Intestinal Research

Original Article

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study: Antonio Tursi, Daniele Piovani, Giovanni Brandimarte, Francesco Di Mario, Walter Elisei, Marcello Picchio, Gisella Figlioli, Gabrio Bassotti, Leonardo Allegretta, Maria Laura Annunziata, Mauro Bafutto, Maria Antonia Bianco, Raffaele Colucci, Rita Conigliaro, Dan L. Dumitrascu, Ricardo Escalante, Luciano Ferrini, Giacomo Forti, Marilisa Franceschi, Maria Giovanna Graziani, Frank Lammert, Giovanni Latella, Daniele Lisi, Giovanni Maconi, Debora Compare, Gerardo Nardone, Lucia Camara de Castro Oliveira, Chaves Oliveira Enio, Savvas Papagrigoriadis, Anna Pietrzak, Stefano Pontone, Ieva Stundiene, Tomas Poškus, Giuseppe Pranzo, Matthias Christian Reichert, Stefano Rodino, Jaroslaw Regula, Giuseppe Scaccianoce, Franco Scaldaferri, Roberto Vassallo, Costantino Zampaletta, Angelo Zullo, Erasmo Spaziani, Stefanos Bonovas, Alfredo Papa, Silvio Danese, DICA International Group; Received March 22, 2024 Accepted May 8, 2024 Published online August 12, 2024; DOI: https://doi.org/10.5217/ir.2024.00046 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).
Methods
An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.
Results
Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]_constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04–1.27; P=0.004; and HR_diarrhea =1.14; 95% CI, 1.03–1.26; P=0.014, respectively).
Conclusions
In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

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Reviews

Miscellaneous

Involvement of the cannabinoid system in chronic inflammatory intestinal diseases: opportunities for new therapies: Priscila A. Lima, Bárbara B. Berg, Marina Gomes Miranda e Castor; Intest Res 2022;20(4):392-417. Published online May 31, 2022; DOI: https://doi.org/10.5217/ir.2021.00160

Abstract PDF PubReader ePub

The components of the endogenous cannabinoid system are widely expressed in the gastrointestinal tract contributing to local homeostasis. In general, cannabinoids exert inhibitory actions in the gastrointestinal tract, inducing anti-inflammatory, antiemetic, antisecretory, and antiproliferative effects. Therefore, cannabinoids are interesting pharmacological compounds for the treatment of several acute intestinal disorders, such as dysmotility, emesis, and abdominal pain. Likewise, the role of cannabinoids in the treatment of chronic intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, is also under investigation. Patients with chronic intestinal inflammatory diseases present impaired quality of life, and mental health issues are commonly associated with long-term chronic diseases. The complex pathophysiology of these diseases contributes to difficulties in diagnosis and, therefore, in the choice of a satisfactory treatment. Thus, this article reviews the involvement of the cannabinoid system in chronic inflammatory diseases that affect the gastrointestinal tract and highlights possible therapeutic approaches related to the use of cannabinoids.

Citations

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Cannabigerol as an anti-inflammatory agent altering the level of arachidonic acid derivatives in the colon tissue of rats subjected to a high-fat high-sucrose diet
Klaudia Sztolsztener, Ewa Harasim-Symbor, Adrian Chabowski, Karolina Konstantynowicz-Nowicka
Biomedicine & Pharmacotherapy.2024; 178: 117286. CrossRef
Pharmacohistory of Cannabis Use—A New Possibility in Future Drug Development for Gastrointestinal Diseases
Dinesh Thapa, Leon N. Warne, Marco Falasca
International Journal of Molecular Sciences.2023; 24(19): 14677. CrossRef

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IBD

Effect of resistance exercise training on Crohn’s disease patients: Konstantinos Papadimitriou; Intest Res 2021;19(3):275-281. Published online November 20, 2020; DOI: https://doi.org/10.5217/ir.2020.00043

