Promising role of D-amino acids in irritable bowel syndrome

Irritable bowel syndrome (IBS) is an important health care concern. Alterations in the microbiota of the gut-brain axis may be linked to the pathophysiology of IBS. Some dietary intake could contribute to produce various metabolites including D-amino acids by the fermentation by the gut microbiota. D-amino acids are the enantiomeric counterparts of L-amino acids, in general, which could play key roles in cellular physiological processes against various oxidative stresses. Therefore, the presence of D-amino acids has been shown to be linked to the protection of several organs in the body. In particular, the gut microbiota could play significant roles in the stability of emotion via the action of D-amino acids. Here, we would like to shed light on the roles of D-amino acids, which could be used for the treatment of IBS.     

Colitis following the use of immune checkpoint inhibitors: A real-world analysis of spontaneous reports submitted to the FDA adverse event reporting system

BackgroundAlthough colitis has been reported in patients treated with immune checkpoint inhibitors (ICIs), associations between colitis and ICIs had not been thoroughly assessed in real-world studies. Here, we identified and characterized significant colitis-associated with ICIs.MethodsBased on the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to December 2019, the disproportionality analysis and Bayesian analysis, including the reporting odds ratio (ROR), the proportional reporting ratio (PRR), the Bayesian confidence propagation neural network (BCPNN) and the multi-item gamma Poisson shrinker (MGPS) algorithms were adopted to data mining of the suspected adverse events of colitis after ICIs administrating. Clinical characteristics of patients with ICIs-associated colitis and the time to onset of colitis following different ICI regimens were collected.ResultsA total of 3786 reports of colitis adverse events were identified with ICIs. Seven ICI monotherapies were associated with the reporting of colitis. Statistically significant ROR, PRR, information component (IC), and empirical Bayesian geometric mean (EBGM) emerged for all ICI monotherapies and combination therapies. ICIs-associated colitis affected mostly male (53.51%), with a wide mean age range (60.65 to 72 years). Colitis adverse events were commonly reported in patients with melanoma and lung cancer. Adverse outcomes of colitis concerning ICI were mainly outcomes of hospitalization-initiated or prolonged and other serious. Among colitis cases, 17.43% cases of colitis concerning ICI lead to death. The adverse event of colitis occurred earliest in ipilimumab monotherapy with a median time to onset of 64.21 days (IQR: 27–69 days) among all monotherapies.ConclusionsICI may lead to severe and disabling ICIs-associated colitis during therapy. Analysis of FAERS data identified signals for adverse events of colitis with ICI regimens. Practitioners should consider the factors that may increase the likelihood of colitis. The findings support a continued surveillance and risk factor identification studies.     

Ultra-Low Anterior Resection with Coloanal Anastomosis for Recurrent Rectal Prolapse in a Young Woman with Colitis Cystica Profunda

This case demonstrates the successful treatment of a young female patient with colitis cystica profunda causing rectal prolapse, after primary treatment with a Delorme procedure had failed. An ultra-low anterior resection with a temporary defunctioning ileostomy was carried out with good postoperative results. This case illustrates the possibility of carrying out sphincter preserving surgery rather than an abdominoperineal resection in the treatment of this condition, which may be preferable for patients.     

A User’s Guide to De-escalating Immunomodulator and Biologic Therapy in Inflammatory Bowel Disease

De-escalation of immunomodulators and biologic agents in inflammatory bowel disease is frequently discussed with patients and must weigh the risk of continued medical therapy with the risk of disease recurrence. Risk factors for disease flare after withdrawal of inflammatory bowel disease medications such as disease activity at de-escalation, disease prognostic features, and prior course of disease have been identified predominately in retrospective studies, allowing for risk stratification of patients. This review evaluates the published literature regarding therapeutic de-escalation and provides a framework for physicians to apply this to clinical practice. Prospective trials are underway and planned, which should provide further insight into this treatment paradigm and better inform patient selection for this strategy.     

