Etiopathogenic and Clinical Aspects in Inflammatory Bowel Disease – Literature Review

Inflammatory bowel disease (IBD) is a chronic inflammatory condition which encompasses Crohn’s disease and ulcerative colitis. IBD does not only affect the gastrointestinal system, but also associates many extraintestinal complications that can affect almost any organ. A large number of patients may have these complications before or after the diagnosis of IBD. Early diagnosis and management of these complications involves a multidisciplinary team and contributes to decrease patient morbidity and mortality, but also to increase the quality of life. The purpose of this extensive literature review is to present systematically and comprehensively the latest data on the extraintestinal manifestations of IBD, and to draw clinicians’ attention to the fact that this condition can have extradigestive manifestations that can be misleading and delay the diagnosis.

Entamoeba histolytica—Gut Microbiota Interaction: More Than Meets the Eye

Amebiasis is a disease caused by the unicellular parasite Entamoeba histolytica. In most cases, the infection is asymptomatic but when symptomatic, the infection can cause dysentery and invasive extraintestinal complications. In the gut, E. histolytica feeds on bacteria. Increasing evidences support the role of the gut microbiota in the development of the disease. In this review we will discuss the consequences of E. histolytica infection on the gut microbiota. We will also discuss new evidences about the role of gut microbiota in regulating the resistance of the parasite to oxidative stress and its virulence.

Do Only Calcium and Vitamin D Matter? Micronutrients in the Diet of Inflammatory Bowel Diseases Patients and the Risk of Osteoporosis

Osteoporosis is one of the most common extraintestinal complications among patients suffering from inflammatory bowel diseases. The role of vitamin D and calcium in the prevention of a decreased bone mineral density is well known, although other nutrients, including micronutrients, are also of extreme importance. Despite the fact that zinc, copper, selenium, iron, cadmium, silicon and fluorine have not been frequently discussed with regard to the prevention of osteoporosis, it is possible that a deficiency or excess of the abovementioned elements may affect bone mineralization. Additionally, the risk of malnutrition, which is common in patients with ulcerative colitis or Crohn’s disease, as well as the composition of gut microbiota, may be associated with micronutrients status.

Vedolizumab in Inflammatory Bowel Disease: West versus East

<b><i>Background:</i></b> Vedolizumab is a humanized immunoglobulin G1 monoclonal antibody, which binds to α4β7 integrin on T lymphocytes, thus disturbing the interaction with mucosal vascular addressin cell adhesion molecule 1 on the intestinal endothelial cells to interfere with lymphocyte trafficking to the gut. <b><i>Summary:</i></b> Vedolizumab is a safe and effective drug to induce and maintain clinical remission in patients with Crohn’s disease (CD) and ulcerative colitis (UC) in both clinical trials and real-world data. Various guidelines recommend vedolizumab as a first- or second-line treatment regimen for steroid-dependent, steroid, or immunomodulator refractory cases of UC and CD; however, it is more effective in anti-TNF-naive patients. The first head-to-head trial (VARSITY trial) comparing the efficacy of vedolizumab to adalimumab has shown better clinical remission and mucosal healing with vedolizumab. <b><i>Key Messages:</i></b> In this review, we have discussed guidelines recommendation of vedolizumab use, as well as its safety data, use in special population, in presence of extraintestinal complications, therapeutic drug monitoring, data from Asian patients, along with other evolving concepts. Because of its excellent safety data and low immunogenicity, vedolizumab is an impressive option for patients with prior malignancy and less chance of reactivation of tuberculosis; however, cost remains an issue.

Secondary infection of amoeba and typhoid fever in severe malnourished pediatric patient with Type I choledocal cyst: a case report

ABSTRACT Amebiasis is caused by the protozoan Entamoeba histolytica. Extraintestinal amebiasis manifestation includes liver abscess and other rare manifestations involving the lungs, heart and brain. Liver abscess is the most common extraintestinal manifestation. Only few cases of amebic splenic abscess and two cases of gall bladder abscess have been reported. Typhoid fever is an infection caused by Salmonella typhi. It can cause extraintestinal complications such as myocarditis, endocarditis, pneumonia, empyema, osteomyelitis, arthritis, cholecystitis, spleen abscess and liver abscess. Choledocal cyst is a congenital dilation of the biliary branch. If left untreated, it can cause morbidity from cholangitis, cyst perforation, liver failure and malignancy. Until now, there is no publication about double infection of amebic and salmonella infection in a child with choledocal cyst.

