Ronkowski (Poland)

Background: Proton pump inhibitors (PPIs) are among the most commonly prescribed medications for acid-related gastrointestinal disorders due to their high efficacy and favorable safety profile. However, emerging evidence suggests that their prolonged use may adversely affect the gut microbiome, potentially leading to clinically relevant complications. Aim: This review aims to analyze the impact of PPI therapy on the composition and function of the intestinal microbiota. Methods: A comprehensive literature review was conducted using databases such as PubMed and Google Scholar. Search terms included “proton pump inhibitors,” “gut microbiota,” “dysbiosis,” and related keywords. Articles were selected based on relevance and recent contributions to understanding PPI-induced microbial changes. Results: PPIs function by irreversibly inhibiting the H⁺/K⁺-ATPase enzyme in gastric parietal cells, thereby suppressing acid secretion. While beneficial in treating conditions like GERD, peptic ulcers, and Helicobacter pylori infection, PPIs also increase gastric pH, weakening the natural defense against ingested pathogens. This alteration facilitates the survival and migration of oral and exogenous microorganisms into the lower gastrointestinal tract, contributing to dysbiosis. Studies reveal significant shifts in microbial composition, including increased prevalence of Klebsiella pneumoniae, Fusobacterium nucleatum, and Campylobacter concisus. Clinically, such changes have been associated with a higher risk of small intestinal bacterial overgrowth (SIBO), Clostridioides difficile infection, and other enteric pathogens. Conclusion: While PPIs remain a cornerstone in gastrointestinal therapy, clinicians should be aware of their potential to disrupt gut microbiota. Rational prescribing practices, guided by appropriate indications and minimal effective duration, are essential to mitigate microbiota-related risks.

Symptom distress is related to decreased quality of life (QOL) among children with cancer, with high levels of pain, nausea, and anxiety reported. Creative arts therapy (CAT) has been related to improved QOL and symptoms in pediatric oncology, but the quality of evidence is mixed. This article aims to examine the QOL symptom subscales in relation to CAT over time in children during the first year of cancer treatment. A secondary analysis of prospective data was performed with linear mixed modeling on 267 observations with predictors of 2 groups: No CAT (n = 18) vs CAT (n = 65). The covariate of time (6 months) was used to explore the CAT relationship with the Pediatric Quality of Life Inventory (PedsQL) symptom subscales (pain and hurt, nausea, procedural anxiety, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication). Children (n = 83) were between 3 and 17 years old (M = 6), 51.2% female, and 32% minority. All tumor types were represented: liquid (37.3%), solid (24.1%), and central nervous system (38.6%). Reduced child report of procedural anxiety was significantly related to receiving CAT with a medium magnitude of association (adjusted effect size = 0.58, P = .01). Creative arts interventions were associated with a longitudinal improvement in anxiety in children with cancer. Further work is needed to target interventions to the appropriate specific burdensome symptoms. Pediatric oncology nurses can advocate for CAT as an effective intervention to ameliorate the burdensome procedural anxiety experienced by patients.

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults.Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1—<40 years old; Group 2—between 40 and 64 years old; Group 3—between 65 and 74 years old; and Group 4—75 years old or older. Groups were compared in terms of peri- and postoperative outcomes.The ratio of complicated appendicitis grew with age (20.97% vs 37.50% vs 43.97% vs 56.84%, P < .001). Similarly, elderly patients more frequently suffered from perioperative complications (5.06% vs 9.3% vs 10.88% vs 13.68%, P < .001) and had the longest median length of stay (3 [Interquartile Range (IQR) 2–4] vs 3 [IQR 3–5], vs 4 [IQR 3–5], vs 5 [IQR 3–6], P < .001) as well as the rate of patients with prolonged length of hospital stay (LOS) >8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48 hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days).The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome.

In 30 anesthetized sheep, we show that repeated bolus injections of autologous zymosan-activated plasma produce pulmonary hypertension, hypoxemia, intrapulmonary thromboxane release, pulmonary leukostasis, and sustained increases in lung lymph flow and protein clearance. Studies with platelet-rich plasma demonstrated that addition of zymosan-activated plasma does not induce platelet aggregation or thromboxane release. We studied the role of cyclooxygenase products as mediators of these pathophysiological responses by pretreating sheep with either meclofenamate (4 mg/kg) or ibuprofen (12.5 mg/kg). Both drugs inhibited thromboxane release and hypoxemia. Ibuprofen, but not meclofenamate, reproducibly attenuated the hypertensive responses and the increases in lymph flow and protein clearance. Neither drug prevented pulmonary leukostasis. These results demonstrate that cyclooxygenase products mediate the development of complement-induced hypoxemia but are not sole mediators of pulmonary hypertension or increases in vascular permeability. Furthermore, ibuprofen has anti-inflammatory actions, not shared by meclofenamate, which enhance the effectiveness of this drug. Since activated leukocytes release reactive oxygen metabolites, we treated sheep with superoxide dismutase (2800 U/kg per hour) to determine the role of superoxide anions in these responses. This treatment significantly attenuated the increases in lung lymph flow and protein clearance. The results suggest that multiple mediators, which may originate from activated leukocytes sequestered in the pulmonary circulation, contribute to the pathophysiological changes seen with intermittent complement activation. Cyclooxygenase products of arachidonic acid contribute to the hypertension and are solely responsible for the hypoxemia. Reactive oxygen metabolites are important mediators of the complement-induced increases in lung vascular permeability.