Search Results (290)

Cryotherapy involves flash freezing of tissue and removing unwanted tissue. Mechanism of injury is causing cell membrane rupture by rapid multiple freeze–thaw cycles, while reserving tissue architecture and the collagen matrix. This promotes favorable wound healing. In recent years, it has gained increasing attention as a treatment option for upper gastrointestinal diseases (Barrett’s Esophagus and early cancer). Currently, two FDA-approved delivery methods are available in the GI tract: Cryoballoon and spray cryotherapy, which will be discussed. In this review, we also propose to examine the expanding role of cryotherapy in gastrointestinal practice, drawing from both clinical studies and illustrative vignettes. In addition, we will highlight its established role in eradicating Barrett’s with low and high-grade dysplasia and compare its outcomes and safety profile with radiofrequency ablation (RFA). We will also discuss the application and safety of spray cryotherapy in the palliation of malignant esophageal strictures when compared with Esophageal stent placement. Cryotherapy may have immunological potential, and it may shrink both primary and metastatic diseases. Ongoing research in this field of Cryo-immunology will be highlighted. Beyond esophageal neoplasia, cryotherapy is increasingly utilized in other upper gastrointestinal precancerous conditions. Through this synthesis, our goal is to provide a timely and comprehensive overview of advancements in cryotherapy and its potential to reshape novel therapeutic approaches in upper gastrointestinal cancers. Finally, we highlight the evolution of a novel platform using nitrous oxide delivered by a handheld device, a contact balloon, and a small replaceable cartridge. This approach may make delivery of cryogen application favorable and a first-line approach in the management of Barrett’s esophagus and early cancer. In addition, Cryoballoon therapy for dysphagia palliation for malignant esophageal strictures may become a preferred approach as more data evolves. Full article

Objective. Limited evidence is available concerning the surgical outcomes of patients with congenital gastrointestinal malformations and perioperative SARS-CoV-2 infection. This study examines the scientific evidence on SARS-CoV-2 infection and congenital gastrointestinal malformations requiring surgery in children. Material and Methods. We performed a systematic review of studies reporting data on children with congenital gastrointestinal malformations and SARS-CoV-2 infection, published in international databases (PubMed and Embase) from pandemic inception up to August 2024. Studies not reporting data on the SARS-CoV-2 infection status on patients with congenital digestive malformation were excluded. We assessed the quality of the included studies according to the Joanna Institute (JBI) appraisal checklist, adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and registered the protocol with the PROSPERO database (CRD42024550744). Results. From the 902 titles retrieved, eight observational studies met the inclusion criteria comprising 29 patients from countries with different socioeconomic statuses. Most patients were neonates (75%) with a median age of 3 days at diagnosis and male to female ratio of 2:1. In total, 18 (62%) presented upper gastrointestinal tract anomalies, including esophageal atresia ± tracheoesophageal fistula (n = 10, 34.48%), duodenal atresia (n = 3, 10.3%), and congenital hypertrophic pyloric stenosis (n = 5, 17.2%). Lower digestive tract malformations (11, 38%) included anorectal malformations (n = 6, 20.6%), intestinal atresia (n = 3, 10.3%), Hirschsprung disease (n = 1, 3.44%), and Meckel’s diverticulum (n = 1, 3.44%). Surgeries were primarily emergency or urgent procedures and only pyloromyotomy (5/5) was consistently operated minimally invasively. SARS-CoV-2 infection was identified mainly on routine screening (>95%). Of 29 patients, 85% were discharged home, and no postoperative surgical mortality and significant complications directly associated with COVID-19 were identified, although routine postoperative morbidity not linked to SARS-CoV-2 was observed. Conclusions. Pediatric patients with congenital gastrointestinal malformationsand perioperative SARS-CoV-2 infection typically have mild illness and favorable surgical outcomes. SARS-CoV-2 positivity alone should not delay essential surgery when infection control measures are ensured. Standardized, multicenter studies are needed to clarify perioperative risks to and inform management of this high-risk group. Full article

