Applying logistic LASSO regression for the diagnosis of atypical Crohn's disease.

In countries with a high incidence of tuberculosis, the typical clinical features of Crohn's disease (CD) may be covered up after tuberculosis infection, and the identification of atypical Crohn's disease and intestinal tuberculosis (ITB) is still a dilemma for clinicians. Least absolute shrinkage and selection operator (LASSO) regression has been applied to select variables in disease diagnosis. However, its value in discriminating ITB and atypical Crohn's disease remains unknown. A total of 400 patients were enrolled from January 2014 to January 2019 in second Xiangya hospital Central South University.Among them, 57 indicators including clinical manifestations, laboratory results, endoscopic findings, computed tomography enterography features were collected for further analysis. R software version 3.6.1 (glmnet package) was used to perform the LASSO logistic regression analysis. SPSS 20.0 was used to perform Pearson chi-square test and binary logistic regression analysis. In the variable selection step, LASSO regression and Pearson chi-square test were applied to select the most valuable variables as candidates for further logistic regression analysis. Secondly, variables identified from step 1 were applied to construct binary logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed on these models to assess the ability and the optimal cutoff value for diagnosis. The area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy rate, together with their 95% confidence and intervals (CIs) were calculated. MedCalc software (Version 16.8) was applied to analyze the ROC curves of models. 332 patients were eventually enrolled to build a binary logistic regression model to discriminate CD (including comprehensive CD and tuberculosis infected CD) and ITB. However, we did not get a satisfactory diagnostic value via applying the binary logistic regression model of comprehensive CD and ITB to predict tuberculosis infected CD and ITB (accuracy rate:79.2%VS 65.1%). Therefore, we further established a binary logistic regression model to discriminate atypical CD from ITB, based on Pearsonchi-square test (model1) and LASSO regression (model 2). Model 1 showed 89.9% specificity, 65.9% sensitivity, 88.5% PPV, 68.9% NPV, 76.9% diagnostic accuracy, and an AUC value of 0.811, and model 2 showed 80.6% specificity, 84.4% sensitivity, 82.3% PPV, 82.9% NPV, 82.6% diagnostic accuracy, and an AUC value of 0.887. The comparison of AUCs between model1 and model2 was statistically different (P < 0.05). Tuberculosis infection increases the difficulty of discriminating CD from ITB. LASSO regression showed a more efficient ability than Pearson chi-square test based logistic regression on differential diagnosing atypical CD and ITB.

Development of Early-Life Gastrointestinal Microbiota in the Presence of Antibiotics Alters the Severity of Acute DSS-Induced Colitis in Mice.

Early-life gastrointestinal microbiota development is crucial for physiological development and immunological homeostasis. In the current study, perinatal microbiota and the development of gastrointestinal microbiota in different early-life periods (perinatal, lactation, and postweaning nutrition periods) were explored by using an antibiotic-interfered mouse model and a dextran sulfate sodium-induced colitis mouse model. Gut microbiota samples were collected from mother mice and litters. The results of 16S rRNA gene sequences suggested that microbiota in the gastrointestinal system were present in prenatal fetal mice, and microbiota structures in different parts of the gastrointestinal system of the fetal mice were similar to those in the corresponding gut parts of maternal mice. Microbiota in mucus samples from different regions exhibited higher diversity at birth than at other periods and varied substantially over time with diet change. Moreover, antibiotic treatment in early life affected the composition and diversity of gastrointestinal microbiota in adult mice and enhanced susceptibility to experimental colitis in mice, particularly in the lactation period. This approach of exploring gut microbiota evolution is hoped to provide an enhanced view of how resident microbiota develop in early life, which in turn might facilitate understanding of gut microbiota and related diseases. IMPORTANCE This study investigated resident microbiota in the whole gastrointestinal (GI) tract to explore gut microbiota development in early life and found that early-life antibiotic exposure exacerbated alterations in gut microbiota and murine dextran sulfate sodium (DSS)-induced colitis. Furthermore, the presence of bacteria in the GI tract of mice before birth and the importance of the lactation period in GI microbiota development were confirmed.

