Search Results (184)

Acute pancreatitis (AP) is the most common cause of gastrointestinal-related hospitalizations in the United States, with gallstone disease and alcohol as the leading etiologies. Management is determined by disease severity, classified as interstitial edematous pancreatitis or necrotizing pancreatitis, with severity further stratified based on local complications and systemic organ dysfunction. Regardless of etiology, initial treatment involves aggressive intravenous fluid resuscitation with Lactated Ringer’s solution, pain and nausea control, early oral feeding in 24 to 48 h, and etiology-directed interventions when indicated. In gallstone pancreatitis, early endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is indicated in the presence of concomitant cholangitis or persistent biliary obstruction, with subsequent laparoscopic cholecystectomy as standard of care for stone clearance. The role of interventional therapy in uncomplicated AP is limited in the acute phase, except for biliary decompression or enteral feeding support with nasojejunal tube placement. However, in severe AP with complications, interventional radiology (IR) and endoscopic approaches play a pivotal role. IR facilitates early percutaneous drainage of symptomatic, acute fluid collections and infected necrosis, particularly in non-endoscopically accessible retroperitoneal or dependent collections, improving outcomes with a step-up approach. IR-guided angiographic embolization is the preferred modality for hemorrhagic complications, including pseudoaneurysms. In the delayed phase, walled-off necrosis (WON) and pancreatic pseudocysts are managed with endoscopic ultrasound (EUS)-guided drainage, with direct endoscopic necrosectomy (DEN) reserved for infected necrosis. Dual-modality drainage (DMD), combining percutaneous and endoscopic drainage, is increasingly utilized in extensive or complex collections, reflecting a collaborative effort between gastroenterology and interventional radiology comparable to that which exists between IR and surgery in institutions that perform video assisted retroperitoneal debridement (VARD). Peripancreatic fluid collections may fistulize into adjacent structures, including the stomach, small intestine, or colon, requiring transpapillary stenting with or without additional closure of the gut leak with over-the-scope clips (OTSC) or suturing devices. Additionally, endoscopic management of pancreatic duct disruptions with transpapillary or transmural stenting plays a key role in cases of disconnected pancreatic duct syndrome (DPDS). Comparative outcomes across interventional techniques—including retroperitoneal, laparoscopic, open surgery, and endoscopic drainage—highlight a shift toward minimally invasive approaches, with decreased morbidity and reduced hospital stay. The integration of endoscopic and interventional radiology-guided techniques has transformed the management of AP complications and multidisciplinary collaboration is essential for optimal patient outcomes. Full article

This review integrates clinical, immunological, microbial, pathophysiological, and therapeutic perspectives on necrotizing enterocolitis (NEC)—a leading cause of morbidity and mortality in premature infants. We summarize the clinical burden and risk factors; elucidate key immune and cellular mechanisms, including TLR4 signaling, epithelial barrier dysfunction, and enteric nervous system involvement; and provide a concise overview of experimental models. We also highlight microbial dysbiosis, ischemia, multiorgan injury, and recent advances in pathogenesis, as well as current and emerging therapies such as probiotics, breast milk components, TLR4 inhibitors, and immunomodulators, emphasizing the need for a multidisciplinary approach to accelerate discovery and improve outcomes. Overall, this review bridges mechanistic insights to clinical applications and supports the pursuit of personalized NEC prevention. Full article

The objective of our study was to verify the intervention effect of Bacillus amyloliquefaciens SC06 on NE by constructing a C. perfringens-induced intestinal damage mouse model. A total of 40 mice were randomly assigned to four treatments: CON (basal diet), CP (basal diet + C. perfringens), SC06 + CP (basal diet + SC06 + C. perfringens) and SC06 (basal diet + SC06). Our findings indicated that SC06 supplementation was effective in maintaining the integrity of the intestinal barrier, enhancing the antioxidant capacity of the intestine, reducing the generation of an inflammatory response, and suppressing enterocyte apoptosis in the presence of C. perfringens. Furthermore, SC06 supplementation enhanced the prefoliation of intestinal stem cells (ISC) and prompted their differentiation into goblet cells and Paneth cells. Moreover, our findings indicate that SC06 promotes the proliferation of C. perfringens-induced jejunum organoids and the expression of genes and proteins associated with ISC differentiation and regeneration. The mechanism by which SC06 modulates ISCs has been validated, and the results align with those obtained in vivo. In conclusion, the findings demonstrated that SC06 stimulates the proliferation and differentiation of ISCs through the activation of the Wnt/β-catenin signaling pathway, thereby accelerating epithelial regeneration and repair. Full article

