Microbiota intestinal y cólicos infantiles: ¿hay lugar para los prebióticos, probióticos y posbióticos? / Gut Microbiota and Infant Colic: is there a Place for Prebiotics, Probiotics, and Postbiotics?

El consumo de probióticos, prebióticos y posbióticos, o su combinación, puede contribuir a mantener una microbiota intestinal saludable ya que permite la regulación de su disbiosis en el caso de algunas enfermedades o trastornos, principalmente en los trastornos gastrointestinales funcionales (TGIF). El microbioma intestinal es protagonista esencial en la fisiopatología de los TGIF a través de sus funciones metabólicas y nutricionales, el mantenimiento de la integridad de la mucosa intestinal y la regulación de la respuesta inmunitaria. Las investigaciones realizadas hasta la fecha indican que los probióticos, prebióticos y posbióticos pueden tener efectos inmunomoduladores directos y clínicamente relevantes. Existen pruebas del uso de esta familia de bióticos en individuos sanos para mejorar la salud general y aliviar los síntomas en una serie de enfermedades como los cólicos infantiles. La colonización y establecimiento de la microbiota comienza en el momento del nacimiento; los primeros 2-3 años de vida son fundamentales para el desarrollo de una comunidad microbiana abundante y diversa. Diversos estudios científicos realizados mediante técnicas tradicionales dependientes de cultivo y más recientemente por técnicas moleculares han observado diferencias en las poblaciones bacterianas de bebés sanos y aquellos que sufren TGIF, estos últimos caracterizados por un aumento de especies patógenas y una menor población de bifidobacterias y lactobacilos, en comparación con los primeros. En tal contexto, se considera que la microbiota intestinal como protagonista en el desarrollo de esos trastornos, entre ellos los cólicos infantiles, a través de sus funciones metabólicas, nutricionales, de mantenimiento de la integridad de la mucosa intestinal y regulación de la respuesta inmunitaria. Esto ha abierto la puerta al estudio de la utilización de prebióticos, probióticos y posbióticos en el tratamiento y/o prevención de los TGIF infantiles. El parto vaginal y de término así como la lactancia son fundamentales en la constitución de una microbiota saludable. Como herramientas de apoyo, existen estudios de eficacia que sustentan la administración de esta familia de bióticos, principalmente en los casos en que la lactancia no sea posible o esté limitada. (AU)

The consumption of probiotics, prebiotics, and postbiotics, or a combination of them, can contribute to maintaining a healthy intestinal microbiota as it allows the regulation of its dysbiosis in the case of some diseases or disorders, mainly in functional gastrointestinal disorders (FGIDs). The gut microbiome is an essential player in the pathophysiology of FGIDs through its metabolic and nutritional functions, the maintenance of intestinal mucosal integrity, and the regulation of the immune response. Research results thus far indicate that probiotics, prebiotics, and postbiotics may have direct and clinically relevant immunomodulatory effects. There is evidence regarding the prescription of this family of biotics in healthy individuals to improve overall health and alleviate symptoms in many conditions like infantile colic. The colonization and microbiota establishment begins at birth; the first 2-3 years of life are critical for developing an abundant and diverse microbial community. Several scientific studies performed by traditional culture-dependent techniques and more recently by molecular techniques have observed differences in the bacterial populations of healthy infants and those suffering from FGIDs, the latter characterized by an increase in pathogenic species and a lower population of bifidobacteria and lactobacilli, compared to the former. In this context, the intestinal microbiota plays a leading role in the onset of these disorders, including infantile colic, through its metabolic and nutritional functions, maintenance of the integrity of the intestinal mucosa, and regulation of the immune response. That has opened the door to the study of prebiotics, probiotics, and postbiotics usage in the treatment and or prevention of infantile FGIDs. Vaginal and term delivery and breastfeeding are fundamental in the constitution of a healthy microbiota. As supportive tools, there are efficacy studies that support the administration of this family of biotics, mainly in cases where lactation is not possible or is limited.

The impact of small intestinal bacterial overgrowth on the growth of children and adolescents / Impacto do sobrecrescimento bacteriano no intestino delgado sobre o peso e a estatura de crianças e adolescentes

ABSTRACT Objective: To evaluate the association between small intestinal bacterial overgrowth (SIBO) and weight and height impairment in children and adolescents with gastroenterology diseases. Methods: Observational and retrospective study. All 162 patients aged less than 19 years old who underwent breath test in search of SIBO between 2011 and 2016 were studied. Breath test was collected after the intake of 10 grams of lactulose. The concentration of hydrogen and methane was measured for 180 minutes after the beginning of the test by 12i QuinTronMicroLyzer device. Results: SIBO was identified in 51 (31.5%) patients. There was no difference between the age of those with (mean=8.7y.o; 25th and 75th percentile: 4.6 and 11.3) and without (mean=7.9y.o 25th and 75th percentile: 4.8 and 12.2) SIBO (p=0.910). There was no association between gender and SIBO (male 26.3% vs. female 36.3%, p=1.00). A lower median of height-for-age Z score (mean=-1.32; 25th and 75th percentile: -2.12 and -0.08 vs. mean=-0.59; 25th and 75th percentile: -1.57 and 0.22; p=0.04) was demonstrated in children with SIBO when compared with children without it. There was no difference between the BMI-for-age Z score of patients with (mean=-0.48) and without SIBO (mean=-0.06) (p=0.106). The BMI of patients with SIBO (median=15.39) was lower than of those without it (median=16.06); however, the statistical analysis was not significant (p=0.052). The weight-for-age Z score was lower in patients with SIBO (mean=-0.96) than in those without SIBO (mean=-0.22) (p=0.02) Conclusions: Children and adolescents with SBIO associated with diseases of the gastrointestinal tract have lower weight and height values.

