Successful Experience of Fecal Transplantation in a Patient with Severe Pseudomembranous Colitis

Introduction. At the present time there is increase the number of patients diagnosed with pseudomembranous colitis due to Clostridiodes difficile, respectively it significantly increases the frequency of hospitalizations, the length of hospital stay and the cost of treatment. Approved drug methods for correcting a  pathological condition are not always able to lead to recovery after the first use, repeated and prolonged courses of therapy are often required, especially with recurrent Clostridiodes difficile. An alternative way of treatment is fecal microbiota transplantation from a donor. Nowadays, fecal microbiota transplantation is included in national clinical guidelines in several countries in Europe, the USA and Australia. In Russia this method has not been registered, however, there are some publications about its successful application in gastrointestinal diseases, oncohematology, and some autoimmune diseases. Aim. To show the result of successful treatment of severe pseudomembranous colitis after a single fecal microbiota transplantation.Material and methods. Outpatient treatment of an acute respiratory infection with a broad-spectrum antibacterial drug caused the development of severe pseudomembranous colitis in a young patient. Standard courses of metronidazole and vancomycin were unsuccessful. Transplantation of fecal microbiota from a donor was performed via ileocolonoscopy.Results. A single fecal microbiota transplantation contributed to the patient’s complete recovery, short term  rehabilitation and the absence of recurrence of Clostridiodes difficile within two years. Conclusions. Evidence-based medicine has shown the high efficiency of fecal microbiota transplantation. In Russia a legislative basis is needed for including fecal microbiota transplantation in clinical guidelines for the treatment of severe Clostridiodes difficile resistant to standard therapy

Protracted fever after infliximab induction therapy in a patient with ulcerative colitis (clinical case)

Inflammatory bowel diseases (ulcerative colitis and Crohn’s disease) tend to increase in frequency and prevalence worldwide and lead to a significant reduction in quality of life with a complicated course. Intravenous administration of corticosteroids in acute severe ulcerative colitis is effective in 60–70 % of cases. Rescue therapy for patients with steroid‐refractory and steroid-dependence attacks is effective for reducing colectomy or colproctectomy and improves long-term treatment outcomes. Despite the proven efficacy of infliximab, limitations to the use of monoclonal antibodies are adverse reactions to the administration of genetically engineered biologic therapy (GEBT), both well-known and studied, and rare.The aim of the study. To analyze a case of an extremely rare and paradoxical incurable hyperergic reaction that occurred after using genetically engineered biological therapy with tumor necrosis factor alpha blockers in a patient suffering from ulcerative colitis.Materials and methods. We carried out the search in the PubMed, Embase, Scopus and Medline databases until November 1, 2022 using the following keywords: inflammatory bowel disease, ulcerative colitis (UC), anti-tumor necrosis factor α (antiTNFα), infliximab, fever, adverse events. In the scientific electronic library eLIBRARY, a search was made for Russian-language publications using similar queries in Russian. We analyzed the patient’s medical records from 03.06.2013 up to the present day; the patient signed an informed consent for the publication and discussion of the presented data.Conclusion. The widespread use of GEBT in the treatment of autoimmune and autoinflammatory diseases leads to the accumulation of both positive and negative experience of clinicians in real clinical practice. The officially described adverse events in the appointment of any drug suggest options for their prevention and treatment. Atypical manifestations or casuistic cases must be systematized for further fundamental pathophysiological studies

Assessment of the State of Cell Membranes against the Background of Prolonged Use of Anticytokine Therapy in Patients with Ulcerative Colitis

