Showing papers in "Digestion in 2017"
TL;DR: FMT for patients with IBS is safe, and relatively effective, and Bifidobacterium-rich fecal donor may be a positive predictor for successful FMT, which showed that FMT improved stool form and psychological status of IBS patients.
Abstract: Background/Aims: Dysbiosis is associated with various systemic disorders including irritable bowel syndrome (IBS). Fecal microbiota transplantation (FMT) might re
172 citations
TL;DR: The present findings suggest that adequate endoscopic treatment strategy for NASDTs can lead to favorable outcomes and an excellent prognosis, and it is necessary to select EMR or ESD adequately for R0 resection of small NAS DTs, according to their size and location.
Abstract: Background: Endoscopic submucosal resection (ESD) and endoscopic mucosal resection (EMR) are well established as curable and safety procedures for treating superf
88 citations
TL;DR: Vonoprazan was effective for most patients with PPI-resistant RE and maintenance therapy with 10 mg VPZ prevented the relapse of esophageal mucosal breaks in 16 out of 21 patients.
Abstract: Background: Vonoprazan (VPZ) is a novel potassium-competitive acid blocker that may be clinically beneficial for proton pump inhibitor (PPI)-resistant reflux esophagitis (RE). The aim of this study was to investigate the efficacies of VPZ therapy at 20 mg for 4 weeks in patients with PPI-resistant RE and VPZ maintenance therapy at 10 mg for 8 weeks in patients who have been successfully treated. Methods: Subjects comprised 24 patients with PPI-resistant RE (Los Angeles classification grade A/B/C/D: 3/7/11/3). After confirming PPI-resistant RE by endoscopy, 20 mg VPZ was administered. Endoscopy was performed 4 weeks after the initiation of VPZ. Symptoms were evaluated using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). Maintenance therapy with 10 mg VPZ was performed and endoscopy was conducted after 8 weeks. Results: In 21 (87.5%) out of 24 patients, esophageal mucosal breaks were successfully treated by 20 mg VPZ. The median FSSG score was significantly lower on days 1-7, 14, and 28 after the initiation of VPZ than before its administration. Maintenance therapy with 10 mg VPZ prevented the relapse of esophageal mucosal breaks in 16 (76.2%) out of 21 patients. Conclusion: VPZ was effective for most patients with PPI-resistant RE.
76 citations
TL;DR: Intestinal microbiota plays a key role in NSAID-induced small intestinal damage, and modulating the composition of the intestinal microbiota could be a new therapeutic strategy for treating this damage.
Abstract: Background: Non-steroidal anti-inflammatory drugs (NSAIDs) damage the small intestine by causing multiple erosions and ulcers. However, to date, no established th
67 citations
TL;DR: Investigation of changes in colorectal motility, structure, and microbiota in response to stress due to maternal separation and corticotropin-releasing hormone (CRH) administration in rats foundstress due to MS altered the gut microbiota composition.
Abstract: Background: Irritable bowel syndrome (IBS) causes chronic abdominal pain and abnormal bowel movements. The etiology involves complicated interactions among viscer
60 citations
TL;DR: In NEN G3, the distinction between NET G3 and NEC G3 is clinically and prognostically meaningful, and platinum-based chemotherapy remains the recommended first-line treatment in metastasized NEC patients.
Abstract: Background: According to the latest WHO classification, neuroendocrine neoplasm (NEN) G3 of the gastrointestinal tract is defined by a proliferation index Ki67 ab
56 citations
TL;DR: L. gasseri OLL2716 has beneficial effects on FD without H. pylori involvement, compared to that in the placebo group, and the impressions regarding the overall effect on gastric symptoms were more positive in the L. glassi Oll2716 group.