RESUMO Objetivo: Avaliar a existência de associação entre sobrecrescimento bacteriano no intestino delgado (SBID) e comprometimento de peso e estatura em crianças e adolescentes com doenças do aparelho digestivo. Métodos: Estudo observacional e retrospectivo em ambulatório de gastroenterologia pediátrica. Foram incluídos todos os 162 pacientes com idade inferior a 19 anos que realizaram teste respiratório para pesquisa de SBID entre 2011 e 2016. O teste respiratório foi realizado após ingestão de dez gramas de lactulose. Foram determinadas as concentrações de hidrogênio e metano em aparelho 12i QuinTron MicroLyzer até 180 minutos após o início do teste respiratório. Resultados: SBID foi caracterizado em 51 (31,5%) dos 162 pacientes. Não houve diferença na idade das crianças com (mediana=8,7 anos; percentil 25-75: 4,6-11,3) e sem (mediana=7,9 anos; percentil 25-75: 4,8-12,2) SBID (p=0,910). Não se observou associação entre SBID e sexo (masculino 27,4% e feminino 36,6%; p=0,283). O escore Z da estatura-idade nos pacientes com SBID (mediana=-1,32; percentil 25-75: -2,12—0,08) foi menor (p=0,040) do que naqueles sem SBID (mediana=-0,59; percentil 25-75: -1,57-0,22). Na comparação do escore Z de índice de massa corpórea-idade não foi observada diferença entre os grupos com (média=-0,489±1,528) e sem (média=-0,067±1,532) SBID (p=0,106). Nos pacientes com menos de 10 anos de idade, o escore Z de peso-idade foi menor nos pacientes com SBID (média=-0,968±1,359) do que nos sem SBID (média=-0,223±1,584) (p=0,026). Conclusões: Crianças e adolescentes com SBID associado a doenças do trato gastrintestinal apresentam menores valores de peso e estatura.

Disminución en la frecuencia de infección por Helicobacter pylori en endoscopías digestivas altas / Helicobacter pylori infection detected during upper gastrointestinal endoscopy

Background: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. Aim: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. Material and Methods: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. Results: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). Conclusions: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.

Microbiota intestinal nas doenças digestivas / Intestinal microbiota in digestive diseases

ABSTRACT BACKGROUND In recent years, especially after the development of sophisticated metagenomic studies, research on the intestinal microbiota has increased, radically transforming our knowledge about the microbiome and its association with health maintenance and disease development in humans. Increasing evidence has shown that a permanent alteration in microbiota composition or function (dysbiosis) can alter immune responses, metabolism, intestinal permeability, and digestive motility, thereby promoting a proinflammatory state. Such alterations can mainly impair the host's immune and metabolic functions, thus favoring the onset of diseases such as diabetes, obesity, digestive, neurological, autoimmune, and neoplastic diseases. This comprehensive review is a compilation of the available literature on the formation of the complex intestinal ecosystem and its impact on the incidence of diseases such as obesity, non-alcoholic steatohepatitis, irritable bowel syndrome, inflammatory bowel disease, celiac disease, and digestive neoplasms. CONCLUSION: Alterations in the composition and function of the gastrointestinal microbiota (dysbiosis) have a direct impact on human health and seem to have an important role in the pathogenesis of several gastrointestinal diseases, whether inflammatory, metabolic, or neoplastic ones.

RESUMO CONTEXTO: Nos últimos anos, especialmente a partir do desenvolvimento de sofisticados estudos metagenômicos, as pesquisas acerca da microbiota intestinal se intensificaram, transformando de forma radical os nossos conhecimentos sobre o microbioma e sua relação com a manutenção da saúde e o desenvolvimento de doenças no ser humano. Evidências crescentes demonstram que uma alteração permanente da composição ou da função da microbiota (disbiose) pode alterar as respostas imunológicas, o metabolismo, a permeabilidade intestinal e a motilidade digestiva, promovendo, dessa maneira, um estado pró-inflamatório. Tais alterações podem comprometer, sobretudo, as funções imunes e metabólicas do hospedeiro, favorecendo o aparecimento de doenças como diabetes, obesidade, doenças digestivas, neurológicas, autoimunes e neoplásicas. Este artigo de revisão é uma compilação da literatura disponível sobre a formação do complexo ecossistema intestinal e seu impacto na incidência de doenças como obesidade, esteatohepatite não alcoólica, síndrome do intestino irritável, doença inflamatória intestinal, doença celíaca e neoplasias digestivas. CONCLUSÃO: Alterações na composição e função da microbiota gastrointestinal (disbiose) têm um impacto direto sobre a saúde humana e parecem ter um papel importante na patogênese de várias doenças gastrointestinais, sejam elas inflamatórias, metabólicas ou neoplásicas.