Rabdosia serra alleviates dextran sulfate sodium salt-induced colitis in mice through anti-inflammation,regulating Th17/Treg balance,maintaining intestinal barrier integrity,and modulating gut microbiota

Rabdosia serra (R. serra), an important component of Chinese herbal tea, has traditionally been used to treat hepatitis, jaundice, cholecystitis, and colitis. However, the chemical composition of R. serra and its effect against colitis remain unclear. In this study, the chemical composition of the water extract of R. serra was analyzed using ultra performance liquid chromatography coupled with a hybrid linear ion trap quadrupole-orbitrap mass spectrometer (UPLC-LTQ-Orbitrap-MS). A total of 46 compounds, comprising ent-kaurane diterpenoids, flavonoids, phenolic acids, and steroids, were identified in the water extract of R. serra, and the extract could significantly alleviate dextran sulfate sodium salt-induced colitis by improving colon length, upregulating anti-inflammatory factors, downregulating proinflammatory factors, and restoring the balance of T helper 17/T regulatory cells. R. serra also preserved intestinal barrier function by increasing the level of tight junction proteins (zonula occludens 1 and occludin) in mouse colonic tissue. In addition, R. serra modulated the gut microbiota composition by increasing bacterial richness and diversity, increasing the abundance of beneficial bacteria (Muribaculaceae, Bacteroides, Lactobacillus, and Prevotellaceae_UCG-001), and decreasing the abundance of pathogenic bacteria (Turicibacter, Eubacterium_fissicatena_group, and Eubacterium_xylanophilum_group). Gut microbiota depletion by antibiotics further confirmed that R. serra alleviated colitis in a microbiota-dependent manner. Overall, our findings provide chemical and biological evidence for the potential application of R. serra in the management of colitis.     

Enfermedades inflamatorias mediadas por inmunidad en pacientes con enfermedad inflamatoria intestinal. Datos basales del estudio Aquiles

Objective

To determine the prevalence of immune-mediated inflammatory diseases (IMID) in a cohort of patients with inflammatory bowel disease (IBD) enrolled in hospital gastroenterology outpatients units for the AQUILES study, a prospective 2-year follow-up study.

Material and methods

We included patients ≥ 18 years old with a prior or new diagnosis of IBD (Crohn disease [CD], ulcerative colitis [UC] or indeterminate colitis). Diagnoses were collected in a cross-sectional manner from the clinical records at enrollment of a new patient in the study.

Results

We included 526 patients (mean age 40.2 years; 47.3% men, 52.7% women), 300 with CD (57.0%), 218 with UC (41.4%) and 8 with indeterminate colitis. Other types of IMID were present in 71 patients (prevalence: 13.5%, 95% CI: 10.8-16.7): 47 were spondyloarthropathies (prevalence: 8.9%); 18 psoriasis (3.4%); 5 pyoderma gangrenosum (1.0%), and 11 uveitis (2.1%). The prevalence of IMID was higher in patients with CD than in those with UC (17.0% [95% CI: 13.2-21.7] vs 9.2% [95% CI: 6.0-13.8], p = 0.011). In the multivariate analysis, the variables associated with the presence of IMID were diagnosis of CD (OR = 1.8 [95% CI: 1.1-3.2]) and duration of IBD ≥ 4 years (OR = 2.1 [95% CI: 1.1-4.1] in those with disease duration 4-8 years, and OR = 2.1 [95% CI: 1.2-3.9] in those with ≥ 8 years vs. < 4 years).

Conclusions

In the cohort of patients with IBD in the AQUILES study, 13.5% had another IMID, with a higher prevalence in patients with CD and > 4 years since disease onset.     

