Bloody Stool Research Articles

Multi-Omics Analysis of Gut Microbiota and Host Transcriptomics Reveal Dysregulated Immune Response and Metabolism in Young Adults with Irritable Bowel Syndrome.

The integrated dysbiosis of gut microbiota and altered host transcriptomics in irritable bowel syndrome (IBS) is yet to be known. This study investigated the associations among gut microbiota and host transcriptomics in young adults with IBS. Stool and peripheral blood samples from 20 IBS subjects and 21 healthy controls (HCs) collected at the baseline visit of an RCT were sequenced to depict the gut microbiota and transcriptomic profiles, respectively. The diversities, composition, and predicted metabolic pathways of gut microbiota significantly differed between IBS subjects and HCs. Nine genera were significantly abundant in IBS stool samples, including Akkermansia, Blautia, Coprococcus, Granulicatella, Holdemania, Oribacterium, Oscillospira, Parabacteroides, and Sutterella. There were 2264 DEGs found between IBS subjects and HCs; 768 were upregulated, and 1496 were downregulated in IBS participants compared with HCs. The enriched gene ontology included the immune system process and immune response. The pathway of antigen processing and presentation (hsa04612) in gut microbiota was also significantly different in the RNA-seq data. Akkermansia, Blautia, Holdemania, and Sutterella were significantly correlated with ANXA2P2 (upregulated, positive correlations), PCSK1N (downregulated, negative correlations), and GLTPD2 (downregulated, negative correlations). This study identified the dysregulated immune response and metabolism in IBS participants revealed by the altered gut microbiota and transcriptomic profiles.

Sophora japonica Extract Inhibits Ulcerative Colitis and Colitis-Associated Colon Cancer via Regulation of Lipid Metabolism

Inflammation is a well-known risk factor for tumor development. Intervening in chronic inflammation may be an effective approach to inhibit the progression of ulcerative colitis (UC) to colitis-associated colon cancer (CAC). Sophora japonica is a medicinal and food plant commonly used to treat hemorrhoids, bleeding, and inflammation, symptoms that coincide with those of patients with CAC. However, studies on using Sophora japonica to treat CAC are scarce. Therefore, this study aimed to investigate the anti-inflammatory and antitumor effects of Sophora japonica extract (SJE) using dextran sodium sulfate (DSS)-induced UC and azoxymethane (AOM)/DSS-induced CAC models. Furthermore, we employed ultraperformance liquid chromatography–quadrupole time-of-flight–tandem mass spectrometry (UPLC–QTOF–MS/MS) technology to explore the metabolomics mechanism through which SJE inhibited the progression of UC to CAC. The results demonstrated that SJE significantly inhibited UC and CAC and alleviated symptoms such as bloody stools, colon shortening, inflammation, and intestinal tissue damage in model mice. Further, 57 differential metabolites were identified by UPLC–QTOF–MS/MS, which were composed mainly of lipids (fatty acids, glycerophospholipids, sterol lipids, pregnenolone lipids, etc.) and peptides (amino acids). Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis suggested that SJE might inhibit the progression of UC to CAC by regulating lipid metabolic pathways such as arachidonic acid metabolism, primary bile acid biosynthesis, and linoleic acid metabolism. This study, for the first time, substantiated the inhibitory effect of SJE on CAC. Employing metabolomics techniques, the research delved into the potential pathways through which SJE may exert its inhibitory effects on CAC by suppressing the progression of UC. These findings contribute scientific evidence to the application of Sophora japonica in functional foods and the development of natural drugs for the prevention and treatment of UC and CAC.

