Bowel Conditions Research Articles

Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery-A Single-Centre Retrospective Cohort Study.

This research analysed early neonatal outcomes of complex and simple gastroschisis following planned elective preterm delivery in relation to prenatal ultrasound assessment of bowel conditions. A retrospective study of 61 neonates with prenatal gastroschisis diagnosis, birth, and management at a single tertiary centre from 2011 to 2021 showed a 96.72% survival rate with no intrauterine fatalities. Most cases (78.7%) were simple gastroschisis. Neonates with complex gastroschisis had longer hospital stays and time to full enteral feeding compared to those with simple gastroschisis-75.4 versus 35.1 days and 58.1 versus 24.1 days, respectively. A high concordance of 86.90% between the surgeon's and perinatologist's bowel condition assessments was achieved. The caesarean delivery protocol demonstrated safety, high survival rate, primary closure, and favourable outcomes compared to other reports. Prenatal ultrasound effectively evaluated bowel conditions and identified complex gastroschisis cases.

Constipation After Elective Laparoscopy for Benign Gynecological Indications–A Prospective Observational Study

Discover the rate of post-operative constipation in participants undergoing elective laparoscopy for benign gynecological indications DESIGN: Prospective observational study SETTING: Single site, tertiary level gynecology unit with a focus on pelvic pain and endometriosis. Recruited participants were patients of the institution over the age of 18 who had planned to undergo an elective laparoscopy for benign gynecological indications prior to enrolment in the study. Participants were excluded if they were not English speaking, had a chronic bowel condition (with the exception of irritable bowel syndrome), were planned to have bowel surgery, hysterectomy, or converted to laparotomy. In this prospective study, participants completed 3 consecutive surveys. One prior to surgery, one a week post-surgery, and a third 3 months post-surgery. The surveys collected data regarding the participant's bowel habits, pain relief used, laxatives used, and the distress or bother caused by their bowels. Constipation was defined by a modified ROME IV criteria. Opiate use and laxative use were defined by patient-reported tablet counts. The level of distress was measured as a continuously variable scale from 0 to 100. Variables adjusted for included subject's demographics, pre-operative constipation, indication for surgery, duration of surgery, estimated blood loss, opiate use (preoperative, peri-operative, and post-operative), laxative use, and length of stay. A total of 153 participants were recruited, of which 103 completed both the pre-operative and post-operative survey. Post-operative constipation was present in 70% of participants. The mean length of time to first bowel motion was 3 days, with 32% of participants having their first bowel motion after the third post-operative day. The level of bother caused by their bowel habit was higher in the constipation group compared to those without constipation. Post-operatively opiates were used in 84.9% of participants, and laxatives were used in 47.1%. Visits to the general practitioner for constipation occurred in 5.8% of participants. Post-operative constipation is common and bothersome in participants who undergo elective laparoscopy for benign gynecological indications. Analysis of individual variables failed to identify any factors that influenced the rate of constipation.

Prophylactic vs. Therapeutic Effect of Probiotics on the Inflammation Mediated by the NF-κB Pathway in Inflammatory Bowel Conditions.

Probiotic supplements consumed adequately at the proper time can affect health by modulating inflammatory pathways in gastrointestinal epithelial cells and modifying the resultant inflammatory response. The current study applied in vitro models to investigate the effectiveness of probiotics in modulating inflammatory pathways and altering inflammatory gene expression in gastrointestinal epithelial cells, with the ultimate goal of promoting probiotic consumption as a therapeutic and preventive measure for chronic inflammatory bowel conditions. HT-29 cells were treated with Gram-negative bacteria to evaluate the changes in pathways related to inflammation activities before and after treatment with a Lactobacillus spp. cocktail (L. plantarum, L. rhamnosus, L. brevis, and L. ruteri) and a Bifidobacterium spp. cocktail (B. bifidum, B. langum, and B. breve) using the real-time PCR method and ELISA for IL-1β and IL-6 as pro-inflammatory cytokines. The results showed that the expression of NF-κB signaling pathway genes and IL-1β and IL-6 cytokines increased after exposure to Gram-negative components. In contrast, all probiotic combinations significantly decreased the expression of genes and the secretion of cytokines. However, this decrease was significantly smaller in cells that underwent probiotic treatment after inflammation induction. In addition, cocktails containing combined Lactobacillus and Bifidobacterium demonstrated robust anti-inflammatory activity relative to solo cocktails. Our observations confirm that probiotic consumption could positively impact inflammatory conditions and alleviate inflammatory symptoms; they can be particularly effective as a preventive measure. Our study provides preliminary evidence to support the lifetime consumption of probiotics.

