Faecalibacterium prausnitzii is not decreased in symptomatic uncomplicated diverticular disease of the colon

In this letter, assessment of the amount of fecal Faecalibacterium prausnitzii in symptomatic uncomplicated diverticular disease (SUDD) is described. Among 44 consecutive patients, comprising 15 SUDD patients, 13 patients with asymptomatic diverticulosis (AD), and 16 healthy controls (HC), the fecal amount of Faecalibacterium prausnitzii was not found to be significantly different between HC, AD and SUDD subjects (p=0.871). Moreover, its count in the HC microbiota (-4.57 +/- 2.15) was lower compared with those in the AD (-4.11 +/- 1.03) and SUDD subjects (-4.03 +/- 1.299). This behavior seems to be different from that occurring in inflammatory bowel disease (IBD) and similar to that of other mucin-degrading species in a SUDD setting

Genômica e proteômica de Anaplasma marginale: contribuições para o controle da riquétsia.

A anaplasmose bovina é causada pela riquétsia intra-eritrocítica Anaplasma marginale, responsável por importantes prejuízos econômicos, por causa da alta morbidade e mortalidade em rebanhos bovinos suscetíveis. A vacinação tem sido uma forma econômica e eficiente de controlar a enfermidade. No entanto, os métodos de imunização tradicionais apresentam efeitos adversos em algumas categorias de animais. Nas últimas décadas, os estudos sobre imunização contra Anaplasma concentraram-se nas proteínas de superfície MSP1a, 1b, 2, 3, 4 e 5. No entanto, até o momento, os resultados foram pouco promissores, apontando a necessidade de ampliar o conhecimento sobre o rol das proteínas de membrana da riquétsia e das relações estruturais entre elas. Nesse contexto, os estudos do genoma e do proteoma da riquétsia têm contribuído com essa finalidade. Pela análise genômica, 14 genes para novas proteínas de membrana externa foram identificados (omp 1-14), dentre os quais, omp2, 3 e 6 não são transcritos. Esses genes ostraram-se altamente conservados entre isolados da riquétsia. As proteínas OMP4, 7, 10 e 14 foram reconhecidas por soros de bovinos imunizados com membrana de A. marginale, mostrando potencial para desenvolvimento de imunógenos. Além disso, mediante análise proteômica, foi possível detectar novas proteínas de membrana, negligenciadas pela anotação genômica. Dentre elas estão AM097 - conjugal transfer protein, AM956 - PepA citosol amino peptidase, AM254 - fator de elongação Tu e quatro proteínas de função desconhecida: AM127, 197, 387 e 854, as quais também foram reconhecidas por soros de bovinos imunizados com membrana de A. marginale.bitstream/CNPGC-2009-09/12410/1/DOC161.pd

Treatment of Relapsing Mild-to-Moderate Ulcerative Colitis With the Probiotic VSL#3 as Adjunctive to a Standard Pharmaceutical Treatment: A Double-Blind, Randomized, Placebo-Controlled Study

OBJECTIVES: VSL#3 is a high-potency probiotic mixture that has been used successfully in the treatment of pouchitis. The primary end point of the study was to assess the effects of supplementation with VSL#3 in patients affected by relapsing ulcerative colitis (UC) who are already under treatment with 5-aminosalicylic acid (ASA) and/or immunosuppressants at stable doses. METHODS: A total of 144 consecutive patients were randomly treated for 8 weeks with VSL#3 at a dose of 3,600 billion CFU/day (71 patients) or with placebo (73 patients). RESULTS: In all, 65 patients in the VSL#3 group and 66 patients in the placebo group completed the study. The decrease in ulcerative colitis disease activity index (UCDAI) scores of 50% or more was higher in the VSL#3 group than in the placebo group (63.1 vs. 40.8; per protocol (PP) P=0.010, confidence interval (CI)\u2089\u2085(%) 0.51-0.74; intention to treat (ITT) P=0.031, CI\u2089\u2085(%) 0.47-0.69). Significant results with VSL#3 were recorded in an improvement of three points or more in the UCDAI score (60.5% vs. 41.4%; PP P=0.017, CI\u2089\u2085(%) 0.51-0.74; ITT P=0.046, CI\u2089\u2085(%) 0.47-0.69) and in rectal bleeding (PP P=0.014, CI\u2089\u2085(%) 0.46-0.70; ITT P=0.036, CI\u2089\u2085(%) 0.41-0.65), whereas stool frequency (PP P=0.202, CI\u2089\u2085(%) 0.39-0.63; ITT P=0.229, CI\u2089\u2085(%) 0.35-0.57), physician's rate of disease activity (PP P=0.088, CI\u2089\u2085(%) 0.34-0.58; ITT P=0.168, CI\u2089\u2085(%) 0.31-0.53), and endoscopic scores (PP P=0.086, CI\u2089\u2085(%) 0.74-0.92; ITT P=0.366, CI\u2089\u2085(%) 0.66-0.86) did not show statistical differences. Remission was higher in the VSL#3 group than in the placebo group (47.7% vs. 32.4%; PP P=0.069, CI\u2089\u2085(%) 0.36-0.60; ITT P=0.132, CI\u2089\u2085(%) 0.33-0.56). Eight patients on VSL#3 (11.2%) and nine patients on placebo (12.3%) reported mild side effects. CONCLUSIONS: VSL#3 supplementation is safe and able to reduce UCDAI scores in patients affected by relapsing mild-to-moderate UC who are under treatment with 5-ASA and/or immunosuppressants. Moreover, VSL#3 improves rectal bleeding and seems to reinduce remission in relapsing UC patients after 8 weeks of treatment, although these parameters do not reach statistical significance

