In the U.S., it’s estimated that 4.5 million adults are diagnosed with chronic liver disease. It develops over time and may be caused by a number of conditions including, hepatitis, genetics, alcohol overuse or cancer. Chronic liver disease is different than acute liver disease, which can come on quickly and may be the result of an injury or a virus.

Regardless of the cause, Dr. Bashar Aqel, a Mayo Clinic transplant hepatologist, says when the liver can no longer function, a life-saving transplant may be needed.

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The liver is the largest internal organ of the body. It is essential for metabolism, digesting food and ridding the body of toxic substances. Liver failure can happen quickly, or over time.

"Once liver disease advances, the only way we can reverse the process and give the patient their life back is by replacing the liver, " says Dr. Bashar.

When patients become a candidate for a liver transplant, they are added to a waitlist. Unfortunately, there are more people waiting for a liver than there are available organs.

"As the patient is waiting on the list, they usually are anxiously waiting for that call when a donor becomes available. And that's what we call the deceased donor liver transplantation."

Another option is a living liver transplant. It's a major surgery where a person donates two-thirds of his or her liver. Donors needs to go through an extensive evaluation to make sure they can donate safely.

"A healthy liver is able to regenerate, and you will be surprised to know that with living donor liver transplantation, both segments of the liver will grow back to almost the normal size within 90 days after transplantation."

Being a living organ donor may not be an option for everyone, but there are ways to people can sign up to be an organ donor. It can be as easy as checking a box on your driver's license.

"Donating your organs is really donating the gift of life to people who are in urgent need for organ transplantation," Dr. Bashar says.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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ROCHESTER, Minnesota — It is a large part of the body that lies deep inside, out of sight and perhaps out of mind: your abdominal core. A new and rapidly developing area of medicine focuses on abdominal core health, including how people can incorporate it into a healthy lifestyle and how to address complex medical problems that arise when it is compromised. Dr. Charlotte Horne, a metabolic and abdominal wall reconstructive surgeon at Mayo Clinic, explains what abdominal core health is, how to protect it and risk factors for problems that may require surgery.

"The abdominal core is the outside muscular container of your abdominal wall," Dr. Horne says. "This starts at the diaphragm and goes all the way down to the pelvic support muscles. Most of the core is muscle and connective tissue. It's a muscular container that holds your internal organs in. Every time you breathe, bend, bear down to have a bowel movement, you're using these muscles."

The abdominal core includes abdominal muscles that people may think of as the "six-pack," and oblique muscles and tissue that wrap all the way around the upper part of the abdomen and connect to the midline of the body, Dr. Horne adds. Many nerves lie between the layers of muscle and tissue, including those that extend to the groin, thighs, back and hips.

Those muscles function as a unit and that unit needs to operate well for you and your body to perform daily activities, Dr. Horne says. One way to strengthen the structural integrity of your abdominal core is to engage it during your normal activities, she explains: You do not have to do thousands of sit-ups or become a bodybuilder.

"One of the things we're realizing is that we need to educate people how to appropriately engage those muscles when they do everything from going from lying to sitting and sitting to standing, lifting objects and other basic movements in their daily lives," she says. "When people do yoga or Pilates, they think about pulling their belly button into their spine. That helps stabilize the deeper muscles of the abdominal wall."

Improving abdominal core health involves conscious engagement of the abdominal muscles, "bringing everything in and holding it in," Dr. Horne says. 

Risk factors for abdominal core problems are wide-ranging. They include cancer treatment; inflammatory bowel disease; chronic or severe coughing; and complications from pregnancy (diastasis recti) and surgery. The most common problems are hernias, when part of an organ or tissue bulges through a weak spot in muscle.

"Coughing can cause large hernias. When you're coughing, you're bearing down and there is a sudden, acute change in intra-abdominal pressure, almost like punching from the outside in or from the inside out," Dr. Horne explains. "When you're doing that all of the time, it causes significant stress to your abdominal wall."

Avoiding smoking and excessive alcohol consumption can help protect abdominal core health. Smoking increases the risk of chronic coughing, while heavy alcohol consumption to the point of cirrhosis can cause hormonal changes that in turn weaken the abdominal wall, Dr. Horne says. 

