Clinical Case Summary

Patient S., born in 1961, was admitted to the gastroenterology department of a multidisciplinary hospital with complaints of frequent liquid stools up to 10 times a day, including up to 5 times at night, without visible pathological impurities, evening temperature rise up to 38 degrees, accompanied by chills, weakness, increased fatigue, and weight loss of 20 kg in 2 months. From the medical history, it was known that for 5 months, he had noted the appearance of liquid stools up to 3-4 times a day and had been observed by an infectious disease specialist and a therapist in his place of residence. Differential diagnosis was performed between celiac disease complicated by erosive-ulcerative lesions of the small and large intestine, enterogenous sepsis, lymphoproliferative disease of the small intestine, and erosive-ulcerative lesions of the small and large intestine of infectious genesis. Laboratory, endoscopic, X-ray methods of examination were used for further examination, and diagnostic laparoscopy with biopsy of a lymph node was performed to verify the diagnosis. Histological and immunohistochemically examination of biopsies of the small intestine and lymph node allowed the diagnosis of celiac disease complicated by T-cell lymphoma for the first time. Chemotherapy was initiated for the patient, which was complicated by pancytopenia and profuse bleeding from the area of tumor decay in the intestine. The patient's condition progressively worsened, and despite the therapy being carried out, cardiac arrest was recorded, and the resuscitation measures carried out were ineffective. Biological death of the patient was recorded.
In a patient with latent gluten enteropathy, the clinical picture manifested itself of T-cell lymphoma of the small intestine. The lack of dispensary observation and active patient referral did not allow for the timely detection of gluten enteropathy and the prevention of fatal complications.
4 illustrations included.

References

Perrotta G, Guerrieri E Celiac disease: definition, classification, historical and epistemological profiles, anatomopathological aspects, clinical signs, differential diagnosis, treatments and prognosis. Proposed diagnostic scheme for celiac disease (DSCNC). Arch Clin Gastroenterol 8(1): 008-019. DOI: 10.17352/2455-2283.000106, 2022
Malamut G, Chandesris O, Verkarre V, et all. Enteropathy associated T cell lymphoma in celiac disease: a large retrospective study. Dig Liver Dis. 2013 May; 45(5):377-84. DOI: 10.1016/j.dld.2012.12.001. Epub 2013 Jan 10.
Marušić M, Gulić S, Gašparov S, et all. Celiac disease and fulminant T lymphoma detected too late in a 35-year-old female patient: case report. Bosn J Basic Med Sci. 2011 Aug; 11(3):190-3. DOI: 10.17305/bjbms.2011.2573.

Introduction

Microplastic particles (MPs) have previously been confirmed to be found in the human body and are suspected to lead to systemic health effects (1). One biological matrix in which MPs have been detected is human faeces (2). While there is growing evidence suggesting potential impacts on the gut microbiome from animal (3) and in-vitro/ex-vivo studies (4), studies investigating this relationship in the human are still lacking.

Aims & Methods

This pilot study aimed to investigate the impact of short-term plastic reduction on the gastrointestinal tract of healthy participants, focussing on MP presence and gut microbial composition.
Sixty healthy volunteers participated by providing two stool samples: one prior to and one after a seven-day intervention during which they actively minimized plastic exposure. To facilitate the reduction, participants were provided with plastic-free alternatives (e.g., glass water bottles, wooden kitchen utensils, plastic-free dental care products, tin lunch boxes), together with instructions on how to avoid plastic-packaged goods and find alternatives. Dietary habits and plastic contact were recorded using detailed questionnaires to assess behavioural changes and identify potential sources of exposure. Stool samples were analysed using 16S rRNA gene sequencing for changes in microbial diversity and potential differential taxa. Additionally the samples were frozen at –80°C for future MP quantification, where method development is ongoing.

