辛开苦降法在结直肠癌化疗相关性腹泻中的应用

在结直肠癌的内科治疗中,化疗有着举足轻重的地位。目前晚期结直肠癌的综合内科治疗仍采用指南推荐的以奥沙利铂、伊立替康、氟尿嘧啶为主的双药或三药联合的化疗方案[1],并且在辅助治疗中化疗也发挥着十分重要的作用。化疗相关性腹泻(chemotherapy induced diarrhea,CID)是以排便次数增加为主要表现的化疗后不良反应之一,在临床上十分常见[2]。其中以氟尿嘧啶类、伊立替康及其联合化疗方案引起的腹泻最为常见[3]。

温肾健脾汤治疗重症肺炎抗生素相关性腹泻的疗效观察及对肠道菌群的影响

重症肺炎是一种常见的呼吸道危重病症,常伴随呼吸衰竭、多器官功能障碍,对患者的生命安全构成严重威胁[1],细菌感染是重症肺炎主要的病因之一[2]。目前,抗生素对于该病的治疗效果取得重大进展[3],在临床治疗该病中抗生素常常联合使用[4],通过强效的抗菌作用消除细菌侵入体内所引起的相关感染,缓解患者的临床症状[5];但因该病治疗过程相对较长,患者常伴有其他疾病,侵入性操作多,抗酸剂应用多及饮食改变,易导致肠黏膜屏障受损;长期抗生素的使用会产生耐药[6],耐药菌一旦产生便容易侵蚀胃肠道黏膜,破坏正常肠道微生物群,导致药源性腹泻、恶心呕吐等一系列不良反应,尤以抗生素相关性腹泻(antibiotic-as-sociated diarrhea,AAD)发病率最高,也相对较为严重,严重者会导致治疗的中断,影响预后及康复[7]。

中药调节肠道菌群治疗肠易激综合征研究进展

肠易激综合征(irritable bowel syndrome,IBS)是常见的慢性功能性胃肠疾病,主要临床特点是反复腹痛或腹部不适,并伴有排便频率或粪便性质的改变[1]。根据确诊患者粪便性状的不同,可将IBS分为便秘型(irritable bowel syndrome with constipation,IBS-C)、腹泻型(irritable bowel syndrome with predominant diarrhea,IBS-D)、混合型(irritable bowel syndrome with mixed bowel habits,IBS-M)、未定型(irritable bowel syndrome unclassifified,IBS-U)[2]。

The protective role of prebiotics and probiotics on diarrhea and gut damage in the rotavirus-infected piglets

Rotavirus is one of the pathogenic causes that induce diarrhea in young animals, especially piglets, worldwide. However, nowadays, there is no specific drug available to treat the disease, and the related vaccines have no obvious efficiency in some countries. Via analyzing the pathogenesis of rotavirus, it inducing diarrhea is mainly due to disturb enteric nervous system, destroy gut mucosal integrity, induce intracellular electrolyte imbalance, and impair gut microbiota and immunity. Many studies have already proved that prebiotics and probiotics can mitigate the damage and diarrhea induced by rotavirus infection in hosts. Based on these, the current review summarizes and discusses the effects and mechanisms of prebiotics and probiotics on rotavirus-induced diarrhea in piglets. This information will highlight the basis for the swine production utilization of prebiotics and probiotics in the prevention or treatment of rotavirus infection in the future.

First identification of a novel Aichivirus D in goats with diarrhea

Kobuvirus comprises 6 officially recognized species,namely Aichivirus A-F,and can be further divided into 20 genotypes through VP1 gene phylogenetic analysis(https://ictv.global/report/chapter/picornaviridae/picornaviridae/kobuvirus).Aichivirus A in human,Aichivirus B in bovine,Aichivirus C in porcine and caprine,Aichivirus D in yak have been proved to be associated with diarrhea(Chen Y S et al.2013;Yang et al.2015;Zhu et al.2016;Zhai et al.2017;Wang et al.2020;Abi et al.2022;Yan et al.2023).

