DEAR MAYO CLINIC: I’m confused about prebiotics and probiotics. Could you help me understand what they are and how they could benefit my health?

ANSWER: You're not alone in wondering about the health benefits of prebiotics and probiotics. Even the names can be confusing.

The human gastrointestinal tract houses roughly 100 trillion microorganisms (good bacteria). These microorganisms make up what's called the gut microbiome.

These good bacteria fight off bad bacteria to help keep our intestinal tract healthy. 

Probiotics: Promoting digestion, benefiting health

Let's start with probiotics. Probiotics are living organisms, also known as microbes. They're primarily bacteria and yeast whose main role is to aid digestion and improve overall health. Probiotics help strengthen the gut barrier, aid in the absorption of nutrients, and replace less beneficial or harmful microbes. 

Research shows that probiotics can treat and even prevent conditions such as gastrointestinal (GI) tract infections, irritable bowel syndrome (IBS), lactose intolerance, allergies, cystic fibrosis, urogenital infections, diarrhea, high cholesterol, eczema and certain cancers. 

Probiotics also may support dental health by treating and preventing tooth decay, periodontal disease and bad breath. 

In addition to aiding digestion, another essential role of probiotics is promoting a healthy immune system and preventing chronic diseases. 

Some examples of probiotics include fermented foods, such as certain yogurts, many cheeses, pickled vegetables, apple cider vinegar, fermented teas and sauerkraut. Probiotic supplements also are available in pill or powder form. 

Prebiotics: Feeding probiotics

Prebiotics are the food for probiotics. They help feed the probiotics through fermentation and metabolization, which are beneficial to the gut. These microorganisms contribute to a variety of processes, including cell energy, immune function, hormone regulation, anti-inflammatory responses and bowel management. 

Research indicates that high prebiotic consumption may enhance our immune system, help regulate blood sugar levels, reduce the risk of colorectal cancer and increase calcium absorption. When good bacteria (probiotics) are fed an abundance of healthful food (prebiotics), our bodies will be healthier.

Prebiotics are found in foods that contain:

• Dietary fibers, which the body doesn't fully digest.
• Resistant starches, which are a form of carbohydrate that isn't digested in the small intestine. Instead, it ferments in the large intestine. 

The most common prebiotics are inulin, oligosaccharides and pectin, which are found in fibrous foods. Foods containing prebiotics include most fruits and vegetables — especially green bananas, asparagus and onions — as well as garlic, nuts, seeds, oats, barley, potatoes, and legumes such as soybeans, dried beans, peas and lentils.

Adding probiotics and prebiotics to your diet

Food composition changes with cooking, so to get the most benefit from prebiotics and probiotics, it's important to pay attention to cooking methods. For example, boiling potatoes is better than baking them. When potatoes are boiled and then chilled, they develop a white starchy film, which is the most beneficial part. Serving beans and legumes hot increases their starch content, which is good for your gut.

Eating most fruits and vegetables while they are fresh and raw will provide healthful prebiotics. 

Researchers suggest gradually introducing these foods into your diet. Adding a lot of new foods containing prebiotics and probiotics may produce gas, cause bloating and lead to gut discomfort.

Anne Harguth, Nutrition, Mayo Clinic Health System, Waseca, Minnesota

The post Mayo Clinic Q&A: What are prebiotics and probiotics? appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — As rates of obesity, high blood pressure, type 2 diabetes and sleep apnea increase, cases of advanced chronic liver disease and resulting liver scarring or cirrhosis also are rising. Patients often are diagnosed based on symptoms, such as gastrointestinal bleeding, fluid retention or jaundice, which happen when liver disease has progressed to a late stage. This problem led Mayo Clinic researchers to develop an artificial intelligence (AI) model that resulted in twice the number of advanced chronic liver disease diagnoses in patients without symptoms, helping physicians treat them before the disease had progressed.

"Chronic liver disease is a progressive condition, so the sooner we can diagnose it, the sooner we can stop it from advancing to irreversible stages. Early intervention may decrease the likelihood that a patient will need a liver transplant in the future," says Doug Simonetto, M.D., a Mayo Clinic transplant hepatologist and lead author of the study published in Nature Medicine.

The heart and liver are closely linked. Liver scarring may lead to increased local pressure that can affect the heart. As a result, a heartbeat test called an electrocardiogram (ECG) can capture electrical signal changes in the heart connected to advanced liver disease. Dr. Simonetto and colleagues developed an AI model to analyze data from 11,513 Mayo Clinic patients undergoing routine ECGs. The model looked for patterns connected to advanced liver disease in the ECG data, and it found twice the number of patients who were diagnosed by standard methods. The diagnosis was confirmed by validated imaging or blood tests.

"As a family physician, I've often seen how advanced liver disease — which frequently has no symptoms until it becomes irreversible — can go undetected," says David Rushlow, M.D., Mayo Clinic Health System family physician and study co-author. "Many patients identified through the AI-ECG model had no idea they were living with advanced liver disease. By identifying these cases earlier, we were able to connect them to the right treatment — at a time when intervention can truly make a difference. For these patients, the technology helped us not only to uncover a diagnosis, it created an opportunity for better health outcomes and, in some cases, may have saved lives."