Background and Clinical Significance: Ingestion of foreign bodies may lead to perforation of the gastrointestinal tract in its various segments. This may be accompanied by infections of the mediastinum after esophageal perforations and peritonitis after perforations of the stomach and bowel. Case Presentation: A 64-year-old man was admitted to the hospital because of abdominal pain and fever. The laboratory testing showed increased indices of inflammation. A CT scan of the abdomen revealed perforation of the stomach pylorus wall from a foreign body. Additionally, there were imaging findings suggesting concealed peritonitis in the adjacent area of stomach perforation. A 3.9 cm foreign body was removed with gastroscopy. The investigation into the nature of the foreign body suggested that it was a fish otolith (a structure composed of calcium carbonate, also known as an ear bone). The patient adhered to a Mediterranean diet. He recalled ingesting parts of the head of a 2.5 kg sea bream about 40 days before his admission to the hospital. The patient received broad-spectrum antimicrobial treatment, specifically intravenous ampicillin/sulbactam (2 g/1 g) every 8 h. He had complete resolution of his infection, with full resolution of symptoms and normalization of all abnormal signs noted in the physical examination at outpatient follow-up. Conclusions: Ingestion of a fish otolith may lead to perforation of the gastrointestinal tract and subsequent intra-abdominal infection. Prompt diagnosis with abdominal imaging, especially a CT scan, removal of the foreign body by upper gastrointestinal endoscopy (if possible), and broad-spectrum antibiotics are necessary for the successful management of such cases. Full article

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with significant morbidity, mortality, and healthcare costs. Many patients undergo early endoscopy despite the absence of active bleeding. PillSense is a novel Food and Drug Administration (FDA)-cleared ingestible capsule that rapidly detects the presence of blood in the upper GI tract and may optimize triage decisions. Methods: We conducted a retrospective study evaluating the impact of PillSense on the management of suspected UGIB in an academic center. The primary outcome was the association between capsule results and clinical decision-making, including endoscopy deferral, prioritization, outpatient scheduling, and airway protection. Secondary outcomes included transfusion requirements, time-to-endoscopy, endoscopic intervention, and 30-day adverse events. Results: A total of 28 patients (mean age 64.4 ± 17.9 years, 82.7% male) were included. Compared with negative results, positive results were associated with higher transfusion requirements (median 3 (IQR 3–6) vs. 2 (IQR 1–3.25) units; p = 0.041) and shorter time-to-endoscopy (median 0.2 (IQR 0.01–1) vs. 2 (IQR 1–15.5) days; p = 0.017). In high-risk for sedated endoscopy patients, negative results were associated with EGD deferral in 53.8%, with no subsequent adverse events within 30 days. Endoscopic intervention was performed in 62.5% of positive-result patients versus 9.5% of negative-result patients. Conclusions: The PillSense results were associated with differences in triage and management of high-risk patients with suspected UGIB. Its rapid, accurate, and non-invasive results may reduce unnecessary urgent endoscopy procedures, improve resource utilization, and enhance patient safety, particularly in the highest-risk populations. Full article

Mucosal melanoma (MM) is a rare, aggressive cancer whose incidence has increased continuously over the years. This subtype of melanoma arises from melanocytes on hairless surfaces, typically in the respiratory tract, gastrointestinal (GI) tract, and urogenital tract. The most common sites of occurrence include the head and neck, the anorectal region, and the vulvovaginal region, while the rare sites of MM are the urinary tract and the upper and lower GI tract, including the esophagus, duodenum and the gallbladder. MM arises in melanocytes of the ectodermal mucosa that originate from neural crest cells and migrate through embryonic mesenchyme to their destination. Although melanocytes are located mainly in the epidermis and dermis, their presence in various extracutaneous sites, such as the eyes, mucosal tissue, and leptomeninges, is known. Although both cutaneous melanoma (CM) and MM differ in their epidemiology, genetic profile, and clinical presentation, their treatment options are similar. In contrast to the higher treatment response of CM, MM is characterized by a lower response rate to available treatment options, resulting in a poorer survival rate. In this review, we provide an overview of the biology of MM and the mechanisms regulating its development, progression and treatment resistance. Full article