Lactose-free milk powder can effectively relieve diarrhea symptoms in weaning SD rats and children

Diarrhea has become the leading cause of illness and death among infants and young children in developing countries.Clinically,patients with diarrhea showed damaged intestinal epithelial villi,usually accompanied by lactase deficiency.In this study,we evaluated the therapeutic effects of lactose-free milk powder on rats and children with diarrhea.Antibiotic-associated diarrhea(AAD)model was established by gavage with antibiotic mixture in SD rats,followed by administration of milk powder containing lactose or not.The results showed that lactose-free milk powder ameliorated A AD-related diarrhea symptoms,and accelerated the recovery from diarrhea.And 16S sequencing results indicated lactose-free milk powder contributed to increase theα-andβ-diversity of intestinal flora,and restore the intestinal microbiota disorder.In conclusion,our data demonstrate that lactose-free milk powder could alleviate diarrhea by restoring gut microbiota and intestinal barrier function.

Transcriptome analysis suggests broad jejunal alterations in Linghu’s obesity-diarrhea syndrome:A pilot study

BACKGROUND Obesity is associated with a significantly increased risk for chronic diarrhea,which has been proposed as Linghu’s obesity-diarrhea syndrome(ODS);however,its molecular mechanisms are largely unknown.AIM To reveal the transcriptomic changes in the jejunum involved in ODS.METHODS In a cohort of 6 ODS patients(JOD group),6 obese people without diarrhea(JO group),and 6 healthy controls(JC group),high-throughput sequencing and bioinformatics analyses were performed to identify jejunal mucosal mRNA expression alterations and dysfunctional biological processes.In another cohort of 16 ODS patients(SOD group),16 obese people without diarrhea(SO group),and 16 healthy controls(SC group),serum diamine oxidase(DAO)and D-lactate(DLA)concentrations were detected to assess changes in intestinal barrier function.RESULTS The gene expression profiles of jejunal mucosa in the JO and JC groups were similar,with only 1 differentially expressed gene(DEG).The gene expression profile of the JOD group was significantly changed,with 411 DEGs compared with the JO group and 211 DEGs compared with the JC group,129 of which overlapped.The enrichment analysis of these DEGs showed that the biological processes such as digestion,absorption,and transport of nutrients(especially lipids)tended to be up-regulated in the JOD group,while the biological processes such as rRNA processing,mitochondrial translation,antimicrobial humoral response,DNA replication,and DNA repair tended to be down-regulated in the JOD group.Eight DEGs(CDT1,NHP2,EXOSC5,EPN3,NME1,REG3A,PLA2G2A,and PRSS2)may play a key regulatory role in the pathological process of ODS,and their expression levels were significantly decreased in ODS patients(P<0.001).In the second cohort,compared with healthy controls,the levels of serum intestinal barrier function markers(DAO and D-LA)were significantly increased in all obese individuals(P<0.01),but were higher in the SOD group than in the SO group(P<0.001).CONCLUSION Compared with healthy controls and obese individuals without diarrhea,patients with Linghu’s ODS had extensive transcriptomic changes in the jejunal mucosa,likely affecting intestinal barrier function and thus contributing to the obesity and chronic diarrhea phenotypes.

Gastrointestinal manifestations of critical ill heatstroke patients and their associations with outcomes:A multicentre,retrospective,observational study

BACKGROUND Extreme heat exposure is a growing health problem,and the effects of heat on the gastrointestinal(GI)tract is unknown.This study aimed to assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes.AIM To assess the incidence of GI symptoms associated with heatstroke and its impact on outcomes.METHODS Patients admitted to the intensive care unit(ICU)due to heatstroke were included from 83 centres.Patient history,laboratory results,and clinically relevant outcomes were recorded at ICU admission and daily until up to day 15,ICU discharge,or death.GI symptoms,including nausea/vomiting,diarrhoea,flatulence,and bloody stools,were recorded.The characteristics of patients with heatstroke concomitant with GI symptoms were described.Multivariable regression analyses were performed to determine significant predictors of GI symptoms.RESULTS A total of 713 patients were included in the final analysis,of whom 132(18.5%)patients had at least one GI symptom during their ICU stay,while 26(3.6%)suffered from more than one symptom.Patients with GI symptoms had a significantly higher ICU stay compared with those without.The mortality of patients who had two or more GI symptoms simultaneously was significantly higher than that in those with one GI symptom.Multivariable logistic regression analysis revealed that older patients with a lower GCS score on admission were more likely to experience GI symptoms.CONCLUSION The GI manifestations of heatstroke are common and appear to impact clinically relevant hospitalization outcomes.

