Probiotics and Fecal Transplant: An Intervention in Delaying Chronic Kidney Disease Progression?

Chronic kidney disease (CKD) is a global health challenge affecting nearly 700 million people worldwide. In the United States alone, the Medicare costs for CKD management has reached nearly USD 80 billion per year. While reversing CKD may be possible in the future, current strategies aim to slow its progression. For the most part, current management strategies have focused on employing Renin Angiotensin Aldosterone (RAS) inhibitors and optimizing blood pressure and diabetes mellitus control. Emerging data are showing that a disruption of the gut-kidney axis has a significant impact on delaying CKD progression. Recent investigations have documented promising results in using microbiota-based interventions to better manage CKD. This review will summarize the current evidence and explore future possibilities on the use of probiotics, prebiotics, synbiotics, and fecal microbial transplant to reduce CKD progression.

Autoimmune Pancreatitis Masquerading as Pancreatic Cancer: A Case Report and Literature Review.

Autoimmune pancreatitis (AIP) is a chronic fibro-inflammatory disease of the pancreas that belongs to the spectrum of immunoglobulin G-subclass 4-related diseases (IgG4-RD). It is sometimes associated with a visible pancreatic mass mimicking pancreatic cancer on imaging. The most common presentations include abdominal pain and obstructive jaundice in elderly men. Similar to other IgG4-RD, it can cause cholangiopathy, nephritis, orbital pseudotumor, and extensive lymphadenopathy. Here, we present the case of a 53-year-old female with abdominal pain and obstructive jaundice, which was diagnosed as AIP in association with significantly elevated tumor marker carbohydrate antigen 19-9 (CA 19-9). She responded to biliary decompression and steroid treatment, potentially avoiding extensive surgical intervention. On follow-up, her CA 19-9 and IgG4 levels were normalized. AIP should be high on the differential diagnosis during the evaluation of a pancreatic mass.

A Rare Case of Signet Cell Carcinoma of Transverse Colon in a Young Patient With Ulcerative Colitis.

Signet ring cell carcinoma (SRCC) represents an extremely rare histological type for colon cancer, accounting for less than 1% of all colon neoplasms. SRCC is usually aggressive and it is associated with poor prognosis. It can be divided into mucinous adenocarcinoma (MAC) with signet cells and signet cell of more than 50% of the tumor area. Main differential diagnosis is metastatic gastric signet cell carcinoma. A 27-year-old African American man with past medical history of ulcerative colitis on mesalamine presented to emergency department with complaints of diarrhea abdominal pain and shortness of breath for 3 weeks. Physical exam was remarkable for tachycardia with a heart rate (HR) of 106 and pallor otherwise normal. Laboratory data showed potassium 2.8 mmol/L, creatinine 1.11 mg/dL, lactic acid 8 mmol/dL, hemoglobin 2 g/dL and white blood cell count 21 × 106/µL. Computed tomography (CT) scan of the abdomen with intravenous (IV) contrast showed distention of the colon, air-fluid levels and loss of haustra. Clostridium difficile stool PCR was positive. A clinical diagnosis of toxic megacolon due to C. difficile infection was made. Packed red blood cells (PRBCs) were transfused, and oral vancomycin and IV fluids were started. Symptoms and labs initially improved. However, on the third day, abdominal pain recurred with lactic acidosis. Diagnosis of refractory ulcerative colitis was made. Surgery was performed. Subtotal colectomy and ileostomy were done. Pathology revealed stage IV invasive signet ring cell adenocarcinoma, in the transverse colon poorly differentiated, with background of marked ulcerative colitis. Patient was started on adjuvant chemotherapy oxaliplatin, leucovorin and 5-flurouracil as an outpatient. Patient is undergoing 12 rounds of chemotherapy; he is currently in round 8 without complications. Patient is scheduled for screening colonoscopy and reversal of colostomy after completion of chemotherapy. SRCC of the colorectum is very rare, comprising less than 1% of colorectal cancer cases. It occurs mainly on the right colon and presents at later stages. Despite the rarity of this tumor, it is associated with ulcerative colitis. The main differential diagnosis is a metastasis from gastric signet cell carcinoma. It is associated with a poor prognosis.

Colonoscopy versus computed tomography colonography for colorectal cancer screening.

Colorectal cancer is second only to lung cancer as the leading cause of death among North Americans of both sexes. Although screening rates for colorectal cancer in the United States have increased over the past decade, these rates (in the range of 45%-60%) are still lower than the screening rates for breast cancer (approximately 80%). Optical colonoscopy has been recognized as the preferred method for colorectal cancer screening in the United States, but computed tomography colonography has recently been gaining favor. This article compares the 2 methods with respect to both advantages and disadvantages.