Non-traumatic gallbladder hemorrhage with shock in Asia: A case report

Gallbladder hemorrhage, rare due to trauma, iatrogenic factors, or conditions like liver/kidney dysfunction or cancer, presents with symptoms such as right upper abdominal pain and fever. In severe cases, gallbladder blood may enter the gastrointestinal tract, causing melena or hematemesis, necessitating surgical intervention. Delay can lead to life-threatening hemorrhagic shock. Diagnosing in the emergency room is challenging, with delayed recognition risking severe outcomes. Ultrasound is vital for diagnosis. A 64-year-old female presented with three days of epigastric pain and nausea, denying trauma, fever, respiratory or chest symptoms. Unstable vital signs were noted. Blood tests showed no abnormalities; ultrasound revealed a distended gallbladder without stones. Post-cholecystectomy confirmed acute hemorrhagic cholecystitis, highlighting ultrasound’s pivotal role. Gallbladder hematoma, rare with vague symptoms, poses diagnostic challenges linked to trauma, tumors, anticoagulant use, or liver/renal disease. Initial symptoms include right upper quadrant pain, tenderness, nausea, and vomiting, resembling cholecystitis. Persistent bleeding may result in dark or bloody stools. Laboratory tests may reveal abnormalities, but sensitivity is limited. Diagnosis is complex, delayed recognition in the emergency department can lead to severe shock and increased mortality. The literature review emphasizes the association with liver/kidney dysfunction and anticoagulant use, presenting symptoms akin to gallbladder inflammation and occasional gastrointestinal bleeding. Ultrasound is pivotal for diagnosis, showcasing features like uneven echoes and localized wall thickening. Treatment approaches vary, with some cases opting for deferred surgical intervention after conservative treatment. Non-traumatic gallbladder hematoma is linked to risk factors like liver/kidney diseases and chronic anticoagulant use. Gallbladder inflammation and gastrointestinal bleeding symptoms coexist, underscoring ultrasound’s crucial role. This study establishes early detection and diagnosis protocols for emergency room settings.

Evaluation of Gastrointestinal Manifestations and Predictive Factors in Pediatric Henoch-Schönlein Purpura

Background: Henoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. Children with HSP often experience gastrointestinal symptoms, such as abdominal pain, nausea/vomiting, gastrointestinal bleeding, and intussusception. These symptoms are estimated to occur in 50-75% of cases. Objectives: In this study, we evaluated the prevalence of gastrointestinal manifestations in children with HSP and identified associated predictive factors. Methods: For this cross-sectional study, we collected data from 295 children with HSP, aged 1 to 16, who were treated at Mofid Children's Hospital in Tehran, Iran, between 2013 and 2022. We gathered the following information from hospital records: Laboratory results for ALT, AST, bilirubin, stool exam (S/E), WBC, RBC, and occult blood (OB), as well as demographic data. Clinical symptoms evaluated included fever, rash, abdominal pain, distension, tenderness, nausea/vomiting, diarrhea, anorexia, and icterus. Results: Our study included 295 children diagnosed with HSP, consisting of 46.77% females and 53.23% males. The average age was 5.3 ± 2.8 years for female patients and 6.2 ± 2.9 years for male patients. Further analysis indicated that anorexia was the most common symptom, followed by abdominal pain, diarrhea, nausea/vomiting, and bloody stool. We observed no significant differences in symptoms based on sex. Physical examination findings, including abdominal distension and tenderness, were similar across both sexes. Elevated levels of AST and ALT, as well as hyperbilirubinemia, were noted in some patients. Stool analysis revealed positive results for RBC, WBC, and occult blood in certain cases, with 21% testing positive for RBC, 24.85% for WBC, and 23.25% for occult blood. Anorexia showed a correlation with increased AST levels, while bloody stool was associated with higher ALT levels, hyperbilirubinemia, and direct hyperbilirubinemia. Logistic regression analysis confirmed a significant association between bloody stools and elevated ALT levels. Conclusions: In this study, we examined the clinical manifestations and laboratory findings in children with small vessel vasculitis to identify associated predictive factors. Our findings indicated that anorexia and abdominal pain were the most common clinical manifestations, with bloody stool also being a prevalent symptom. Additionally, logistic regression analysis demonstrated that the presence of bloody stool is a significant predictive factor for elevated ALT levels.

Therapeutic effect and study of human umbilical cord blood mononuclear cells in patients with ischaemic bowel disease

Ischaemic bowel disease (ICBD) is a group of intestinal ischaemia syndromes caused by various aetiologies of reduced intestinal blood flow or vascular occlusion. ICBD can present as abdominal pain, bloody stool, and diarrhoea. This disease often occurs in middle-aged and elderly individuals with cardiovascular and cerebrovascular diseases. The incidence of ischaemic bowel disease has been increasing for decades, and it is difficult to diagnose, resulting in rapid disease progression and a high mortality rate. Therefore, fully understanding this disease, improving the diagnosis rate of this disease, and finding appropriate treatment methods are urgently needed to improve the condition and prognosis of patients. Umbilical cord blood stem cells are accessible, have weak immunogenicity, and have various biological functions, such as angiogenesis, inflammation and immune regulation. Many studies have confirmed that cord blood stem cells can relieve ischaemia, and these cells have attracted tremendous amounts of attention in regenerative medicine in recent years. In this paper, we discuss the clinical characteristics of ICBD, analyse the characteristics of human umbilical cord blood mononuclear cells (HUCB-MNCs), and use its to treat ischaemic bowel disease. Additionally, we compare the clinical manifestations and related indicators before and after treatment to evaluate the efficacy and safety of these methods.