A CRISPR/Cas12a-based platform for rapid on-site bovine viral diarrhea virus diagnostics

Bovine viral diarrhea virus(BVDV)is a positive-sense single-stranded RNA virus,belonging to the genus Pestivirus in the Flaviviridae family(Riitho et al.2020).Currently,BVDV is divided into 3 main genotypes,BVDV-1,BVDV-2,and BVDV-3,based on the genetic differences in the 5′untranslated region(5′UTR)(Muasya et al.2022).

Effects of early postnatal gastric and colonic microbiota transplantation on piglet gut health

Background Diarrhea is a major cause of reduced growth and mortality in piglets during the suckling and weaning periods and poses a major threat to the global pig industry.Diarrhea and gut dysbiosis may in part be prevented via improved early postnatal microbial colonization of the gut.To secure better postnatal gut colonization,we hypothesized that transplantation of colonic or gastric content from healthy donors to newborn recipients would prevent diarrhea in the recipients in the post-weaning period.Our objective was to examine the impact of transplanting colonic or gastric content on health and growth parameters and paraclinical parameters in recipient single-housed piglets exposed to a weaning transition and challenged with enterotoxigenic Escherichia coli(ETEC).Methods Seventy-two 1-day-old piglets were randomized to four groups:colonic microbiota transplantation(CMT,n=18),colonic content filtrate transplantation(CcFT,n=18),gastric microbiota transplantation(GMT,n=18),or saline(CON,n=18).Inoculations were given on d 2 and 3 of life,and all piglets were milk-fed until weaning(d 20)and shortly after challenged with ETEC(d 24).We assessed growth,diarrhea prevalence,ETEC concentration,organ weight,blood parameters,small intestinal morphology and histology,gut mucosal function,and microbiota composition and diversity.Results Episodes of diarrhea were seen in all groups during both the milk-and the solid-feeding phase,possibly due to stress associated with single housing.However,CcFT showed lower diarrhea prevalence on d 27,28,and 29 compared to CON(all P<0.05).CcFT also showed a lower ETEC prevalence on d 27(P<0.05).CMT showed a higher alpha diversity and a difference in beta diversity compared to CON(P<0.05).Growth and other paraclinical endpoints were similar across groups.Conclusion In conclusion,only CcFT reduced ETEC-related post-weaning diarrhea.However,the protective effect was marginal,suggesting that higher doses,more effective modalities of administration,longer treatment periods,and better donor quality should be explored by future research to optimize the protective effects of transplantation.

Calcium/calcimimetic via calcium-sensing receptor ameliorates cholera toxin-induced secretory diarrhea in mice

BACKGROUND Enterotoxins produce diarrhea through direct epithelial action and indirectly by activating the enteric nervous system.Calcium-sensing receptor(CaSR)inhibits both actions.The latter has been well documented in vitro but not in vivo.The hypothesis to be tested was that activating CaSR inhibits diarrhea in vivo.AIM To determine whether CaSR agonists ameliorate secretory diarrhea evoked by cholera toxin(CTX)in mice.METHODS CTX was given orally to C57BL/6 mice to induce diarrhea.Calcium and calci-mimetic R568 were used to activate CaSR.To maximize their local intestinal actions,calcium was administered luminally via oral rehydration solution(ORS),whereas R568 was applied serosally using an intraperitoneal route.To verify that their actions resulted from the intestine,effects were also examined on Cre-lox intestine-specific CaSR knockouts.Diarrhea outcome was measured biochemically by monitoring changes in fecal Cl-or clinically by assessing stool consistency and weight loss.RESULTS CTX induced secretory diarrhea,as evidenced by increases in fecal Cl-,stool consistency,and weight loss following CTX exposure,but did not alter CaSR,neither in content nor in function.Accordingly,calcium and R568 were each able to ameliorate diarrhea when applied to diseased intestines.Intestinal CaSR involvement is suggested by gene knockout experiments where the anti-diarrheal actions of R568 were lost in intestinal epithelial CaSR knockouts(villinCre/Casrflox/flox)and neuronal CaSR knockouts(nestinCre/Casrflox/flox).CONCLUSION Treatment of acute secretory diarrheas remains a global challenge.Despite advances in diarrhea research,few have been made in the realm of diarrhea therapeutics.ORS therapy has remained the standard of care,although it does not halt the losses of intestinal fluid and ions caused by pathogens.There is no cost-effective therapeutic for diarrhea.This and other studies suggest that adding calcium to ORS or using calcimimetics to activate intestinal CaSR might represent a novel approach for treating secretory diarrheal diseases.