In this randomized clinical trial, 248 clinicians at Mayo Clinic in Rochester and throughout the Mayo Clinic Health System participated.

"The idea that a simple, noninvasive and inexpensive test could help identify patients at risk of developing advanced liver disease was very compelling. This study provided an opportunity to evaluate AI in our real-world clinical environment, where the true test of innovation is whether it improves care for patients in the community," says Dr. Rushlow. "We're only beginning to understand the full potential of AI-enabled tools like this and the promise they hold for preventive, personalized care."

In the next steps, the researchers will follow up with the patients, who were newly diagnosed with advanced liver disease, over the next two years.

The research is part of a larger effort at Mayo Clinic called the Precure initiative focused on developing tools that empower clinicians to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions.

Review the study for a complete list of authors, disclosures and funding.  

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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:

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic researchers develop AI-ECG model to diagnose liver disease earlier appeared first on Mayo Clinic News Network.

These discoveries reflect progress across three major innovation efforts at Mayo Clinic. Mayo Clinic clinicians and scientists are working together to develop tools to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions through the Precure initiative. They are advancing new cures for end-organ failure beyond traditional transplantation as part of the Genesis initiative. They are also uniting clinical insight with cutting-edge engineering to deliver novel neurological diagnostics and therapies through the Bioelectronics Neuromodulation Innovation to Cure (BIONIC) initiative. 
 

1. 'Virtual clinical trials' may predict success of heart failure drugs 

Mayo Clinic researchers have created "virtual clinical trials" that advance the discovery of therapies while reducing time, cost and the risk of failed studies by combining advanced computer modeling with real-world patient data as part of the Precure and Genesis initiatives. Through one virtual clinical trial, they have developed a new way to predict whether existing drugs could be repurposed to treat heart failure, one of the world's most pressing health challenges. 

"Clinical trials will always remain essential," says Cui Tao, Ph.D., the Nancy Peretsman and Robert Scully Chair of Artificial Intelligence and Informatics and vice president of Mayo Clinic Platform Informatics. "But this innovation demonstrates how AI can make research more efficient, affordable and broadly accessible. Integrating trial emulation, simulation, synthetic trials and biomedical knowledge modeling opens the door to a new paradigm in translational science." 

2. New discovery may unlock regenerative therapies for lung disease

Mayo Clinic researchers have uncovered the molecular "switch" that directs a small but powerful set of cells that choose whether to repair tissue or fight infection, a discovery that could inform regenerative therapies for chronic lung diseases, which is part of Mayo Clinic's Genesis initiative.
 
"We were surprised to find that these specialized cells cannot do both jobs at once," says Douglas Brownfield, Ph.D., senior author of the study. "Some commit to rebuilding, while others focus on defense. That division of labor is essential — and by uncovering the switch that controls it, we can start thinking about how to restore balance when it breaks down in disease." 

3. Stem cells may offer new hope for end-stage kidney disease treatment

Mayo Clinic researchers found that injecting patients' own stem cells from fat cells into the vein before hemodialysis, a treatment for end-stage kidney disease, often helped prevent inflammation and vein narrowing. This could help millions of people tolerate dialysis longer, extending the time before they require a kidney transplant as part of the Mayo Clinic Genesis initiative. 

"This approach has the potential to improve outcomes for millions of patients with kidney failure, reduce healthcare costs and inform new clinical guidelines for dialysis access management if validated in larger clinical trials," says Sanjay Misra, M.D., a Mayo Clinic interventional radiologist. 

4. Mayo Clinic physicians map patients' brain waves to personalize epilepsy treatment

Using detailed maps of each patient's unique brain wave patterns, Mayo Clinic physicians can now pinpoint where stimulation is most effective, moving beyond the traditional one-size-fits-all approach to epilepsy treatment. This research is part of the BIONIC initiative.

"The long-term goal is to quiet the seizure network, so it is eventually forgotten. Reorganizing the neuronal network could move us beyond controlling seizures to actually curing epilepsy," says Nick Gregg, M.D., a Mayo Clinic neurologist. 

5. New genetic biomarker flags aggressive brain tumors

Mayo Clinic researchers found when meningiomas — the most common type of brain tumor — show activity in a gene called telomerase reverse transcriptase (TERT), it tends to recur more quickly, even if it looks low grade under the microscope. This is part of the Mayo Clinic Precure initiative. 

"High TERT expression is strongly linked to faster disease progression," says Gelareh Zadeh, M.D., Ph.D., a neurosurgeon at Mayo Clinic and senior author of the study. "This makes it a promising new biomarker for identifying patients who may be at greater risk of developing aggressive disease."

6. Mayo Clinic researchers discover the immune system's 'fountain of youth'

Mayo Clinic researchers have found that some older people maintain "immune youth" – a new term coined by Mayo researchers to explain a young immune system in someone over age 60.  
 