The current study aims to investigate the effects of additional valine and isoleucine in different necrotic enteritis (NE) challenge intensities. A total of 648 seven-day-old male Cobb 500 were allotted to nine treatments with six replicates. Two different NE intensity experiments (Exp-1 and Exp-2) were conducted. The five treatments for each NE experiment were as follows: (1) non-challenged shared control (NC), (2) NE challenge (NE), (3) 130% additional valine (VAL), (4) 130% additional isoleucine (ILE), and (5) 130% valine and isoleucine (MIX). In both experiments, all NE-challenged groups had decreased body weight gain compared to the NC group (p < 0.05). The ILE group in Exp-1 had further reduced body weight compared to the NE group on day 21 (p < 0.05). No significant differences were observed in intestinal permeability, jejunal NE lesion score, jejunal C. perfringens colony counts, jejunal morphology, jejunal gene expression levels, breast muscle yield, and body mineral compositions among all NE-challenged groups (p > 0.05). In conclusion, 130% additional valine and isoleucine hardly mitigated the negative effects of NE. Additional isoleucine may further worsen chicken growth performance, but this effect may vary depending on the intensity of the NE challenge. Full article

From January 2019 to April 2020, the Minnesota Veterinary Diagnostic Laboratory (MVDL) received cases of hepatitis and spiking mortality in young turkey poults (average age 15.5 days) from multiple turkey-producing states. Meat-type turkeys were mainly affected, with a few cases in breeders. Of 188 cases, 88 (47.5%) tested positive for reovirus by virus isolation, with most of the positive cases from 7 to 14-day-old birds (n = 42). Gross lesions consisted of hepatosplenomegaly with acute, multifocal necrosis in both liver and spleen. Microscopically, liver sections showed congestion of hepatic sinusoids and necrotizing hepatitis with infiltration of lymphocytes, plasma cells, and macrophages. Reovirus was detected in liver samples by electron microscopy and in situ hybridization (ISH). Sections of spleen showed areas of necrosis with infiltration of the mixed population of inflammatory cells and depletion of lymphocytes. We consistently isolated reoviruses from livers and tentatively named the virus “Turkey Hepatitis Reovirus” (THRV). Phylogenetic analysis of the newly emerged THRVs revealed their clustering into four distinct groups. This study also highlighted the close antigenic relation between TARV and THRV compared to turkey enteritis reoviruses (TERVs), which shed light on the probable origin of this newly emerged pathotype. In summary, further molecular and pathogenicity studies are recommended on THRVs to help diagnose and control this serious variant. Full article

This study evaluated zinc glycinate (ZG) on necrotic enteritis (NE) in chickens through two in vivo experiments and one in vitro experiment. In vivo, ZG was supplemented (study 1: 40–120 mg/kg; study 2: 100–160 mg/kg). In total, 192 (exp. 1) and 240 Cobb male birds (exp. 2) (n = 6) were studied for 28 days. ZG at 120 mg/kg significantly improved BWG by day 28 (p < 0.05), while 140 mg/kg reduced FCR (p < 0.05). Lesions were significantly reduced by 120 mg/kg (p < 0.01), and mortality was lowered by 80 mg/kg (study 1, p < 0.05) and 120 mg/kg (study 2, p < 0.01). ZG at 160 mg/kg increased IFN-γ expression in the spleen (p < 0.01), and 140 mg/kg decreased Zn/Cu SOD1 in the cecal tonsils (p < 0.05). In vitro, zinc (10–1000 µM) enhanced intestinal cell viability under Clostridium perfringens challenge. Cytotoxicity in HD-11 cells decreased significantly at concentrations ≥100 µM after 12 h (p < 0.001) and ≥10 µM after 24 h (p < 0.001), with the lowest levels observed at 100 µM (p < 0.001). We recommend increasing zinc to 120 mg/kg as ZG in poultry feed against NE infection. Full article

Necrotic enteritis, caused by Clostridium perfringens (C. perfringens) is a disease present worldwide and causes major economic losses. The re-emergence of the disease, in recent years, is mainly due to the ban of the usage of antibiotics as growth promoters in the EU. The aim of this study was to establish a reliable, robust challenge model. Ross hybrid broilers were divided into randomized groups: a positive and a negative control group, a group receiving antibiotic treatment and three groups fed with assorted feed supplements, all receiving the same basal diet. The birds in the treatment groups were vaccinated twice using a 10-times dose of an Infectious Bursitis live vaccine and the animals were challenged four times with a NetB toxin producing C. perfringens strain. The presence of clinical signs and body weight gain were monitored. At the end of the study necropsy was performed and the gut lesions were scored. During the experiment, clinical signs were absent in the negative control group and in the antibiotic treated group. The other animals displayed diarrhea and feather loss. These symptoms were the most pronounced in the positive control group. The gut lesion scores showed significant differences between the negative and positive control groups, with the former scoring the lowest. Based on these results, the challenge model establishment was successful and in this setup the assessment of the potency of feed additives is also possible. Full article

