5-Fluorouracil (5-Fu) is a commonly used chemotherapy drug, but it frequently induces toxic side effects such as intestinal mucositis and is closely associated with ferroptosis‌. Gancao Xiexin (GCXX) decoction, a renowned formula in traditional Chinese medicine, is widely employed for treating gastrointestinal inflammatory diseases. However, the therapeutic effects and underlying mechanisms of GCXX on 5-Fu-induced intestinal mucositis remain unclear‌. This study aims to investigate whether GCXX alleviates 5-Fu-induced intestinal mucositis in mice by suppressing ferroptosis. Using a 5-Fu-induced intestinal mucositis mouse model, we found that oral administration of GCXX not only effectively alleviated 5-Fu-induced intestinal mucositis symptoms including weight loss, diarrhea, and colon shortening, but also reduced pathological changes such as villi atrophy, crypt damage, and goblet cell depletion. Furthermore, GCXX significantly mitigated 5-Fu-triggered intestinal barrier dysfunction by restoring proliferating cell nuclear antigen (PCNA) and occludin expression while reducing myeloperoxidase (MPO) expression of colon tissues and serum levels of diamine oxidase (DAO), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α). Mechanistically, GCXX reduced ferroptosis biomarkers including accumulation of iron and 4-hydroxynonenal (4-HNE) via reducing Kelch-like ECH-associated protein 1 (Keap1) expression and activating nuclear factor erythroid 2-related factor 2 (Nrf2) anti-oxidant pathway, as well as down-regulating long-chain-fatty-acid-CoA ligase 4 (ACSL4) expression and mitogen-activated protein kinases (MAPKs) activation. Molecular docking, dynamics simulation, and drug affinity responsive target stability (DARTS) assays confirmed a stable binding of liquiritin (the main active component of GCXX) with ACSL4 and Keap1, elucidating its anti-ferroptosis mechanism. Our findings demonstrated that GCXX alleviated 5-Fu-induced intestinal mucositis in mice through blocking ferroptosis by activating the Keap1-Nrf2 signaling and inhibiting the ACSL4 and MAPKs pathway, further supporting its clinical utility in mitigating chemotherapy-related toxic side effects.

Chemotherapy- and radiotherapy-induced gastrointestinal injury is a common complication of cancer treatment and may present with diarrhea, abdominal pain, urgency, bloating, rectal bleeding, and reduced oral intake. Although many cases improve after treatment completion, some patients develop persistent or late bowel dysfunction that impairs nutrition, treatment tolerance, daily functioning, and quality of life. Conventional terms such as toxicity, mucositis, and enteritis are clinically useful, but they do not fully capture the problem of incomplete functional recovery. We propose a practical recovery-oriented framework that operationalizes meaningful recovery across four interconnected domains: structural recovery, barrier recovery, clinical recovery, and patient-centered recovery. Using this framework, we summarize the acute-to-chronic clinical spectrum of luminal gastrointestinal injury, examine mechanisms of failed recovery, review clinical assessment and management, and discuss emerging strategies including biomarker-guided monitoring, microbiome-directed interventions, organoid-based platforms, and regenerative therapies. Current care remains largely supportive and symptom-centered. A recovery-oriented model may improve clinical decision-making by integrating symptom trajectory, nutritional status, treatment tolerance, patient-reported burden, and selected biological signals to better monitor and restore gastrointestinal function.

Food protein-induced enterocolitis syndrome (FPIES) is a severe non-IgE-mediated food allergy with unclear prevalence and pathophysiology. FPIES typically presents in the first year of life but can present later in adulthood in an acute or chronic manner. Acute FPIES manifests 1-4 hours after ingestion of foods such as rice, oats, and cow's milk, causing repetitive vomiting, diarrhea, lethargy, dehydration, and hypovolemic shock. Interestingly, affected infants are generally mistakenly diagnosed with sepsis or viral gastroenteritis. Chronic FPIES presents with episodic vomiting, watery diarrhea, and poor growth, potentially leading to dehydration and hypovolemic shock over days to weeks in infants under 3 months who are receiving cow's milk or soy formula. Unlike classic food allergies, FPIES does not present with rash, urticaria, or respiratory symptoms, and specific blood IgE and skin prick tests are negative for the culprit food. While most cases resolve by the age of 3-5 years, some may persist into adulthood, particularly in individuals allergic to cow's milk and soy. Aside from avoiding offending foods, no specific treatment exists. The first international consensus guideline for diagnosing and managing FPIES was established in 2017, marking a vital advancement in the field. However, further research is needed to better understand the pathogenesis, diagnosis, and treatment options for the disease.

