Assuntos
Enterite , Eosinofilia , Humanos , Eosinofilia/imunologia , Enterite/terapia , Enterite/imunologia , Gastrite/imunologia , Pesquisa BiomédicaRESUMO
The clinical presentation of eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis (non-EoE EGIDs) varies depending on the gastrointestinal segments affected by the eosinophilic inflammation, the extent of eosinophilic inflammation within the gastrointestinal tract and its depth through the bowel wall. Non-EoE EGIDs with mucosal involvement tend to present with diarrhea, malabsorption, and sometimes bleeding, those with muscular involvement may present with symptoms of obstruction or pseudo-obstruction, intussusception, and even perforation, whereas those with serosal involvement may present with eosinophilic ascites. Here we describe the differences in symptoms experienced by children with non-EoE EGIDs with varying degrees of eosinophilic inflammation through the bowel wall.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Criança , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Gastrite/diagnóstico , Enterite/diagnóstico , Enterite/terapia , InflamaçãoRESUMO
Endoscopic evaluation with biopsies is a mainstay of the diagnosis of eosinophilic esophagitis (EoE) and non-EoE eosinophilic gastrointestinal diseases (EGIDs). Increasing knowledge has resulted in the development of 2 standardized scoring systems: the Endoscopic REFerence Score (EREFS) for EoE and the EG-REFS for eosinophilic gastritis, although the latter has not been validated. In EGIDs, diagnosis and follow-up focus on eosinophil infiltration in biopsies. In this article, we will discuss the most commonly used endoscopic scores in EoE and non-EoE EGIDs, their validity for the diagnosis and follow-up of disease activity, as well as endoscopic interventions and areas of uncertainty.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Endoscopia/métodos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnósticoRESUMO
Eosinophilic gastrointestinal diseases (EGID), such as eosinophilic gastritis (EoG), eosinophilic enteritis, and eosinophilic colitis (EoC), are chronic inflammatory conditions characterized by persistent gastrointestinal symptoms and elevated levels of activated eosinophils in the gastrointestinal tract. EoG and eosinophilic duodenitis (EoD) are strongly associated with food allergen triggers and TH2 inflammation, whereas EoC shows minimal transcriptomic overlap with other EGIDs. The level of expression of certain genes associated with TH2 immune response is associated with certain histopathologic findings of EoG, EoD, and EoC. Current immune therapy for EoG depletes tissue eosinophilia with persistence of other histopathologic features of disease.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Gastrite/terapia , InflamaçãoRESUMO
Patients with non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) are prone to nutritional deficiencies due to food-avoidant behaviors, malabsorption, and high nutrition impact symptoms. Nutrient deficiencies correspond to the segment, depth, and extent of the gastrointestinal tract involved and can impact organs distant from the gut. Patients with non-EoE EGIDs are often atopic, and some appear to respond to dietary avoidance of specific food allergens. Tests to identify food triggers other than response to elimination diets are lacking. Dietary restriction therapy should be considered in such patients and is best implemented through a multidisciplinary approach to avoid nutritional complications.
Assuntos
Enterite , Eosinofilia , Hipersensibilidade Alimentar , Gastrite , Humanos , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Gastrite/terapia , Eosinofilia/terapia , Eosinofilia/diagnóstico , Hipersensibilidade Alimentar/terapia , AlérgenosRESUMO
Eosinophilic gastrointestinal disorder (EGID) is an umbrella term encompassing a group of chronic, immune-mediated disorders characterized by eosinophil-rich inflammation affecting one or more segments of the gastrointestinal tract. A recent consensus in nomenclature and emerging data made possible through multi-center consortia are beginning to unravel the molecular and cellular underpinnings of EGIDs below the esophagus. These emerging findings are revealing both overarching commonalities related to a food allergen-driven, chronic, Th2-mediated immune response as well as location-specific nuances in the pathophysiology of the collective EGIDs. Altogether, these advances offer promise for improved diagnoses and more efficacious interventional strategies.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Eosinofilia/diagnóstico , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapiaRESUMO
Mast cells play a central role in the pathogenesis of eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis. Their interactions with immune and structural cells, involvement in tissue remodeling, and contribution to symptoms make them attractive targets for therapeutic intervention. More is being discovered regarding the intricate interplay of mast cells and eosinophils. Recent studies demonstrating that depletion of eosinophils is insufficient to improve symptoms of EGIDs have raised the question of whether other cells may play a role in symptomatology and pathogenesis of EGIDs.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Mastócitos , Enterite/terapia , Enterite/diagnóstico , Gastrite/diagnóstico , Gastrite/terapia , Esofagite Eosinofílica/terapia , Esofagite Eosinofílica/diagnósticoRESUMO
