7-month-old castrated male Maltese with bladder-neck/proximal-urethral thickening. A positive veterinary bladder tumor antigen test, compatible serial imaging, and low-cellularity urine cytology showing suspected urothelial hyperplasia with dysplasia supported clinical suspicion; however, BRAF and BRAF-PLUS assays were negative and histopathology was unavailable. Case 2 was an 11-year-old neutered male Poodle with a BRAF V595E-positive urethrovesical-junction lesion on imaging, without histopathologic confirmation. Both dogs received NSAIDs, Immucothel^® (1 mg subcutaneously), intravenous sodium selenite (200 μg/kg), and oral selenium (100 μg/dog q24h). Serial CT and ultrasonography documented persistent localized abnormalities over prolonged follow-up, but measurements obtained by different modalities were not treated as directly comparable. Adverse events were assessed retrospectively and not prospectively graded using VCOG-CTCAE criteria. Because the diagnoses were presumptive and the interventions were concurrent and uncontrolled, the independent contribution, efficacy, and safety of KLH cannot be determined. These cases are descriptive and hypothesis-generating. Full article

Background and Objectives: Topical diclofenac is recommended over oral non-steroidal anti-inflammatory drugs (NSAIDs) for osteoarthritis, particularly in older adults and those with comorbidities, on the assumption that low systemic absorption limits renal effects. Whether this presumed safety extends to patients already at increased risk of kidney injury has not been systematically evaluated. This review assessed the evidence on renal outcomes of topical diclofenac in adults. Materials and Methods: We conducted a systematic review (PROSPERO CRD420261393454) of studies reporting renal outcomes after topical diclofenac exposure. PubMed, Embase, Web of Science, and Scopus were searched from inception to 19 April 2026. Studies were stratified a priori into increased-renal-risk and general populations and synthesised separately, without pooling. Risk of bias was assessed with RoB 2, ROBINS-I, and JBI tools, certainty with GRADE, and synthesis followed the SWiM framework. Results: Eighteen studies, contributing data from more than 500,000 participants, were included; 14 underwent primary risk-of-bias appraisal (three at low, three at serious or high risk). In general populations, topical diclofenac produced little to no change in serum creatinine or creatinine clearance and smaller renal effects than oral diclofenac, providing high-certainty evidence of a favourable profile. In increased-renal-risk populations, one adjusted cohort reported higher acute kidney injury (AKI) risk among topical NSAID users, although exposure was predominantly to non-diclofenac agents; within the same cohort, topical NSAIDs carried lower risk than systemic NSAIDs. No study evaluated early renal injury biomarkers; certainty was moderate owing to indirectness. Conclusions: Relative to oral diclofenac, topical diclofenac shows a favourable renal safety profile, with high-certainty evidence in general populations. In adults at increased renal risk, moderate-certainty evidence derived from predominantly non-diclofenac exposure over short observation windows cannot exclude a modest excess of any-stage AKI; renal risk therefore appears reduced rather than absent. Diclofenac-specific studies in chronic kidney disease using sensitive biomarkers and longer follow-up are needed. Full article

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for pain, inflammation, and fever. Although many NSAIDs are available without a prescription, inappropriate use may increase the risk of renal, gastrointestinal, and cardiovascular complications. This study evaluated NSAID dispensing patterns and potential risk practices in community pharmacies in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study was conducted in 90 community pharmacies across Al-Ahsa, Al-Dammam, and Jubail Industrial City between February and March 2025. Data on demographics, NSAID type, indication, dosage, frequency, duration, and concomitant medication use were collected and analyzed descriptively. Results: Among the 171 documented NSAID dispensing cases, 98 (57.3%) occurred without a prescription, whereas 73 (42.7%) involved prescription-based dispensing. Ibuprofen (62%) and diclofenac (36.3%) were the most commonly dispensed agents, with oral tablets being the preferred formulation (76.6%). Most documented treatment durations were short (3–7 days) with once- or twice-daily dosing. Common documented indications included dental conditions, pain, and inflammation, although the indication was not specified in 57.3% of cases. At least one potential interaction was identified in 11(7.8%, 95% CI 4.4–13.4%) of the 141 cases with concomitant medication use, corresponding to 13 (5.9%, 95% CI 3.5–9.9%) potential interaction pairs. Conclusions: Frequent non-prescription NSAID dispensing, incomplete documentation, and potentially clinically relevant drug interactions highlight the need to strengthen medication review, documentation, public awareness, regulatory oversight, and pharmacist counseling in community pharmacy practice. Full article

Stereotactic body radiotherapy (SBRT) is an effective and increasingly utilized treatment modality for abdominal tumors, offering high rates of local control with generally acceptable toxicity profiles. Nevertheless, rare but severe late gastrointestinal complications, including radiation-induced ulceration, may occur and significantly impair patients’ quality of life, as well as continuation of oncologic treatment. Hyperbaric oxygen therapy (HBOT) has shown potential benefit in the management of chronic radiation-induced tissue injury, although evidence regarding its role following SBRT remains limited. We report the case of a 75-year-old woman with cholangiocellular carcinoma who developed severe radiation-induced duodenal ulceration following liver SBRT, presenting with persistent postprandial pain, nausea, vomiting, and substantial weight loss despite standard supportive treatment. Helicobacter pylori testing was negative, non-steroidal anti-inflammatory drug use was excluded, and histopathology showed chronic inflammatory and fibrotic mucosal injury with reactive epithelial changes. Despite high-dose proton pump inhibition, bismuth subcitrate, and nutritional support, symptoms and endoscopic ulceration persisted. HBOT was administered at 2.4 atmospheres absolute for 60 min over 30 sessions. Clinical improvement was noted after three sessions, and treatment was completed without adverse effects. Follow-up endoscopy demonstrated almost complete ulcer regression, with complete symptom resolution, improved oral intake, and a 10 kg weight gain. To the best of our knowledge, this represents the first reported case describing the successful use of HBOT as a potentially effective adjunctive treatment for severe radiation-induced duodenal ulceration following liver SBRT in a patient with cholangiocarcinoma. Although encouraging, this observation should be interpreted cautiously, and prospective clinical studies are needed to further evaluate the efficacy, safety, and optimal timing of HBOT in this setting. Full article