Optimising triage of urgent referrals for suspected IBD: results from the Birmingham IBD inception study

ObjectiveDiagnostic delays in inflammatory bowel disease (IBD) result in adverse outcomes. We report a bespoke diagnostic pathway to assess how best to combine clinical history and faecal calprotectin (FCP) for...

Mpox Case Presenting With Genital Lesions and Proctitis.

Monkeypox (Mpox) is a zoonotic Orthopoxvirus of the Poxviridae family, endemic to Africa. In August 2022, the US government declared it an emergency because of the worldwide spread. Traditionally, Mpox infection spreads through contact with infected animals. However, the 2022 outbreak Centers for Disease Control and Prevention (CDC) data note that 94% of cases had recent male-to-male sexual or close intimate contact, suggesting a novel sexual transmission. In this article, we report a 39-year-old HIV-positive man presenting with a diffuse cutaneous rash, perianal pain, and bloody stool of 2-week duration. A medical history includes intravenous drug use and multiple sexual partners. Physical examination revealed umbilicated, tan-colored, crusted cutaneous papules scattered across the face, trunk, and genital regions. Perianal lesion biopsy showed an acanthotic epidermis with spongiosis, ballooning degeneration of keratinocytes, and the formation of multinucleated syncytial keratinocytes. A dermal superficial/lichenoid mixed inflammatory cell infiltrate with multinucleated giant cells was noted. Perianal lesion polymerase chain reaction (PCR) was positive for Mpox. Colonoscopy revealed a 3-cm circumferential rectal ulcer with gray exudate and necrosis. A rectal ulcer biopsy showed an ulcerated mucosa with acute proctitis and necrosis. There were scattered macrophages with intranuclear inclusion and glassy vacuolization, and Mpox infection was confirmed by immunostaining with a Mpox-specific anti-Vaccinia virus antibody.

Gut Immunomodulation with Vedolizumab prior to Allogeneic Hematopoietic Stem Cell Transplantation in Pediatric Patients with Inflammatory Bowel Disease

Inborn errors of immunity (IEI) are often associated with inflammatory bowel disease (IBD). IEI can be corrected by allogeneic hematopoietic stem cell transplantation (HSCT); however, peritransplantation intestinal inflammation may increase the risk of gut graft-versus-host disease (GVHD). Vedolizumab inhibits the homing of lymphocytes to the intestine and may attenuate gut GVHD, yet its role in preventing GVHD in pediatric patients with IEI-associated IBD has not been studied. Here we describe a cohort of pediatric patients with IEI-associated IBD treated with vedolizumab before and during allogeneic HSCT. The study involved a retrospective chart review of pediatric patients with IEI-associated IBD treated with vedolizumab at 6 weeks, 4 weeks, and 1 week before undergoing HSCT. The conditioning regimen consisted of treosulfan, fludarabine, and cyclophosphamide with rabbit antithymocyte globulin, and GVHD prophylaxis included tacrolimus and steroids. Eleven patients (6 females) with a median age of 5 years (range, .4 to 14 years) with diverse IEI were included. IBD symptoms were characterized by abdominal pain, loose stools, and blood in stools. Four patients had developed a perianal fistula, and 1 patient had a rectal prolapse. One patient had both a gastrostomy tube and a jejunal tube in situ. Treatment of IBD before HSCT included steroids in 11 patients, anakinra in 2, infliximab in 4, sulfasalazine in 2, mesalazine in 2, and vedolizumab. IBD symptoms were considered controlled in the absence of abdominal pain, loose stools, or blood in stools. Graft sources for HSCT were unrelated donor cord in 5 patients (2 with a 5/8 HLA match, 2 with a 7/8 match, and 1 with a 6/8 match), peripheral blood stem cells in 5 patients (2 haploidentical, 1 with a 9/10 HLA match, and 2 with a 10/10 match), and bone marrow in 1 patient (10/10 matched sibling donor). The median number of vedolizumab infusions was 4 (range, 3 to 12) before HSCT and 1 (range, 1 to 3) after HSCT, and all were reported to be uneventful. All patients had engrafted. Acute GVHD occurred in 4 patients and was limited to grade I skin GVHD only. Chronic GVHD occurred in 1 patient and again was limited to the skin. There was no gut GVHD. Three patients experienced cytomegalovirus viremia, and 2 patients had Epstein-Barr virus viremia. At the time of this report, all patients were alive with no evidence of IBD at a median follow-up of 15 months (range, 3 to 39 months). Administration of vedolizumab pre- and post-HSCT in pediatric patients with IEI-associated IBD is well tolerated and associated with a low rate of gut GVHD. These findings provide a platform for the prospective study and use of vedolizumab for GVHD prophylaxis in pediatric patients with known intestinal inflammation as a pre-HSCT comorbidity.