GUIDELINE TITLE: Joint ESPGHAN/NASPGHAN Guidelines on Childhood Eosinophilic Gastrointestinal Disorders Beyond Eosinophilic Esophagitis RELEASE DATE: July 4, 2023 (e-publication ahead of print) PRIOR VERSION(S): None DEVELOPER: European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the North American Society for Pediatrics Gastroenterology, Hepatology and Nutrition (NASPGHAN) FUNDING SOURCE: ESPGHAN and NASPGHAN TARGET POPULATION: Children with eosinophilic gastrointestinal disorders beyond eosinophilic esophagitis.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Médicos Hospitalares , Humanos , Eosinofilia/diagnóstico , Eosinofilia/terapia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Criança , Gastrite/diagnóstico , Gastrite/terapia , Enterite/diagnóstico , Enterite/terapia , Guias de Prática Clínica como AssuntoRESUMO
Although eosinophilic gastrointestinal diseases, including eosinophilic esophagitis, have been described over the past 2 to 3 decades, barriers to diagnosis and treatment are common and compounded by issues related to social determinants of health, race, ethnicity, and access to care. These barriers contribute to delays in diagnosis, resulting in persistent inflammation in the gastrointestinal tract, which can have significant consequences, including fibrostenotic complications in adults, failure to thrive in children, and decreased quality of life in all affected patients. In this commentary, we summarize gaps in knowledge regarding the epidemiology of eosinophilic gastrointestinal diseases, highlight barriers to diagnosis, discuss potential approaches based on best practices in other atopic and chronic gastrointestinal diseases, and provide recommendations for reducing barriers to timely diagnosis of eosinophilic gastrointestinal diseases in underserved populations.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Adulto , Criança , Humanos , Qualidade de Vida , Enterite/diagnóstico , Enterite/epidemiologia , Enterite/terapia , Gastrite/diagnóstico , Gastrite/epidemiologia , Gastrite/terapia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/epidemiologia , Esofagite Eosinofílica/terapiaRESUMO
Radiation enteritis is a common complication of abdominal and pelvic radiotherapy. Several previous studies showed that fecal microbiota transplantation (FMT) could alleviate radiation enteritis. In this study, we investigated the efficacy of FMT in alleviating radiation enteritis and explored the mechanisms by multi-omics approaches. Briefly, C57BL/6J mice were subjected to 9 Gy irradiation to the localized abdominal field, and randomized received FMT from healthy donor mice or saline. H&E staining of harvested small intestine showed FMT decreased epithelial injury. Radiation-induced microbiota dysbiosis, characterized by a decrease in beneficial bacteria Lactobacillaceae and Lachnospiraceae, while these bacteria were restored by FMT. Fecal metabolomics analysis revealed that FMT modulated metabolic dysregulation. Two tryptophan pathway metabolites, indole-3-acetaldehyde and N-Acetyl-5-hydroxytryptamine were decreased after irradiation, whereas these metabolites showed a pronounced recovery in mice receiving FMT. Proteomics analysis of small intestine indicated that radiation enteritis triggered immune-inflammatory responses, which were potentially mitigated by FMT. In 21 patients receiving pelvic radiotherapy for cervical cancer, those who developed enteritis (n = 15) had higher abundance in Lachnospiraceae. Moreover, Indole-3-acetaldehyde was reduced after irradiation. These findings provide insights into the therapeutic effects of FMT in radiation enteritis and highlight Lachnospiraceae and the tryptophan metabolite, Indole-3-acetaldehyde may protect against radiation enteritis.
Assuntos
Enterite , Transplante de Microbiota Fecal , Microbioma Gastrointestinal , Camundongos Endogâmicos C57BL , Triptofano , Animais , Triptofano/metabolismo , Enterite/terapia , Enterite/metabolismo , Enterite/microbiologia , Enterite/etiologia , Microbioma Gastrointestinal/efeitos da radiação , Camundongos , Feminino , Humanos , Lesões por Radiação/terapia , Lesões por Radiação/metabolismo , Lesões por Radiação/microbiologia , MasculinoRESUMO
BACKGROUND: The gut microbiota is strongly associated with radiation-induced gut damage. This study aimed to assess the effectiveness and safety of intestinal microecological transplantation for treating patients with chronic radiation enteritis. CASE SUMMARY: A 64-year-old female with cervical cancer developed abdominal pain, diarrhea, and blood in the stool 1 year after radiotherapy. An electronic colonoscopy was performed to diagnose chronic radiation enteritis. Two courses of intestinal microecological transplantation and full-length 16S rRNA microbiological analysis were performed. The patient experienced short- and long-term relief from symptoms without adverse effects. Whole 16S rRNA sequencing revealed significant differences in the intestinal flora's composition between patient and healthy donors. Pathogenic bacteria, such as Escherichia fergusonii and Romboutsia timonensis, were more in the patient. Beneficial bacteria such as Faecalibacterium prausnitzii, Fusicatenibacter saccharivorans, Ruminococcus bromii, and Bifidobacterium longum were more in the healthy donors. Intestinal microbiota transplantation resulted in a significant change in the patient's intestinal flora composition. The composition converged with the donor's flora, with an increase in core beneficial intestinal bacteria, such as Eubacterium rectale, and a decrease in pathogenic bacteria. Changes in the intestinal flora corresponded with the patients' alleviating clinical symptoms. CONCLUSION: Intestinal microecological transplantation is an effective treatment for relieving the clinical symptoms of chronic radiation enteritis by altering the composition of the intestinal flora. This study provides a new approach for treating patients with chronic radiation enteritis.