HELICOBACTER PYLORI INFECTION IN PATIENTS WITH DIFFERENT GASTROINTESTINAL DISEASES FROM NORTHERN BRAZIL

Background - The mechanisms whereby Helicobacter pylori produces different pathological manifestations in the stomach and duodenum are not fully understood. Considering the geographic diversity in the prevalence of virulence factors of this microorganism and their association with the development of different diseases, the search for pathogenicity markers such as CagA and VacA alleles by molecular techniques has intensified. Objectives - To investigate the presence of H. pylori infection and the frequency of different genotypes of this bacterium in patients with gastrointestinal diseases from Northern Brazil, and to establish their association with the histopathological findings. Methods - In a prospective study, samples were collected from 554 patients with different gastrointestinal diseases (gastritis, duodenal ulcer, gastric ulcer, and gastric cancer) seen at a referral hospital attending the entire State of Pará, located in the metropolitan region of Belém. Data such as gender and age obtained with an epidemiological questionnaire were analyzed. The presence of H. pylori and the bacterial genotype were investigated by PCR. Gastric biopsies were assessed histologically. Results - The prevalence of H. pylori infection was 91%. Infection was more frequent among patients with gastric ulcer and gastric cancer. In these groups, there was a predominance of men and older patients when compared to the other two groups studied. The predominant bacterial genotype was s1m1cagA+, which was more frequent among patients with gastric ulcer, duodenal ulcer and gastric cancer. A significant association was observed between s1m1cagA+ strains and a higher degree of inflammation, neutrophil activity and development of intestinal metaplasia. Conclusion - The present study demonstrates a high incidence of H. pylori infection in the patients analyzed, especially among those with gastric ulcer and gastric cancer. Virulent s1m1cagA+ strains predominated and were associated with more severe lesions.

Contexto - Os mecanismos pelos quais o H. pylori produz diferentes quadros patológicos no estômago e no duodeno não são totalmente conhecidos. Considerando a diversidade geográfica relacionada à prevalência dos fatores de virulência desse microrganismo e sua associação com o desenvolvimento de diferentes doenças, vem se intensificando a pesquisa de marcadores de patogenicidade, como o CagA e os alelos do VacA por técnicas moleculares. Objetivos - O objetivo desse estudo foi investigar a presença da infecção por H. pylori, e a frequência dos diferentes genótipos dessa bactéria em pacientes com doenças gastrointestinais da nossa região, procurando estabelecer sua associação com os achados histopatológicos. Métodos - Em estudo prospectivo, foram coletadas amostras de 554 pacientes com diferentes doenças gastrointestinais (gastrite, úlcera duodenal, úlcera gástrica e câncer gástrico), atendidos em hospital de referência para todo o Estado do Pará, localizado na região metropolitana de Belém. Foram analisados dados obtidos através de questionário epidemiológico, relacionados ao sexo e faixa etária desses pacientes. A presença do H. pylori e do genótipo bacteriano foi detectada utilizando a PCR. As biopsias gástricas foram avaliadas histologicamente. Resultados - Observou-se uma prevalência de 91% da infecção pelo H. pylori, sendo mais frequente nos portadores de úlcera gástrica e câncer gástrico, nos quais houve predomínio do sexo masculino e a idade foi maior que a dos outros dois grupos estudados. O genótipo bacteriano predominante foi o s1m1cagA positivo, sendo mais frequentes entre os pacientes com úlcera gástrica, úlcera duodenal e câncer gástrico. Houve associação significante das cepas com o genótipo s1m1cagA positivo com maior grau de inflamação, atividade neutrofílica e desenvolvimento de metaplasia intestinal. Conclusão - Nosso estudo demonstra a alta incidência da infecção pelo H. pylori nos pacientes analisados em nosso meio, especialmente em portadores de úlcera e câncer gástricos. As cepas virulentas s1m1cagA+ foram predominantes e estavam associadas a lesões mais graves.

Um ensaio randomizado duplo-cego e controlado por placebo com probióticos em casos de supercrescimento bacteriano no intestino delgado em crianças tratadas com omeprazol / A double-blind placebo-controlled randomized trial on probiotics in small bowel bacterial overgrowth in children treated with omeprazole

