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Şahin NÜ, Şahin N. Endoscopic characterization of gastrointestinal manifestations in children with undifferentiated recurrent fever. Arab J Gastroenterol 2024:S1687-1979(24)00066-2. [PMID: 39069426 DOI: 10.1016/j.ajg.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/15/2024] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND STUDY AIMS Systemic autoinflammatory diseases are characterized by recurrent or chronic inflammation, and monogenic forms are increasingly defined. However, a group of patients without genetic diagnosis is called the syndrome of undifferentiated recurrent fever (SURF). This study analyzed the clinical and endoscopic features of patients with SURF presenting with gastrointestinal (GI) symptoms. PATIENTS AND METHODS Between 2019 and 2022, GI endoscopy were performed in patients with SURF who presented with GI symptoms. Clinical, genetic, laboratory, and endoscopy findings were analyzed. RESULTS Fifteen patients were included in the study, eight (53.3 %) were girls. The mean age was 10.5 ± 5.80 years, and the median age at symptom onset was 4 (0.3-16) years. All patients experienced fever and abdominal pain. Thirteen patients (86.7 %) experienced diarrhea, 11 (73.3 %) reported myalgia, and 10 (66.7 %) had joint involvement. Lymphoid follicles in the terminal ileum mucosa were detected in 10 patients (66.7 %), and nodular lymphoid hyperplasia in the terminal ileum was the histopathological finding in 12 patients (80 %). CONCLUSIONS The current study found that patients with SURF experiencing gastrointestinal symptoms have excessive lymph node formation in the terminal ileal mucosa due to an exaggerated inflammatory response. This may be the cause of their GI symptoms.
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Affiliation(s)
- Nilüfer Ülkü Şahin
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Bursa City Hospital, Bursa, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
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Wu BY, Xu P, Cheng L, Wang QQ, Qiu HY, Yan XJ, Chen SL. Mucosa-Associated Microbiota Dysbiosis in the Terminal Ileum Correlates With Bowel Symptoms in Diarrhea-Predominant Irritable Bowel Syndrome. Clin Transl Gastroenterol 2024; 15:e00658. [PMID: 37937852 PMCID: PMC10887450 DOI: 10.14309/ctg.0000000000000658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION The mucosa-associated microbiota (MAM) is not as frequently studied in diarrhea-predominant irritable bowel syndrome (IBS-D) compared with the fecal microbiota. In this study, we examined the MAM in the terminal ileum and its correlation with bowel symptoms in IBS-D. METHODS Mucosal biopsies of the terminal ileum from 25 patients with IBS-D and 25 healthy controls were collected for 16S ribosomal RNA gene sequencing. Correlation analysis was performed. RESULTS Compared with healthy controls, the MAM in the terminal ileum showed a decreased alpha diversity in the IBS-D cohort (Chao1 and Shannon indexes, P < 0.05). And the overall MAM profile clustered separately into 2 groups (ADONIS [PERMANOVA, permutational multivariate analysis of variance], P < 0.05). At the phylum level, the relative abundance of Proteobacteria was significantly higher in the ileal MAM of patients with IBS-D while that of Firmicutes was significantly lower. At the genus level, the relative abundance of Pseudomonas was significantly higher in the IBS-D cohort, with lower Bacteroides and Ruminococcus . Moreover, 40.0% of patients with IBS-D had multiple small nodules (nodular lymphoid hyperplasia) on the mucosal surface of the terminal ileum, which indicated a low-grade inflammation. In patients with IBS-D with nodular lymphoid hyperplasia, the changes of Pseudomonas and Bacteroides were more overt. Correlation analysis revealed that the relative abundance of Pseudomonas positively correlated with abdominal pain and the severity of IBS. DISCUSSION Patients with IBS-D showed a dysbiosis of MAM in the terminal ileum, which may be associated with bowel symptoms. Moreover, 40.0% of them displayed mucosal low-grade inflammation, with a more severe mucosal microbial disturbance.
