Bowel Disease Research Articles

Education, intelligence, and 20 gastrointestinal disorders: A Mendelian randomization study.

Previous observational studies have suggested that higher levels of education attainment and intelligence (IQ) are associated with better health outcomes in humans. However, the causal link between education attainment and IQ and their association with health outcomes remains unclear. This study aims to investigate the distinct impacts of intelligence and educational attainment on gastrointestinal symptoms. From the genome-wide association between educational attainment and the IQ study database, results were obtained from the FinnGen summary database. We used univariate and multivariate Mendelian randomization (MR) techniques to explore the relationship between exposures and outcomes. To assess the validity of inverse-variance-weighted-based results, we used several supplementary analytical techniques and performed sensitivity analysis. Our multivariate MR study confirmed the findings from univariable analyses and showed a genetically predicted causal association between educational attainment and 8 gastrointestinal disorders, including gastroesophageal reflux disease, chronic gastritis, gastroduodenal ulcer, cirrhosis, cholelithiasis, acute pancreatitis, chronic pancreatitis, and irritable bowel syndrome. Our univariate MR study found an association between IQ and 6 gastrointestinal conditions: gastroesophageal reflux disease, cirrhosis, cholelithiasis, acute pancreatitis, pancreatic malignancy, and irritable bowel syndrome. However, the connection was much weaker in multivariate MR analysis. Our study revealed causal relationships between gastrointestinal disorders and educational attainment. Educational attainment may mediate between intelligence and the impacts on the gastrointestinal system. However, further research is required to understand the underlying pathogenic processes completely.

Leaky gut in systemic inflammation: exploring the link between gastrointestinal disorders and age-related diseases.

Global average life expectancy has steadily increased over the last several decades and is projected to reach ~ 77years by 2050. As it stands, the number of people > 60years currently outnumbers children younger than 5years, and by 2050, it is anticipated that the global population of people aged > 60years will double, surpassing 2.1 billion. This demographic shift in our population is expected to have substantial consequences on health services globally due to the disease burden associated with aging. Osteoarthritis, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, and cognitive decline associated with dementia are among the most common age-related diseases and contribute significantly to morbidity and mortality in the aged population. Many of these age-related diseases have been linked to chronic low-grade systemic inflammation which often accompanies aging. Gastrointestinal barrier dysfunction, also known as "leaky gut," has been shown to contribute to systemic inflammation in several diseases including inflammatory bowel disease and irritable bowel syndrome, but its role in the development and/or progression of chronic low-grade systemic inflammation during aging is unclear. This review outlines current literature on the leaky gut in aging, how leaky gut might contribute to systemic inflammation, and the links between gastrointestinal inflammatory diseases and common age-related diseases to provide insight into a potential relationship between the intestinal barrier and inflammation.

Multiple Renal Infarctions in Spontaneous Double Renal Artery Dissection: A Case Report

Background: As spontaneous renal artery dissection (SRAD) is a rare cause of abdominal pain, bilateral dissection is an extremely rare event. Only approximately two hundred cases of SRAD have been reported in the literature. The diagnosis is often delayed due to the rarity of the disease and non-specific clinical presentations such as flank pain, hypertension, fever, nausea, vomiting, and hematuria, which can be often misdiagnosed as a genito-urinary infection or gastrointestinal or bowel disease. Before 1980, the diagnosis of SRAD was mostly confirmed via autopsy or, rarely, via angiography. At present, the diagnosis is made using advanced imaging approaches, including computed tomography angiography (CTA) and magnetic resonance angiography (MRA), with a higher number of incidentally diagnosed SRADs. Methods: we performed laboratory tests and radiological examinations (computed abdominal tomography and multiplanar reconstruction) that revealed multiple infarctions and ischemic areas with hypoperfusion in the upper middle third of the left kidney and in a large part of middle and lower areas of the right kidney; the left renal artery exhibited increased intimal thickening and arteritis. Results: The multiplanar reconstruction revealed bilateral renal artery dissection and multiple arterial infarctions disseminated throughout both kidneys. After a clinical follow-up and hypertension retargeting, the patient was discharged with dual antiplatelet therapy and ACE inhibitor drugs. No lipid-lowering therapy was needed. Conclusions: Spontaneous renal artery dissection (SRAD) is a rare clinical event that typically presents with acute low-back or flank pain, hypertension, fever, hematuria, and acute renal failure. The condition could be misdiagnosed or receive a delayed diagnosis due to its relative rarity and non-specific presentation. The gold standard is enhanced computed tomography (CT) scans, and if the diagnosis is positive, vascular multiplanar reconstruction is generally suggested, as it can display lesions more clearly. Over 300 cases have been reported since the first characterization of SRAD; however, to date, a consensus has not been reached on the most appropriate treatment. Conservative therapy, open surgery, and intravascular intervention have been reported as treatments for SRAD.

