Role of gut microbiota in Crohn’s disease pathogenesis:Insights from fecal microbiota transplantation in mouse model

BACKGROUND Inflammatory bowel disease,particularly Crohn’s disease(CD),has been associated with alterations in mesenteric adipose tissue(MAT)and the phenomenon termed“creeping fat”.Histopathological evaluations showed that MAT and intestinal tissues were significantly altered in patients with CD,with these tissues characterized by inflammation and fibrosis.AIM To evaluate the complex interplay among MAT,creeping fat,inflammation,and gut microbiota in CD.METHODS Intestinal tissue and MAT were collected from 12 patients with CD.Histological manifestations and protein expression levels were analyzed to determine lesion characteristics.Fecal samples were collected from five recently treated CD patients and five control subjects and transplanted into mice.The intestinal and mesenteric lesions in these mice,as well as their systemic inflammatory status,were assessed and compared in mice transplanted with fecal samples from CD patients and control subjects.RESULTS Pathological examination of MAT showed significant differences between CDaffected and unaffected colons,including significant differences in gut microbiota structure.Fetal microbiota transplantation(FMT)from clinically healthy donors into mice with 2,4,6-trinitrobenzene sulfonic acid(TNBS)-induced CD ameliorated CD symptoms,whereas FMT from CD patients into these mice exacerbated CD symptoms.Notably,FMT influenced intestinal permeability,barrier function,and levels of proinflammatory factors and adipokines.Furthermore,FMT from CD patients intensified fibrotic changes in the colon tissues of mice with TNBS-induced CD.CONCLUSION Gut microbiota play a critical role in the histopathology of CD.Targeting MAT and creeping fat may therefore have potential in the treatment of patients with CD.

Fecal microbiota transplantation:whole grain highland barley improves glucose metabolism by changing gut microbiota

Highland barley(HB)is a high-altitude cereal with rich nutritional components and potential health benefits.To clarify its hypoglycemic effect and mechanism,we investigated the effect of whole grain HB and fecal microbiota transplantation(FMT)on glucose metabolism and gut microbiota in high-fat diet and streptozotocin(HFD/STZ)-induced diabetic mice.The results showed that HB(40%)significantly decreased fasting blood glucose and the area under the glucose tolerance curve,significantly increased insulin secretion and improved insulin resistance in HFD/STZ-induced diabetic mice(P<0.05).Inflammatory factors and blood lipid indices were also significantly alleviated after 12 weeks of 40%HB intervention(P<0.05).Additionally,beneficial bacteria,such as Bifidobacterium and Akkermansia,were significantly enriched in the gut of diabetic mice after whole grain HB intervention.Meanwhile,the results of further FMT experiments verified that the fecal microbiota after the 40%HB intervention not only significantly increased the relative abundance of Bifidobacterium and Akkermansia but also effectively improved glucose metabolism and alleviated the inflammatory state in HFD/STZ-induced diabetic mice.Collectively,our study confirmed the bridge role of gut microbiota in improving glucose metabolism of whole grain HB,which could promote the development of precision nutrition.

Fecal calprotectin and endoscopic scores: The cornerstones in clinical practice for evaluating mucosal healing in inflammatory bowel disease

Managing inflammatory bowel disease(IBD)is becoming increasingly complex and personalized,considering the advent of new advanced therapies with distinct mechanisms of action.Achieving mucosal healing(MH)is a pivotal therapeutic goal in IBD management and can prevent IBD progression and reduce flares,hospitalization,surgery,intestinal damage,and colorectal cancer.Employing proactive disease and therapy assessment is essential to achieve better control of intestinal inflammation,even if subclinical,to alter the natural course of IBD.Periodic monitoring of fecal calprotectin(FC)levels and interval endoscopic evaluations are cornerstones for evaluating response/remission to advanced therapies targeting IBD,assessing MH,and detecting subclinical recurrence.Here,we comment on the article by Ishida et al Moreover,this editorial aimed to review the role of FC and endoscopic scores in predicting MH in patients with IBD.Furthermore,we intend to present some evidence on the role of these markers in future targets,such as histological and transmural healing.Additional prospective multicenter studies with a stricter MH criterion,standardized endoscopic and histopathological analyses,and virtual chromoscopy,potentially including artificial intelligence and other biomarkers,are desired.