Small intestine angioleiomyoma as a rare cause of perforation:A case report

BACKGROUND Angioleiomyoma is a rare and benign stromal tumor typically found in subcutaneous tissue.It rarely occurs in the gastrointestinal tract.Among the reported cases,the most common complication was gastrointestinal bleeding.Perforation has only been reported as a complication in the last few decades.CASE SUMMARY This case report detailed the discovery of intestinal angioleiomyoma in a 47-yearold male presenting with abdominal pain that had persisted for 3 d.After suspecting hollow organ perforation,surgical intervention involving intestinal resection and anastomosis was performed.CONCLUSION The report underscores the significance of early surgical intervention in effectively treating angioleiomyoma while emphasizing the pivotal role of timely and appropriate measures for favorable outcomes.

Relationship between dietary fiber intake and chronic diarrhea in adults

BACKGROUND Dietary fiber is essential for human health and can help reduce the symptoms of constipation.However,the relationship between dietary fiber and diarrhea is,poorly understood.AIM To evaluate the relationship between dietary fiber and chronic diarrhea.METHODS This retrospective study was conducted using data from the United States National Health and Nutrition Examination Survey,conducted between 2005 and 2010.Participants over the age of 20 were included.To measure dietary fiber consumption,two 24-hour meal recall interviews were conducted.The independent relationship between the total amount of dietary fiber and chronic diarrhea was evaluated with multiple logistic regression and interaction analysis.RESULTS Data from 12829 participants were analyzed.Participants without chronic diarrhea consumed more dietary fiber than participants with chronic diarrhea(29.7 vs 28.5,P=0.004).Additionally,in participants with chronic diarrhea,a correlation between sex and dietary fiber intake was present:Women who consume more than 25 g of dietary fiber daily can reduce the occurrence of chronic diarrhea.CONCLUSION Dietary fiber can reduce the occurrence of chronic diarrhea.

Sporadic gastrinoma with refractory benign esophageal stricture:A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.

When the vermiform appendix resembles a polyp: Be cautious of an intussuscepted appendix polypectomy

This article discusses a recently published case report on a rare instance of type IV appendiceal intussusception with a concurrent mucinous adenocarcinoma of the cecum in a young individual.The report highlights challenges in diagnosing ap-pendiceal intussusception,emphasizing the importance of endoscopic expertise in preventing impulsive decisions such as inappropriate polypectomies.The rarity of the concurrent intussuscepted appendix and mucinous cecal cancer is under-scored,prompting consideration of malignancy in appendiceal intussusception cases.Additionally,the report addresses the increasing incidence of early-onset colorectal cancer and the need for a revaluation of diagnostic paradigms in the context of evolving epidemiological trends.The awareness of potential misinter-pretations and the imperative for further investigation into this rare condition are emphasized.

Alteration of ascending colon mucosal microbiota in patients after cholecystectomy

BACKGROUND Cholecystectomy is a successful treatment option for gallstones,although the inci-dence of colorectal cancer(CRC)has notably increased in post-cholecystectomy(PC)patients.However,it remains uncertain whether the altered mucosal micro-biota in the ascending colon is related.In total,30 PC patients and 28 healthy controls underwent colonoscopies to collect mucosal biopsy samples.PC patients were divided based on their clinical features.Then,16S-rRNA gene sequencing was used to analyze the amplicon,alpha diversity,beta diversity,and composition of the bacterial communities.Addi-tionally,the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States(PICRUSt)database,sourced from the Kyoto Encyclopedia of Genes and Genomes,was used to predict the functional capabilities of the bac-teria.RESULTS PC patients were comparable with healthy controls.However,PC patients older than 60 years had a distinct composition compared to those under 60 years old.Bacteroidetes richness was considerably higher at the phylum level in PC patients.Bacteroides,Parabacteroides,and Bilophila were more abundant in the PC group than in the control group.Furthermore,PC patients exhibited greater enrichment in metabolic pathways,specifically those related to lipopolysaccharide biosynthesis and vancomycin group antibiotic production,than controls.CONCLUSION This study indicated that the mucosal microbiota in PC patients was altered,perhaps offering new perspectives on the treatment possibilities for CRC and diarrhea following cholecystectomy.

Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

参苓白术散穴贴联合蒙脱石散治疗重症患者肠内营养相关性腹泻的疗效观察

重症患者因病情严重且复杂,需长期卧床,常伴有免疫能力下降、肌肉萎缩,以及消化功能紊乱,导致患者出现营养不良等症状[1]。肠内营养是ICU患者重要的营养支持方式,早期采用肠内营养支持不仅有助于胃肠道功能恢复,改善肠黏膜屏障功能,还能有效提高患者的免疫力,但在进行肠内营养治疗过程中常因吸收不良、营养液渗透压较高等原因会出现肠内营养相关性腹泻(enteral nutrition related diarrhea, ENAD)[2]。

Exploring the impact of rotavirus vaccination on antibiotic prescription and resistance:A comprehensive systematic review

BACKGROUND Rotavirus is a highly contagious virus responsible for a significant burden of acute gastroenteritis,particularly among infants and young children worldwide,however,vaccination against this viral agent is available.Several studies have hypothesized that rotavirus vaccination has been linked to lower rates of antibiotic resistance.AIM To assess the relationship between rotavirus vaccination and antibiotic resistance.METHODS The present systematic review was tailored based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Several electronic databases(PubMed/MEDLINE,Scopus and Web of Science)were searched independently by two investigators in order to retrieve relevant publications published until April 2023 that investigated the aforementioned research question.RESULTS The comprehensive database search identified a total of 91 records.After the duplicates were removed(n=75),we screened the titles and abstracts of 16 potentially eligible publications.After the irrelevant records were excluded(n=5),we screened the full texts of 11 manuscripts.Finally,5 studies were entered into the qualitative and quantitative analysis.CONCLUSION In conclusion,all the studies support the idea that vaccinations can reduce the need for antibiotic prescriptions which could potentially contribute to mitigating antibiotic resistance.However,to fully comprehend the mechanisms of antibiotic resistance,enhance treatment guidelines,and consider diverse demographic situations,further research is necessary to use evidence-based strategies to fight antibiotic misuse and resistance.

Frequency of Rotavirus among under 5 Children Admitted to Wad Madani Pediatric Teaching Hospital with Diarrhea, Gezira State, Sudan (2021-2022)

Rotavirus is the leading cause of acute gastroenteritis and responsible for 20% of death in children under 5 years of age approximately 111 million episodes of gastroenteritis due to Rotavirus in under 5 children, which result in 25 million visits to clinic, 2 million hospitalization and 352,000 - 592,000 deaths. Children in the poorest countries account 82% of rotaviruses death. Diarrhea disease are major cause of death and disease among children under five years, a child on average suffers 2 to 3 attacks of diarrhea every year. Stools samples were collected from 196 children suffering from diarrhea and were tested for rotaviruses by immune chromatography test antigen (ICT-Ag), ELISA and RT PCR The data were analyzed using statistical package for the Social Sciences (SPSS). The results showed that prevalence of rotavirus was 26/196 (13.3%) by ICT Ag and ELISA and confirmed by RT-PC R. 87.8% of the children were vaccinated by Rota vaccine, 70% of their mothers not using soap for cleaning the children and thought diarrhea not infectious disease and believed it was caused by teething. In conclusion there was a decrease in prevalence of diarrhea by Rotavirus due to insertion of Rota vaccine in routine vaccination, rotavirus infection mostly occurs in poor family that not able to provide safe water and due to poor sanitation and low education of mother beside that some children suffered from malnutrition, so it recommended to incorporate ELISA as a diagnostic tool in routine diagnosis of rotavirus among children suffered from gastroenteritis.