Background The gut microbiome of patients with inflammatory bowel diseases (IBD) is characterized by increased longitudinal variability. It remains unknown if this is caused by increased instability of the microbiome to external factors. We investigated the influence of osmotic diarrhea induced by bowel preparation as an external source of irritation on the gut microbiome in IBD patients and healthy comparators.

Abstract Background Anti-TNF therapy is still the most frequently used first-line biologic treatment in inflammatory bowel disease (IBD). This study aimed to determine length of treatment persistence and to describe reasons for discontinuation of first-line anti-TNF therapy used in the standard care of IBD patients. Methods A single-center, real-world, retrospective study including IBD patients (Crohn’s disease (CD), ulcerative colitis (UC), IBD unclassified (IBD-U)), who received an anti-TNF therapy in the last 20 years at the study center, was conducted. Length of first-line anti-TNF therapy, differences in treatment duration between infliximab (IFX) and adalimumab (ADA) and between CD and UC, reasons for discontinuation, side effects leading to cessation, treatment following first-line anti-TNF therapy, rates of surgery and death, and factors being associated with treatment failure were assessed. Results 586 patients were identified as having received first-line anti-TNF therapy at the study center. 48 patients were excluded due to shortness of available data. 538 patients (CD: 367, UC: 147, IBD-U: 24) with a median follow-up of 8.1 years were included in the analysis. Median (IQR) treatment persistence was 21.0 (6.0, 57.0) months in the total cohort. Treatment withdrawal arose frequently (40%) within the first year of therapy and treatment persistence was longer in CD compared to UC (CD: 27.0 (8.0, 71.0) months, UC: 11.0 (3.0, 34) months, p<0.001). Treatment failure (51%) and side effects (24%) were the most commonly noticed reasons for withdrawal from therapy. 14% withdrew from therapy due to remission. The diagnosis of UC, female sex, the absence of prior intestinal resections, lower hemoglobin and albumin levels at anti-TNF initiation predicted treatment failure. Patients with CD continued ADA treatment longer than IFX treatment (ADA: (40.5 (14.2, 80.5) months, IFX: 18.0 (4.8, 65.0) months, p<0.001). Within the follow-up period, 17% of UC patients underwent colectomy and 34% of CD patients had at least one intestinal resection after start of first-line anti-TNF therapy. 2% of all patients died due to various reasons. Conclusion Treatment persistence of first-line anti-TNF therapy is limited in IBD patients due to a large proportion of treatment failures and side effects.

Einleitung Obwohl IgG4 nur einen geringen Anteil der Serum-Immunglobuline ausmacht und bei immunologischen Mechanismen eine untergeordnete Rolle spielt, steigt die Prävalenz der IgG4- assoziierten Erkrankungen. Nahezu alle Organe können betroffen sein, wobei ein Befall der Speiseröhre selten auftritt. Anhand eines rezenten Falls berichten wir über die Schwierigkeiten der Diagnosestellung sowie der Therapie.

Double-blind randomised studies investigating faecal microbiota transplantation (FMT) in chronic active ulcerative colitis (UC) have shown promising results so far. Factors influencing the efficacy of FMT in UC still remain unclear. FMT protocols for the treatment of UC patients vary in dose, frequency, route of application and donor stool preparation and might thus influence remission rates. The aim of this analysis was to find clinical predictors for non-response to FMT in UC. 54 patients suffering from chronic active ulcerative colitis were treated with repeated FMT (5 times every second week) using the same protocol with the exception of donor stool preparation. Thirty patients (mean age 37 y ± 9) were treated with frozen donor stool (mixed with sodium chloride and glycerol, stored at −80°C) and 24 patients (mean age 43 y ± 14) with freshly prepared donor stool (not older than 6 h). Remission and response were determined by total Mayo score (TMS) before FMT and at Day 90. Clinical response was defined as a decrease of ≥3 points in TMS from baseline, along with either a decrease of >1 point in the rectal bleeding subscore or the absolute rectal bleeding subscore of 0 or 1. Remission was defined as a TMS <2 and an endoscopic subscore of 0 or 1. Clinical data as well as blood and stool analysis were assessed at any time point and potential predictors for non-response were calculated using regression analysis. At baseline patients had a total Mayo score of 9.0 ± 2.0 and an endoscopic subscore of 2.5 ± 1.0. 65% of patients had failed previous biologic therapy and 70% previous immunosuppressive treatment. In total 59% of patients responded to FMT, 24% achieved remission while 41% showed no response. The mean total Mayo score dropped to 5.3 ± 3.2 at Day 90. Non-response to biologics (hazard ratio (HR): 0.23 (95% CI 0.06–0.85), p: 0.03), a total Mayo score before FMT ≥9 (HR: 0.26 (95% CI 0.07–0.95), p: 0.04) and a high endoscopic subscore before FMT (HR: 0.27 (0.10–0.69, p < 0.01) were associated with lower remission rates. There was no significant difference in decrease of TMS (p = 0.51) or in remission and response rates (p = 0.97), respectively in patients receiving fresh or frozen donor stool at Day 90. Failure to previous biologic treatment as well as a high total Mayo score and a high endoscopic subscore are associated with lower remission rates to FMT in chronic active ulcerative colitis.

Liver cirrhosis is accompanied by significant changes of the intestinal microbiome including the regression of beneficial and autochthonous taxa. Probiotics are said to modulate the microbiome and have been shown to be beneficial in cirrhosis patients. However, their effect on the microbiome in cirrhosis has not been comprehensively studied yet.

Anhand doppelblinder, randomisierter Studien konnte kürzlich die Überlegenheit der fäkalen Mikrobiota-Transplantation (FMT) im Vergleich zu Placebo bei der Behandlung der aktiver Colitis ulcerosa (CU) gezeigt werden. Durch unterschiedliche Ergebnisse bei verschiedenen FMT-Protokollen sind jedoch hierfür noch viele Fragen offen. Die Verwendung von gefrorenem Spenderstuhl zur FMT bei Clostridium difficile-Infektionen hat sich als genauso wirksam erwiesen wie frischer Spenderstuhl. Das Ziel dieser Studie war es, die klinische Wirksamkeit von gefrorenem Stuhl für die FMT auch bei Colitis ulcerosa zu untersuchen.

Hintergrund: Das Auftreten einer sekundären Amyloidose ist eine seltene, schwerwiegende Komplikation des Morbus Crohn (MC) und mit einer sehr ungünstigen Prognose vergesellschaftet. Die 5 Jahresmortalität liegt in historischen Arbeiten zwischen 11 und 90%, wobei die Nierenbeteiligung den lebenslimitierenden Faktor darstellt. Der Einfluss einer kombinierten immunsuppressiven Therapie auf den Krankheitsverlauf ist durch die Seltenheit diese Fälle bisher unklar.