Clinical Study A Randomized Prospective Study of Bowel Preparation for Colonoscopy with Low-Dose Sodium Phosphate Tablets versus Polyethylene Glycol Electrolyte Solution

Optimal bowel preparation is essential for the safety and outcome of colonoscopy. A solution containing polyethylene glycol (PEG) is often used as a bowel cleansing agent, but some patients are intolerant of PEG, and this may lead to discontinuation of colonoscopy. Sodium phosphates (NaP) tablets are designed to improve patient acceptance and compliance. The objective of this study was to compare bowel preparation efficiency and patient acceptance of a 30 NaP tablet preparation (L-NaP) and a 2 L PEG preparation. Patients were randomized into either the L-NaP or PEG group. The primary endpoint was the efficiency of colon cleansing as assessed by a validated four-point scale according to the Aronchick scale by endoscopists and was verified by blinded investigators. The secondary endpoints were patients' tolerability and acceptance. Colon-cleansing efficiency was not significantly different between the two preparations. However, patients' overall judgment was significantly in favor of L-NaP, reflecting better acceptance of L-NaP than PEG. Additionally, more patients favored L-NaP over PEG in a hypothetical future occasion requiring colonoscopy

Successful remission of ulcerative colitis flare-up during pregnancy with adsorptive granulomonocytapheresis plus tacrolimus

Ulcerative colitis (UC) is 1 of the 2 major phenotypes of chronic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms that impair function and quality of life. Further, IBD often affects women during childbearing age. Indeed, UC activity frequently increases during pregnancy, and the medications used to induce remission may adversely affect the health of the mother and the unborn child. We report successful induction of a remission in a UC case who experienced a flare-up in the first trimester of pregnancy. Upon relapse, she was treated with steroids and adsorptive granulomonocytapheresis (GMA) with the Adacolumn plus tacrolimus. This combination therapy induced a stable remission that was maintained during her entire pregnancy. She gave birth to a healthy child at 36 weeks of pregnancy with no maternal or fetal complications. Our experience indicates that GMA, as a non-drug therapeutic intervention with a favorable safety profile, plus tacrolimus might be a relevant treatment option for patients with active IBD during pregnancy. A future study of a large cohort of pregnant patients should strengthen our findings

A Randomized Prospective Study of Bowel Preparation for Colonoscopy with Low-Dose Sodium Phosphate Tablets versus Polyethylene Glycol Electrolyte Solution

Optimal bowel preparation is essential for the safety and outcome of colonoscopy. A solution containing polyethylene glycol (PEG) is often used as a bowel cleansing agent, but some patients are intolerant of PEG, and this may lead to discontinuation of colonoscopy. Sodium phosphates (NaP) tablets are designed to improve patient acceptance and compliance. The objective of this study was to compare bowel preparation efficiency and patient acceptance of a 30 NaP tablet preparation (L-NaP) and a 2 L PEG preparation. Patients were randomized into either the L-NaP or PEG group. The primary endpoint was the efficiency of colon cleansing as assessed by a validated four-point scale according to the Aronchick scale by endoscopists and was verified by blinded investigators. The secondary endpoints were patients’ tolerability and acceptance. Colon-cleansing efficiency was not significantly different between the two preparations. However, patients’ overall judgment was significantly in favor of L-NaP, reflecting better acceptance of L-NaP than PEG. Additionally, more patients favored L-NaP over PEG in a hypothetical future occasion requiring colonoscopy

Peyer’s Patches and Mesenteric Lymph Nodes Cooperatively Promote Enteropathy in a Mouse Model of Food Allergy

<div><p>Background and Objective</p><p>To improve the efficacy and safety of tolerance induction for food allergies, identifying the tissues responsible for inducing intestinal inflammation and subsequent oral tolerance is important. We used OVA23-3 mice, which express an ovalbumin-specific T-cell receptor, to elucidate the roles of local and systemic immune tissues in intestinal inflammation.</p><p>Methods and Results</p><p>OVA23-3 mice developed marked enteropathy after consuming a diet containing egg white (EW diet) for 10 days but overcame the enteropathy (despite continued moderate inflammation) after receiving EW diet for a total of 28 days. Injecting mice with anti-IL-4 antibody or cyclosporine A confirmed the involvement of Th2 cells in the development of the enteropathy. To assess the individual contributions of Peyer’s patches (PPs), mesenteric lymph nodes (MLNs), and the spleen to the generation of effector CD4⁺ T-cells, we analyzed the IL-4 production, proliferation in response to ovalbumin, and CD4⁺ T-cell numbers of these tissues. EW feeding for 10 days induced significant IL-4 production in PPs, the infiltration of numerous CD4⁺ T-cells into MLNs, and a decrease in CD4⁺ T-cell numbers in spleen. On day 28, CD4⁺ T-cells from all tissues had attenuated responses to ovalbumin, suggesting tolerance acquisition, although MLN CD4⁺ T-cells still maintained IL-4 production with proliferation. In addition, removal of MLNs but not the spleen decreased the severity of enteropathy and PP-disrupted mice showed delayed onset of EW-induced inflammatory responses. Disruption of peripheral lymphoid tissues or of both PPs and MLNs almost completely prevented the enteropathy.</p><p>Conclusions</p><p>PPs and MLNs coordinately promote enteropathy by generating effector T-cells during the initial and exacerbated phases, respectively; the spleen is dispensable for enteropathy and shows tolerogenic responses throughout EW-feeding. The regulation of PPs may suppress the initiation of intestinal inflammation, subsequently restricting MLNs and inhibiting the progression of food-allergic enteropathy.</p></div

