Lower Bifidobacteria counts in both duodenal mucosa-associated and fecal microbiota in irritable bowel syndrome patients

AIM: To determine the composition of both fecal and duodenal mucosa-associated microbiota in irritable bowel syndrome (IBS) patients and healthy subjects using molecular-based techniques. METHODS: Fecal and duodenal mucosa brush samples were obtained from 41 IBS patients and 26 healthy subjects. Fecal samples were analyzed for the composition of the total microbiota using fluorescent in situ hybridization (FISH) and both fecal and duodenal brush samples were analyzed for the composition of bif idobacteria using real-time polymerase chain reaction. RESULTS: The FISH analysis of fecal samples revealed a 2-fold decrease in the level of bifidobacteria (4.2 ± 1.3 vs 8.3 ± 1.9, P < 0.01) in IBS patients compared to healthy subjects, whereas no major differences in other bacterial groups were observed. At the species level, Bifidobacterium catenulatum levels were significantly lower (6 ± 0.6 vs 19 ± 2.5, P < 0.001) in the IBS patients in both fecal and duodenal brush samples than in healthy subjects.CONCLUSION: Decreased bifidobacteria levels in both fecal and duodenal brush samples of IBS patients compared to healthy subjects indicate a role for microbiotic composition in IBS pathophysiology.

C-reactive protein levels during a relapse of Crohn’s disease are associated with the clinical course of the disease

AIM： TO explore if C-reactive protein （CRP） levels might serve as a prognostic factor with respect to the clinical course of Crohn＇s disease and might be useful for classification. METHODS： In this retrospective cohort study we enrolled 94 patients from the inflammatory bowel disease （IBD） database of the University Medical Centre Utrecht. CRP levels during relapse were correlated with the number of relapses per year. Severity of relapses was based on endoscopic reports and prednisone use. Furthermore, patients were categorized in a low or high CRP group based on their CRP response during relapse and demographic and clinical features were compared. RESULTS： Overall, a positive correlation between CRP levels, number of relapses, and severity of relapse was found （respectively rs = 0.31, P 〈 0.01 and rs = 0.50, P 〈 0.001）. Employing a cut-off level of 15 mg/L, the index CRP level was found to discriminate patients with respect to the number of relapses per year, as well as for severity of relapses （respectively 0.25 ± 0.16 vs 0.36 ± 0.24, P 〈 0.05 and 4.4 ± 1.2 vs 3.2 ± 1.1 on a 10-point visual analogue scale, P 〈 0.001 for the high CRP and low CRP groups respectively）. In addition, the high CRP group showed more cumulative days of prednisone use per year （107 ± 95 vs 58 ± 48, P 〈 0.05）, as well as a better response to infiiximab （93 % vs 33 %, P = 0.06）. CONCLUSION： A higher CRP level during relapse seems to be associated with a more severe clinical course of disease.

Crohn's disease, fatigue, and infiiximab: Is there a role for cytokines in the pathogenesis of fatigue?

AIM: To study the effect of infliximab on fatigue in relation to cytokine levels in Crohn's disease (CD) patients. METHODS: Fourteen CD patients were blinded for treatment and received placebo at baseline, and infliximab 2 wk later, with a follow-up of 4 wk. Blood samples were drawn on a regular basis, and questionnaires on fatigue, depression, quality of life, and clinical disease activity were completed at regular intervals. RESULTS: After placebo infusion, fatigue scores decreased within 3 d (3.5 points±1.1, P≤0.01), but returned to baseline values 14 d after this infusion. The drop of fatigue scores following infliximab infusion sustained until the end of the study (3.8 points±1.4, P≤0.05). Quality of life was increased at the end of the study compared to baseline values (138.6±9.4 vs 179.4±6.7; P≤0.005), whereas depression scores were decreased (20.4±9.4 vs 11.3±2.2; P≤0.01). No correlation between the severity of fatigue and the level of cytokines was observed. CONCLUSION: The reduction of fatigue after infliximab infusion is subjective to a placebo effect. The effect of infliximab on fatigue, however, persists while the placebo effect disappears after a short period of time. A clear role of cytokines could not be substantiated.