Post-Antibiotic Gut Mucosal Microbiome Reconstitution Is Impaired by Probiotics and Improved by Autologous FMT.

Consumption of over-the-counter probiotics for promotion of health and well-being has increased worldwide in recent years. However, although probiotic use has been greatly popularized among the general public, there are conflicting clinical results for many probiotic strains and formulations. Emerging insights from microbiome research enable an assessment of gut colonization by probiotics, strain-level activity, interactions with the indigenous microbiome, safety and impacts on the host, and allow the association of probiotics with physiological effects and potentially useful medical indications. In this Perspective, we highlight key advances, challenges and limitations in striving toward an unbiased interpretation of the large amount of data regarding over-the-counter probiotics, and propose avenues to improve the quality of evidence, transparency, public awareness and regulation of their use.

The pros, cons, and many unknowns of probiotics

Intestinal failure (IF) can be defined as the reduction of functional gut mass below the minimal amount necessary for digestion and absorption adequate to satisfy the nutrient and fluid requirements for maintenance in adults or growth in children. In developed countries, IF mainly includes individuals with the congenital or early onset of conditions requiring protracted or indefinite parenteral nutrition (PN). Short bowel syndrome was the first commonly recognized cause of protracted IF. The normal physiologic process of intestinal adaptation after extensive resection usually allows for recovery of sufficient intestinal function within weeks to months. During this time, patients can be sustained on parenteral nutrition. Only a few children have permanent intestinal insufficiency and life-long dependency on PN. Non-transplant surgery including small bowel tapering and lengthening may allow weaning from PN in some cases. Hormonal therapy with recombinant human growth hormone has produced poor results while therapy with glucagon-like peptide-2 holds promise. Congenital diseases of enterocyte development such as microvillus inclusion disease or intestinal epithelial dysplasia cause permanent IF for which no curative medical treatment is currently available. Severe and extensive motility disorders such as total or subtotal intestinal agangli-onosis (long segment Hirschsprung disease) or chronic intestinal pseudo-obstruction syndrome may also cause permanent IF. PN and home-PN remain are the mainstays of therapy regardless of the cause of IF. Some patients develop complications while receiving long-term PN for IF especially catheter related complications (thrombosis, sepsis) and liver disease. These patients may be candidates for intestinal transplantation. This review discusses the causes of irreversible IF and emphasizes the specific medico-surgical strategies for prevention and treatment of these conditions at several stages of IF.

Irreversible intestinal failure.

https://www.gastrojournal.org/article/S0016-5085(15)01773-4/pdf

The Toronto Consensus Statements for the Management of Inflammatory Bowel Disease in Pregnancy

https://www.gastrojournal.org/article/S0016-5085(05)02410-8/pdf

Causes and management of intestinal failure in children.

During the past years incidence of Inflammatory Bowel Disease (IBD) in pediatric population is increasing. The aim of this study is to facilitate diagnosis. Authors presented the clinical characteristics and current diagnostic guidelines. The work also describes the Paris classification, currently used in children.

Aktualne wytyczne klasyfikacji i diagnostyki nieswoistych zapaleń jelit u dzieci

We describe a 42-month-old child with protracted diarrhoea that began at 6 months of age. Severe secretory diarrhoea persisted despite therapy with exclusion diets, total parenteral nutrition, chemotherapeutics, antisecretory drugs. The diagnosis of autoimmune enteropathy with total villous atrophy and anti-enterocyte antibodies was established at 16 months of age. Prednisone therapy induced a clinical remission. After dose reduction, clinical relapse occurred, complicated with HCV infection with elevated serum alanine aminotransferase activity. Increasing the prednisone dose did not result in clinical improvement. Treatment with cyclosporine induced clinical remission. After 10 months cyclosporine therapy is still continued and the boy is doing well.

[Autoimmune enteropathy--difficulties in diagnosis and treatment].

To achieve clinical remission was the primary target in medical therapy of both types of inflammatory bowel diseases (IBD): ulcerative colitis (UC) and Crohn's Disease (CD). Currently, however, it is mucosal healing to be the most important factor in beneficial change of natural history of IBD. Mucosal healing is associated with sustained clinical remission, reduced rate of hospitalization and surgical procedures. Therefore, assessment of the grade of intestinal inflammation is important to establish and to monitor a proper medical treatment. Although endoscopy is a necessary procedure in assessment of bowel inflammation, this method is invasive, burdensome and expensive. Therefore gastroenterologists are looking for alternative, non-invasive approach to assess the presence and degree of mucosal inflammation in IBD. To avoid invasive investigations several non-invasive markers have been suggested to be useful to assess mucosal healing. In this review we explored some of the alternative methods. We compared blood markers, fecal tests and imaging modalities and try to define the best test to evaluate a mucosal inflammation and healing. Fecal calprotectin is supposed to be the most accurate to evaluate mucosal healing in IBD. However, new clinical studies to assess the mucosal healing with existing or new markers are necessary in the future.