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Affiliation(s)
- Bi-Yu Wu
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Ping Xu
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Li Cheng
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Qian-Qian Wang
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Hong-Yi Qiu
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiu-Juan Yan
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Sheng-Liang Chen
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Diseases, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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Mitev S, Atanasova EG, Kyoseva D. Flat nodular lymphoid hyperplasia resembling "apple tree branches" in the colon. Endoscopy 2023; 55:E771-E772. [PMID: 37308145 PMCID: PMC10260370 DOI: 10.1055/a-2086-2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Stefan Mitev
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Evelina G Atanasova
- Gastroenterology Clinic, University Hospital St Ivan Rilski, Sofia, Bulgaria
| | - Diana Kyoseva
- Department of General and Clinical Pathology, University Hospital Alexandrovska, Sofia Medical University, Sofia, Bulgaria
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Salarieh N, Emami Meibodi A, Alipour S, Azimirad M, Looha MA, Asadzadeh Aghdaei H, Yadegar A, Shahrokh S, Zali MR. Characterization of the mucosal microbiota in patients with nodular lymphoid hyperplasia with concurrent irritable bowel syndrome compared to healthy controls. Mol Biol Rep 2023; 50:145-155. [PMID: 36315327 DOI: 10.1007/s11033-022-07974-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/21/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Nodular lymphoid hyperplasia (NLH) is known as a lymphoproliferative lesion in which multiple small nodules appear on the intestinal wall. It has been documented that patients who struggle with irritable bowel syndrome (IBS) are at greater risk of developing NLH. Here, we aimed to investigate the previously reported pathogens and the abundance of a selection of mucosal microbiota in IBS + NLH patients compared to IBS, and healthy controls. METHODS AND RESULTS Terminal ileum biopsies were collected from 37 IBS + NLH, 37 IBS, and 29 healthy controls. Bacterial culture and PCR was performed to detect the presence of pathogens in biopsies. A qPCR assay was applied to assess the abundance of a selection of bacterial taxa. Totally, five bacterial isolates including two enteropathogenic and one enteroaggregative Escherichia coli (EPEC, EAEC), one enterotoxigenic Staphylococcus aureus (SEA), and one Yersinia enterocolitica strains were detected among the IBS + NLH cases. The relative abundance of Bacteroidetes and Streptococcus spp. in IBS + NLH patients was significantly less than IBS and healthy controls. Firmicutes, Pseudomonas spp., Haemophilus spp., and Campylobacter spp. were notably more abundant in IBS + NLH than in IBS patients. The abundance of Verrucomicrobia was higher in NLH + IBS than in healthy controls. Actinobacteria was also significantly more abundant among NLH + IBS patients than the controls. CONCLUSION Our results demonstrated that mucosal microbiota composition in NLH + IBS patients slightly differs from that of IBS patients and healthy controls. Further research using large-scale cohorts are needed to enhance current understanding of the contribution of the mucosal microbiota to NLH pathogenesis with concurrent IBS.
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Affiliation(s)
- Naghmeh Salarieh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armitasadat Emami Meibodi
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Alipour
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Azimirad
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shabnam Shahrokh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Bischoff NS, Proquin H, Jetten MJ, Schrooders Y, Jonkhout MCM, Briedé JJ, van Breda SG, Jennen DGJ, Medina-Reyes EI, Delgado-Buenrostro NL, Chirino YI, van Loveren H, de Kok TM. The Effects of the Food Additive Titanium Dioxide (E171) on Tumor Formation and Gene Expression in the Colon of a Transgenic Mouse Model for Colorectal Cancer. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:1256. [PMID: 35457963 PMCID: PMC9027218 DOI: 10.3390/nano12081256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022]
Abstract
Titanium dioxide (TiO2) is present in many different food products as the food additive E171, which is currently scrutinized due to its potential adverse effects, including the stimulation of tumor formation in the gastrointestinal tract. We developed a transgenic mouse model to examine the effects of E171 on colorectal cancer (CRC), using the Cre-LoxP system to create an Apc-gene-knockout model which spontaneously develops colorectal tumors. A pilot study showed that E171 exposed mice developed colorectal adenocarcinomas, which were accompanied by enhanced hyperplasia in epithelial cells, lymphatic nodules at the base of the polyps, and increased tumor size. In the main study, tumor formation was studied following the exposure to 5 mg/kgbw/day of E171 for 9 weeks (Phase I). E171 exposure showed a statistically nonsignificant increase in the number of colorectal tumors in these transgenic mice, as well as a statistically nonsignificant increase in the average number of mice with tumors. Gene expression changes in the colon were analyzed after exposure to 1, 2, and 5 mg/kgbw/day of E171 for 2, 7, 14, and 21 days (Phase II). Whole-genome mRNA analysis revealed the modulation of genes in pathways involved in the regulation of gene expression, cell cycle, post-translational modification, nuclear receptor signaling, and circadian rhythm. The processes associated with these genes might be involved in the enhanced tumor formation and suggest that E171 may contribute to tumor formation and progression by modulation of events related to inflammation, activation of immune responses, cell cycle, and cancer signaling.