Assessment, diagnosis and management of inflammatory bowel disease emergencies

Acute severe ulcerative colitis (ASUC) and Crohn's disease (CD) can present as medical emergencies that require immediate and coordinated care due to the risk of significant morbidity and mortality. This clinical review explores the assessment and management of inflammatory bowel disease emergencies, including ASUC, toxic megacolon, massive haemorrhage, intra-abdominal abscesses, and bowel obstruction. The review highlights the critical importance of prompt diagnosis, patient-centred care, and the integration of multidisciplinary teams (MDTs) in managing these complex cases. It also outlines the clinical approaches, necessary investigations, and both medical and surgical management strategies essential for optimising patient outcomes. The review emphasises the need for healthcare professionals to be equipped with the knowledge and confidence to manage these emergencies effectively, thus enhancing patient care and safety. This article does not aim to explore UC and CD in their entirety but rather aims to focus on the acute emergencies associated with these conditions.

S121 Crohn’s Disease and Small Bowel Adenocarcinoma: An Unexpected Finding

S121 Crohn’s Disease and Small Bowel Adenocarcinoma: An Unexpected Finding

Editorial: Recent advances in understanding the role and mechanisms of gut microbiota in inflammatory bowel disease and irritable bowel syndrome

Editorial: Recent advances in understanding the role and mechanisms of gut microbiota in inflammatory bowel disease and irritable bowel syndrome

Probiotic nanovesicles encapsulating baicalin: a strategy to overcome colorectal cancer.

Escherichia coli Nissle 1917 (EcN) is a unique probiotic utilized to treat inflammatory bowel disease and irritable bowel syndrome. Outer membrane vesicles (OMVs) from EcN can not only deliver pro-biotic anti-inflammatory molecules to cancer cells to exert anti-rectal cancer effects, but also deliver therapeutic drugs, genes, and other "cargoes" encapsulated in the vesicles to specific cells, making them an ideal vehicle for drug delivery. In this study, we successfully isolated OMVs of probiotic origin and obtained BCN-OMVs by encapsulating baicalin (BCN) in EcN-OMVs. Fluorescence microscopy showed that both fluorescently labeled EcN-OMVs and BCN-OMVs were able to enter HT-29 cells. The results of CCK-8, plate cloning, flow cytometry, and western blotting indicated that the vitality and proliferation of HT-29 cells were sensibly inhibited after treatment with BCN-OMVs. Additionally, apoptosis-related proteins and proteins involved in the NF-κB pathway were also expressed differently. The results above suggest that EcN-OMVs, serving as a bio-nanocarrier of BCN, can effectively address the limitations of BCN, such as poor water solubility and low bioavailability. They also play a significant anti-tumor role by enhancing cancer cell apoptosis, showing promising potential in targeted therapy for colorectal cancer (CRC).