Necrotic enteritis (NE), caused by Clostridium perfringens, poses significant economic challenges to the global poultry industry. The widening ban on in-feed antibiotics in livestock production underscores the need for alternative strategies to combat NE. Deoxycholic acid (DCA), a secondary bile acid, has shown promise in NE mitigation. However, its protective mechanism remains largely unexplored. A total of 120 newly hatched, male Cobb broilers were randomly divided into four treatments to investigate the impact of DCA on host response and intestinal microbiome in both healthy and NE-infected chickens. The results demonstrated that the dietary supplementation of 1.5 g/kg DCA significantly improved animal survival, reversed growth inhibition, and alleviated intestinal lesions (p < 0.01). Furthermore, DCA selectively inhibited the NE-induced proliferation of C. perfringens and other pathobionts such as Escherichia and Enterococcus cecorum. Concurrently, DCA markedly enriched dominant lactic acid bacteria like Lactobacillus johnsonii in both the ileum and cecum of NE-infected chickens. However, DCA had a marginal effect on the jejunal transcriptomic response in both mock- and NE-infected chickens. Therefore, we conclude that DCA protects chicken from NE mainly through the targeted inhibition of pathobionts including C. perfringens, with minimum impact on the host. These findings elucidate the protective mechanisms of DCA, supporting its development as a promising antibiotic alternative for NE mitigation. Full article

Background/Objectives: The gut microbiota (GM) is pivotal for immune regulation, metabolism, and neurodevelopment. Infants undergoing surgery for congenital gastrointestinal anomalies are especially prone to microbial imbalances, with a paucity of beneficial bacteria (e.g., Bifidobacteria and Bacteroides) and diminished short-chain fatty acid production. Dysbiosis has been associated with severe complications, including necrotizing enterocolitis, sepsis, and feeding intolerance. This narrative review aims to critically examine strategies for microbiota modulation in this high-risk cohort. Methods: An extensive literature analysis was performed to compare the evolution of GM in healthy neonates versus those requiring gastrointestinal surgery, synthetizing strategies to maintain eubiosis, such as early nutritional interventions—particularly the use of human milk—along with antibiotic management and supplementary treatments including probiotics, prebiotics, postbiotics, and lactoferrin. Emerging techniques in metagenomic and metabolomic analysis were also evaluated for their potential to elucidate microbial dynamics in these patients. Results: Neonates undergoing gastrointestinal surgery exhibit significant alterations in microbial communities, characterized by reduced levels of eubiotic bacteria and an overrepresentation of opportunistic pathogens. Early initiation of enteral feeding with human milk and careful antibiotic stewardship are linked to improved microbial balance. Adjunctive therapies, such as the administration of probiotics and lactoferrin, show potential in enhancing gut barrier function and immune modulation, although confirmation through larger-scale studies remains necessary. Conclusions: Modulating the GM emerges as a promising strategy to ameliorate outcome in neonates with congenital gastrointestinal surgical conditions. Future research should focus on the development of standardized therapeutic protocols and the execution of rigorous multicenter trials to validate the efficacy and safety of these interventions. Full article

Background/Objective: We sought to address ongoing gaps in understanding the relationship between first-week percent maximal weight loss (MWL) and average first-week total fluid intake (TFI), enteral intake, and parenteral intake among premature newborns with adverse in-hospital outcomes born in low- and middle-income countries (LMICs). Methods: We evaluated newborns born <34 weeks gestation or <1500 g who survived at least 7 days at the St. Paul’s Hospital Millennium Medical College (SPHMMC) neonatal intensive care unit in Ethiopia. We performed univariate and multivariate regression models analyzing the first-week MWL, average TFI, parenteral, and enteral intake and their relationships with adverse in-hospital outcomes. Results: Among N = 490 moderately and very preterm newborns, multivariate regression models demonstrated that >13% MWL was associated with significantly increased odds of suspected necrotizing enterocolitis (NEC), culture-positive sepsis, retinopathy of prematurity (ROP), and a longer length of stay (LOS). An average enteral intake of >60 mL/kg/day was significantly associated with reduced odds of all-cause mortality, suspected NEC, culture-positive sepsis, ROP, and a shorter LOS, whereas an average parenteral intake of >60 mL/kg/day was associated with increased odds of in-hospital mortality, culture-positive sepsis, ROP, and a longer LOS. Conclusions: In moderately and very preterm neonates in an LMIC setting, >13% MWL is associated with adverse health outcomes. Increasing the average parenteral intake over the first week after birth among moderately and very preterm neonates is significantly associated with adverse in-hospital outcomes whereas increasing the average enteral intake is associated with improved outcomes. Full article

