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Fecal microbiota transplantation as potential first-line treatment for patients with Clostridioides difficile infection and prior appendectomy

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World Journal of Gastrointestinal Surgery 2023年第2期15卷 303-306页

作者： Jing-Wen Zhao Bing Chang Li-Xuan Sang Department of Gastroenterology Shengjing Hospital of China Medical UniversityShenyang 110022Liaoning ProvinceChina Department of Gastroenterology The First Affiliated Hospital of China Medical UniversityShenyang 110001Liaoning ProvinceChina

Clostridioides difficile infection(CDI)is a global health problem.The association of appendectomy on the severity and prognosis of CDI has been reported in many literatures,but there are still contradictions.In a retrospective study entitled“Patients with Closterium diffuse infection and prior appendectomy may be prone to word outcomes”published in World J Gastrointest Surg 2021,the author found that prior appendectomy affects the severity of CDI.Appendectomy may be a risk factor for increasing the severity of CDI.Therefore,it is necessary to seek alternative treatment for patients with prior appendectomy when they are more likely to have severe or fulminant CDI.

关键词： Clostridioides difficile infection Appendectomy Fecal microbiota transplantation Intestinal microbiota Toxic megacolon Colectomy

Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1436-1447页

作者： Danial Haris Shaikh Harish Patel Rezwan Munshi Haozhe Sun Shehriyar Mehershahi Ahmed Baiomi Ahmed Alemam Usman Pirzada Iqra Nawaz Kamrun Naher Siddarth Hanumanthu Suresh Nayudu Division of Gastroenterology Department of MedicineBronxCare Health SystemBronxNY 10457United States Department of Medicine Nassau University Medical CenterNew YorkNY 11554United States Department of Medicine BronxCare Health SystemBronxNY 10457United States

BACKGROUND Clostridium difficile infection(CDI)occurs due to a dysbiosis in the colon.The appendix is considered a‘safe house’for gut microbiota and may help repopulate gut flora of patients with CDI.AIM To study the impact of prior appendectomy on the severity and outcomes of CDI.METHODS We retrospectively reviewed data of 1580 patients with CDI,admitted to our hospital between 2008 to 2018.Patients were grouped based on the presence or absence of the appendix.The primary aim was to(1)assess all-cause mortality and(2)the severity of CDI.Severity was defined as per the Infectious Diseases Society of America criteria.Logistic regression,and propensity score analysis using inverse probability of treatment weights(IPTW)was performed.RESULTS Of the 1580 patients,12.5%had a history of appendectomy.There was no statistical difference in mortality between patients with a prior appendectomy or without(13.7%vs 14%,P=0.877).However,a history of appendectomy affected the severity of CDI[odds ratio(OR)=1.32,95%confidence interval:1.01-1.75].On IPTW,this association remained significant(OR=1.59,PToxic megacolon(OR=5.37,PToxic megacolon and the eventual need for colectomy.Since treatment of CDI is governed by its severity,stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.

关键词： Appendectomy Clostridium difficile Toxic megacolon Colectomy Gut microbiome

Treatment of acute severe ulcerative colitis using accelerated infliximab regimen based on infliximab trough level:A case report

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World Journal of Clinical Cases 2021年第13期9卷 3219-3226页

作者： Ana Lorena Sousa de Vasconcelos Garate Thiara Barcelos Rocha Luciana Rocha Almeida Rodrigo Quera Jaqueline Ribeiro Barros Julio Pinheiro Baima Rogerio Saad-Hossne Ligia Yukie Sassaki Department of Internal Medicine São Paulo State University(Unesp)Medical SchoolBotucatu 18618687São PauloBrazil Inflammatory Bowel Disease Program GastroenterologyMedicine DepartmentClínica Universidad de los AndesSantiago 7550000Chile

BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitisassociated with high levels of circulating tumor necrosis factor alpha, due to theintense inflammation and faster stool clearance of anti-tumor necrosis factordrugs. Dose-intensified infliximab treatment can be beneficial and is associatedwith lower rates of colectomy. The aim of the study was to present a case of apatient with ASUC and megacolon, treated with hydrocortisone and acceleratedscheme of infliximab that was monitored by drug trough level.CASE SUMMARYA 22-year-old female patient diagnosed with ulcerative colitis, presented withdiarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen.During investigation, a positive toxin for Clostridium difficile and colonic dilatationof 7 cm consistent with megacolon were observed. She was treated with oralvancomycin for pseudomembranous colitis and intravenous hydrocortisone forsevere colitis, which led to the resolution of megacolon. Due to the persistentsevere colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drugtrough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (< 30 μg/g). Based onthe low infliximab trough level after one week from the first infliximab dose, thepatient received a second infusion at week 1, consistent with the acceleratedregimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical andendoscopic response after 6 mo of therapy, without the need for a colectomy.CONCLUSIONInfliximab accelerated infusions can be beneficial in ASUC unresponsive to thetreatment with intravenous corticosteroids. Longitudinal studies are necessary todefine the best therapeutic drug monitoring and treatment regimen for thesepatients.

关键词： Infliximab Acute severe ulcerative colitis Toxic megacolon Ulcerative colitis Inflammatory bowel disease Case report

Ulcerative Colitis in Sub-Saharan Africa: Analysis of 24 Cases in Dakar (Senegal)

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Open Journal of Gastroenterology 2020年第6期10卷 128-136页

作者： Mamadou Ngoné Gueye Sokhna Niang Diop Salamata Diallo Gnagna Diouf Cheikh Ahmadou Bamba Cissé Marème Polèle Fall Mame Aissé Thioubou Marie Louise Bassène Daouda Dia Mouhamadou Mbengue Department of Gastroenterology Idrissa Pouye General Hospital (Former Grand Yoff General Hospital) Dakar Senegal Cheikh Anta Diop University Dakar Senegal Department of Gastroenterology Aristide Le Dantec Hospital Dakar Senegal Department of Gastroenterology Peace Hospital Ziguinchor Senegal

Introduction: The aim of our study was to determine the socio-demographic, diagnostic and therapeutic aspects of ulcerative colitis (UC) in one of the largest gastroenterology departments in Senegal. Patients and Method: This was a retrospective and descriptive study based on the analysis of the records of patients hospitalized in the Hepato-Gastroenterology Department of the Grand Yoff General Hospital (Dakar, Senegal) between January 2013 and December 2019. All cases of UC were collected. Clinical, biological, endoscopic and histological data were collected, as well as treatment options. Results: We observed 24 cases, representing a prevalence of 0.87% of inpatients. The mean age of patients was 36 (ranged 18 to 73) and sex ratio 0.9 (13 females). The mean diagnostic delay was 1.6 years (ranged 4 months to 5 years). The clinical symptomatology was dominated by diarrhea with blood and mucus (18 cases). The Litchiger score on admission averaged 8 and 5 patients (20.8%) had severe acute colitis. Colonoscopy showed pancolonic involvement (Montreal E3) in 11 cases (45.8%) and severe endoscopic lesions (stage 3 of the Mayo endosc

关键词： Ulcerative Colitis Sub-Saharan Africa Toxic megacolon 5 ASA Azathioprine