As knowledge about abdominal core health grows, approaches to protecting it and healing it are advancing, Dr. Horne says. For example:

• Pregnancy causes muscles to expand to accommodate a baby, and sometimes those muscles do not go back to normal. Exercise regimens during and after pregnancy can help to stabilize them.
• Healthcare experts are realizing that restrictions on movement after surgery may not help and sometimes may be harmful. Rather than telling people not to lift anything, it may be more appropriate to explain how to safely reengage those muscles and tendons, Dr. Horne suggests.
• People with inflammatory bowel disease are likelier to have surgery and therefore are likelier to develop hernias. Surgeons now know that in those patients, mesh should be placed in different anatomic planes to prevent the mesh from touching the bowel and potentially causing problems later, Dr. Horne says.
• Pelvic floor physical therapy can help women experiencing urinary or fecal incontinence after pregnancy or menopause, she says.
• There is growing recognition that mesh used to repair hernias isn't one-size-fits-all. Dr. Horne's research focuses on hernia repair in women, including mesh and mesh techniques.

In her practice, Dr. Horne specializes in complex hernia surgeries.

"Most of the patients that I care for have more of their abdominal contents outside of their abdominal cavity than inside," she explains.

Even with hernias as large as 10 to 15 centimeters, surgeries can be performed with a robot to minimize the incision, or can be done with a mix of robotic surgery and minimal open surgery, Dr. Horne says. She uses 3D-printed models to help plan surgeries. Sometimes Botox is used to lengthen the abdominal wall muscles, she adds.

"The best part is that patients go from a dysfunctional abdominal wall to one that is functional within about a week in the hospital," Dr. Horne says. "Seeing them at their checkup a year later is the best thing because they go from saying `I couldn't do anything' to `I've gone on all these trips, I've done all these things that I've wanted to do for years but haven't been able to.' They are so happy that they can put that whole thing behind them, which is great."

###

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

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DEAR MAYO CLINIC: A friend was just diagnosed with colorectal cancer. She's only 30. I didn't know young people could get this cancer. Can you tell me more about it?

ANSWER: Unfortunately, your friend is among a growing number of adults under 50 who are being diagnosed with colorectal cancer. Many younger adults don't consider themselves at risk, since screening for colorectal cancer typically doesn't start until age 45.

That's why it's especially important to know the warning signs of colorectal cancer and not put off getting medical attention. Early diagnosis is essential to surviving colorectal cancer. If this cancer is found when it's only in the colon or rectum, the five-year survival rate is over 90%. That survival rate drops to roughly 15% if the cancer spreads beyond the colon and rectum.

 What is colorectal cancer?

It's not one type of cancer but two: colon and rectal cancer. The large intestine has several regions. The last part of the large intestine is known as the rectum. The other areas of the large intestine are called the colon. The treatments for cancers of the colon and rectum are different.

Who is at risk for this cancer?

Risk factors for colorectal cancer include:

• Older age
• Black race 
• Low-fiber, high-fat diet 
• Not exercising regularly
• Diabetes 
• Obesity 
• Smoking
• Drinking alcohol 

Those who are at higher risk for colorectal cancer tend to have at least one of these factors:

• Medical condition that places them at higher risk.
• Genetic condition that increases their risk. 
• Family history that places them at higher risk. For example, this is could be a first-degree family member such as parents or siblings who have had a diagnosis of colorectal cancer or advanced polyps.

Are there warning signs?

Four warning signs of colorectal cancer are:

• Abdominal pain
• Rectal bleeding
• Diarrhea
• Iron deficiency anemia

Although these symptoms can be embarrassing, you need to share them with a healthcare professional — don't put it off.

You may not easily notice blood loss after bowel movements, but that bleeding can lead to low iron levels. If a routine blood test reveals iron deficiency in a young adult, it can prompt the primary care clinician to consider colorectal cancer.

What is the screening process for colorectal cancer?

Your primary healthcare professional may order a screening that can help detect colon polyps or cancer. These tests include:

Stool DNA test. This test uses a stool sample to look for changes in cells' genetic material. Certain DNA changes are a sign that cancer is present or that it might happen in the future. The stool DNA test also looks for hidden blood in the stool.

If your stool DNA test returns positive (abnormal), you'll need a follow-up colonoscopy.

Colonoscopy. This test looks inside the colon. For it to be most effective, you need to thoroughly cleanse your colon, which involves reducing the fiber in your diet. The last step is consuming a special solution to ensure your colon is clean so the gastroenterologist is able to get a clear view. Although preparing for the procedure can be unpleasant, your care team can provide tips to make it more doable.

If the gastroenterologist finds any precancerous growths, called polyps, these will be removed during the colonoscopy and sent for testing. The number, size and type of polyps removed help determine when the next colonoscopy should be scheduled. If cancer is found, your care team will discuss treatment options with you.

How can I reduce my risk for colorectal cancer?  

