Gelatin tannate and tyndallized probiotics: a novel approach for treatment of diarrhea

Intestinal permeability impairment is implicated in many gastrointestinal (GI) diseases. Chronic diarrhea, defined as the presence of diarrhea for more than 3 weeks in adults and 2 weeks in children, requires a different diagnostic and therapeutic work-up than acute diarrhea. Gelatin tannate, by reducing the clinical activity of acute colitis and the proinflammatory effects of lipopolysaccharide (LPS), is emerging as a mucosal barrier protector

Myeloid-derived miR-223 regulates intestinal inflammation via repression of the NLRP3 inflammasome

MicroRNA (miRNA)-mediated RNA interference regulates many immune processes, but how miRNA circuits orchestrate aberrant intestinal inflammation during inflammatory bowel disease (IBD) is poorly defined. Here, we report that miR-223 limits intestinal inflammation by constraining the nlrp3 inflammasome. miR-223 was increased in intestinal biopsies from patients with active IBD and in preclinical models of intestinal inflammation. miR-223-/y mice presented with exacerbated myeloid-driven experimental colitis with heightened clinical, histopathological, and cytokine readouts. Mechanistically, enhanced NLRP3 inflammasome expression with elevated IL-1β was a predominant feature during the initiation of colitis with miR-223 deficiency. Depletion of CCR2+ inflammatory monocytes and pharmacologic blockade of IL-1β or NLRP3 abrogated this phenotype. Generation of a novel mouse line, with deletion of the miR-223 binding site in the NLRP3 3′ untranslated region, phenocopied the characteristics of miR-223-/y mice. Finally, nanoparticle-mediated overexpression of miR-223 attenuated experimental colitis, NLRP3 levels, and IL-1β release. Collectively, our data reveal a previously unappreciated role for miR-223 in regulating the innate immune response during intestinal inflammation

The Role of Purported Mucoprotectants in Dealing with Irritable Bowel Syndrome, Functional Diarrhea, and Other Chronic Diarrheal Disorders in Adults

Chronic diarrhea is a frequent presenting symptom, both in primary care medicine and in specialized gastroenterology units. It is estimated that more than 5% of the global population suffers from chronic diarrhea. and that about 40% of these subjects are older than 60 years. The clinician is frequently faced with the need to decide which is the best therapeutic approach for these patients. While the origin of chronic diarrhea is diverse, impairment of intestinal barrier function, dysbiosis. and mucosal micro-inflammation are being increasingly recognized as underlying phenomena characterizing a variety of chronic diarrheal diseases. In addition to current pharmacological therapies, there is growing interest in alternative products such as mucoprotectants, which form a mucoadhesive film over the epithelium to reduce and protect against the development of altered intestinal permeability, dysbiosis, and mucosal micro-inflammation. This manuscript focuses on chronic diarrhea in adults, and we will review recent evidence on the ability of these natural compounds to improve symptoms associated with chronic diarrhea and to exert protective effects for the intestinal barrier

Impact of SARS-CoV-2 Infection on the Course of Inflammatory Bowel Disease in Patients Treated with Biological Therapeutic Agents: A Case-Control Study.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has raised concerns in patients with inflammatory bowel disease (IBD), not only due to consequences of coronavirus disease 2019 itself but also as a possible cause of IBD relapse. The main objective of this study was to assess the role of SARS-CoV-2 in IBD clinical recurrence in a cohort of patients undergoing biological therapy. Second, we evaluated the difference in C-reactive protein (CRP) levels between the start and end of the follow-up period (ΔCRP) and the rate of biological therapy discontinuation. Patients with IBD positive for SARS-CoV-2 infection were compared with non-infected patients. IBD recurrence was defined as the need for intensification of current therapy. We enrolled 95 IBD patients with SARS-CoV-2 infection and 190 non-infected patients. During follow-up, 11 of 95 (11.6%) SARS-CoV-2-infected patients experienced disease recurrence compared to 21 of 190 (11.3%) in the control group (p = 0.894). Forty-six (48.4%) SARS-CoV-2-infected patients discontinued biological therapy versus seven (3.7%) in the control group (p < 0.01). In the multivariate analysis, biological agent discontinuation (p = 0.033) and ΔCRP (p = 0.017), but not SARS-CoV-2 infection (p = 0.298), were associated with IBD recurrence. SARS-CoV-2 infection was not associated with increased IBD recurrence rates in this cohort of patients treated with biological agents

Prevalence of severe irritable bowel syndrome among Italian adults. A meta-analysis