Ensemble Approach on Deep and Handcrafted Features for Neonatal Bowel Sound Detection.

For the care of neonatal infants, abdominal auscultation is considered a safe, convenient, and inexpensive method to monitor bowel conditions. With the help of early automated detection of bowel dysfunction, neonatologists could create a diagnosis plan for early intervention. In this paper, a novel technique is proposed for automated peristalsis sound detection from neonatal abdominal sound recordings and compared to various other machine learning approaches. It adopts an ensemble approach that utilises handcrafted as well as one and two dimensional deep features obtained from Mel Frequency Cepstral Coefficients (MFCCs). The results are then refined with the help of a hierarchical Hidden Semi-Markov Models (HSMM) strategy. We evaluate our method on abdominal sounds collected from 49 newborn infants admitted to our tertiary Neonatal Intensive Care Unit (NICU). The results of leave-one-patient-out cross validation show that our method provides an accuracy of 95.1% and an Area Under Curve (AUC) of 85.6%, outperforming both the baselines and the recent works significantly. These encouraging results show that our proposed Ensemble-based Deep Learning model is helpful for neonatologists to facilitate tele-health applications. The source code of our proposed work can be found at: https://gitlab.com/lbur0010/ensemble-approach-to-neonatal-bowel-sound-classification/-/tree/main/.

Surgical management outcome and its associated factors among intestinal obstruction patients admitted to adult surgical ward of Wollega University Referral Hospital, Ethiopia

BackgroundGlobally, bowel obstruction is the most common cause of surgical emergencies. It remains a challenge to healthcare workers in spite of improvements in management techniques. There is a lack of the study to determine the surgical management outcome and its associated factors in the area of study. Hence, this study aimed to determine management outcome and its associated factors among surgically treated intestinal obstruction patients at Wollega University Referral Hospital, 2021.MethodsFacility-based cross-sectional study was conducted among all cases surgically managed for intestinal obstruction between September 1, 2018 and September 1, 2021. Data were collected using a structured checklist. The collected data were checked for completeness and entered into data entry software and then exported to SPSS version 24 for data cleaning and analysis. Both bi-variable and multivariable logistic regressions were run. P-value < 0.05 was used to declare a statistically significant association in multivariable logistic regression. The odds ratio along with 95%CI was estimated to measure the strength of the association.Result116 (59.2%) patients had favorable surgical management outcome for intestinal obstruction. Male sex (AOR = 3.694;95%CI:1.501,9.089), absence of fever (AOR = 2.636; 95%CI:1.124,6.18), ≤ 48 h duration of illness before operation (AOR = 3.045; 95%CI:1.399,6.629), viable intraoperative bowel condition (AOR = 2.372; 95%CI:1.088, 5.175), having bowel resection and anastomosis (AOR = 0.234; 95%CI:0.101,0.544) were the significantly associated factors of the favorable surgical management outcome for intestinal obstruction.Conclusion and recommendationThe favorable management outcome of patients with intestinal obstruction who were treated surgically in this study was low. Factors like sex, fever, short duration of illness, viable intraoperative bowel condition, and bowel resection and anastomosis were found to influence the surgical management outcome of patients with intestinal obstruction. The patient with intestinal obstruction should seek health care on time. Health professionals have to be skilled and provide appropriate care for the patients to reduce the risk of complications.