"We observed that these patients have very young immune systems despite being in their 60s and 70s. But the price they pay for that is autoimmunity," says Cornelia Weyand, M.D., Ph.D., a Mayo Clinic rheumatologist and clinician-scientist. This is part of the Mayo Clinic Precure initiative.

7. Mayo Clinic tools predict, identify and diagnose Alzheimer's, dementia quicker

Mayo Clinic researchers have developed new tools to estimate a person's risk of developing Alzheimer's disease years before symptoms appear as part of the Precure initiative and to help clinicians identify brain activity patterns linked to nine types of dementia, including Alzheimer's disease, using one scan. They also confirmed the accuracy of an FDA-approved blood test that can be used at outpatient memory clinics to diagnose the disease in patients with a range of cognitive impairment. 

"Every patient who walks into my clinic carries a unique story shaped by the brain's complexity," says David T. Jones, M.D., a Mayo Clinic neurologist. "That complexity drew me to neurology and continues to drive my commitment to clearer answers."

8. Mayo Clinic research improves dense breast cancer screening and early detection

Nearly half of all women in the U.S. have dense breast tissue, which can make detecting breast cancer difficult with a mammogram. Mayo Clinic researchers found that adding another test, called molecular breast imaging, or MBI, to a 3D mammogram, improved the ability to find cancer in dense tissue by more than double. 
 
"Our research focuses on detecting the most lethal cancers, which can include invasive tumors that grow quickly. If these are detected earlier, we likely can save more lives," says Carrie Hruska, Ph.D., a Mayo Clinic professor of medical physics and lead author of the study. 

9. Mayo Clinic researchers find 'sugar coating' cells can protect those typically destroyed in type 1 diabetes

After identifying a sugar molecule that cancer cells use on their surfaces to hide from the immune system, Mayo Clinic researchers have found the same molecule may eventually help in the treatment of type 1 diabetes, once known as juvenile diabetes. 

"A goal would be to provide transplantable cells without the need for immunosuppression," says Virginia Shapiro, Ph.D., a Mayo Clinic immunology researcher. "Though we're still in the early stages, this study may be one step toward improving care."

10. New study calculates autoimmune disease prevalence

Mayo Clinic researchers and collaborators have described — for the first time — the prevalence of autoimmune diseases in the U.S. Their research reports that about 15 million people are estimated to have one or more of 105 autoimmune diseases. The study also found that autoimmune diseases occur most often in women, and it identified the top autoimmune diseases by prevalence, sex and age. 
 
"Knowing the number of patients with an autoimmune disease in the U.S. is critical to assess whether these diseases are increasing or decreasing over time and with treatment," says DeLisa Fairweather, Ph.D., vice-chair of translational research for the Department of Cardiovascular Medicine at Mayo Clinic in Florida and corresponding author of the study.

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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: 

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post A Year of Discovery: 10 Mayo Clinic research breakthroughs moving medicine forward  appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers have uncovered how aging "zombie cells" trigger harmful inflammation that accelerates a severe and increasingly common form of fatty liver disease called metabolic dysfunction-associated steatohepatitis (MASH). As obesity rates rise worldwide, MASH is projected to increase and is already one of the leading causes of liver transplantation. 

"Liver scarring and inflammation are hallmarks of MASH. If left untreated, it can progress to liver cancer. This is why it's so important to understand the mechanisms driving the disease so that we can prevent it or develop more effective treatments," says Stella Victorelli, Ph.D., who is the lead author of the study published in Nature Communications.  

Dr. Victorelli and colleagues, who study aged or senescent "zombie" cells, identified a mechanism by which these cells drive liver scarring and inflammation. They found that small molecules called mitochondrial RNA, typically found within the cell's energy-producing mitochondria, can leak into the main part of the cell, where they mistakenly activate antiviral sensors called RIG-I and MDA5 — normally triggered when a virus infects a cell. In this case, the danger signal comes from the cell's own mitochondria, prompting a wave of inflammation that can damage nearby healthy tissue. 

When the researchers blocked the sensors, inflammation dropped sharply. The study also found that proteins BAX and BAK, which help open pores in the mitochondrial membrane, enable mitochondrial RNA to escape. In a preclinical MASH model, inhibiting BAX and BAK prevented RNA from escaping and was associated with less inflammation and healthier liver tissue. 

What are 'zombie' cells?

As we age, some cells enter senescence — a state in which they stop dividing but continue releasing inflammatory and tissue‑damaging molecules. When people are young, the immune system typically eliminates these senescent, or "zombie," cells. With age, however, they can persist and contribute to a range of age‑related health problems and diseases. 

While some research focuses on removing these cells, this team investigated how to quiet their harmful signals.  

"With age, we accumulate 'zombie' cells, which can lead to more disease," says João Passos, Ph.D., senior author of the study. "Our idea is that if we can quiet these cells earlier, we can prevent runaway inflammation and the development of many age‑related conditions, including liver disease. Understanding the mechanisms that drive disease allows us to target and delay those processes — potentially benefiting more than one condition." 

