Ulcerative colitis (UC) is a chronic inflammatory disease, whose etiology is still unclear.Its pathogenesis involves an interaction between genetic factors, immune response and the "forgotten organ", Gut Microbiota.Several studies have been conducted to assess the role of antibiotics and probiotics as additional or alternative therapies for Ulcerative Colitis.Escherichia coli Nissle (EcN) is a nonpathogenic Gram-negative strain isolated in 1917 by Alfred Nissle and it is the active component of microbial drug Mutaflor ® (Ardeypharm GmbH, Herdecke, Germany and EcN, Cadigroup, In Italy) used in many gastrointestinal disorder including diarrhea, uncomplicated diverticular disease and UC.It is the only probiotic recommended in ECCO guidelines as effective alternative to mesalazine in maintenance of remission in UC patients.In this review we propose an update on the role of EcN 1917 in maintenance of remission in UC patients, including data about efficacy and safety.Further studies may be helpful for this subject to further the full use of potential of EcN.
Breath tests are non-invasive, non-radioactive, safe, simple and effective tests able to determine significant metabolic alterations due to specific diseases or lack of specific enzymes. Carbon isotope (13)C, the stable-non radioactive isotope of carbon, is the most used substrate in breath testing, in which (13)C/(12)C ratio is measured and expressed as a delta value, a differences between readings and a fixed standard. (13)C/(12)C ratio is measured with isotope ratio mass spectrometry or non-dispersive isotope-selective infrared spectrometer and generally there is a good agreement between these techniques in the isotope ratio estimation. (13)C/(12)C ratio can be expressed as static measurement (like delta over baseline in urea breath test) or as dynamic measurement as percent dose recovery, but more dosages are necessary. (13)C Breath-tests are involved in many fields of interest within gastroenterology, such as detection of Helicobacter pylori infection, study of gastric emptying, assessment of liver and exocrine pancreatic functions, determination of oro-caecal transit time, evaluation of absorption and to a lesser extend detection of bacterial overgrowth. The use of every single test in a clinical setting is vary depending on accuracy and substrate costs. This review is meant to present (13)C the meaning of (13)C/(12)C ratio and static and dynamic measure and, finally, the instruments dedicated to its use in gastroenterology. A brief presentation of (13)C breath tests in gastroenterology is also provided.
Zollinger-Ellison syndrome is characterized by recurrent peptic ulcers and diarrhea that result from gastrin-secreting neuroendocrine tumors of the gastrointestinal tract; nevertheless, severe hypergastrinemia may also have alternative pathogenetic explanations.A 61-year-old woman of Caucasian origin presented with a history of epigastric pain and early satiety, severe hypergastrinemia (approximately 2000 pg/mL) and a neuroendocrine polyp in the corpus of her stomach. Chronic atrophic gastritis and intestinal metaplasia was present, but she denied use of acid suppressant drugs and the results of tests for Helicobacter pylori as well as gastric parietal cell and intrinsic factor antibodies were negative. She underwent a radical gastric tangential resection. Six months later, serum gastrin was still elevated despite lack of recurrence of tumor.The clinical picture was suggestive for a hypochlorhydria-related hypergastrinemia with subsequent development of a non-secreting carcinoid. We suggest a periodic endoscopic follow-up in patients with severe hypochlorhydria-related hypergastrinemia in order to earlier detect neuroendocrine polyps.
: Microplastics and nanoplastics (MNPs) are becoming an increasingly severe global problem due to their widespread distribution and complex impact on living organisms. Apart from their environmental impact, the effects of MNPs on living organisms have also continued to attract attention. The harmful impact of MNPs has been extensively documented in marine invertebrates and larger marine vertebrates like fish. However, the research on the toxicity of these particles on mammals is still limited, and their possible effects on humans are poorly understood. Considering that MNPs are commonly found in food or food packaging, humans are primarily exposed to them through ingestion. It would be valuable to investigate the potential harmful effects of these particles on gut health. This review focuses on recent research exploring the toxicological impacts of micro- and nanoplastics on the gut, as observed in human cell lines and mammalian models. Available data from various studies indicate that the accumulation of MNPs in mammalian models and human cells may result in adverse consequences, in terms of epithelial toxicity, immune toxicity, and disruption of gut microbiota. The paper also discusses the current research limitations and prospects in this field, aiming to provide a scientific basis and reference for further studies on the toxic mechanisms of micro- and nanoplastics.
Abstract Background Crohn's disease (CD) is a leading cause of short bowel syndrome (SBS) in adults, which can result in intestinal failure (IF) when intravenous nutritional or electrolyte supplementation is required. SBS is frequently associated with sarcopenia, characterized by loss of muscle mass and function, which adversely impacts quality of life and increases the risk of complications. This study aimed to evaluate differences in body composition and muscle strength among CD patients at varying risk levels for SBS. Methods We conducted a cross-sectional study involving consecutive CD outpatients. The participants were divided into two groups. Group A consisted of CD patients diagnosed with SBS and patients who had undergone two or more bowel resections, or a resection of more than 50 cm. Group B included patients who had never undergone surgery or those who had undergone a resection of less than 50 cm. Body composition was assessed using bioimpedance analysis (BIA), and muscle strength was measured via hand grip testing with a dynamometer, recording the best result of three attempts with the dominant hand. We administered food frequency questionnaire (FFQ) to assess eating habits. Statistical analyses, including t-tests or Mann-Whitney tests, were used as appropriate, with a significance threshold of p < 0.05. Results The study cohort included 150 patients (mean age 53 years [±19,2]; 24% female). Group A showed an average BMI of 23,7±4 kg/m2, whereas group B showed an average BMI of 24.6±5 kg/m2. Muscle strength measured between groups was reduced in group A showing significant differences in hand grip test compared to group B (p-value<0.001). However, no significant differences were observed in BIA parameters, including muscle mass, or in eating habits across the groups. Conclusion Our study revealed that SBS patients and CD patients resected two or more times or with a resection greater than 50 cm had reduced muscle strength without a corresponding reduction in muscle mass, indicating impaired muscle function. Further research is needed to better understand the relationship between Crohn's disease-related resections and their impact on both muscle quality and quantity. Funded by:2.1 "Rafforzamento e potenziamento della ricerca biomedica del SSN",finanziato dall’Unione europea–NextGenerationEU, CUP C53C22001140007. 2022 PNRR Project "Changing the future of intestinal failure in intestinal chronic inflammation:towards innovative predictive factors and therapeutic targets"code:PNRR-MAD-2022-12376791
Clostridioides difficile infection (CDI) and inflammatory bowel disease (IBD) are two pathologies that share a bidirectional causal nexus, as CDI is known to have an aggravating effect on IBD and IBD is a known risk factor for CDI. The colonic involvement in IBD not only renders the host more prone to an initial CDI development but also to further recurrences. Furthermore, IBD flares, which are predominantly set off by a CDI, not only create a need for therapy escalation but also prolong hospital stay. For these reasons, adequate and comprehensive management of CDI is of paramount importance in patients with IBD. Microbiological diagnosis, correct evaluation of clinical status, and consideration of different treatment options (from antibiotics and fecal microbiota transplantation to monoclonal antibodies) carry pivotal importance. Thus, the aim of this article is to review the risk factors, diagnosis, and management of CDI in patients with IBD.