No matter your age, there are five steps you can take to avoid developing colon cancer:

1. Eat your vegetables and healthy fats. Research has shown that the Western diet correlates to higher colorectal cancer rates. People who eat high-fiber diets are less likely to develop the disease.
2. Get moving. Exercise benefits your heart and helps you maintain your weight. It also can lower your colon cancer risk. Aim for 30 minutes of moderate exercise on most days of the week.
3. Watch your weight. Talk to your health care team if you need help losing weight.
4. Limit alcohol and don't smoke. If you choose to drink alcohol, do so moderately. That means no more than one drink a day for women or two drinks a day for men. And if you smoke, quit.
5. Follow colorectal cancer screening guidelines.

Derek Ebner, M.D., Gastroenterology, Mayo Clinic in Rochester

The post Mayo Clinic Q and A: Colorectal cancer in young adults appeared first on Mayo Clinic News Network.

Editor's note: March is Colorectal Cancer Awareness Month.

Colorectal cancer is no longer a disease of older people. People in their 50s, 40s and younger are increasingly being diagnosed with cancers of the colon and rectum. Incidence rates increased by about 2% per year in people younger than 50 during the past decade, according to the American Cancer Society. In 2019, 20% of colorectal cancers were in people ages 54 years or younger, up from 11% in 1995.

Another trend: Rectal cancer is more common than colon cancer in younger people. Of the estimated 46,050 new cases of rectal cancer in 2023, 37% will be in people younger than 50 versus 24% in people 65 or older.

Because of these trends, experts now recommend screening for colorectal cancer at age 45. But Derek Ebner, M.D., a Mayo Clinic Comprehensive Cancer Center gastroenterologist, says adults of all ages should be aware of the symptoms of colon and rectal cancer and report them to a healthcare professional.

"When we detect cancer early, and it's still confined to the colon or the rectum, that five-year survival is wonderful — it's 90% or better. Detecting cancer later, when it's had an opportunity to move beyond the colon or the rectum, the five-year survival is much lower — typically 15% or less," says Dr. Ebner.

Here's what you need to know to prevent colorectal cancer or catch it early when it's most treatable:

Everyone is at average or high risk of colorectal cancer.

"The truth is everyone's at risk for colorectal cancer," says Dr. Ebner. "But we typically divide people into two groups, those who are average risk and those who are high risk."

People at average risk of colorectal cancer might not experience symptoms associated with the disease and don't have any known factors that make them high risk.

"For those at high risk, there tends to be at least one of three variables: A medical condition, a genetic condition, or a family history that places them at higher risk," says Dr. Ebner.

Medical conditions that increase the risk of colorectal cancer include a personal history of colorectal cancer or polyps, inflammatory bowel disease, diabetes and obesity.

Genetic conditions that increase the risk of colorectal cancer include familial adenomatous polyposis and Lynch syndrome. Familial adenomatous polyposis (FAP) is a rare condition caused by a defect in the adenomatous polyposis coli (APC) gene. While most people inherit the gene from a parent, the genetic mutation occurs spontaneously in 25% to 30% of people with FAP. Lynch syndrome is a condition that increases the risk of many kinds of cancer, including colon and endometrial cancer, and it is passed from parents to children.

Family history associated with a higher risk of colorectal cancer involves a first-degree family member — a parent or sibling — with a colorectal cancer diagnosis or precancerous polyps. If you have a family history, you must start screening sooner and perhaps more often than people at average risk.

Dr. Ebner says healthcare professionals don't yet know the reason for the increased rate of colorectal cancer among younger people, but suspect environmental factors are involved. "Over the last 50 years, we've had major changes in diet — ultraprocessed food, higher quantities of red meats," he says. "These changes have perhaps led to changes in gut bacteria. Our gut microbiome might not be as protective as it once was. We also question the role of less exercise and increasing obesity rates."

Dr. Ebner encourages everyone to reduce their risk of colorectal cancer by eating a more plant-based diet and exercising regularly.

Non-invasive screening options exist, but you may be unable to avoid a colonoscopy forever.

Most colorectal polyps do not cause symptoms, so you may have polyps without knowing it. This is why beginning colorectal cancer screening at the recommended age of 45 is critical.

Screening reduces the risk of cancer by identifying polyps in the colon and rectum that could develop into cancer. You may need to begin screening younger than 45 if you have risk factors. Ask your healthcare professional when you should start screening.

Dr. Ebner says it's impossible to overemphasize the importance of screening. "If we're able to identify polyps, we have the opportunity to remove them and prevent the development of cancer. If we diagnose cancer, unfortunately, we've missed that opportunity," he says.

In the U.S., colonoscopy is the most common screening method. A long, flexible tube (colonoscope) is inserted into the rectum during a colonoscopy. A tiny video camera at the tip of the tube allows a healthcare professional to look for changes — such as swollen, irritated tissues, polyps or cancer — in the colon and the rectum. The professional can also remove polyps or other types of abnormal tissue through the scope during a colonoscopy. Sedation or anesthesia is usually recommended.