Helicobacter Pylori and Sociodemographic Characteristics Distribution

Introduction and Aim: Helicobacter pylori is a gram-negative bacterium that affects up to half of the world's population, particularly in poorer nations. It is the leading cause of chronic gastritis, ulcers, gastric lymphoma, and gastric cancer, with more frequent cases in children and adolescents. Transmission can occur through fecal-oral, gastro-oral, oral-oral, or sexual means. The infection is caused by H. pylori's urease activity, invasion of host gastric epithelial cells, and adherence to host cell receptors. Early treatment can enhance gastric protection. Materials and Methods: Between November 2022 and July 2023, 103 samples were collected from patients at Mihrabani Surgical Hospital in Erbil City to identify Helicobacter pylori infection. Blood samples and stool samples were used to test for antibodies. Results: The study found a relatively equal gender representation in the patient and control groups, with 48.48% of men in the patient group and 48.64% in the control group. However, there are significant differences in age distribution, with G3 of age (<35) having the highest prevalence of H.pylori (48.48%). Additionally, 62.12% of patients are rural residents, while 97.29% of the control group are urban residents. Finally, 56.07% of patients are married, indicating a significant difference. Conclusion: The study found equal gender representation in patient and control groups but significant age differences, rural residency, and marital status, with G3 under 35 having the highest H.pylori prevalence.

Malnutrition as an unfavorable prognostic factor after surgical treatment for metastatic colorectal cancer.

<b><br>Introduction:</b> Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. Distant metastases are usually located in the liver and are present in 50% of patients.</br> <b><br>Aim:</b> The aim of this study is to evaluate changes in body composition and phase angle before and after surgical treatment of CRC liver metastases, as well as survival time and treatment costs.</br> <b><br>Material and methods:</b> The study included 134 patients who received 174 surgeries for CRC liver metastases. Bioelectrical impedance analysis (BIA) was performed using an AKERN BIA 101 analyzer.</br> <b><br>Results:</b> BIA was performed before and after surgery. The results of tests (total body water content [TBW], body cell mass [BCM], and phase angle) showed a reduction in BCM by 2.21 kg and a statistically significant decrease in phase angle values after surgery (from 5.06 to 4.25 in women and from 5.34 to 4.76 in men). These values are below the reference range for both sexes. There was a correlation between phase angle values and muscle mass, both before (R = 0.528, p<0001) and after surgery (R = 0.634, p<000.1). Preoperative levels of the tumor marker CEA were elevated in more than half of the patients. The median survival time after resection of liver metastases was 37.6 months.</br> <b><br>Discussion:</b> A significant factor that increases complications, mortality, and treatment costs of cancer patients is malnutrition, which could be the earliest symptom of malignant disease.</br> <b><br>Conclusions:</b> Successful treatment of CRC requires the patients to participate in follow-up examinations and to be aware of early signs associated with recurrence (e.g., blood in the stool or weight loss). The patients' nutritional status should be monitored and recorded in a DILO card.</br&gt.

Antcin-H, a natural triterpene derived from Antrodia cinnamomea, ameliorates dextran sulfate sodium-induced colitis in mice by inhibiting the NLRP3 inflammasome