炎症性肠病患者病耻感体验的质性研究

目的探索炎症性肠病患者的病耻感体验,揭示患者的病耻感经历及其影响因素,为医护人员开展针对性心理护理提供理论依据。方法采用目的抽样法,选取2017年3月—2019年7月在浙江省3家三级甲等医院消化内科门诊就诊和病房住院的16例炎症性肠病患者为研究对象,采用描述性质性研究的方法,对患者进行面对面半结构式访谈,运用传统内容分析法分析资料。结果分析得出炎症性肠病患者病耻感体验的4个主题,分别为感知病耻感、实际病耻感、内化病耻感及影响病耻感产生的因素。结论受疾病、治疗、自身心理状态及社会风俗文化等因素的影响,多数炎症性肠病患者确诊疾病后存在病耻感体验,但其具体表现形式及程度存在差异。医护人员应在了解患者病耻感体验的基础上,提供个体化的照护,并给予可行的病耻感应对策略。     

环胞菌素A治疗溃疡性结肠炎的临床分析

目的：环胞菌素A(CsA)对于激素治疗无效而以往只有选择手术处理的重度溃疡性结肠炎患者是一种很有希望的治疗手段。我院对CsA治疗重症溃疡性结肠炎进行了有益的尝试。方法：分析我院1998—2002年收治的溃疡性结肠炎病人中，应用激素治疗无效而改用CsA治疗的患者的临床资料。结果：5例重症溃疡性结肠炎患者静脉激素治疗无效，接受了口服或静脉CsA治疗，避免了结肠切除术，有效率为100％。5例均未发生药物副作用。结论：CsA用以治疗激素无效的重症溃疡性结肠炎病人具有很好疗效。在对药物副作用密切监控下使用本治疗方案是激素无效的重症溃疡性结肠炎病人的一种最佳选择。     

美沙拉嗪与柳氮磺吡啶治疗溃疡性结肠炎的效果比较

目的：比较美沙拉嗪与柳氮磺吡啶治疗溃疡性结肠炎的效果。方法选取安达市医院2012年8月—2014年8月收治的76例溃疡性结肠炎患者,根据入院顺序分为治疗组与对照组,每组38例。治疗组采用美沙拉嗪治疗,对照组采用柳氮磺吡啶治疗,比较两组的临床效果及不良反应发生情况。结果治疗组的总有效率高于对照组,不良反应发生率低于对照组,差异有统计学意义（ P﹤0.05）。结论美沙拉嗪治疗溃疡性结肠炎的效果优于柳氮磺吡啶,且不良反应少。     

原发性硬化性胆管炎27例临床病理特点分析

目的 总结原发性硬化性胆管炎(PSC)的临床病理特点,提高临床医师对该病的认识.方法 回顾性分析27例PSC患者的临床资料并随访患者当前情况.临床资料主要包括各项肝功能指标、自身抗体及免疫球蛋白,影像学及病理学检查结果将PSC患者分为大胆管型或小胆管型;治疗措施包括药物、内镜及手术治疗,治疗3～6个月后,ALT≤1.5倍、Tbil≤2倍、ALP≤2.5倍正常上限为有效.大胆管型PSC与小胆管型PSC的疗效比较采用非参数检验CMH法,P＜0.05为差异有统计学意义.结果 27例PSC患者中,男性7例,女性20例,平均年龄47.6岁.大胆管型PSC 18例,小胆管型PSC 9例.主要临床表现为黄疸(85.2%)、瘙痒(48.1%)、乏力(68.4%)、腹痛(40.7%)及发热(14.8%);常见体征包括:肝大(44.4%)、脾大(48.1%)、腹水(14.8%)等;胆红素升高10倍以上者占30.8%,IgG异常率81.8%、抗核抗体阳性率69.6%、抗中性粒细胞胞浆抗体阳性率52.9%;合并溃疡性结肠炎者占22.2%,干燥综合征患者占22.2%.经药物、内镜或手术治疗后,部分病例病情缓解,3例死亡;小胆管型PSC的疗效优于大胆管型PSC(66.7%比33.3%,x2=4.173,P=0.041).结论 本组少数PSC患者合并溃疡性结肠炎.小胆管型PSC治疗效果优于大胆管型PSC,提示早期诊治的必要性.