Abstract PDF PubReader ePub

Crohn’s disease (CD) is observed with increased levels of cytokines which cause inflammation in many parts of the digestive tract. Aerobic exercise contributes to the reduction of the intestine’s inflammation and increases the quality of life. Another type of exercise that shows research interest about its effects on CD symptoms is the resistance exercise (RE). The aim of the study was to review the influence of RE on CD patients. The study’s literature was collected from PubMed and Scholar databases. According to the results, the main phase of a RE training program must have a gradual increase of intensity (60%–80%) and resting periods of 15–30 seconds after each exercise, and 2–3 minutes between exercises. Also, CD patients who were in remission improved the muscle strength and quality of life via their participation in RE training program. However, the secretion of interleukin-6 in both CD and RE contributes in various physiological mechanisms setting a contradictory role in the effectiveness of RE at the disease’s inflammatory situation. So, the use of RE training in CD patients needs more research for safer participation.

Citations

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Original Article

Inflammatory Bowel Diseases

Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn’s disease: Sanchit Sharma, Arti Gupta, Saurabh Kedia, Samagra Agarwal, Namrata Singh, Sandeep Goyal, Saransh Jain, Vipin Gupta, Pabitra Sahu, Sudheer Kumar Vuyyuru, Bhaskar Kante, Raju Sharma, Rajesh Panwar, Peush Sahni, Govind Makharia, Vineet Ahuja; Intest Res 2021;19(3):291-300. Published online May 26, 2020; DOI: https://doi.org/10.5217/ir.2019.09172

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Exclusive enteral nutrition (EEN), an established modality for pediatric Crohn’s disease (CD) is seldomly utilized in adults. The present study reports the outcome of EEN in adult CD patients at a tertiary care hospital in India.
Methods
This was a retrospective analysis of CD patients who received EEN as a sole modality/adjunct to other treatment. The primary and secondary outcomes changed in Crohn’s Disease Activity Index (CDAI), and clinical response (decline in CDAI > 70), respectively, at 4 and 8 weeks. Subgroup analysis evaluated response across different phenotypes, EEN formulations and prior treatment. Linear mixed effect model was created to assess the predictors of EEN response.
Results
Thirty-one CD patients received EEN over median duration of 4 weeks (range, 2–6 weeks). CDAI showed a significant improvement post EEN at 4 (baseline 290 [260–320] vs. 240 [180–280], P= 0.001) and 8 weeks (baseline 290 [260–320] vs. 186 [160–240], P= 0.001), respectively. The cumulative clinical response rates at 4 and 8 weeks were 37.3% and 80.4% respectively. The clinical response rates at 8 weeks across B1 (n = 4), B2 (n = 18) and B3 (n = 9) phenotypes were 50%, 78.8% and 100% respectively (log-rank test, P= 0.093). The response rates at 8 weeks with polymeric (n = 8) and semi-elemental diet (n = 23) were 75% and 82.6%% respectively (log-rank test, P= 0.49). Baseline CDAI (odds ratio, 1.008; 95% confidence interval, 1.002–1.017; P= 0.046) predicted response to EEN.
Conclusions
EEN was effective in inducing clinical response across different phenotypes of CD. Baseline disease activity remained the most important predictor of clinical response to EEN.

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Focused Review: Colorectal Cancer

Colorectal neoplasia

Intestinal microbiota, chronic inflammation, and colorectal cancer: Chan Hyuk Park, Chang Soo Eun, Dong Soo Han; Intest Res 2018;16(3):338-345. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.338

Abstract PDF PubReader ePub

In addition to genetic and epigenetic factors, various environmental factors, including diet, play important roles in the development of colorectal cancer (CRC). Recently, there is increasing interest in the intestinal microbiota as an environmental risk factor for CRC, because diet also influences the composition of the intestinal microbiota. The human intestinal microbiota comprises about 100 trillion microbes. This microbiome thrives on undigested dietary residues in the intestinal lumen and produces various metabolites. It is well known that the dietary risk factors for CRC are mediated by dysbiosis of the intestinal microbiota and their metabolites. In this review, we describe the bacterial taxa associated with CRC, including Fusobacterium nucleatum, enterotoxigenic Bacteroides fragilis, Escherichia coli, and butyrate-producing bacteria. We also discuss the host-diet interaction in colorectal carcinogenesis.