Dr. Passos and colleagues also are developing new technology to spatially map senescent cells throughout the body during aging. 

This research was conducted in partnership between the Robert and Arlene Kogod Center on Aging and the Center for Cell Signaling in Gastroenterology (C-SiG) at Mayo Clinic. 

The research is part of a larger effort at Mayo Clinic called the Precure initiative, which is focused on developing tools that empower clinicians to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions. 

Review the study for a complete list of authors, disclosures and funding.   

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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: 

• Kelley Luckstein, Mayo Clinic Communications, newsbureau@mayo.edu

The post ‘Zombie’ cells spark inflammation in severe fatty liver disease, Mayo Clinic researchers find  appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Resolutions to improve health typically include measures such as more exercise, a healthier diet and stopping smoking. But what about your gut microbiome? Taking steps to protect and improve it can benefit digestive health and more, says Purna Kashyap, M.B.B.S., a gastroenterologist at Mayo Clinic who specializes in the gut microbiome and gastrointestinal disorders.

"The microbiome is essentially a community of bacteria, fungi, viruses and all of their genes," Dr. Kashyap explains. "The skin, lungs and reproductive system each have their own microbiomes. The gut microbiome is probably the most diverse in our body. Its microbes perform several functions. The body's other microbiomes tend to be more specialized."

Your gut microbiome is as unique as your fingerprint. These bacteria perform important jobs, including breaking down fiber and starches; synthesizing vitamins and amino acids, such as vitamins B and K; and producing short-chain fatty acids (SCFA) that help prevent disease. They also maintain the intestinal barrier, a protective gut lining.

"For example, when you eat an apple, your stomach and small intestine break down some of it. The rest of the apple goes to your colon, where bacteria do the rest of the work for you," says Dr. Kashyap, the Bernard and Edith Waterman Director of the Microbiomics Program at the Mayo Clinic Center for Individualized Medicine.

"As the bacteria break down the apple's fiber, they produce substances that are good for the cells of the colon and the body."

If you lose these healthy bacteria, it creates an opportunity for some of the bacteria that cause disease to thrive. One example is Clostridioides difficile, or C. diff, a bacterium that can infect the colon, the longest part of the large intestine. Symptoms can range from diarrhea to life-threatening damage to the colon. Risk factors for C. diff infection include antibiotic use, hospitalization and certain medications that affect the immune system.

"If you take antibiotics, your microbiome might change for a short time, but it usually goes back to its original state," Dr. Kashyap says. "The same thing can happen with other changes or behaviors, such as traveling or eating a lot of fast food. Think of your microbiome like a rubber band. You can stretch it a bit, and it bounces back. But if you stretch it too much, it might get disrupted."

In addition to gut infections like C. diff, microbial imbalances are thought to play a role in other diseases and symptoms, including colon cancer; diabetes; depression and other mood disorders; Alzheimer's disease; Parkinson's disease; and cardiovascular disease. More research is needed to understand ties between the gut microbiome and these diseases, Dr. Kashyap says.

How far you can stretch your microbiome depends on several factors. Those include how long the disruption lasts. This is one reason it's important to avoid overusing antibiotics, Dr. Kashyap says.

Some underlying diseases, such as inflammatory intestinal diseases can affect which communities of bacteria can thrive in your gut and which can't. These include inflammatory bowel diseases such as Crohn's disease and ulcerative colitis.

Dr. Kashyap is studying the interactions between gut bacteria and dietary carbohydrates and how they influence the gastrointestinal system. His long-term goal is to develop new biomarkers and microbiota-targeted therapies for treatment of functional gastrointestinal disorders, including irritable bowel syndrome and chronic bloating, also known as functional bloating.

Lifestyle can also play an important role in the health of your gut microbiome, Dr. Kashyap adds: "Gut bacteria eat what you eat. If you eat a lot of sugary, salty, fatty foods such as snacks, sweets and highly processed foods or consume a lot of alcohol, you'll starve bacteria. As a result, they will try to get nutrients from your gut lining and will damage it in the process."

On the other hand, if your diet is loaded with a diverse array of fruits, vegetables and fiber, you'll nourish a diverse microbial community in your gut.

"The more diverse your gut microbes, the farther you can stretch things before you experience disruption," Dr. Kashyap says. "Happy bugs, happy life."

Other lifestyle habits will help to protect gut health:

• Drink plenty of healthy fluids such as water and limit or avoid alcohol.
• Exercise for at least 30 minutes most days.
• Don't smoke.
• Manage stress.

For more information about the microbiome and microbiome research at Mayo Clinic, visit Mayo Clinic Press and the Mayo Clinic Center for Individualized Medicine.

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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:

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

The post Get to know your microbiome: It can improve gut health and more, Mayo Clinic expert explains appeared first on Mayo Clinic News Network.

After 41 years with Crohn's disease, Moi Monroe underwent ostomy surgery at Mayo Clinic in Florida. A few years later, he cycled from Alaska to Florida, and his bag didn’t slow him down.  