Nieinwazyjna diagnostyka zmian zapalnych błony śluzowej jelita w nieswoistych zapaleniach jelit u dzieci

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a chronic condition characterized by abdominal pain, diarrhoea, bleeding, and malabsorption. The disease is common in young people (children and young adults) yet it is rather rare in children younger than 2 years. A distinct phenotype of early onset IBD (EO-IBD) in infants and small children with severe intractable enterocolitis and greater tendency to develop colonic disease has been described. Recent work has demonstrated that EO-IBD with manifestation in the first months of life can be monogenic, resulting from mutations in interleukin-10 (IL-10) or its receptor and leading to a loss of IL-10 function. Allogeneic haematopoietic stem cell transplantation (HSCT) can be a successful treatment for those patients. We present here a case of a female IL-10R-deficient patient with severe EO-IBD who underwent HSCT. Streszczenie Nieswoiste zapalenia jelit (inflammatory bowel disease – IBD), ktore obejmują chorobe Leśniowskiego-Crohna i wrzodziejące zapalenie jelit, stanowią grupe przewleklych chorob ukladu pokarmowego. Do charakterystycznych objawow nalezą: bol brzucha, biegunka, krwawienie z dolnego odcinka przewodu pokarmowego oraz niedozywienie. Choroba czesto pojawia sie w mlodym wieku (dzieci i mlodzi dorośli), jednak stosunkowo rzadko u dzieci mlodszych niz 2 lata. U pacjentow z wczesną manifestacją IBD (EO-IBD) choroba czesto lokalizuje sie w jelicie grubym, jej przebieg jest ciezki i szybko rozwija sie zapalenie calego jelita grubego. Najnowsze doniesienia wskazują na związek EO-IBD zdiagnozowanej w pierwszych miesiącach zycia z defektem monogenicznym i mutacjami interleukiny 10 (IL-10) i/lub jej receptora, co powoduje utrate funkcji IL-10. Przeszczep allogenicznych komorek szpiku (haematopoietic stem cell transplantation – HSCT) stanowi jedyne skuteczne leczenie dla tych pacjentow. Autorzy przedstawiają przypadek pacjentki z deficytem IL-10R oraz ciezkim przebiegiem EO-IBD, ktora przeszla HSCT.

https://www.termedia.pl/Journal/-41/pdf-21158-10?filename=Interleukin-10 receptor.pdf

Interleukin-10 receptor deficiency in a Polish paediatric patient with early onset inflammatory bowel disease

Background According to ECCO/ESPGHAN consensus for managing acute severe ulcerative colitis in children, Cyclosporin A remains a rescue therapy in acute steroid-refractory ulcerative colitis. Aim To describe clinical features of children qualified for Cyclosporin A (CsA) treatment. Material and methods It is a retrospective, single centre study. We describe a clinical characteristic of children who underwent CsA treatment in the course of ulcerative colitis (UC). Results We evaluated 59 children's medical charts treated in our department with Cyclosporin A in the course of ulcerative colitis in years 2005–2015. There is a female predominance in the study (34/59). The median age at the diagnosis was 11.9 years, while the median age of the initiation of CsA 15 years. Ulcerative colitis had lasted on median 20 months when CsA was initiated. The median PUCAI score at the onset of CsA therapy was 50.00. Almost 80% of patients had a moderate/severe course. Conclusion CsA was in our department the drug of choice in case of steroid refractory ulcerative colitis.

Jarosław Kierkuś

Papers

Aktualne wytyczne klasyfikacji i diagnostyki nieswoistych zapaleń jelit u dzieci

[Autoimmune enteropathy--difficulties in diagnosis and treatment].

Nieinwazyjna diagnostyka zmian zapalnych błony śluzowej jelita w nieswoistych zapaleniach jelit u dzieci

Interleukin-10 receptor deficiency in a Polish paediatric patient with early onset inflammatory bowel disease

A clinical characteristic of paediatric ulcerative colitis patients qualified for a Cyclosporin A therapy