Revisiting the anatomy and physiology of the lower gastrointestinal tract

Nurses working within any aspect of gastrointestinal nursing could benefit from a review of the anatomy and physiology of the gastrointestinal tract. This article aims to provide a refresher on the topic, enabling nurses to better recognise the cause of bowel changes and provide more effective care for people with bowel conditions

Neurophysiological Effects of Electrical Stimulation on a Patient with Neurogenic Bowel Dysfunction and Cauda Equina Syndrome after Spinal Anesthesia: A Case Report

Neurogenic bowel dysfunction (NBD) is common in patients with cauda equina syndrome (CES). Previous studies have reported that electrical stimulation (ES) improves NBD but more neurophysiologic evidence is required. This case report describes a patient who experienced difficulty with defecation as a result of cauda equina syndrome (CES) that developed after a cesarean section performed 12 years ago under spinal anesthesia. The neurophysiological effects were assessed using the bulbocavernosus reflex (BCR) and electromyography (EMG). Two ES treatments, interferential current therapy and transcutaneous electrical stimulation, were used to stimulate the intestine and the external anal sphincter, respectively. The BCR results showed right-side delayed latency and no response on the left side. Needle EMG revealed abnormal spontaneous activities of the bilateral bulbocavernosus (BC) muscles. Electrodiagnostic testing revealed chronic bilateral sacral polyradiculopathy, compatible with CES. After treatment, the patient reported an improved perianal sensation, less strain and time for defecation than before, and satisfaction with her bowel condition. At the follow-up electrodiagnosis, the BCR latency was normal on the right side-needle EMG revealed reductions in the abnormal spontaneous activities of both BC muscles and re-innervation of the right BC muscle. Electrodiagnostic testing can offer insight into the neurophysiological effects of ES, which can help in understanding the mechanism of action and optimizing the therapy for patients with NBD.

EVALUATION OF THE OUTCOME OF VARIOUS OPERATIVE PROCEDURES IN ACUTE SIGMOID VOLVULUS – OUR EXPERIENCE.

Volvulus is a condition in which a segment of the intestine twists on its own mesenteric axis and results in partial or complete obstruction. Increase in the intraluminal pressure of the bowel along with compromised blood supply leads to gangrene and perforation if unrelieved immediately. Sigmoid volvulus accounts for 2-3% of all intestinal obstructions. Even though it effects both sexes, males are more effected. Treatment differs based on the mode of presentation of volvulus. Relief of intestinal obstruction and resection of gangrenous sigmoid colon are the two main considerations. It is a surgical emergency condition and laparotomy is performed in all patients. Treatment can be divided into resection and nonresection procedures. Primary resection with end-to-end anastomosis is gold standard treatment for sigmoid volvulus. Sigmoid volvulus is more commonly seen in males when compared to females with high incidences in old aged around 5th and 6th decade of life. Procedures such as Sigmoidopexy are done in non-gangrenous and viable bowel conditions, while procedures such as resection and end-to-end anastomosis and Hartmann's procedures are done in cases with gangrene bowel, but carry a risk of mortality

Factors influencing sonographer-led bowel ultrasound services in the UK

IntroductionThere is a growing understanding of the potency of bowel ultrasound leading to an increasing application of ultrasound in examining different bowel conditions. However, sonographers' involvement in bowel ultrasound is under-researched. This study investigated the factors influencing sonographers' experience in adult bowel ultrasound. MethodsA convenience sampling method was used to promote the study in April 2021. A mixed methods online questionnaire was utilised to explore the participants' views. Quantitative data were analysed using descriptive analysis on Excel, while qualitative data were analysed using inductive thematic analysis. ResultsAlmost half of the participants (53%; n = 16) indicated low confidence in using ultrasound to examine the bowel for abnormalities. While 63% of the participants reported having high confidence in examining the bowel for suspected appendicitis, 70% (n = 21) reported low confidence in carrying out ultrasound in examining Inflammatory bowel disease. Furthermore, 23 participants (77%) indicated a high interest in bowel ultrasound training.Qualitative findings revealed mixed opinions on bowel ultrasound practice. Factors influencing sonographers' experience are the need for more training opportunities, preference for other imaging modalities, management challenges, radiologists' influence, sonographers' perspectives, and positive perspectives. ConclusionSeveral factors influence sonographers' confidence in using ultrasound for bowel abnormalities. However, the findings emphasise the need for more research into the future design and implementation of sonographers' bowel ultrasound training. Implication for practiceThis study brings new insight to an under-researched area on the scope of sonography practice, highlighting some sonographers' experience, opinions, and involvement in bowel ultrasound. It further strengthens the argument for more training to be made available to sonographers on bowel ultrasound.