Fecal microbiota transplantation for treatment of non-alcoholic fatty liver disease:Mechanism,clinical evidence,and prospect

The population of non-alcoholic fatty liver disease(NAFLD)patients along with relevant advanced liver disease is projected to continue growing,because currently no medications are approved for treatment.Fecal microbiota transplantation(FMT)is believed a novel and promising therapeutic approach based on the concept of the gut-liver axis in liver disease.There has been an increase in the number of pre-clinical and clinical studies evaluating FMT in NAFLD treatment,however,existing findings diverge on its effects.Herein,we briefly summarized the mechanism of FMT for NAFLD treatment,reviewed randomized controlled trials for evaluating its efficacy in NAFLD,and proposed the prospect of future trials on FMT.

Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions

Fecal microbiota transplantation(FMT)offers a potential treatment avenue for hepatic encephalopathy(HE)by leveraging beneficial bacterial displacement to restore a balanced gut microbiome.The prevalence of HE varies with liver disease severity and comorbidities.HE pathogenesis involves ammonia toxicity,gut-brain communication disruption,and inflammation.FMT aims to restore gut microbiota balance,addressing these factors.FMT's efficacy has been explored in various conditions,including HE.Studies suggest that FMT can modulate gut microbiota,reduce ammonia levels,and alleviate inflammation.FMT has shown promise in alcohol-associated,hepatitis B and C-associated,and non-alcoholic fatty liver disease.Benefits include improved liver function,cognitive function,and the slowing of disease progression.However,larger,controlled studies are needed to validate its effectiveness in these contexts.Studies have shown cognitive improvements through FMT,with potential benefits in cirrhotic patients.Notably,trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of care.Although evidence is promising,challenges remain:Limited patient numbers,varied dosages,administration routes,and donor profiles.Further large-scale,controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and efficacy.While FMT holds potential for HE management,ongoing research is needed to address these challenges,optimize protocols,and expand its availability as a therapeutic option for diverse hepatic conditions.

Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of life.Many modalities of treatment exist for FI.Sacral nerve stimulation is a well-established treatment for FI.Given the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI incompatibility.Medtronic MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely used.AIM To evaluate the efficacy,outcomes and complications of the MRI-compatible InterStim.METHODS Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and analyzed.Patient demographics,clinical features,surgical techniques,complications,and outcomes were analyzed.Strengthening the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were used.RESULTS Seventy-three patients had the InterStim implanted.The mean age was 63.29±12.2 years.Fifty-seven(78.1%)patients were females and forty-two(57.5%)patients had diabetes.In addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant placement.Thirty-two(43.8%)patients underwent rechargeable InterStim placement.Three(4.1%)patients needed removal of the implant.Migration of the external lead connection was observed in 7(9.6%)patients after the stage I procedure.The explanation for one patient was due to infection.Seven(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and bleeding.The mean follow-up was 6.62±3.5 mo.Sixty-eight(93.2%)patients reported significant improvement of symptoms on follow-up evaluation.CONCLUSION This study shows promising results with significant symptom improvement,good efficacy and good patient outcomes with low complication rates while using MRI compatible InterStim for FI.Further long-term follow-up and future studies with a larger patient population is recommended.

Garg incontinence scores: New scoring system on the horizon to evaluate fecal incontinence. Will it make a difference?

The main aim of this opinion review is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593–4603.The authors in the published article developed a new scoring system,Garg incon-tinence scores(GIS),for fecal incontinence(FI).FI is a chronic debilitating disease that has a severe negative impact on the quality of life of the patients.Rome IV criteria define FI as multiple episodes of solid or liquid stool passed into the clothes at least twice a month.The associated social stigmatization often leads to significant under-reporting of the condition,which further impairs management.An important point is that the complexity and vagueness of the disease make it difficult for the patients to properly define and report the magnitude of the problem to their physicians.Due to this,the management becomes even more difficult.This issue is resolved up to a considerable extent by a scoring ques-tionnaire.There were several scoring systems in use for the last three decades.The prominent of them were the Cleveland Clinic scoring system or the Wexner scoring system,St.Marks Hospital or Vaizey’s scores,and the FI severity index.However,there were several shortcomings in these scoring systems.In the opinion review,we tried to analyze the strength of GIS and compare it to the existing scoring systems.The main pitfalls in the existing scoring systems were that most of them gave equal weightage to different types of FI(solid,liquid,flatus,etc.),were not comprehensive,and took only the surgeon’s perception of FI into view.In GIS,almost all shortcomings of previous scoring systems had been addressed:different weights were assigned to different types of FI by a robust statistical methodology;the scoring system was made comprehensive by including all types of FI that were previously omitted(urge,stress and mucus FI)and gave priority to patients’rather than the physicians’perceptions while developing the scoring system.Due to this,GIS indeed looked like a paradigm shift in the evaluation of FI.However,it is too early to conclude this,as GIS needs to be validated for accuracy and simplicity in future studies.