Colonic drug delivery systems: Exploring the potential of biodegradable polymers for systemic effects

Targeted drug delivery to the colon is highly desirable for the local treatment of various bowel diseases, including ulcerative colitis, Crohn’s disease, amebiasis, and colonic cancer, as well as for the systemic delivery of protein and peptide drugs. The colon-specific drug delivery system (CDDS) must protect the drug during transit through the stomach and small intestine, ensuring that release and absorption occur only in the colon. The colon is an ideal site for drug absorption due to its lower enzymatic activity compared to the small intestine, which helps protect peptide drugs from degradation, and its long residence time, which enhances systemic bioavailability.While the oral route is the most convenient for CDDS, rectal administration is also used, though it can be uncomfortable and less effective for targeting the proximal colon. Intrarectal drug preparations, such as solutions, foams, and suppositories, are used for both systemic dosing and local treatment of the large intestine. The efficacy of these drugs often depends on their formulation, spreading capacity, and retention time.The colon’s high water absorption capacity and viscous contents can limit drug availability to the absorptive membrane. However, the presence of a diverse bacterial flora in the colon can be leveraged for drug metabolism and targeted delivery of peptide-based macromolecules, such as insulin. Understanding the anatomy and physiology of the gastrointestinal tract (GIT), including variations in pH, is crucial for designing effective CDDS. This knowledge helps optimize drug release and absorption, ultimately improving therapeutic outcomes for patients.

Unraveling the Role of the Human Gut Microbiome in Health and Diseases.

The human gut is a complex ecosystem that supports billions of living species, including bacteria, viruses, archaea, phages, fungi, and unicellular eukaryotes. Bacteria give genes and enzymes for microbial and host-produced compounds, establishing a symbiotic link between the external environment and the host at both the gut and systemic levels. The gut microbiome, which is primarily made up of commensal bacteria, is critical for maintaining the healthy host's immune system, aiding digestion, synthesizing essential nutrients, and protecting against pathogenic bacteria, as well as influencing endocrine, neural, humoral, and immunological functions and metabolic pathways. Qualitative, quantitative, and/or topographic shifts can alter the gut microbiome, resulting in dysbiosis and microbial dysfunction, which can contribute to a variety of noncommunicable illnesses, including hypertension, cardiovascular disease, obesity, diabetes, inflammatory bowel disease, cancer, and irritable bowel syndrome. While most evidence to date is observational and does not establish direct causation, ongoing clinical trials and advanced genomic techniques are steadily enhancing our understanding of these intricate interactions. This review will explore key aspects of the relationship between gut microbiota, eubiosis, and dysbiosis in human health and disease, highlighting emerging strategies for microbiome engineering as potential therapeutic approaches for various conditions.

Computed tomography enterography radiomics and machine learning for identification of Crohn’s disease

BackgroundCrohn’s disease is a severe chronic and relapsing inflammatory bowel disease. Although contrast-enhanced computed tomography enterography is commonly used to evaluate crohn’s disease, its imaging findings are often nonspecific and can overlap with other bowel diseases. Recent studies have explored the application of radiomics-based machine learning algorithms to aid in the diagnosis of medical images. This study aims to develop a non-invasive method for detecting bowel lesions associated with Crohn’s disease using CT enterography radiomics and machine learning algorithms.MethodsA total of 139 patients with pathologically confirmed Crohn’s disease were retrospectively enrolled in this study. Radiomics features were extracted from both arterial- and venous-phase CT enterography images, representing both bowel lesions with Crohn’s disease and segments of normal bowel. A machine learning classification system was constructed by combining six selected radiomics features with eight classification algorithms. The models were trained using leave-one-out cross-validation and evaluated for accuracy.ResultsThe classification model demonstrated robust performance and high accuracy, with an area under the curve of 0.938 and 0.961 for the arterial- and venous-phase images, respectively. The model achieved an accuracy of 0.938 for arterial-phase images and 0.961 for venous-phase images.ConclusionsThis study successfully identified a radiomics machine learning method that effectively differentiates Crohn’s disease bowel lesions from normal bowel segments. Further studies with larger sample sizes and external cohorts are needed to validate these findings.