The DICA Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists: an International Study

Background & Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (kappa) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal. was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD

International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

The statements produced by the Chairmen and Speakers of the 3rd International Symposium on Diverticular Disease, held in Madrid on April 11th-13th 2019, are reported. Topics such as current and evolving concepts on the pathogenesis, the course of the disease, the news in diagnosing, hot topics in medical and surgical treatments, and finally, critical issues on the disease were reviewed by the Chairmen who proposed 39 statements graded according to level of evidence and strength of recommendation. Each topic was explored focusing on the more relevant clinical questions. The vote was conducted on a 6-point scale and consensus was defined a priori as 67% agreement of the participants. The voting group consisted of 124 physicians from 18 countries, and agreement with all statements was provided. Comments were added explaining some controversial areas

Long-term, Real-life, Observational Study in Treating Outpatient Ulcerative Colitis with Golimumab

Background and Aims: Several studies have found Golimumab (GOL) effective and safe in the short-term treatment of ulcerative colitis (UC), but few long-term data are currently available from real world. Our aim was to assess the long-term real-life efficacy and safety of GOL in managing UC outpatients in Italy. Methods: A retrospective multicenter study assessing consecutive UC outpatients treated with GOL for at least 3-month of follow-up was made. Primary endpoints were the induction and maintenance of remission in UC, defined as Mayo score ≤2. Several secondary endpoints, including clinical response, colectomy rate, steroid free remission and mucosal healing, were also assessed during the follow-up. Results: One hundred and seventy-eight patients were enrolled and followed up for a median (IQR) time of 9 (3-18) months (mean time follow-up: 33.1±13 months). Clinical remission was achieved in 57 (32.1%) patients: these patients continued with GOL, but only 6 patients (3.4%) were still under clinical remission with GOL at the 42nd month of follow-up. Clinical response occurred in 64 (36.4%) patients; colectomy was performed in 8 (7.8%) patients, all of them having primary failure. Steroid-free remission occurred in 23 (12.9%) patients, and mucosal healing was achieved in 29/89 (32.6%) patients. Adverse events occurred in 14 (7.9%) patients. Conclusions: Golimumab does not seem able to maintain long-term remission in UC in real life. The safety profile was good

Role of Inflammation in the Pathogenesis of Diverticular Disease

Diverticulosis of the colon is the most common condition in Western societies and it is the most common anatomic alteration of the human colon. Recurrent abdominal pain is experienced by about 20% of patients with diverticulosis, but the pathophysiologic mechanisms of its occurrence are not completely understood. In the last years, several fine papers have showed clearly the role of low-grade inflammation both in the occurrence of symptoms in people having diverticulosis, both in symptom persistence following acute diverticulitis, even if the evidence available is not so strong. We do not know yet what the trigger of this low-grade inflammation occurrence is. However, some preliminary evidence found colonic dysbiosis linked to low-grade inflammation and therefore to symptom occurrence in those patients. The aim of this paper is to summarize current evidences about the role of inflammation in symptom occurrence in symptomatic uncomplicated diverticular disease and in symptom persistence after an episode of acute diverticulitis