Long-term prognosis and its associated predictive factors in patients with eosinophilic gastroenteritis

BACKGROUND Eosinophilic gastroenteritis(EGE)is a chronic recurrent disease with abnormal eosinophilic infiltration in the gastrointestinal tract.Glucocorticoids remain the most common treatment method.However,disease relapse and glucocorticoid dependence remain notable problems.To date,few studies have illuminated the prognosis of EGE and risk factors for disease relapse.AIM To describe the clinical characteristics of EGE and possible predictive factors for disease relapse based on long-term follow-up.METHODS This was a retrospective cohort study of 55 patients diagnosed with EGE admitted to one medical center between 2013 and 2022.Clinical records were collected and analyzed.Kaplan-Meier curves and log-rank tests were conducted to reveal the risk factors for long-term relapse-free survival(RFS).RESULTS EGE showed a median onset age of 38 years and a slight female predominance(56.4%).The main clinical symptoms were abdominal pain(89.1%),diarrhea(61.8%),nausea(52.7%),distension(49.1%)and vomiting(47.3%).Forty-three(78.2%)patients received glucocorticoid treatment,and compared with patients without glucocorticoid treatments,they were more likely to have elevated serum immunoglobin E(IgE)(86.8%vs 50.0%,P=0.022)and descending duodenal involvement(62.8%vs 27.3%,P=0.046)at diagnosis.With a median follow-up of 67 mo,all patients survived,and 56.4%had at least one relapse.Six variables at baseline might have been associated with the overall RFS rate,including age at diagnosis<40 years[hazard ratio(HR)2.0408,95%confidence interval(CI):1.0082–4.1312,P=0.044],body mass index(BMI)>24 kg/m^(2)(HR 0.3922,95%CI:0.1916-0.8027,P=0.014),disease duration from symptom onset to diagnosis>3.5 mo(HR 2.4725,95%CI:1.220-5.0110,P=0.011),vomiting(HR 3.1259,95%CI:1.5246-6.4093,P=0.001),total serum IgE>300 KU/L at diagnosis(HR 0.2773,95%CI:0.1204-0.6384,P=0.022)and glucocorticoid treatment(HR 6.1434,95%CI:2.8446-13.2676,P=0.003).CONCLUSION In patients with EGE,younger onset age,longer disease course,vomiting and glucocorticoid treatment were risk factors for disease relapse,whereas higher BMI and total IgE level at baseline were protective.

All-trans retinoic acid alleviates transmissible gastroenteritis virus-induced intestinal inflammation and barrier dysfunction in weaned piglets

Background Transmissible gastroenteritis virus(TGEV)is one of the main pathogens causing severe diarrhea of pig-lets.The pathogenesis of TGEV is closely related to intestinal inflammation.All-trans retinoic acid(ATRA)is the main active metabolite of vitamin A,which has immunomodulatory and anti-inflammatory properties.However,it is unclear whether ATRA can alleviate TGEV-induced intestinal inflammation and barrier dysfunction in piglets.This study aimed to investigate the effects of ATRA on growth performance,diarrhea,intestinal inflammation and intesti-nal barrier integrity of TGEV-challenged piglets.Methods In a 19-d study,32 weaned piglets were randomly divided into 4 treatments:Control group(basal diet),TGEV group(basal diet+TGEV challenge),TGEV+ATRA5 group(basal diet+5 mg/d ATRA+TGEV challenge)and TGEV+ATRA15 group(basal diet+15 mg/d ATRA+TGEV challenge).On d 14,piglets were orally administered TGEV or the sterile medium.Results Feeding piglets with 5 and 15 mg/d ATRA alleviated the growth inhibition and diarrhea induced by TGEV(P<0.05).Feeding piglets with 5 and 15 mg/d ATRA also inhibited the increase of serum diamine oxidase(DAO)activ-ity and the decrease of occludin and claudin-1 protein levels in jejunal mucosa induced by TGEV,and maintained intestinal barrier integrity(P<0.05).Meanwhile,5 mg/d ATRA feeding increased the sucrase activity and the expres-sions of nutrient transporter related genes(GLUT2 and SLC7A1)in jejunal mucosa of TGEV-challenged piglets(P<0.05).Furthermore,5 mg/d ATRA feeding attenuated TGEV-induced intestinal inflammatory response by inhibit-ing the release of interleukin(IL)-1β,IL-8 and tumor necrosis factor-α(TNF-α),and promoting the secretion of IL-10 and secretory immunoglobulin A(sIgA)(P<0.05).Feeding 5 mg/d ATRA also down-regulated the expressions of Toll-like receptors and RIG-I like receptors signaling pathway related genes(TLR3,TLR4,RIG-I,MyD88,TRIF and MAVS)and the phosphorylation level of nuclear factor-κB-p65(NF-κB p65),and up-regulated the inhibitor kappa B alpha(IκBα)protein level in jejunal mucosa of TGEV-challenged piglets(P<0.05).Conclusions ATRA alleviated TGEV-induced intestinal barrier damage by inhibiting inflammatory response,thus improving the growth performance and inhibiting diarrhea of piglets.The mechanism was associated with the inhibi-tion of NF-κB signaling pathway mediated by TLR3,TLR4 and RIG-I.