OBJETIVO: Avaliar a incidência de SBID em crianças tratadas com omeprazol e testar se os probióticos influenciam essa incidência. MÉTODOS: Um ensaio duplo-cego controlado por placebo foi realizado em 70 crianças tratadas oralmente, durante 4 semanas, com 20 mg de omeprazol por dia. Desses, 36 indivíduos receberam diária e simultaneamente Lactobacillus rhamnosus R0011 (1,9 x 10(9) cfu) e Lactobacillus acidophillus R0052 (0,1 x 10(9) cfu) (grupo probiótico), enquanto 34 receberam placebo (grupo placebo). O diagnóstico de SBID teve como base o desenvolvimento de sintomas sugestivos em combinação com um teste respiratório com glicose positivo. RESULTADOS: Após um mês de tratamento com IBP, 30% (21/70) apresentaram um teste respiratório positivo sugerindo SBID; desses, 62% foram sintomáticos. Cinco crianças desenvolveram sintomas parecidos com os de SBID, mas apresentaram um teste respiratório negativo; 44 (63%) não apresentavam sintomas e tiveram teste respiratório negativo. Não houve diferença na incidência de testes respiratórios positivos no grupo probiótico em comparação ao grupo placebo (33% em comparação a 26,5%; p: 0,13). CONCLUSÕES: Como houve sintomas sugestivos de SBID em 26% das crianças tratadas com IBP e o teste respiratório com glicose deu resultados anormais em 72% delas, esse efeito colateral deve ser levado em consideração com mais frequência. O probiótico testado não reduziu o risco de desenvolver SBID.

OBJECTIVE:To evaluate the incidence of small bowel bacterial overgrowth (SBBO) in children treated with omeprazole, and to test whether probiotics influence the incidence. METHODS: A double-blinded, placebo-controlled trial was performed in 70 children treated orally during four weeks with 20 mg omeprazole per day. Lactobacillus rhamnosus R0011 (1.9 x 10(9) cfu) and Lactobacillus acidophillus R0052 (0.1 x 10(9) cfu) were simultaneously given daily to 36 subjects (probiotic group), while 34 subjects received placebo (placebo group). The diagnosis of SBBO was based on the development of suggestive symptoms, in combination with a positive glucose breath test. RESULTS: After one month of proton pump inhibitor (PPI) treatment, 30% (21/70) had a positive breath test suggesting SBBO; of these 62% were symptomatic. Five children developed SBBO-like symptoms, but had a negative breath test; and 44 (63%) were symptom free and had a negative breath test. There was no difference in the incidence of positive breath tests in the probiotic versus the placebo group (33% vs 26.5%; p = 0.13). CONCLUSIONS: Since symptoms suggesting SBBO developed in 26% of PPI-treated children, and since the glucose breath test was abnormal in 72% of these, this side-effect should be more frequently considered. The probiotic tested did not decrease the risk to develop SBBO.

Targeting the microbiota in the management of gastrointestinal and liver disease / Apuntando a la microbiota en el manejo de las enfermedades gastrointestinales y hepáticas

Thanks to rapid advances in technology the details of the human microbiome and its functions in health and disease are being progressively revealed. Though many reports have linked various disease states with an altered microbiome and while some associations between the microbiome and disease states are well established, many of these studies are largely descriptive and the changes reported in the microbiome have yet to be shown to be causative. A number of strategies are available to modify the microbiota; some such as the use of antibiotics for specific indications, are well established, others such as the use of probiotics and prebiotics in a variety of disease states are supported by more limited data. Fecal transplantation has emerged as an exciting, albeit rather drastic, intervention for intestinal and, perhaps, other disorders. Other approaches, such as the isolation, purification and formulation of small molecules with specific biological actions, derived from the microbiota look very promising.

Gracias al rápido avance de la tecnología los detalles del microbioma humano y sus funciones en salud y enfermedad están siendo conocidos progresivamente. A pesar que muchos reportes han relacionado varios estados de enfermedad con un microbioma alterado y mientras algunas asociaciones entre el microbioma y estados de enfermedad están bien establecidas, muchos de estos estudios son solo descriptivos y los cambios reportados en el microbioma todavía tienen que demostrarse que son la causa. Existen muchas estrategias para cambiar la microbiota; algunas como el uso de antibióticos para indicaciones específicas, están muy bien determinadas, otras, como el uso de probióticos y prebióticos en una gran variedad de enfermedades, están sustentadas en data más limitada. El trasplante fecal ha surgido como una alternativa muy emocionante, aunque algo drástica, para las enfermedades intestinales y quizás también para otras patologías. Otros abordajes como el aislamiento, purificación y formulación de pequeñas moléculas con acciones biológicas específicas, derivados de la microbiota aparecen como muy prometedoras.

Detección molecular y genotipificación de Helicobacter pylori en biopsias gástricas de pacientes adultos sintomáticos de la ciudad de Santa Fe, Argentina / [Molecular detection and genotypification of Helicobacter pylori in gastric biopsies from symptomatic adult patients in Santa Fe, Argentina].

Our goals were: a) to detect Helicobacter pylori in gastric biopsies of symptomatic adults by PCR, b) to detect the presence of the cagA gene as well as of the allelic variants of the vacA gene, and c) to correlate genotypes with the endoscopic diagnoses. H. pylori was detected in 81

(39/48) of patients by nested PCR for hsp60. The presence of cagA was detected in 15/22 of samples and vacA s1 - m1 was the most frequent allelic combination (15/22). Gastritis, the most frequent diagnosis, was associated with genotype cagA+ in 10/13 of patients. In this group, 9/13 showed the allelic variant vacA s1- m1. The variant vacA s2 - m2 was detected in 3/3 of gastritis cases by H. pylori with the cagA- genotype. These results are the first reported in our region and provide data of epidemiological interest.