Background/Objectives: The primary goal of Crohn’s disease (CD) treatment is to achieve mucosal healing (MH). The best test to assess the effectiveness of therapy is endoscopic examination of the gastrointestinal (GI) tract, which is an invasive examination associated with a potentially high risk of complications resulting from the examination technique itself and the general anesthesia procedure. Previously used noninvasive methods for assessing the activity of CD show an unsatisfactory correlation with the severity of endoscopic lesions. There is a need to develop new, noninvasive indicators of the severity of inflammatory lesions in the GI tract in the course of CD. The aim of the study was to assess the clinical usefulness of the Mucosal Inflammation Noninvasive Index (MINI) as a noninvasive indicator of MH in pediatric patients with CD. Methods: The study included 199 children with CD who underwent endoscopic examinations of the upper and lower GI tract. The study group consisted of both patients with a diagnosis of CD and those whose indication for esophagogastroduodenoscopy and colonoscopy was a suspicion of inflammatory bowel disease. The clinical activity of CD was assessed using the Pediatric Crohn’s Disease Clinical Activity Index—PCDAI, and the severity of endoscopic inflammatory lesions was assessed using the simplified scale of endoscopic Crohn’s disease activity—SES-CD. The study assessed the correlation between the results of laboratory tests, PCDAI, SES-CD, and MINI. Results: In the study group positive correlation was found between MINI and PCDAI (r = 0.52, p < 0.001) and between MINI and SES-CD (r = 0.54, p < 0.001). A MINI score of 15 points or more indicated severe CD, defined as SES-CD ≥ 16 points, with a diagnostic sensitivity of 86% and specificity of 89%. Additionally, MINI was shown to be positively correlated with white blood cell count (WBC; r = 0.39, p < 0.001) and platelet count (PLT; r = 0.59, p = 0.007). Conclusions: MINI shows moderate correlation with endoscopic and clinical indices and may serve as a complementary, non-invasive marker for the assessment of MH in pediatric CD. Additional advantages of MINI are non-invasiveness, objectivity, and simplicity. Full article

Background: There is an insufficient knowledge base for optimal parenteral nutrition (PN) use for patients with incurable cancer, leading to vague guidelines and varied practices. The aim of the study is to describe the practices and actual outcomes of PN in patients with incurable cancer at Norwegian hospitals. Methods: This multicentre study retrospectively reviewed 507 deceased patients (>18 years) receiving PN between 2011 and 2017. Data were collected from PN initiation until death, and analyses were descriptive. Results: Fifty-one percent had upper and lower gastrointestinal cancers, and the main PN indications were insufficient intake (75%) and gastrointestinal malfunction (47%). Sixty-seven percent received no anticancer treatment. Forty-three (8%) received PN as temporary bridging to anticancer treatment, of whom fifteen (35%) resumed or initiated treatment. The median PN dose corresponded to 53% of estimated energy requirements, and 94% of the patients had complementary energy intake. The most common reason for discontinuation was expected imminent death (47%). While common symptoms during PN were nausea (52%), vomiting (46%), and oedema (37%), 15% reported improved wellbeing. Conclusions: In this real-world cohort, up to 80% of the patients would not meet the eligibility criteria of previous trials due to cancer diagnosis and treatment, gastrointestinal tract function, weight loss criteria or complications such as ascites. This study highlights the heterogeneity in how patients with incurable cancer receive PN, and emphasises the importance of individualised PN treatment, carefully and safely managed to meet the patients’ palliative care situation. Future real-world pragmatic patient-centred protocols bridging the gap between clinical trials and patients in clinical practice are warranted. Full article