Diarrheic Escherichia coli: A Predominant Etiological Agent of Gastroenteritis, a Case Study in Douala, Cameroon

Context: Gastroenteritis remains an infectious disease with high morbidity and mortality particularly in low incomes countries, where the capacity to search all etiological agents, especially pathogenic Escherichia coli, is very limited. We investigated the contribution of pathogenic Escherichia coli and their antibiotic resistance profiles in cases of gastroenteritis. Methods: A cross-sectional study was carried out on human stool samples from October 2021 to June 2022 at Laquintinie Hospital. Samples were received from patients of all age groups and screened for bacteriological and parasitological identification by microscopy, bacterial culture, biochemical identification, and antimicrobial susceptibility tests. Results: A total of 296 patients with gastroenteritis complaints, were enrolled in the study with ages ranging from 5 months to 90 years old (Median = 35.5;SD = 20.8). Among the samples analyzed, 1.7% (n = 5/296) were positive for parasites and 27% (n = 80/296) were positive for bacterial pathogens. Parasites were found in mono parasitism, mainly Entamoeba histolytica (60%;n = 3/5), followed by Trichomonas intestinalis (20%;n = 1/5), and Giardia intestinalis (20%;n = 1/5). Three species of bacterial pathogens were identified with no co-infection: diarrheic Escherichia coli (DEC), Salmonella sp, and Shigella sp with respective proportions of 90% (n = 72/80), 6.3% (n = 5/80), and 3.7% (n = 3/80). For antibiotic resistance profiles (ARPs) of the 72 isolates of DEC, high levels of resistance were observed globally with amoxicillin (93.1%;n = 67/72), followed by ciprofloxacin (75%;n = 54/72), and to trimethoprim + sulfamethazole (73.6%;n = 53/72). In contrast, DEC showed low resistance rates with nitrofurans (6.9%;n = 5/72) and imipenem (2.8%;n = 2/72). The strains had 56 distinct ARPs, of which 88.9% (n = 64/72) were MDR. Salmonella sp and Shigella sp showed high levels of resistance to amoxicillin and trimethoprim + sulfamethazole. Conclusion: These results emphasize the need to consider DEC as the main cause of consultation in cases of gastroenteritis and reiterate the urgent need to rationalize antibiotic use in Cameroon.