Abstract: Background/Aims: Probiotics appear to improve Helicobacter pylori-associated dyspepsia via an inhibitory effect on H. pylori; however, uncertainty exists regarding their effects in H. pylori-uninfected individuals. We evaluated the efficacy of Lactobacillus gasseri OLL2716 (L. gasseri OLL2716) on H. pylori-uninfected individuals with functional dyspepsia (FD). Methods: A double-blind, parallel-group, placebo-controlled, randomized, controlled trial was performed. Participants were randomly assigned to ingest L. gasseri OLL2716-containing yogurt (L. gasseri OLL2716 group) or L. gasseri OLL2716-free yogurt (placebo group) for 12 weeks. Participants completed questionnaires that dealt with a global assessment as well as symptom severity. The per-protocol (PP) population was evaluated for efficacy in accordance with a plan prepared beforehand. Results: Randomization was performed on 116 individuals; the PP population consisted of 106 individuals (mean age 42.8 ± 9.0). The impressions regarding the overall effect on gastric symptoms were more positive in the L. gasseri OLL2716 group compared to that in the placebo group (statistical trend; p = 0.073). The elimination rate for major FD symptoms was 17.3 and 35.3% in the placebo and L. gasseri OLL2716 groups respectively (p = 0.048). Conclusion:L. gasseri OLL2716 has beneficial effects on FD without H. pylori involvement.
54 citations
TL;DR: Anthocyanins prevented the formation and growth of colorectal cancer in AOM/DSS-treated Balb/c mice, suggesting that plant-derived anthocyanin-rich extract from bilberries have anti-inflammatory and chemopreventive properties.
Abstract: Background: Colorectal cancer is the main leading cause of cancer-related deaths worldwide. Present data suggest that plant-derived anthocyanins have anti-inflammatory and chemopreventive properties. This study was aimed at evaluating the effect of an anthocyanin-rich extract from bilberries on colorectal tumour development and growth in the administration of azoxymethan (AOM)/dextran sodium sulfate (DSS) mouse model. Methods: Colonic carcinogenesis was induced by AOM and DSS 3 or 5%, respectively, in 50 female Balb/c mice. Mice received either normal food (controls) or a diet containing either 10 or 1% anthocyanin-rich bilberry extract. Colonoscopy took place at week 4 and 9 after initiation of carcinogenesis. After termination at week 9, colon samples were analysed macroscopically and microscopically. Results: Mice receiving 10% anthocyanins showed significantly (p < 0.004) less reduced colon length (12.1 cm [8.5-14.4 cm]) as compared to controls (11.2 cm [9.8-12.3]) indicating less inflammation. Mice fed with 10% anthocyanin-rich extract revealed significantly less mean tumour numbers (n = 1.2) compared to control (n = 14) and anthocyanin 1% treated mice (n = 10.6, p < 0.001). Conclusion: Anthocyanins prevented the formation and growth of colorectal cancer in AOM/DSS-treated Balb/c mice. Further studies should investigate the mechanisms of how anthocyanins influence the development of colorectal cancer. (C) 2017 S. Karger AG, Basel.
47 citations
TL;DR: Faecal markers, in particular faecal calprotectin (FC), have given proof of being reliable markers of intestinal inflammation with good clinical sensitivity, and many clinicians are uncomfortable in dosing FC, due to its low specificity and the variability of cut-off values.
Abstract: Background: To make a distinction between organic and functional disease is essential for gastroenterologists in their daily practice, but it may be challenging, given the variety and aspecificity of gastrointestinal symptoms among the general population. The clinician aim is to avoid diagnostic delay and to restrict unnecessary invasive and expensive exams. Summary: Faecal markers, in particular faecal calprotectin (FC), have given proof of being reliable markers of intestinal inflammation with good clinical sensitivity. Calprotectin is useful in the differential diagnosis between inflammatory bowel disease and irritable bowel syndrome, as well as in the follow-up of inflammatory bowel disease patients and in predicting treatment response, with an excellent correlation with endoscopic activity. Its role in collagenous colitis and infectious colitis is less clear and still under investigation. Key Message: Despite the growing evidence supporting its use, many clinicians are uncomfortable in dosing FC, due to its low specificity and the variability of cut-off values. Indeed there are no clear guidelines about how to manage patients with intermediate levels of FC. The aim of this article is to review recent literature on calprotectin and its use. The strong points and the limits of FC measurement will be analysed, and a practical approach in the daily clinical routine will be proposed.
45 citations
TL;DR: Elevated salivary SP concentrations stimulated by capsaicin greatly improve the safety and efficacy of swallowing, and shorten the swallow response in older patients with OD.
