Asymptomatic small intestinal ulcerative lesions: Obesity and Helicobacter pylori are likely to be risk factors

Idiopathic terminal ileitis: myth or true entity?

PURPOSE OF REVIEW

Isolated terminal ileitis is an increasing phenomenon identified during colonoscopy. Idiopathic terminal ileitis (IDTI) is a diagnosis of exclusion, representing a significant challenge from a diagnostic and management point of view. This review provides an overview of the most recent and relevant evidence on idiopathic IDTI, focusing on its evolution, the natural history and the management strategies proposed in the literature.

RECENT FINDINGS

IDTI is uncommon, with a reported prevalence between 0.5 and 7%. The main differential is with Crohn's disease and intestinal tuberculosis in endemic countries. A proportion of patients (0-50%) can progress and develop Crohn's disease; however, there are no reliable predictive factors to stratify IDTI patients.

SUMMARY

IDTI is a challenging entity, with a small proportion of patients progressing to Crohn's disease over time thus requiring follow-up. Noninvasive modalities such as capsule endoscopy are useful for follow-up, but further research is required to better understand this entity.

DHA-enriched phosphatidylserine alleviates high fat diet-induced jejunum injury in mice by modulating gut microbiota

A long-term high-fat diet (HFD) is one of the high-risk factors for intestinal barrier damage. Docosahexaenoic acid-enriched phosphatidylserine (DHA-PS) has multiple biological activities, while its protective effect on HFD-caused jejunum injury remains unknown. Thus, the present study investigated the protective effect of DHA-PS on HFD-induced jejunum injury in mice. Our results showed that DHA-PS (100 mg per kg per d) could protect against HFD-caused jejunum injury by decreasing the levels of inflammatory factors such as interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α) in the serum and jejunum tissues, with histological analysis confirming this injury amelioration. Additionally, DHA-PS alleviated the HFD-caused oxidative stress by decreasing malondialdehyde (MDA) and increasing total antioxidant capacity (T-AOC), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) levels in the jejunum. Moreover, DHA-PS significantly increased the expression of tight junction proteins (ZO-1, occludin, and claudin-4) in the jejunum, and modulated the HFD-induced gut microbiota disorder by decreasing the Firmicutes and Bacteroidetes ratio, and reducing the relative abundance of Lachnoclostridium, Coriobacteriaceae, Desulfovibrionaceae, and Helicobacter, while increasing the relative abundance of Lachnospiraceae_NK4A136_group, Alistipes, norank_f__Muribaculaceae, and Bacteroides. Overall, these results support that DHA-PS can alleviate the HFD-caused jejunum injury.

Nonspecific ileitis: Impact of histopathology and gastrointestinal ultrasound in achieving the diagnosis of Crohn's disease

Background and Aim

Nonspecific ileitis is inflammation of the ileum without specific diagnostic features. A minority may go on to develop Crohn's disease, but optimal pathways of further investigation have not been established. This study aimed to identify a cohort of patients with nonspecific ileitis and to determine the value of ileal histology and gastrointestinal ultrasound in identifying/excluding Crohn's disease.

Patients and Methods

In a retrospective analysis, all patients having nonspecific ileitis at colonoscopy from January 2010 to August 2021 were identified. Clinical associations with those subsequently diagnosed with Crohn's disease were examined with specific reference to ileal histology and gastrointestinal ultrasound.

Results

Of 29 638 procedures, 147 patients (0.5%) had nonspecific ileitis. Crohn's disease was subsequently diagnosed in 8 patients (5.4%) at a median of 148 (range 27–603) days after colonoscopy. The presence of chronic inflammation on ileal biopsies was more common in those subsequently diagnosed with Crohn's disease (63% vs 20%; P = 0.0145). On gastrointestinal ultrasound, none of the 26 patients with normal bowel wall thickness (<3 mm) were subsequently diagnosed with Crohn's disease, and repeat ultrasound in 15 patients 1 year later showed no change. Of the nine patients with abnormal sonographic findings, three were diagnostic for Crohn's disease. Repeat ultrasound revealed Crohn's disease in two, while four had resolution of the abnormal findings.

Conclusion

Although ileal histology was of limited value in identifying patients with nonspecific ileitis who were subsequently diagnosed with Crohn's disease, gastrointestinal ultrasound was highly informative. Prospective studies are needed to confirm the value of gastrointestinal ultrasound as a diagnostic and monitoring tool in this setting.

Helicobacter pylori and Alzheimer's Disease-Related Metabolic Dysfunction: Activation of TLR4/Myd88 Inflammation Pathway from p53 Perspective and a Case Study of Low-Dose Radiation Intervention

Gut dysbiosis is observed in Alzheimer's disease (AD) and is frequently associated with AD-induced metabolic dysfunction. However, the extent and specific underlying molecular mechanisms triggered by alterations of gut microbiota composition and function mediating AD-induced metabolic dysfunction in AD remain incompletely uncovered. Here, we indicate that Helicobacter pylori (H. pylori) is abundant in AD patients with relative metabolic dysfunction. Fecal microbiota transplantation from the AD patients promoted metabolic dysfunction in mice and increased gut permeability. H. pylori increased gut permeability through activation of the TLR4/Myd88 inflammation pathway in a p53-dependent manner, leading to metabolic dysfunction. Moreover, p53 deficiency reduced bile acid concentration, leading to an increased abundance of H. pylori colonization. Overall, these data identify H. pylori as a key promoter of AD-induced metabolic dysfunction.

Comment “Asymptomatic small intestinal ulcerative lesions: Obesity and Helicobacter pylori are likely to be risk factors”

There are many causes of anemia. It is unreasonable to simply associate anemia with asymptomatic ulcers in the small intestine.