OBJECTIVE: To provide a summary estimate of the prevalence of irritable bowel syndrome (IBS) and IBS with severe symptomatology, stratified by gender and subtype, among Italian adults. MATERIALS AND METHODS: We searched MedLine and Scopus databases to identify surveys on IBS prevalence among Italian samples, and/or severe IBS prevalence among Caucasian populations, up to June 2017. Random-effect proportion meta-analyses were used to obtain summary estimates of IBS prevalence. Raw numbers of adults with IBS or severe IBS were computed multiplying pooled prevalence estimates by the current Italian adult population. For both IBS and severe IBS, several estimates were provided according to different scenarios, using the pooled estimates from meta-analyses, their highest and lowest 95% confidence intervals (CI), and the lowest prevalence among all individual studies. RESULTS: The pooled prevalence of IBS among Italian adults, resulting from a meta-analysis of 5 studies including 40,654 subjects, was 7.7% (95% CI: 6.0%-9.7%). The lowest published estimate was 5.4%. The overall number of Italian adults with IBS may thus range between a minimum of 2,736,700 (1,797,800 females; 65.7%) and 4,915,800. From a meta-analysis of 17 studies including 16,873 subjects, the pooled proportion of severe IBS was 23.5% (95% CI: 18.7%-28.7%), with a lowest published estimate of 8.4%. The overall number of Italian adults with severe IBS may thus range between 229,900 (86,600 with constipation-predominant subtype; 70,600 diarrhea-predominant; 72,600 mixed/alternating) and 1,410,800. In a standard, still conservative scenario, based upon the lowest 95% CIs from meta-analyses, the Italians with severe IBS would be 511,800. CONCLUSIONS: Using an extremely conservative, lowest plausible estimate, no less than 230,000 Italian adults are suffering from severe IBS, requiring appropriate treatment and recognition by healthcare providers. A standardized instrument to measure IBS severity is urgently required to support diagnostic and therapeutic processes, and improve the precision of epidemiological estimates

Efficacy of gelatin tannate for acute diarrhea in children: a systematic review and meta-analysis

Aim: To investigate by meta-analysis the efficacy of gelatin tannate (GT), a mucosal barrier protector, in children with acute gastroenteritis. Methods: A comprehensive literature search was conducted. Studies were selected according to PICO: Participants: children aged 0-12 years with acute diarrhea; Intervention: GT; Comparison: oral rehydration solution and/or placebo; Outcomes: diarrhea-related outcomes. Results: Three published randomized controlled trials were identified of pediatric diarrhea treated with GT (n = 203) or control (n = 204). GT significantly (p < 0.01) reduced stool frequency at 12 h in two randomized controlled trials. A significant treatment effect (risk ratio = 0.74; p < 0.01) in favor of GT was found for the exploratory composite outcome of 'diarrhea or liquid stools at 24 h' in three studies. Risk ratios in a single study which reported the percentage of patients with liquid stools at 12, 24 and 48 h favored GT at all time points. No significant differences were found between GT and control for patients with diarrhea at 12 or 24 h or for duration of diarrhea. Conclusion: GT improved stool frequency and stool consistency in children with acute diarrhea, although further well-controlled studies would be useful to confirm a beneficial treatment effect

Gelatin tannate and tyndallized probiotics: a novel approach for treatment of diarrhea

Intestinal permeability impairment is implicated in many gastrointestinal (GI) diseases. Chronic diarrhea, defined as the presence of diarrhea for more than 3 weeks in adults and 2 weeks in children, requires a different diagnostic and therapeutic work-up than acute diarrhea. Gelatin tannate, by reducing the clinical activity of acute colitis and the proinflammatory effects of lipopolysaccharide (LPS), is emerging as a mucosal barrier protector

Gelatin tannate and tyndallized probiotics: a novel approach for treatment of diarrhea

Intestinal permeability impairment is implicated in many gastrointestinal (GI) diseases. Chronic diarrhea, defined as the presence of diarrhea for more than 3 weeks in adults and 2 weeks in children, requires a different diagnostic and therapeutic work-up than acute diarrhea. Gelatin tannate, by reducing the clinical activity of acute colitis and the proinflammatory effects of lipopolysaccharide (LPS), is emerging as a mucosal barrier protector

Inflammatory Bowel Disease Patients With Coronavirus Disease 2019: The Picture Is Taking Shape

We read with interest the systematic review on inflammatory bowel disease (IBD) patients with coronavirus disease 2019 (COVID-19) published by D\u2019Amico et al.1 The authors provided a comprehensive and up-to-date picture on the epidemiologic and clinical characteristics of IBD patients affected by COVID-19. We would like to elaborate on some points covered in their review. In particular, D\u2019Amico et al1 reported a cumulative prevalence of COVID-19 among IBD patients of 0.4%. This prevalence rate appears to be comparable with that found in the general population. Indeed, Taxonera et al2 recently reported that when these data were adjusted for age of the patients, a significantly lower standardized risk of COVID-19 was observed in patients with IBD compared with the general population (odds ratio, 0.74; 95% CI, 0.70\u20130.77; P < .001). We suggest that the reassuring prevalence rates of COVID-19 reported in patients with IBD largely are owing to IBD patients adhering to the preventive measures recommended by gastroenterologists. This belief also is confirmed by the absence of COVID-19 cases in 2 cohort studies of IBD patients from regions with a high prevalence of COVID-19 such as Wuhan (China) and Bergamo (Lombardy, Italy), where strict preventive measures were taken.3 , 4 The major preventive measures consisted of social distancing, hand washing, the use of personal protective equipment as recommended by the health authorities, and the creation of specific dedicated paths for patients who needed to access the hospital for the administration of biological infusion therapies.5 Obviously, similar preventive measures have been ensured for the health personnel involved in the management of these patients. Furthermore, all unnecessary visits were replaced with telemedicine. Hospitalizations and endoscopies were limited to emergencies.6 These positive results should encourage clinicians to continue diligent protection of patients with IBD, even in those countries where the pandemic curve has flattened. The persistence of active outbreaks of severe acute respiratory syndrome coronavirus 2 could lead to a second wave of viral spread. Obviously, in countries with a reduction in the incidence of the pandemic, diagnostic, endoscopic, and nonurgent surgical activities are resuming according to an order of priority decided on a case-by-case basis. Resumption strategies always should favor the safety of patients and health professionals