Correlation of mental and psychological status with disease activity in patients with inflammatory bowel disease using SCL-90 R Questionnaire.

Introduction: Inflammatory bowel disease (IBD) can affect mental health. There is no evidence that stress is a direct cause of the disease. Most IBD patients describe an emotional impact, mainly feelings of depression and anxiety. Many questionnaires are used to assess anxiety in those patients, including SCL-90. Aim: To investigate the correlation between mental and psychological status to disease activity in patients with inflammatory bowel disease using 90-Item Symptom Checklist (SCL-90 R) questionnaire. Material and methods: The study included 100 patients (50 Crohn's disease (CD) patients - 50 ulcerative colitis (UC) patients). Detailed history taking, systemic physical examination, laboratory investigations, colonoscopy, and the SCL-90-R symptom checklist - a self-report psychometric instrument (questionnaire) for each patient. Results: The mean age of Crohn's disease patients was 24.2 ±3.6 years. In ulcerative colitis the mean age was 28.5 ±7.3 years. No age or gender relation could be detected with the SCL-90 score in both groups. Our study showed a direct correlation of CD disease activity (CDAI) and endoscopic activity (SES) according to the SCL-90 R questionnaire. There was direct correlation of UC disease activity (SCCAI) and endoscopic activity (UCEIS) according to the SCL-90 R questionnaire. Conclusions: There is a direct correlation between disease activity and endoscopic activity in UC and CD according to the SCL-90 R questionnaire.

Study of Fecalibacteria prausntzii in Egyptian patients with inflammatory bowel disease.

Introduction: Inflammatory bowel diseases (IBD) are characterised by chronic inflammation of the gastrointestinal tract. There aetiopathogenesis has not yet been fully elucidated. Faecalibacterium prausnitzii is one of the most abundant in human gut, and it is found in about 5% of the gut microbiota. Aim: To study the role of F. prausnitzii in Egyptian patients with ulcerative colitis (UC) and Crohn's disease (CD) and to assess its relationship with the disease activity. Material and methods: This study includes 80 patients divided as follows: group I: 30 patients with UC; group II: 30 patients with CD; and group III: 20 healthy patients as control. DNA execration was performed using a faecal extraction kit and quantitative SYBR green real time PCR to identify the core of F. prausnitzii. Results: In group 1 of UC patients, the level of bacteria was reduced by a mean of 1.68E-01, and in the control group by a mean of 2.72E-01 (p 2 = 0.004, significant). Regarding F. prausnitzii in UC patients according to Mayo score, in severe patients the level of bacteria was reduced significantly by a median of 4.80E-02. Regarding F. prausnitzii in group 2 of CD, the level of bacteria was significantly reduced by mean of 1.70E-01, and in the control group by a mean of 2.72E-01 (p 3 = 0.037, significant). Conclusions: There was a significant difference between CD and UC patients and the control group in F. prausnitzii. There was a significant reduction in the level of F. prausnitzii in severe UC cases.

Study of the gut microbiome in Egyptian patients with type 1 diabetes mellitus.

Introduction: Type 1 diabetes mellitus (T1DM) is an autoimmune disease. The gut microbiota has been proposed as a key actor in the pathogenesis of T1DM. Aim: To identify the gut microbiome that are likely to be related to T1DM. This may have an impact on the future understanding of the pathogenesis of T1DM and possible approaches to prevent and treat it. Material and methods: The study included 40 T1DM patients and a cross-matching control group of 20 healthy subjects of matched age and sex; stool specimens were taken from each group. Quantitative SYBR Green Real-Time PCR technique targeting 16S rRNA was done for the identification and quantitation of Bacteroides, Prevotella, Ruminococcus, Lactobacillus johnsonii, Lactobacillus reuteri, and Veillonella. Results: T1DM patients showed significantly higher Bacteroides (p < 0.001) and Lactobacillus johnsonii (p = 0.003), but lower Veillonella (p = 0.013) than the control group. However, there was no statistical difference between T1DM and control cases as regards Prevotella (p = 0.204), Ruminococcus (p = 0.598), Lactobacilli (p = 0.901), and Lactobacillus reuteri (p = 0.332). Conclusions: Egyptian patients showed dysbiosis of the gut microbiome that can be related to the pathogenesis of T1DM. This hopefully points to the potential therapeutic benefits of manipulating the composition of the gut microbiome in the management of, or even protection from, T1DM.