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Original Article

High C-reactive protein level is associated with high-risk adenoma: Hyae Min Lee, Jae Myung Cha, Jung Lok Lee, Jung Won Jeon, Hyun Phil Shin, Kwang Ro Joo, Jin Young Yoon, Joung Il Lee; Intest Res 2017;15(4):511-517. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.511

Abstract PDF PubReader ePub

Background/Aims

There is substantial evidence supporting a role of inflammation in the pathogenesis of colorectal cancer; however, little is known about the association between serum C-reactive protein (CRP) and the risk of colorectal adenoma. This study was conducted to investigate the association between serum CRP and colorectal adenoma risk.

Methods

A retrospective cross-sectional study was performed on first-time screening colonoscopies in asymptomatic subjects who also had their serum CRP level measured during a routine health check-up between September 2006 and September 2009 in Korea. Serum CRP level was compared between high-risk and low-risk adenoma groups and independent predictors of high-risk adenoma were analyzed using multivariate regression analysis.

Results

Among the 3,309 eligible patients, the high-risk adenoma group had higher serum CRP levels than the low-risk adenoma group (P=0.000). In addition, patients with a high-risk adenoma were more frequently included in the high CRP group than in the low CRP group (8.6% vs. 4.0%, P<0.001). The prevalence of high-risk adenoma was 3.5 times higher in the highest quartile of CRP level (P=0.000) compared with that in the lowest quartile. In logistic regression analysis, a higher quartile CRP level was found to be an independent risk factor for high-risk adenoma (odds ratio, 1.8; 95% confidence interval, 1.3–2.5; P=0.000).

Conclusions

High CRP level is associated with high-risk adenoma in both men and women. Our data may support the association between chronic inflammation and colorectal neoplasia, which warrants further investigation.

Citations

Citations to this article as recorded by

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Systematic Review

Histological inflammation increases the risk of colorectal neoplasia in ulcerative colitis: a systematic review: Ruben J. Colman, David T. Rubin; Intest Res 2016;14(3):202-210. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.202

Abstract PDF PubReader ePub

Background/Aims

Ulcerative colitis (UC) patients are at greater risk for the development of colorectal neoplasia. Several individual studies have demonstrated associations between severity of histologic inflammation and colorectal neoplasia. However, a comprehensive systematic review has not been completed. We performed a systematic review and meta-analysis to explore the relationship between histologic inflammation and risk for neoplasia among available observational studies.

Methods

Three databases (EMBASE, MEDLINE and the Cochrane Library) were systematically searched. Studies were included if they included UC patients who underwent colonoscopic assessment and when histologic inflammation and colorectal neoplasia were both reported. Colorectal neoplasia rates were compared. Quantitative meta-analysis was attempted.

Results

Four of 1,422 records found were eligible. Results from 2 case-control studies reported a 3.5-fold increased risk for colorectal neoplasia associated with a single point increase in histologic inflammation. This result was further corroborated by one cohort study that demonstrated increased hazard ratios. The second cohort study reported outcomes for patients with normal gross endoscopy, but had increased histological inflammation when neoplasia was assessed. Finally, this study reported increased risk for neoplastic progression by histological inflammation among patients who were normal by gross endoscopic evaluation. Quantitative meta-analysis was unsuccessful due to heterogeneity between study measures.

Conclusions

There is strong evidence that histologic inflammation among patients with UC increases the risk of colorectal neoplasia. The depth and nature of assessment of additional clinical variables was varied and may have resulted in greater outcome discrepancy. Additional study related to mechanisms of inflammation-related neoplasia and therapeutic modification is needed.

Citations

Citations to this article as recorded by

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