Diagnostic tools for fecal incontinence: Scoring systems are the crucial first step

The main aim of this editorial is to comment on the recent article published by Garg et al in the World Journal of Gastroenterology 2023;29:4593-4603.This original research presents a new scoring system for fecal incontinence.Fecal incontinence is a chronic disease with a severe impact on the quality of life of the patients.Substantial social stigmatization often leads to significant underreporting of the condition even during visits to a specialist and could lead to further misman-agement or non-existent management of the disease.An important fact is that patients are often unable to describe their condition when not asked precisely defined questions.This problem is partially resolved by scoring questionnaires.Several scoring systems are commonly used;however,each of them has their shortcomings.For example,the absence of different kinds of leakage besides flatus and stool could further lead to underscoring the incontinence severity.Therefore,there has long been a call for a more precise scoring system.The correct identification of the presence and severity of fecal incontinence is paramount for further diagnostic approach and for choosing the appropriate therapy option.This editorial describes fecal incontinence,its effect on quality of life in general and further evaluates the diagnostic approach with a particular focus on symptom scoring systems and their implications for clinical practice.

The role of a novel antibacterial substance,cyclic opine-producing Lacticaseibacillus rhamnosus LS8 in ameliorating ulcerative colitis:a fecal microbiota transplantation study

Intestinal microbiota imbalance may worsen the progression of ulcerative colitis(UC).Lacticaseibacillus rhamnosus LS8(LR)has the potential ability to regulate microbiota through producing a novel antibacterial substance,cyclic opine:cycloalanopine.This study aimed to investigate whether LR could ameliorate dextran sulfate sodium-induced UC in mice via modulating intestinal microbiota using fecal microbiota transplantation(FMT)experiment.The results showed that both LR and FMT attenuated UC as evidenced by 1)alleviating disease activity index and colonic pathology;2)up-regulating MUCs and tight junction proteins;3)increasing oxidative mediators and decreasing antioxidant mediators;4)down-regulating proinflammatory cytokines and chemokines.These results were mainly attributable to the microbiota-regulating effect of LR,including increasing beneficial bacteria(like Akkermansia)and its related SCFAs,while decreasing harmful bacteria(like Proteobacteria)and its related LPS,thereby suppressing the hyperactivation of TLR4/NF-κB pathway.Consequently,LR can alleviate UC and is a potential dietary supplement to attenuate UC.

Fecal microbiota transplantation for irritable bowel syndrome:Current evidence and perspectives

In this editorial we comment on the article published in the recent issue of the World journal of Gastroenterology.We focus specifically on the mechanisms underlying the effects of fecal microbiota transplantation(FMT)for irritable bowel syndrome(IBS),the factors which affect the outcomes of FMT in IBS patients,and challenges.FMT has emerged as a efficacious intervention for clostridium difficile infection and holds promise as a therapeutic modality for IBS.The utilization of FMT in the treatment of IBS has undergone scrutiny in numerous randomized controlled trials,yielding divergent outcomes.The current frontier in this field seeks to elucidate these variations,underscore the existing knowledge gaps that necessitate exploration,and provide a guideline for successful FMT implementation in IBS patients.At the same time,the application of FMT as a treatment for IBS confronts several challenges.

Dual-targeted treatment for inflammatory bowel disease:Whether fecal microbiota transplantation can be an important part of it

Inflammatory bowel disease(IBD)is a chronic gastrointestinal inflammatory disease.With the emergence of biologics and other therapeutic methods,two biologics or one biologic combined with a novel small-molecule drug has been proposed in recent years to treat IBD.Although treatment strategies for IBD are being optimized,their efficacy and risks still warrant further consideration.This editorial explores the current risks associated with dual-targeted treatment for IBD and the great potential that fecal microbiota transplantation(FMT)may have for use in combination therapy for IBD.We are focused on addressing refractory IBD or biologically resistant IBD based on currently available dual-targeted treatment by incorporating FMT as part of this dual-targeted treatment.In this new therapy regimen,FMT represents a promising combination therapy.