Agentes patógenos responsables de trastornos gastrointestinales en sujetos infectados con VIH / Enteropathogens responsible of gastrointestinal disorders in HIV patients

Los trastornos gastrointestinales o TGI son afecciones debilitantes muy comunes en individuos infectados con el virus de inmunodeficiencia humana (VIH), que pueden conducir a muerte. Numerosos agentes etiológicos y mecanismos patofisiológicos han sido propuestos causar esta afección. A pesar del uso de terapia antirretroviral, que ha reducido enormemente la prevalencia de TGI en estos pacientes, patógenos entéricos como virus, bacterias, parásitos y hongos logran actuar todavía como agentes oportunistas. Citomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus y algunos más recientemente descritos, como bocavirus y Aichi virus han sido detectados en pacientes con VIH. Sin embargo, a excepción del citomegalovirus, hay muy poca certeza acerca del papel que juegan algunos de ellos en estas afecciones. Varias especies de Criptosporidium, microsporidos, Salmonella, micobacterias atípicas y Campylobacter jejuni han sido reconocidos también como una importante causa de TGI en estos pacientes. La progresiva incorporación de técnicas inmunoenzimáticas y moleculares, cada vez más sensibles para la detección de antígenos, anticuerpos y agentes patógenos en heces ha mejorado el diagnóstico de las diarreas y contribuido a esclarecer la importancia etiológica de algunos microorganismos en los pacientes inmunocompetentes. En Venezuela existen algunos datos acerca de la prevalencia de patógenos entéricos en pacientes inmunodeficientes infectados con VIH. La identificación del agente etiológico responsable de TGI podría ser de gran utilidad para el manejo y tratamiento de estos pacientes, para quienes la enteritis viral es una manifestación morbosa que reduce la calidad de vida y ocasiona un elevado gasto en salud pública.

Gastrointestinal disorders or GID are debilitating conditions common in individuals infected by the human immunodeficiency virus (HIV), capable of leading to death. Numerous etiological agents and pathophysiological mechanisms have been involved in this status. Although the use of highly active antiretroviral therapy (HAART) in many countries has greatly reduced the prevalence of gastrointestinal infections, enteric pathogens such as bacteria, parasites, fungi and viruses may still act as opportunist agents in these patients. Cytomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus and some more recently described, like bocavirus and Aichi virus, have been detected in HIV patients. However, except for cytomegalovirus, which is an established etiological agent of GID in these patients, the role of the other viruses remains unclear. Several species of Cryptosporidium, microsporidia, Salmonella, atipical mycobacteria and Campylobacter jejuni, have also been recognized as important causes of GID in HIV patients. The progressive incorporation of increasingly sensitive immunological and molecular assays for antigen, antibody and pathogens detection from faeces, has improved the diagnosis of diarrhea and contributed to clarify the etiological significance of some microorganisms in immunocompetent patients. In Venezuela, some information is available about the prevalence of enteric pathogens in immunocompromised patients infected with HIV. The identification of the etiologic agent responsible for this condition may be useful for the management and treatment of these patients, for whom viral enteritis is a disease, which reduces their quality of life and causes a high public health spending.

Roles of Enteric Microbial Composition and Metabolism in Health and Diseases / 대한소화기학회지

A complex microbiota colonizes mucosal layers in different regions of the human gut. In the healthy state, the microbial communities provide nutrients and energy to the host via fermentation of non-digestible dietary components in the large intestine. In contrast, they can play roles in inflammation and infection, including gastrointestinal diseases and metabolic syndrome such as obesity. However, because of the complexity of the microbial community, the functional connections between the enteric microbiota and metabolism are less well understood. Nevertheless, major progress has been made in defining dominant bacterial species, community profiles, and systemic characteristics that produce stable microbiota beneficial to health, and in identifying their roles in enteric metabolism. Through studies in both mice and humans, we are recently in a better position to understand what effect the enteric microbiota has on the metabolism by improving energy yield from food and modulating dietary components. Achieving better knowledge of this information may provide insights into new possibilities that reconstitution of enteric microbiota via diet can provide the maintenance of healthy state and therapeutic/preventive strategies against metabolic syndrome such as obesity. This review focuses on enteric microbial composition and metabolism on healthy and diseased states.

Histoplasmosis gastrointestinal: una presentación atipica / [Gastrointestinal histoplasmosis: an atypical presentation].

Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum. It is an endemic disease in the American continent. It is spread hematogenously and any organ can be affected. It is more frequent in immunodeficient patients and the most common opportunist mycosis associated with HIV Exclusive gastrointestinal involvement is rare and invariably mortal without treatment. It is considered to be impossible to diagnose the disease based on the macroscopic aspect of lesions. We report a 43-year-old male in apparent good health status who was admitted with intermittent proctorrhagia of one year of evolution associated to burning proctalgia, without any further symptoms. A videocolonoscopy (VCC) with proctologic exam was conducted The patient was warned about the potential orificial origin of the bleeding and the importance of screening for colorectal neoplasia. The proctologic exam revealed internal congestive hemorrhoids. VCC showed during the routine exploration of the terminal ileon lesions both in that level and rectum, although of a different morphology. The colon had normal endoscopic appearance. Biopsies of both lesions identified Histoplasma. Later studies diagnosed HIV/AIDS and the patient was referred to the infectology department to complete diagnostic tests and begin treatment of both diseases. In conclusion, we present an atypical case of this mycosis because of its exclusive gastrointestinal allocation, in anasymptomatic patient, in apparent good health, with unknown HIV/AIDS, who was admitted because of a proctorrhagia of orificial origin. Endoscopic biopsies of lesions of different morphologies, located in the terminal ileon and rectum, allowed the diagnosis of this disease, that had no clinical expression. This casual endoscopic diagnosis enabled to change the life expectancy of the patient. We consider that the described endoscopic lesions in rectum are of a particular morphology and can rarely be found in other pathologies. The diffusion of these images could warn other endoscopists of these phenomena.

Gastrointestinal pathogen distribution in symptomatic children in Sydney, Australia

There is limited information on the causes of paediatric diarrhoea in Sydney. This cross-sectional study used clinical and microbiological data to describe the clinical features and pathogens associated with gastrointestinal illnesses for children presenting to two major public hospitals in Sydney with diarrhoea, for the period January 2007-December 2010. Of 825 children who tested positive for an enteric pathogen, 430 medical records were reviewed. Adenovirus, norovirus and rotavirus were identified in 20.8%, 20.3% and 21.6% of reviewed cases, respectively. Younger children were more likely to have adenovirus and norovirus compared with rotavirus [P = 0.001]. More viruses were detected in winter than in the other three seasons [P = 0.001]. Rotavirus presented a distinct seasonal pattern with the lowest rates occurring in the warm months and peaking in the cooler months. Adenovirus showed a less consistent monthly trend, and norovirus detection increased in the cooler months [P = 0.008]. A decline in the number of rotavirus cases was observed after mid-2008. The majority of childhood diarrhoeal illnesses leading to hospital presentations in Sydney are caused by enteric viruses with most infections following clear seasonal patterns. However, a sustained decrease in the incidence of rotavirus infections has been observed over the study period

Gastrointestinal Basidiobolomycosis mimicking colon cancer in a Sudanese patient

Basidiobolomycosis is a rare disease caused by the fungus Basidiobolus ranarum. The incidence Rate of Gastrointestinal Basidiobolomycosis is approximately 1 in 45,333,334 or 0.00% in every 5 people in USA], member of the class Zygomycetes found worldwide [1].Basidiobolomycosis is usually a subcutaneous infection but rarely gastrointestinal1. This fungus is found mainly in the soil and on decaying vegetations2. It has been isolated from the banks of tropical rivers in West Africa, and has also been found in association with some insects2. The fungus is known to be present in the gastrointestinal tracts of reptiles, amphibians, and some bat species3. Definitive diagnosis requires culture and serological testing may be helpful. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features. Basidiobolomycosis is treated with surgical resection and itracanzole 200mg BD for three months or Amphotericin B 5mg /kg iv/24 hrs4

Infecciones gastrointestinales y VIH / Gastrointestinal infections and HIV

El sistema gastrointestinal debe ser considerado parte de la infección por virus de inmunodeficiencia humana (VIH), tanto por su rol en la patogénesis de la enfermedad como por ser blanco de infecciones en etapas avanzadas de la enfermedad (bajo 200 linfocitos CD4/ul). A nivel orofaríngeo y esofágico la infección predominante es candidiasis, en caso de descartarse o no responder a tratamiento, el estudio con endoscopía digestiva alta y biopsia será lo más atingente para guiar el tratamiento. A nivel gástrico, las manifestaciones infecciosas son más infrecuentes y habitualmente encontradas durante el estudio endoscópico. El intestino delgado y grueso pueden sufrir lesiones focales asociadas a distintas infecciones, pero la manifestación más habitual será diarrea, ésta debe ser objeto de estudio etiológico no invasivo con cultivos para enteropatógenos, leucocitos fecales y coproparasitológico. Es recomendable también el estudio con toxina de Clostridium difficile, y en pacientes muy avanzadas (bajo 50 CD4 por ul), realizar tinción ácido alcohol resistente modificada en deposiciones y estudio de Microsporidia con tinción tricrómica. Si los síntomas persisten y el estudio es negativo, se debe realizar colonoscopía y biopsia. Si no se encuentra causa, debe considerarse la posibilidad de una enteropatía asociada a VIH. Varios agentes etiológicos descritos en distintos segmentos tienen tratamiento específico, pero la terapia antirretroviral es lo que logra erradicar el cuadro en la mayoría de los casos. No obstante, las reacciones adversas digestivas asociadas a terapia antirretroviral constituyen un diagnóstico diferencial de las infecciones gastrointestinales.