Abstract: Background/Aims: The standard of care for older patients with oropharyngeal dysphagia (OD) is poor. Stimulation of transient receptor potential vanilloid 1 might
42 citations
TL;DR: RFA is currently the preferred treatment for patients with tumor burden restricted to the liver and not eligible for surgical resection, and sorafenib remains the first-line systemic treatment option after several large clinical trials have failed to show superiority of other molecular targeted therapies in HCC patients.
Abstract: Background: Hepatocellular carcinoma (HCC) is an aggressive liver tumor with a poor 5-year survival rate. Many HCCs are not amenable to surgical resection, becaus
TL;DR: The standard values of 13C-acetate breath test should be modified bearing the gender difference in mind to understand the mechanisms of functional dyspepsia.
Abstract: Background and Aim: Delayed gastric emptying is one of the reasons why functional dyspepsia (FD) occurs. The 13 C-acetate breath test is widely used to evaluate gastric emptying. Nevertheless, the standard value of 13 C-acetate breath test has not taken into account the gender difference of gastric emptying among healthy individuals. The main aim of this study was to readjust the standard value of 13 C-acetate breath test in the light of gender differences. In addition, we clarified the prevalence and clinical characteristics of delayed gastric emptying in patients with FD using the modified standard values of 13 C-acetate breath test. Methods: Fifty-two healthy individuals and 126 patients with patients with FD were enrolled. Gastric emptying was evaluated by the 13 C-acetate breath test. The cut-off points of T max for the diagnosis of delayed gastric emptying were determined on the basis of results from healthy individuals making a distinction of genders. Gastroesophageal reflux symptoms, dyspeptic symptoms, scores of anxiety and depression, age, body mass index (BMI), smoking and alcohol consumption were compared between the delayed gastric emptying group and the non-delayed gastric emptying group. Results: Since gastric emptying was delayed in healthy women compared with that in healthy men (T max , 53.6 ± 19.3 vs. 42.7 ± 16.9 min, p = 0.04), we set the cut-off points of T max at 60 min in men and at 75 min in women. In patients with FD, the prevalence of delayed gastric emptying was not different between men and women with the modified standard values of 13 C-acetate breath test. (31.0 vs. 27.4%, p = 0.68). BMI was lower in the delayed gastric emptying group than in the non-delayed group among the male patients. Reflux symptoms were more severe in delayed gastric emptying group than in the non-delayed group among the female patients. Conclusion: The standard values of 13 C-acetate breath test should be modified bearing the gender difference in mind. It provides us more appropriate information to understand the mechanisms of FD.
TL;DR: H2RAs and PPIs were associated with a modestly increased risk of IBD-related hospitalization or surgery.
Abstract: Background: The intestinal microbiota may influence inflammatory bowel disease (IBD) activity. Histamine 2 receptor antagonists (H2RAs) and proton pump inhibitors
TL;DR: Vonoprazan may be a better therapy for the treatment of patients with PPI-refractory RE after acid clearance time and the total number of reflux events, including acid and proximal reflux Events, were significantly reduced.
Abstract: Background/Aim: The effects of vonoprazan and proton pump inhibitors (PPIs) in patients with reflux esophagitis (RE) have not yet been compared using multichannel
TL;DR: It is found that LG may be useful in reducing aspirin-induced small bowel injuries and in mitigating gastrointestinal symptoms and the FSSG and GSRS scores were significantly improved in the LG group but not in the placebo group.
Abstract: Background: Although there is evidence about the beneficial effects of probiotics, their effects on aspirin-induced small bowel injuries have not been well examin
TL;DR: M-BLI and M- BLI-bright provided excellent visualization of microstructures and microvessels similar to M-NBI, and irregular MSP in a moderately differentiated adenocarcinoma might be frequently visualized using M-BLi and M -BLi-bright compared with using M -NBI.
Abstract: Background/Aims: The diagnostic efficacy of magnifying blue laser imaging (M-BLI) and M-BLI in bright mode (M-BLI-bright) in the identification of early gastric c
TL;DR: The classification of subtypes based on high-resolution manometry will help to consider which treatment option can be selected as a first-line treatment depending upon the subtypes of disorders of EGJOO.