Eosinophilic gastroenteritis:An unusual type of gastroenteritis

Eosinophilic gastroenteritis(EGE) is a rare disorder characterized by eosinophilic infiltration of the bowel wall with various gastrointestinal manifestations.Till date only 280 cases have been described in the literature.A high index of suspicion,by excluding other causes of peripheral eosinophilia,is a pre requisite for accurate diagnosis.EGE is an uncommon gastrointestinal disease affecting both children and adults.It was first described by Kaijser in 1937.Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course.This condition can respond to low dose steroid therapy,thereby preventing grave complications like ascites and intestinal obstruction that might need surgical intervention.The natural history of EGE has not been well documented.Eosinophilic gastroenteritis is a chronic,waxing and waning condition.Mild and sporadic symptoms can be managed with reassurance and observation,whereas disabling gastrointestinal(GI) symptom flare-ups can often be controlled with oral corticosteroids.When the disease manifests in infancy and specific food sensitization can be identified,the likelihood of disease remission by late childhood is high.GI obstruction is the most common complication.Fatal outcomes are rare.

Fecal microbiota transplantation and prednisone for severe eosinophilic gastroenteritis

Eosinophilic gastroenteritis is a rare disease of unknown etiology.It is characterized by patchy or diffuse eosinophilic infiltration of the bowel wall to a variable depth and various gastrointestinal manifestations.We describe a case of severe eosinophilic gastroenteritis presenting as frequent bowel obstruction and diarrhea in a 35-year-old man.The patient was misdiagnosed and underwent surgery because of intestinal obstruction when he was first admitted to a local hospital.Then he was misdiagnosed as having Crohn’s disease in another university teaching hospital.Finally,the patient asked for further treatment from our hospital because of the on-going clinical trial for treating refractory Crohn’s disease by fecal microbiota transplantation.Physical examination revealed a slight distended abdomen with diffuse tenderness.Laboratory investigation showed the total number of normal leukocytes with neutrophilia as 90.5%,as well as eosinopenia,monocytopenia and lymphocytopenia.Barium radiography and sigmoidoscopy confirmed inflammatory stenosis of the sigmoid colon.We diagnosed the patient as having eosinophilic gastroenteritis by multi-examinations.The patient was treated by fecal microbiota transplantation combined with oral prednisone,and was free from gastrointestinal symptoms at the time when we reported his disease.This case highlights the importance of awareness of manifestations of a rare disease like eosinophilic gastroenteritis.

Prevalence and Genotypes of Rotavirus A and Human Adenovirus among Hospitalized Children with Acute Gastroenteritis in Fujian, China, 2009-2017

Gastroenteritis is an infectious diarrhea that has been considered as an important cause of hospitalizations and death in children aged < 5 years, particularly in developing countries. Unsanitary water, contaminated food, poor hygiene, and inadequate disposal of waste and feces are all risk factors for gastroenteritis, resulting in the higher incidence in developing countries. Gastroenteritis is generally caused by viral infections, among which rotavirus (RV) infections have been reported to be the most common, especially among young children aged < 5 years with acute gastroenteritis in Asia and Africa[1]. Other viruses associated with acute gastroenteritis include human Adenovirus (HAdV), Norovirus, Sapovirus (SaV), human Astrovirus (HAstV), and Aichi virus. Recent research has reported that adenovirus types 40 and 41, belonging to species F, cause gastroenteritis and were therefore termed as enteric adenoviruses. In addition, non-enteric HAdV species such as A, B, C, and D have been associated with diarrheal.