Contribution of gut microbiota to the development of Crohn's disease:Insights gained from fecal microbiota transplantation studies in mice

We would like to present some new thoughts on the publication in the journalpublished in August 2024 in World Journal of Gastroenterology.We specificallyfocused on the alterations in the intestinal tract,mesenteric adipose tissue(MAT),and systemic inflammatory changes in mice following fecal flora transplantationinto a mouse model of Crohn's disease(CD).Accumulating evidence suggests thatthe occurrence of CD is influenced by environmental factors,host immune status,genetic susceptibility,and flora imbalance.One microbiota-based intervention,fecal microbiota transplantation,has emerged as a potential treatment option forCD.The MAT is considered a"second barrier"around the inflamed intestine.Theinteraction between gut microbes and inflammatory changes in MAT has attractedconsiderable interest.In the study under discussion,the authors transplantedfetal fecal microorganisms from patients with CD and clinically healthy donors,respectively,into 2,4,6-trinitrobenzene sulfonic acid-induced CD mice.Theresearch explored the complex interplay between MAT,creeping fat,inflammation,and intestinal flora in CD by evaluating intestinal and mesenteric lesions,along with the systemic inflammatory state in the mice.This article providesseveral important insights.First,the transplantation of intestinal flora holdssignificant potential as a therapeutic strategy for CD,offering hope for patientswith CD.Second,it presents a novel approach to the diagnosis and treatment ofCD:The inflammatory response in CD could potentially be assessed throughpathological or imaging changes in the MAT,and CD could be treated bytargeting the inflammation of the MAT.

Does young feces make the elderly live better? Application of fecal microbiota transplantation in healthy aging

As we are facing an aging society,anti-aging strategies have been pursued to reduce the negative impacts of aging and increase the health span of human beings.Gut microbiota has become a key factor in the anti-aging process.Modulation of gut microbiota by fecal microbiota transplantation(FMT)to prevent frailty and unhealthy aging has been a hot topic of research.This narrative review summarizes the benefits of FMT for health span and lifespan,brains,eyes,productive systems,bones,and others.The mechanisms of FMT in improving healthy aging are discussed.The increased beneficial bacteria and decreased pathological bacteria decreased gut permeability and systemic inflammation,increased short-chain fatty acid(SCFA)and SCFA-producing bacteria,and other factors are listed as mechanisms of FMT to improve healthy aging.The points that need to be considered to ensure the optimal outcomes of FMT are also discussed,such as recipients’age,sex,genetic background,and gut microbiota after FMT.Although thisfield is still in its infancy,it has shown that FMT has great potential to improve healthy aging.

Application of fecal immunochemical test in colorectal cancer screening:A community-based,cross-sectional study in averagerisk individuals in Hainan

BACKGROUND The incidence of colorectal cancer(CRC)in China is steadily rising,with a high proportion of advanced-stage diagnoses.This highlights the significance of early detection and prevention measures to enhance survival rates.Fecal immunochemical testing(FIT)is a globally recommended CRC screening method;however,limited research has been conducted on its application in Hainan.AIM To assess the efficacy and adherence of FIT screening among average-risk individuals in Hainan,while also examining the risk factors associated with positive FIT results.METHODS This population-based cross-sectional study implemented FIT screening for CRC in 2000 asymptomatic participants aged 40-75 years from five cities and 21 community health centers in Hainan Province.The study was conducted from August 2022 to April 2023,employing a stratified sampling method to select participants.Individuals with positive FIT results subsequently underwent colonoscopy.Positive predictive values for confirmed CRC and advanced adenoma were calculated,and the relationship between relevant variables and positive FIT results was analyzed usingχ2 tests and multivariate logistic regression.RESULTS A total of 1788 participants completed the FIT screening,with a median age of 57 years(interquartile range:40-75).Among them,503(28.1%)were males,and 1285(71.9%)were females,resulting in an 89.4%compliance rate for FIT screening.The overall positivity rate of FIT was 4.4%[79 out of 1788;95%confidence interval(CI):3%-5%].The specific positivity rates for Haikou,Sanya,Orient City,Qionghai City,and Wuzhishan City were 9.6%(45 of 468;95%CI:8%-11%),1.3%(6 of 445;95%CI:0.1%-3.1%),2.7%(8 of 293;95%CI:1.2%-4.3%),3.3%(9 of 276;95%CI:1.0%-6.3%),and 4.2%(11 of 406;95%CI:1.2%-7.3%),respectively.Significant associations were found between age,dietary habits,and positive FIT results.Out of the 79 participants with positive FIT results,55 underwent colonoscopy,demonstrating an 82.2%compliance rate.Among them,10 had a clean gastrointestinal tract,43 had polyps or adenomas,and 2 were confirmed to have CRC,yielding a positive predictive value of 3.6%(95%CI:0.9%-4.2%).Among the 43 participants with polyps or adenomas,8 were diagnosed with advanced adenomas,resulting in an advanced adenoma rate of 14.5%(95%CI:10.1%-17.7%).CONCLUSION In the Hainan region,FIT screening for CRC among asymptomatic individuals at average risk is feasible and wellreceived.