A non-invasive option for colorectal cancer screening is a stool DNA test(offered under the brand name Cologuard), which uses a stool sample to look for signs of colon cancer. The test checks for changes in cells' DNA. Certain DNA changes indicate that cancer is present or might develop. The test also looks for hidden blood in the stool.

"If the result of a stool DNA test or another non-invasive test is positive, it's critical to follow up with a colonoscopy," says Dr. Ebner.

Know the symptoms of colorectal cancer, and don't wait to talk to a healthcare professional if you experience them.

The symptoms of colon and rectal cancer can include:

• A change in bowel habits, such as diarrhea, constipation or more frequent bowel movements.
• Rectal bleeding or blood in the stool.
• Narrow stool.
• Ongoing discomfort in the belly area, such as cramps, gas or pain.
• A feeling that the bowel doesn't empty.
• Weakness or fatigue.
• Losing weight without trying.

People younger than 50 who develop colorectal cancer seem to experience slightly different symptoms than older people diagnosed with the disease, says Dr. Ebner. "We still see abdominal pain and blood after bowel movements, but the change in bowel habits is more often diarrhea," he says.

A recent study of people diagnosed with early-onset colorectal cancer confirms this. Study participants experienced four warning signs in the period of three months to two years before their diagnosis:

• Abdominal pain
• Rectal bleeding
• Diarrhea
• Iron deficiency anemia

"Blood loss after a bowel movement can lead to iron deficiency anemia," says Dr. Ebner. "But sometimes that blood loss is slow or small, so you may not see it. If we see a sign of iron deficiency on a blood test, that will prompt us to explore further."

If you notice any of these symptoms, contact your healthcare professional. "These symptoms can be embarrassing, but I can't stress enough — if you have any of them, share them with a healthcare professional. We see folks experiencing these symptoms for months, sometimes up to a year," Dr. Ebner says. "Any delay in sharing this information translates to a delay in diagnosis, which can lead to later-stage cancer, and later-stage cancers can be more challenging to treat and have lower five-year survival rates. Don't delay. Make an appointment.

This article first published on the Mayo Clinic Comprehensive Cancer Center blog.

Related posts:

• Mayo Clinic Minute: Tips to make colonoscopy bowel prep easier
• Mayo Clinic Minute: Why millennials should know colon cancer symptoms
• Mayo Clinic Minute: What’s the right colorectal cancer screening option for you?

The post You’re at risk of colorectal cancer. Know the symptoms. Get screened. appeared first on Mayo Clinic News Network.

Dr. Umair Majeed, a Mayo Clinic oncologist, says improved treatment options mean better outcomes for patients, even for those with late-stage colorectal cancer.

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Colon cancer is staged from 0 to 4. The stage determines the extent of the cancer — and the treatment.

"Stages 3 and 4 are considered advanced stages, where the cancer goes into the lymph nodes in stage 3 disease, and it goes into distant organs like the lungs, liver or bones in stage 4 disease," says Dr. Majeed.

When colorectal cancer spreads

The liver is the most common organ colorectal spreads to.

"We are offering liver transplantation as an option to select patients. We have a hepatic artery infusion pump program also available for those patients where the cancer has spread from the colon or the rectum to the liver," he says.

The pump delivers chemotherapy directly to artery that supplies the liver. He says, in addition to surgery, treatment options include better drugs, immunotherapy and targeted therapies. 

"We have surgeons who specialize in advanced procedures such as cytoreductive surgery and HIPEC, which is a form of specialized chemotherapy given into the peritoneum for select patients," Dr. Majeed says.

With all these advanced options, Dr. Majeed remains cautiously optimistic.

"Colorectal cancer is a type of cancer where, even if it's stage 4, there is a chance of cure in select cases," he says.

Related topics:

• Mayo Clinic Minute: Warning signs of colorectal cancer in younger adults
• Mayo Clinic Minute: Are colon and rectal cancers treated differently?
• Hepatic artery infusion pump therapy for colorectal liver metastases

The post (VIDEO) Treatment options for advanced colorectal cancer appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I just turned 45 and am dreading my first colonoscopy. Why do I need to be screened if I'm not having issues? Can you walk me through the process?

ANSWER: Feeling anxious or afraid surrounding a procedure, particularly when you've never done it before, is completely normal. The purpose of screening is to act before someone develops symptoms. If we're able to identify polyps, which are precancerous lesions in the lining of the colon, we would then have the opportunity to remove them and prevent the development of cancer in the first place. So through screening, we can prevent cancer. At the time of diagnosing cancer, we've missed that opportunity. 

