Are there new biomarkers of the gastroduodenal microbiota useful in the diagnosis of coeliac disease in children? A pilot study.

The changing of microbiome could precede the development of coeliac disease (CeD). We compared the bacterial profile of microbiota of tissues collected simultaneously from the stomach and duodenum in newly diagnosed patients with CeD. Biopsies were collected from 60 children and adolescents aged 2-18 years: (1) 40 patients with CeD; (2) 20 children as control group. The evaluation of the bacterial microbiota was carried out by sequencing the V3-V4 regions of the 16S rRNA subunit, using next-generation sequencing (NGS). The composition of bacterial microbiota was correlated with clinical and blood parameters. The beta diversity analysis revealed a significant dissimilarity in the gastric samples between the CeD and control group (Bray-Curtis index, P = 0.008, and weighted UniFrac distance, P = 0.024). At L2 (phylum level), Campylobacterota was only present in the stomach of the CeD group. A comparison of the abundance of bacteria between the stomach and duodenum showed significant differences in 10 OTUs (operational taxonomic units) in the control and 9 OTUs in the CeD group at L6 (genus) and in 8 OTUs and in 6 OTUs, respectively, at L7 (species). A significant correlation was observed between the genus Novosphingobium in stomach of CeD group and possession of the DQ2.5 and DQ 8 allele, and in the duodenum - between the DQ 8 allele and the species Blautia wexlerae. Significant differences in selected, little-known genera of bacteria suggest their potential role as new biomarkers in the development of CeD. To fully understand the mechanism of CeD development in genetically predisposed individuals, it is necessary to take into account not only the abundance of a given genus or species of bacteria, but also the anatomical location of its occurrence.

Alterations in intestinal Archaea composition in pediatric patients with Crohn's disease based on next-generation sequencing - a pilot study.

Intestinal dysbiosis can lead to the induction of systemic immune-mediated inflammatory diseases, such as Crohn's disease Although archaea are part of the commensal microbiota, they are still one of the least studied microorganisms. The aim of our study was the standardization of the optimal conditions and primers for sequencing of the gut archaeome using Next Generation Sequencing, and evaluation of the differences between the composition of archaea in patients and healthy volunteers, as well as analysis of the changes that occur in the archaeome of patients depending on disease activity. Newly diagnosed patients were characterized by similar archeal profiles at every taxonomic level as in healthy individuals (the dominance of Methanobacteria at the class level, and Methanobrevibacter at the genus level). In turn, in patients previously diagnosed with Crohn's disease (both in active and remission phase), an increased prevalence of Thermoplasmata, Thermoprotei, Halobacteria (at the class level), and Halococcus, Methanospaera or Picrophilus (at the genus level) were observed. Furthermore, we have found a significant correlation between the patient's parameters and the individual class or species of Archaea. Our study confirms changes in archaeal composition in pediatric patients with Crohn's disease, however, only in long-standing disease. At the beginning of the disease, the archeal profile is similar to that of healthy people. However, in the chronic form of the disease, significant differences in the composition of archaeome begin to appear. It seems that some archaea may be a good indicator of the chronicity and activity of Crohn's disease.

Immunization Coverage in Children with Inflammatory Bowel Disease.

Patients suffering from inflammatory bowel diseases (IBD) are at increased risk of infections, mainly due to immunosuppressive treatment. Moreover, infections may cause flares of IBD. Vaccination is the most effective way of preventing many infections. The aim of this study was to evaluate the vaccination status of Polish children with IBD. Individual immunization cards of children with IBD and healthy controls were reviewed. Demographic data such as age, sex, and IBD history, including therapy type, were collected. We enrolled 267 children into the study, including 214 children with IBD and 53 controls. None of the children had completed the full up-to-date routine childhood immunization schedule recommended in Poland. Controls were more than 4 times more likely to be vaccinated than the IBD patients, with the vaccines that enjoy the insurance reimbursed (OR 4.1, 95% CI 2.2-7.9). In conclusion, the study demonstrates a poor vaccination status in children suffering from IBD.

Solitary Rectal Ulcer Syndrome in Children: A Case Series Study.