Diagnosis of eosinophilic gastroenteritis is easily missed

AIM To analyze the clinical characteristics of eosinophilic gastroenteritis(EGE)and to investigate the situations of missed diagnosis of EGE.METHODS First,the clinical characteristics of 20 EGE patients who were treated at our hospital were retrospectively summarized.Second,159 patients who underwent gastroscopy and 211 patients who underwent colonoscopy were enrolled.The pathological diagnosis showed only chronic inflammation in their medical records.The biopsy slides of these patients were reevaluated to determine the number of infiltrating eosinophils in order to assess the probability of a missed diagnosis of EGE.Finally,122 patients who experienced refractory upper gastrointestinal symptoms for at least one month were recruited.At least 6biopsy specimens were obtained by gastroscopy,and the number of eosinophils that had infiltrated was evaluated.Those who met the pathological diagnostic criteria of EGE underwent further examination to confirm the diagnosis of EGE.The probability of a missed diagnosis of EGE was prospectively investigated.RESULTS Among the 20 patients with EGE,mucosal EGE was found in 15 patients,muscular EGE was found in 3patients and serosal EGE was found in 2 patients.Abdominal pain was the most common symptom.The number of peripheral blood eosinophils was elevated in all 20 patients,all of whom were sensitive to corticosteroids.Second,among the 159 patients who underwent gastroscopy,7(4.40%)patients met the criteria for pathological EGE(eosinophil count≥25/HPF).Among the 211 patients who underwent colonoscopy,9(4.27%)patients met the criteria for pathological EGE(eosinophil count≥30/HPF).No patients with eosinophil infiltration were diagnosed with EGE in clinical practice before or after endoscopy.Although these patients did not undergo further examination to exclude other diseases that can also lead to gastrointestinal eosinophil infiltration,these might be the cases where the diagnosis of EGE was missed.Finally,among the 122 patients with refractory upper gastrointestinal symptoms,eosinophil infiltration was seen in 7 patients(5.74%).The diagnosis of EGE was confirmed in all 7 patients after the exclusion of other diseases that can also lead to gastrointestinal eosinophil infiltration.A positive correlation was observed between the duration of the symptoms and the risk of EGE(r=0.18,P<0.01).The patients whose symptoms persisted longer than 6 mo more readily developed EGE.None of the patients were considered to have EGE by their physicians before endoscopy.CONCLUSION Although EGE is a rare inflammatory disorder,it is easily misdiagnosed.When a long history of abdominal symptoms fails to improve after conventional therapy,EGE should be considered.

Acute gastroenteritis outbreak caused by a GII.6 norovirus

AIM:To report an acute gastroenteritis outbreak caused by a genogroup 2 genotype 6(GII.6) strain norovirus in Shanghai,China.METHODS:Noroviruses are responsible for approximately half of all reported gastroenteritis outbreaks in many countries.Genogroup 2 genotype 4 strains are the most prevalent.Rare outbreaks caused by GII.6 strains have been reported.An acute gastroenteritis outbreak occurred in an elementary school in Shanghai in December of 2013.Field and molecular epidemiologic investigations were conducted.RESULTS:The outbreak was limited to one class in an elementary school located in southwest Shanghai.The age of the students ranged from 9 to 10 years.The first case emerged on December 10,2013,and the last case emerged on December 14,2013.The cases peaked on December 11,2013,with 21 new cases.Of 45 students in the class,32 were affected.The main symptom was gastroenteritis,and 15.6%(5/32) of the cases exhibited a fever.A field epidemiologic investigation showed the pathogen may have been transmitted to the elementary school from employees in a delicatessen via the first case student,who had eaten food from the delicatessen one day before the gastroenteritis episodes began.A molecular epidemiologic investigation identified the cause of the gastroenteritis as norovirus strain GII.6;the viral sequence of the student cases showed 100% homology with that of the shop employees.Genetic relatedness analyses showed that the new viral strain is closely related to previously reported GII.6 sequences,especially to a strain reported in Japan.CONCLUSION:This is the first report to show that norovirus strain GII.6 can cause a gastroenteritis outbreak.Thus,the prevalence of GII.6 noroviruses requires attention.