Gastrointestinal tract plays an important role in Human Immunodeficiency Virus (HIV) infection, both for its participation in the pathogenesis of the disease as for being affected by different infections at late stages of disease (under 200 CD4/ul). In oropharinx and esophagus, candidiasis is the most common infection. If it is discarded or does not improve with appropriate treatment, endoscopic study and biopsy is the most adequate approach to guide the treatment. In the stomach, infections are not so important and frequently found during endoscopic studies. Small and large bowel can be the target of different focal infections, but diarrhea will be the most common clinical picture. Diarrhea must be assessed with stool leukocyte examination, stool cultures for enteric bacterial pathogens, examination for ova and parasites. Assay for Clostridium difficile toxin is recommended and, in patients under 50 CD4/ul, modified acid-fast stain and special trichrome staining may be useful. In patients with persistent symptoms and negative non-invasive study, endoscopic and hystologic studies must be performed, if not any cause is identified; HIV-associated enteropathy has to be considered. Some etiologies have specific therapy, but antiretroviral therapy is the most effective treatment in most cases. Nonetheless, gastrointestinal side effects of antiretroviral therapy are now part of differential diagnosis of intestinal infections.

Two cases of gastrointestinal anthrax with an unusual presentation from Kermanshah [Western Iran]

During 1988 - 1994 a total of 38 cases of human anthrax were admitted to Sina Hospital in Kermanshah [western Iran]. There were two cases of gastrointestinal anthrax [5.3%] with culture positive ascitic fluid. Among the many reported gastrointestinal signs and symptoms, unexpectedly one of our patients had only vomiting and ascites whereas the other case had only ascites. Neither had abdominal pain, tenderness, diarrhea, hematemesis, melena, or other expected signs and symptoms of anthrax. Therefore, in contrast to the available reports, these cases presented atypically and despite receiving a sufficient dose of penicillin, the drug of choice at that time, both patients died. Gastrointestinal anthrax is not as rare as reported but due to an unusual presentation it may be misdiagnosed. Paying attention to gastrointestinal anthrax in the differential diagnosis of ascites with unknown origin and other gastrointestinal presentations in endemic areas may help to diagnose more cases of anthrax. Timely appropriate management in an early stage of the disease, may increase their chances of survival

Associação entre lesões da mucosa gastroduodenal e Helicobacter Pylori em pacientes com doença hepática crônica / Association between Helicobacter pylori infection and gastroduodenal lesions in patients with chronic liver disease

Contexto: A relação entre a infecção por Helicobacter pylori e lesões da mucosa gastroduodenal em pacientes com doença hepática crônica permanece controversa. Objetivo: Avaliar a presença de lesões da mucosa gastroduodenal e sua relação com Helicobacter pylori em pacientes com doença hepática crônica. Métodos: Estudaram-se 46 pacientes e 27 controles com dispepsia funcional, submetidos a endoscopia digestiva alta. Foram consideradas lesões da mucosa gastroduodenal a gastropatia da hipertensão portal, erosão e úlcera péptica. O Helicobacter pylori foi detectado através de duas amostras de biopsia do antro e do corpo gástrico, pelo método de Giemsa. Resultados: As lesões da mucosa gastroduodenal foram identificadas em 38 (82,6 por cento) pacientes com doença hepática crônica, significantemente mais frequente que nos controles (P = 0,02). A presença de Helicobacter pylori foi observada em 13 (28,2 por cento) dos pacientes com doença hepática e em 17 (62,9 por cento) dos controles. A estimativa de risco mostrou interação significante entre lesão da mucosa e doença hepática crônica (P = 0,04; OR 5,1 IC 95 por cento, 1,6-17,3). Quando associada à presença do Helicobacter pylori, o risco foi mais elevado na ausência da bactéria (P = 0,005; OR 13,0 IC 95 por cento, 1,4-327,9). Conclusão: Pacientes com doença hepática crônica mostram risco aumentado de desenvolver lesões da mucosa gastroduodenal, independente da presença de Helicobacter pylori.

Context: The relationship between Helicobacter pylori infection and gastroduodenal lesions in chronic liver disease remains controversial. Objective: Evaluate the evidence of the role of H. pylori infection in gastroduodenal lesions in patients with chronic liver disease. Methods: Forty-six patients with chronic liver disease were matched with 27 dyspeptic persons for age and sex. The gastroduodenal lesions were portal hypertension gastropathy, erosion and peptic ulcer. All patients underwent upper endoscopy: two biopsies were taken in the antrum and in the gastric body. The biopsies were used for Giemsa staining. Results: A gastroduodenal lesions were found in 38 (82.6 percent) patients with liver disease and was significantly more frequent than among controls (P = 0.002). H. pylori infection was detected at histological assessment in 13 (28.2 percent) patients with chronic liver disease and in 17 (62.9 percent) controls. The odds ratio (OR) showed an interaction statistically significant between gastroduodenal lesions and chronic liver disease (P = 0.04; OR = 5.1; 95 percent CI = 1.6-17.3). When adjusted for the presence of H. pylori OR was significantly with H. pylori negative (OR 13.0 IC 95 percent, 1.4-327.9). Conclusion: Patients with chronic liver disease showed higher risk of developing gastroduodenal lesions regardless of the presence of the H. pylori infection.

