Partners of patients with ulcerative colitis exhibit a biologically relevant dysbiosis in fecal microbial metacommunities.

AIM: To investigate alterations in the fecal microbiome using 16S rRNA amplicon sequencing in couples in the same cohabitation environment. METHODS: Fecal samples were collected from eight ulcerative colitis (UC) patients and their healthy partners at Lishui People's Hospital, Zhejiang Province, China. DNA was extracted and the variable regions V3 and V4 of the 16S rRNA genes were PCR amplified using a two-step protocol. Clear reads were clustered into operational taxonomic units (OTUs) at the 97% sequence similarity level using UCLUST v1.2.22. The Wilcoxon rank-sum test (R v3.1.2) was used to compare inter-individual differences. Differences with a P value < 0.05 were considered statistically significant. RESULTS: Fecal microbial communities were more similar among UC patients than their healthy partners (P = 0.024). UC individuals had a lower relative abundance of bacteria belonging to the Firmicutes, especially Blautia, Clostridium, Coprococcus and Roseburia (P < 0.05). Microbiota dysbiosis was detected in UC patients and their healthy partners. Relevant genera included Akkermansiam, Bacteroides, Escherichia, Lactobacillales, Klebsiella and Parabacteroides. The enriched pathways in fecal samples of UC patients were related to lipid and nucleotide metabolism. Additionally, the pathways involved in membrane transport and metabolism of cofactors and vitamins were more abundant in the healthy partners. CONCLUSION: Our results suggested that the microbial composition might be affected in healthy partners cohabiting with UC patients, especially in terms of microbiota dysbiosis.

Centralized isolation of Helicobacter pylori from multiple centers and transport condition influences.

AIM: To evaluate the efficacy of centralized culture and possible influencing factors. METHODS: From January 2010 to July 2012, 66452 patients with suspected Helicobacter pylori (H. pylori) infection from 26 hospitals in Zhejiang and Jiangsu Provinces in China underwent gastrointestinal endoscopy. Gastric mucosal biopsies were taken from the antrum for culture. These biopsies were transported under natural environmental temperature to the central laboratory in Hangzhou city and divided into three groups based on their transport time: 5, 24 and 48 h. The culture results were reported after 72 h and the positive culture rates were analyzed by a χ (2) test. An additional 5736 biopsies from H. pylori-positive patients (5646 rapid urease test-positive and 90 (14)C-urease breath test-positive) were also cultured for quality control in the central laboratory setting. RESULTS: The positive culture rate was 31.66% (21036/66452) for the patient samples and 71.72% (4114/5736) for the H. pylori-positive quality control specimens. In the 5 h transport group, the positive culture rate was 30.99% (3865/12471), and 32.84% (14960/45553) in the 24 h transport group. In contrast, the positive culture rate declined significantly in the 48 h transport group (26.25%; P < 0.001). During transportation, the average natural temperature increased from 4.67 to 29.14 °C, while the positive culture rate declined from 36.67% (1462/3987) to 24.12% (1799/7459). When the temperature exceeded 24 °C, the positive culture rate decreased significantly, especially in the 48 h transport group (23.17%). CONCLUSION: Transportation of specimens within 24 h and below 24 °C is reasonable and acceptable for centralized culture of multicenter H. pylori samples.

[Analysis of risk factors for anastomotic infectious complications following bowel resection for Crohn disease].

OBJECTIVE: To investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease. METHODS: Clinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively. The risk factors were identified by χ(2) test and Logistic regression. RESULTS: Fourteen patients (12.3%, 14/114) developed anastomotic infectious complications in the postoperative period, including anastomotic leak (n=7), intra-abdominal abscess (n=6), and enterocutaneous fistula (n=1). Crohn disease activity index (CDAI)>150 (OR=2.185, 95%CI:1.098-6.256, P=0.040), steroid usage (OR=2.674, 95%CI:1.118-8.786, P=0.027), and the presence of preoperative abscess/fistula (OR=3.447, 95%CI:1.254-10.462, P=0.014) were identified as independent risk factors of anastomotic infectious complications. In the absence of these 3 risk factors, the rate of anastomotic infectious complication was 5.7% (3/53), which increased to 11.4% (4/35) when one risk factor was present, 21.1% (4/19) when two risk factors were present, and 42.9% (3/7) when all the 3 risk factors were present. CONCLUSIONS: CDAI>150, steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease. A prudent management should be carried out if risk factors can not be eliminated preoperatively.

[Diagnostic value of Crohn disease activity indices in assessing postoperative recurrence].

OBJECTIVE: To evaluate the diagnostic value of Crohn disease activity indices (CDAI) in assessing symptomatic recurrence following ileocolic resection for Crohn disease. METHODS: A total of 85 patients who underwent ileocolic resection between March 2003 and March 2010 were included. Clinical and endoscopic evaluation were performed within 12 months after operation. Endoscopic appearance was assessed using Rutgeers score and endoscopic recurrence was defined as endoscopic score ≥i2. Symptomatic recurrence was defined by the composite of symptom severity warranting medical therapy and endoscopic recurrence. The receiver operator characteristic (ROC) curve was used to explore the utility of CDAI in determining the presence or absence of symptomatic disease. RESULTS: Nineteen patients had symptomatic recurrence within 12 months postoperatively. The mean CDAI of patients with symptomatic recurrence was 205±93, significantly higher than those with sustained remission(97±44, P<0.01). The area under the ROC curve for symptomatic recurrence and CDAI was 0.786. Symptomatic recurrence was best predicted by a CDAI cutoff of 150 and the sensitivity, specificity, and accuracy was 73.7%, 81.8% and 80.0% respectively. When a combined endoscopic and CDAI was applied, the specificity and accuracy was markedly improved to 95.5% and 90.6%. In comparison to CDAI alone, the combined use of CDAI and endoscopic evaluation had a higher level of agreement on symptomatic recurrence(Kappa value, 0.718 vs. 0.462). CONCLUSIONS: CDAI is effective to predict symptomatic recurrence. A combination of CDAI and endoscopic evaluation can further improve the accuracy of assessing symptomatic recurrence.

[Value of quantitative examination via contrast-enhanced ultrasonography in evaluating the activity of Crohn disease at endoscopy].

OBJECTIVE: To evaluate the predictive value of quantitative examination via contrast-enhanced ultrasonography on the activity of Crohn disease at endoscopy. METHODS: A total of 59 cases with Crohn disease in People's Hospital of Lishui City between January 2009 and December 2010 were collected prospectively and underwent both colonoscopy and contrast-enhanced ultrasonography. According to the Simple Endoscopic Score, Crohn disease was divided into inactive and active disease by colonoscopy. To assess the vascularization of the involved bowel loop in a region expected to be seen at colonoscopy, the contrast agent uptake was measured by using quantitative analysis. Measurement of contrast enhancement was assessed as the percentage of increase in wall brightness in regions of interest (ROI). The receiver operating characteristic curve was used to evaluate the value of contrast agent uptake in predicting the severity determined at endoscopy. RESULTS: Colonoscopy showed active lesions in 45 cases and inactive lesions in 14 cases, in whom the percentages of increase of brightness were (90±32)% and (41±29)% respectively. At a threshold value of 45% for the percentage of increase of brightness, sensitivity, specificity and accuracy of predicting the severity at endoscopy were 95.6%, 78.6% and 91.5%, the Youden index was 0.74, and area under curve was 0.846. CONCLUSIONS: Quantitative measurement of bowel enhancement by using contrast-enhanced ultrasonography can discriminate between active and inactive Crohn disease at endoscopy. Contrast-enhanced ultrasonography may be a useful technique to monitor the activity of Crohn disease.