Responses to faecal microbiota transplantation in female and male patients with irritable bowel syndrome

BACKGROUND Faecal microbiota transplantation(FMT)seems to be a promising treatment for irritable bowel syndrome(IBS)patients.In Western countries(United States and Europe),there is a female predominance in IBS.A sex difference in the response to FMT has been reported recently in IBS patients.AIM To investigate whether there was a sex difference in the response to FMT in the IBS patients who were included in our previous randomized controlled trial of the efficacy of FMT.METHODS The study included 164 IBS patients who participated in our previous randomized controlled trial.These patients had moderate-to-severe IBS symptoms belonging to the IBS-D(diarrhoea-predominant),IBS-C(constipation-predominant)and IBSM(mixed)subtypes,and had not responded to the National Institute for Health and Care Excellence(NICE)-modified diet.They belonged in three groups:placebo(own faeces),and active treated group(30-g or 60-g superdonor faeces).The patients completed the IBS severity scoring system(IBS-SSS),Fatigue Assessment Scale(FAS)and the IBS quality of life scale(IBS-QoL)questionnaires at the baseline and 2 wk,1 mo and 3 mo after FMT.They also provided faecal samples at the baseline and 1 mo after FMT.The faecal bacteria profile and dysbiosis were determined using the 16S rRNA gene polymerase chain reaction DNA amplification covering V3-V9;probe labelling by single nucleotide extension and signal detection.The levels of short-chain fatty acids(SCFAs)were determined by gas chromatography and flame ionization.RESULTS There was no sex difference in the response to FMT either in the placebo group or active treated group.There was no difference between females and males in either the placebo group or actively treated groups in the total score on the IBS-SSS,FAS or IBS-QoL,in dysbiosis,or in the faecal bacteria or SCFA level.However,the response rate was significantly higher in females with diarrhoea-predominant(IBS-D)than that of males at 1 mo,and 3 mo after FMT.Moreover,IBS-SSS total score was significantly lower in female patients with IBS-D than that of male patients both 1 mo and 3 mo after FMT.CONCLUSION There was no sex difference in the response to FMT among IBS patients with moderate-to-severe symptoms who had previously not responded to NICEmodified diet.However,female patients with IBS-D respond better and have higher reduction of symptoms than males after FMT.

Routine diagnosis of intestinal tuberculosis and Crohn's disease in Southern India

AIM:To investigate whether routinely measured clinical variables could aid in differentiating intestinal tuberculosis(ITB)from Crohn’s disease(CD).METHODS:ITB and CD patients were prospectively included at four South Indian medical centres from October 2009 to July 2012.Routine investigations included case history,physical examination,blood biochemistry,ileocolonoscopy and histopathological examination of biopsies.Patients were followed-up after 2 and 6 mo of treatment.The diagnosis of ITB or CD was re-evaluated after 2 mo of antituberculous chemotherapy or immune suppressive therapy respectively,based on improvement in signs,symptoms and laboratory variables.This study was considered to be an exploratory analysis.Clinical,endoscopic and histopathological features recorded at the time of inclusion were subject to univariate analyses.Disease variables with sufficient number of recordings and P<0.05 were entered into logistic regression models,adjusted for known confounders.Finally,we calculated the odds ratios with respective confidence intervals for variables associated with either ITB or CD.RESULTS:This study included 38 ITB and 37 CD patients.Overall,ITB patients had the lowest body mass index(19.6 vs 22.7,P=0.01)and more commonly reported weight loss(73%vs 38%,P<0.01),watery diarrhoea(64%vs 33%,P=0.01)and rural domicile(58%vs 35%,P<0.05).Endoscopy typically showed mucosal nodularity(17/31 vs 2/37,P<0.01)and histopathology more frequently showed granulomas(10/30vs 2/35,P<0.01).The CD patients more frequently reported malaise(87%vs 64%,P=0.03),nausea(84%vs 56%,P=0.01),pain in the right lower abdominal quadrant on examination(90%vs 54%,P<0.01)and urban domicile(65%vs 42%,P<0.05).In CD,endoscopy typically showed involvement of multiple intestinal segments(27/37 vs 9/31,P<0.01).Using logistic regression analysis we found weight loss and nodularity of the mucosa were independently associated with ITB,with adjusted odds ratios of 8.6(95%CI:2.1-35.6)and 18.9(95%CI:3.5-102.8)respectively.Right lower abdominal quadrant pain on examination and involvement of≥3 intestinal segments were independently associated with CD with adjusted odds ratios of 10.1(95%CI:2.0-51.3)and 5.9(95%CI:1.7-20.6),respectively.CONCLUSION:Weight loss and mucosal nodularity were associated with ITB.Abdominal pain and excessive intestinal involvement were associated with CD.ITB and CD were equally common.

Real-life chromoendoscopy for dysplasia surveillance in ulcerative colitis

AIM To evaluate the use of chromoendoscopy for surveillance of ulcerative colitis in a real-life community hospital setting.METHODS Patients with extensive ulcerative colitis, having disease duration of more than 8 years and who presented between the years of 1999 to 2013, were offered enrolment in this single cohort prospective study. All participants underwent standard bowel preparation with sodium phosphate and chromoendoscopy. Two expert endoscopists, novice to chromoendoscopy, evaluated each segment of the colon with standarddefinition colonoscopes after spray application of 0.4% indigo carmine. All observed lesions were recorded and evaluated before being removed and/or biopsied. In addition, nontargeted biopsies were taken from each segment of the colon. The dysplasia detection rate and dysplasia detection yield were ascertained. RESULTS A total of 21 neoplastic lesions(2 carcinomas, 4 of high-grade dysplasia and 15 of low-grade dysplasia) and 27 nondysplastic lesions were detected in 16 of the total 67 patients(70% male; median disease duration: 17 years; median age at diagnosis: 25 years; 92% aminosalicylate-treated). The dysplasia detection rate was 10.5%(7/67 patients). The dysplasia detection yield was 20.8%(10/48) for targeted biopsies and 3.5%(11/318) for nontargeted biopsies. The sensitivity and specificity for the macroscopic evaluation of neoplasia using chromoendoscopy were 48% [95% confidence interval(CI): 26%-70%] and 96%(95%CI: 93%-98%), respectively. The positive predictive and negative predictive values were 42%(95%CI: 27%-59%) and 97%(95%CI: 95%-98%), respectively. A total of 19/21 dysplastic lesions were detected in mucosa with histologic inflammation.CONCLUSION Chromoendoscopy seems to be of value for dysplasia surveillance of ulcerative colitis in a community hospital setting. The yield of non-targeted biopsies is negligible.