Inflammatory bowel disease (IBD) comprises idiopathic intestinal disorders, including ulcerative colitis and Crohn's disease. Patients with IBD experience a significantly reduced quality of life, and effective management remains challenging. The NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasome controls the expression of the pro-inflammatory cytokines interleukin (IL)-1β and IL-18. Abnormal activation of the NLRP3 inflammasome is a crucial factor in the pathogenesis of IBD, making it an attractive therapeutic target. We discovered that Antcin-H, a triterpene isolated from the unique medicinal fungus Antrodia cinnamomea found in Taiwan, effectively inhibits the NLRP3 inflammasome in macrophages and alleviates dextran sulfate sodium (DSS)-induced colitis in a mouse model. We noted that Antcin-H effectively suppresses the NLRP3 inflammasome in macrophages by diminishing reactive oxygen species production, alleviating mitochondrial damage, and reducing apoptosis-associated speck-like protein containing a CARD (ASC) oligomerization. Importantly, these effects are achieved without impacting NF-κB activation. Oral administration of Antcin-H improved symptoms such as diarrhea, bloody stool, weight loss, colon length shortening, and splenomegaly in DSS-treated mice. Antcin-H inhibits colonic expression of NLRP3, ASC, active caspase-1, IL-1β, IL-6, tumor necrosis factor-alpha, monocyte chemoattractant protein-1, myeloperoxidase, C-X-C motif chemokine ligand 1, and cyclooxygenase-2 in DSS-treated mice. Furthermore, Antcin-H modulates the colonic expression of long non-coding RNAs involved in the regulation of NLRP3 inflammasome activation. These results indicate that Antcin-H has the potential to improve IBD by reducing colonic inflammation and suppressing NLRP3 inflammasome activation.

Diosmin alleviates ulcerative colitis in mice by increasing Akkermansia muciniphila abundance, improving intestinal barrier function, and modulating the NF-κB and Nrf2 pathways

Ulcerative colitis is a common type of inflammatory bowel disease that affects millions of individuals around the world. Traditional UC treatment has focused on suppressing immune responses rather than treating the underlying causes of UC, which include oxidative stress, inflammation, and microbiota dysbiosis. Diosmin (DIO), a naturally occurring flavonoid, possesses antioxidant and anti-inflammatory properties. This study aimed to assess the efficacy of DIO in treating dextran-sulfate sodium (DSS)-induced colitis, and to investigate some of its underlying mechanisms, with an emphasis on Akkermansia muciniphila abundance, inflammatory markers, and intestinal barrier function. C57BL/6 mice were given 4% (w/v) DSS to induce colitis. DSS-induced mice were administered DIO (100 and 200 mg/kg) or sulfasalazine orally for 7 days. Every day, the disease activity index (DAI) was determined by recording body weight, diarrhea, and bloody stool. Changes in fecal A. muciniphila abundance, colonic MUC1 and MUC2 expression, as well as oxidative stress and inflammatory markers were all assessed. Histopathological changes, colonic PIK3PR3 and ZO-1 levels, and immunohistochemical examinations of occludin and claudin-1, were investigated. DIO administration resulted in a dose-dependent decrease in DAI, as well as increase in A. muciniphila abundance and MUC2 expression while decreasing MUC1 expression. DIO also dramatically reduced colonic oxidative stress and inflammation by regulating the NF-κB and Nrf2 cascades, restored intestinal barrier integrity by inhibiting PIK3R3 and inducing ZO-1, and improved occludin/claudin-1 gene expression and immunostaining. This study provides the first evidence that DIO preserves intestinal barrier integrity and increases A. muciniphila abundance in DSS-induced colitis. However, more research is required to explore the impact of DIO on the overall composition and diversity of the gut microbiota. Likewise, it will be important to fully understand the molecular mechanisms by which A. muciniphila maintains intestinal barrier function and its potential use as an adjuvant in the treatment of UC.

Evaluation of infection prevention and control programmes according to the European Centre for Disease Prevention and Control and the World Health Organization in Spain 2012–2022: indicators of core component 1

Key and core components of effective infection prevention and control programmes (IPCPs) issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have been described. WHO core component 1 relates to the structure, organization and management of IPCPs. The objective of this study was to assess the status and the time trends of some indicators of core component 1 of IPCPs in acute hospitals in Spain throughout the period 2012-2022. Hospital-level data from the Spanish point prevalence survey for years 2012-2022 were analysed. Core component 1 indicators were calculated and tested for association to healthcare-associated infections (HAIs). In addition, trends were also examined. Overall, 67.0% and 57.2% of Spanish hospitals reported having an annual infection prevention and control (IPC) plan and an annual IPC report that was approved by the hospital managing director, respectively. The global median number of full-time equivalent (FTE) IPC nurses per 250 beds for the period was 0.87 and the global median number of FTE IPC doctors was 0.70. The rates of blood cultures and stool tests for Clostridioides difficile were 39.9 and 6.1 per 1000 patient-days, respectively. No significant correlation was found between core component 1 indicators and HAI prevalence. Spain is currently at a basic level on the structure, organization and management of IPCPs. Profound differences were found between hospitals depending on size and type.

