Introduction

Collagenous colitis (CC) is a debilitating, non-destructive inflammatory bowel disease (IBD) that causes intense watery, non-bloody diarrhoea. The abnormal immune response is thought to be initiated by deficient tolerance to commensal gut microbiota, and fecal sample analyses indicate similarities with classic IBD forms as ulcerative colitis and Crohn’s disease. Yet, the exact members of the microbiome that might trigger and maintain the disease remain unknown.

Aims & Methods

To identify primary microbial triggers of CC pathogenesis that could directly interact with intestinal epithelial and submucosal cells, we isolated subepithelial mucosa from CC and healthy control (Hc) formalin-fixed paraffin-embedded samples (n=7-10) by using a laser microdissection microscope (PALM MicroBeam LCM, Zeiss, Germany). Isolated nucleic acids were sequenced using shotgun metagenomics in a NovaSeq 6000 platform (Illumina, USA). Microbial communities were identified using MetaPhlan3/4, and microbial metabolic and molecular function pathways using Humann3.2 algorithms.

Results

Bray-Curtis and Jaccard similarity coefficients showed that CC subepithelial microbiome was similar to that from Hc samples. Still, further analyses indicated that microbial metabolic pathways and molecular functions could differ. Microbiota that was associated with CC included Anoxybacillus and Barnesiella, whereas microbiota associated with Hc comprised Bacteroides, Leuconostoc and Lactobacillus.

Conclusion

Mucosa-associated microbiota in CC did not significantly differ from healthy microbiota. However, our results point to a relation of CC with bacteria that form biofilms (Anoxybacillus) and affect the variability of colitis development (Barnesiella). Thus, validation and further follow-up of these results could help us identify CC triggers in the future.

References

Carstens A. The Gut Microbiota in Collagenous Colitis Shares Characteristics With Inflammatory Bowel Disease-Associated Dysbiosis. Clin Transl Gastroenterol. 2019 Jul;10(7):e00065

Disclosure

AM has received salary for consultancies from Tillotts Pharma AG, Ferring, Vifor and Dr Falk Pharma; speaker’s honoraria from Tillotts Pharma AG and Vifor. The remaining authors declare no conflicts of interest.

Introduction

In a previous case study, we reported the use of endoscopic band ligation for weight loss (1). Based on this, we performed the same procedure on 13 female cases.

Aims & Methods

This trial aimed to assess the efficacy and safety of endoscopic band ligation for weight loss among 13 female cases with initial body weight (kg) mean ± SD of 104.769 ± 17.316 (80–145), BMI mean ± SD of 40.4315 ± 4.9145 and a mean excess weight (kg) of 40.0769 ± 14.3669, Table 1.
For the endoscopy, the patients were sedated with propofol, and oxygen was used for endoscopic air insufflation. The ligatures were applied in the gastric body, starting distally; five parallel rows were created with 20–30 bands, with the last one placed in the proximal body. The entire procedure lasted 20–30 min.

Results

No immediate complications occurred during the endoscopy. After the procedure, the patients remained well and were discharged within 2–3 h. For the first three days, most complained of nausea, vomiting, and epigastric pain, and one patient experienced mild hematemesis. All complications were controlled with medications (pantoprazole 40 mg twice daily for the 1st month, plus antiemetics and antispasmodics as required).
The patients consumed a pureed diet for 2 weeks, followed by a soft diet for another 2 weeks. A follow -up endoscopy after 1 month revealed nicely healed ulcer scars in the gastric body, causing marginal narrowing of the lumen.
The patients’ weight loss (kg) was mean ± SD 96.6154 ± 16.8004, corresponding to 22.336% excess weight loss and 7.8752% total weight loss after 1 month, Table 2.

Conclusion

Endoscopic band ligation for weight loss is a new procedure that may help in the management of obesity. The procedure was safe and cost-effective; however, more studies are needed to assess the effectiveness and safety of band ligations in the management of obesity.

References

1. Abeid Mohamed, Kaddah Tarek. Endoscopic band ligation for weight loss. Endoscopy 2021; 53: E287–E288.

Introduction

Inflammatory bowel disease (IBD) is a growing cause for concern and often missed or not thought of among pediatric population in developing economies. It is reported that about 25% of IBDs present before the age of 20.
Growing plethora of investigations have not been able to replace the role of direct visualisation of intestinal mucosa in various colorectal issues. Macroscopic findings may or may not help in clinching the diagnosis of IBD, hence “Biopsy” remains the Elixir of diagnosis. In this article, we review and attempt to correlate colonoscopic(macroscopy) and histological (microscopy) findings of colonoscopies in pediatric population, done over a period of 1 year.

Aims & Methods

Aim and objectives: To compare macroscopic findings versus histopathology findings of colonoscopies in pediatric population in suspected IBD.
To study the correlation of macroscopic findings with histopathologic findings of colonoscopies in pediatric population and to assess the frequency and pattern of microscopic impressions of colonoscopies in our cohort.
Material and methods: A prospective observational study carried out in a tertiary referral centre in children who underwent colonoscopies, aged 1 month to 17 years over a period of 12 months.
All children whose parents consented were included in the study. Inclusion and Exclusion criteria were formulated. Informed consent was obtained from the parents. Clinical details, colonoscopy findings and histopathology reports were. A total of 135 cases were enrolled during our study period. Results were collated using Microsoft Excel ™.
© Ethical clearance was obtained from the institutional ethical committee.