Eosinophilic gastroenteritis associated with eosinophilic cystitis:Computed tomography and magnetic resonance imaging findings

Eosinophilic gastroenteritis(EG) is a rare,distinct clinical entity,and EG associated with eosinophilic cystitis(EC) is extremely rare and has not been well documented.Here,we report two cases of EG and coexistent EC along with findings from computed tomography(CT) and magnetic resonance imaging(MRI).An 18-year-old male with a history of hematuria,urgency and occasional urodynia for two weeks and a 34-year-old male with a history of abdominal distention for one week were admitted to our hospital.Abdominal contrast-enhanced CT in both patients revealed wall thickening in different parts of the gastrointestinal tract with inhomogeneous reinforcement,coexistent with local or diffuse bladder wall thickening with progressive enhancement,and also showed that the bladder mucosal lining was nondestructive.Pelvic MRI showed that the local or diffuse thickened bladder wall was iso-intense on T1-weighted images,hypointense on T2-weighted images,and slightly restricted on diffusion weighted imaging(DWI) in one case.After therapy,the thickened wall of the gastrointestinal tract and urinary bladder had improved markedly in the two cases.To the best of our knowledge,this is the first report on the radiological imaging of EG and coexistent EC by both CT and MRI and the first with DWI findings.

Treatment of rotaviral gastroenteritis with Qiwei Baizhu powder

AIM To observe the effects of Qiwei Baizhu Powder ( QWBZP) on rotaviral gastroenteritis in children and in animal models.``METHODS Enrolled patients were divided into two groups, and one group was treated with oral rehydration solution(ORS) and the other treated with oral liquid of QWBZP. Neonate mice were orally infected with 50 μLrotavirus suspension (4 × l0s PFU/mL) and treated with ORS or oral liquid of QWBZP, respectively.``RESULTS Eighty-three cases of rotaviral gastroenteritis treated with QWBZP revealed a better efficacy than that treated with ORS (x2 - 10.8T, P<0.05). The contents of sodium and glucose as well as number of patients with positive human rotavirus antigen in stool in QWBZP group were all less than that in ORS group. In animal models,QWBZP was found effective in treating rotavirus gastroenteritis in neonate NIH mice, as compared with control groups. In QWBZP group, the mortality of infected mice was decreased by 73.3%, the body weight of infected mice was increased, the contents of sodium and glucose as well as number of mice with positive rotavirus antigen in feces were significantly reduced, and the pathological changes such as damage of small intestinal mucosa and villi were also obviously alleviated.``CONCLUSION QWBZP has effects on improving the absorptive function of small intestine, shortening the duration of diarrhea and rotavirus shedding from stool and alleviating the pathological changes of small intestine induced by rotavirus.

Massive hemorrhagic ascites: A rare presentation of eosinophilic gastroenteritis

According to Klein's classification system, the symp-tomatology of eosinophilic gastroenteritis(EG), a rare disease, differs based on the affected tissue layer. Pati-ents with subserosal EG often have peritoneal effusion. Hemorrhagic ascites due to EG is extremely rare and has not been reported in the literature. Here, we report a 57-year-old woman with EG and massive hemorrhagic ascites. Laboratory investigations showed elevated per-ipheral eosinophils with significant eosinophilia(65.6%). Ultrasonography showed massive abdominal ascites. Ab-dominal paracentesis revealed hemorrhagic peritoneal fluid and microscopy showed predominant eosinophils. Upper gastrointestinal endoscopy revealed erosions, ex-udates, and mucosal rings in the duodenal mucosa; hist-ological examination indicated eosinophilic infiltration. EG presenting with hemorrhagic ascites was diagnosed by histologic examination of eosinophilic infiltration. She was empirically treated with ketotifen 1 mg bid po with rapid resolution of ascites and a remarkable decline in peripheral eosinophil counts. Clinicians should consider the different-ial diagnosis of unexplained hemorrhagic ascites.

Epidemiological and Clinical Features of Rotavirus and Adenovirus Related Gastroenteritis in Beijing:A Retrospective Case-control Study in Pediatric Patients

Rotavirus(RV)is the most common cause of viral gastroenteritis among children younger than 5-yearold worldwide.RV has nine groups(Group A to I)and Group A(RVA)is the main cause of severe gastroenteritis disease in children.Human adenovirus(HAdV)consists of 7 species(HAdV-A through HAdV-G)including over 70 serotypes,and group F serotypes 40 and 41 are related to gastroenteritis[1].There were reports that revealed co-infection of AdV with RVA and Norovirus[2].Here we report an epidemiological and clinical analysis of RVA and AdV infection through a single-centered retrospective case-control study.