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Affiliation(s)
- Nicolaj S. Bischoff
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
| | - Héloïse Proquin
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
- National Institute for Public Health and Environment (RIVM), Bilthoven, 3721 MA De Bilt, The Netherlands
| | - Marlon J. Jetten
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
- Faculty of Health, Medicine and Life Science, Maastricht University Medical Center, 6229 ES Maastricht, The Netherlands
| | - Yannick Schrooders
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
- Laboratory of Biosignaling & Therapeutics, Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Marloes C. M. Jonkhout
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
- Laboratory of Biosignaling & Therapeutics, Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium
| | - Jacco J. Briedé
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
| | - Simone G. van Breda
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
| | - Danyel G. J. Jennen
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
| | - Estefany I. Medina-Reyes
- Laboratorio de Carcinogénesis y Toxicología, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City 54090, Mexico; (E.I.M.-R.); (N.L.D.-B.); (Y.I.C.)
| | - Norma L. Delgado-Buenrostro
- Laboratorio de Carcinogénesis y Toxicología, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City 54090, Mexico; (E.I.M.-R.); (N.L.D.-B.); (Y.I.C.)
| | - Yolanda I. Chirino
- Laboratorio de Carcinogénesis y Toxicología, Unidad de Biomedicina, Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Mexico City 54090, Mexico; (E.I.M.-R.); (N.L.D.-B.); (Y.I.C.)
| | - Henk van Loveren
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
| | - Theo M. de Kok
- Department of Toxicogenomics, GROW School for Oncology and Reproduction, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands; (H.P.); (M.J.J.); (Y.S.); (M.C.M.J.); (J.J.B.); (S.G.v.B.); (D.G.J.J.); (H.v.L.); (T.M.d.K.)
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Jiang QL, Lu Y, Zhang MJ, Cui ZY, Pei ZM, Li WH, Lu LG, Wang JJ, Lu YY. Mucosal bacterial dysbiosis in patients with nodular lymphoid hyperplasia in the terminal ileum. World J Gastroenterol 2022; 28:811-824. [PMID: 35317097 PMCID: PMC8900573 DOI: 10.3748/wjg.v28.i8.811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/19/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nodular lymphoid hyperplasia (NLH) in the small intestine is a rare benign lesion characterized by multiple small nodules on the intestinal surface. Patients with terminal ileal NLH may experience long-term abdominal pain, diarrhea, and abdominal distension, among other symptoms. Supplementation with probiotics could mitigate these symptoms. NLH is linked to the immune system, and it may result from accumulation of plasma-cell precursors due to a maturational defect during the development of B lymphocytes. The intestinal microbiome plays an essential role in the immune system. Thus, we speculate that the gut flora plays a key role in terminal ileal NLH.
AIM To explore the correlation between intestinal flora and terminal ileal NLH.
METHODS We collected mucosal biopsy samples that were obtained via colonoscopy from 15 patients with terminal ileal NLH (the test group) and 15 normal subjects (the control group). We subsequently performed 16S-rRNA gene amplicon sequencing of these samples, and the results were evaluated using alpha diversity, beta diversity and microbial composition analyses. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was used to predict the metabolic pathways and orthologous groups according to the Kyoto Encyclopedia of Genes and Genomes database.
RESULTS Compared with the control group, the terminal ileal NLH group showed an increased alpha diversity (P < 0.05). The overall intestinal microbiota in the NLH group was significantly different from that of the control group (P < 0.05), implying that there was the dysbiosis in the terminal ileal NLH patients. The relative abundance of phylum Bacteroidetes was significantly lower in the NLH group, while that of Patescibacteria and Campilobacterota was significantly higher. The genus Bacteroides was the dominant gut microbiota in both groups, but its abundance was significantly lower in the test group than it was in the control group. Conversely, the relative abundances of Haemophilus, Streptococcus, Pseudomonas, Actinomyces, TM7X, Fusobacterium nucleatum, Parvimonas, Granulicatella, Helicobacter, and the [Eubacterium] nodatum group were significantly higher in the test group than they were in the control group. In addition, several altered metabolic pathways, orthologous groups, and modules were found. For example, the Peptidoglycan biosynthesis and Aminoacyl tRNA biosynthesis were both increased in the test group.
CONCLUSION Maintaining the microbial balance and supplementing targeted protective bacteria could improve symptoms and potentially reduce the risk of lymphoma transformation in patients with terminal ileal NLH.
