OC-003 No clinical benefit of prebiotics in the treatment of active Crohn's disease: a double-blind, randomised, placebo-controlled trial:

Benjamin, Jane; Hedin, Charlotte; Κουτσουμπασ, Ανδρεασ; Ng, Susanna S.S.; Hart, AL; Kamm, MA; Sanderson, J; Knight, SC; Forbes, Angus; Stagg, A J; Whelan, Kevin; Lindsay, J O

doi:10.1136/gut.2009.208934c

Cited by 4 publications

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“…Increased lactate and bilirubin have both been widely found to predict short-term mortality in critically ill cirrhotic patients [5, 11, 12, 14, 16, 21, 23], but this is the first time they have been associated with poor long-term outcome. Whilst the odds ratio of 4.82 for PT ratio appears large, this ratio represents the increased risk of mortality associated with an increase in the PT ratio of 1, a significant clinical deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Novel scores have also been designed for the acutely ill cirrhotic population, such as the Royal Free Hospital (RFH) score [11] and the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) [22]. Increased serum lactate has been widely found to predict short-term mortality in critically ill cirrhotic patients [5, 11, 12, 16, 23], leading to the development of scores incorporating lactate such as SOFA-Lactate [16]. Child–Pugh + Lactate was also found to be the best performing score at predicting ICU mortality in a previous study from this centre [5].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Warren

Soulsby

Puxty

et al. 2017

Ann. Intensive Care

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ObjectivesThe prevalence of liver cirrhosis is increasing, and many patients have acute conditions requiring consideration of intensive care. This study aims to: (a) report the outcome at 12 months of patients with cirrhosis admitted to ICU, (b) identify factors predictive of long-term mortality and (c) evaluate the ability of scoring systems to predict long-term outcome.DesignObservational cohort study.SettingGeneral adult critical care unit in a UK teaching hospital.PatientsEighty-four patients admitted to critical care between June 2012 and December 2013.Primary outcome measuresCumulative survival at ICU discharge, hospital discharge and 12 months.ResultsEighty-four patients with diagnosed cirrhosis were followed up at 12 months. Clinical variables collected at ICU admission were entered into a multivariate regression analysis for mortality and eight predetermined scoring systems calculated. Cumulative survival at ICU discharge, hospital discharge and 12 months was 64.8, 47.1 and 44.1%, respectively. Twelve months of cumulative survival in patients with Child–Pugh class A was 100%, class B was 50% and class C was 25% (log rank p = 0.002). Independent predictors of mortality at 12 months were lactate, bilirubin, PT ratio and age. The Child–Pugh + Lactate score was modified to produce an objective score comprising Albumin, Bilirubin and Clotting (PT ratio) added to serum lactate concentration in mmol L−1 (ABC + Lactate). This score was the best predictor of 12-month survival, with an AUC of 0.83. A proposed classification by ABC + Lactate score was highly significant (p = 0.001), with those in the highest class having ICU mortality of 75% and hospital and 12-month mortality of 93%.ConclusionsPatients with cirrhosis admitted to ICU have high initial mortality but low mortality after hospital discharge. Child–Pugh class at ICU admission predicts outcome at 12 months. The ABC + Lactate classification system may be useful in identifying critically ill cirrhotic patients with very high long-term mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Warren

Soulsby

Puxty

et al. 2017

Ann. Intensive Care

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“…The same group have recently presented the clinical data from a large double-blind, randomised, placebo-controlled trial of ITF (15 g/d) in 103 patients with active CD ( 211 ) . Analysed on an intention-to-treat basis, there were no significant differences in disease activity or the numbers entering disease remission between groups.…”

Section: Prebiotic Effects and Gastro-intestinal Disordersmentioning

confidence: 99%

“…Of the identified clinical trials of ingredients showing a prebiotic effect in IBD, numerous limitations in their reporting and trial design have been highlighted. First, a number have only been published as conference abstracts ( 205 , 210 , 211 ) , therefore impeding detailed data extraction. Many of the studies used different compounds, some with unconfirmed prebiotic properties, and in different doses.…”

Section: Prebiotic Effects and Gastro-intestinal Disordersmentioning

confidence: 99%

Prebiotic effects: metabolic and health benefits

et al. 2010

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The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, ‘normobiosis’ characterises a composition of the gut ‘ecosystem’ in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to ‘dysbiosis’, in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in ‘prebiotic effects’), defined as: ‘The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.’ Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies.

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The Coexistence of Sjögren's Syndrome and Primary Biliary Cirrhosis: A Comprehensive Review

Sun

Zhang

et al. 2015

Clinic Rev Allerg Immunol

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Organ-specific and systemic autoimmune diseases share numerous features and often coexist in the same patient. Autoimmune cholangitis/primary biliary cirrhosis and Sjogren syndrome represent paradigmatic examples of the common grounds of different autoimmunity phenotypes based on similarities in clinical manifestations and immunopathogenesis. In fact, primary biliary cirrhosis and Sjogren's syndrome have both been coined as an autoimmune epithelitis in which apoptosis may be in both cases the key element to explain the organ-specific immune-mediated injury against the biliary and exocrine gland epithelia, respectively. Further, growing evidence supports in both diseases the view that B cells, T cytotoxic cells, and T helper cells are involved in chronic inflammation, likely via the altered expression of pro-inflammatory cytokines. The presence of estrogen receptors on the biliary and exocrine gland epithelia has been advocated as a key to the female predominance encountered in primary biliary cirrhosis and Sjogren's syndrome. Sadly, despite available data, therapeutic approaches remain largely unsatisfactory and recent studies with mechanistic approaches (as in the case of B cell depletion with rituximab) have been of partial benefit only. Future studies should focus on new molecular tools (single-cell transcriptomics, microRNA, epigenetics) to provide unique insights into common mechanisms.

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OC-003 No clinical benefit of prebiotics in the treatment of active Crohn's disease: a double-blind, randomised, placebo-controlled trial:

Cited by 4 publications

References 0 publications

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Prebiotic effects: metabolic and health benefits

The Coexistence of Sjögren's Syndrome and Primary Biliary Cirrhosis: A Comprehensive Review

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