Differentiation of intestinal tuberculosis and Crohn's disease through an explainable machine learning method.

Differentiation between Crohn's disease and intestinal tuberculosis is difficult but crucial for medical decisions. This study aims to develop an effective framework to distinguish these two diseases through an explainable machine learning (ML) model. After feature selection, a total of nine variables are extracted, including intestinal surgery, abdominal, bloody stool, PPD, knot, ESAT-6, CFP-10, intestinal dilatation and comb sign. Besides, we compared the predictive performance of the ML methods with traditional statistical methods. This work also provides insights into the ML model's outcome through the SHAP method for the first time. A cohort consisting of 200 patients' data (CD = 160, ITB = 40) is used in training and validating models. Results illustrate that the XGBoost algorithm outperforms other classifiers in terms of area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision and Matthews correlation coefficient (MCC), yielding values of 0.891, 0.813, 0.969, 0.867 and 0.801 respectively. More importantly, the prediction outcomes of XGBoost can be effectively explained through the SHAP method. The proposed framework proves that the effectiveness of distinguishing CD from ITB through interpretable machine learning, which can obtain a global explanation but also an explanation for individual patients.

Immunomodulatory Effect of Serum Exosomes From Crohn Disease on Macrophages via Let-7b-5p/TLR4 Signaling.

BACKGROUND: Exosomes are extensively reported to be strongly associated with many immunologic diseases, including Crohn disease (CD). Meanwhile, the dysfunction of macrophage activation has been proposed to be critical for the pathogenesis of CD. However, it is an unsettled issue whether serum exosomes from CD could activate macrophages and participate in its pathogenesis. Our study intended to clarify the role of CD-derived exosomes on macrophages to elucidate a novel mechanism and possible diagnostic and therapeutic strategies. METHODS: Serum exosomes were isolated and identified. Functional assays in vitro were performed on Raw264.7 macrophages, followed by exosomal microRNA (miRNA) profiling and bioinformatics analyses via high-throughput sequencing. In animal experiments, exosomes were intraperitoneally injected into dextran sulfate sodium-induced colitis. RESULTS: In vitro CD-derived exosomes induced proinflammatory cytokine expression and increased macrophage counts. Meanwhile, the intervention of exosomes from CD with epithelial cells led to increased permeability of the intestinal epithelial barrier. In vivo, CD-derived exosomes could circulate into the intestinal mucosa and significantly aggravate colitis. Furthermore, CD changed the miRNA profile of exosomes and further analysis revealed a differential expression of let-7b-5p. Mechanistically, the let-7b-5p/TLR4 pathway was recognized as a potential contributor to macrophage activation and inflammatory response. Furthermore, serum exosome-mediated let-7b-5p mimic delivery alleviated colitis significantly. CONCLUSIONS: Our study indicated that serum exosomes can circulate into the intestinal mucosa to aggravate colitis by regulating macrophage activation and epithelial barrier function. In addition, CD showed altered exosomal miRNA profiles. Furthermore, serum exosome-mediated let-7b-5p-mimic delivery may significantly alleviate colitis, providing potential novel insight into an exosome-based strategy for the diagnosis and treatment of CD.

Clinical features of NK/T-cell EBV-associated LPD manifested as gastrointestinal symptoms in patients with normal immunity: a case report and literature review.