Abstract: Background: Based on Chicago Classification version 3.0, the disorders of esophagogastric junction outflow obstruction (EGJOO) include achalasia (types I, II and
TL;DR: Careful clinical monitoring is required in individuals with AIP to exclude the occurrence of malignancy and the overall incidence rate of malignant diseases in these patients was significantly increased compared to the expected incidence in the German population.
Abstract: Background/Aims: Autoimmune pancreatitis (AIP) has been associated with an increased risk of malignant diseases. We aimed to describe the incidence of malignant d
TL;DR: After the fifth year following eradication, early-stage gastric cancer sufferers should be alert to the incidence of EGC, irrespective of the severity of mucosal atrophic change.
Abstract: Background/Aims: Early-stage gastric cancer (EGC) is detected even after successful Helicobacter pylori eradication. This study is aimed at clarifying the clinicopathological characteristics of EGC detected after successful H. pylori eradication. Methods: This retrospective study analyzed 57 cases of EGC detected after successful H. pylori eradication and resected endoscopically at Kyoto Prefectural University of Medicine, between January 2009 and June 2014. Clinicopathological findings of 57 cases (H. pylori-eradicated group) were investigated, and compared with those in active H. pylori infection resected in the same period (H. pylori-positive group). Results: Most EGCs were detected in patients with severe atrophic mucosa, both in H. pylori-eradicated and H. pylori-positive groups, while the percentage of EGC detected in patients with mild atrophic mucosa gradually increased over time from successful eradication (H. pylori-positive: 7%, up to the fourth year since eradication: 11%, after the fifth year since eradication: 32%). The percentage of EGC detected in patients with mild atrophic mucosa after the fifth year since eradication was significantly higher than that in patients with active H. pylori infection (p = 0.004). Conclusion: After the fifth year following eradication, we should be alert to the incidence of EGC, irrespective of the severity of mucosal atrophic change.
TL;DR: This is the first study to demonstrate the risk factors of metastasis in NAD-NETs ≤20 mm in diameter and these findings may be helpful for determining the appropriate therapeutic approach and the clinical strategy of treatment following ER.
Abstract: Background/Aims: The treatment strategy for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤20 mm in diameter has not been established. In this study, we
TL;DR: Vonoprazan treatment might be appropriate as a promising new strategy for PPI-refractory GERD and co-existing functional dyspepsia, sleep disturbances, and alcohol abstinence were significantly associated with P-CAB non-response.
Abstract: Background/Aims: Approximately 20-40% of patients with gastroesophageal reflux disease (GERD) are refractory to proton pump inhibitor (PPI) treatment. The acid-in
TL;DR: The prevalence rate of AiP may account for 9% of patients with nonalcoholic pancreatitis but is almost never observed in patients with alcoholic pancreatitis, and the incidence in Germany appears lower than 1 per 100,000 population.
Abstract: BACKGROUND/AIMS The prevalence and incidence of autoimmune pancreatitis (AiP) in those living in western countries are largely unknown. We aimed to determine the prevalence of AiP among patients with pancreatitis presenting to our tertiary referral center in Mannheim, Germany; and to estimate the incidence of AiP in the Southwest of Germany. METHODS We performed a retrospective cross-sectional analysis and determined the prevalence of AiP in patients with acute pancreatitis (AP) or chronic pancreatitis (CP). Patients (n = 704; alcoholic pancreatitis n = 373, nonalcoholic pancreatitis n = 331) were stratified into the Retrospective-Pancreas-Cohort (RPC, period 1998-2008, n = 534) and the Pancreas-Clinic-Cohort (PCC, periods 2008-2010 and 2013-2014, n = 170, with detailed investigation for features of AiP). Diagnosis of AiP was established by International-Consensus-Diagnostic-Criteria and Unifying-Autoimmune-Pancreatitis-Criteria. RESULTS In the RPC, the prevalence of AiP was 5.9% (n = 13/221) among individuals with nonalcoholic pancreatitis (n = 1/61 with AP, 1.6%; n = 12/160 with CP, 7.5%). In the PCC, the prevalence of AiP was 9.1% (n = 10/110) among patients with nonalcoholic pancreatitis (n = 2/24 with AP, 8.3%; n = 8/86 with CP, 9.3%), and 1.7% (n = 1/60) among subjects with alcoholic pancreatitis. We estimated the incidence of AiP with 0.29 per 100,000 population each year. CONCLUSION The prevalence rate of AiP may account for 9% of patients with nonalcoholic pancreatitis but is almost never observed in patients with alcoholic pancreatitis. The incidence of AiP in Germany appears lower than 1 per 100,000 population.