There are a number of ways we can screen for colorectal cancer. In the U.S., we most often use a colonoscopy. Colonoscopy is an invasive test, but it allows us an opportunity to not only see polyps, but also remove them at the same time. For people with no additional risk factors besides age, it is recommended to start screening at the age of 45. If other risk factors are present, though, it may be recommended to have a colonoscopy sooner than 45. 

The colon preparation prior to the colonoscopy is key. The goal of colonoscopy prep is to make sure that there is nothing in the colon by using a laxative liquid solution. Then, at the time of the colonoscopy, we're able to see and detect even small precancerous lesions so they can be removed. 

It is very common to hear complaints from patients about the preparation, such as the consistency or taste of the solution, cramping, abdominal bloating or discomfort. That's to be anticipated. Unfortunately, some patients also experience nausea. Try slowing down how fast you are drinking the solution. For those who tend to struggle with the taste or consistency, try drinking it through a straw. You can also bite into a small wedge of lime or lemon, or you can chew gum or ice between drinks. 

After you finish the last of the prep solution and check in for your appointment, you'll often be greeted by the front desk team and then escorted back by a healthcare team member. They will review things like your medical history and medications and see how the colon prep treated you. There is a risk that you may have to come back and repeat the test at a later time if the colon prep was not adequate.

Another critical thing they will do is establish your intravenous therapy or IV. The IV is the route in which they will give you the medication to help make the procedure a little bit more comfortable. Some people don't do any sedation at all, but it is totally appropriate to opt for it. There are several different ways that sedation could be done for the procedure. A lot of that depends upon how the procedure is scheduled with your healthcare team. Then, you will end up going back to the procedure room where they will review the nature of the procedure before starting the colonoscopy. Afterwards, there's a bit of a recovery period, and then you're able to head back home. Because of the sedation, we don't want people driving, consuming alcohol or making any critical decisions for 24 hours. 

We still don't have a perfect recipe for preventing polyps, but maintaining a healthy diet and exercise can protect you. It is important to be aware of any symptoms and then follow through with screening. Best of luck as you take this important first step. — Derek Ebner, M.D., Gastroenterology, Mayo Clinic, Rochester, Minnesota.

The post Mayo Clinic Q and A: So you’re having a colonoscopy: What to expect appeared first on Mayo Clinic News Network.

Colorectal cancer, the third-most common cancer in the U.S., has been rising among younger people for the past two decades. It is not one type of cancer but two cancers: colon cancer, which starts in the large intestine, and rectal cancer, which begins in the last part of the large intestine, known as the rectum. 

Dr. Derek Ebner, a Mayo Clinic gastroenterologist, notes that colorectal cancer has been increasing in adults under age 50, particularly for rectal cancer. He says it's important to know the warning signs of colorectal cancer and to not delay medical treatment.

Watch: The Mayo Clinic Minute

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"Historically, colorectal cancer was equally divided along the colon and rectum, but particularly for those with early onset colorectal cancer — age less than 50 — we're seeing higher rates of rectal cancer among the younger onset," says Dr. Ebner.

Case of colorectal cancer has been increasing in adults under age 50, particularly for rectal cancer.

Warning signs and symptoms of colorectal cancer

Dr. Ebner says four key symptoms have been identified for people under 50 who are diagnosed with colorectal cancer.

"Abdominal pain, diarrhea, seeing blood with bowel motions, as well as iron deficiency anemia," he says.

Dr. Ebner notes that blood loss after bowel movements, even if not visibly apparent, can lead to low iron levels.

"If on a blood test, for example, we see a sign of iron deficiency, that would then prompt us to explore further," he says.

Even though it may be embarrassing, he stresses, "If you have any of those symptoms, you need to share it with a healthcare provider. That way, they can navigate those subsequent steps."

Which can lead to early treatment and better outcomes.

Reducing risks of colorectal cancer

While it's not possible to completely prevent cancer, there are ways to reduce your risks and that includes following a healthy lifestyle.

"Abiding by a healthy lifestyle is critical," says Dr. Ebner. "Following a well-rounded diet, staying physically active, for instance, perhaps can be protective. The other key, though, is just being very mindful of those symptoms, and then also underscoring the importance of screening."

• Screening: Talk to your healthcare team about colorectal cancer screening.
• Exercise: Aim for 30 minutes of exercise most days.
• Nutrition: Eat fruits, veggies and whole grains.
• Weight: Maintain a healthy weight.
• Lifestyle: Don't smoke, limit alcohol consumption.

Related posts:

• Innovative treatments for rectal cancer
• Mayo Clinic Minute: What’s the right colorectal cancer screening option for you?

