1
|
Dilaghi E, Felici E, Lahner E, Pilozzi E, Furio S, Lucchini L, Quatrale G, Piccirillo M, Parisi P, Curto S, Annibale B, Ferretti A, Mennini M, Persechino S, Di Nardo G. Helicobacter Pylori infection in children with inflammatory bowel disease: a prospective multicenter study. BMC Pediatr 2024; 24:417. [PMID: 38951792 PMCID: PMC11218114 DOI: 10.1186/s12887-024-04902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND The relationship between Helicobacter-pylori(Hp)infection and inflammatory-bowel-disease(IBD) in pediatric-patients remains controversial. We aimed to assess the Hp-infection occurrence in newly-diagnosed pediatric-patients with IBD compared to no-IBD patients. Additionally, we aimed to examine differences in clinical-activity-index(CAI) and endoscopic-severity-score(ESS)between IBD-patients with and without Hp-infection, at baseline and at 1-year-follow-up(FU), after eradication-therapy(ET). METHODS IBD diagnosis was based on Porto-criteria, and all patients underwent gastroscopy at baseline and 1-year FU. For Crohn's-disease(CD) and ulcerative colitis(UC), IBD-CAI and -ESS were classified using PCDAI/SES-CD and PUCAI/UCEIS, respectively. RESULTS 76 IBD-patients were included in the study[35 F(46.1%),median-age 12(range 2-17)]. CD and UC were diagnosed in 29(38.2%) and 45(59.2%)patients, respectively, and unclassified-IBD in two(2.6%)patients. Non-IBD patients were 148[71 F(48.0%),median-age 12(range 1-17)]. Hp-infection at baseline was reported in 7(9.2%) and 18(12.2%)IBD and non-IBD patients, respectively(p = 0.5065). The 7 IBD patients with Hp infection were compared to 69 IBD patients without Hp-infection at baseline evaluation, and no significant differences were reported considering CAI and ESS in these two groups. At 1-year FU, after ET, IBD patients with Hp infection improved, both for CAI and ESS, but statistical significance was not reached. CONCLUSION The occurrence of Hp-infection did not differ between IBD and no-IBD patients. No differences in CAI or ESS were observed at the diagnosis, and after ET no worsening of CAI or ESS was noted at one-year FU, between Hp-positive and -negative IBD patients.
Collapse
Affiliation(s)
- Emanuele Dilaghi
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio E Biagio E C. Arrigo, Alessandria, Italy
| | - Edith Lahner
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Emanuela Pilozzi
- Department of Clinical and Molecular Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Silvia Furio
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Livia Lucchini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Giovanna Quatrale
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Marisa Piccirillo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Pasquale Parisi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Sara Curto
- Pediatric and Pediatric Emergency Unit, Children Hospital, AO SS Antonio E Biagio E C. Arrigo, Alessandria, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandro Ferretti
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Maurizio Mennini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Severino Persechino
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy
| | - Giovanni Di Nardo
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University of Rome, Pediatric Unit, Sant'Andrea University Hospital, Via Grottarossa 1035, Rome, 00189, Italy.
| |
Collapse
|
2
|
Gao W, Xu Y, Liu J, Wang X, Dong X, Teng G, Liu B, Dong J, Ge C, Ye H, Zhang X, Cheng H. A real-world exploratory study on the feasibility of vonoprazan and tetracycline dual therapy for the treatment of Helicobacter pylori infection in special populations with penicillin allergy or failed in previous amoxicillin-containing therapies. Helicobacter 2023; 28:e12947. [PMID: 36650673 DOI: 10.1111/hel.12947] [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: 10/17/2022] [Revised: 12/05/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The treatment of Helicobacter pylori (H. pylori) infection is a challenge for those who cannot use amoxicillin. OBJECTIVE To evaluate the eradication rate and adverse effects of vonoprazan and tetracycline dual therapy as first-line and rescue treatment regimens used in special populations with penicillin allergy or failed in previous amoxicillin-containing therapies. DESIGN Patients enrolled were those who were H. pylori-positive with selected conditions: (1) allergic to penicillin, either naïve to treatment or had failed before; or (2) failed in previous amoxicillin-containing therapies. All enrolled patients accepted 14-day vonoprazan and tetracycline dual therapy (VT dual therapy) as follows: vonoprazan (20 mg b.i.d.) and tetracycline (500 mg t.i.d. [body weight < 70 kg] or 500 mg q.i.d. [body weight ≥ 70 kg]). H. pylori status was evaluated by 13 C-urease breath test 6 weeks after treatment. All adverse effects were recorded. Some patients underwent bacterial culture and antibiotic susceptibility testing. RESULTS A total of 62 patients were enrolled; 18 of them received VT dual therapy as first-line treatment, 44 patients received VT dual therapy as rescue treatment. Overall, 58 of 62 patients achieved successful eradication (93.5%), while all involved (100%,18/18) succeeded in the first-line treatment group and 40 cases (90.9%, 40/44) succeeded in the rescue treatment group. Sixty-one (61/62, 98.4%) patients completed the whole course of treatment. Adverse events occurred in 6 patients (6/62, 9.7%), while one patient quit because of skin rash. All adverse effects were mild and relieved spontaneously after H. pylori treatment. Five patients achieved successful H. pylori culture, and all strains isolated were sensitive to tetracycline. CONCLUSIONS For the treatment of H. pylori infection in special populations with penicillin allergy or failed in previous amoxicillin-containing therapies, a 14-day vonoprazan and tetracycline dual therapy was effective and safe as first-line and rescue treatment in our study. Further study is warranted to verify its efficacy, especially for those who cannot use amoxicillin.