TL;DR: The publication of 3 large single-center retrospective studies on streptozocin-(STZ)-based chemotherapy in advanced PNETs in 2015 confirmed the effectiveness of this treatment as described in previously reported trials and strongly supported the value of the Ki-67 index as a robust prognostic marker.
Abstract: Background: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms accounting for less than 5% of all pancreatic malignancies. These tumors are characterized by clinical and prognostical heterogeneity and are predominantly diagnosed in a metastatic stage. Cytotoxic chemotherapy, along with alkylating agents and antimetabolites as well as molecular targeted agents (everolimus, sunitinib), is used in the treatment of advanced PNETs. After the approval of lanreotide for unresectable PNETs, an additional therapeutic option has become available; however, the best sequence of therapies and patient stratification to different treatments remains challenging. Furthermore, no randomized phase-3 trials or head-to-head comparisons are available to support treatment decisions. Summary: The publication of 3 large single-center retrospective studies on streptozocin-(STZ)-based chemotherapy in advanced PNETs in 2015 confirmed the effectiveness of this treatment as described in previously reported trials. All studies investigated markers for progression-free and overall survival and strongly supported the value of the Ki-67 index as a robust prognostic marker. Interestingly, chemotherapy consistently displayed antitumor efficacy in different therapeutic lines. Moreover, a recent study of dacarbazine (DTIC) in a cohort of patients predominantly with PNETs demonstrated that a once monthly infusional DTIC schedule was well tolerated and yielded similar response rates (RR) as STZ-based schedules. Given the overall good tolerability of a monthly infusion and RR similar to STZ schedules, DTIC thus represents a feasible alternative or additional treatment option for PNETs. In this article, we review the current standard and summarize the most recent advances in the field of cytotoxic chemotherapy for PNET patients. Key Messages: (1) Despite the lack of phase3 trials, cytotoxic chemotherapy offers efficacy for patients with advanced PNETs; (2) the best therapeutic option and sequence remain open since comparable randomized studies are lacking; (3) careful patient selection and treatment stratification may increase overall outcome; and (4) currently, no biomarkers for clinical routine exist to predict response to chemotherapy.
TL;DR: This pilot study shows the possibility that HCV eradication by SOF/LED was accompanied by an improvement of glucose metabolism in the population with or without diabetes, and suggests further investigation.
Abstract: Background/Aims: Direct-acting antiviral agents (DAAs) have increased the sustained viral response rate with minimal adverse effects and short treatment duration. In addition, recent data suggest the possibility that hepatitis C virus (HCV) clearance results in rapid improvement in metabolic pathways. The aim of the present study was to evaluate whether the DAA treatment without ribavirin lowers hemoglobin A1c (HbA1c) at 12 weeks after therapy completion. Methods: We performed an observational study to assess the effect of sofosbuvir and ledipasvir (SOF/LED) treatment on glycemic control. We compared HbA1c levels before and after treatment with SOF/LED, considering that anemia is not a side effect of these drugs. Results: In the 36 patients with HCV eradication, HbA1c levels decreased significantly after treatment (pre-treatment 5.85% vs. post-treatment 5.65%, p < 0.01). Conclusion: This pilot study shows the possibility that HCV eradication by SOF/LED was accompanied by an improvement of glucose metabolism in the population with or without diabetes, and suggests further investigation.
TL;DR: The current standard for perioperative or neoadjuvant approaches for esophageal cancer is reviewed and the most recent and encouraging therapeutic advances in esophagal cancer are summarized.
Abstract: Background: Esophageal cancer represents a heterogeneous malignancy mostly diagnosed in advanced stages. Worldwide, squamous cell carcinomas (SCCs) continue to be
TL;DR: Endoscopic atrophy was examined and the relationship with the ABC classification system was investigated and a new titer cut-off of the Hp-Ab improved the discrimination of group A with CAG by 8%.