The post Mayo Clinic Minute: Warning signs of colorectal cancer in younger adults appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I've had a sensitive stomach since I can remember. My life has been constantly inconvenienced by too many trips to the bathroom. My family thinks I have undiagnosed irritable bowel syndrome. I should have sought care sooner, but what can I do now to treat it? What causes IBS? What are its symptoms?

ANSWER: First off, you are not alone. Irritable bowel syndrome (IBS) is common and affects approximately 1 in 10 adults in the U.S. IBS is characterized by abdominal pain with disordered defecation (constipation, diarrhea or both). IBS can generally be easily treated with a combination of education, reassurance, diet and medications.

IBS is categorized as a disorder of gut-brain interaction. This means that the bidirectional pathway between the brain and the gut is overactive. Patients with IBS are more sensitive in their gut than other patients. IBS may develop due to genetic reasons or insults to the gastrointestinal (GI) tract including food poisoning, prior infections, surgeries, trauma and stressful life events. Stress can greatly affect the GI tract via the brain-gut axis. This can include physical, emotional or financial stress and other types.

The key symptom of IBS is abdominal pain, which would be present at least one day per week on average. In addition, patients have symptoms of disordered defecation, meaning constipation (going days without a bowel movement or straining during a bowel movement) or diarrhea (watery, loose and urgent bowel movements). Some patients have alternating constipation and diarrhea. Overriding symptoms for many patients include gas, bloating and distension, which means a visible or measurable increase in belly size. 

Patients often wonder when to see a healthcare professional. A diagnosis of IBS is based on:

• Unintentional weight loss
• New anemia
• Family history of IBS or colorectal cancer

It is important to note that for most patients, extensive testing is not required to make a diagnosis of IBS, but rather taking a careful history and performing a thoughtful physical exam while using the criteria above. Since IBS is a disorder of gut hypersensitivity and of the gut-brain axis, blood tests, X-rays, colonoscopies, CT scans and other tests generally do not reveal an underlying problem such as an ulcer or a blockage.

It is also important to note that the "best" therapy for IBS is very patient-independent. Every patient is a unique individual with different types and levels of symptoms: 

• Mild symptoms: Symptoms are somewhat bothersome but not intrusive.
• Moderate symptoms: Symptoms are affecting daily quality of life.
• Severe symptoms: You may have been to the emergency department because of your symptoms.

One of the exciting things in the field of gastroenterology is the recognition in the last 10 years that we have this very dynamic gut-brain connection, this bidirectional pathway. What that really means to a patient is that it's not just the standard prescription of over-the-counter medications for IBS with diarrhea or adding more fiber to help improve symptoms of constipation — it's using different therapies such as FDA-approved medications, behavioral therapy and diet to quiet down this hyperactive, extra-sensitive GI tract in either the brain or gut. This improves overall symptoms, especially that of abdominal pain, which is the cornerstone of the diagnosis of IBS. The future is exciting, and there is hope for you and many others. —Brian Lacy, M.D., Ph.D., Gastroenterology, Mayo Clinic, Jacksonville, Florida

The post Mayo Clinic Q and A: Struggling with IBS symptoms? appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: I'm hearing more about the exposome and the role of the environment on our health. Can you tell me more about how it is being studied? I'm worried about the future when I read about studies that show microplastics and chemicals accumulating in our environment. 

ANSWER: The Centers for Disease Control and Prevention defines the exposome as the measure of all environmental exposures, from prenatal stages through a person's lifetime, and how those exposures interact with genetic factors to affect health. The term is very inclusive. It includes, for example, diet; pollution; and natural substances, such as radiation. Everyone's exposome is unique.

I appreciate your concern about environmental exposures. The point I like to make is that not all exposures are harmful. Some exposures may protect us from disease. When we're talking about the exposome, it includes elements that are a risk for health, such as tobacco use, and elements protecting us from illness, such as access to green space.

Historically, researchers have studied some environmental exposures. Epidemiological studies in the past have told us that excessive alcohol use, for example, has an effect on the human body, and this relates to disease. We have also known that exposures to some bacteria cause disease, such as salmonella or tuberculosis.

But given that there are millions of different types of environmental exposures, better and more systematic studies are needed to understand what this means to our health. 

As a scientific field, the exposome explores exposures that have an effect on humans biology. For me, as a physician and researcher, I would like to know more about exposures that affect our genes, cells and organs, or, in other words, how exposures affect human biology. Your exposome is the environmental complement to your complete set of DNA, called your genome. 

Scientists have more recently realized that only about 15% of most disease risk can be attributed to genetic elements. So we are left with the question: What else contributes to disease? Families, of course, share not only genes but their environment. They live in the same household. And this is how exposome science started, to try to be able to assess environmental exposures. 