Biological markers of disease activity in inflammatory bowel diseases.

Inflammatory bowel diseases (IBD) are chronic intestinal conditions of multifactorial aetiology including genetic susceptibility, immunological impairment, dysbiosis, and environmental factors. The diagnosis is based on both clinical and endoscopic features, wherein histopathological evaluation remains a gold diagnostic standard. However, fast, reliable, and non-invasive biological markers have been used for years for diagnosis as well as for disease activity monitoring. Currently, commonly used faecal calprotectin is the only biomarker approved and recommended by the European Crohn's and Colitis Organization (ECCO). Nonetheless, other biological markers discriminating between functional and organic bowel conditions have been widely studied. Therefore, the aim of this manuscript was to review new potential biomarkers of inflammation in IBD. The aim of this study was to review currently available biomarkers of intestinal inflammation and increased gut permeability in IBD.

A National Inpatient Sample Analysis of Racial Disparities After Segmental Colectomy for Inflammatory Colorectal Diseases.

Racial disparities and poor access to care are common among African Americans (AA), potentially adversely affecting surgical outcomes in inflammatory bowel conditions. We aimed to analyze the effect of race on outcomes in patients undergoing segmental colectomy for inflammatory bowel conditions. Retrospective review of data from the National Inpatient Sample between 2010 and 2015 identified patients who underwent segmental colectomy without ostomy for Crohn's or diverticular disease. AA patients were compared with Caucasians using a multivariable analysis model. Primary outcomes of interest were overall complications, mortality, and extended hospital stay. 38,143 admissions were analyzed; AA patients constituted 8% of the overall cohort. Diagnoses included Crohn's (11%) and diverticular disease (89%). After multivariable analysis, AA patients had significantly higher overall risk of complications (OR = 1.27; 95% CI, 1.15-1.40) and extended hospital stay (OR = 1.59; 95% CI, 1.45-1.75) than Caucasians. On bivariate analysis, there was no significant difference in mortality between AA and Caucasian patients. AA patients had significantly higher rates of Medicaid insurance (14% vs 6%, P < .001), lower rates of private insurance (35% vs 47%, P < .001), and were less likely to undergo surgery at a private hospital (31% vs 41%, P < .001). AA patients requiring segmental colectomy for inflammatory colorectal conditions experience significantly higher rates of postoperative complications, longer hospital stays, and lower rates of private insurance. Direct correlation between insurance status and postoperative outcomes could not be established, but we speculate such great disparity in outcomes may stem from these socioeconomic differences.

Dysbiosis and reduced small intestinal function are required to induce intestinal insufficiency in mice.

Extensive bowel resection can lead to short bowel syndrome and intestinal failure. Resection-induced dysbiosis may be related to the specific anatomic site of resection and influences the disease progression. Although patients with end-jejunostomy are at high risk for intestinal failure, preservation of the ileocecal valve and colon counteracts this risk. The present study investigated the role of the cecum in maintaining microbial homeostasis after different types of small bowel resection. Male C57BL6/J mice were anesthetized by intraperitoneal injection of ketamine-xylazine and received extended ileocecal resection (extended ICR), limited ileocecal resection (limited ICR), or mid-small bowel resection (SBR). Stool samples were collected before surgery and between postoperative days 2-7, for 16S rRNA gene sequencing. Only extended ICR, but neither limited ICR nor SBR, induced intestinal insufficiency. α-Diversity was reduced in both ICR variants but not after SBR. All resections resulted in an increase in Proteobacteria. Pathobionts, such as Clostridia, Shigella, and Enterococcus, increased after SBR while Muribaculaceae, Lactobacillus, and Lachnospiraceae decreased. Limited ICR resulted in an increase of members of the Clostridium sensu stricto group, Terrisporobacter and Enterococcus and a decrease of Muribaculaceae. The increase of Enterococcus was even more pronounced after extended ICR while Muribaculaceae and Akkermansia were dramatically reduced. Both ICR variants caused a decrease in steroid biosynthesis and glycosaminoglycan degradation-associated pathways, suggesting altered bile acid transformation and mucus utilization.NEW & NOTEWORTHY Resection-induced dysbiosis affects disease progression in patients with short bowel syndrome. Severe dysbiosis occurs after removal of the ileocecal valve, even in the absence of short bowel conditions, and is associated with the loss of Muribaculaceae and Akkermansia and an increase of Clostridium and Enterococcus. The preservation of the cecum should be considered in surgical therapy, and dysbiosis should be targeted based on its specific anatomical signature to improve postoperative bacterial colonization.