Ayurveda management of Oral Lichen Planus

Background: Oral Lichen Planus (OLP) is a chronic inflammatory disease that affects the mucus membrane of the oral cavity. It is a T-cell mediated autoimmune disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. It is characterized by lesions consisting of radiating white, gray, velvety, thread-like papules in a linear, annular and retiform arrangement forming typical lacy, reticular patches, rings and streakes. Although the exact etiology of this disease is still unknown, but some factors are associated with it like dental materials, autoimmunity, food allergies, stress, trauma, bowel diseases, infectious diseases, genetics etc. Aims and Objectives: To study the role of Ayurveda Chikitsa in the management of Oral Lichen Planus. Materials and Methods: A female patient aged 41 years presented with complaints of oral lesion with burning, pain, occasionally bleeding from gums while brushing. Patient was diagnosed with disease Oral Lichen Planus. Patient was treated with administration of Deepana Pachana Aushadhis followed by Trivritta Churna, Guduchyadi Kwatha internally and with Rasayanadi Yoga being used as local application. After the two month’s treatment, a significant response seen in symptoms like burning, pain and bleeding from gums while brushing. Result: There is a need to make treatments that are widely recognized, widely successful, and capable of withstanding systematic replication available. These treatments should be able to significantly reduce the volume, recurrence and impact of Oral Lichen Planus. Conclusion: Ayurveda has great approach in curing the Oral Lichen Planus.

Perspectives on the sustained engagement with digital health tools: protocol for a qualitative interview study among people living with Inflammatory Bowel Disease or irritable bowel syndrome

IntroductionDigital health tools can be beneficial in the care of patients with chronic conditions and have the potential for widespread impact as readily scalable and cost-effective health interventions. However, benefits...

Long-term follow-up of children with Crohn's disease and small bowel mucosal lesions detected through video capsule endoscopy.

We report disease outcomes of pediatric Crohn's disease (CD) affecting the proximal small bowel (SB) and detected through video capsule endoscopy (VCE). We undertook a retrospective review of CD patients with VCE performed under age 18 between 2003 and 2017 and having received any biologics. We identified patients from our institutional registry. Eligible patients (n = 118) had their first VCE performed after a median of 0.1 years after diagnostic endoscopies at a median age of 12.2 years. The proximal SB disease group (Paris classification L4b inclusive) comprised 70 patients with extensive SB lesions in 81% and deep ulcers in 79%. Patients with Paris L1-3 disease with no findings in VCE or disease restricted to the terminal ileum comprised the control group. At first VCE, levels of albumin (34 g/L vs. 37 g/L) and hemoglobin (117 g/L vs. 127 g/L) were lower in SB patients (p < 0.02). After the first VCE, 68% were introduced to biologics, while 10% already received them. Follow-up VCE was performed after a median of 2.4 years (SB group n = 42; controls n = 21). Proximal SB findings had disappeared in 40% of SB patients, and extensive lesions and deep ulcers had decreased to 26% and 29%, respectively (p = 0.001). In the control group, one had progressed to proximal disease. During the clinical follow-up of a median of 4.7 years, one patient with SB underwent surgery for a jejunal stricture. Proximal SB disease detected through capsule endoscopy abated in most patients with biological medication.

Long-Term Sequelae of SARS-CoV-2 Infection in Patients with Inflammatory Bowel Diseases Compared to Relatives with SARS-CoV-2 Infection without Inflammatory Bowel Disease and Inflammatory Bowel Disease Patients without SARS-CoV-2: Results of a Retrospective Case-Control Study