Collapse
Affiliation(s)
- Wen Gao
- GI Department, Peking University First Hospital, Beijing, China
| | - Ying Xu
- GI Department, Peking University First Hospital, Beijing, China
| | - Jianxiang Liu
- GI Department, Peking University First Hospital, Beijing, China
| | - Xiaolei Wang
- GI Department, Peking University First Hospital, Beijing, China
| | - Xinhong Dong
- GI Department, Peking University First Hospital, Beijing, China
| | - Guigen Teng
- GI Department, Peking University First Hospital, Beijing, China
| | - Binbin Liu
- GI Department, Peking University First Hospital, Beijing, China
| | - Jinpei Dong
- GI Department, Peking University First Hospital, Beijing, China
| | - Chaoyi Ge
- GI Department, Peking University First Hospital, Beijing, China
| | - Hui Ye
- TCM and Integrative Medicine Department, Peking University First Hospital, Beijing, China
| | - Xuezhi Zhang
- TCM and Integrative Medicine Department, Peking University First Hospital, Beijing, China
| | - Hong Cheng
- GI Department, Peking University First Hospital, Beijing, China
| |
Collapse
|
3
|
Ali I, Abdo Q, Al-Hihi SM, Shawabkeh A. Association between ulcerative colitis and Helicobacter pylori infection: A case-control study. Heliyon 2022; 8:e08930. [PMID: 35198786 PMCID: PMC8841358 DOI: 10.1016/j.heliyon.2022.e08930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 02/07/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Ulcerative Colitis (UC), a type of inflammatory bowel disease (IBD), is defined as chronic inflammation of the superficial mucosal layer of the large intestine. In this study, we aimed to investigate the association between Helicobacter pylori (H. pylori) colonization, and UC in Palestine. Methods A total of 35 Palestinian patients of UC and 105 age-matched and gender-matched controls were retrospectively studied for a period of one year. Diagnosis of ulcerative colitis was based on both colonoscopy and biopsy. The presence of H. pylori in the stomach was evaluated by the H. pylori stool antigen test (HpSA). An interview-based data collection form was filled for all patients with UC before starting the test. Results The overall positivity of H. pylori infection in patients with UC was 14.3%, significantly lower than the control group, 41.9% (odds ratios (OR) = 0.23, 95% confidence intervals (CI): 0.083–0.643, P-value = 0.003). Interestingly, the presence of H. pylori showed no correlation with the extension of UC (P-value = 0.44). Moreover, there were no relationships between the presence of H. pylori and age (P-value = 0.97), gender (P-value = 0.26), smoking (P-value = 0.08), and medication regimen (P-value = 0.80). Conclusion The rate of H. pylori infection was significantly lower in patients with UC compared with the control group suggesting a protective role of H. pylori against the occurrence of UC.