Localised Delivery of Macromolecules to the Large Intestine: Translation to Clinical Trials.

Oral administration of macromolecules aimed at systemic delivery has been at the forefront of pharmaceutical research for over 50 years. Yet, in terms of clinical translation for systemic delivery, output is limited to five US Food and Drug Administration (FDA)-approved oral peptide products to date, such are the hurdles. Somewhat neglected by comparison but with potentially lower delivery demands, the goal of local delivery of macromolecules directed mostly to the terminal ileum and colon to treat inflammatory bowel conditions has led to a range of macromolecules including gut-restricted peptides, fusion proteins, enzymes, antibodies, and antisense oligonucleotides that have reached clinical trials. While some of these trials reached primary endpoints, others are at early clinical stages, but it is likely that at least a few approvable products will emerge to supplement the current cohort of parenterally administered macromolecules and oral small molecules. The outstanding successes to date are the FDA approvals of two gut-restricted guanylate cyclase C-activating peptides to treat irritable bowel syndrome (constipated). Over-expressed targets for macromolecules in the gut wall of inflammatory bowel disease patients include α4β7 integrin, TNF-α, CD-3, ICAM-1, and SMAD-7, while reduced responses to IL-10 and melanocortin offer opportunities for macromolecular agonists. In this Leading Article, a landscape of locally delivered macromolecules to access the gut that have recently reached clinical trials is provided.

A Glimpse of Few Diagnostic Laboratory Tests

Medical laboratories perform numerous in vitro diagnostic tests for the diagnosis and prognosis of a variety of diseases. There are some well renowned medical laboratories in Pakistan performing a spectrum of advanced diagnostic tests. This editorial provides a glimpse of few advanced laboratory tests with diagnostic significance Calprotectin (detected in stools): Calprotectin is a protein released by neutrophils, &amp; its presence in the stool is indicative of inflammation in the intestines; its detection also enables to distinguish between inflammatory bowel disease &amp; non-inflammatory bowel conditions, thus also estimated to monitor Ischemic Bowel Disease (IBD) activity, or Irritable bowel syndrome (IBS).

Effect of old age on the subpopulations of enteric glial cells in human descending colon.

Old age is associated with a higher incidence of lower bowel conditions such as constipation. Recent evidence suggest that colonic motility may be influenced by enteric glial cells (EGCs). Little is known about the effect of aging on the subpopulation of EGCs in the human colon. We assessed and compared the pattern of distribution of EGCs in adult and elderly human colon. Human descending colon were obtained from 23 cancer patients comprising of adults (23-63 years; 6 male, 7 female) and elderly (66-81 year; 6 male, 4 female). Specimens were serially-sectioned and immunolabeled with anti-Sox-10, anti-S100 and anti-GFAP for morphometric analysis. Standardized procedures were utilized to ensure unbiased counting and densitometric evaluation of EGCs. The number of Sox-10 immunoreactive (IR) EGCs were unaltered with age in both the myenteric plexus (MP) (respectively, in adult and elderly patients, 1939 ± 82 and 1760 ± 44/mm length; p > .05) and submucosal plexus; there were no apparent differences between adult males and females. The density of S100-IR EGCs declined among the elderly in the circular muscle and within the MP per ganglionic area. In the adult colon, there were more S100-IR EGCs distributed in the circular muscle per unit area than the Taenia coli. There was little or no GFAP-IR EGCs in both adult and elderly colon. We concluded that aging of the human descending colon does not result in a loss of Sox-10-IR EGCs in the MP and SMP but reduces S100-IR EGCs density within the musculature. This alteration in myenteric EGCs density with age may contribute to colonic dysfunction.