Information on solitary rectal ulcer syndrome (SRUS) in children is limited and based on case reports only. This study was undertaken with the objective of describing the clinical history, symptoms, diagnostic work-up, and treatment of a large case series of pediatric patients with SRUS. The study was multi-center and retrospective. All pediatric endoscopists in Poland were invited to participate in the study and were asked to look through their endoscopic databases to identify SRUS cases from the last 10 years. The charts of SRUS patients were reviewed with respect to demographic data, and endoscopic and histological findings. Additionally, treatment methods and outcomes were assessed. In total, 31 patients (18 males, mean age of 13 years, range 5-18 years) were included in the study. All patients reported rectal bleeding. Other common symptoms included: abdominal pain (64.5%), perianal pain (54.8%), and passage of mucus (51.6%). The diagnostic work-up lasted from 1 to 48 months. Colonoscopic findings revealed rectal ulceration in 96.8% of patients. Therapeutic approaches included: high fiber diet (64.5%), laxatives (54.8%), topical corticosteroids (63.3%), 5-aminosalicylates administered orally and topically (29.1% and 96.8%, respectively), sucralfate (9.7%), and a biofeedback training (6.6%). Endoscopic argon plasma coagulation was performed in 2 patients and surgical intervention was necessary in 4 of them. Treatment was unsuccessful in 36% of patients. The findings of this study indicate that SRUS is rare in pediatric population, its diagnosis may be considerably delayed, and the treatment applied is often ineffective.

A role of hydrogen peroxide producing commensal bacteria present in colon of adolescents with inflammatory bowel disease in perpetuation of the inflammatory process.

Bacteria in the gut play a central role in the initiation and progress of inflammatory bowel disease (IBD). This study was prepared to elucidate the role in the inflammatory process of the bacterial species which are able to produce hydrogen peroxide, present in samples taken from colon lesions in adolescents with inflammatory bowel disease. Fifty eight adolescents were enrolled into the study from January 2004 to October 2006 in Cracow, Poland. Biopsies and stool samples were collected. Bacteriological examinations and measurements of hydrogen peroxide production by enterococci, streptococci and lactobacilli were performed. For the first time it has been shown here that HP producing bacteria may contribute to increased amounts of hydrogen peroxide in the inflamed mucosa of Crohn's disease and ulcerative colitis patients. Moreover, we have been able to demonstrate an increase of total populations of aerobic bacteria but not anaerobes in the studied samples of mucosa of adolescents with inflammatory bowel disease which is an indirect evidence of higher oxygen tension present in inflamed tissues in IBD. We have also been able to demonstrate the direct relationship between presence of blood in stools of IBD adolescents and increased populations of Enterobacteriaceae but not streptococci in samples of colon mucosa. It is, therefore, possible that different products of Enterobacteriaceae and especially their lipopolysaccharides may also contribute to perpetuation of the chronic colon inflammation.

Epidemiology and impact of rotavirus diarrhoea in Poland.

Hospital and laboratory data were analysed in three hospitals to estimate rotavirus disease burden in 1994-96. Community acquired gastroenteritis was diagnosed in 757 children of whom 41% tested positive for rotavirus. A total of 196 children had rotavirus nosocomial infections (39% of all rotavirus community-acquired and nosocomial cases). Infants less than 24 months old and children less than 3 months old comprised 74% and 11.9% of admissions for rotavirus, respectively. Almost 94% of children with rotavirus infection had severe gastroenteritis (score > or =11). The annual rate of rotavirus associated hospitalization in Poland in 1996 was 3.1/1000 children under the age of 60 months and 5.2/1000 infants under 24 months of age. The mean hospital stay was 9.5 d (+/-9.8 d). We estimated that 8918 children under 60 months of age were hospitalized for rotavirus gastroenteritis in 1996; they accounted for 84899 inpatient days. We conclude that rotavirus is a leading aetiological agent of severe gastroenteritis in young children in Poland and that the burden of this infection is significant. Rotavirus vaccine could significantly decrease the hospitalization rate and the financial impact of rotavirus gastroenteritis in Poland.

[Foreign bodies in the respiratory tract of infants and young children taken from personal material]. / Ciala obce w drogach oddechowych u niemowlat i malych dzieci w materiale wlasnym.

The paper presents problems related to the aspiration of foreign bodies to the respiratory tract of children aged 0-2 years. The authors analyze the most common symptoms corresponding to particular stages of changes in the respiratory tract following foreign body aspiration along with their radiological pictures. Approximately 65% of aspiration cases in children occur in the period between 6 months and 3 years of life. The symptoms may suggest a misdiagnosis of chronic respiratory tract disease. Detailed analysis of the course of the disease in particular children may facilitate proper diagnostic and therapeutic management.