Prevalence of shiga toxins(stx_1,stx_2),eaeA and hly genes of Escherichia coli O157:H7 strains among children with acute gastroenteritis in southern of Iran

Objective:To survey the prevalence severe diarrhea arising from these bacteria in children under 5 years old in Marvdasht.Methods:In this study faecal sample from 615 children aged <5years old who were hospitalized lor gastroenteritis in Fars hospitals in Iran were collected and then enriched in Escherichia coli(E.coli) broth and modified tryplone soy broth with novobiocin media,fermentation of sorbitol,lactose and β— glucoronidase activity of isolated strains was examined by CT—SMAC,VRBA and chromogenic media respectively.Then isolation of E.coli O157:H7 have been confirmed with the use of specific antisera and with multiplex PCR method presence of virulence genes including:xtx_1.stx_2,eae.A.hly has been analyzed.Results:E.coli O157:H7 was detected in 7(1.14%) stool specimens.A significanl difference was seen between detection rale of isolated bacteria from age groups 18-23 months and other age groups(P=0.004).Out of considered virulence genes.only 1 of the isolated strains(0.16%)he stx,and eaeA genes were seen and also all isolated hacleria had resistance to penicillin,ampicillin and erythromycin antibiotics.Conclusions:We found thai children < 2 years of age were at highest risk of infection with E.coli O157:H7.Regarding severity of E.coli O157:H7 pathogenesis,low infectious dose and lack of routine assay for detection ol these bacleria in clinical laboratory,further and completed studies on diagnosis and genolyping of this E.coli O157:H7 strain has been recommended.

Diagnosis and Treatment of Porcine Transmissible Gastroenteritis

Porcine transmissible gastroenteritis （TGE） caused by corona virus is an acute, highly contagious, and intestinal infectious disease. TGE is a common disease in intensive pig farms and prevalent throughout the world. Disease in affected pigs is characterized by diarrhea, vomiting and dehydration. In the present article, the pathogen, epidemiology, diagnosis and treatment were elaborated, so as to effectively prevent TGE and provide a reference for treatment.

Cloning and Identification of S Gene from Chinese Isolate TH-98 of Transmissible Gastroenteritis Virus

Chinese isolate of transmissible gastroenteritis virus(TGEV)was propagated and harvested in swine testicle(ST)cells.Two pairs of primers were designed according to the published sequence with Oligo 4.1 and DNasis softwares.The products of RT-PCR were named Sa and Sb,of 2.3kb and 2.1kb respectively.Sa was inserted in EcoR I and Kpn I sites after Sb was cloned in Kpn I and Pst I sites of the same pUC18 plasmid.The recombinant designated pUC-S was verified and analyzed by corresponding restriction endonuclease(RE)and nested PCR on the basis of genetic sites of S gene and physical map of pUC18 plasmid,which was identified as S gene from Chinese isolate of TGEV.

Molecular characterization of VP4,VP6,VP7 and NSP4 genes of group B rotavirus strains from outbreaks of gastroenteritis

Objective:To characterize VP4,VP6,VP7 and NSP4 genes of representative GBR strains(NIV- 005625.MV-04622 and NIV-094456) delected as the major eliolngic agenl in the outbreaks of gastroenteritis in western India.Methods:Fecal specimens collected during the outbreaks of gastroenteritis were processed for RNA isolation.RT-PCR using GBR VP4.VP6.VP7 and NSP4 gene specific primers,nucleotide sequencing of the amplicons and phylogenetic analysis of the sequences.Results:Phylogenetic analysis of all of the VP4.VP6.VP7 and NSP4 gene sequences revealed clustering of GBR strains in Indian-Bangladeshi lineage of genotype G2 with 95.8%- 99.4%nucleotide and 97.3%-100.0%amino acid identities.However,all three strains showed the presence of unique amino acid substitutions in the VP4 protein suggesting alteration in the antigenicity of outbreak strains of GBR.The VP8* and VP5* regions of VP4 proteins showed respectively 0.5%-6.3%and 0.2%-1.1%amino acid divergence from human GBR strains of Indian-Bangladeshi lineage.Conclusions:These data confirm the reported variability of VP8* region and suggest the possible role of this region in the perpetuation of GBR infections in the environment.This is the first study to document the phylogenetic relationship of VP4,VP6.VP7 and NSP4 genes of GBR strains detected in the outbreaks of gastroenteritis from India with the CBR strains from other parts of world.