Association of Helicobacter pylori restriction endonuclease-replacing gene, hrgA with overt gastrointestinal diseases / Associação entre o hrgA (Helicobacter pylori restriction endonuclease-replacing gene) com as principais doença gastrointestinais

BACKGROUND and AIM: Helicobacter pylori has been proven to be responsible for causing various gastrointestinal disorders including gastric adenocarcinoma. Several genes of pathogen (the genes of the cag-PAI, vacA, iceA, and babA) either in combination or independently have been reported to significantly increase the risk of ulceration/gastric carcinoma, with the cagA gene having the strongest predictive value. Pursuit to identify new genes which could serve as a marker of overt disease progression, lead to the discovery of hrgA gene. METHODS: Fifty-six indigenous strains of H. pylori from subjects with various gastric disorder were screened to assess the status of hrgA gene along with the cagA gene using simple polymerase chain reaction using specific oligonucleotide primers. Post-amplification, amplicons were subjected for sequencing to identify any strain specific variations in sequences from the H. pylori isolated from different disease manifestations. Histopathological analysis was done to ascertain any significant change in the histological scores of subjects infected with cagA+/hrgA+ and cagA-/hrg+ strains. RESULTS: All the 56 (100 percent) subjects amplified with the oligonucleotide primers specific to hrgA gene, whereas 81.71 percent subjects showed the presence of cagA gene. Sequencing of the amplimers showed 99 percent homology. Histology of the cagA+/hrgA+ and cagA-/hrg+ subjects did not show any significant difference. CONCLUSION: hrgA gene of Helicobacter pylori is not a ideal surrogate marker for identifying individuals with higher risk of developing overt gastro-duodenal diseases such as neoplasia of the stomach.

RACIONAL e OBJETIVOS: O Helicobacter pylori tem sido incriminado como causador de vários distúrbios digestivos, incluindo o adenocarcinoma gástrico. Diversos genes patogênicos (os genes do cag-PAI, vacA, iceA e babA), em combinação ou independentes, têm sido reportados como fatores de aumento de risco para ulceração/carcinoma gástrico, tendo o gene cagA forte valor preditivo. A procura da identificação de novos genes que possam vir a ser marcadores da progressão da doença levaram à descoberta do gene hrgA. MÉTODOS: Cinqüenta e seis amostras de H. pylori provenientes de pacientes com diversas afecções gástricas foram examinadas para caracterizar a presença do hrgA juntamente ao cagA, usando iniciadores específicos da reação de cadeia da polimerase. Após amplificação, os produtos amplificados pela PCR foram seqüenciados para a identificação de variações específicas nas seqüências do H. pylori isolado de diferentes doenças gastroduodenais. A análise histopatológica foi feita para assegurar qualquer mudança significativa nos escores dos indivíduos infectados com cagA+hrgA+ e cagA-/hrgA+. RESULTADOS: Todas as 56 amostras (100 por cento) foram amplificadas com iniciadores específicos para o hrgA, enquanto que 81,71 por cento mostraram a presença do cagA. O seqüenciamento do produto amplificado pela PCR mostrou 99 por cento de homologia. A histologia entre os grupos cagA+/hrgA+ e cagA-/hrgA+ não mostrou nenhuma diferença significante. CONCLUSÃO: O gene hrgA do H. pylori não é o marcador ideal para identificar indivíduos com alto risco de desenvolvimento de doenças gastrointestinais como a neoplasia de estômago.

Helicobacter pylori e doença péptica: estudo comparativo de métodos diagnósticos / Helicobacter pylori and peptic disease: comparative study of the diagnostic methods

Foram estudados, prospectivamente, 150 pacientes. Estudo endoscópico revelou gastrite crônica em 109 pacientes (72,6 por cento), úlcera gástrica em 6 (4 por cento), duodenite crônica em 9 (6 por cento) e úlcera duodenal em 26 (17,4 por cento). Quanto à avaliação metodológica para pesquisa do Helicobacter pylori, 103 (68,67 por cento) apresentaram teste da urease positivo, 104 (69,33 por cento), positividade histopatológica e 98 (65,33 por cento), positividade sorológica. Não houve diferença estatística entre os métodos. Pela facilidade de realização, o teste da urease credencia-se como o de melhor indicação nos pacientes que também se beneficiarão com o diagnóstico endoscópico. Caso a endoscopia digestiva alta não possa ou não deva ser realizada, está recomendado o teste sorológico.

Prospective endoscopic study of 150 patients revealed chronic gastritis in 109 (72.6 percent), gastric ulcer in 6 (4 percent), chronic duodenitis in 9 (6 percent) and duodenal ulcer in 26 (17.4 percent). Searching for Helicobacter pylori, positive urease test was observed in 103 (68.67 percent), histologic evidence in 104 (69.33 percent) and positive serologic test in 98 (65.33 percent), without statistical difference. The urease test is recommended in the diary medical practice, for the patients who also will benefit themselves with the endoscopic diagnosis. On the other hand, the serologic test is useful when the endoscopy of the upper digestive tract cannot or must not be realized.