BACKGROUND: Epstein-Barr virus (EBV)-associated NK/T-cell lymphoproliferative disorder (LPD) involving the gastrointestinal tract is rarely observed in individuals with normal immunity. The atypical clinical, colonoscopic manifestations often confuse clinicians, leading to misdiagnosis and delays in the treatment. CASE PRESENTATION: Herein, we reported on a single case of a patient with gastrointestinal symptoms. Several colonoscopies showed multiple irregular ulcerations, while biopsies showed colitis with infiltration of neutrophils or lymphocytes. After 2 months follow-up, the patient was diagnosed with the extranodal NK/T-cell lymphoma, nasal type, and was treated with thalidomide. Later on, a second check was performed on his first pathological sample. Immunohistochemistry revealed EBV associated NK/T-cell LPD. CONCLUSIONS: Multiple, multiform, and segmental gastrointestinal ulcers should be an indication for EBV infection, regardless of the presence of fever, lymphadenopathy, and hepatosplenomegaly. If EBV-associated NK/T-cell LPD is considered, serum EBV-DNA should be measured, and the tissue obtained by biopsy should be carefully analyzed for a positive expression of the EBER marker.

R-JaunLab: Automatic Multi-Class Recognition of Jaundice on Photos of Subjects with Region Annotation Networks.

Jaundice occurs as a symptom of various diseases, such as hepatitis, the liver cancer, gallbladder or pancreas. Therefore, clinical measurement with special equipment is a common method that is used to identify the total serum bilirubin level in patients. Fully automated multi-class recognition of jaundice combines two key issues: (1) the critical difficulties in multi-class recognition of jaundice approaches contrasting with the binary class and (2) the subtle difficulties in multi-class recognition of jaundice represent extensive individuals variability of high-resolution photos of subjects, huge coherency between healthy controls and occult jaundice, as well as broadly inhomogeneous color distribution. We introduce a novel approach for multi-class recognition of jaundice to detect occult jaundice, obvious jaundice and healthy controls. First, region annotation network is developed and trained to propose eye candidates. Subsequently, an efficient jaundice recognizer is proposed to learn similarities, context, localization features and globalization characteristics on photos of subjects. Finally, both networks are unified by using shared convolutional layer. Evaluation of the structured model in a comparative study resulted in a significant performance boost (categorical accuracy for mean 91.38%) over the independent human observer. Our work was exceeded against the state-of-the-art convolutional neural network (96.85% and 90.06% for training and validation subset, respectively) and showed a remarkable categorical result for mean 95.33% on testing subset. The proposed network makes a performance better than physicians. This work demonstrates the strength of our proposal to help bringing an efficient tool for multi-class recognition of jaundice into clinical practice.

Automatically discriminating and localizing COVID-19 from community-acquired pneumonia on chest X-rays.

The COVID-19 outbreak continues to threaten the health and life of people worldwide. It is an immediate priority to develop and test a computer-aided detection (CAD) scheme based on deep learning (DL) to automatically localize and differentiate COVID-19 from community-acquired pneumonia (CAP) on chest X-rays. Therefore, this study aims to develop and test an efficient and accurate deep learning scheme that assists radiologists in automatically recognizing and localizing COVID-19. A retrospective chest X-ray image dataset was collected from open image data and the Xiangya Hospital, which was divided into a training group and a testing group. The proposed CAD framework is composed of two steps with DLs: the Discrimination-DL and the Localization-DL. The first DL was developed to extract lung features from chest X-ray radiographs for COVID-19 discrimination and trained using 3548 chest X-ray radiographs. The second DL was trained with 406-pixel patches and applied to the recognized X-ray radiographs to localize and assign them into the left lung, right lung or bipulmonary. X-ray radiographs of CAP and healthy controls were enrolled to evaluate the robustness of the model. Compared to the radiologists' discrimination and localization results, the accuracy of COVID-19 discrimination using the Discrimination-DL yielded 98.71%, while the accuracy of localization using the Localization-DL was 93.03%. This work represents the feasibility of using a novel deep learning-based CAD scheme to efficiently and accurately distinguish COVID-19 from CAP and detect localization with high accuracy and agreement with radiologists.

Subphrenic splenic implantation after splenectomy： A case report. / 脾切除术后膈下种植脾1例.