Avian reovirus (ARV) has emerged as an important pathogen in turkeys, causing economic losses through tenosynovitis, necrotizing hepatitis, immunosuppression, and enteric disease. Despite its ubiquity, the evolutionary history of ARV cross-species transmission among chickens, turkeys, and wild birds remains poorly understood, hindering effective control and surveillance. This study investigates ARV temporal phylogenetics with an emphasis on interspecies transmission in turkeys. Whole genome sequences (WGSs) from seventy-seven turkey cases and one quail case at the Iowa State University Veterinary Diagnostic Laboratory, along with 74–136 segment sequences per gene from GenBank (1970–2023), were analyzed. Temporal phylogenetic analyses identified chickens as the ancestral host, with spillover into turkeys beginning in the mid-20th century, followed by stable transmission within turkey populations. Migration analyses revealed predominantly unidirectional transmission from chickens to turkeys. WGS analyses showed high variability in the M2 and σC-encoding region of the S1 segment, suggesting selective pressure on outer capsid proteins. M2, S1 σC, and L3 had the highest substitution rates, implicating their role in adaptation and antigenic diversity. These findings highlight the complexity of ARV evolution across hosts and underscore the need for robust genotyping schemes and surveillance strategies to mitigate outbreaks in poultry. Full article

Background/Objectives: Acute pancreatitis (AP) is an illness that requires prompt diagnosis and treatment since it has the potential to become life-threatening. The American College of Gastroenterology 2024 (ACG24) guidelines offer a framework for diagnosis, severity, and treatment criteria. To assess Google Gemini application of ACG24 guidelines to Medical Information Mart for Intensive Care-III AP cases for risk, nutrition, and complication management. Methods: This observational cross-sectional study was based on 512 patients with AP who were treated in the Medical Information Mart for Intensive Care-III database from 2001 to 2012. The study compared the efficiency of Gemini in relation to the ACG24 guidelines in the three main areas of risk stratification, enteral nutrition timing, and necrotizing pancreatitis management. Enteral nutrition, according to the ACG24 guidelines, should be started within 48 h for patients who are capable, and antibiotics should only be used for confirmed infected necrosis. Results: The study included 512 patients who were divided into two groups: 213 patients with mild pancreatitis (41.6%) and 299 patients with severe pancreatitis (58.4%). The model achieved 85% accuracy for mild cases and 82% accuracy for severe cases of pancreatitis. The Acute Physiology and Chronic Health Evaluation II and Ranson scores matched the predictions of Gemini for both mild cases (p = 0.28 and p = 0.33, respectively) and severe cases (p = 0.31 and p = 0.27, respectively). The recommendations for early enteral nutrition and delayed feeding in mild cases were correct for 78% of patients, but the system suggested oral intake prematurely in 8% of severe cases. The antibiotic guideline compliance reached 82% among 156 patients with necrotizing pancreatitis, and the procedure for draining infected necrosis was correct 85% of the time. Conclusions: The Gemini model achieved 78–85% accuracy in determining pancreatitis severity and adherence to treatment guidelines but showed lower accuracy in nutrition timing compared to other parameters. Core Tip: This study evaluated the Google Gemini model in applying the American College of Gastroenterology 2024 guidelines for acute pancreatitis across 512 Medical Information Mart for Intensive Care-III cases. Results demonstrated 85% accuracy in severity classification, precise prediction of Acute Physiology and Chronic Health Evaluation II and Ranson scores, and 78–85% compliance with nutritional and necrotizing pancreatitis management guidelines. These findings suggest that artificial intelligence-based clinical decision support systems can provide rapid, consistent, and guideline-concordant recommendations, which are particularly valuable in settings with limited specialist expertise. Full article