Collapse
|
4
|
Chiba M, Tsuji T, Ohno H, Komatsu M. Stepwise Treatment With Plant-Based Diet and Medication for Patient With Mild Ulcerative Colitis. Perm J 2021; 25. [PMID: 35348099 DOI: 10.7812/tpp/21.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We regard inflammatory bowel disease as a lifestyle disease mainly mediated by a westernized diet. We developed a plant-based diet (PBD) to counter the westernized diet. PBD can induce remission without medication in a subset of mild cases of ulcerative colitis. Medication is provided when induction of remission is not achieved solely with PBD. We describe such a case in this report. CASE PRESENTATION A 34-year-old woman visited us in October 2016 with a complaint of loose stool for nearly 5 years. Laboratory examination revealed mild abnormalities including elevation of C-reactive protein (CRP). Ulcerative colitis was diagnosed due to diffuse colonic inflammation and pathological findings consistent with ulcerative colitis. She was admitted for educational hospitalization for 19 days in the middle of November, during which PBD was provided. A few days after admission, her stool became normal. CRP concentration decreased to within the normal range. However, colonoscopy on discharge showed minimum improvement. Thereafter, CRP was abnormal on three successive occasions, and her stool alternated between normal and loose. Sulfasalazine was initiated at the end of March 2017. Thereafter, her stool was normally formed, and CRP decreased to normal. Endoscopic remission was confirmed in August. Her PBD score, which evaluates adherence to PBD, was 8 before admission, and 37 and 16 at 7 and 21 months after discharge, respectively. CONCLUSION Medication was administered when restoration of a healthy dietary lifestyle was insufficient to induce remission. Our stepwise treatment makes the shift from one-size-fits-all medication toward medication to the right patient. REGISTRATION http://www.umin.ac.jp UMIN000019061.
Collapse
Affiliation(s)
- Mitsuro Chiba
- Division of Gastroenterology, Akita City Hospital, Akita City, Japan
| | - Tsuyotoshi Tsuji
- Division of Gastroenterology, Akita City Hospital, Akita City, Japan
| | - Hideo Ohno
- Division of Gastroenterology, Akita City Hospital, Akita City, Japan
| | - Masafumi Komatsu
- Division of Gastroenterology, Akita City Hospital, Akita City, Japan
| |
Collapse
|
5
|
Fujita Y, Tominaga K, Tanaka T, Sugaya T, Yoshihara S. Ulcerative colitis relapse after Helicobacter pylori eradication in a 12-year-old boy with duodenal ulcer. BMC Gastroenterol 2021; 21:424. [PMID: 34758726 PMCID: PMC8579552 DOI: 10.1186/s12876-021-02010-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) prevalence is lower in patients with inflammatory bowel disease (IBD) than in those without IBD, suggesting that H. pylori plays a protective role in IBD. It has been reported that IBD may occur due to H. pylori eradication; however, it is unclear whether H. pylori eradication increases the incidence of IBD. Moreover, the effect of H. pylori eradication on IBD activity is unclear. Case presentation An 11-year-old boy diagnosed with ulcerative colitis (UC) was in clinical remission, with treatment involving 5-aminosalicylic acid. Fecal calprotectin (FC) level had decreased to 33.2 mg/kg, indicating mucosal healing. At age 12, he experienced epigastric pain on an empty stomach, which was relieved with dietary intake. His FC level was elevated without UC symptoms, such as diarrhea and bloody stools. He was diagnosed with H. pylori duodenal ulcer. H. pylori eradication (clarithromycin and amoxicillin for 7 days and a proton-pump inhibitor) led to symptom improvement the day after treatment initiation. However, he developed diarrhea and his FC level remained high despite improvement in duodenal ulcer symptoms and endoscopic findings of H. pylori eradication. Colonoscopy results indicated UC relapse. Conclusions H. pylori eradication may worsen UC activity. However, further studies are required as this case report involved only one pediatric patient with increased UC activity after H. pylori eradication.
Collapse
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| |
Collapse
|
6
|
Homolak J, Nikolić M, Potoč D, Živković M, Bakula D, Budimir I, Pavić I, Hrabar D, Ljubičić N, Vražić D. The onset of ulcerative colitis upon Helicobacter pylori eradication in a 72-year-old woman: report of a rare case with a 3-year follow-up. BMC Gastroenterol 2021; 21:303. [PMID: 34332529 PMCID: PMC8325205 DOI: 10.1186/s12876-021-01876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological studies suggest an inverse association between H. pylori infection/exposure and inflammatory bowel disease prevalence/incidence, however, there are no reports of individual patients who developed a "non-transient" ulcerative colitis (UC) following H. pylori eradication. CASE PRESENTATION We report a case of a 72-year-old female with an elderly-onset UC developed upon H. pylori eradication and a 3-year follow-up of the progression to steroid-dependent colitis complicated with enteropathic arthritis and final containment of the disease with golimumab. In our patient, H. pylori eradication was associated with the development of pancolitis that evolved into clinically, endoscopically, and pathohistologically confirmed UC. CONCLUSIONS The case of our patient provides a unique clinical context for a growing body of literature suggesting molecular mechanisms involved in the interaction of genes, environment, and microbiota to be of critical importance in the etiopathogenesis of UC, and thus, provides a valuable set of complementary translational information for preclinical and epidemiological research on the topic.