Physical Therapy Management of Functional Constipation in Adults Executive Summary: A 2021 Evidence-Based Clinical Practice Guideline From the American Physical Therapy Association's Academy of Pelvic Health Physical Therapy

Background: Functional constipation, diagnosed by physicians utilizing the Rome criteria, is a nonpathologic bowel condition resulting in difficulty with defecation. Adults with functional constipation experience infrequent defecation and may strain and/or use manual maneuvers to produce a bowel movement. Physical therapy should be offered as part of conservative intervention. The goals of this guideline were to describe the available evidence and create a reference document of evidence for physical therapists managing adults with functional constipation symptoms. Methods: A systematic search of the literature was performed for articles published between 1990 and 2019 related to physical therapy interventions for adult functional constipation. A summary of details including benefits, risks, harms, and costs related to each intervention category is provided. Results: Strong evidence suggests that physical therapists should offer biofeedback interventions to their patients with functional constipation, including either electromyographic, rectal balloon catheter, or anorectal manometry biofeedback. Moderate evidence supports the use of manual therapy, whereas weak evidence was found to support the use of electrical stimulation to manage adult functional constipation. Finally, although we were not able to grade the evidence for the use of patient education and therapeutic exercise in the physical therapy management of functional constipation, we did provide a summary of these interventions in the literature. Discussion/Conclusions: Our findings suggest that physical therapists can confidently include biofeedback interventions into the plan of care for adults with functional constipation, as they are supported by strong evidence. Manual therapy also provided a degree of evidence suitable to recommend its use.

Musculoskeletal Considerations in Pelvic Health

Patients seek rehabilitation services for various conditions related to pelvic muscle dysfunction. If not referred by their physician, patients often refer themselves. Healthcare providers treating patients with pelvic concerns must be sensitive and authentic when communicating with patients about their pelvic health and sexuality. Individualized care and respectful interaction are imperative in developing an effective therapeutic relationship. Pelvic health physical therapists evaluate and treat patients of all genders with musculoskeletal conditions related to weakness, overactivity, pain, menopause, following genital surgery, and gender‐affirming surgery. This presentation will highlight the role of pelvic health physical therapy and the bladder, bowel, sexual, and post‐surgical conditions treated. The terminology used when communicating with patients to enhance the therapeutic alliance and treatment outcomes will also be discussed.

A Glimpse of New Diagnostic Laboratory Tests

Medical laboratories perform numerous in vitro diagnostic tests for the diagnosis and prognosis of a variety of diseases. There are some well renowned medical laboratories in Pakistan performing a spectrum of advanced diagnostic tests. This editorial provides a glimpse of few advanced laboratory tests with diagnostic significance. Calprotectin (detected in stools): Calprotectin is a protein released by neutrophils, &amp; its presence in the stool is indicative of inflammation in the intestines; its detection also enables to distinguish between inflammatory bowel disease &amp; non-inflammatory bowel conditions, thus also estimated to monitor Ischemic Bowel Disease (IBD) activity, or Irritable bowel syndrome (IBS)

Evidence-Based and Emerging Diet Recommendations for Small Bowel Disorders.