A Case Report of Giant Splenic Artery Pseudoaneurysm with Splenic Infarctions

The splenic artery is a frequently affected site for pseudoaneurysms, abnormal bulges in the artery wall. Pseudoaneurysms of the splenic artery are typically linked to pancreatic issues, including acute pancreatitis, chronic pancreatitis, and the formation of pancreatic pseudocysts.[1,2,3,4] These pseudoaneurysms can rupture into nearby organs, leading to gastrointestinal bleeding.[5] Common symptoms associated with splenic artery pseudoaneurysms include the passage of bloody stools (hematochezia) or dark, tarry stools (melena), vomiting blood (hematemesis), abdominal pain, and a condition known as hemosuccus pancreaticus.[6] In the instance of our patient, hematemesis, anaemia, and stomach pain were observed.[6]
 The preferred imaging method for diagnosing splenic artery pseudoaneurysm is CT angiography.[7] Diagnosing a pseudoaneurysm of the splenic artery can be challenging due to its rarity. Still, splenic infarct can provide a valuable diagnostic clue, as was the case similar to our patient.[6]
 Pseudoaneurysm of the splenic artery is a relatively rare complication with associated pancreatitis.[1] While pseudoaneurysms can develop in any blood vessel near the pancreas, the splenic artery is most frequently affected, accounting for about 60% of cases due to its proximity to the pancreas.[8] In autopsy studies, the reported incidence of splenic artery pseudoaneurysms ranges from approximately 0.098% to 10.4%.[9] Identifying this less common vascular complication is crucial because it has the potential to rupture and lead to gastrointestinal bleeding.[5]

Mechanism of Qingchang compound against coccidiosis based on network pharmacology-molecular docking.

The aim of this study was to investigate the anti-Eimeria tenella mechanism of Qingchang Compound (QCC) and provide a basis for its clinical application. The active ingredients, active ingredient-disease intersection targets, and possible pathways of QCC for the treatment of chicken coccidiosis were analyzed, the binding ability of pharmacodynamic components and target proteins was determined by network pharmacology and the molecular docking, and a model of infection with coccidiosis was constructed to verify and analyze the mechanism of action of QCC against coccidiosis. Among the 57 components that met the screening conditions, the main bioactive components were quercetin, dichroine, and artemisinin, with IL-1β, IL-6, IL-10, IFN-γ, and IL-8 as the core targets. Simultaneously, the KEGG signaling pathway of QCC anti-coccidiosis in chickens was enriched, including cytokine-cytokine receptor interactions. The results showed that the main pharmacodynamic components of QCC and the core targets could bind well; artemisinin and alpine possessed the largest negative binding energies and presented the most stable binding states. In addition, in vivo studies showed that QCC reduced blood stool in chickens with coccidiosis, restored cecal injury, and significantly reduced the mRNA and protein expression levels of IL-1β, IL-10, and IFN-γ in ceca (p < 0.01). Our results suggest that the main active ingredients of QCC are artemisinin and alpine and its mechanism of action against coccidiosis may be related to the reduction of the inflammatory response by acting on specific cytokines.

Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation.

To investigate the clinical characteristics of neonatal necrotizing enterocolitis (NEC) complicated by intestinal perforation and predict the incidence of intestinal perforation in NEC. Neonates diagnosed with NEC at the Affiliated Hospital of Zunyi Medical University from January 2012 to May 2022 were enrolled, and the clinical data were collected and analyzed retrospectively. The patients were divided into two groups based on intestinal perforation occurrence or not. Mann-Whitney U tests, t-tests, chi-squaretests, and fisher's exact tests were performed between-group comparisons. Logistic and lasso regressions were applied to screen independent risk factors for concomitant bowel perforation, and R software (RMS package) was used to formulate the nomogram prediction model. In addition, the receiver operating curve (ROC) and the calibration curve were drawn to verify the predictive power, while decision curve analysis (DCA) was constructed to evaluate the clinical applicability of the nomogram model. One hundred eighty neonates with NEC were included, of which 48 had intestinal perforations, and 132 did not; the overall incidence of intestinal perforation was 26.67% (48/180). Bloody stool (OR = 5.60), APTT ≥ 50s (OR = 3.22), thrombocytopenia (OR = 4.74), and hypoalbuminemia (OR = 5.56) were identified as independent risk variables for NEC intestinal perforation (P < 0.05) through multivariate logistic regression analysis. These factors were then applied to develop a nomogram prediction model (C-index = 0.838) by using the R software. The area under the curve (AUC) for the nomogram in the training and validation cohorts were 0.838 (95% Cl: 0.768, 0.908) and 0.802 (95% CI: 0.659, 0.944), respectively. The calibration curve shown that the nomogram has a good predictive ability for predicting the risk of intestinal perforation occurrence. And the decision curve and clinical impact curve analyses demonstrated good clinical utility of the nomogram model. We found that Bloody stool, APTT ≥ 50s, Thrombocytopenia, and hypoalbuminemia could be used as independent risk factors for predicting intestinal perforation in neonates with NEC. The nomogram model based on these variables had high predictive values to identify NEC patients with intestinal perforation.