Introduction: Long-term sequelae following acute SARS-CoV-2 infection appear to be common in patients with inflammatory bowel diseases (IBDs). Methods: We examined the frequency and characteristics of post-COVID-symptoms in patients with IBD (IBD-COVID), comparing them to two control cohorts: infected household members of the IBD-COVID patients without IBD (CONT-COVID) and IBD patients without SARS-COV-2 infection (IBD-no-COVID). A questionnaire for the retrospective documentation of possible post-COVID-19 symptoms was distributed to patients and controls from eight referral centers. Results: The 319 IBD-COVID, 108 CONT-COVID, and the 221 IBD-no-COVID patients were similar in terms of sex, age, and comorbidities. The occurrence and duration of fatigue in the IBD-COVID cohort correlated with IBD activity. Other complaints such as reduced cognitive performance (p &lt; 0.05) and sleeping disorders (p &lt; 0.05) were even more common in IBD-COVID patients. Persistent hematochezia (p &lt; 0.001), abdominal pain (p &lt; 0.005), diarrhea (p &lt; 0.0001), and anal problems (p &lt; 0.01) were more often in the IBD-COVID patients than in the CONT-COVID cohort. Furthermore, typical IBD-associated symptoms persist for a longer period after an infection. Frequency of post-COVID complaints is higher in IBD patients compared to controls. After infection, the number of outpatient consultations increased in IBD-COVID patients (7.8% vs. 10.9%, p = 0.008). Conclusion: Fatigue, cognitive impairment, and sleep disturbances are more prevalent among IBD-COVID than CONT-COVID patients. Furthermore, typical IBD-associated symptoms persist for a longer period after an infection. Frequency of post-COVID complaints is higher in IBD patients compared to controls. Tight control of IBD activity could be a suitable tool to avoid post-COVID problems.

The role of Gαq in regulating NLRP3 inflammasome activation.

G proteins are a class of important signal transducers in mammalians. G proteins can corpoarated with G proteincoupled receptors (GPCRs) and transmit signals from extracellular stimuli into intracellular response, which will regulate a series of biological functions. G-proteins are heterotrimeric proteins composed of Gα, Gβ, and Gγ subunits. Based on structural and functional similarity of their α-subunits, G proteins are typically grouped into four classes (Gi, Gs, Gq/11, and G12/13). The Gq/11 subfamily consists of Gq, G11, G14, and G15/16 proteins. Gαq is the α-subunit of Gq protein and encoded by GNAQ. Our previous studies revealed that Gαq play an important role in regulating T cell survival and T cell differentiation. Inflammasomes are multiprotein complexes that play a critical role in modulating innate inflammatory response. NLRP3 inflammasome is currently the most extensively studied inflammasome. We found that Gαq suppressed NLRP3 inflammasome activation in macrophage, Gαq also suppressed NLRP3 inflammasome activation in a LPS-induced sepsis mouse model. Gαq can locate to mitochondria and Gαq was required for the maintenance of mitochondrial homeostasis. Gαq regulated NLRP3 inflammasome activation by modulating mitochondrial reactive oxygen species (mtROS). We found that Gαq suppressed NLRP3 inflammasome activation in macrophage, Gαq also suppressed NLRP3 inflammasome activation in a LPS-induced sepsis mouse model. Gαq can locate to mitochondria and Gαq was required for the maintenance of mitochondrial homeostasis. Gαq regulated NLRP3 inflammasome activation by modulating mitochondrial reactive oxygen species (mtROS). Our results indicate that Gαq regulates NLRP3 inflammasome activation by modulating mitochondrial ROS production. Our research provides new mechanistic insight into the activation of NLRP3 inflammasome. As it has been proved that NLRP3 inflammasome plays an important role in the pathogenesis many diseases such as Alzheimer's disease, cancer, and inflammatory bowel disease, Gαq might become a novel drug target for these diseases in future.

Atopic disease and inflammatory bowel disease: A bidirectional Mendelian randomization study.