Results

We found that the diagnosis of IBD was much more specific than expected with good sensitivity when data was matched between Macroscopy and Microscopy

Conclusion

• It is our standard practice to do colonoscopic biopsies from 7 areas (terminal ileum, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum) of the colon to exclude microscopic colitis which may be missed by the endoscopist or marked as ‘normal’.
• Microscopic findings are considered as ‘Gold standard’ in the diagnosis of IBD and we envisage that it will remain the gold standard in the many next decades to come
• Our data of sensitivity and sensitivity of the microscopic findings inclined the relevance of colonic mucosal biopsies in children with a normal-appearing mucosa and also the need to analyse every segment of the colon to diagnose IBD that may masquerade as “normal” in children which will add burden to the family, society and health care system and more importantly to the child’s quality of life.

References

1. Manfredi, Michael A et al. “Good agreement between endoscopic findings and biopsy reports supports limited tissue sampling during pediatric colonoscopy.” Journal of pediatric gastroenterology and nutrition vol. 58,6 (2014): 773-8.
2. Altamimi, Eyad & Odeh, Yousef & Al-Quraan, Tuka & Mohamed, Elmi & Rawabdeh, Naif. (2022). Diagnostic and therapeutic outcomes of pediatric colonoscopies in Jordanian children. Journal of Pediatric and Neonatal Individualized Medicine. 11.

Introduction

Collagenous colitis (CC) and lymphocytic colitis (LC), the two main subtypes of microscopic colitis (MC), are chronic inflammatory diseases of the colon of unknown etiology. Colonic barrier dysfunction has been identified in patients with MC. However, whether molecular and structural alterations underlie an aberrant barrier in MC remains to be defined.

Aims & Methods

To identify the molecular pathways involved in the colonic epithelial brush border structure and its ultrastructural alterations in MC. Total RNA and protein were obtained from sigmoid mucosal biopsies of healthy controls (Hc) (N=11), patients with active diarrhoea predominant irritable bowel syndrome (IBS-D) patients (N=13), and active newly diagnosed naive of treatment MC patients (N=12 CC and N=12 LC). Transcriptomic and proteomic analyses were performed by RNAseq analysis and liquid chromatography mass spectrometry, respectively. Additionally, in a subset of patients (N=8 CC, N=8 LC, N=8 IBS-D and N=8 Hc) sigmoid biospies were collected and processed for scanning and transmission electron microscopy (SEM and TEM, respectively), to perform a qualitative and quantitative assessment of the colonic epithelium. Integrated data assessment was performed to explore biological and molecular functions.

Results

By RNA-Seq enrichment study, three microvilli-related pathways (organization, regulation of microvilli organization and length) were significantly enriched in the colonic mucosa of CC patients compared to LC, IBS-D and Hc. The integrated multi-omic analysis identified 28 genes with a significant positive correlation between RNA expression and its corresponding protein expression, (4 genes with a strong correlation (r>0.7, p<0.05) and 21 genes with a moderate correlation (0.3<r<0.7, p<0.05)), which were related to each other at the network level by string database analysis. Reduced expression of the microvilli proteins, was observed in CC compared to Hc, IBS-D and LC patients. Reduced expression of the actin-binding proteins, was also observed in CC. Moreover, decreased protein expression and an increased expression of proteins in the actin-membrane junction, were observed in CC and LC. Ultrastructural observation revealed that microvilli on the colonic surface of MC patients were more scattered, irregular and shorter in MC than IBS-D and Hc. Furthermore, the number of microvilli per colonocyte length (microvilli/um) was lower in CC (3.7[2.8-5.3], p<0.0001) and LC patients (5.2[4.0-6.6], p=0.01) compared to Hc (7.5[6.6-8.7]). Similarly, microvilli length was also reduced in CC (0.5[0.4-0.8], p=0.0003) and LC (0.6[0.4-1.1], p=0.04) patients compared to Hc (1.1[1.0-1.4]). No differences in the number and length of microvilli were observed between IBS-D and Hc groups.

Conclusion

Dysregulated brush border molecular pathways underlie epithelial colonic dysfunction in MC compared to Hc and IBS-D patients at both molecular and ultrastructural levels. These previously undescribed data open new perspectives in defining the pathophysiological mechanisms of MC, especially in CC. Given the fundamental role of the brush border in maintaining intestinal homeostasis and even water absorption, further understanding of these mechanisms may have significant diagnostic and therapeutic implications for MC.

Disclosure

Dr Javier Santos has served as consultant for Noventure SL, Devintecpharma, Reckitt, Ipsen, Aboca & Pileje and discloses present and past recent scientific collaborations with Salvat, Norgine, Alfa-Sigma, Cosmo, Adare, Ordesa and Danone that do not constitute a conflict of interest in developing the content of the present manuscript.