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.

Najczęstszą lokalizacją zmian zapalnych w chorobie Leśniowskiego-Crohna (ChLC) jest końcowy odcinek jelita krętego i początkowy jelita grubego. Może ona jednak dotyczyć wszystkich odcinków przewodu pokarmowego. Najrzadszą zaś jej lokalizacją jest prawdopodobnie górny odcinek układu oddechowego – jama nosowa. Lokalizacja ta może przysporzyć wielu trudności w diagnostyce ChLC, wymaga bowiem bardzo szerokiej diagnostyki różnicowej. Obraz kliniczny ChLC u dzieci jest bardzo zróżnicowany, a najczęstszymi zgłaszanymi objawami są: bóle brzucha, gorączka, biegunka i niedożywienie. Coraz częściej obserwuje się jednak objawy spoza przewodu pokarmowego, które mogą być jedynymi początkowymi objawami choroby. W artykule przedstawiono przypadek 15-letniej pacjentki z ciężką postacią ChLC, u której w trakcie leczenia obserwowano narastające objawy obturacji przewodów nosowych. Na podstawie przeprowadzonej diagnostyki wykluczono schorzenia otolaryngologiczne. Opierając się na wyniku badania histopatologicznego oraz natychmiastowej poprawie stanu klinicznego po włączonym leczeniu postawiono rozpoznanie nosowej lokalizacji ChLC. Po zapoznaniu się z dostępną nam literaturą, nie odnaleźliśmy polskiego opisu podobnego przypadku – nosowej lokalizacji choroby Leśniowskiego-Crohna wśród populacji pediatrycznej.

Unusual localization of inflammatory changes in the Crohn’s disease in children

Crohn’s disease (CD) together with ulcerative colitis (UC) belong to chronic gastrointestinal condition called inflammatory bowel disease (IBD). The clinical course of both disorders is similar and is characterized by exacerbations and spontaneous or drug-induced remissions but their histopathological features are different. Moreover, the various clinical patterns are reflected in the microscopic features observed in biopsies obtained during endoscopy, which is used for monitoring of disease activity. However, endoscopic mucosal biopsies do not show all the characteristic features of CD. In the last years, many disease-specific instruments, especially complex numeric activity indices to measure activity have been created. Therefore, the review of biopsies, in combination with clinical, laboratory, radiographic and endoscopic observations, is needed for both diagnosis and monitoring of IBD, and for the differentiation CD and UC from other conditions. The aim of this article is to make a revision of available clinical, endoscopic and histopathological scales used in common practice for diagnosis and monitoring of CD.

/pdf/monitoring-crohn-s-disease-activity-clinical-endoscopic-and-p32it3at17.pdf

Monitoring Crohn’s disease activity: clinical, endoscopic and histological indices

Cyclosporin A is an immunosuppressive cyclic peptide. It has not only been a milestone in a transplantology, but is also a treatment's option in gastrology and hepatology. Cyclosporin A primarily affects T lymphocytes activation and proliferation through a calcineurin inhibition. Cyclosporin's A pharmacokinetic features force a dose modification based on its blood concentration and expected therapeutic level. The most frequent adverse effects are renal function impairment, hypertension, and hirsutism. CsA is metabolized mainly in the liver by cytochrome P450 enzymes, hence many drug interactions may occur. Although CsA presents variable bioavailability and poses a threat of adverse effects development, it induces remission in refractory paediatric ulcerative colitis and autoimmune hepatitis.

Zastosowanie cyklosporyny A we wrzodziejącym zapaleniu jelita grubego i autoimmunizacyjnym zapaleniu wątroby u dzieci

Introduction. Faecal calprotectin (FC) is a good marker in monitoring adults with ulcerative colitis (UC). Its concentrations in faeces is related to state of mucosa observed in endoscopy. There are a few studies concerning FC in mucosa status assessment in UC paediatric population. Aim. Determination of cut-off points for FC levels in children with UC corresponding to the severity of inflammation in the colon. Material and methods. 91 patients with UC (F 45, M 46, median 14.79 years) were involved to the study and had colonoscopy performed and FC level within a week before endoscopy measured. Mucosa status was assessed with Mayo score. We have identified three subgroups: those with mucosal healing and Mayo score 0 or 1, patients with moderate inflammation in gut mucosa defined as Mayo score 2 and those with sever colitis described as Mayo score 3. The ROC was used as a statistical method to establish cut-off points. The AUC assesses the differentiation quality of the study group. We also analysed other laboratory, clinical or demographic data to established their impact on state of mucosa. Results. Strong significant positive correlation between Mayo score and PUCAI and FC was found, with r = 0.61; r = 0.68 respectively. AUC for FC in differentiation between mucosal healing and moderate disease was 0.90 whereas mild colitis and sever disease was 0.53. The optimal cut-off levels of FC of discrimination between subgroup with no or low disease activity and moderate activity in endoscopy findings was 300 μg/g with sensitivity 0.90 and specificity 0.82. Conclusions. Only FC and PUCAI are strongly correlated with state of mucosa in children with UC. FC of 300 μg/g let us to distinguish children with no or low activity of the disease between those with moderate colitis. The differentiation between moderate and sever colitis is not possible in UC children with usage of model based only on FC.

Jarosław Kierkuś

Papers

Unusual localization of inflammatory changes in the Crohn’s disease in children

Monitoring Crohn’s disease activity: clinical, endoscopic and histological indices

Zastosowanie cyklosporyny A we wrzodziejącym zapaleniu jelita grubego i autoimmunizacyjnym zapaleniu wątroby u dzieci

Can we predict mucosal inflammation in children with ulcerative colitis without colonoscopy? Own experience in assessing faecal calprotectin

Abdominal trauma before the onset of chronic pancreatitis – cause of disease or fortuity?