Assuntos
Enterite , Transplante de Microbiota Fecal , Microbioma Gastrointestinal , Lesões por Radiação , Neoplasias do Colo do Útero , Humanos , Feminino , Pessoa de Meia-Idade , Enterite/microbiologia , Enterite/diagnóstico , Enterite/etiologia , Enterite/terapia , Lesões por Radiação/diagnóstico , Lesões por Radiação/microbiologia , Lesões por Radiação/etiologia , Lesões por Radiação/cirurgia , Microbioma Gastrointestinal/efeitos da radiação , Transplante de Microbiota Fecal/métodos , Neoplasias do Colo do Útero/radioterapia , RNA Ribossômico 16S/genética , Resultado do Tratamento , Doença Crônica , Colonoscopia , Intestinos/microbiologia , Intestinos/efeitos da radiação , Fezes/microbiologia , Radioterapia/efeitos adversosAssuntos
Consenso , Enterite , Eosinofilia , Esofagite Eosinofílica , Guias de Prática Clínica como Assunto , Humanos , Criança , Eosinofilia/diagnóstico , Eosinofilia/terapia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Gastrite/terapia , Gastroenteropatias/diagnóstico , Gastroenteropatias/terapiaRESUMO
Abstract The aim of the present study was to evaluate the effect of systemic administration of probiotics (PROB) on the progression of experimentally induced oral and intestinal mucositis in rats immunosuppressed by chemotherapy (5-fluorouracil: 5-FU). Twenty-four rats were divided into the following groups (n=6): GC (control), GPROB, G5FU and G5-FU/PROB. Groups GPROB and G5-FU/PROB received 1 g of probiotic incorporated into each 100 g of feed (Bacillus subtilis, Bifidobacterium bifidum, Enterococcus faecium and Lactobacilllus acidophilus), beginning 30 days before oral mucositis induction. Groups G5FU and G5-FU/PROB received 60 mg/kg of 5-FU on days 0 and 2. The left oral mucosa of each animal was irritated by mechanical trauma (days 1 and 2). On days 3 and 7, three animals from each group were sacrificed, and their oral mucosa and small intestine were biopsied and processed for histopathological analysis. Groups G5-FU and G5-FU/PROB showed ulcerated oral lesions at day 3, with progression in group G5-FU and regression in group G5-FU/PROB at day 7. Histologically, less severe signs of inflammation in the oral mucosa were observed in group G5-FU/PROB than in group G5-FU. Regarding the intestine, villus-related defects of lesser magnitude were observed in group G5-FU/PROB, compared with group G5-FU. Group GPROB showed greater villus height than group GC. It can be concluded that probiotic supplementation reduced oral and intestinal inflammation in immunosuppressed rats with experimentally induced mucositis, and may protect the intestine from changes induced by chemotherapy, thus contributing to overall health.
Assuntos
Animais , Masculino , Estomatite/patologia , Estomatite/terapia , Probióticos/uso terapêutico , Enterite/patologia , Enterite/terapia , Estomatite/imunologia , Fatores de Tempo , Biópsia , Distribuição Aleatória , Reprodutibilidade dos Testes , Resultado do Tratamento , Ratos Wistar , Enterite/induzido quimicamente , Imunocompetência , Mucosa Intestinal/efeitos dos fármacos , Mucosa Intestinal/patologia , Intestino Delgado/efeitos dos fármacos , Intestino Delgado/patologia , Mucosa Bucal/efeitos dos fármacos , Mucosa Bucal/patologiaRESUMO
Chronic actinic enteritis is a severe complication that ocurrs in oncological patients under radiation therapy. It is associated with significant morbidity and mortality rates. This article is focused on the acute and chronic actinic enteritis and their predisposing factors. Due to the multifactorial etiology of the gastrointestinal symptoms in these patients, it is important to have a diagnostic approach based on clinical background information and tests, that will allow to establish one etiology and rule out differential diagnoses. As for the treatment, drugs with variable effectiveness and validity are mentioned. In more complex patients successful treatment with better results has been achieved, but these have a higher cost and are less available. In severe cases, parenteral nutrition and/or surgery have been used. From the point of view of prevention, the utility of the drugs has been documented for acute enteritis. However, in order to reduce the risk of chronic enteritis it is critical to take actions resulting in less toxicity during the radiation therapy. The participation of a multidisciplinary team is very important both in the management and prevention of actinic enteritis.