Archaea, one of the three domains of life, are increasingly recognized as consistent, though often underappreciated, members of the human microbiome, yet their roles in health and disease remain poorly understood. Unlike bacteria, no archaeal species have been conclusively identified as primary mammalian pathogens, but their widespread presence across diverse body sites suggests potential indirect contributions to host physiology and pathology. Current evidence is synthesized on archaeal diversity and habitat specificity across multiple human-associated sites, encompassing the gastrointestinal, aerodigestive, and urogenital tracts as well as the skin. Methanogens dominate the lower gastrointestinal tract (LGT), where they influence fermentation dynamics and methane production, while members of the class Nitrososphaeria are prevalent on the skin and upper aerodigestive tract (UAT), reflecting ecological specialization. Variability in archaeal composition across niches highlights possible links to disease processes: methanogens have been associated with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), obesity, and colorectal cancer (CRC); Methanobrevibacter oralis is enriched in periodontal disease; and archaea have been detected in the lungs of cystic fibrosis patients. Although archaea lack canonical bacterial virulence factors, they may contribute indirectly through metabolic cross-feeding, immune modulation, synergy in polymicrobial infections, and alteration of host–microbiome network dynamics. This review explores the emerging concept of the human “archaeome”, evaluates current evidence for archaeal involvement in disease, and highlights emerging technologies, such as bacteria-MERFISH and multi-omics profiling, that enable translational applications including microbiome diagnostics, therapeutic targeting, and microbiome engineering. Full article

Chemerin, encoded by the RARRES2 gene, is an adipokine with potent immunometabolic functions mediated through CMKLR1, GPR1, and CCRL2. Its regulation is tissue- and context-dependent, conferring dual protective and pathogenic roles. In the upper GI tract, chemerin facilitates immune tolerance in Barrett’s adenocarcinoma and promotes invasion in esophageal and gastric cancers. In pancreatic disease, it acts as a biomarker of acute and chronic injury, while modulating β-cell function and carcinogenesis. In the liver, chemerin contributes to NAFLD/NASH pathogenesis with both anti-inflammatory and pro-steatotic actions, predicts prognosis in cirrhosis, and demonstrates tumor-suppressive potential in hepatocellular carcinoma. In IBD, chemerin exacerbates colitis via impaired macrophage polarization, yet protects epithelial antimicrobial defense, underscoring its context-specific biology. Collectively, these findings position chemerin as a versatile regulator bridging metabolic dysfunction, inflammation, and gastrointestinal malignancy, and as a potential candidate for biomarker development and therapeutic intervention. Full article

Background/Objectives: Anterior cervical meningocele (ACM) is a rare congenital condition characterized by the herniation of the meninges through a defect in the anterior vertebral column. ACM clinical management is not standardized because this condition is rare, and guidelines are missing. Hereby, a systematic literature review is performed to determine management options and outcomes. Methods: The case of a 62-year-old patient with incidental diagnosis of C3-C5 ACM is presented. A systematic review was conducted using standard PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for all cases of anterior cervical meningocele from 1837 to 2025. Results: The review provided nine clinical cases and our illustrative case. The median age was 47 years, with a predominance of female patients (70%). The most common presenting symptom was neck pain (60%), followed by paresthesia and hypoesthesia in the upper limbs. Four patients underwent conservative management with clinical and radiological follow-up, while four patients underwent neurosurgical intervention. Surgical treatment was complicated by cerebrospinal fluid (CSF) leak in two patients, and one of them developed meningitis. Conclusions: ACM is typically associated with mesodermal dysplasia and dural ectasia. ACM usually has a benign clinical course, requiring neurological follow-up and conservative management alone. However, a surgical approach should be considered in cases of vertebral instability or symptoms related to upper airway compression or upper gastrointestinal tract compression despite the high risk of CSF leak when surgical repair is attempted. Full article