Efficacy and safety of fecal microbiota transplantation for treatment of ulcerative colitis:A post-consensus systematic review and metaanalysis

BACKGROUND Numerous studies have assessed the efficacy and safety of fecal microbiota transplantation(FMT)as a therapy for ulcerative colitis(UC).However,the treatment processes and outcomes of these studies vary.AIM To evaluate the efficacy and safety of FMT for treating UC by conducting a systematic meta-analysis.METHODS The inclusion criteria involved reports of adult patients with UC treated with FMT,while studies that did not report clinical outcomes or that included patients with infection were excluded.Clinical remission(CR)and endoscopic remission(ER)were the primary and secondary outcomes,respectively.RESULTS We included nine studies retrieved from five electronic databases.The FMT group had better CR than the control group[relative risk(RR)=1.53;95%confidence interval(CI):1.19-1.94;P<0.0008].ER was statistically significantly different between the two groups(RR=2.80;95%CI:1.93-4.05;P<0.00001).Adverse events did not differ significantly between the two groups.CONCLUSION FMT demonstrates favorable performance and safety;however,well-designed randomized clinical trials are still needed before the widespread use of FMT can be recommended.Furthermore,standardizing the FMT process is urgently needed for improved safety and efficacy.

Fecal microbiota transplantation in the treatment of hepatic encephalopathy:A perspective

Due to its complex pathogenesis,treatment of hepatic encephalopathy(HE)continues to be a therapeutic challenge.Of late,gut microbiome has garnered much attention for its role in the pathogenesis of various gastrointestinal and liver diseases and its potential therapeutic use.New evidence suggests that gut micro-biota plays a significant role in cerebral homeostasis.Alteration in the gut microbiota has been documented in patients with HE in a number of clinical and experimental studies.Research on gut dysbiosis in patients with HE has opened newer therapeutic avenues in the form of probiotics,prebiotics and the latest fecal microbiota transplantation(FMT).Recent studies have shown that FMT is safe and could be effective in improving outcomes in advanced liver disease patients presenting with HE.However,questions over the appropriate dose,duration and route of administration for best treatment outcome remains unsettled.

Effectiveness of colonoscopy,immune fecal occult blood testing,and risk-graded screening strategies in colorectal cancer screening

BACKGROUND Colorectal cancer(CRC)is one of the most common malignant tumors,and early screening is crucial to improving the survival rate of patients.The combination of colonoscopy and immune fecal occult blood detection has garnered significant attention as a novel method for CRC screening.Colonoscopy and fecal occult blood tests,when combined,can improve screening accuracy and early detection rates,thereby facilitating early intervention and treatment.However,certain risks and costs accompany it,making the establishment of a risk classification model crucial for accurate classification and management of screened subjects.AIM To evaluate the feasibility and effectiveness of colonoscopy,immune fecal occult blood test(FIT),and risk-graded screening strategies in CRC screening.METHODS Based on the randomized controlled trial of CRC screening in the population conducted by our hospital May 2020 to May 2023,participants who met the requirements were randomly assigned to a colonoscopy group,an FIT group,or a graded screening group at a ratio of 1:2:2(after risk assessment,the high-risk group received colonoscopy,the low-risk group received an FIT test,and the FITpositive group received colonoscopy).The three groups received CRC screening with different protocols,among which the colonoscopy group only received baseline screening,and the FIT group and the graded screening group received annual follow-up screening based on baseline screening.The primary outcome was the detection rate of advanced tumors,including CRC and advanced adenoma.The population participation rate,advanced tumor detection rate,and colonoscopy load of the three screening programs were compared.RESULTS A total of 19373 subjects who met the inclusion and exclusion criteria were enrolled,including 8082 males(41.7%)and 11291 females(58.3%).The mean age was 60.05±6.5 years.Among them,3883 patients were enrolled in the colonoscopy group,7793 in the FIT group,and 7697 in the graded screening group.Two rounds of follow-up screening were completed in the FIT group and the graded screening group.The graded screening group(89.2%)and the colonoscopy group(42.3%)had the lowest overall screening participation rates,while the FIT group had the highest(99.3%).The results of the intentional analysis showed that the detection rate of advanced tumors in the colonoscopy group was greater than that of the FIT group[2.76%vs 2.17%,odds ratio(OR)=1.30,95%confidence interval(CI):1.01-1.65,P=0.037].There was no significant difference in the detection rate of advanced tumors between the colonoscopy group and the graded screening group(2.76%vs 2.35%,OR=1.9,95%CI:0.93-1.51,P=0.156),as well as between the graded screening group and the FIT group(2.35%vs 2.17%,OR=1.09%,95%CI:0.88-1.34,P=0.440).The number of colonoscopy examinations required for each patient with advanced tumors was used as an index to evaluate the colonoscopy load during population screening.The graded screening group had the highest colonoscopy load(15.4 times),followed by the colonoscopy group(10.2 times),and the FIT group had the lowest(7.8 times).CONCLUSION A hierarchical screening strategy based on CRC risk assessment is feasible for screening for CRC in the population.It can be used as an effective supplement to traditional colonoscopy and FIT screening programs.

Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Fecal microbiota transplantation for the maintenance of remission in patients with ulcerative colitis:A randomized controlled trial

BACKGROUND Fecal microbial transplantation(FMT)is a promising new method for treating active ulcerative colitis(UC),but knowledge regarding FMT for quiescent UC is scarce.AIM To investigate FMT for the maintenance of remission in UC patients.METHODS Forty-eight UC patients were randomized to receive a single-dose FMT or autologous transplant via colonoscopy.The primary endpoint was set to the maintenance of remission,a fecal calprotectin level below 200μg/g,and a clinical Mayo score below three throughout the 12-mo follow-up.As secondary endpoints,we recorded the patient’s quality of life,fecal calprotectin,blood chemistry,and endoscopic findings at 12 mo.RESULTS The main endpoint was achieved by 13 out of 24(54%)patients in the FMT group and by 10 out of 24(41%)patients in the placebo group(log-rank test,P=0.660).Four months after FMT,the quality-of-life scores decreased in the FMT group compared to the placebo group(P=0.017).In addition,the disease-specific quality of life measure was higher in the placebo group than in the FMT group at the same time point(P=0.003).There were no differences in blood chemistry,fecal calprotectin,or endoscopic findings among the study groups at 12 mo.The adverse events were infrequent,mild,and distributed equally between the groups.CONCLUSION There were no differences in the number of relapses between the study groups at the 12-mo follow-up.Thus,our results do not support the use of a single-dose FMT for the maintenance of remission in UC.

The Diagnostic Value of Fecal Fusobacterium nucleatum Combined with FIT and CA199 in the Diagnosis of Colorectal Cancer

Objective:To analyze the diagnostic value of fecal Fusobacterium nucleatum detection,fecal immunochemical test(FIT),and carbohydrate antigen 19-9(CA19-9)detection for colorectal cancer(CRC).Method:Atotal of 78 CRC patients and 60 healthy individuals were enrolled in this study.Stool and blood samples were collected for the 3 diagnoses,and ROC curves were analyzed for diagnostic value.Result:The 3 diagnoses’positive detection rates in CRC samples were significantly higher than those of healthy samples(P<0.05).The combined CRC diagnoses showed significantly higher sensitivity as compared to individual fecal F.nucleatum detection(χ^(2)=6.495,P=0.011),FIT(χ^(2)=4.871,P=0.027),and serum CA19-9 detection(χ^(2)=7.371,P=0.007).The area under the ROC curve for fecal F.nucleatum detection was 0.63[95%confidence interval(CI)=1.124–6.238],with a sensitivity of 73.08%and specificity of 85.00%,whereas FIT was 0.65(95%CI=1.365–9.241),with a sensitivity of 51.28%and specificity of 96.67%,meanwhile,serum CA19-9 detection was 0.62(95%CI=1.517–12.342),with a sensitivity of 69.23%and specificity of 98.33%.The combined CRC diagnoses showed an area under the ROC curve of 0.76(95%CI=1.213–6.254),with a sensitivity of 87.18%and specificity of 70.00%.Conclusion:The combined diagnoses of fecal F.nucleatum detection,FIT,and serum CA19-9 detection can significantly improve the sensitivity and accuracy of CRC diagnosis,which has high clinical application value to provide guidance for clinical CRC screening and early intervention treatment.