La enteritis actínica crónica es una complicación grave y creciente que se presenta en pacientes oncológicos sometidos a radioterapia. Se asocia a morbilidad y mortalidad significativas. El presente artículo está enfocado en las formas aguda y crónica de la enteritis actínica y sus factores predisponentes. Dada la etiología multifactorial de los síntomas gastrointestinales en estos pacientes, es importante una aproximación diagnóstica basada en los antecedentes clínicos y exámenes que permitan definir una etiología y excluir diagnósticos diferenciales. En cuanto al tratamiento, se mencionan fármacos con efectividad variable y validez limitada. En pacientes más complejos se han realizado tratamientos con resultados más exitosos, pero de mayor costo y de difícil disponibilidad. En casos graves se debe recurrir a la nutrición parenteral y/o cirugía. Desde el punto de vista de la prevención, se ha documentado la utilidad de fármacos en la enteritis aguda. Sin embargo, para reducir el riesgo de la enteritis crónica es fundamental adoptar medidas que conduzcan a una menor toxicidad durante la radioterapia. Tanto en el manejo como en la prevención de la enteritis actínica es importante el enfoque de un equipo multidisciplinario.
Assuntos
Humanos , Enterite/terapia , Lesões por Radiação/terapia , Doença Aguda , Doença Crônica , Enterite/prevenção & controle , Fatores de Risco , Neoplasias/radioterapia , Lesões por Radiação/prevenção & controleRESUMO
Este artigo revisa o tema probióticos com o objetivo de avaliar seus possíveis potenciais como agentes bioterapêuticos na prevenção e/ou tratamento de algumas doenças relacionadas com a via intestinal. Os probióticos representam uma área de pesquisa em extensão. Muitas publicações enfatizam o potencial significado dessa emergente área, entretanto muito ainda necessita ser comprovado e realizado no sentido de definir o real significado do termo probiótico; se for efetivo, quais as cepas que preenchem os critérios de um real microorganismo probiótico e em quais circunstâncias clínicas são indicadas
This article reviews the theme probiotics with the objective to evaluate their potentials as possible biotherapeutic agents for the prevention and/or treatment of some illnesses related tothe intestinal tract. Probiotics represents an expanding research area. Many publications emphasizes the potential significance of this emerging field, meanwhile, much still remains to be proved and to be done in order to standardize the real meaning of the term probiotic and, if they are real, which strains actually fulfill the criteria of true probiotics microorganisms and in which clinical circumstances they are really useful
Assuntos
Probióticos/uso terapêutico , Doenças Inflamatórias Intestinais/prevenção & controle , Doenças Inflamatórias Intestinais/terapia , Encefalopatia Hepática/terapia , Infecções por Helicobacter/prevenção & controle , Infecções por Helicobacter/terapia , Neoplasias do Colo/prevenção & controle , Diarreia/prevenção & controle , Diarreia/terapia , Enterite/prevenção & controle , Enterite/terapia , Prebióticos , Simbióticos , Gastroenteropatias/prevenção & controle , Gastroenteropatias/terapia , Hipersensibilidade/prevenção & controle , Intestinos/microbiologiaRESUMO
Intensas pesquisas realizadas nas ultimas tres decadas procuraram obter metodos capazes de nutrir adequadamente individuos em situacao normal e apos trauma. A criacao de preparacoes orais sinteticas permitiram avaliar a acao dos varios nutrientes em situacoes especificas, e as assim chamadas dietas elementares se mostraram eficazes. Diversos autores conseguiram produzir enterite actinica tipica, aguda ou cronica, o que permitiu o estudo de substancias radioprotetoras. As dietas elementares tambem foram testadas como "radioprotetores" fisiologicos uma vez que elas poderiam ao mesmo tempo diminuir a lesao intestinal primaria e tratar suas complicacoes. Preparacoes a base de pequenos peptideos, dissacaridios, e acidos graxos de cadeia media conseguiram diminuir a fase aguda em alguns modelos de animais utilizando roedores e caes, e solucoes a base de amino-acidos foram eficazes na prevencao e no tratamento de lesoes cronicas do retossigmoide no rato. Progressos recentes diminuiram a morbidade e mortalidade da fase aguda, mas ainda nao se conseguiram resultados satisfatorios para as lesoes cronicas e irreversiveis. Experimentos em andamento na atualidade vem estudando esta questao, uma vez que as dietas elementares poderao inferir no estabelecimento das sequelas cronicas da radiacao ionizante....