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Affiliation(s)
- Qiao-Li Jiang
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
| | - You Lu
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
| | - Meng-Jie Zhang
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
| | - Zhen-Yu Cui
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
| | - Zhong-Mei Pei
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
| | - Wen-Hua Li
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
| | - Lun-Gen Lu
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Jing-Jing Wang
- Shanghai Key Laboratory of Pancreatic Diseases, Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Ying-Ying Lu
- Department of Gastroenterology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201803, China
- Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
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Montazeri SA, Mahfoodh FH, Naybandi Atashi S, Sima AR, Saffar H, Radmard AR. Nodular lymphoid hyperplasia of terminal ileum: how to avoid overdiagnosis of Crohn's terminal ileitis in MR enterography? Abdom Radiol (NY) 2021; 46:1846-1854. [PMID: 33236219 DOI: 10.1007/s00261-020-02866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the magnetic resonance enterography (MRE) characteristics of nodular lymphoid hyperplasia (NLH) and Crohn's terminal ileitis (CTI). METHODS Of 1552 MREs from November 2011 to July 2018, 61 individuals with biopsy-proven NLH (n = 24) and CTI (n = 37, 27 with active CTI) were selected based on the inclusion criteria. NLH cases were also followed up for median (range) of 40 (21-61) months. Two board-certified radiologists, blind to clinical data and diagnosis, reviewed MRE in consensus. Conventional, morphological, enhancement, and diffusion parameters were assessed. Mann-Whitney, χ2, and logistic regression analyses were conducted. RESULTS No NLH patient developed inflammatory bowel disease or lymphoproliferative disorders during the follow-up. Serosal surface irregularity (65% vs. 8%), pseudo-diverticula (27% vs. 0), and mesenteric fat involvement (38% vs. 4%) were more frequent in CTI than NLH (p < 0.01), while mucosal nodularity was more prevalent in NLH (71%) than CTI (19%) (p < 0.001). The upstream luminal diameter (15.0 vs. 12.5 mm, p = 0.015) and mural thickness (6.0 vs. 4.0 mm, p < 0.001) of the terminal ileum showed higher values in CTI than NLH. CONCLUSIONS Unlike enhancement and diffusion parameters, morphological features (mucosal nodularity, serosal surface irregularity, and mesenteric fat involvement) could distinguish NLH from CTI regardless of CTI activity.
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Affiliation(s)
- S Ali Montazeri
- Department of Radiology, Mayo Clinic, Florida, USA
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran
| | - Fatima Haitham Mahfoodh
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran
| | - Sara Naybandi Atashi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran
| | - Ali Reza Sima
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, North Kargar St, Tehran, 14117, Iran.
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8
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Marzollo A, Bresolin S, Colavito D, Cani A, Gaio P, Bosa L, Mescoli C, Rossini L, Barzaghi F, Perilongo G, Leon A, Biffi A, Cananzi M. Case Report: Intestinal Nodular Lymphoid Hyperplasia as First Manifestation of Activated PI3Kδ Syndrome Due to a Novel PIK3CD Variant. Front Pediatr 2021; 9:703056. [PMID: 34692603 PMCID: PMC8528001 DOI: 10.3389/fped.2021.703056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Nodular lymphoid hyperplasia (NLH) is a lymphoproliferative disease caused by non-clonal expansion of lymphoid cells in the gut mucosa. Little is known about the pathogenesis of NLH, which is often disregarded as an insignificant or para-physiologic phenomenon. We present the case of a girl with isolated diffuse NLH (extending from the stomach to the rectum) caused by activated PI3Kδ syndrome (APDS) due to the novel p.Glu525Gly variant in PIK3CD. The gain-of-function effect of the variant was confirmed by demonstration of over activation of the Akt/mTOR pathway in the patient's cells. APDS diagnosis led to treatment with sirolimus, which resulted in the complete remission of NLH and in the prevention of extra intestinal complications. In conclusion, we identify APDS as a novel cause of isolated NLH and suggest that patients with severe pan-enteric NLH should be screened for this disorder that may not be apparent on first-line immunological testing.