Microbiome diversity in African American, European American, and Egyptian colorectal cancer patients.

Purpose: Although there is an established role for microbiome dysbiosis in the pathobiology of colorectal cancer (CRC), CRC patients of various race/ethnicities demonstrate distinct clinical behaviors. Thus, we investigated microbiome dysbiosis in Egyptian, African American (AA), and European American (EA) CRC patients. Patients and methods: CRCs and their corresponding normal tissues from Egyptian (n = 17) patients of the Alexandria University Hospital, Egypt, and tissues from AA (n = 18) and EA (n = 19) patients at the University of Alabama at Birmingham were collected. DNA was isolated from frozen tissues, and the microbiome composition was analyzed by 16S rRNA sequencing. Differential microbial abundance, diversity, and metabolic pathways were identified using linear discriminant analysis (LDA) effect size analyses. Additionally, we compared these profiles with our previously published microbiome data derived from Kenyan CRC patients. Results: Differential microbiome analysis of CRCs across all racial/ethnic groups showed dysbiosis. There were high abundances of Herbaspirillum and Staphylococcus in CRCs of Egyptians, Leptotrichia in CRCs of AAs, Flexspiria and Streptococcus in CRCs of EAs, and Akkermansia muciniphila and Prevotella nigrescens in CRCs of Kenyans (LDA score >4, adj. p-value <0.05). Functional analyses showed distinct microbial metabolic pathways in CRCs compared to normal tissues within the racial/ethnic groups. Egyptian CRCs, compared to normal tissues, showed lower l-methionine biosynthesis and higher galactose degradation pathways. Conclusions: Our findings showed altered mucosa-associated microbiome profiles of CRCs and their metabolic pathways across racial/ethnic groups. These findings provide a basis for future studies to link racial/ethnic microbiome differences with distinct clinical behaviors in CRC.

Serum matrix metalloproteinase-9 concentration as a marker of disease activity in patients with inflammatory bowel disease.

BACKGROUND AND AIM: Diagnosing inflammatory bowel disease (IBD), determining the appropriate treatment and follow-up of patients rely mainly on endoscopy and biopsy. Finding a sensitive, specific, cost-effective and less-invasive biomarker is the focus of much of the current research in this field. The aim was to investigate the relation between serum matrix metalloproteinase-9 (MMP-9) levels and disease activity in patients with IBD, correlating with clinical and endoscopic indices of disease activity and with treatment received. PATIENTS AND METHODS: Sixty patients (30 with ulcerative colitis, 30 with Crohn's disease) and 20 controls were included. Serum MMP-9 levels were measured for all patients and controls by ELISA. Clinical activity was determined by partial Mayo score for patients with ulcerative colitis and Crohn's Disease Activity Index for patients with Crohn's disease, and endoscopic activity was assessed using Ulcerative Colitis Endoscopic Index of Severity for patients with ulcerative colitis and Simple Endoscopic Score of Crohn's disease for patients with Crohn's disease. RESULTS: Serum MMP-9 was higher in patients with active ulcerative colitis than in patients with inactive disease and the control group. Serum MMP-9 was also higher in patients with active Crohn's disease than in patients with inactive disease and the control group. In both ulcerative colitis and Crohn's disease groups, there was a significant difference between serum MMP-9 levels in patients receiving conventional treatment and those on biological treatment, with lower levels of the marker detected in the sera of patients subgroups receiving biologics. CONCLUSION: Serum MMP-9 can be used to differentiate between active and inactive IBD (including both ulcerative colitis and Crohn's disease).

Computed tomography enterocolongraphy in assessment of degree of ulcerative colitis activity.