Observational studies have reported associations between atopic diseases, including allergic rhinitis (AR), asthma, atopic dermatitis (AD), and inflammatory bowel disease (IBD), but the causal relationship remains unknown. We utilized pooled data from genome-wide association studies, qualified instrumental variables were screened according to the 3 hypotheses of MR, and bidirectional causality between atopic diseases and IBD was assessed using 2-sample Mendelian randomization analysis (2SMR). The results of our study suggest that AR increased the risk of Crohn disease (CD) (IVW OR = 1.19, 95% CI = 1.02-1.39, P = .026), ulcerative colitis (UC) (IVW OR = 1.14, 95% CI = 1.01-1.29, P = .031) and overall IBD (IVW OR = 1.15, 95% CI = 1.03-1.28, P = .015); Asthma increased the risk of CD (IVW OR = 7.66, 95% CI = 1.58-37.20, P = .012), UC (IVW OR = 3.81, 95% CI = 1.09-13.32, P = .036) and overall IBD (IVW OR = 5.13, 95% CI = 1.48-17.70, P = .010); AD increased the risk of CD (IVW OR = 1.19, 95% CI = 1.02-1.39, P = .023) and overall IBD (IVW OR = 1.14, 95% CI = 1.03-1.28, P = .015) risk. In reverse causality, only CD increased the risk of AR (IVW OR = 1.02, 95% CI = 1.00-1.05, P = .031). This study shows that atopic diseases of AR and asthma are causally related to IBD and its subtypes, and AD is causally related to IBD (which may be attributed to CD). Of the reverse causality, only CD was causally related to AR.

Psoriasis management tree based on comorbidity.

Psoriasis, a common chronic inflammatory skin disorder, encompasses various subtypes, including guttate, pustular, erythrodermic, and the most common type, plaque psoriasis. Irrespective of the subtype, psoriasis can manifest with multisystemic presentations, including psoriatic arthritis, metabolic disorders, cardiovascular disease, malignancies, chronic kidney disease (CKD), psychiatric illness, and inflammatory bowel disease (IBD). Many comorbidities and concomitant conditions must be considered when selecting the most appropriate therapy for a patient (Kaushik etal., 2019 and Monks etal., 2021) . Ongoing clinical trials and the development of new therapeutic targets contribute to the continuous improvement of available treatment options. Given the dynamic landscape of therapies, particularly when managing complex patients with multiple comorbidities, dermatologists are constantly challenged with the task of adeptly tailoring treatments to each psoriasis patient. This article systematically reviews the current evidence, presenting it as an updated Psoriasis Decision Tree to assist physicians in selecting tailored treatment options.

Opportunities and challenges for identifying undiagnosed Rare Disease patients through analysis of primary care records: long QT syndrome as a test case.

Patients with rare genetic diseases frequently experience significant diagnostic delays. Routinely collected data in the electronic health record (EHR) may be used to help identify patients at risk of undiagnosed conditions. Long QT syndrome (LQTS) is a rare inherited cardiac condition associated with significant morbidity and premature mortality. In this study, we examine LQTS as an exemplar disease to assess if clinical features recorded in the primary care EHR can be used to develop and validate a predictive model to aid earlier detection. 1495 patients with an LQTS diagnostic code and 7475 propensity-score matched controls were identified from 10.5million patients' electronic primary care records in the UK's Clinical Practice Research Datalink (CPRD). Associated clinical features recorded before diagnosis (with p < 0.05) were incorporated into a multivariable logistic regression model, the final model was determined by backwards regression and validated by bootstrapping to determine model optimism. The mean age at LQTS diagnosis was 58.4 (SD 19.41). 18 features were included in the final model. Discriminative accuracy, assessed by area under the curve (AUC), was 0.74, (95% CI 0.73, 0.75) (optimism 6%). Features occurring at significantly greater frequency before diagnosis included: epilepsy, palpitations, syncope, collapse, mitral valve disease and irritable bowel syndrome. This study demonstrates the potential to develop primary care prediction models for rare conditions, like LQTS, in routine primary care records and highlights key considerations including disease suitability, finding an appropriate linked dataset, the need for accurate case ascertainment and utilising an approach to modelling suitable for rare events.

A Comparative Study of Hand-Sewn and Stapled Anastomosis in Gastrointestinal Surgeries.