Subphrenic splenic implantation is a rare disease, usually occurred followed the splenic trauma and splenectomy. Surgeries are often necessary for diagnosing and treating it. A 46-year-old male post-splenectomy patient, tolerating abdominal bloating and pain for more than 1 year, was admitted to the Second Xiangya Hospital, Central South University. Fundus bulge suggested a possibility of stromal tumors originating from the muscularispropria layer with endoscopic ultrasound. Slightly stomachic thickness was detected using enhanced computed tomography (CT). Without any improvement for symptoms after medication, the patient strongly requested to undergo an endoscopic therapy. Natural orifice transluminal endoscopic surgery (NOTES) result confirmed it as subphrenic splenic implantation with postoperative pathology. In this case, NOTES helped us to confirm the diagnosis, relieve the symptoms, as well as prevent secondary surgery injury, which would be helpful to other clinicians.

Intestinal ulcers as an initial finding in EBV-associated lymphoproliferative disorder: A case report.

RATIONALE: Epstein-Barr virus (EBV)-associated T-cell lymphoproliferative disorder (LPD) usually occurs in children and young adults. Gastrointestinal involvement is rare. EBV-associated T-cell lymphoproliferative disorder manifesting as intestinal ulcers poses diagnostic challenges clinically and pathologically because of the atypical manifestations. We concluded that some indicators according to our case and literatures, which might be helpful to the diagnosis of EBV-associated LPD manifested as intestinal ulcers. PATIENT CONCERNS: Here we present a 26-year-old man with complaints of diarrhea and abdominal pain that had persisted for 1 year. Multiform and multifocal deep ulcers were discovered in the colonoscopy. Cell atypia was not obvious but colitis with crypt distortion was found in pathology. DIAGNOSES: According to the symptoms, laboratory examinations, colonoscopy and pathology results, Crohn Disease was diagnosed. INTERVENTIONS: Infliximab therapy was initiated based on the diagnosis of Crohn Disease. OUTCOMES: After the fifth course of therapy, intermittent fever and hematochezia occurred. Physical examination revealed swollen tonsils and ulcers, and purulent exudate from the right tonsil and palatoglossal arch were observed. Biopsies obtained through colonoscopy and nasopharyngoscopy demonstrated EBV-associated T-cell proliferation disease (level 3). After that, the tissue sample from the first colonoscopy was reexamined immunohistochemically. The result suggested EBV-associated T-cell proliferation disease (level 1). LESSONS: When we confront with patients with multiform and multifocal deep intestinal ulcers, not only the common diseases such as Crohn Disease and intestinal tuberculosis should be considered, EBV-associated T-cell proliferation disease should be considered as well. Repeated multiple biopsy, gene rearrangement, EBV DNA quantitative analysis result, EBV-encoded RNA(EBER) and experienced pathologists might be helpful to the diagnosis.

An Effective CNN Method for Fully Automated Segmenting Subcutaneous and Visceral Adipose Tissue on CT Scans.

One major role of an accurate distribution of abdominal adipose tissue is to predict disease risk. This paper proposes a novel effective three-level convolutional neural network (CNN) approach to automate the selection of abdominal computed tomography (CT) images on large-scale CT scans and automatically quantify the visceral and subcutaneous adipose tissue. First, the proposed framework employs support vector machine (SVM) classifier with a configured parameter to cluster abdominal CT images from screening patients. Second, a pyramid dilation network (DilaLab) is designed based on CNN, to address the complex distribution and non-abdominal internal adipose tissue problems of biomedical image segmentation in visceral adipose tissue. Finally, since the trained DilaLab implicitly encodes the fat-related learning, the transferred DilaLab learning and a simple decoder constitute a new network (DilaLabPlus) for quantifying subcutaneous adipose tissue. The networks are trained not only all available CT images but also with a limited number of CT scans, such as 70 samples including a 10% validation subset. All networks are yielding more precise results. The mean accuracy of the configured SVM classifier yields promising performance of 99.83%, while DilaLabPlus achieves a remarkable performance improvement an with average of 98.08 ± 0.84% standard deviation and 0.7 ± 0.8% standard deviation false-positive rate. The performance of DilaLab yields average 97.82 ± 1.34% standard deviation and 1.23 ± 1.33% standard deviation false-positive rate. This study demonstrates considerable improvement in feasibility and reliability for the fully automated recognition of abdominal CT slices and segmentation of selected abdominal CT in subcutaneous and visceral adipose tissue, and it has a high agreement with a manually annotated biomarker.