Marine macroalgae (seaweed) are a rich source of bioactive polysaccharides such as agar, carrageenan, and alginate. These three compounds are classified as food additive ingredients, widely used as gelling, thickening, stabilizing, and emulsifying agents in the food, nutraceutical, pharmaceutical, and cosmetic industries. However, the growing concern for a safer world has sparked renewed interest in their safety evaluation. Unlike synthetic compounds with specified structures, seaweed polysaccharides exhibit substantial structural heterogeneity due to variations in species, habitat, and processing, affecting bioactivity, digestibility, and interactions within the gastrointestinal tract. Although the safety of these compounds is generally accepted, there are still significant gaps in our understanding of their physicochemical behaviour. This highlights the need to develop a standardized digestion model to ensure their safety and evaluate their potential long-term health effects. Most of these compounds are only partially absorbed in the upper gastrointestinal tract, where they are fermented into metabolites with varying health effects. The safety of carrageenan, in particular, remains a subject of debate due to ambiguous results reported by various researchers’ groups. This review highlights the importance of adopting standardized digestion assays, integrated analytical tools, and multidisciplinary approaches. These are crucial for thoroughly evaluating the molecular integrity, metabolism, and biological impact of seaweed polysaccharides, which will ultimately support evidence-based regulatory frameworks and ensure their safe use in human nutrition. This critical analysis focuses on food safety and security, with a methodology that can be applied to other foods or compounds. Full article

Background: Surgical procedures and alterations of the gastrointestinal (GI) tract increase the risk of small intestinal bacterial overgrowth (SIBO), which is associated with GI symptoms and complications that compromise postoperative recovery. However, the prevalence and clinical impact of SIBO after various upper GI surgical procedures remain poorly understood. Objective: This study aimed to evaluate the prevalence of SIBO after different types of upper GI surgery and to investigate the associated clinical factors. Methods: We conducted an observational study involving 157 patients with a history of upper GI surgery: Roux-en-Y gastric bypass (RYGB), laparoscopic single-anastomosis gastric bypass (OAGB), subtotal (STG) or total gastrectomy (TG), subtotal (SP)or total pancreatectomy (TP), cephalic duodenopancreatectomy (WR), and small bowel resection for Crohn’s disease. A glucose–hydrogen breath test was performed, and demographic, clinical, and treatment-related data were collected. Statistical analyses included t-tests, non-parametric tests, ANOVA, and correlation analyses using R software. Results: At a median follow-up of 25.7 ± 18.1 months, 31% (48/157) of patients tested positive for SIBO. The highest prevalence was observed after RYGB and OAGB (43%), followed by TG (30%), STG (29%), TP/WR (28%), and Crohn’s disease bowel resection (19%). No cases of SIBO were observed after SP. SIBO positivity was significantly associated with bloating and flatulence (p = 0.002), lactose intolerance (p = 0.047), systemic sclerosis (p = 0.042), T2D (p = 0.002), and exposure to adjuvant chemotherapy (p = 0.001) and radiotherapy (p = 0.027). In addition, the risk of SIBO increased proportionally with the duration of GI resection or exclusion (p = 0.013). Conclusions: In our study, the prevalence of SIBO after upper GI surgery was 31%, with the highest incidence (43%) observed in metabolic surgery patients. Importantly, adjuvant radio/chemotherapy was associated with an increased risk of SIBO, and extensive small bowel resection or exclusion was strongly associated with an increased risk of SIBO. Furthermore, the limitations of current diagnostic methods, which lack sufficient sensitivity and specificity, highlight the importance of early screening and standardization of diagnostic techniques to improve patient management and outcomes. Full article