Over the last roughly 50 years, chemicals have been mass produced by humans. Decades ago, we couldn't measure chemicals in our bloodstream in a scalable and affordable way. So we used questionnaires to ask, "Do you smoke?" "Do you drink?" "Have you been exposed to pesticides?" We were looking for the outcomes of those exposures to human health. 

For example, in my laboratory, we were studying a rare liver disease called primary sclerosing cholangitis, and we asked a decade ago whether patients were exposed to pesticides, as well as other environmental elements. But the questionnaires didn't show a difference between healthy people and those with primary sclerosing cholangitis. 

Years later, when we could use blood tests to measure chemicals in the bloodstream, we found a significant difference in a specific pesticide present among primary sclerosing cholangitis patients compared with healthy people.

So, based on several studies, we now know that pesticides are in our food chain and in our bloodstream in small amounts, and we need to know how they affect human biology and disease.

Also, massive plastic production within the last 70 years also has created microparticles that can be found inside people's tissues. We need to study these exposures both in health and in diseases such as cancer, heart disease, stroke, respiratory illness and autoimmune disease.

Nevertheless, when we do studies, often we find chemicals that are more prevalent in healthy people compared to patients with diseases. Scientists are working to identify those elements associated with wellness or with a lack of disease because these substances may protect us from illness. For example, some studies have shown that drinking coffee may reduce risk of neurological disease or liver disease. We need to understand this in more depth for therapeutic opportunities.

Current methodologies enable us to measure the exposome better than before through blood, urine, saliva and hair. I envision that 10 years from now, if not earlier, we will have screens of exposures that we will measure in our bloodstream. That will become part of a person's care at some point in the future and help us guide lifestyle changes, prevention strategies and make diagnosis as well as treatment decisions for patients. — Konstantinos Lazaridis, M.D., Gastroenterology/Hepatology and Center for Individualized Medicine

Learn more about the exposome:

• Tomorrow’s Cure: How a lifetime of exposures impact health – exposome explained
• Researchers link environmental exposures to liver disease

The post Mayo Clinic Q and A: How environmental exposures affect your health appeared first on Mayo Clinic News Network.

Growing mini-organs to find new treatments for complex disease

Mayo Clinic investigators are growing three-dimensional human intestines in a dish to track disease and find new cures for complex conditions such as inflammatory bowel disease. These mini-organs function like human intestines, with the ability to process metabolites that convert food into energy on a cellular level and secrete mucus that protects against bacteria. These 3D mini-intestines in a dish, known as "organoids," provide a unique platform for studying the intricacies of the human gut.

"We think this has the potential to revolutionize the way we approach disease research. We hope to save time and resources and avoid the development of therapies that fail upon translation into patients," says Charles Howe, Ph.D., who leads the Translational Neuroimmunology Lab. "Understanding which treatments show potential for success in human organoids could dramatically accelerate the rate of new therapies for patients with unmet needs."

Brain stimulation shows promise in treating drug addiction

Physicians use neurostimulation to treat a variety of human disorders, including Parkinson's disease, tremor, obsessive-compulsive disorder and Tourette syndrome. A Mayo Clinic neurosurgeon and his colleagues believe one form of that treatment, called deep brain stimulation (DBS), is poised to solve one of the most significant public health challenges: drug addiction.

"Drug addiction is a huge, unmet medical need," says Kendall Lee, M.D., Ph.D., who has published nearly 100 journal articles on DBS along with his colleagues. Key to treating it, he says, is cutting off the pleasurable "high" that comes with the addiction — which DBS potentially can do.

A new class of AI aims to improve cancer research and treatments

Mayo Clinic researchers have invented a new class of artificial intelligence (AI) algorithms called hypothesis-driven AI, which is a significant departure from traditional AI models that learn solely from data. The researchers note that this emerging class of AI offers an innovative way to use massive datasets to help discover the complex causes of diseases, such as cancer, and improve treatment strategies.

"This fosters a new era in designing targeted and informed AI algorithms to solve scientific questions, better understand diseases and guide individualized medicine," says co-inventor Hu Li, Ph.D., a Mayo Clinic systems biology and AI researcher. "It has the potential to uncover insights missed by conventional AI."

What's lurking in your body? Mayo probes health risks of tiny plastic particles

Similar to natural elements like iron and copper, people can ingest, absorb, or even inhale microplastics and nanoplastics and their chemical additives. A landmark study published in the New England Journal of Medicine links microplastics and nanoplastics found in plaques of human blood vessels to a potential increased risk of heart attack, stroke or death.

"Plastics have made our lives more convenient and spurred many medical advances, but we must understand their impact on human health for the years to come," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for Mayo Clinic's Center for Individualized Medicine.