Results

Fifty-five participants completed the study, with an average self-reported success rate of 76% in adhering to the intervention. Forty percent of participants fully avoided plastic packaging, while 56% achieved partial avoidance. Participants noted challenges, particularly in avoiding plastic in meat and dairy products and during restaurant visits. Despite these obstacles, 92.7% expressed a lasting commitment to reducing plastic use post-intervention, with many reporting intentions to continue purchasing fresh products, reduce fast food intake, and adopt sustainable household practices, especially replacing plastic utensils. Initial microbiome analysis revealed no significant changes in alpha or beta diversity following reduced plastic exposure; however, differential abundance analysis identified potential specific taxa shifts. One species each within the genera Clostridium, Ruminococcus, and Blautia showed reduced abundance post-intervention, while species from the genera Bacteroides and Anaerostipes were associated with increased abundance after plastic fasting.

Conclusion

A short-term reduction in plastic exposure is feasible and can effectively raise awareness and promote long-term behavioural change in plastic consumption habits. However, no significant changes in gut microbial diversity were observed within the study period, with only shifts in a limited number of species visible. Due to the stability of the gut microbial composition, longer changes in plastic exposure might be necessary to trigger stronger effects.

References

(1) Prata, J. C., da Costa, J. P., Lopes, I., Duarte, A. C., & Rocha-Santos, T. (2020). Environmental exposure to microplastics: An overview on possible human health effects. The Science of the total environment, 702, 134455. https://doi.org/10.1016/j.scitotenv.2019.134455
(2) Schwabl, P., Köppel, S., Königshofer, P., Bucsics, T., Trauner, M., Reiberger, T., & Liebmann, B. (2019). Detection of Various Microplastics in Human Stool: A Prospective Case Series. Annals of internal medicine, 171(7), 453–457. https://doi.org/10.7326/M19-0618
(3) Hirt, N., & Body-Malapel, M. (2020). Immunotoxicity and intestinal effects of nano- and microplastics: a review of the literature. Particle and fibre toxicology, 17(1), 57. https://doi.org/10.1186/s12989-020-00387-7
(4) Tamargo, A., Molinero, N., Reinosa, J. J., Alcolea-Rodriguez, V., Portela, R., Bañares, M. A., Fernández, J. F., & Moreno-Arribas, M. V. (2022). PET microplastics affect human gut microbiota communities during simulated gastrointestinal digestion, first evidence of plausible polymer biodegradation during human digestion. Scientific reports, 12(1), 528. https://doi.org/10.1038/s41598-021-04489-w

Clinical Case Summary

Colonoscopy is an essential tool in the diagnosis and management of various gastrointestinal disorders, yet it carries a risk of complications that can complicate patient care. Among these, post-colonoscopy appendicitis represents a rare but critical condition. The interplay between colonoscopy-induced inflammation and pre-existing appendiceal pathology may contribute to this phenomenon. A thorough understanding of the pathophysiology, clinical manifestations, and management strategies associated with post-colonoscopy appendicitis is vital for healthcare professionals to enhance early recognition and optimize patient outcomes.
A sixty-one-year-old female patient underwent esophagogastroduodenoscopy(EGD) and colonoscopy due to recurrent episodes of diffuse, non-radiating mild abdominal pain, as well as for colorectal cancer screening. The procedure was conducted without complications, but the bowel preparation was deemed inadequate (BBPS: 1-2-1). Twenty-four hours later, the patient presented to the emergency department, reporting severe diffuse non-radiating abdominal pain accompanied by multiple episodes of vomiting, nausea, and watery non-bloody diarrhea. Computed tomography of the abdomen was performed showing acute appendicitis. Subsequently, open appendectomy was performed with a course of intravenous antibiotics and patient then discharged home in good physical condition.
In conclusion, this case highlights the potential for post-colonoscopy appendicitis as a rare but significant complication that can arise following gastrointestinal procedures. It underscores the importance of maintaining a high index of suspicion for appendicitis in patients presenting with abdominal symptoms after colonoscopy, facilitating timely diagnosis and treatment.

References

• Ali,Mohammad MD¹; Patel, Jigar MD²; Katz, Douglas MD²; Friedel, David MD³. Post-Colonoscopy Appendicitis: A Rare but Concerning Entity: 1548. American Journal of Gastroenterology 113():p S891, October 2018
• ASGE review of adverse events in colonoscopyKothari, Shivangi T. et al.
  Gastrointestinal Endoscopy, Volume 90, Issue 6, 863 - 876.e3