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

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

Proteobacteria: A Common Factor in Human Diseases

N/

Winter Is Coming and COVID-19 Vaccine Is Available! The Role of Gastroenterologist in Increasing COVID-19 Vaccine Acceptability Among IBD Patients

N/

Exploring Bacteroidetes: Metabolic key points and immunological tricks of our gut commensals

Bacteroidetes are the largest phylum of Gram-negative bacteria inhabiting our gastrointestinal tract and are considered the leading players of the healthy state and sophisticated homeostasis safeguarded by gut microbiota. Furthermore, specific roles have been attributed to some Bacteroidetes genera in the development of immune dysregulation, systemic disease such as metabolic syndrome and also neurological disorders. Glycoproteins secretion, short fatty acids imbalance, toxins production and molecular mimicry are only a part of the functions exerted by these commensals interacting with the host. The aim of this review is to summarize the current knowledge on the recognized role of Bacteroidetes in physiological functions and pathological networks in order to define the needs for future research and clarify the potential role for targeted microbial therapies

Actinobacteria: A relevant minority for the maintenance of gut homeostasis

Actinobacteria are one the four major phyla of the gut microbiota and, although they represent only a small percentage, are pivotal in the maintenance of gut homeostasis. During the last decade many studies focused the attention on Actinobacteria, especially on their role both in gastrointestinal and systemic diseases and on their possible therapeutic use. In fact, classes of this phylum, especially Bifidobacteria, are widely used as probiotic demonstrating beneficial effects in many pathological conditions, even if larger in vivo studies are needed to confirm such encouraging results. This review aims to explore the current knowledge on their physiological functions and to speculate on their possible therapeutic role(s) in gastrointestinal and systemic diseases

Human herpesvirus 8-associated colonic Kaposi's sarcoma during vedolizumab treatment in ulcerative colitis: A case report and review of the literature

Background: Kaposi's sarcoma (KS) is a rare vascular tumor associated with human herpesvirus (HHV)-8 infection. One of the variants of KS is defined iatrogenic and is overall reported in transplanted patient but also, although less frequently, in patients treated with long-standing immunosuppressive therapy, such as in inflammatory bowel disease including ulcerative colitis and Crohn's disease. Case presentation: Herein, we report the first case of KS in a human immunodeficiency virus (HIV)-negative 47-year old male with UC after treatment with the α4-β7 integrin inhibitor vedolizumab (VDZ). The patient underwent to colectomy for a medical refractory disease and the histological examination of the surgical specimen showed the typical findings of KS together with the HHV-8 positivity. The patient achieved a good health status, without any sign of disease recurrence. Conclusions: In the present case, we can assume that VDZ may have promoted the reactivation of a latent HHV-8 infection endowed with oncogenic potentialities and, in turn, the onset of KS. We also briefly reviewed all the cases of KS in HIV-negative patients with inflammatory bowel disease

How to face the advent of sars-cov-2 vaccination in ibd patients: Another task for gastroenterologists

The severity of the COVID-19 pandemic has led to an unprecedented effort to develop vaccines against SARS-CoV-2 infection since this seems to be the most effective strategy to counter the pandemic. In the past weeks, the administration of vaccines has started in different parts of the world sustaining the hype of significantly containing the impact of SARS-CoV-2 infection. However, the rapid time lapse from vaccine development to distribution has raised several concerns on its safety and efficacy. This topic is particularly felt by patients with chronic conditions and immumodulating therapies that could compromise their immune system such as inflammatory bowel disease (IBD). Here, we explore the potential future implications of the SARS-CoV-2 vaccines introduction in the IBD field, touching upon the clinical experience coming from available data on vaccinations against other infections. We also dissect the factors associated with the acceptability of SARS-CoV-2 vaccination, describing the possible strategies that gastroenterologist should adopt to reach the highest rate of vaccinations in IBD patients

Microbiota Composition in Diverticular Disease: Implications for Therapy

Gut microbiota (GM) composition and its imbalance are crucial in the pathogenesis of several diseases, mainly those affecting the gastrointestinal tract. Colon diverticulosis and its clinical manifestations (diverticular disease, DD) are among the most common digestive disorders in developed countries. In recent literature, the role of GM imbalance in the onset of the different manifestations within the clinical spectrum of DD has been highlighted. This narrative review aims to summarize and critically analyze the current knowledge on GM dysbiosis in diverticulosis and DD by comparing the available data with those found in inflammatory bowel disease (IBD). The rationale for using probiotics to rebalance dysbiosis in DD is also discussed

Covid-19 and the management of patients with inflammatory bowel disease: a practical decalogue for the post-pandemic phase

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised several concerns for patients with chronic immune-mediated diseases, including inflammatory bowel disease (IBD). As the outbreak appears to be in the descending phase, at least in some part of the world, as in most European countries, guidance is urgently needed to provide optimal care for our IBD patients in order to gradually and safely reduce the gap in care that has been accumulated in the months of lockdown and to face all the backlogs. Therefore, we have provided a decalogue of practical recommendations for gastroenterologists to manage patients with IBD in the post-peak phase of the COVID-19 pandemic. They include all the aspects of IBD care, not only pharmacological ones but also endoscopy, surgery, psychological treatment, telemedicine, diagnostics and educational tasks provided by doctors and patient associations