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.

Endoscopic retrograde cholangiopancreatography (ERCP) is nowadays a valuable method for detailed diagnostic evaluation and minimally invasive therapy for biliary and pancreatic diseases in pediatric population. The technique of ERCP is no more difficult in children than in adults, and except infants, there is no need for use a special pediatric endoscope. In children ERCP is usually performed with the patient under general anesthesia. Routine antibiotic prophylaxis is controversial, because there is no pediatric data regarding this problem. Pediatric indications for ERCP are similar to those for adults, though with a much lower incidence of malignant diseases. Among children with pancreatic diseases a common indications are: acute or recurrent acute pancreatitis, chronic pancreatitis, abdominal pain suspected to be of pancreaticobiliary origin, suspicion of pancreatic ductal anomaly, pancreatic trauma, differential diagnosis of focal pancreatic lesions and preoperative evaluation. Therapeutic ERCP constitutes 30-78% of all ERCPs and has a significant impact on the management of patients with pancreatic diseases, offering an alternative to surgical treatment in some cases. Pediatric studies demonstrates that ERCP has a high degree of technical success and a low rate of complications when performed by experienced endoscopists. MRCP nowadays has become the first-line diagnostic tool for biliopancreatic diseases and in the future ERCP may play a role mainly as a therapeutic intervention.

Endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreatic diseases

Najnowszy konsensus histopatologiczny Europejskiej Organizacji ds. nieswoistych chorob zapalnych jelit (ECCO), wydany w 2013 roku, obejmuje opis i wytyczne diagnozowania mikroskopowego zapalenia jelita grubego (MZJG). W związku z tym powstaje pytanie, czy MZJG nalezy zaliczyc do nieswoistych chorob zapalnych jelit, wraz z chorobą Leśniowskiego-Crohna oraz wrzodziejącym zapaleniem jelita grubego. Zagadnienie to bylo rowniez dyskutowane podczas 9. Kongresu ECCO, ktory odbyl sie w Kopenhadze w lutym 2014 roku.

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Czy mikroskopowe zapalenie jelita grubego należy do nieswoistych chorób zapalnych jelit

Introduction. Pancreatic cyst is a pathological fluid collection located in the pancreas or directly adjacent to it. Pancreatic pseudocyst is the most common complication of acute or chronic pancreatitis. However, due to the rare occurrence of these entities in children, the knowledge about evolution and management of pancreatic cysts in paediatric patients is still very low. Aim. To evaluate the management of pancreatic cysts in paediatric population. Material and methods. Clinical data of 57 children with pancreatic cyst treated in a 10-year period were reviewed comprehensively: 13 with posttraumatic pancreatic pseudocyst, 13 with pancreatic cyst in the course of acute pancreatitis (AP) of other than traumatic etiology, 22 with pseudocysts as a complication of chronic pancreatitis (CP) and 9 patients with cysts of different etiology. The relationship between the etiological factor, treatment method and clinical outcome of the patients was analyzed. Results. Among 26 paediatric patients with pancreatic cysts in the course of AP, both posttraumatic or not, 5 children (19.2%) were managed by conservative methods (antibiotics, nutritional therapy). Ten children (38.5%) underwent endoscopic treatment. Pseudocysts resolved after endoscopic cystogastrostomy or endoscopic retrograde cholangiopancreatography (ERCP) in 7 children (70%). There were no ERCP-related complications. Seventeen patients (65.4%) were treated by surgical drainage or resection. In 3 patients serious complications occurred, requiring relaparotomy or blood transfusion. Fifteen children (88.2%) after surgery had clinical and radiologic resolution of their cysts. Since 2007, 22 of 215 children (10.7%) with CP were diagnosed with pancreatic pseudocyst. Twelve patients (52.2%) were treated by observation. Ten children (45.5%) underwent endoscopic cystogastrostomy or pancreatic duct stenting. Eight children after endoscopic treatment had clinical and radiologic resolution of their PP. Five patients (22.7%) were treated surgically. PP resolved after operation in all cases. There were no complications or failures related to surgical procedures. Some patients fell into more than one category. Conclusions. 1. Endoscopic or surgical drainage of pancreatic cysts in children is a safe and effective procedure. 2. Asymptomatic cysts can be managed by a period of observation.

Management of pancreatic cysts in children

It is known that certain patients with very early onset IBD (diagnosis before 6 years of age) have a higher possibility of immune deficiency with monogenetic aetiology. The growing prevalence of these types of disorders forces the gastroenterologist to gain some knowledge about the symptoms and further diagnostic management, which includes consultation with the clinical immunologist. The resemblance of the clinical manifestation of early-onset Crohn's disease with ulcerative colitis and high incidence rate of unclassified IBD suggests caution in IBD diagnosis in younger patients.

Nieswoista choroba zapalna jelit o wczesnym i bardzo wczesnym początku

Deleted in malignant brain tumours 1 protein (DMBT1) and surfactant protein D (SFTPD) are antimicrobial peptides previously linked to inflammatory bowel disease (IBD) susceptibility. This study attempts to link the most potential IBD-associated polymorphisms in DMBT1 and SFTPD with the disease severity in children. A total of 406 IBD patients (Crohn’s disease (CD) n = 214 and ulcerative colitis (UC) n = 192) were genotyped using hydrolysis probe assay. Clinical expression was described by disease activity scales, albumin and C-reactive protein levels, localisation and behaviour (Paris classification), systemic steroid, immunosuppressive, biological, and surgical treatment, number of exacerbation-caused hospitalisations, relapses and nutritional status. IBD patients with the risk genotype (AA) in DMBT1 rs2981804 had more frequent biological treatment (AA: vs. AG/GG; p = 0.012), concomitant diseases (AA vs. AG vs. GG; p = 0.015) and cutaneous manifestations (AA vs. AG/GG, p = 0.008). In UC, rs2981804 genotypes might be linked with albumin concentrations at diagnosis (AA vs. AG vs. GG; p = 0.009). In CD, DMBT1 rs2981745 was significantly associated with the number of severe relapses per year of disease (p = 0.020) and time-to-immunosuppression (p = 0.045). SFTPD was seemingly found to be associated with age at first immunosuppression in IBD (CC vs. CT vs. TT; p = 0.048). In conclusion, selected polymorphisms of DMBT1 and SFTPD might be associated with some disease severity measures in children with IBD. However, the magnitude of associations and their clinical relevance might be minor.

Jarosław Kierkuś

Papers

Endoscopic retrograde cholangiopancreatography (ERCP) in children with pancreatic diseases

Czy mikroskopowe zapalenie jelita grubego należy do nieswoistych chorób zapalnych jelit

Management of pancreatic cysts in children

Nieswoista choroba zapalna jelit o wczesnym i bardzo wczesnym początku

Genetic Variants of DMBT1 and SFTPD and Disease Severity in Paediatric Inflammatory Bowel Disease-A Polish Population-Based Study.