Resolution of acute gastroenteritis symptoms in children and adults treated with a novel polyphenol-based prebiotic

AIM:To test efficacy and durability of a polyphenolbased prebiotic treatment for acute gastroenteritis in a300 patient double-blinded clinical study.METHODS:A two-arm randomized,double-blinded,placebo-controlled clinical study was conducted at two public health centers in Managua,Nicaragua.Potential subjects who qualified based on inclusion and exclusion criteria were randomly assigned to one of two treatment arms.Two thirds of the subjects(n=200)received a single titrated 0.5-2 ounce liquid dose of a novel polyphenol-based prebiotic(AlivaTM)diluted with 2 to eight ounces of oral rehydration solution(ORS).One third of the subjects(n=100)were randomized to receive two liquid ounces of a taste and color-matched placebo diluted in eight ounces of ORS.The outcome variables measured included stool consistency,stomach discomfort,gas and bloating,and heartburn/indigestion.The study subjects ranked their stool consistency and the severity of their subjective symptoms at specified intervals from immediately prior to treatment,to five days post treatment.All subjects recorded their symptoms in a study diary.The study subjects also recorded the time and consistencies of all stools in their study diary.Stool consistency was compared to the picture and descriptions on the Bristol Stool Chart,and any stool rated greater than Type4 was considered unformed.The clinical study team reviewed the study diaries with subjects during daily follow-up calls and close-out visits,and recorded the data in case report forms.RESULTS:After receiving a single dose,Aliva treated subjects reported shorter median time to their last unformed stool(1 h 50 min)than placebo treated subjects(67 h 50 min.),a statistically significant difference[95%CI:-3178-(-2018),P=0.000].Aliva treated subjects also reported shorter median their time to last unformed stool(TTLUS)(1hrs 50 min)than placebo treated subjects(67 h 50 min),which was also a statistically significant difference(P=0.000).The percentage of subjects recording TTLUS was greater for those who received Aliva vs placebo at 30 min(P=0.027),2 h(P=0.000),24 h(P=0.000),48 h(P=0.000),72 h(P=0.000),and 5 d(P=0.000)post dose.There were 146 study subjects 14 years old or older,which was the criteria set for reliable self-reporting of subjective symptoms.Of those 146 subjects,142reported stomach pain and discomfort during screening.From 90 minutes[95%CI:-1.8-(-0.01),P=0.048]through 5 d[95%CI:-3.4-(-1.9),P=0.000),the subjects treated with Aliva experienced significantly less stomach pain and discomfort than those who received placebo.Of those same 146 participants,114 subjects reported gas and bloating during screening.Similarly,subjects who received Aliva experienced significantly less gas and bloating from 2 h[95%CI:-1.7-(-0.39),P=0.030]through 5 d(95%CI:-2.0-0.42,P=0.005)compared with the placebo arm.CONCLUSION:In this double-blind,randomized clinical study,subjects with acute gastroenteritis receiving Aliva prebiotic showed significant and sustained improvement of multiple symptoms vs those receiving placebo.