The complications observed in preterm infants are largely attributable to underdeveloped organ systems and inadequate nutritional stores at birth. Insufficient nutritional support can further exacerbate persistent sequelae, such as bronchopulmonary dysplasia (BPD), metabolic bone disease of prematurity (MBDP), and retinopathy of prematurity (ROP). As a result, clinicians have collaborated to develop optimal nutrition strategies for preterm neonates. However, these clinical nutrition plans may be hindered by several factors, including fluid restrictions due to patent ductus arteriosus (PDA) and delayed enteral nutrition following necrotizing enterocolitis (NEC). Modified strategies for specific conditions can help prevent further deterioration, but inadequate nutritional support may limit organ growth and contribute to additional complications. Achieving an optimal balance between nutritional support and managing specific medical conditions varies across institutions. In addition to fluid balance and energy intake, supplementary nutrition—such as vitamins and probiotics—plays a crucial role in disease prevention. Drawing on recent evidence and our clinical experiences with neonatal nutritional strategies, this review article summarizes the specialized nutritional management required for preterm neonates with conditions such as BPD, NEC, MBDP, PDA, and ROP. Full article

Background/Objectives: Clostridium perfringens is a normal inhabitant of the intestinal tract of poultry, and it has the potential to induce cholangiohepatitis and necrotic enteritis (NE). The poultry industry suffers significant financial losses because of NE, and treatment becomes more challenging due to resistant C. perfringens strains. Methods: The antimicrobial and antibiofilm activities of cellulose nanocrystals/zinc oxide nanocomposite (CNCs/ZnO) were assesses against pan drug-resistant (PDR) C. perfringens isolated from chickens and turkeys using phenotypic and molecular assays. Results: The overall prevalence rate of C. perfringens was 44.8% (43.75% in chickens and 58.33% in turkeys). Interestingly, the antimicrobial susceptibility testing of C. perfringens isolates revealed the alarming PDR (29.9%), extensively drug-resistant (XDR, 54.5%), and multidrug-resistant (MDR, 15.6%) isolates, with multiple antimicrobial resistance (MAR) indices ranging from 0.84 to 1. All PDR C. perfringens isolates could synthesize biofilms; among them, 21.7% were strong biofilm producers. The antimicrobial potentials of CNCs/ZnO against PDR C. perfringens isolates were evaluated by the agar well diffusion and broth microdilution techniques, and the results showed strong antimicrobial activity of the green nanocomposite with inhibition zones’ diameters of 20–40 mm and MIC value of 0.125 µg/mL. Moreover, the nanocomposite exhibited a great antibiofilm effect against the pre-existent biofilms of PDR C. perfringens isolates in a dose-dependent manner [MBIC50 up to 83.43 ± 1.98 for the CNCs/ZnO MBC concentration (0.25 μg/mL)]. The transcript levels of agrB quorum sensing gene and pilA2 type IV pili gene responsible for biofilm formation were determined by the quantitative real time-PCR technique, pre- and post-treatment with the CNCs/ZnO nanocomposite. The expression of both genes downregulated (0.099 ± 0.012–0.454 ± 0.031 and 0.104 ± 0.006–0.403 ± 0.035, respectively) when compared to the non-treated isolates. Conclusions: To the best of our knowledge, this is the first report of CNCs/ZnO nanocomposite’s antimicrobial and antibiofilm activities against PDR C. perfringens isolated from chickens and turkeys. Full article

Clostridium perfringens is a major cause of necrotizing enteritis in chickens. This study aimed to investigate the effects of zinc oxide quantum dots (ZnO-QDs) on growth performance, redox status, and gut microbiota in broilers challenged with C. perfringens. A total of 320 1-day-old chicks were divided into five groups: negative control (NC) without treatment; positive control (PC) infected with C. perfringens; and the other three groups (40, 80, and 120 Zn) were given ZnO-QDs at doses of 40, 80, and 120 mg/kg, respectively, under C. perfringens infection, respectively. The results show that, compared to the NC group, the PC group exhibited negative effects on growth performance, intestinal morphology, and antioxidant status in broilers. However, compared to the PC group, 120 mg Zn increased (p < 0.05) the body weight of broilers at 21 days, while 40 mg Zn reduced (p < 0.05) serum diamine oxidase activity. The intestinal macroscopic evaluation showed that the PC group had the highest lesion scores, whereas the 120 mg Zn group exhibited the lowest lesion score. Meanwhile, compared to the PC group, the 40 mg Zn group had higher (p < 0.05) CAT and GPX activities and a lower (p < 0.05) MDA concentration. Moreover, the 40 mg Zn group up-regulated (p < 0.05) the gene expression of Cathelicidin-1, IL-10, Claudin-1, and MLCK in the jejunum. Furthermore, the 120 mg Zn group increased (p < 0.05) the abundance of Blautia, Parasutterella, and Lachnospiraceae FCS020 in the cecum. In conclusion, ZnO-QDs exerted a beneficial effect on improving growth performance and overall health in broilers under C. perfringens infection, potentially by regulating redox balance and gut microbiota. Full article