Collapse
Affiliation(s)
- J Homolak
- Department of Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Nikolić
- Gastroenterology and Hepatology Unit, University Hospital Centre "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia. .,University of Zagreb School of Dental Medicine, Zagreb, Croatia.
| | - D Potoč
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - M Živković
- Gastroenterology and Hepatology Unit, University Hospital Centre "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia
| | - D Bakula
- Gastroenterology and Hepatology Unit, University Hospital Centre "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia
| | - I Budimir
- Gastroenterology and Hepatology Unit, University Hospital Centre "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Zagreb, Croatia
| | - I Pavić
- Department of Pathology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - D Hrabar
- Gastroenterology and Hepatology Unit, University Hospital Centre "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Ljubičić
- Gastroenterology and Hepatology Unit, University Hospital Centre "Sestre Milosrdnice", Vinogradska 29, 10000, Zagreb, Croatia.,University of Zagreb School of Dental Medicine, Zagreb, Croatia.,University of Zagreb School of Medicine, Zagreb, Croatia
| | - D Vražić
- Department of Periodontology, University of Zagreb School of Dental Medicine, Zagreb, Croatia
| |
Collapse
|
7
|
Chiba M, Tsuji T, Nakane K, Tsuda S, Ishii H, Ohno H, Watanabe K, Ito M, Komatsu M, Sugawara T. Induction with Infliximab and a Plant-Based Diet as First-Line (IPF) Therapy for Crohn Disease: A Single-Group Trial. Perm J 2018; 21:17-009. [PMID: 29035182 DOI: 10.7812/tpp/17-009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately 30% of patients with Crohn disease (CD) are unresponsive to biologics. No previous study has focused on a plant-based diet in an induction phase of CD treatment. OBJECTIVE To investigate the remission rate of infliximab combined with a plant-based diet as first-line (IPF) therapy for CD. METHODS This was a prospective single-group trial conducted at tertiary hospitals. Subjects included consecutive adults with a new diagnosis (n = 26), children with a new diagnosis (n = 11), and relapsing adults (n = 9) with CD who were naïve to treatment with biologics. Patients were admitted and administered a standard induction therapy with infliximab (5 mg/kg; 3 infusions at 0, 2, and 6 weeks). Additionally, they received a lacto-ovo-semivegetarian diet. The primary end point was remission, defined as the disappearance of active CD symptoms at week 6. Secondary end points were Crohn Disease Activity Index (CDAI) score, C-reactive protein (CRP) concentration, and mucosal healing. RESULTS Two adults with a new diagnosis were withdrawn from the treatment protocol because of intestinal obstruction. The remission rates by the intention-to-treat and per-protocol analyses were 96% (44/46) and 100% (44/44), respectively. Mean CDAI score (314) on admission decreased to 63 at week 6 (p < 0.0001). Mean CRP level on admission (5.3 mg/dL) decreased to 0.2 (p < 0.0001). Mucosal healing was achieved in 46% (19/41) of cases. CONCLUSION IPF therapy can induce remission in most patients with CD who are naïve to biologics regardless of age or whether they have a new diagnosis or relapse.
Collapse
Affiliation(s)
- Mitsuro Chiba
- Chief of the Inflammatory Bowel Disease Section at Akita City Hospital in Japan.
| | - Tsuyotoshi Tsuji
- Chief of the Gastrointestinal Endoscopy Section at Akita City Hospital in Japan.
| | - Kunio Nakane
- Chief of the Gastroenterology Division at Akita City Hospital in Japan.
| | - Satoko Tsuda
- Gastroenterologist at Akita City Hospital in Japan.
| | - Hajime Ishii
- Gastroenterologist at Akita City Hospital in Japan.
| | - Hideo Ohno
- Gastroenterologist at Akita City Hospital in Japan.