When Moi Monroe walked into Mayo's ostomy class, his first thought was, "What am I doing here?"  

The next day, he was scheduled for surgery to remove his colon and add an ostomy, often called a "bag," to his side. At age 62, Moi was one of the youngest patients in the room. Yet he had been suffering from Crohn's disease for over half his life.  

For most of that time, it had only affected the first few inches of his colon. His latest scan, however, revealed it was rapidly spreading.  

It had seemed like the right time to act, but as Moi looked around the classroom, he felt a flicker of doubt. 

Then the instructor began to speak. When she revealed she was an "ostomate," relief washed over Moi. The day before, the woman who'd helped with his paperwork had shared the same. Their stories felt like a sign he was in the right place. 

That sense deepened as Moi opened his ostomy kit. Inside was a pamphlet with a photo of people swimming and cycling.  

"I could hardly get on a bike anymore," he says. "I'd wondered if I was going to be able to do that after the surgery. This felt like huge confirmation. After that, I never looked back."  

Moi was ready to move forward — and with Mayo's help, he'd soon be back on two wheels.  

Making his home at Mayo 

Moi's health journey began in 1978 when he was diagnosed, at age 21, with Crohn's disease. For years, he saw a local physician. But as he got older, Moi wanted continuity of care across several specialties.  

He found that at Mayo Clinic in Florida. That's also where he met Donna Shelton, a nurse practitioner in Gastroenterology, who quickly became his advocate, or as he says, his "angel."  

Shelton never failed to answer his questions quickly. As new drugs emerged, she helped him decide which ones to try. "She was just always there," says Moi. 

Unfortunately, Moi's disease didn't respond to treatment. In 2019, after his Crohn's suddenly spread, they began to discuss surgery more seriously.  

Both knew his disease was stealing his joy. Too often, he was saying "no" to things he loved, like playing with his grandkids or hopping on his bike. An ostomy could give him back so much, but it was also a permanent decision that takes time to embrace.   

"It's a big step to take out the colon," says Dr. Michael Picco, the Mayo Clinic gastroenterologist who has cared for Moi for nearly 20 years. "Patients might think an ostomy will be an awful thing. But it actually gives them control again — a much more predictable lifestyle."  

After 41 years of Crohn's, and lots of prayer and research, Moi said "yes" to surgery. "He jumped in and faced it the way he does everything else — to the 'nth' degree," says Shelton. "He's always all in."  

This didn't surprise Dr. Picco, who describes Moi as courageous and forward-thinking, always looking for the next step toward healing.  

Moi saw that same commitment from his care team. "You never feel like they've forgotten who you are," he says. "If you have four appointments in a day, each one is going to know everything about your medical history. And they'll tie it all together."  

Finding Moi again 

In late 2019, Dr. Luca Stocchi, a Mayo Clinic colon and rectal surgeon, removed Moi's entire colon and created an opening, or stoma, in his side. Connecting Moi's small intestine allowed waste to exit into a bag.  

"The next day, all the pain from my Crohn's was gone," says Moi.  

His only regret was not doing it sooner.   

Just a few months later, Moi was cycling cross-country with a buddy. Then, in 2023, the pair planned a 4,500-mile trip from Alaska to Florida to raise money for childhood cancer awareness.  

Without a colon, which plays a key role in hydration, Moi knew the journey would be difficult. But he was determined to get back to doing what he loved. "Patients with this indestructible attitude are such an inspiration to me," says Dr. Stocchi. "Moi was not going to let the bag stop him." 

For 45 days, Moi cycled 100 miles a day, pushing his body harder than ever. His bag stayed tucked against his side with the help of a special belt, even across the rugged terrain of British Columbia.  

Not once did he have to worry about abdominal pain — he could just enjoy the ride.  

Expanding his horizons  

Moi hasn't stopped there. Other postsurgical wins include catching 500-pound bluefin tuna in Canada and reeling in sailfish in Costa Rica.  

"I can do anything," says Moi. "I can go offshore fishing all day. I can ride my bike for a hundred miles at a time. I can travel with my wife without holding anyone back."     

These days, that means lots of visits to see their grandkids. "They were growing up before my eyes, and I couldn't share the joy with them," he says, teary-eyed at the memory. Now, "Papa," as the kids call Moi, is no longer hurting on the sidelines.  

This, he says, is the greatest outcome of his surgery.  

"I really can't ask for anything more," he says. "Thanks to Mayo, I've gotten my life back."  

The post Mayo patient cycles 4,500 miles after ostomy surgery for Crohn’s disease  appeared first on Mayo Clinic News Network.

DEAR MAYO CLINIC: My 39-year-old brother was just diagnosed with gastric cancer. The diagnosis was especially shocking because of his age. Is this becoming more common? Does age affect the approaches to treatment?

ANSWER: Stomach cancer, also referred to as gastric cancer, was once thought of as a disease of older adults. However, it is increasingly affecting people under the age of 50, mirroring a similar shift that is observed with colorectal and other gastrointestinal cancers. It's important to note that while this shift in early-onset stomach cancer is unsettling, the overall incidence of stomach cancer remains relatively stable. 