[Clinical analysis of IgG4-related disease].

OBJECTIVE: To analyze the clinical features, diagnosis and treatment in patients with immunoglobulin 4 (IgG4)-related diseases.
 Methods: The clinical data (including general situation, clinical manifestations, laboratory examination, imaging examination, pathological examination, treatment and follow-up) in 21 patients, who were diagnosed with IgG4-related diseases in Second Xiangya Hospital of Central South University from June 2014 to February 2018, were retrospectively analyzed.
 Results: Among the 21 patients, including men 16 (76.2%) and women 5 (23.8%), the age was 37.00-78.00 (59.19±12.93) years old. Multi-organ involvement was discovered in 10 patients (47.6%), among which the lung (42.9%), pancreas (38.1%), kidney (33.3%), bile duct (19.0%) and liver (14.3%) were the main organs involved. The serum IgG4 levels in 19 patients (90.5%) were increased [8.63 (1.13-36.50) g/L]. The condition of 16 patients (84.2%) was improved after glucocorticoid therapy.
 Conclusion: IgG4-related diseases are mostly found in middle-aged and elderly men. Multiple organs or tissues of the body can be involved. Affected organs are mostly seen in lung, pancreas, kidney and bile duct, with diverse clinical manifestations. Glucocorticoid and immunosuppressive therapy are effective.

Effects of Different Diets on Microbiota in The Small Intestine Mucus and Weight Regulation in Rats.

While the microbial community of the small intestine mucus (SIM) may also play a role in human health maintenance and disease genesis, it has not been extensively profiled and whether it changes with diet is still unclear. To investigate the flora composition of SIM and the effects of diet on it, we fed SD rats for 12 weeks with standard diet (STD), high-fat diet (HFD), high-sugar diet (HSD) and high-protein diet (HPD), respectively. After 12 weeks, the rats were sacrificed, SIM and stool samples were collected, and high-throughput 16S rRNA gene sequencing was used to analyze the microbiota. We found that fecal microbiota (FM) was dominated by Firmicutes and Bacteroidetes, while in SIM, Firmicutes and Proteobacteria were the two most abundant phyla and the level of Bacteroidetes dramatically decreased. The microbiota diversity of SIM was less than that of feces. The community composition of SIM varied greatly with different diets, while the composition of FM altered little with different diets. The relative abundance of Bacteroidetes and Allobaculum in SIM were negatively correlated with weight gain. There was no significant correlation between FM and weight gain. In conclusion, the community profile of SIM is different from that of feces and susceptible to diet.

Dynamic distribution of gallbladder microbiota in rabbit at different ages and health states.

The internal environment of the gallbladder has been considered extremely unfavorable for bacterial growth, and the microbial profile of the gallbladder still unknown. By high-throughput sequencing of the bacterial 16S rRNA gene, we studied the microbial profile of the gallbladder from healthy rabbits before and after weaning. Moreover, we investigated the difference of microbiota between the gallbladder and gut. Our results showed that the gallbladder was dominantly populated by Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria in the phylum throughout the developmental stages of rabbits. The adult rabbits showed higher species richness and exhibited higher bacterial diversity than rabbits before weaning based on the results of alpha diversity. Beta diversity analyses indicated differences in the bacterial community composition between different developmental stages. In the comparison of the gallbladder and feces, Firmicutes and Bacteroidetes were dominant in the phylum, as they were present in about 61% and 21% of the feces, respectively. Conversely, in the gallbladder, Firmicutes was the most dominant (about 41%), and Bacteroidetes and Proteobacteria were present in about 16% and 22% of the gallbladder, respectively. The Unweighted UniFrac Principal Coordinate Analysis results illustrated samples clustered into 2 categories: the gallbladder and feces. Our study might provide a foundation for knowledge on gallbladder microbiota for the first time and a basis for further studies on gallbladder and intestinal health.