Biological therapy in the treatment of immune-mediated conditions has changed their course, the quality of life of patients and the prognosis of diseases. The accumulated by mankind 20 years of experience with the use of genetically engineered drugs has led to a number of questions regarding, among other issues, safety in the long-term administration of biological therapy. Patients suffering from ulcerative colitis revealed changes in cell membranes, reflecting their structural and energy characteristics. Long-term administration of Infliximab leads to the stabilization of energy processes in the erythrocyte membrane and improves homeostatic function of the kidneys.The aim of the study was to evaluate the effect of long-term use of TNF-α blockers (Infliximab) on the structural and functional characteristics of cell membranes and the functional state of the kidneys in patients with moderate to severe ulcerative colitis.Materials and methods. We examined 103 patients with moderate to severe ulcerative colitis during the period of acute attack and remission, of which 28 patients received basic therapy using the drug Infliximab (IFX) for 10 years, 75 patients received standard basic treatment. The patients of the biological therapy group took the original drug Infliximab – Remicade. The comparison group consisted of 30 healthy volunteers, comparable by sex and age. The analysis of the state of erythrocyte membranes was carried out using a set of physicochemical methods: UV spectroscopy (SF-46m spectrophotometer), high-performance thin-layer reaction paper chromatography, membrane ultrafiltration, erythrocyte NMR spectroscopy on phosphoric (31P) and proton (1H) nuclei. The functional state of the kidneys was evaluated using a dynamic scintigraphic study (with the technemage –Tc-99m).Results. Prolonged use of anticytokine therapy with Infliximab for 10 years in patients with ulcerative colitis, upon reaching deep remission, improves endogenous intoxication, restores the structural and functional characteristics of cell membranes, normalizes cell energy metabolism and does not negatively affect the functional state of the kidneys

Fecal calprotectin and microbiota of the gut

Analysis of the literature and our research showed that an imbalance of the intestinal microbiota is associated with many diseases. We present some of the mechanisms of disease. Using non-invasive, simple, affordable method of determination of fecal calprotectin reveals the presence and progression of chronic non-specific inflammatory bowel disease, and can be widely used in clinical practic

Association of Interleukin-10 Gene Polymorphisms with Ulcerative Colitis

This literature review is devoted to the study of the role of polymorphic variants of the anti-inflammatory interleukin-10 gene (Interleukin-10, IL10) in the etiology and pathogenesis of ulcerative colitis in patients of various ethnic groups.Aim. To generalize the results obtained from electronic databases on the study of the characteristics of the course of ulcerative colitis in patients of different ethnic groups, taking into account the carriage of IL10 gene polymorphisms.Materials and methods. Twenty-five studies were selected, including four meta-analyzes devoted to the  study of associative relationships of single nucleotide polymorphisms (SNPs) of the IL10 gene isolated from  blood samples at positions -592AA/CA, -819CT, -1082АА/GA, and rs3024505 in the development and course of ulcerative colitis.Results. A number of researchers from Europe, Saudi Arabia report an increased incidence of ulcerative colitis among carriers of the IL10-1082AA SNP and a low incidence among carriers of -592AA. Positive associations of IL10-819CT with the prevalence of ulcerative colitis are presented in single reports from Europe, the Middle East and in a number of studies from Asian countries. However, the identified associations, even within the  same population, are often contradictory. Perhaps the discrepancies are due to the ethnic heterogeneity of the groups in the considered cohorts, and therefore it is necessary to continue epidemiological studies with a large sample size in specific geographic areas

Peculiarities of topographic anatomy and crypt compartment of distal colon in Wistar rats

We studied distal colon of Wistar rats including descending transverse colon and rectum. Feature of distal colon in the left flexure are short mesenterium growing in size towards rectum, common mesenterium with small intestine attached to it on the right side and ligament forming left flexure and attached to it on the left side. It was found that one of the variants of normal blood supply is the absence of a. mesenterica caudalis. In this case blood supply comes from arterial arch formed by a. rectalis media and a. colica media. Moreover, in the classic variant of blood supply we revealed a variation in the amount of straight branches that go to this segment of colon wall from left colic and superior rectal arteries (from 3 to 5 from each artery). The structural features of rectum is weak expression of rectal ampulla that causes the depletion of fecal masses immediately after passing into rectum. Crypt compartment of colon of Wistar rats consists by 80,6 % of obligatory flora represented with Bacteroides ssp., Lactobacillus spp., Bifidobacterium spp., Enterococcus faecalis, E. coli (lac+), Grampositive rods. Facultative flora is represented with Proteus mirabilis, Peptococcus spp., Candida spp., Staphylococcus epidermidis, Citrobacter freundii and makes 19,4 %

Результаты оценки микробиоты в условиях экспериментального язвенного поражения толстой кишки

