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.

Badanie rezonansu magnetycznego (MR) jest coraz częściej wykorzystywane w diagnostyce i dalszej kontroli pacjentów z nieswoistym zapaleniem jelit (IBD). Głównym wskazaniem do wykonania badania jest ocena zmian zapalnych w obrębie jelita cienkiego. Ma to znaczenie w różnicowaniu jednostek IBD, czyli wrzodziejącego zapalenia jelita grubego i choroby Crohna, jak i w ocenie stopnia zaawansowania choroby. MR może być przeprowadzone w dwóch formach – enterografii i enteroklizy. Obie metody różni sposób przygotowania jelita do badania, a mianowicie metoda podaży substancji kontrastującej, mającej za zadanie odpowiednie wypełnienie pętli jelita cienkiego. W enterografii rezonansu magnetycznego kontrast podawany jest doustnie. W przypadku enteroklizy MR kontrast podawany jest z użyciem sondy nosowo-jelitowej. Największymi zaletami badania są brak narażenia na promieniowanie jonizujące oraz wysoka czułość w uwidacznianiu zmian charakterystycznych dla IBD. Dzięki bezpiecznemu charakterowi badania, MR stopniowo zastępuje inne metody wykorzystujące promieniowanie jonizujące. Dużą zaletą MR jest możliwość uwidaczniania zmian pozajelitowych jak ropnie czy przetoki. Autorzy w poniższym artykule przedstawiają technikę badania wraz z opisem możliwych do uwidocznienia zmian charakterystycznych dla IBD.

Magnetic resonance technique in children with inflammatory bowel disease

Inflammatory bowel disease (IBD) is a term, which includes ulcerative colitis (UC) and Crohn’s disease (CD) – chronic inflammatory bowel diseases with unknown etiology. Disease is commonly thought to be caused by combination of immunological, genetic and environmental factors. Most often diagnosis of IBD is established among young, 15-29 years old people, but the age of diagnosis is systematically reduced. Treatment plan depends on phase of disease, symptoms intensity and patient age. The main type of treatment are enteral nutrition, pharmacological therapy and finally surgical intervention in case of insufficient response. Until now, in pediatric patients U.S. Food and Drug Administration (FDA) approved biologic agents, infliximab and adalimumab as CD treatment and infliximab only as UC treatment. Currently new biological agents are being studied as part of effective and safe IBD therapy in children. Particular attention is now given to vedolizumab which is already used and approved as part of IBD treatment algorithm in adults. Purpose of this article is to present two cases in which vedolizumab was used in CU as well as CD therapy in pediatric patients.

Vedolizumab therapy in pediatric inflammatory bowel disease – case report

Introduction. To successfully perform MR enterography technique the distention of the small bowel is necessary. However, there is no guidelines of bowel preparation. Aim. To detect efficacy in bowel distention of 3% sorbitol solution as contrast for MR enterography in children with IBD. Material and methods. 58 patients, who had magnetic resonance enterography, were included. Amount of 3% sorbitol solution for enterography depended on children’s age. The bowel preparation had been started 2 hours before examination. Children younger than 12y old were recommended to drink solution composed of 35 ml 3% sorbitol mixed in 200 ml water. Older drank 45 ml in 200 ml water and 50 ml in 200 ml water for 12-15y old and older than 15y old, respectively. After that in every 10-15 min they were drink water to fulfil small bowel. Results. 7/58 (12%) patients presented intolerance to sorbitol solution. 4 (6.9%) experienced vomiting, 3 (5.3%) had diarrhoea after contrast adjustment. As a result of severe vomiting in case of 1 patient MR was not performed and for another one study was stopped. Segmental, not sufficient small bowel distention were observed in 21.1% and in 17.5% cases MR showed lesions suggested inflammation which could be false positive results. There was found strong statistically significant correlation between these two variables. However, magnetic resonance enterography in 94.8% has shown good distention of terminal ileum. Conclusions. Generally, bowel preparation for magnetic resonance enterography was good tolerated. Ileum terminale was successfully evaluated in 94.8%. However, for 21.1% cases segmental insufficient small bowel distention was observed.

Efficacy of 3% sorbitol solution in preparation to magnetic resonance enterography in children with inflammatory bowel disease

Introduction. Gastrointestinal disorders are becoming more common for the pediatric population. Among them constipation are one of the most common problems in pediatric gastroenterology. Aim. The aim of the study was to assess the epidemiology of constipation in pediatric population. Material and methods. We conducted a retrospective analysis of consecutive visits in the pediatric outpatient gastroenterology clinic. Authors rated why patients reported to the clinic and what percentage of all visits concerned constipation. Then, an analysis of the most commonly reported symptoms among patients with constipation and the medical treatment were performed. Results. Total number of 1091 consecutive children reported on a visit to the outpatient clinic up to 2015 were enrolled to retrospective study. Patients aged between one month old up to 18 years old. Among them 400 (36.9%) patients signed up for a visit because of constipation. Mean age at the time of first visit was 5.46 years. Mean time from the onset of symptoms to the visit in outpatient clinic was 1.38 y. Less than 3 bowel movements per week occurred in 39.7% patients. The most commonly reported symptoms were: abdominal pain 61.6% and defecation with effort 66.7%. Retention of fecal masses felt during the abdominal palpation in 55.1%. There were several course of treatment, almost every patient were asked for using fiber-rich diet – 91.4%. Conclusions. Constipation is one of the most common gastrointestinal disorders in outpatient gastroenterology clinic. Abdominal pain and painful defecation are the most common symptoms of constipation in children.

Constipation in pediatric outpatient gastroenterology clinic – epidemiology and clinical presentation

Background Primary sclerosing cholangitis (PSC) and autoimmune sclerosing cholangitis (ASC) are often associated with ulcerative colitis (UC). The impact on the course of UC remains unclear, and up-to-date evidence in pediatric populations is scarce. The aim of the study was to analyze the course of UC in pediatric patients transplanted owing to PSC or ASC. Material and Methods We retrospectively reviewed data from children with PSC/ASC and UC who underwent orthotopic liver transplantation (OLT). In all patients UC diagnosis was based on clinical presentation, endoscopy, and histology. Results Seventeen patients (9 female) with PSC or ASC underwent OLT from deceased donors at a median age of 16.8 years (range = 11.5-18.2 years). In 15 patients, UC was diagnosed before OLT (median age of diagnosis = 10.6 years; range = 6.6-18.0 years), and 2 patients developed UC after OLT. Ten patients (59%) presented with pancolitis on initial endoscopy. Disease activity was severe in 9 patients (53%) and most patients improved after initial treatment with steroids. Before OLT only 2 patients (13%) had severe disease activity. After OLT, 4 patients developed flares of the disease. These patients were successfully treated and remained in remission at the end of the posttransplant follow-up period (median = 3.76 years; range = 0.4-15.5 years). None of the patients developed colorectal cancer or underwent colectomy during 3.7 years of post-OLT follow-up. Conclusion In our experience, the course of UC was not aggravated by OLT for PSC, and UC did not adversely affect patient or graft survival.

Jarosław Kierkuś

Papers

Magnetic resonance technique in children with inflammatory bowel disease

Vedolizumab therapy in pediatric inflammatory bowel disease – case report

Efficacy of 3% sorbitol solution in preparation to magnetic resonance enterography in children with inflammatory bowel disease

Constipation in pediatric outpatient gastroenterology clinic – epidemiology and clinical presentation

The Course of Ulcerative Colitis After Pediatric Liver Transplantation for Sclerosing Cholangitis.