Analysis of Phenotypic Variables and Differentiation Between Untypical Crohn's Disease and Untypical Intestinal Tuberculosis.

BACKGROUND: The differentiation between untypical intestinal tuberculosis (UITB) and untypical Crohn's disease (UCD) is a challenge. AIMS: To analyze phenotypic variables and propose a novel prediction model for differential diagnosis of two conditions. METHODS: A total of 192 patients were prospectively enrolled. The clinical, laboratory, endoscopic, and radiological features were investigated and subjected to univariable and multivariable analyses. The final prediction model for differentiation between UCD and UITB was developed by logistic regression analysis and Fisher discriminant analysis on the training set. The same discriminant function was tested on the validation set. RESULTS: Twenty-five candidates were selected from 52 phenotypic variables of typical Crohn's disease (TCD), UCD, and UITB patients. UCD's variables overlapped with both TCD and UITB. The percentages of tuberculosis history, positive PPD, and positive T-SPOT result in UCD were all significantly higher than that in TCD (11.6% vs. 0.0%, 27.9% vs. 0.0%, 25.6% vs. 4.5%, respectively, P < 0.05). The regression equations and Fisher discriminant function for discrimination between UCD and UITB were developed. In the training data, the area under the receiver operating characteristic of equations was 0.834, 0.69, and 0.648 in the clinical-laboratory, endoscopic, and radiological model, respectively. The accuracy of Fisher discriminant function for discrimination was 86% in UCD and 73% in UITB in the validation data. CONCLUSIONS: Phenotypes of UCD patients in TB-endemic countries may be associated with TB infection history. Fisher discriminant analysis is a good choice to differentiate UCD from UITB, which is worthy of verification in clinical practice.

Antitumor mechanisms of bifidobacteria.

Cancer remains one of the most common causes of mortality globally. Chemotherapy, one of the major treatment strategies for cancer, primarily functions by targeting the cancer cells and affecting them physiologically, but also affects normal cells, which is a major concern at present. Therefore, adverse effects of chemotherapy drugs, including myelosuppression and liver and kidney damage, are of concern. Now, microbial products have attracted attention in cancer treatment research. Notably, carcinogenesis is considered to be associated with microbial dysbiosis, particularly the positive antitumor effects of bifidobacteria. Although there remains a substantial amount to be understood about the regulation of bifidobacteria, bifidobacteria remain an attractive and novel source of cancer therapeutics. The present review focuses on introducing the latest information on the antitumor effects of bifidobacteria and to propose future strategies for using bifidobacteria in the development of cancer therapeutics.

Acute major gastrointestinal bleeding caused by hookworm infection in a patient on warfarin therapy: A case report.

RATIONALE: The use of anticoagulants is a contributor to gastrointestinal (GI) bleeding. Most bleeding patients on anticoagulant therapy such as warfarin commonly have basic lesions existing in their GI mucosa. PATIENT CONCERNS: We report a case of major GI bleeding following the use of anticoagulants in a patient with hookworm infection. DIAGNOSES: The patient was diagnosed with nephrotic syndrome with pulmonary embolism. INTERVENTIONS: He was treated with anticoagulants and suffered from acute major GI bleeding during the treatment. Capsule endoscopy revealed many hookworms in the lumen of jejunum where fresh blood was seen coming from the mucosa. OUTCOMES: The patient was successfully rescued and cured with albendazole. LESSONS: Latent hookworm infection can be a cause of massive small-bowel hemorrhage in patients on anticoagulant therapy and anthelmintic treatment is the key to stop bleeding.