A changing risk profile

Researchers are investigating the reasons behind these trends, and several factors appear to play a role. 

Diet is among the most likely contributors to the increase in early-onset stomach cancer. Over the past several decades, the typical American diet has shifted dramatically toward ultra-processed foods. These foods can promote chronic inflammation and alter the gut microbiome, which is the ecosystem of microbes that live in your intestines. The microbiome supports digestive health. Both inflammation and microbiome changes have been linked to a greater risk of developing gastrointestinal cancers over time. Other possible mechanisms include direct DNA damage and carcinogenesis from harmful food additives, as well as the displacement of protective nutrients such as fiber, vitamins and antioxidants.

Traditional risk factors for stomach cancer remain relevant as well. Infection with Helicobacter pylori, a bacterium that can cause inflammation of the stomach lining or ulcers, is a significant risk factor. Smoking, frequent consumption of smoked or preserved foods, obesity and heavy alcohol use can also increase risk.

Younger people diagnosed with stomach cancer often lack these classic risk factors, making their diagnoses more perplexing. This difference has prompted increased attention to lifestyle, dietary and environmental influences that might contribute to the disease.

The challenge of early detection for stomach cancer

Early detection of stomach cancer remains difficult, particularly in younger adults. The symptoms of this disease can be subtle, including persistent indigestion, bloating, and mild upper abdominal pain or heartburn that does not respond to over-the-counter remedies. These nonspecific symptoms are often mistaken for minor gastrointestinal issues.

When symptoms persist for several weeks or when additional warning signs appear, such as unexplained weight loss, vomiting or severe abdominal pain, further evaluation is needed. An upper endoscopy with biopsy is the standard method for diagnosing stomach cancer.

Because early symptoms may be overlooked, younger patients are sometimes diagnosed at more advanced stages of the disease.

Treatment approaches and innovations

Treatment for stomach cancer depends on the tumor's stage, location and molecular characteristics rather than the patient's age. 

Surgery remains a cornerstone of care for localized disease. In recent years, surgical techniques have advanced significantly, with more minimally invasive and robotic approaches that can reduce recovery time and improve long-term quality of life. In addition to these less invasive techniques, novel reconstructive procedures, such as J-pouch and double-tract reconstructions, are helping restore digestive function and reduce long-term complications after partial or total removal of the stomach. These approaches aim to improve nutrition absorption, reduce reflux and help patients return to eating habits that more closely resemble those before their diagnosis.

Oncologists can also analyze tumors for biomarkers such as HER2, PD-L1 and markers of microsatellite instability to guide treatment decisions and predict patient outcomes, especially in patients with advanced stomach cancer. Identifying these biomarkers helps determine whether targeted therapy or immunotherapy may be appropriate. This approach allows treatment to be more personalized for increased precision and efficacy.

For patients whose disease has spread within the abdominal cavity, an innovative therapy called hyperthermic intraperitoneal chemotherapy (HIPEC) offers a promising option. In this procedure, following surgical removal of visible tumors, heated chemotherapy is circulated throughout the abdominal cavity to destroy remaining cancer cells. 

Because stomach cancer is relatively uncommon, outcomes tend to be better when care is provided at multidisciplinary centers, like Mayo Clinic, that have extensive experience treating this disease. Collaboration among surgical, medical and radiation oncologists ensures that each patient receives an individualized treatment plan.

A reason for optimism

Stomach cancer remains a serious disease, but progress in early recognition and treatment is improving outcomes. Advances in surgery, precision medicine and supportive care have made it possible for many people to live longer and with a better quality of life after treatment.

It is essential that anyone experiencing persistent gastrointestinal symptoms, especially those that do not respond to routine, over-the-counter care, seek out a timely medical evaluation. Awareness, early detection and access to expert, coordinated care can make a meaningful difference.

Travis Grotz, M.D., Hepatobiliary and Pancreas Surgery, Mayo Clinic, Minnesota

The post Mayo Clinic Q&A: Is stomach cancer on the rise in young adults? appeared first on Mayo Clinic News Network.

Primary sclerosing cholangitis (PSC) causes inflammation and scarring of the bile ducts. This rare liver disease is often accompanied by inflammatory bowel disease (IBD). Together, these diseases increase the risk of colorectal cancer by more than sixfold compared to the general population.

Until recently, it wasn't clear whether that increased colorectal cancer risk extended to people with PSC alone, but Mayo Clinic researchers have helped answer this question. Their findings could help open the door to earlier colorectal cancer screening and better prevention for people with PSC.

"We wanted to answer something that was overlooked in the guidelines because these patients are a smaller group and have been understudied in research," says Dr. Saqr Alsakarneh, a fellow in the Department of Gastroenterology at Mayo Clinic and lead author of the study, published in Alimentary Pharmacology and Therapeutics.

Searching data for cancer prevention blind spots

In the largest population-based analysis of its kind, Dr. Alsakarneh and his co-authors analyzed data from 115 million de-identified health records from 65 healthcare organizations across the U.S. Their goal was to understand long-term risk of colorectal and other gastrointestinal cancers in people with PSC.