Diet plays a key role in the manifestation and severity of gastrointestinal symptoms, with increasing research interest on the role of diet in small bowel disorders. There are predominantly 3 small bowel conditions that have potential dietary interventions. Self-reported nonceliac gluten/wheat sensitivity is prevalent. Although gluten is believed to be a potential trigger for symptoms, other components of wheat may also be triggers, including fructans, alpha-amylase trypsin inhibitors, and wheat germ agglutinins. The diagnosis can be challenging, given the lack of validated biomarkers. A gluten-free diet that excludes the abovementioned triggers is the cornerstone of treatment; however, unlike celiac disease, there is uncertainty about the level of adherence or whether the gluten-free diet is a lifelong intervention. Several primary gastrointestinal disorders are associated with an increase in inflammatory cells including eosinophils. Diet seems to be an important driver of disease pathogenesis in eosinophilic gastroenteritis, with elimination and elemental diets showing promise in management, with further robust trials required. Small intestinal bacterial overgrowth is an example of microbial dysbiosis, with renewed interest in diet being postulated to cause an adaptive change of the microbes colonizing the small intestine. However, the diagnosis of small intestinal bacterial overgrowth is limited by a lack of sensitive and specific tests, with significant knowledge gaps in relation to therapeutic measures to manage and cure small intestinal bacterial overgrowth. Currently, antimicrobials are the established management option. There have been significant clinical advances in dietary interventions related to the small bowel, but this area is currently a novel and advancing field for both patients and clinicians.

A165 VEDOLIZUMAB IS AN OPTION TO TREAT MICROSCOPIC COLITIS IN PATIENTS DEPENDENT ON ORAL STEROIDS OR HAVE FAILED A BIOLOGIC: A MULTICENTRE CANADIAN CASE SERIES

BackgroundMicroscopic colitis (MC) is an inflammatory bowel condition demonstrating normal mucosa on endoscopy, with evidence of inflammation and lymphocytosis on pathologic analysis of biopsies. The pathophysiology for this disease is largely unknown, and evidence for its management in cases refractory to oral steroids or after failing a biologic is sparse. Vedolizumab, an integrin receptor antagonist, has been used in a handful of persons with MC with limited literature.AimsReview literature on the use of Vedolizumab in treatment of MC. Present 7 cases of MC where Vedoluzimab was used to manage patients refractory to therapy (either steroid dependent, or failing biologic therapy).MethodsPatients with MC managed with Vedolizumab were identified by soliciting practicing Gastroenterologists within Winnipeg at 3 health centres. A chart review was conducted to obtain pertinent information including patient demographics, symptoms, and medications previously trialed.ResultsReview of literature revealed 3 case reports, and 4 case series reporting on the use of Vedolizumab in MC. We identified 7 cases; 6 female, and a mean age at diagnosis of 50.7. Histologies included 3 lymphocytic, 2 collagenous, 1 developed from lymphocytic to collagenous over time, and 1 with evidence of both. 4 patients were on a biologic prior to initiating Vedolizumab with a mean duration of therapy of 24.25 months. Indications for initiating Vedolizumab included: 3 with steroid dependency, 3 Infliximab failures, and 1 with Adalimumab-associated hepatotoxicity. Mean disease duration prior to initiating Vedolizumab was 112.7 months. Number of stools pre-Vedolizumab were: 1–3 = 0, 4–6 = 2, 7–9 = 2, >/=10 = 3, compared to >6 months post-Vedolizumab: 1–3 = 5, 4–6 = 1, 7–9 = 1, >/=10 = 0. Symptoms pre-Vedolizumab compared to >6 months post-Vedolizumab included: 4 with urgency pre-Vedolizumab versus 1, 3 had incontinence versus 0, and 4 had nocturnal symptoms versus 0. Use of alternative medications included anti-diarrheals, oral 5-aminosalicylic acid, and immunomodulators. On average, patients tried 7.6 different treatments prior to starting Vedolizumab. 1 case is considered to have failed Vedolizumab due to increasing symptoms.ConclusionsThis multicentre case series is the first in Canada to assess patient characteristics and symptoms before and after Vedolizumab induction in persons with MC who are either steroid dependent or have failed a biologic. Our results demonstrate an overall improvement in symptoms when assessed >6 months after induction therapy. This review was limited in not having a symptom inventory/severity index completed at each clinic visit, resulting in a number of difficult-to-compare and incomplete data points.Funding AgenciesNone