Intestinal Barrier and Gut Microbiota in Patients with Overlapping Irritable Bowel Syndrome and Functional Dyspepsia.

BACKGROUND: Disturbances in the intestinal barrier and gut dysbiosis have been observed in patients with functional bowel diseases. AIMS: To investigate the correlation between biomarkers of intestinal barrier disorders at different layers and the severity of symptoms in patients with overlapping diarrhea-predominant irritable bowel syndrome and functional dyspepsia (IDFO), as well as with gut microbiota taxa. METHODS: This study included 45 patients with IDFO and 16 healthy controls. Endoscopy with biopsy of the duodenum and sigmoid colon (SC) was performed to count intraepithelial lymphocytes (IELs) and mucosal eosinophils (subepithelial layer), assess fatty acid binding protein (FABP; epithelial layer) level, and stain for mucin-2 (MUC-2; pre-epithelial layer). Composition of the gut microbiota was evaluated using 16S rRNA gene sequencing. RESULTS: Patients with IDFO exhibited an increase in biomarkers of intestinal barrier disorders at all layers studied. IEL count in the duodenum was correlated with the severity of bloating (r = 0.336; p = 0.024) and, in the SC, was correlated with tenesmus severity (r = 0.303; p = 0.042). FABP-1 level in the SC was correlated with the severity of diarrhea (r = 0.577; p = 0.001), and FABP-5 concentration in the SC was correlated with abdominal distension (r = 0.477; p = 0.010). MUC-2 concentration in the duodenum was correlated with the severity of heartburn (r = 0.572; p = 0.025) and burning sensation in the epigastrium (r = 0.518; p = 0.048). All biomarkers of intestinal barrier permeability were correlated with the abundance of some gut microbiota taxa. CONCLUSION: Patients with IDFO exhibited disrupted intestinal barrier function in all layers, which was associated with clinical symptom severity and changes in the gut microbiota.

Effect of Rebamipide on the Intestinal Barrier, Gut Microbiota Structure and Function, and Symptom Severity Associated with Irritable Bowel Syndrome and Functional Dyspepsia Overlap: A Randomized Controlled Trial.

Treatment of functional digestive disorders is not always effective. Therefore, a search for new application points for potential drugs is perspective. Our aim is to evaluate the effect of rebamipide on symptom severity, intestinal barrier status, and intestinal microbiota composition and function in patients with diarrheal variant of irritable bowel syndrome overlapping with functional dyspepsia (D-IBSoFD). Sixty patients were randomized to receive trimebutine (TRI group), trimebutine + rebamipide (T + R group), or rebamipide (REB group) for 2 months. At the beginning and end of the study, patients were assessed for general health (SF-36), severity of digestive symptoms (Gastrointestinal Symptom Rating and 7 × 7 scales), state of the intestinal barrier, and composition (16S rRNA gene sequencing) and function (short-chain fatty acid fecal content) of the gut microbiota. The severity of most digestive symptoms was reduced in the REB and T + R groups to levels similar to that observed in the TRI group. The duodenal and sigmoidal lymphocytic and sigmoidal eosinophilic infiltration was decreased only in the REB and T + R groups, not in the TRI group. Serum zonulin levels were significantly decreased only in the REB group. A decrease in intraepithelial lymphocytic infiltration in the duodenum correlated with a decrease in the severity of rumbling and flatulence, while a decrease in infiltration within the sigmoid colon correlated with improved stool consistency and decreased severity of the sensation of incomplete bowel emptying. In conclusion, rebamipide improves the intestinal barrier condition and symptoms in D-IBSoFD. The rebamipide effects are not inferior to those of trimebutine.

A case report of colonic stent placement without X-ray control in the COVID-19 era: a practical method or a mistake?

Background: During the recent 2-year quarantine, the coronavirus disease 2019 (COVID-19) pandemic changed the course of medical treatment and posed some new challenges to the care of particularly vulnerable oncology patients. Despite the re-purposing of The Second University Clinic (Sechenov University), we still admitted many patients with colonic obstruction. The endoscopic unit was situated in a separate facility, but due to the intensive use of all of our X-ray equipment for COVID-19 patients, the question arose about the possibility of placing a stent without fluoroscopic control. Here, we present the first case report of colonic stent placement without X-ray guidance. Case Description: An 81-year-old woman was admitted in January 2021 with clinical signs of colonic obstruction. An emergency computed tomography (CT) abdominal scan revealed an irregular focal thickening of the wall of the rectosigmoid. At the medical case conference, a minimally invasive intervention was recommended to decompress the intestine and prepare the patient for radical surgery. A colonoscopy of the rectosigmoid area showed circumferential tumor infiltration with narrowing of the lumen to approximately 3 mm. Bowel decompression was performed by placing a self-expandable metallic stent (SEMS) via colonoscopy without fluoroscopic monitoring. After performing the stenting procedure, the patient's clinical symptoms were relieved, and she reported passing of stool and gases, pain reduction, and reduction of abdominal bloating. Conclusions: In 6 months we performed 13 colonic stentings with effective decompression of the intestines without any complications. From our point of view, our forced clinical experience showed us that in desperate situations with severely impacted patients, an experienced endoscopic team can perform colonic stenting without direct X-ray navigation (provided there is the appropriate selection of stent design and size according to findings on a preliminary CT scan), if due to unforeseen circumstances an X-ray is unavailable.

Endobronchial lipoma: a rare cause of subsegmental bronchial obstruction.

Endobronchial lipoma is a rare cause of bronchial obstruction. Early identification and diagnosis of endobronchial lipoma can prevent damage of the lung parenchyma. Clinicians should be aware of this rare tumour. Bronchoscopic resection is the first choice of treatment, but surgical operation should be indicated in certain circumstances.