 Background. The increased incidence of inflammatory bowel disease (IBD) in the world and the lack of consensus on the causes and development mechanisms of IBD are the key elements that determine the relevance of the study. According to some authors, in the pathogenesis of the development and occurrence of ulcerative colitis, one of the leading causes is a change in the composition of the colon microflora and the impact of the products of their metabolism on the enteric system and intestinal motility.The aim was to study the qualitative and quantitative changes in the colon microbiota in rats when modeling ulcerative lesions by the original method.Materials and methods. The experimental study was carried out using male Wistar rats (n = 24). Ulcerative colitis was modeled in an original way. The quantitative and qualitative composition of the parietal microflora of the distal colon was determined.Results. When modeling ulcerative lesions of the colon using the original method, changes in the qualitative and quantitative composition of the parietal microflora of the colon were revealed. On the 3rd day there was a decrease in Lactobacillus ssp. and Escherichia coli, as well as the growth of  fungal microflora and the appearance of representatives of opportunistic microflora. The changes were progressive in nature, and by the 7th day of the study revealed a marked reduction of the total parietal concentration of the normal flora bacteria and an increased percentage and absolute number of representatives of conditionally pathogenic microflora. By the 10th day of the experiment, with a small increase in the total number of parietal bacteria, the  predominant microorganisms were Bacteroides ssp. (26.8%) and Peptococcus ssp. (27.6%).  Введение. Язвенный колит – хроническое  рецидивирующее системное воспалительное заболевание с преимущественным поражением слизистой оболочки  толстой кишки. Каждый год регистрируется до 20 новых случаев заболевания на 100 тыс. населения, в основном среди лиц трудоспособного возраста. По мнению ряда авторов, в патогенезе развития и возникновения  заболевания одну из ведущих причин играет изменение в составе микрофлоры толстой кишки, а также продукты их метаболизма, воздействующие на энтериновую систему и моторику кишечника.Цель. Изучить показатели микробиоты толстой кишки у самцов крыс линии Вистар при моделировании язвенного поражения.Материалы и методы. Экспериментальное исследование выполнено с использованием самцов крыс линии Вистар (n = 24). Предложен оригинальный способ модели язвенного колита. Определен количественный и качественный состав пристеночной микрофлоры дистального отдела толстой кишки.Результаты. Выявлены изменения качественного и количественного состава пристеночной микрофлоры толстой кишки: на 3-и сут отмечали снижение концентрации Lactobacillus ssp. и Escherichia coli, а также рост грибковой микрофлоры, появление представителей условно-патогенной микрофлоры. Изменения носили прогрессирующий характер, и уже к 7-м сут выявляли  выраженное снижение общей пристеночной концентрации бактерий нормофлоры и повышение процентного и абсолютного числа представителей условно-патогенной микрофлоры. К 10-м сут эксперимента при малом увеличении общей численности пристеночных бактерий преобладающей микрофлорой являются Bacteroides ssp. (26,8%) и Peptococcus ssp. (27,6%).

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

The hardware method of biomaterial preparation for fecal transplantation

Background: Nowadays fecal transplantation (FT) is considered as a  component of the treatment for a  wide range of disorders, including autoimmune diseases (ulcerative colitis, Crohn's disease, type 1 diabetes mellitus and insulin resistance, multiple sclerosis, psoriasis). High-quality preparation of the biomaterial is a necessary procedure that allows for long-time storage of the prepared fecal transplant at ultralow temperature conditions and it use as needed.Aim: To optimize the method of preparation of the biomaterial for fecal transplantation and to evaluate its "survival" at different time points under cryopreservation conditions.Materials and methods: A device for the preparation of donor fecal material for transplantation has been developed and proposed (the Russian Federation patent No. 2659417 from July 2, 2018). Donor fecal material (collected in a  sterile container on the same day of preparation in the morning), the solvent, and glycerol are homogenized automatically in the closed loop device and passed through a disposable filter with attached sterile hemocon container. Freezing at ultralow temperature (cryopreservation at -80 °C) allows for long time storage of this fecal graft. We studied the microbial composition of the obtained native substrate and samples that were cryopreserved at different time points (7 to 365 days).Results: The proposed original method makes it possible to prepare the biomaterial for storage at a low temperature mode without any contact, in a  closed loop, for subsequent fecal transplantation within 6–12 months. The analysis of the fecal transplant at different time points has shown no qualitative and quantitative differences in the microbial composition between the native donor material and the freshly prepared filtrate. The biomaterial prepared according to the original method is stable for 12 months.Conclusion: The proposed hardware method for preparing the biomaterial for fecal transplantation is easy to use and allows for the preparation of a  graft with minimal external microbial contamination, in contrast to the conventional method of donor material preparation by filtering fecal matter through gauze or coffee filters with manual assistance