Fast Magnetic Resonance Enterography Protocol for the Evaluation of Patients with Crohn’s Disease: A Pilot Study

Objective: Magnetic resonance enterography has achieved an increasingly importance in the evaluation of patients with Crohn’s disease, although it is limited by high costs and prolonged scanning times. The aim of our work was to design a “fast” abbreviated MRE protocol and to compare it with the standard one. Materials and Methods: A single-center retrospective study was performed on 73 patients with Crohn’s disease who underwent MRE with standard protocol over a 7-month period. The images of the standard protocol were separated from those included in the proposed abbreviated one and independently evaluated by two radiologists with different years of experience in MRE imaging. Statistical analysis was performed with the Cohen kappa (κ) value, used to assess the agreement in case of categorical variables, the Lin’s concordance correlation coefficient and Bland–Altman plot, in assessing the degree of agreement between numerical measurements, while the non- parametric Mann–Whitney U-test was used in comparing the evaluation times of the two protocols. Results: The intraobserver evaluation showed a perfect agreement between the two protocols for presence, number and extension of lesions, abdominal complications, and excellent/perfect in identification of active inflammation.The interobserver reproducibility was excellent for overall presence and number of lesions, for the presence and number of lesions in any abdominal quadrant, inflammation, intestinal and extraintestinal complications, and lesions extension. Conclusion: The proposed protocol achieves comparable performance with standard MRE. Furthermore, it would carry potential benefits in terms of patient’s comfort, time, and health-care costs savings.

Cerebral Vasculitis in Ulcerative Colitis Is Predominantly Venular: Case Report and Review of the Literature

Extraintestinal complications of ulcerative colitis include isolated case reports of cerebral vasculitis. In this case report, we describe autopsy findings in a 50-year-old female who died as a result of massive multifocal cerebral hemorrhage. Microscopic examination of the left colon showed findings typical for ulcerative colitis. Examination of the brain showed an extensive vasculitis. More affected vessels were noted in grey matter than in white matter. Many showed fibrinoid necrosis, invasion by neutrophils and thrombosis. There was extensive perivascular hemorrhage with associated infarction. Vessel analysis shows most of the vessels to have been venous rather than arterial. There were no perivascular sleeves of demyelination to suggest a primary demyelinating disorder, such as acute hemorrhagic leucoencephalitis. Our analysis shows that veins are the likely target of cerebral vasculitis in ulcerative colitis. This has clinical implications because venous occlusion generally causes massive intracerebral hemorrhage with a high mortality.

Virulence typing and antibiotic susceptibility profiling of thermophilic Campylobacters isolated from poultry, animal, and human species

Background and Aim: Campylobacteriosis finds its place among the four important global foodborne illnesses. The disease, though self-limiting, needs antibacterial therapy in extraintestinal complications. Therefore, the present study was designed to estimate the prevalence of thermophilic Campylobacters in poultry, animals, and humans of the Kumaon region of Uttarakhand. Materials and Methods: A total of 609 samples comprising of poultry ceca (n=116), poultry droppings (n=203), and feces of pigs (n=71), cattle (n=61), sheep (n=19), goat (n=17), human beings (n=88), and laboratory animals (n=34) (rats, rabbits, and guinea pigs) were collected. The thermophilic Campylobacters, Campylobacter jejuni and Campylobacter coli were confirmed using multiplex polymerase chain reaction. The isolates were also screened for the presence of virulence genes, and their antibiotic susceptibility testing was done against eight antibiotics. Results: An overall prevalence of 6.24% was revealed with highest from poultry ceca (15.52%), followed by poultry droppings (5.91%), cattle feces (4.92%), human stools (3.40%), and pig feces (2.82%). The virulence genes, namely cadF, flaA, virB11, and pldA, were present in 38 (100%), 37 (97.37%), 7 (18.42%), and 14 (36.84%) isolates, respectively. All the isolates were resistant to nalidixic acid, while all were sensitive to erythromycin and co-trimoxazole. Conclusion: It was concluded that the animals and humans in the region harbored the thermophilic Campylobacters which may contribute to the human illness. Resistance shown among the isolates may complicate the antimicrobial therapy.

Dry Gangrene in Children with Typhoid Intestinal Perforation: A Report of Two Cases

Intestinal perforation is a life-threatening complication of typhoid fever commonly seen in developing countries, but extraintestinal complications are infrequently reported. We report herein two cases of gangrene seen in children managed for typhoid intestinal perforation, highlighting the challenges faced in their management.