Chronic constipation (CC) is one of the most common gastrointestinal disorders worldwide. Its pathogenesis, however, remains largely unclear. The purpose of the present work was to gain an insight into the role of contractility and microbiota in the etiology of CC. To this end, we studied spontaneous and evoked contractile activity of descending colon segments from patients that have undergone surgery for refractory forms of CC. The juxta-mucosal microbiota of these colon samples were characterized with culture-based and 16S rRNA sequencing techniques. In patients with CC the spontaneous colonic motility remained unchanged compared to the control group without dysfunction of intestinal motility. Moreover, contractions induced by potassium chloride and carbachol were increased in both circular and longitudinal colonic muscle strips, thus indicating preservation of contractile apparatus and increased sensitivity to cholinergic nerve stimulation in the constipated intestine. In the test group, the gut microbiota composition was assessed as being typically human, with four dominant bacterial phyla, namely Firmicutes , Bacteroidetes , Proteobacteria , and Actinobacteria , as well as usual representation of the most prevalent gut bacterial genera. Yet, significant inter-individual differences were revealed. The phylogenetic diversity of gut microbiota was not affected by age, sex, or colonic anatomy (dolichocolon, megacolon). The abundance of butyrate-producing genera Roseburia , Coprococcus , and Faecalibacterium was low, whereas conventional probiotic genera Lactobacillus and Bifidobacteria were not decreased in the gut microbiomes of the constipated patients. As evidenced by our study, specific microbial biomarkers for constipation state are absent. The results point to a probable role played by the overall gut microbiota at the functional level. To our knowledge, this is the first comprehensive characterization of CC pathogenesis, finding lack of disruption of motor activity of colonic smooth muscle cells and insufficiency of particular members of gut microbiota usually implicated in CC.
Determination of the ONL index (the ratio of neutrophils to lymphocytes) is a simple, inexpensive, very popular method abroad that allows to predict the course and outcomes of a wide range of diseases. The possibility of application of ONL in the diagnosis, course prognosis and differential diagnosis of diverticular disease of the colon represents significant clinical interest. Aim — to determine the diagnostic significance of the ONL index in complicated diverticulitis. Material and methods. In retrospective analysis, the ONL index was evaluated in 58 patients with diverticular disease, 42 patients with colon cancer, 31 patients with inflammatory bowel diseases and 46 patients with hemorrhoidal disease, who were hospitalized in the coloproctology department of the Republican Clinical Hospital of Tatarstan for the period from 2015 to 2021. Results. Average of ONL in patients with DD (diverticular disease) were 7,96±5,43, minimal value — 1,16, maximal — 27,42. ONL increased according to aggravation of inflammatory changes in the walls of diverticulum, its spreading beyond the bowel wall. On the contrary, decrease of ONL was marked as a result of relief of inflammation by conservative or surgical treatment, which allowed to state the tendency of decrease of the index at discharge from hospital to 2,75±1,3 (p<0,05). There was also a correlation in the prolongation of patients’ hospital treatment with high ONL indexes as a result of severe inflammatory complications. The correlation coefficient was rxy = 0,468 (p <0,05). There was a statistically significant difference in the ONL index in patients with diverticular disease and patients with cancer of the colon (p <0,05), as well as a significant difference in the ONL index between patients with diverticular disease and patients with hemorrhoidal disease (p <0,001), while the ONL index in patients with diverticular disease and patients with inflammatory bowel diseases did not demonstrate such differences (p >0,05). Conclusion. Thus, the determination of the ONL index can be used in clinical practice not only for the diagnosis and control of the disease, but also for differential diagnosis with other diseases of the colon.
AIM: to establish the consensus on controversial issues of the surgery for Сrohn’s disease by Delphi method.METHODS: a cross-sectional study was conducted by the Delphi method. 62 experts voted intramural and anonymous (31.03.23). 5 statements from the current edition of clinical guidelines were selected for correction by working group and further voting [2]. Based on the practical experience of the working group and literature data, 3 new statements were created also. Statements that do not reach the required level of agreement (80% or more) will be subjected to Round 2 of the Delphi method.RESULTS: all experts took part in the anonymous voting. The panel of experts is represented by 8 different areas of practical medicine and the median of the professional experience of the respondents was 30 (12–49) years. Of the 8 statements submitted for voting, consensus (80% or more) was reached on 6 out of 8. 2 statements have been revised by working group for the distance 2nd round of the Delphi study. Consensus (more than 80%) was reached on both.CONCLUSION: a cross-sectional study by the Delphi method provided the opinions of a panel of experts on controversial issues in the surgical treatment of Crohn’s disease. Statements that reach consensus will be included by the working group in a new edition of clinical guidelines of Crohn’s disease.
Intestinal microbiota appears to be implicated in the pathogenesis of diverticular disease. We present the case of a patient with diverticular colon disease complicated by a pelvic abscess. During the successful surgical treatment, two specimens were taken from the resected colon segment for the microbiota analysis: an inflamed and perforated diverticulum and a diverticulum without signs of inflammation. Culturing and 16S rRNA gene sequencing revealed significant changes in the microbial community structure and composition associated with the acute inflammation and perforation of the colonic diverticulum. The characteristics that are usually associated with the inflammatory process in the gut, namely reduced microbial diversity and richness, decreased Firmicutes-to-Bacteroidetes (F/B) ratio, depletion of butyrate-producing bacteria, and Enterobacteriaceae blooming, were more pronounced in the non-inflamed diverticulum rather than in the adjacent inflamed and perforated one. This is the first study of the intraluminal microbiota of the diverticular pockets, which is more relevant to the etiology of diverticular disease than mucosa-associated microbiota via biopsies and luminal microbiota via fecal samples.
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