Osteoporosis as an initial manifestation in a patient with Crohn's disease: A case report.

The present case report details a rare case of osteoporosis as the initial manifestation of Crohn's disease (CD). A 43-year-old male was referred to the Second Xiangya Hospital of Central South University (Changsha, China) for further examination of low back pain (LBP) without digestive symptoms. Bone mineral density (BMD) analysis indicated osteoporosis, particularly in the lumbar spine. Endoscopy revealed an inflamed and strictured ileocecal valve with less inflammation in the ascending, transverse colon, sigmoid colon and rectum, compatible with CD, which was in accordance with the appearance of an abdominal computed tomography scan. Duodenal-balloon enteroscopy indicated segmental ulceration and stricture in the jejunum, in accordance with CD. The patient was diagnosed with CD following examination. It was suspected that osteoporosis may be an extra-intestinal manifestation of CD. Steroids and biological agents were prescribed in sequence. LBP and BMD rapidly improved following treatment, and inflammatory markers returned to normal after 1.5 years of treatment. According to this case, osteoporosis with unknown causes should be considered as a possible sign of small intestinal CD.

Colorectal carcinoma masked by systemic inflammatory response syndrome: A case report.

The present study described the case of a 68-year-old woman who presented to the Second Xiangya Hospital of Central South University (Changsha, China) with progressive abdominal pain, distention and diarrhea. These symptoms were diagnosed as the initial manifestations of systemic inflammatory response syndrome associated with colorectal carcinoma (CRC). The presentation appeared as a common emergency medical case, which was eventually recognized as a CRC masked by this emergency symptom. This case highlights the fact that a correct diagnosis can be made by looking through the outward appearance to perceive the essence of the condition. Therefore, vigilant surveillance is of utmost importance in order to expedite prompt recognition and rapid management of this presentation of CRC.

Complications Following Stem Cell Therapy in Inflammatory Bowel Disease.

BACKGROUNDS: Pharmacotherapy and surgery constitute the mainstay of treatment for inflammatory bowel disease (IBD). But post-treatment relapsing and recurrence persist as concerns in patients with IBD. Stem cell therapy (SCT) has emerged as a promising treatment strategy in inflammatory bowel disease (IBD), including hematopoietic stem cells (HST), mensenchymal stem cells (MSCs). However, severe complications limit the clinical use of SCT in IBD. Therefore, this review aims to summarize SCT-associated complications, and illustrate possible prevention strategies. METHODS: We searched Pubmed for studies which reported the use of SCT to treat patients with IBD. Searching terms included 'IBD' or 'Inflammatory bowel disease' or 'CD' or 'Crohn's disease' and 'stem cell therapy' or 'stem cell transplantation'. RESULTS: HSCT can restore the immune tolerance following chemotherapy-induced immune ablation, and MSCs could affect immune cells or secret trophic factors to treat IBD. However, severe complications limit the clinical use of SCT in IBD. Dominant SCT-associated complications include infection, ectopic tissues, and graft-versus-host disease (GVHD), especially for auto-HSCT. As for infection, bacteremia and virus infection were found after SCT treatment, and the use of anti-microbial regimens could reduce incidences of infection. Ectopic tissue formation in the recipient was observed after treatment with HSCT or MSC. Homing and tissue integration might be the possible mechanisms for not forming ectopic tissues. In addition, GVHD was also observed in allogeneic HSCT. Therefore, autologous HSCT and MSCs transplantation were recommended to avoid GVHD. CONCLUSIONS: MSCs with their low immunogenicity property eliminate the need for chemotherapy, and are over HSCT in reducing the risk of severe complications. For better application of SCT in IBD, antimicrobial prophylaxis should be used combined with SCT.