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Affiliation(s)
- Antonio Marzollo
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Padua University Hospital, Padua, Italy.,Fondazione Citta' della Speranza, Istituto di Ricerca Pediatrica, Padua, Italy
| | - Silvia Bresolin
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Padua University Hospital, Padua, Italy.,Istituto di Ricerca Pediatrica, Citta' della Speranza, Padua, Italy
| | - Davide Colavito
- Research and Innovation (R and I Genetics) Srl, Padua, Italy
| | - Alice Cani
- Istituto di Ricerca Pediatrica, Citta' della Speranza, Padua, Italy
| | - Paola Gaio
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Luca Bosa
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Claudia Mescoli
- Unit of Surgical Pathology and Cytopathology, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy
| | - Linda Rossini
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Padua University Hospital, Padua, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Stem Cell Program, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Perilongo
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Alberta Leon
- Research and Innovation (R and I Genetics) Srl, Padua, Italy
| | - Alessandra Biffi
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Padua University Hospital, Padua, Italy
| | - Mara Cananzi
- Unit of Pediatric Gastroenterology, Digestive Endoscopy, Hepatology and Care of the Child With Liver Transplantation, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
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9
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Cakir M, Sag E, Saygin I, Orhan F. Ileocolonic Lymphonodular Hyperplasia in Children Related to Etiologies Ranging from Food Hypersensitivity to Familial Mediterranean Fever. Med Princ Pract 2020; 29:473-479. [PMID: 32000163 PMCID: PMC7511677 DOI: 10.1159/000506257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/30/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE We aimed to share our observations on the demographics, clinical characteristics, and outcomes of lymphonodular hyperplasia (LNH) in children. SUBJECTS AND METHODS The study included children on whom colonoscopy was performed between January 2015 and May 2018 (n = 361). Demographics, treatment modalities, and outcomes of the patients with LNH were recorded. RESULTS LNH was found in 66 patients (18.3%; mean age 8.6 ± 5.96 years, 59.1% male). We found that the etiologic factors were food hypersensitivity (FH) in 25 (37.8%), nonspecific colitis in 12 (18.2%), irritable bowel syndrome in 10 (15.2%), familial Mediter-ranean fever in 7 (10.6%), primary immunodeficiency in 4 (6.1%), and intestinal dysmotility, oxyuriasis, Crohn's disease, and giardiasis in 1 (1.5%) patient. Additionally, in the genetic analysis of patients with idiopathic LNH (n = 4), we detected heterozygote MEFV mutations in all. Cow's milk and egg (25%) were the most common allergens in patients with FH. Symptoms of all patients (n = 25) improved after an elimination diet. CONCLUSIONS LNH is a common finding in pediatric colonoscopies with a variety of etiologies ranging from FH and familial Mediterranean fever to immunodeficiency.
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Affiliation(s)
- Murat Cakir
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey,
| | - Elif Sag
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Ismail Saygin
- Department of Pathology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Fazil Orhan
- Department of Pediatric Allergy and Immunology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
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10
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García-Carrasco M, Mendoza-Pinto C, Munguía-Realpozo P, Méndez-Valderrabano F, Méndez Martínez S, Etchegaray Morales I, Montiel-Jarquín Á, López-Colombo A, Schmulson M. Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case-control study. Neurogastroenterol Motil 2019; 31:e13693. [PMID: 31373090 DOI: 10.1111/nmo.13693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls. METHODS Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs. KEY RESULTS Responders included 113 SLE patients and 122 age-matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7-19.1) globus (3.5, 1.3-9.3), anorectal pain (3.4, 1.4-8.4), and FH (2.5, 1.5-4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3-19.9) and non-steroidal anti-inflammatory drugs (NSAIDs; 3.0, 1.1-8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1-47.3). CONCLUSIONS AND INFERENCES Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.
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Affiliation(s)
- Mario García-Carrasco
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México.,Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, IMSS, Puebla, México.,Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México.,Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, IMSS, Puebla, México.,Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Fabiola Méndez-Valderrabano
- Systemic Autoimmune Diseases Research Unit, Hospital de Especialidades, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Socorro Méndez Martínez
- Research in Health Coordination, Puebla Delegation, Instituto Mexicano del Seguro Social, Puebla, México
| | - Ivet Etchegaray Morales
- Immunology and Rheumatology, Medicine School, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Álvaro Montiel-Jarquín
- Division of Health Research, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Aurelio López-Colombo
- State Research and Education Department, UMAE Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla, México
| | - Max Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina-Universidad Nacional Autónoma de México (UNAM)-Hospital General de México, Dr. Eduardo Liceaga., Mexico City, México
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11
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Santos-Vigil KI, Ilhuicatzi-Alvarado D, García-Hernández AL, Herrera-García JS, Moreno-Fierros L. Study of the allergenic potential of Bacillus thuringiensis Cry1Ac toxin following intra-gastric administration in a murine model of food-allergy. Int Immunopharmacol 2018; 61:185-196. [DOI: 10.1016/j.intimp.2018.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023]
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