GGI诺如病毒致胃肠炎饮水型暴发的调查

诺如病毒是引起人类急性胃肠炎的重要病原体，其感染基因型包括GGI、GGⅡ和GGⅣ^[1]。调查显示我国人群诺如病毒感染十分普遍^[2]，尽管如此，国内报道的诺如病毒基因型多为GGⅡ^[3-5]，而GGI特别是多区域人群暴发的研究较少涉及。2008年3月杭州市某区发生一起GGI诺如病毒的暴发疫情，调查结果如下。

中西医结合治疗慢性腹泻63例疗效观察

慢性腹泻病因及发病机理较为复杂,有时虽经西医综合性治疗,仍有许多病人反复发作,影响生活质量。笔者自2003年11月～2006年10月,参考少林寺益寿方剂,采用中西医结合治疗慢性腹泻63例,治疗效果良好。现总结如下：

Nutritional status and nutritional therapy in inflammatory bowel diseases

Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease(IBD).In addition,a significant number of children with IBD,especially Crohn's disease(CD) have impaired linear growth.Nutrition has an important role in the management of IBD.In adults with CD,enteral nutrition(EN) is effective in inducing clinical remission of IBD,although it is less efficient than corticosteroids.Exclusive EN is an established primary therapy for pediatric CD.Limited data suggests that EN is as efficient as corticosteroids for induction of remission.Additional advantages of nutritional therapy are control of inflammation,mucosal healing,positive benefits to growth and overall nutritional status with minimal adverse effects.The available evidence suggests that supplementary EN may be effective also for maintenance of remission in CD.More studies are needed to confirm these findings.However,EN supplementation could be considered as an alternative or as an adjunct to maintenance drug therapy in CD.EN does not have a primary therapeutic role in ulcerative colitis.Specific compositions of enteral dietselemental diets or diets containing specific components-were not shown to have any advantage over standard polymeric diets and their place in the treatment of CD or UC need further evaluation.Recent theories suggest that diet may be implicated in the etiology of IBD,however there are no proven dietary approaches to reduce the risk of developing IBD.

Dietary and metabolomic determinants of relapse in ulcerative colitis patients: A pilot prospective cohort study

AIM To identify demographic, clinical, metabolomic, and lifestyle related predictors of relapse in adult ulcerative colitis(UC) patients.METHODS In this prospective pilot study, UC patients in clinical remission were recruited and followed-up at 12 mo to assess a clinical relapse, or not. At baseline information on demographic and clinical parameters was collected. Serum and urine samples were collected for analysis of metabolomic assays using a combined direct infusion/liquid chromatography tandem mass spectrometry and nuclear magnetic resolution spectroscopy. Stool samples were also collected to measure fecal calprotectin(FCP). Dietary assessment was performed using a validated self-administered food frequency questionnaire. RESULTS Twenty patients were included(mean age: 42.7 ± 14.8 years, females: 55%). Seven patients(35%) experienced a clinical relapse during the follow-up period. While 6 patients(66.7%) with normal body weight developed a clinical relapse, 1 UC patient(9.1%) who was overweight/obese relapsed during the follow-up(P = 0.02). At baseline, poultry intake was significantly higher in patients who were still in remission during follow-up(0.9 oz vs 0.2 oz, P = 0.002). Five patients(71.4%) with FCP > 150 μg/g and 2 patients(15.4%) with normal FCP(≤ 150 μg/g) at baseline relapsed during the follow-up(P = 0.02). Interestingly, baseline urinary and serum metabolomic profiling of UC patients with or without clinical relapse within 12 mo showed a significant difference. The most important metabolites that were responsible for this discrimination were trans-aconitate, cystine and acetamide in urine, and 3-hydroxybutyrate, acetoacetate and acetone in serum. CONCLUSION A combination of baseline dietary intake, fecal calprotectin, and metabolomic factors are associated with risk of UC clinical relapse within 12 mo.

Impact of environmental and dietary factors on the course of inflammatory bowel disease

Besides their possible effects on the development of inflammatory bowel disease(IBD),some environmental factors can modulate the clinical course of both ulcerative colitis(UC) and Crohn's disease(CD).This review is mainly devoted to describing the current knowledge of the impact of some of these factors on the outcome of IBD,with special emphasis on smoking and diet.Although the impact of smoking on the susceptibility to develop CD and UC is firmly established,its influence on the clinical course of both diseases is still debatable.In CD,active smoking is a risk factor for postoperative recurrence.Beyond this clinical setting,smoking cessation seems to be advantageous in those CD patients who were smokers at disease diagnosis,while smoking resumption may be of benefit in ex-smokers with resistant UC.The role of dietary habits on the development of IBD is far from being well established.Also,food intolerances are very frequent,but usually inconsistent among IBD patients,and therefore no general dietary recommendations can be made in these patients.In general,IBD patients should eat a diet as varied as possible.Regarding the possible therapeutic role of some dietary components in IBD,lessons should be drawn from the investigation of the primary therapeutic effect of enteral nutrition in CD.Low-fat diets seem to be particularly useful.Also,some lipid sources,such as olive oil,medium-chain triglycerides,and perhaps omega-3 fatty acids,might have a therapeutic effect.Fermentable fiber may have a role in preventing relapses in inactive UC.

Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues in organ culture: Differential effects on ulcerative colitis and Crohn's disease

AIM： To investigate the influence of fish oil enriched enteral diet on intestinal tissues taken from Crohn＇s disease （CD）, ulcerative colitis （UC） and non-inflamed non-IBD control patients in vitro. METHODS： Colonoscopic biopsies from patients with active CD （n = 4）, active UC （n = 7）, and non-inflamed non-IBD control patients （n = 4） were incubated （three dilutions of 1：20, 1：10, and 1：5） with Waymouth＇s culture medium and enteral elemental diet （EO28, SHS, Liverpool, UK） modified in the fatty acid composition with fish oil （EF） in an organ culture system for 24 h. In each experimental set-up, incubation with Waymouth＇s medium alone as control was included. Tissue viability was assessed by adding bromodeoxyuridine （BrdU） to the culture fluid and immunohistochemically staining for BrdU uptake. Cytokine ratio of IL-1ra/IL-1β （low ratio indicative of inflammation） and production of those cytokines as a percentage of medium control were assayed in the culture supernatant. RESULTS： Incubation of CD-affected tissue with EF （1：20, 1：10, and 1：5） modestly and non-significantly increased IL-1ra/IL-1β ratio as compared with medium control （CD 39.1±16.1; 26.5±7.8, 47.1±16.8 vs control 13.0±2.2）, but incubation of UC-affected tissues increased IL-1ra/IL-1β ratio significantly in all three dilutions （UC 69.1±32.2, P〈0.05; 76.1±36.4, P = 0.05; 84.5±37.3, P〈0.02; vs control 10.2±3.7）. Incubation of non-inflamed non-IBD control tissue did not increase the IL-1ra/IL-1β ratio in any dilution compared to medium control （69.3±47.0, 54.1±30.6, 79.4±34.0 vs control 76.1±37.3）. Average percentage production of IL-1β indexed against medium control was significantly less in UC after EF incubation as compared with CD （UC 24.0±4.8 vs CD 51.8±8.1; P〈0.05）. Average percentage production of IL-tra was markedly higher in UC （135.9±3.4） than that in control patients （36.5±4.3） （p〈0.0001）. CONCLUSION： IBD tissues, after incubation with elemental diet modified in its fatty acid composition with fish oil, show an increase in IL-1ra/IL-1β cytokine ratio. This effect of ω-3 fatty acid modulation is significantly more marked in UC compared with CD and is accompanied by both a reduction of IL-1β and increase of IL-1ra. The positive direct anti-inflammatory effect of elemental diet with fish oil in tissue affected with UC suggests dietary treatment of UC may be possible.

Differential effects of energy balance on experimentally-induced colitis

AIM： To characterize the influence of diet-induced changes in body fat on colitis severity in SlVlAD3-/- mice.METHODS： SMAD3-/- mice （6-8 wk of age） were ran- domly assigned to receive a calorie restricted （30% of control; CR）, control （CON）, or high fat （HF） diet for 20 wk and were gavaged with sterile broth or with Helicobacter hepaticus （H. hepaticus） to induce colitis. Four weeks after infection, mice were sacrificed and the cecum and colons were processed for histological evaluation.RESULTS： Dietary treatment significantly influenced body composition prior to infection （P 〈 0.05）, with CR mice having less （14%±2%） and HF-fed mice more body fat （32% ± 7%） compared to controls （22%±4%）. Differences in body composition were associated with alterations in plasma levels of leptin （HF 〉 CON 〉 CR） and adiponectin （CON 〉 HF 〉/ CR） （P 〈 0.05）. There were no significant differences in colitis scores between CON and HF-fed mice 4 wk post-infection. Consistent with this, differences in proliferation and in- flammation markers （COX-2, iNOS）, and infiltrating cell types （CD3^＋ T lymphocytes, macrophages） were not observed. Unexpectedly, only 40% of CR mice survived infection with H. hepaticus, with mortality observed as early as I wk following induction of colitis.CONCLUSION： Increased adiposity does not influence colitis severity in SMAD3-/- mice. Importantly, caloric restriction negatively impacts survival following pathogen challenge, potentially due to an impaired immune response.