To Diet or Not to Diet This Is the Question in Food-Protein-Induced Allergic Proctocolitis (FPIAP)-A Comprehensive Review of Current Recommendations.

Food-protein-induced allergic proctocolitis (FPIAP) is an increasingly reported transient and benign form of colitis that occurs commonly in the first weeks of life in healthy breastfed or formula-fed infants. Distal colon mucosal inflammation is caused by a non-IgE immune reaction to food allergens, more commonly to cow's milk protein. Rectal bleeding possibly associated with mucus and loose stools is the clinical hallmark of FPIAP. To date, no specific biomarker is available, and investigations are reserved for severe cases. Disappearance of blood in the stool may occur within days or weeks from starting the maternal or infant elimination diet, and tolerance to the food allergen is typically acquired before one year of life in most patients. In some infants, no relapse of bleeding occurs when the presumed offending food is reassumed after a few weeks of the elimination diet. Many guidelines and expert consensus on cow's milk allergy have recently been published. However, the role of diet is still debated, and recommendations on the appropriateness and duration of allergen elimination in FPIAP are heterogeneous. This review summarizes and compares the different proposed nutritional management of infants suffering from FPIAP, highlighting the pros and cons according to the most recent literature data.

A107 ANALYSIS OF THE EFFICACY IN TRANSITIONING FROM FOBT TO FIT FOR COLORECTAL CANCER SCREENING AT A SINGLE CENTRE IN ONTARIO

Abstract Background Colonoscopy is the gold standard for detecting colorectal cancer (CRC) and advanced lesions, but is an invasive and carries some risks, with limited availability and accessibility. Alternatively, the fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are both non-invasive, cost-effective screening tests that can also be used to detect CRC, advanced lesions, and polyps, identifying individuals to be prioritized to undergo colonoscopy. FOBT screens for small amounts of blood in stool by detecting heme through a chemical reaction. FIT confirms the presence of blood in stool by using antibodies to detect hemoglobin. Prior to 2019, Ontario employed FOBT as the preferred method for CRC screening in eligible individuals. In early 2019, Ontario transitioned to FIT as the preferred screening test, due its established superior test performance for identifying patients with high risk lesions for colon cancer. Aims This single-centre retrospective study analyzed the change in efficacy of detecting advanced lesions, when transitioning from FOBT to FIT, as identified on subsequent colonoscopy Methods A retrospective chart review was conducted of approximately 1000 patients undergoing colonoscopy for FOBT or FIT at Cambridge Memorial Hospital, covering the period of transition from FOBT to FIT. Colonoscopies were performed by 10 endoscopists. Patients were stratified into 2 groups based on fecal test type, FOBT (N = 344) and FIT (N = 572). Overall and individual proportions of cancer, polyps, adenomas, advanced adenomas (AA), and sessile serrated adenomas (SSA) detection in the subsequent colonoscopies were calculated for both groups. The efficacy of both tests was then assessed using statistical analysis. Results In total, 344 patients were included for FOBT analysis and results included: cancer (5.52%), any polyp (56.69%), adenoma (43.6%), AA (20.64), and SSA (6.1%). In contrast, 572 patients were included for analysis of FIT group and results included: cancer (3.85%), any polyp (83.22%), adenoma (76.92%), AA (43.01), and SSA (12.94%). Cancer detection was similar in the 2 groups. There was significant improvement in polyp, adenoma, advanced adenoma, and sessile serrated adenoma detection with FIT compared to FOBT. This improvement was consistent in all endoscopists, but more pronounced in endoscopists with lower detection rates in FOBT cases. Conclusions The use of FIT as a screening stool test, as compared to FOBT, was associated with a significantly improved detection for polyps, adenomas, AA, and SSA, confirming greater accuracy and sensitivity of FIT as a screening tool. This result confirms the premise, at least at a single institution, that by switching to FIT, Ontario has improved colon cancer screening and prevention with more efficient and higher yield utilization of a limited and costly health care resource Funding Agencies None