Background Bowel anastomosis is a key part of gastrointestinal surgery where two sections of the intestines are connected. It is a critical step as it restores the digestive tract's continuity after removing damaged or diseased bowel. Stapler devices are a new method that helps connect bowel loops faster and with less tissue damage. This study aimed to evaluate and compare the safety and effectiveness of stapled anastomosis versus hand-sewn anastomosis in surgeries involving the bowel. Methods In this prospective non-randomized study, the study population included 60 patients with various gastrointestinal surgeries admitted to our institution from August 2022 to June 2024 within a single unit. The inclusion criteria included all patients aged over 18 years who underwent surgeries such as gastrojejunostomy, hemicolectomy, and small bowel resection with anastomosis. The exclusion criteria were age under 18, pregnancy, and immunocompromised states. Patients were divided into two groups based on how their digestive tract was reconstructed: 28 had stapled anastomoses and 32 had hand-sewn anastomoses, either as elective or emergency surgery. We examined multiple outcomes such as surgery duration in hours, time until bowel function returned post surgery, length of hospital stay in days, anastomotic leak rate, albumin levels to leak rate, post-surgery pain, and surgical site infection (SSI) rate for the two groups. Southampton wound grading system and the visual analog scale (VAS) were used to assess the SSI and pain score, respectively. Results When comparing the operation time for the suture and staple groups among the elective cases, the p-value was significant (0.02), with 15 patients having prolonged surgery in the suture group compared to only five in the staple group. Regarding the time until the return of bowel sounds post surgery, the p-value was significant (0.02) for elective cases in the two groups, with nine patients having their bowel sounds returning after the third postoperative day (POD) in the suture group. When comparing the duration of stay in the hospital for elective cases for the staple and suture groups, the p-value was significant (0.04), with eight patients staying after the seventh POD in the suture group. When comparing the leak rates for the two groups for elective cases, the p-value was significant (0.04), with four leaks in the suture group and no leaks in the staple group. On comparing the association between the albumin level and anastomotic leak, the p-value was significant at 0.001 and 0.0006 for the suture and staple groups, respectively, with more leaks associated with an albumin level of <3 mg/dl. When comparing pain scores of the suture and staple groups separately in elective and emergency settings, the p-values were both 0.4, which is not significant. Among the elective cases comparing SSIs for the suture and staple groups, the p-value was significant (0.04), with six patients having SSIs in the suture group compared to one patient in the staple group. Among the emergency cases, when comparing SSIs for the suture and staple groups, the p-value was not significant (0.1). Conclusion In elective surgeries, stapled anastomosis reduces surgery time, accelerates bowel function recovery, enables earlier discharge, and lowers anastomotic leak rates compared to sutures. The staples group showed no difference from sutures in the leak rate to albumin levels and pain while offering superior SSI prevention.

Calprotectin as a marker of disease activity in spondyloarthritis

Introduction: Spondyloarthritis is a group of arthritic diseases that classically manifest as inflammation of the sacroiliac and limb joints, as well as the axial skeleton. Microscopic bowel inflammation is identifiable in over 50% of these patients. Calprotectin measured in the serum and stool is an emerging surrogate marker of disease activity and/or bowel inflammation in spondyloarthritis. Objective: This article aims to review published literature to determine the accuracy of serum and faecal calprotectin levels for use in monitoring bowel inflammation and spondyloarthritis disease activity. Methods: Boolean operator strategy was used to search two databases (Embase and PubMed) and 52 relevant articles were identified. Duplicate results were eliminated, inclusion and exclusion criteria were applied. Results: Ten studies met the inclusion criteria and were summarized and analyzed. The EBL Validity questionnaire was applied to determine study quality. All research articles found calprotectin to be elevated in spondyloarthritis patients when compared to controls. Faecal calprotectin was superior in detecting disease activity and correlated with disease activity questionnaires, radiology and endoscopy results. Only one study assessed the effect of treatment on calprotectin and its correlation to bowel inflammation. Conclusion: Faecal calprotectin shows promise as a surrogate marker for disease activity and bowel inflammation in spondyloarthritis. Future studies should focus on the effect of treatment on faecal calprotectin and whether some treatments are better at preventing the progression of bowel inflammation in addition to treating spondyloarthritis. Supplementary investigations are needed to identify whether faecal calprotectin is useful as a marker of disease activity in response to treatment.