Mayo Clinic researchers' new tool links Alzheimer's disease types to rate of cognitive decline

Mayo Clinic researchers have discovered a series of brain changes characterized by unique clinical features and immune cell behaviors using a new corticolimbic index tool for Alzheimer's disease, a leading cause of dementia. The tool categorizes Alzheimer's disease cases into three subtypes according to the location of brain changes and continues the team's prior work, demonstrating how these changes affect people differently. Uncovering the microscopic pathology of the disease can help researchers pinpoint biomarkers that may affect future treatments and patient care.

"Our team found striking demographic and clinical differences among sex, age at symptomatic onset and rate of cognitive decline," says Melissa Murray, Ph.D., a translational neuropathologist at Mayo Clinic.

Mayo scientists explore swabs for early endometrial, ovarian cancer detection

Early detection improves treatment outcomes for endometrial and ovarian cancers, yet far too often, women are diagnosed when in advanced stages of these diseases. Unlike many other cancers, there are no standard screenings for early detection of endometrial and ovarian cancers. Mayo Clinic researchers have uncovered specific microbial signatures linked to endometrial and ovarian cancers, and they are working toward developing innovative home swab tests for women to assess their susceptibility.

"This research not only brings us closer to understanding the microbial dynamics in cancer, but also holds the potential to transform early detection and treatment strategies to positively impact women's health globally," says Marina Walther-Antonio, Ph.D., an assistant professor of surgery leading this research.

Reversing racism's toll on heart health

People who experience chronic exposure to racism may be affected by factors such as intergenerational trauma, reduced access to healthcare, differential treatment in healthcare settings and psychological distress. These negatively affect heart health and can have a cumulative effect throughout a person's life. Researchers from Mayo Clinic and the University of Minnesota published a paper which provides a new framework describing how racism affects heart health among people of color in Minnesota. The researchers are focused on reversing these disparities.

"This framework will help scientists explore and measure how chronic exposure to racism, not race, influences health outcomes," says Sean Phelan, Ph.D., a Mayo Clinic health services researcher. "This will help enable researchers to design interventions that address the root causes of these disparities and improve heart health for people of color everywhere."

Teamwork and research play a key role in Mayo Clinic's first larynx transplant

A team of six surgeons and 20 support staff combined expertise from the Department of Otolaryngology and the Department of Transplantation in an extraordinary 21-hour operation at Mayo Clinic. The team transplanted a donor larynx to a 59-year-old patient with cancer whose damaged larynx hampered his ability to talk, swallow and breathe. This groundbreaking surgery was only the third larynx transplant in the U.S., and the world's first known successful total larynx transplant performed in a patient with an active cancer as part of a clinical trial.

"All transplants are complex, but there are more tissue types and moving parts with laryngeal transplantation than other transplants," says David Lott, M.D., lead surgeon. "Mayo Clinic's team science approach made it possible for us to offer this type of transplant on a scale that was previously unattainable."

Space: A new frontier for exploring stem cell therapy

Two Mayo Clinic researchers say that stem cells grown in microgravity aboard the International Space Station have unique qualities that could one day help accelerate new biotherapies and heal complex disease. The research analysis by Abba Zubair, M.D., Ph.D., a laboratory medicine expert and medical director for the Center for Regenerative Biotherapeutics at Mayo Clinic in Florida, and Fay Abdul Ghani, Mayo Clinic research technologist, finds microgravity can strengthen the regenerative potential of cells. 

"Studying stem cells in space has uncovered cell mechanisms that would otherwise be undetected or unknown within the presence of normal gravity," says Dr. Zubair. "That discovery indicates a broader scientific value to this research, including potential clinical applications."

Mayo Clinic’s largest-ever exome study offers blueprint for biomedical breakthroughs

Mayo Clinic's Center for Individualized Medicine has achieved a significant milestone with its Tapestry study. It generated Mayo's largest-ever collection of exome data, which includes genes that code for proteins—key to understanding health and disease.  

Researchers analyzed DNA from over 100,000 participants of diverse backgrounds, providing important insights into certain genetic predispositions to support personalized and proactive medical guidance.  "The implications of the Tapestry study are monumental," says Konstantinos Lazaridis, M.D., the Carlson and Nelson Endowed Executive Director for the Center for Individualized Medicine. "As this study continues to inform and transform the practice of personalized medicine, it also sets a new standard for how large-scale medical research can be conducted in an increasingly digital and decentralized world."   

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Colette Gallagher, Mayo Clinic Communications, newsbureau@mayo.edu

The post 10 Mayo Clinic research advances in 2024, spanning stem cell therapy in space to growing mini-organs appeared first on Mayo Clinic News Network.