Eosinophilic gastroenteritis with abdominal pain and ascites:A case report

BACKGROUND Eosinophilic gastroenteritis(EGE)is a rare disease that presents many unspecific gastroenterological symptoms.The disease includes three types depending on the depth of eosinophil infiltration in the gastrointestinal tract.The serosal type is the most rare,presenting as ascites.CASE SUMMARY A 34-year-old man presented with abdominal pain,diarrhea without bloody stool,or nausea.Laboratory test results revealed a peripheral blood eosinophil count(4.85×10^(9)/L),which was remarkedly elevated.Computed tomography scan demonstrated extensive intestinal wall edema thickening in the duodenum,jejunum,ascending colon and transverse colon;multiple exudative effusion surrounding the intestinal tract,and ascites in the abdominal cavity.A series of examinations excluded eosinophil elevation in secondary diseases.Endoscopic multipoint biopsy detected eosinophilic infiltration in the mucous layer of the transverse colon,with≥50 eosinophils/high power field.All symptoms vanished after a few days of steroid therapy and ascites disappeared within 2 wk.CONCLUSION EGE should be considered in patients with abdominal pain,ascites,and eosinophilia.Multiple point biopsies are essential for diagnosis.

Antibiotic Resistance in <i>Campylobacter</i>Isolated from Patients with Gastroenteritis in a Teaching Hospital in Ghana

Campylobacter is a leading causal agent of bacterial enteritis worldwide, but its prevalence is not well documented in Ghanaian hospitals. This study isolated Campylobacter species from patients with enteritis or urinary tract infections attending Komfo Anokye Teaching Hospital and assessed the antibiogram profile of isolated species. Two hundred and two (202) in-patients and outpatients samples of all age groups diagnosed with enteritis or UTI infections were analyzed from May 2013 to August 2013. Campylobacter species were detected using selective agar (mCCDA) and confirmed on API Campy system (bioMérieux, France), with disk diffusion method determined the resistance profile of the species. Of the 128 enteritis and 74 UTI patients samples analyzed, 26 and 9 isolates were respectively confirmed as Campylobacter spp. giving a prevalence of 17.3% (35/202). Species identified were C. jejuni (40%), C. jejuni sub sp. doylei (2.8%), C. coli (37%) and C. lari (20%). Resistance was 92.3% - 100% each to erythromycin and the β-lactams, 61.5% - 86.7% to trimethoprim sulfamethoxazole, 92.3% - 93.3% to tetracycline, 46.2% - 80% to chloramphenicol, 0% - 60% to aminoglycosides and 0% to imipenem. Multidrug resistance of 97.1% was detected among species. Empirical treatment of Campylobacter enteritis with erythromycin and other common and cheap drugs may result in treatment failure in the face of high level resistance observed among the Campylobacter species.

Cloning and Homology Comparison of S Gene for Isolate TH-98 of Porcine Transmissible Gastroenteritis Virus

TH-98 isolate of transmissible gastroenteritis virus (TGEV) was propagated and harvested on swine testicle (ST) monolayer cell. Two pairs of primers were designed to amplify S gene by RT-PCR according to the published sequence of TGEV'S gene cDNA with Oligo version 4.1 and DNasis software. The products of PCR were named Sa and Sb, of 2.3 kb and 2.1 kb respectively. Sa was inserted in EcoR I and Kpn I sites after Sb was cloned in Kpn I and Pst I multiple cloning sites of the same pUC18 plasmid. The recombinant pUC-S plasmid was identified and analyzed by corresponding restriction endonuclease and nested PCR on the basis of the genetic sites of S gene and pUC18 plasmid, which was identified as S gene of TGEV. Recombinant pUC-S was sequenced and analyzed in comparison with the other strains. Gene sequence comparison indicated that TH-98 shared 99, 97, 98, 97 and 94% identities with Purdue-115(US), Miller(US), TO14(Japan), FS772(British), 96-1933(British), respectively, their deduced amino acid homology was 99, 97, 97, 96 and 93% correspondingly. In addition, the analysis report verified that pUC-S owned a complete open reading frame (ORF) including initiation codon, signal sequences, remaining sequences and termination codon as well. Therefore, the results affirmed that S gene of TGEV TH-98 was extremely conservative.