| | | | - Mai Ito
- Gastroenterologist at Akita City Hospital in Japan.
| | - Masafumi Komatsu
- Gastroenterologist and the Director of Akita City Hospital, in Japan.
| | | |
Collapse
|
8
|
Zhang H, Dai Y, Liu Y, Wu T, Li J, Wang X, Wang W. Helicobacter pylori Colonization Protects Against Chronic Experimental Colitis by Regulating Th17/Treg Balance. Inflamm Bowel Dis 2018; 24:1481-1492. [PMID: 29788098 DOI: 10.1093/ibd/izy107] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Epidemiological studies have demonstrated an inverse association between Helicobacter pylori infection and the risk of developing inflammatory bowel disease (IBD). The mechanisms by which H. pylori infection protects against IBD are unclear. Here, we explored the possible protective effects and mechanisms of gastric H. pylori colonization on a chronic colitis model, with focus on whether H. pylori exerted its effects through regulating Th17/Treg immune responses. METHODS Chronic colitis was induced by dextran sulfate sodium (DSS) treatment. Flow cytometry analysis was performed to determine Th17 cells, Treg cells, and M1/M2 macrophages in the spleen, mesenteric lymph nodes, and colonic lamina propria. The levels of Th17- and Treg-associated cytokines were measured by quantitative polymerase chain reaction. The direct effect of H. pylori extract on the polarization status of macrophages was determined in vitro. RESULTS Gastric H. pylori colonization significantly ameliorated the severity of chronic DSS-induced colitis. H. pylori colonization decreased Th17 cells and mRNA levels of IL-17A, IL-17F, and IL-21 in the colon. Simultaneously, H. pylori colonization increased Treg cells and IL-10 expression. As to cytokines driving Th17 and Treg differentiation, H. pylori colonization increased TGFβ and decreased IL-6 and IL-23. Moreover, H. pylori colonization significantly increased M2 macrophages in the colon. In vitro, H. pylori extract promotion of M2 macrophage polarization was dependent on the presence of CagA. CONCLUSIONS H. pylori colonization protects against chronic DSS-induced colitis via balancing Th17/Treg responses and shifting macrophages toward anti-inflammatory M2 phenotype. Our results strengthen the rationale for gastric H. pylori colonization affecting the immune homeostasis of the colon.
Collapse
Affiliation(s)
- Hongchen Zhang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Yun Dai
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Yun Liu
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Ting Wu
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Jing Li
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Xiaolei Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| | - Weihong Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing, China
| |
Collapse
|
9
|
Zhao HY, Yang GT, Sun NN, Kong Y, Liu YF. Efficacy and safety of stellate ganglion block in chronic ulcerative colitis. World J Gastroenterol 2017; 23:533-539. [PMID: 28210090 PMCID: PMC5291859 DOI: 10.3748/wjg.v23.i3.533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/18/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy and safety of stellate ganglion block for the treatment of patients with chronic ulcerative colitis.
METHODS A total of 120 randomly selected patients with chronic ulcerative colitis treated in Cangzhou Central Hospital from January 2014 to January 2016 were included in this study. These patients were divided into two groups: control group (n = 30), patients received oral sulfasalazine treatment; experimental group (n = 90), patients received stellate ganglion block treatment. Clinical symptoms and disease activity in these two groups were compared before and after treatment using endoscopy. Blood was collected from patients on day 0, 10, 20 and 30 after treatment. Enzyme-linked immunosorbent assay was performed to determine interleukin-8 (IL-8) level. The changes in IL-8 level post-treatment in the two groups were compared using repeated measures analysis of variance.
RESULTS After treatment, clinical symptoms and disease activity were shown to be alleviated by endoscopy in both the control and experimental groups. However, patients in the control group did not have obvious abdominal pain relief. In addition, the degree of pain relief in the experimental group was statistically better than that in the control group (P < 0.05). Ten days after treatment, IL-8 level was found to be significantly lower in the experimental group than in the control group, and the difference was statistically significant (P < 0.05). In addition, adverse events were significantly higher in the control group than in the experimental group, and the difference was statistically significant (χ2 = 33.215, P = 0.000).
CONCLUSION The application of stellate ganglion block effectively improves treatment efficacy in chronic ulcerative colitis, relieves clinical symptoms in patients, and reduces the level of inflammatory factors. Furthermore, this approach also had a positive impact on the disease to a certain extent.
Collapse
|