The researchers found that people with PSC without IBD have nearly three times the risk of developing colorectal cancer compared to the general population. 

"This is important because it challenges the current assumption that only primary sclerosing cholangitis with IBD causes colorectal cancer," says Dr. Alsakarneh.

While colorectal cancer prevention guidelines recommend annual screening and increased surveillance for people who have PSC and IBD, no specific guidelines exist for people with only PSC. Dr. Alsakarneh says this is a missed opportunity for early detection of colorectal cancer, which is highly preventable with proper screening.

In addition to discovering an increased risk for colorectal cancer, the study confirmed an association between PSC alone and higher rates of bile duct, liver and pancreatic cancers. While previous research has suggested this connection, the study provides large-scale data to support the need for continued vigilance and screening strategies tailored to people with PSC.

Translating discovery to better care

Dr. Alsakarneh says these findings are an important first step toward a better understanding of PSC and cancer risk, although more studies are needed to confirm how this information should be incorporated into healthcare guidelines.

"Before anything is put into guidelines, the first step is always to validate the findings," says Dr. Alsakarneh. "Colleagues from the gastrointestinal community have reached out and are interested, so this is something we are working on."

As researchers investigate further, Dr. Alsakarneh says it's important that clinicians with PSC patients be aware of this association, tune into emerging evidence and keep their patients informed as findings develop.

Continuing a legacy of PSC discovery at Mayo Clinic

Dr. Alsakarneh's research continues a legacy of PSC discovery at Mayo Clinic that dates back to the '70s. That was when Dr. Nicholas LaRusso, a gastroenterologist at Mayo Clinic, first began studying the cluster of symptoms that he eventually helped describe and define as PSC in a 1980 study.

"It's important to me that this study comes from Mayo Clinic because Dr. LaRusso, who still has a lab here, made so much progress in this disease. He is the reason I came to Mayo Clinic to do my training," says Dr. Alsakarneh.

Alongside Dr. LaRusso, Dr. Alsakarneh next plans to lead Mayo Clinic research investigating why and how PSC increases cancer risk.

Review the study for a complete list of authors, disclosures and funding. 

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DEAR MAYO CLINIC: I've recently been diagnosed with inflammatory bowel disease. I'm trying to understand what IBD is and how it will affect me. Will I need surgery?

ANSWER: Inflammatory bowel disease, or IBD, is an umbrella term for a group of chronic conditions that cause inflammation and swelling in the digestive tract. It primarily includes two conditions: ulcerative colitis and Crohn's disease. While both involve inflammation, they affect different parts of the gastrointestinal (GI) tract and behave differently over time.

Symptoms of both categories of IBD usually include belly pain, diarrhea, rectal bleeding, extreme fatigue. Ulcerative colitis typically affects the colon and rectum, and it leads to the development of sores called ulcers. Crohn's disease primarily affects the small intestine and often involves the deeper layers of the digestive tract and weight loss. Some people experience mild illness, while in others, the disease can be debilitating and lead to life-threatening complications.

Diagnosing IBD

Diagnosing IBD involves a combination of tests and procedures. Your care team will begin by taking a detailed medical history and asking about your symptoms. To confirm the diagnosis, your care team may recommend:

• Blood tests to check for signs of inflammation, anemia or infection.
• Stool studies to rule out infections and detect markers of inflammation.
• Endoscopic procedures, such as:
  • Colonoscopy, which allows doctors to view the entire colon and take biopsies.
  • Flexible sigmoidoscopy, used when the colon is too inflamed for a complete colonoscopy.
  • Upper endoscopy, if symptoms involve the upper GI tract.
  • Capsule endoscopy, where you swallow a small camera to examine the small intestine.
  • Balloon-assisted enteroscopy, which is used to explore deeper parts of the small bowel.

A biopsy, a small tissue sample taken during endoscopy, is essential to confirm the diagnosis and distinguish IBD from other causes of inflammation.

Understanding the role of surgery

Most people with IBD are treated first with medications. These include anti-inflammatory drugs, immune system suppressors and biologics that target specific pathways in the immune response. However, surgery can become necessary when medications are no longer effective, not well tolerated or when complications arise.

In ulcerative colitis, a colectomy is performed when medications fail or when complications like perforation, obstruction, or cancerous changes occur. A colectomy is when the surgeon removes the entire colon and rectum. An internal pouch is then made and surgically attached to the anus to allow passing waste without an external bag. Sometimes, an internal pouch isn't possible. In these cases, a permanent opening is surgically created in the abdomen, called an ileostomy.

Up to two-thirds of people with Crohn’s disease will require at least one surgery in their lifetime. During this operation, the surgeon removes the damaged part of the digestive tract and reconnects the healthy sections. Surgeons aim to preserve as much of the healthy intestine as possible. Surgery also may be needed for issues such as fistulas, bowel obstructions or perforations.

