Alteration of gut microbial composition associated with the therapeutic efficacy of fecal microbiota transplantation in Clostridium difficile infection.

BACKGROUND/PURPOSE: Clostridium difficile infection (CDI) leads to a significant cause of hospital-acquired morbidity and mortality. Fecal microbiota transplantation (FMT) is effective to treat recurrent or refractory CDI (rCDI). However, the change of microbial composition contributed by FMT and its association with treatment outcomes is not well determined in Taiwan. We aimed to investigate the efficacy of FMT and the association with microbial alteration endemically. METHODS: Twelve patients who received FMT for rCDI in Taipei Veterans General Hospital were prospectively enrolled from April 2019 to July 2020. The clinical assessments and fecal microbial analyses in comparison with fecal materials of unrelated donors were conducted before and after FMT. RESULTS: The overall success rate of FMT for rCDI was 91.7%. A prominence of Proteobacteria, Gammaproteobacteria and Enterobacteriales were observed in the feces of patients with rCDI. Increased fecal phylogenetic diversities and a significant microbial dissimilarity were provided by successful FMT compared to patients before treatment. However, the distinctness was not obvious between patients' feces at baseline and after unsuccessful FMT. Moreover, dynamic change of fecal microbial composition after FMT was observed during follow-up but did not interrupt the treatment effects of FMT. CONCLUSION: Gut dysbiosis commonly co-exists in patients with rCDI. Restoration of gut microbial communities by FMT provides a promising strategy to treat antibiotic-failed CDI, and the extent of microbial change would be related to the treatment outcomes of FMT. Besides, the effectiveness of FMT for CDI could be maintained even the gut microbiota has diverged over time.

Helicobacter pylori-negative low-grade extranodal B-cell primary gastric mucosa-associated lymphoid tissue lymphoma.

Helicobacter pylori-negative primary mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach--a primary gastric lymphoma (PGL)--is not very common. Herein, we report a 77-year-old man with the chief complaint of intermittent epigastric pain. Initial upper gastrointestinal (UGI) endoscopy showed multiple irregular ulcers (GUs) over the antrum with poor distention of the stomach, and gastric adenocarcinoma (Borrmann type IV, linitis plastica) was suspected. But the biopsy specimens of the GUs showed chronic inflammation without malignant change or H. pylori infection. Nevertheless, delayed healing of the GUs, specific endoscopic findings and enlarged paragastric lymph nodes on computed tomography of the abdomen alerted us to the possibility of PGL. After repeat UGI endoscopies, the patient was finally diagnosed with extranodal B-cell PGL. The patient received radical subtotal gastrectomy and Billroth II operation; the surgical margins were free of tumor cells. The patient was followed up in the outpatient department for 20 months, and his postoperative condition was good.

Retroperitoneal bronchogenic cyst mimicking pancreatic cystic lesion.

Retroperitoneal bronchogenic cyst is detected extremely rarely and often masquerades as other diseases. Here, we report 2 cases of retroperitoneal bronchogenic cyst mimicking pancreatic mucinous tumor. Histologically, both cysts were composed of ciliated respiratory-like epithelium with abundant mucin content, smooth muscle bundles and mature cartilage, compatible with the diagnosis of retroperitoneal bronchogenic cyst. In addition to these 2 cases, another 42 retroperitoneal bronchogenic cysts reported in the English literature were collected for review and analysis. Twelve (28%) were located over the peripancreatic area. Just over half (51%) of them were asymptomatic. No accurate preoperative diagnosis could be made for any of the lesions. About a third (33.3%) of the peripancreatic retroperitoneal bronchogenic cysts masqueraded as pancreatic cystic lesions.

Primary congenital pulmonary hypoplasia of a neonate.

Pulmonary hypoplasia is a rare but usually lethal disease. We report a full-term male neonate who presented with respiratory failure immediately after birth. Chest X-ray revealed a small lung volume despite advanced ventilator support. Respiratory failure persisted and this baby died at 40.5 hours of age. The autopsy showed a lung-to-birth weight ratio of 0.69% and a radial alveoli count of 2.97. All this information confirmed the diagnosis of primary congenital pulmonary hypoplasia.

Smoking and hyperpepsinogenemia are associated with increased risk for duodenal ulcer in Helicobacter pylori-infected patients.

BACKGROUND: Although Helicobacter pylori has been established as a major etiologic factor of chronic gastritis and makes an important contribution to peptic ulceration, the reason why H. pylori causes different gastroduodenal diseases in different people is at present not clear. GOALS: The aim of this study is to identify risk factors associated with duodenal ulcers in H. pylori-infected patients in a multivariate context. STUDY: Demographic data, personal habits, stressful life events, psychologic distress, severity of histology of antral mucosa, and serum pepsinogen I concentrations were studied in 54 consecutive dyspeptic patients with duodenal ulcers and 40 patients with functional dyspepsia. RESULTS: As compared with functional dyspepsia patients, duodenal ulcer patients had more smokers (53.7% vs. 12.5%, P=0.000), higher pepsinogen I levels (median 96.0 vs. 74.5 ng/mL; P=0.002), more males (74.1% vs. 42.5%, P=0.004), more single (22.6% vs. 7.5%, P<0.05), and less in religion belief (44% vs. 70%, P<0.05). Only smoking remained significant on multivariate analysis (odds ratio=10.86, 95% CI=2.92-40.41, P<0.001). Among nonsmokers, only serum pepsinogen I level was found higher in duodenal ulcer patients as compared with functional dyspepsia patients (88 vs. 71, P<0.05). CONCLUSIONS: Smoking and hyperpepsinogenemia are associated with increased risk for duodenal ulcer in H. pylori-infected patients.

Immunoglobulin G antibody against Helicobacter pylori: clinical implications of levels found in serum.

The clinical significance of high levels of antibody against Helicobacter pylori is still unclear. We sought to evaluate whether the serum antibody levels could predict the presence of macroscopic gastroduodenal disease, to identify factors that correlate with antibody levels in a multivariate context, and to determine the predictive value of antibody levels for diagnosing H. pylori infection. The grades of gastritis and density of H. pylori colonization were scored separately using the updated Sydney system for antral and body mucosa. An enzyme-linked immunosorbent assay (ELISA) for the quantitative detection in serum of IgG antibodies to H. pylori was performed. Of the 170 dyspeptic patients, 105 (62%) had H. pylori infection. There was no difference in antibody levels among endoscopic findings of normal mucosa, chronic gastritis, and duodenal ulcer. On multivariate linear regression analysis, the status of H. pylori infection, mononuclear cell infiltration of body mucosa, and age correlated with antibody levels. The negative predictive value for antibody levels of <30 U/ml is 94%, and the positive predictive value of antibody levels of >70 U/ml is 98%. We conclude that serum antibody levels do not predict the severity of gastroduodenal diseases or the density of H. pylori colonization in H. pylori-infected dyspeptic patients. Higher levels are associated with the presence of H. pylori infection, the chronic gastritis score of the corpus, and older age. Setting a gray zone is necessary for ELISA, since the accuracy in this zone does not allow a precise determination of H. pylori status.