A254 CANAGLIFLOZIN EXACERBATES CHEMICALLY INDUCED COLITIS WHEN COMBINED WITH A HIGH SUGAR DIET

Abstract Background Consumption of high-sugar diets exacerbates inflammation and hinders the healing process in animal models of acute colitis. Canagliflozin (CANA) is a sodium glucose cotransporter-2 (SGLT2) inhibitor primarily used for the management of type 2 diabetes and cardiovascular disease. CANA has demonstrated the ability to suppress human T cell and macrophage effector function and to improve inflammation in rat colitis models. Based on these findings, we hypothesized that CANA would mitigate the deleterious effects of a high sugar diet in a DSS colitis model through its effects on immune effector cells. Aims The aim of this study was to examine the effects of a high sugar diet and CANA administration on colonic inflammation in an animal model of acute colitis. Methods Adult wild-type male and female 129/SvEv mice were placed on standard chow or a high-sugar diet (HSD) containing 50% sucrose (AIN76A) ± CANA (10mg/kg) gavaged daily (n=4-6 for each group). Following three days on the respective diet, mice received 1.8-2% dextran sodium sulfate (DSS) in their drinking water for 5 days, followed by water alone for 4 days. Disease Activity Index (DAI) was computed daily based on changes in animal weight, stool consistency, and blood in stool. Colonic tissues were evaluated for histological changes, weight-to-length ratio, and cytokine levels using the MesoScale discovery platform. Results Mice on the HSD had increased severity of colitis compared with chow fed mice as evidenced by enhanced DAI, increased weight loss, and increased levels of colonic TNFα (pampersand:003C0.02). Response to CANA treatment was both sex and diet dependent. Contrary to our hypothesis, CANA treatment increased severity of colitis in male mice on the HSD as evidenced by increased DAI and delayed healing with increased enterocyte injury and increased levels of lamina propria neutrophils and lymphocytes. CANA treatment did not exacerbate disease severity in females on the HSD but did delay healing as evidenced by increased lamina propria neutrophils and lymphocytes and worse enterocyte injury. These effects were not observed in mice that were fed standard chow diets with CANA. Conclusions A high-sugar diet significantly exacerbates chemically induced colitis and delays healing. This effect is intensified when combined with CANA, especially in male mice. These findings indicate that effects of SGLT2 inhibitors on colonic inflammation can be modulated by both dietary intake and sex. Funding Agencies CCC

Fucoxanthin Alleviates Dextran Sulfate Sodium-Induced Colitis and Gut Microbiota Dysbiosis in Mice.

The purpose of this study was to evaluate the preventive role and underlying mechanisms of fucoxanthin (Fx) on dextran sulfate sodium (DSS)-induced colitis in mice. The present data demonstrated that oral administration of Fx (50 and 200 mg/kg body weight/day) for 36 days significantly alleviated the severity of colitis in DSS-treated mice, as evidenced by attenuating body weight loss, bloody stool, diarrhea, shortened colon length, colonic epithelium distortion, a thin mucus layer, goblet cell depletion, damaged crypts, and extensive infiltration of inflammatory cells in the colonic mucosa. Additionally, Fx notably relieved DSS-induced intestinal epithelial barrier dysfunction via maintaining the tight junction function and preventing excessive apoptosis of colonic epithelial cells. Moreover, Fx effectively diminished colonic inflammation and oxidative stress in DSS-treated mice, and its mechanisms might be due to blunting the activation of NF-κB and NLRP3 inflammasome signaling pathways. Furthermore, Fx also modulates DSS-induced gut microbiota dysbiosis via recovering the richness and diversity of gut microbiota and reshaping the structure of gut microbiota, such as increasing the Firmicutes and Bacteroidota (F/B) ratio and elevating the relative abundance of some potential beneficial bacteria, including Lactobacillaceae and Lachnospiraceae. Overall, Fx might be developed as a promising functional ingredient to prevent colitis and maintain intestinal homeostasis.