Roles of T-cells and IL-4 in food-allergic intestinal inflammation.

<p>Weight changes and jejunal sections (hematoxylin and eosin stain) of EW- or CN-fed OVA23-3 mice treated with (A) cyclosporine A (CsA) or (B) anti-IL-4 mAb. Morphologic changes were analyzed between days 10 and 12. (A) Open circles: CsA-treated, CN-fed (CN, n = 3); solid circles: CsA-treated, EW-fed (EW, n = 5); solid diamonds: vehicle (control)-treated EW-fed (n = 4). (B) Open circles: Control Ab-treated (EW, n = 3); solid circles: anti IL-4-treated (EW, n = 3); solid diamonds, untreated (EW, n = 2). *, Value is significantly (<i>P</i><0.05) different from that for vehicle-treated EW or control Ab-treated EW mice. All data are representative of three independent experiments.</p

The spleen is dispensable for the establishment of enteropathy in EW-fed OVA23-3 mice.

<p>Weight change (left panel) and jejunal sections (right panel, day 7) of splenectomized EW-fed (SPlackEW, n = 5), splenectomized CN-fed (SPlackCN, n = 3), and sham-operated EW-fed (Mock EW, n = 4) OVA23-3 mice. *, Significant (<i>P</i><0.05) difference between values for splenectomized CN-fed and EW-fed mice.</p

Roles of CD4⁺ T-cells from PPs, MLNs, and spleen differ in EW-fed OVA23-3 mice.

<p>(A) Number of CD4⁺ T-cells (mean±1 SD) that infiltrated into (left, <i>n</i> = 3) and the proliferation of CD4⁺ T-cells (mean±1 SD) purified from (right, <i>n</i> = 4) the PPs, MLNs, and spleens of OVA23-3 mice on the EW or the CN diet over time. (B) IL-4 production (mean±1 SD) by CD4⁺ T cells from each tissue of OVA23-3 mice (<i>n</i> = 4) on the EW or the CN diet over time. All data are representative of two independent experiments.</p

Potential contribution of MLNs to the intestinal inflammatory immune response.

<p>(A) Weight changes of MLN-ectomized EW-fed (EW, n = 7); sham-operated EW-fed (Mock, n = 4); and MLN-ectomized CN-fed (CN, n = 3) mice. *, Value is significantly (<i>P</i><0.05) different between those for MLN-ectomized EW and sham-operated EW groups or those for MLN-ectomized EW and MLN-ectomized CN groups. (B) Jejunal sections obtained on day 7 (during inflammation, upper panels) or on day 28 (during tolerance, lower panels). (C) Arrows indicate MLNs or site of mesenteric lymphadenectomy in OVA23-3 mice on day 7 of the EW (Mock EW or MLN-ectomized EW) or CN (MLN-ectomized CN) diet. All data are representative of two independent experiments.</p

Manifestation of food allergy in EW-fed PP^– OVA23-3 mice.

<p>(A) Weight change in EW-fed PP^– (PPlackEW, n = 18); EW-fed PP⁺, (PPnormalEW, n = 17; CN-fed PP^– (PPlackCN, n = 8); and CN-fed PP⁺ (PPnormalCN, n = 8) mice. Value significantly (*, <i>P</i><0.05; **, <i>P</i><0.01) different between those for PP^– and PP⁺ EW-fed OVA23-3 mice. (B) Jejunal sections. (C) alkaline phosphatase activity in the jejunum (PPlackEW, n = 6; PPnormalEW, n = 3). (D) Proliferation of (left panel) and IL-4 production by (right panel) MLN CD4⁺ T-cells from PP^– or PP⁺ EW-fed OVA23-3 mice on day 3. Data are representative of two or three experiments.</p