This study aimed to investigate the association between a healthy lifestyle and the risk of chronic diarrhea. A total of 2921 eligible participants from the 2007 to 2010 National Health and Nutrition Examination Survey cycles were included in our study. We collected information on lifestyle factors such as diet, physical activity, sleep, smoking, and alcohol consumption, and defined chronic diarrhea as self-reported usual stool type corresponding to types 6 or 7 on the Bristol Stool Form Scale. The primary analysis used survey-weighted logistic regression to assess the association between healthy lifestyle behaviors and the risk of chronic diarrhea, and sensitivity analyses were performed to confirm the robustness of the findings. After adjusting for covariates, survey-weighted logistic regression showed that compared with the low lifestyle score group (0-2), the high lifestyle score group (4-5) was associated with a lower risk of chronic diarrhea (odds ratio [OR] = 0.49, 95% confidence interval [CI] = 0.29-0.82). When the high lifestyle score group was used as the reference, both the low-score group (OR = 2.06, 95% CI = 1.22-3.47) and the middle-score group (score of 3) (OR = 1.57, 95% CI = 1.03-2.39) were associated with a higher risk of chronic diarrhea. However, in the analysis of individual lifestyle factors after covariate adjustment, only the inverse association between diet and chronic diarrhea remained significant (OR = 0.58, 95% CI = 0.35-0.99). In addition, the interaction analysis did not identify any significant interactions among the covariates. A greater number of low-risk lifestyle factors may be associated with a lower risk of chronic diarrhea. Improving lifestyle behaviors holds substantial potential as a primary prevention strategy for chronic diarrhea, particularly among populations in economically underdeveloped regions.

BACKGROUND One-anastomosis gastric bypass (OAGB) is an effective bariatric surgery; however, there may be serious instances of metabolic and nutritional complications that may require complete reversal. Reversal of complete OAGB to near-normal physiology, especially with a background of sleeve gastrectomy, is extremely rare. This case report discusses the complications associated with reversal of OAGB. CASE REPORT Our patient was a 28-year-old woman who had a history of a sleeve gastrectomy procedure and later underwent a revisional OAGB procedure for poor weight loss/weight regain. She later developed weakness, chronic diarrhea, vomiting, severe protein-calorie malnutrition, refractory micronutrient deficiencies, and severe liver dysfunction with significant hepatocellular damage. She was admitted in unstable medical condition. After multidisciplinary evaluation, the patient underwent a laparoscopic reversal of OAGB to near-normal anatomy. The postoperative course was complicated by septic shock and multi-organ dysfunction requiring critical care interventions. With comprehensive multidisciplinary management, the patient gradually improved. After more than 8 months of follow-up, she demonstrated recovery in nutritional status, liver function, and functional capacity, despite the presence of a reduced gastric reservoir due to prior sleeve gastrectomy. CONCLUSIONS This case confirms that complete reversal of OAGB can be life-saving in selected patients with severe malnutrition and metabolic issues. Early identification of nutritional deficiencies and multidisciplinary care are critical to optimize outcomes in high-risk patients following bariatric surgery.

Emamectin benzoate emulsion is a macrocyclic lactone insecticide that is not classified as an organophosphate or carbamate. We report the case of a man in his 80s with chronic kidney disease and cardiovascular comorbidities who ingested emamectin benzoate emulsion. On day 2, he presented with abdominal pain, diarrhea, and marked sialorrhea; his vital signs were stable; however, his serum cholinesterase (ChE) had markedly declined (18 U/L). The patient was discharged with supportive care. From day 3, watery diarrhea recurred and neurobehavioral symptoms progressed. On day 5, he presented with pinhole miosis and further ChE suppression (2 U/L). Therefore, atropine was administered, and the patient was transferred for close monitoring. After discharge (day 8), miosis and sialorrhea persisted, and ChE remained low for weeks. Findings suggestive of tubular injury were observed during follow-up. The patients' symptoms resolved gradually, with ChE partially recovering by days 75 - 95. This case underscores the need for serial reassessment and structured follow-up after pesticide exposure, even when the patient appears stable at the initial presentation.

The GLIM malnutrition diagnostic framework includes the etiologic criterion for reduced dietary intake or assimilation (i.e., digestion or absorption). This criterion required further specification to support consistent use in clinical practice. Three rounds of a modified Delphi was undertaken to develop consensus on guidance to support identification of this criterion. A working group (n = 11) developed surveys iteratively. Invited global experts with diverse disciplines and practice contexts (n = 30) fully completed surveys; consensus was determined at 75% agreement. Three surveys and rounds of voting resulted in 15 guidance statements. Notable points include: (a) using usual intake as the comparator for reduced dietary intake rather than energy requirement, (b) use of gastrointestinal symptoms and nutrition impact symptoms to determine challenges with absorption or assimilation, rather than solely gastrointestinal conditions, and (c) using clinical judgment to determine severity of these symptoms. The final criterion is "less than or equal to 50% dietary intake in the last week or any reduction in intake greater than 2 weeks OR severe gastrointestinal or nutrition impact symptoms (e.g., dysphagia, nausea, vomiting, diarrhea) as a result of an acute or chronic condition or therapy." Future work should confirm the feasibility of this criterion in clinical practice and its criterion validity within the GLIM framework.