BACKGROUND: Inflammatory bowel diseases are gaining more interest in the past few years. Ulcerative colitis (UC) is a chronic disease that requires accurate follow-up for a good treatment plan. Colonoscopy alone cannot be efficient to detect disease extent and has a high risk of perforation in acute severe UC and toxic megacolon. Computed tomographic enterocolonography (CTE) is widely used now to detect intramural, extra-intestinal involvement and intestinal complications. Hence, this study aimed to evaluate CTE in the assessment of the degree of activity of UC. PATIENTS AND METHODS: This cross-sectional study was carried on 50 UC patients, divided into 36 males and 14 females presented at the Gastroenterology Unit, Alexandria Main University, Faculty of Medicine. Assessment of UC activity was done to all patients on three levels; the ulcerative colitis disease activity index for the clinical level, ulcerative colitis endoscopic index of severity by endoscopy and pathologically by degree of neutrophilic invasion, crypt abscess or cryptitis, presence of oedema and mucosal surface ulceration, then CTE was done and the findings were compared with the histopathological findings. Bowel wall thickening in CTE was divided into: normal (<3 mm, score 0), mild (3-6 mm, score 1), moderate (6-9 mm, score 2) and severe (>9 mm, score 3). Mesenteric hyperaemia, mucosal hyper enhancement and enlarged pericolic lymph nodes were recorded. RESULTS: CTE findings in the form of bowel wall thickening and hyper enhancement were found in 74% of active cases and were correlated with all histopathological findings investigated in this study with high statistical significance except in chronic stages, whereas lymph node enlargement and mesenteric hyperaemia did not show statistical significance with disease activity. CONCLUSION: CTE is a good tool for diagnosing disease activity in UC.

Study of gut microbiome in Egyptian patients with autoimmune thyroid diseases.

BACKGROUND: Hashimoto's thyroiditis (HT) and Graves' disease (GD) are the most prevalent forms of autoimmune thyroid disorders (ATD). A pathogenic link with gut microbial dysbiosis has been described in different autoimmune disorders but not yet fully elucidated in patients with ATD. AIM OF THE WORK: The present study aimed to elucidate changes in gut microbiome in Egyptian patients with ATD. PATIENTS AND METHODS: The gut bacterial composition of 20 patients with ATD and 30 age, sex, and BMI-matched healthy subjects as controls was analysed using Quantitative SYBR Green Real-Time PCR technique targeting 16S rRNA of selected bacterial genera and/or species. RESULTS: Compared with controls; the Firmictus/Bacteroidetes ratio (known to be representative for healthy status) was significantly decreased in patients with ATD (P < .001), without a significant difference between GD and HT patients. Also, the relative abundance of beneficial bacteria associated with the gut barrier and anti-inflammatory state; A. mucinophilia, Bifidobacterium, Lactobacillus, and F. prausnitzii, were decreased in ATD patients. TRAb in GD patients and anti-TPO in HT patients showed a significant positive correlation with Bacteroidetes (P = .001) and (P = .018), respectively. CONCLUSION: Egyptian patients with ATD show dysbiosis of the gut microbiome that can be related to the pathogenesis of ATD. This hopefully points to the potential therapeutic benefits of manipulating the composition of the gut microbiome in the management or even protection from ATD.

Phylogenetic and pathotype analysis of Escherichia coli stool isolates from Egyptian patients with inflammatory bowel disease.

INTRODUCTION: The role of Escherichia coli in the pathogenesis of inflammatory bowel disease (IBD) is still controversial. The study aimed to investigate the pathotypes and the phylogenetic groups of E. coli in Egyptian patients with IBD in an attempt to find an association between any type or group with the severity of the disease. METHODS: Thirty ulcerative colitis (UC), 30 Crohn's disease (CD), and 20 control subjects with normal colonoscopy were included in a cross-sectional study. E. coli were isolated from stool samples by culture. Eight intestinal virulence genes coding for diarrheagenic E. coli were investigated using multiplex PCR. Phylogenetic grouping was performed by a triplex PCR. Antimicrobial susceptibility of all isolates was done using disc diffusion method. RESULTS: Enteroaggregative E. coli (EAEC) were identified in 25% (15/60) of IBD cases and in none of the controls (p=0.013). Out the 60 IBD cases, 30 (50%) were from phylogenetic group B2. No statistically significant differences in the distribution of E. coli phylogenetic groups were found between study groups. However, 80% of EAEC were assigned to group B2 and D. No statistically significant differences in calprotectin level or in disease severity scores were reported between the four phylogenetic groups. E. coli from both UC and CD patients showed a high rate of resistance to most antimicrobials when compared to the control group. CONCLUSIONS: The identification of EAEC belonging mainly to group B2 and D in IBD cases may indicate the importance of this pathotype in the pathogenesis of IBD in Egyptian patients.