Background: Bile salt hydrolase (BSH) is a key probiotic trait, as it facilitates both host metabolism and bacterial survival into the gastrointestinal tract (GIT), through bile acid (BA) deconjugation, keeping intestinal homeostasis. Objectives: The present study aims to investigate the viability of the Lacticaseibacillus rhamnosus VB4 strain and its effects on bile acid deconjugation during the gastrointestinal tract (GIT) passage, under a fed condition, using the in vitro SHIME^® (Simulator of the Human Intestinal Microbial Ecosystem) model. Methods: Gastric, small intestinal and colonic fractions were monitored and a fecal slurry from a healthy donor was inoculated into the colonic compartment to establish the intestinal microbiota. Samples were collected at the end of stomach, duodenum, jejunum, ileum phases, and colon after 0, 16 and 24 h. Strain survival was assessed by culturing method, and bsh gene expression was revealed by quantitative PCR (qPCR). In addition, UHPLC/HR-MS was performed to reveal the hypothetical changes in BAs profile after strain administration. Results: Good survivability of the VB4 strain in the upper GIT was revealed. Furthermore, VB4-inculated sample showed sustained expression of bsh in both the stomach/small intestine and colon fractions at all sampling times. Analysis of the BAs profile shown that the VB4 strain reduced the levels of the main conjugated BAs in the small intestine under fed condition and improved the deconjugation efficiency during colonic transit compared with the control. Conclusions: These findings highlight the survivability of L. rhamnosus VB4 strain inside the gut and its potential as biotherapeutic BAs-mediator candidate, demonstrating that transcriptomic and metabolomic approaches coupled to a dynamic in vitro gut model represent a robust tool for selection of a BSH-positive probiotic candidate. Full article

Background: Acute infections in children are prevalent and often lead to antibiotic overuse due to the lack of evidence-based alternative approaches. Phytotherapeutic, homeopathic treatments and bee products are frequently sought as alternative or adjunctive therapies. This scoping review aims to map the existing evidence on the efficacy and safety of these interventions in managing acute pediatric infections. Methods: A comprehensive literature search was conducted across multiple databases to identify studies assessing the use of phytotherapeutic, homeopathic remedies and bee products in children with acute infections. Gastrointestinal infections were not considered since the use of non-antibiotic treatments (probiotics) in these conditions has been widely addressed. Effectiveness: Phytotherapeutic agents and bee products demonstrated promising results in reducing symptom severity and duration in respiratory infections, whereas homeopathic data were limited and inconsistent. Regarding safety, both interventions were generally well-tolerated, with few adverse events reported. No studies or very limited evidence were available for other acute infections such as urinary, dermatological, osteoarticular and nervous system infections. Conclusions: Phytotherapeutic interventions and bee products, particularly in acute upper respiratory tract and acute bronchitis, show encouraging signals of efficacy and safety in pediatric populations. However, evidence for their use in other frequent childhood infections, such as otitis media, or gastrointestinal infections, is almost entirely lacking. In addition, the available literature on homeopathic remedies is scarce and methodologically inconsistent, preventing any firm conclusions. Well-designed, large-scale clinical trials focusing on these underexplored conditions are needed to clarify the potential role of phytotherapeutics and homeopathy in pediatric infectious diseases. Full article

The gut microbiome is strongly implicated in the development of obesity and type 2 diabetes mellitus (T2DM). A recent study demonstrated that 6-week oral supplementation of Anaerostipes rhamnosivorans (ARHAM) combined with the prebiotic myo-inositol (MI) reduced fasting glucose levels in mice. In the present study, we investigated the effects of a 13-week ARHAM-MI supplementation in high-fat diet-fed mice and examined the metabolic fate of MI, including its microbial conversion into short-chain fatty acids (SCFAs), using ¹³C-MI and stable isotope tracers in the cecum, portal vein, and peripheral blood. The results showed that the ARHAM-MI group gained less weight than the MI-only and placebo groups. Analysis of intestinal mRNA and stable isotope tracing revealed that MI is primarily absorbed in the upper gastrointestinal tract, whereas microbial conversion to SCFAs predominantly occurs in the cecum and is enhanced by ARHAM. ARHAM-MI mice also showed increased cecal Gpr43 mRNA expression, indicating enhanced SCFA-mediated signaling. Notably, SCFAs derived from MI displayed distinct distribution patterns: ¹³C-butyrate was detected exclusively in the cecum, ¹³C-propionate was present in the cecum and portal vein, whereas ¹³C-acetate was the only SCFA detected in peripheral blood. Collectively, ARHAM-MI co-supplementation confers modest metabolic benefits in high-fat diet-fed mice, underscoring the need to optimize the dosage and administration frequency of ARHAM-MI to enhance its therapeutic efficacy. Full article