Surgical decisions are highly individualized and should be made in collaboration between the patient, gastroenterologist and surgeon. Factors that influence the decision include:

• Severity and location of disease.
• Response to medications.
• Overall health and nutritional status.
• Quality of life and personal preferences.

In urgent situations, such as a perforated bowel or severe bleeding, surgery may be performed immediately. But in most cases, there's time for thoughtful discussion and planning.

What to expect moving forward

If you're facing surgery for IBD, know that you're not alone — and you're not without options. The goal of surgery is always to improve your quality of life, reduce symptoms and prevent complications. Seek care from centers like Mayo Clinic that are well versed in IBD treatment and that approach care in a collaborative, compassionate way, tailoring the treatment plan to your unique needs.

Patients should feel empowered to ask questions and be part of the decision-making process. When surgery isn't urgent, your team will work with you to ensure you're in the best possible health before the operation and choose the approach to support long-term success.

Kellie Mathis, M.D., Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota

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Curtis Jackson was living his dream life — a loving and supportive wife, three wonderful kids, and a future that looked as bright as could be.

Then, one day, without warning, the dream was shattered.

At only 46, Curtis was diagnosed with cholangiocarcinoma, one of the deadliest and most aggressive forms of cancer. It's a silent killer that strikes the liver. It is often diagnosed in later stages, leaving patients with few treatment options and little time to live.

The Jackson family turned to Mayo Clinic, where a team of experts fought the cancer with a weapon rarely used in the battle against this aggressive form of cancer.

Watch: A rare cancer. A rare weapon. Curtis Jackson's inspiring story of survival.

Journalists: Broadcast-quality video (2:17) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

The rare cancer

Years before his cancer diagnosis, Curtis was diagnosed with primary sclerosing cholangitis (PSC). PSC is a chronic liver disease that causes inflammation and scarring to the bile ducts, which work with the liver to help with digestion.

PSC put the Arizona man at higher risk for liver cancer, requiring him to get regular diagnostic screenings. As with most forms of cancer, but particularly cholangiocarcinoma, doctors say early detection is key to improving patient outcomes.

However, with cholangiocarcinoma, there are often no warning signs or symptoms alerting patients of the need to consult with their doctor about getting screened, until it's too late. In Curtis' case, the cholangiocarcinoma was detected in one of his routine screenings at Mayo Clinic, which doctors say likely helped save his life.

"It's a very rare cancer that tends to grow unnoticed," says Dr. Tanios Bekaii-Saab, an oncologist with the Mayo Clinic Comprehensive Cancer Center in Arizona. "If the cancer gets to the point where it's too advanced for surgery or transplantation, universally this is a noncurative or noncurable cancer."

The rare weapon

Doctors say a liver transplant can sometimes be an option for some patients. However, not many transplant centers perform liver transplants on patients diagnosed with cholangiocarcinoma. Mayo Clinic is one of the few centers that do offer liver transplantation for some patients who meet certain criteria.

In Curtis' case, doctors at Mayo Clinic determined a liver transplant was his best chance for survival.

"It is a unique form of therapy that is based on research that started at Mayo Clinic in Rochester, Minnesota," says Dr. Bashar Aqel, director of the Mayo Clinic Transplant Center in Arizona.

"We developed some protocols that helped us improve the outcome of transplant in these patients, and without these protocols, a lot of patients with this type of cancer would not make it to transplant," says Dr. Aqel.

The treatment

Curtis first underwent chemotherapy and radiation at Mayo Clinic. He was then placed on the liver transplant waiting list for a donor organ. While waiting, Curtis says he kept his focus on his family.

"I spent all the time I could with my wife and kids, like basketball practices, homework, anything we could do to help our kids," says Curtis.

When Curtis got the call a donor organ was found, he immediately reported to Mayo Clinic to undergo his lifesaving liver transplant. The surgery was a success. Four weeks later, Curtis was back at home with family recovering well and feeling a deep sense of gratitude for his organ donor and his team at Mayo Clinic.

"Thank you because now I get to see my daughters get married, go to college, I get to see my son live his dreams and go to college and get married," says Curtis. "I get to live and grow old with my wife. I can't say this enough to everyone, 'thank you.'"

"We're already observing excellent function from Curtis' new liver, with the majority of his liver tests returning normal results," says Dr. Aqel. "His recovery has been remarkably swift and impressive."

"A lot of love goes out to the people in that family," says Gwyn Jackson, Curtis' oldest daughter in reference to the organ donor's family. "They allowed us to have our dad back and we're so grateful because we love him so much."

Doctors at Mayo Clinic are monitoring Curtis' progress closely. Meanwhile, Curtis' future is back to looking bright, only now with even deeper gratitude in his heart.

"This truly is the gift of life," says Curtis.

Related stories:

• (VIDEO) Breathing easy thanks to the gift of life and new Mayo Clinic Lung Transplant Program in Arizona
• Breaking barriers: Helping Native Americans in need get the gift of life
• Jessie’s Journey
• (VIDEO) Harnessing the power of innovation and a patient’s will to survive

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