Mapping of aetiologies and clinical presentation of acute colitis: Results from a prospective cohort study in a tertiary centre

Objective

Our objective was to describe the aetiologies of acute colitis and to identify patients who require diagnostic endoscopy.

Methods

Patients with symptoms of gastrointestinal infection and colonic inflammation on computed tomography were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD) were excluded. Stools were screened with BD-Max and BioFire FilmArray GI panel. Faecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. The study was registered into clinicaltrials.gov (NCT02709213).

Results

One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp (n = 57, 55.3%), Escherichia coli spp (n = 8, 7.8%), Clostridium difficile (n = 23, 22.3%), Salmonella spp (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and others (n = 4, 3.9%). Eighty-six patients underwent colonoscopy, which was compatible with ischemic colitis in 18 patients (10.1%) and IBD in 4 patients (2.2%). Among patients with negative FilmArray, a faecal calprotectin >625μg/g allowed identifying patients with IBD with an area under ROC curve of 85.1%. Introduction of a diagnostic management algorithm including FilmArray and faecal calprotectin could allow decreasing unnecessary colonoscopies from 82 to 29 (corresponding to a decrease of 64.6%).

Conclusion

Computed tomography-proven colitis was mostly of infectious aetiology. Diagnostic management of patients with acute colitis should include broad molecular testing of the stools and, in patients with a calprotectin concentration >625μg/g, colonoscopy to exclude IBD.

Maternal metabolic syndrome induces liver injury and promotes tumor growth in the offspring

Objective

Obesity is a growing disease entity affecting a third of women of reproductive age. Epidemiological studies show that children of obese mothers suffer from obesity, long-term morbidity and an increased rate of childhood cancers. However, the mechanisms of disease transmission remain unknown. The aim of this study is to test this hypothesis in a mouse model and shed light on the involved mechanisms of vertical transmission.

Methods

Female mice were fed a high fat or standard diet (HFD/SD) for 16 weeks before being mated with mice fed a normal diet. Corresponding diet was continued until weaning, all offspring were thereafter fed a SD. Metabolic profile, weight gain, liver enzymes and the gut microbiota profile were assessed in the offspring (n = 24). Additional groups of offspring (n = 48) were injected with a carcinogen (diethylnitrosamine) at week two, tumor characteristics were assessed by computed tomography scan at week 36.

Results

Mothers fed HFD developed obesity and non-alcoholic fatty liver disease (NAFLD). Female offspring of mothers fed HFD gained significantly more weight (+33.7%, p = 0.001), had increased alanine transaminase levels (62 vs 18 IU/L, p = 0.003) and a significantly altered liver histology exemplified by an increased NAFLD activity score (3.8 vs 0.6, p = 0.016). Expression levels of several candidate genes were studied of which FGF21 showed the largest differential expression between HFD and SD offspring (9 vs 1 2^ΔΔCT, p = <0.001). However, epigenetic analysis of FGF21 in the liver revealed no changes in methylation level between HFD and SD offspring. Furthermore, offspring of HFD mothers had a distinctly altered gut microbiome with lower proportions of Bacteroides caccae, Bacteroidales and Parasutterella excrementihominis. Interestingly, the proportion of female offspring developing tumors was significantly higher in offspring of HFD mothers (83 vs 44%, p = 0.011), the average total tumor volume was larger (234 vs 3.5mm3, p = 0.022) and the offspring developed more tumors (3.5 vs 0.6, p = 0.010).

Conclusion

Maternal obesity promotes liver tumor growth in the offspring, alters metabolic patterns and induces liver suffering in the progeny in a sex-dependent manner. The gut microbiome seems to play a role in this transmission of disease. Yet further research is needed to determine the vectors of transmission and evaluate preventive interventions in obese mothers.