Venous thromboembolism in patients with inflammatory bowel disease: review of literature and practical algorithms.

Inflammatory bowel disease (IBD) is associated with several extra-intestinal complications, including venous thromboembolism (VTE). In patients with IBD, VTE occurs at younger age and is associated with higher recurrence and mortality rates as compared to patients without IBD. The risk appears to be higher during active disease and hospitalization. In this review we target the importance of prophylaxis and aim to describe strategies for treatment of VTE in patients with IBD. More awareness is needed, given the fact that VTE is often preventable with appropriate pharmacological prophylaxis. Algorithms are provided on which patients should be given prophylaxis and on treatment duration of VTE in patients with inflammatory bowel disease.

Diagnostic approach for detection and identification of emerging enteric pathogens revisited: the (Ali)arcobacter lanthieri case.

An immunocompetent patient without a history of recent travel or animal exposure developed persistent abdominal bloating and cramps without diarrhoea or fever. Negative additional investigations excluded gastritis, infectious colitis, inflammatory bowel disease and neoplasia, but routine stool culture detected a Campylobacter-like organism. The isolate was obtained with use of a polycarbonate filter technique, emphasizing the importance of culture to support and validate the occurrence of emerging and new bacterial enteric pathogens. The ensuing extensive laboratory examinations proved challenging in identifying this potential pathogen. Phylogenetic marker analysis based on the 16S ribosomal RNA and rpoB gene sequences revealed that the isolate was most closely related to Arcobacter lanthieri and Arcobacter faecis. Subsequent analysis of a draft whole genome sequence assigned the isolate to A. lanthieri. We report the presence of five virulence genes, cadF, ciaB, mviN, hecA and iroE, indicating a possible pathogenic nature of this organism. This case demonstrated the importance of the use of agnostic methods for the detection of emerging pathogens in cases of enteric disease with a wide array of gastrointestinal symptoms.

Fecal microbiota transplantation in ulcerative colitis.

BACKGROUND/STUDY AIMS: Fecal microbiota transplantation (FMT), a treatment aiming to restore dysbiosis by transferring stool from a healthy donor into the patient, has cure rates up to 90% in the management of recurrent Clostridium difficile (C. difficile) diarrhea. This paper tries to determine whether FMT is safe and effective in the treatment of ulcerative colitis, and what the potential characteristics could be of a 'super donor'. METHODS: The PubMed database was searched using the term fecal microbiota transplantation inflammatory bowel disease. Only articles discussing the use of FMT in the treatment of ulcerative colitis were withheld. Finally, 31 original studies (10 case reports, 17 open label trials, 4 randomized controlled trials (RCTs)) and 1 meta-analysis were included. RESULTS: So far 4 RCTs have investigated the effectiveness of FMT in treating UC. Three RCTs reported a significant difference between FMT and a control group, achieving clinical remission in 24 to 44% of patients (vs. 5 to 20% of patients in control groups). The meta-analysis confirms that significantly more patients in the FMT-group achieve clinical remission in comparison to patients in the control group (p=0,01) : 42,1% vs. 22,6%. The composition of the gut microbiota plays an important role in the success of FMT-treatment. CONCLUSION: FMT seems to be a promising and safe therapy in the management of UC. Further research, with larger cohorts, will be needed to confirm this and to determine the optimal FMT procedure.

A man with abdominal pain and eosinophilia : tissue is the issue.

A 24-year-old male presented with abdominal pain, postprandial vomiting and weight loss. Lab results showed an elevated serum eosinophil count and CT-scan demonstrated a thickened antral, duodenal and jejunal wall. Repetitive endoscopic mucosal biopsies were normal. Work-up of eosinophilia-associated gastro-intestinal disorders excluded secondary causes. Bone marrow showed an elevated eosinophil count without arguments for a primary hypereosinophilic syndrome. Endoscopic ultrasound-guided fine needle biopsy detected a strongly elevated number of eosinophils in the muscularis layer of the duodenum. The diagnosis of muscularispredominant eosinophilic gastroenteritis together with a secondary hypereosinophilic syndrome was made. The patient was started on steroids and all symptoms vanished within a few days.

Progressive familial intrahepatic cholestasis and benign recurrent intrahepatic cholestasis: a review.

Progressive familial intrahepatic cholestasis (PFIC) and benign recurrent intrahepatic cholestasis (BRIC) are two rare autosomal recessive disorders, characterized by cholestasis. They are related to mutations in hepatocellular transport system genes involved in bile formation. The differentiation between PFIC and BRIC is based on phenotypic presentation: PFIC is a progressive disease, with evolution to end-stage liver disease. BRIC is characterized by intermittent recurrent cholestatic episodes, with irresistible pruritus, mostly without evident liver damage. Between symptomatic periods, patients are completely asymptomatic. In this article, a short overview of the aetiology, the clinical and diagnostic characteristics and the therapy of both PFIC and BRIC are given.