Abstract: Backgrounds and Aims: The serological risk-prediction system combined the pepsinogen (PG) test, and anti-Helicobacter pylori antibody is available for evaluation of gastric cancer risk In this system, chronic atrophic gastritis (CAG) or H pylori infection is diagnosed Subjects with H pylori negative and PG test negative (group A) are supposed to be those who have never been infected with H pylori and are at extremely low risk for gastric cancer However, a certain proportion of patients with CAG has been identified as the extremely low-risk group (group A) Here we examined endoscopic atrophy and investigated its relationship with the ABC classification system Methods: We examined 540 patients All patients underwent an endoscopic examination for evaluating corpus atrophy Fasting sera were collected and serum PGs and anti-H pylori antibody (Hp-Ab) titer (E-plate Eiken) were evaluated Results: Of the 540 patients, 306 were classified into group A However, 136 of them showed signs of endoscopic atrophy (group A with CAG) Group A with CAG frequently comprised the elderly A new titer cut-off (<3 U/mL) of the Hp-Ab improved the discrimination of group A with CAG by 8% Conclusion: The prevalence of group A with CAG patients is a critical problem, especially in elderly subjects
TL;DR: Gastric NHPH infection was found to be the highest in patients with gastric MALT lymphoma and duodenal ulcer, the former being independent of co-infection with H. pylori and the latter being dependent.
Abstract: Background: Non- Helicobacter pylori -helicobacters (NHPH) compose a group of gram negative zoonotic bacteria that may induce in humans gastric d
TL;DR: Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding.
Abstract: Background Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. Methods From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of 500,000 yen). Results Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. Conclusion Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding.
TL;DR: This study provides a clinical model to detect the presence of CMV infection in patients hospitalized with UC exacerbation, which could direct proper investigation and facilitate timely empirical therapy.
Abstract: Background/Aims: The role of cytomegalovirus (CMV) reactivation during exacerbations of ulcerative colitis (UC) is yet a matter of debate, and assessment of CMV infection in UC patients remains an ongoing challenge. We aimed to identify associated parameters and compare detection methods for CMV infection during UC exacerbation. Methods: Clinical, pathological and virological parameters were retrospectively analyzed in all patients hospitalized in our institution for UC exacerbation between January 2009 and April 2015, who underwent full evaluation for CMV infection in colonic tissue by histopathology, immunohistochemistry (IHC) and CMV-PCR. Results: Of 28 patients who underwent full examination for tissue CMV-infection, 13 (46.4%) were found to be positive for CMV. Tissue CMV-PCR was more sensitive for the detection of CMV infection than histopathology and IHC. CMV-positive patients had a statistically higher frequency of recent steroid treatment and fever, with higher mean partial Mayo scores and lower mean albumin levels. There were no significant differences between CMV-positive and CMV-negative patients in terms of age, severity of colitis and disease duration. In a multivariable model, only recent steroid treatment and fever were independently associated with colonic CMV infection. Conclusions: This study provides a clinical model to detect the presence of CMV infection in patients hospitalized with UC exacerbation, which could direct proper investigation and facilitate timely empirical therapy
TL;DR: It is suggested that randomized trials are required to establish whether a change in therapeutic paradigm, that is, targeting gram-positive bacteria with nonabsorbable antibiotics, may have therapeutic benefits in patients with IBD.
Abstract: Background: The pathogenesis of inflammatory bowel disease (IBD) is complex and involves the contribution of genetic and environmental factors. Many patients with very early onset IBD are difficult to treat. The current antibiotic medication that targets gram-negative and anaerobic bacteria provides only moderate efficacy in subsets of patients with IBD. Methods: We report a case series of 5 children with a mean age of 1.6 years (range 6 months to 2.7 years) during IBD onset, who were previously refractory to standard treatments and who received oral vancomycin with or without gentamicin. Results: Four out of 5 children demonstrated substantial therapeutic effect, and the effect was sustained in 3 children over a follow-up period of 12-33 months. Conclusion: Our findings are consistent with model systems and suggest that randomized trials are required to establish whether a change in therapeutic paradigm, that is, targeting gram-positive bacteria with nonabsorbable antibiotics, may have therapeutic benefits.