Fecal microbiota transplantation broadening its application beyond intestinal disorders

Intestinal dysbiosis is now known to be a complication in a myriad of diseases.Fecal microbiota transplantation(FMT),as a microbiota-target therapy,is arguably very effective for curing Clostridium difficile infection and has good outcomes in other intestinal diseases.New insights have raised an interest in FMT for the management of extra-intestinal disorders associated with gut microbiota.This review shows that it is an exciting time in the burgeoning science of FMT application in previously unexpected areas,including metabolic diseases,neuropsychiatric disorders,autoimmune diseases,allergic disorders,and tumors.A randomized controlled trial was conducted on FMT in metabolic syndrome by infusing microbiota from lean donors or from self-collected feces,with the resultant findings showing that the lean donor feces group displayed increased insulin sensitivity,along with increased levels of butyrate-producing intestinal microbiota.Case reports of FMT have also shown favorable outcomes in Parkinson's disease,multiple sclerosis,myoclonus dystonia,chronic fatigue syndrome,and idiopathic thrombocytopenic purpura.FMT is a promising approach in the manipulation of the intestinal microbiota and has potential applications in a variety of extra-intestinal conditions associated with intestinal dysbiosis.

Clinical features of upper gastrointestinal serrated lesions: An endoscopy database analysis of 98746 patients

AIM To analyse the clinical features of patients with the serrated lesions in the upper gastrointestinal tract(UPGI) tract.METHODS Patients who underwent routine esophagogastroduodenoscopy(EGD) at the Digestive Endoscopy Centre of General Hospital, Tianjin Medical University between january 2011 and December 2015 were consecutively recruited. Patients with UPGI serrated lesions were consecutively identified. The patients' demographics and histopathology were recorded. The colorectal findings for patients who underwent colonoscopy simultaneously or within six months were also extracted from the colonoscopy database. In addition, we analyseddifferences in colorectal neoplasia detection between the study patients and randomly selected patients matched for age and gender who did not exhibit serrated lesions and who also underwent colonoscopy in the same period.RESULTS A total of 21 patients out of 98746 patients(0.02%) who underwent EGD were confirmed to have serrated lesions with predominantly crenated, sawtooth-like configurations. The mean age of the 21 patients was(55.3 ± 17.2) years, and 11 patients were male(52.4%). In terms of the locations of the serrated lesions, 17 were found in the stomach(including 3 in the cardia, 9 in the corpus and 5 in the antrum), 3 were found in the duodenum, and 1 was found in the esophagus. Serrated lesions were found in different mucosal lesions, with 14 lesions were detected in polyps(8 hyperplastic polyps and 6 serrated adenomas with low grade dysplasia), 3 detected in Ménétrier gastropathy, 3 detected in an area of inflammation or ulcer, and 1 detected in the intramucosal carcinoma of the duodenum. In addition, colonoscopy data were available for 18 patients, and a significantly higher colorectal adenoma detection rate was observed in the UPGI serrated lesions group than in the randomly selected age- and gender-matched group without serrated lesions who also underwent colonoscopy in the same period(38.9% vs 11.1%, OR = 5.091, 95%CI: 1.534-16.890, P = 0.010). The detection rate of advanced adenoma was also higher in the UPGI serrated lesions group(22.2% vs 4.2%, OR = 6.571, 95%CI: 1.322-32.660, P = 0.028).CONCLUSION Serrated lesions in the UPGI were detected in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is recommended for the detection of concurrent colorectal adenoma for these patients.

Detection Rate, Distribution, Clinical and Pathological Features of Colorectal Serrated Polyps

Background：Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries.However,few Asian studies have investigated the comprehensive clinical features of serrated polyps in symptomatic populations.The aim of the study was to evaluate the features of colorectal serrated polyps in a Chinese symptomatic population.Methods：Data from all consecutive symptomatic patients were documented from a large colonoscopy database and were analyzed.Chi-square test or Fisher＇s exact test and logistic regression analysis were used for the data processing.Results：A total of 9191 （31.7%） patients were detected with at least one colorectal polyp.The prevalence of serrated polyps was 0.53% （153/28,981）.The proportions of hyperplastic polyp （HP）,sessile serrated adenoma/polyp （SSA/P）,and traditional serrated adenoma （TSA） of all serrated polyps were 41.2%,7.2%,and 51.6%,respectively,which showed a lower proportion of HP and SSA/P and a higher proportion of TSA.Serrated polyps appeared more in males and elder patients while there was no significant difference in the subtype distribution in gender and age.The proportions of large and proximal serrated polyps were 13.7% （21/153） and 46.4% （71/153）,respectively.In total,98.9% （89/90） serrated adenomas were found with dysplasia.Moreover,14 patients with serrated polyps were found with synchronous advanced colorectal neoplasia,and large serrated polyps （LSPs） （odds ratio：3.446,95% confidence interval：1.010-11.750,P 〈 0.05）,especially large HPs,might have an association with synchronous advanced neoplasia （AN）.Conclusions：The overall detection rate ofcolorectal serrated polyps in Chinese symptomatic patient population was low,and distribution pattern of three subtypes is different from previous reports.Moreover,LSPs,especially large HPs,might be associated with an increased risk of synchronous AN.

预测克罗恩病患者对英夫利昔单抗原发无应答的nomogram模型:一项多中心研究

背景:英夫利昔单抗(IFX)治疗克罗恩病(CD)可诱导并维持临床缓解及黏膜愈合,但有9%40%的患者对IFX治疗原发无应答。本研究旨在建立并预测CD患者对IFX原发无应答的Nomogram模型。方法:2008年9月至2019年9月间在四家三甲医院接受IFX诱导治疗的343例CD患者纳入研究,并被随机分为训练队列(240例)和验证队列(103例)。主要结局指标是原发无应答,次要结局指标是黏膜愈合。基于训练队列,采用多因素逻辑回归分析建立Nomogram模型,通过曲线下面积(AUC)和校准曲线评估模型的预测价值,并采用决策曲线分析评估模型的临床实用性。结果:基于年龄、治疗2周时C反应蛋白水平、体质指数和非狭窄非穿透型(B1)病变四个独立预测因素,建立原发无应答的Nomogram预测模型,该模型在训练队列和验证队列的AUC分别为0.77和0.76。基于治疗前克罗恩病内镜严重度指数、治疗2周时C反应蛋白水平、B1型病变和病程四个独立预测因素,建立黏膜愈合的Nomogram预测模型,其在训练队列和验证队列的AUC分别为0.79和0.72。这两个Nomogram模型在训练队列和验证队列都显示出良好的拟合度,优于上述单个的预测因素以及文献报道的矩阵模型。决策曲线显示出了原发无应答Nomogram模型的临床实用性。结论:我们建立并验证了预测CD患者对IFX原发无应答和黏膜愈合的Nomogram模型,这种图像模型使用简单,并能为临床医生的治疗决策提供支持。

Smoldering Multiple Myeloma Arising in Ulcerative Colitis

To the Editor： A 67-year-old man presented with recurrent diarrhea and abdominal pain of increasing severity for 7 months in May 2016. He had mucopurulent stool for about 4-6 times a day, with bellyache, tenesmus, and weight loss. He took a colonoscopy, which showed universal colitis, and a biopsy revealed crypt abscesses and inflammatory cell infiltration and he was diagnosed with ulcerative colitis （UC）. 5-Aminosalicylic acid （mesalazine） was administered, with symptoms remitted after 3 months.