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," Dr. Kashyap says. "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.

###

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. 

The post Mayo Clinic study sheds light on colorectal cancer risk in overlooked group appeared first on Mayo Clinic News Network.

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

The post Mayo Clinic Q&A: What does an IBD diagnosis mean for me? appeared first on Mayo Clinic News Network.

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

The post (VIDEO) A rare cancer. A rare weapon. Curtis Jackson’s inspiring story of survival appeared first on Mayo Clinic News Network.

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.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:17) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

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. Aqel.

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. Aqel 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.

The post (VIDEO) Why more liver donors are needed appeared first on Mayo Clinic News Network.

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

The post Your abdominal core: Expert shares tips for protecting a part of the body you may not think about   appeared first on Mayo Clinic News Network.

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.