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Current evidence suggests that impaired intestinal motility may facilitate gallstone formation by influencing biliary deoxycholate levels or by modulating interdigestive gall bladder motility (fig 2), although a primary intestinal defect in gallstone pathogenesis has not yet been demonstrated. In the cold war period, most interesting events, from a political point of view, occurred at the border between capitalist and communist systems, near the iron curtain. Similarly, the gall bladder and biliary tract can be viewed as the border between liver and intestinal tract, where many interesting things occur with profound impact on both systems. Combined efforts by researchers in the field of hepatology and gastrointestinal motility should brake down the Berlin wall of ignorance of one of the most common diseases in the Western world.

Following the introduction of an improved surveillance system for infectious intestinal disease outbreaks in England and Wales, the Public Health Laboratory Service Communicable Disease Surveillance Centre received reports of 26 outbreaks between 1 January 1992 and 31 December 1995 in which there was evidence for waterborne transmission of infection. In these 26 outbreaks, 1756 laboratory confirmed cases were identified of whom 69 (4%) were admitted to hospital. In 19 outbreaks, illness was associated with the consumption of drinking water from public supplies (10 outbreaks) or private supplies (9 outbreaks). The largest outbreak consisted of 575 cases. In 4 of the remaining 7 outbreaks, illness was associated with exposure to swimming pool water. Cryptosporidium was identified as the probable causative organism in all 14 outbreaks associated with public water supplies and swimming pools. Campylobacter was responsible for most outbreaks associated with private water supplies. This review confirms a continuing risk of cryptosporidiosis from chlorinated water supplies in England and Wales, and reinforces governmental advice to water utilities that water treatment processes should be rigorously applied to ensure effective particle removal. High standards of surveillance are important for prompt recognition of outbreaks and institution of control measures. As microbiological evidence of water contamination may be absent or insufficient to implicate a particular water supply, a high standard of epidemiological investigation is recommended in all outbreaks of suspected waterborne disease.

Fallstudie aus drei Regionen in Maputaland zur Datensammlung über verbreitete Krankheiten. Cholera und Diarrhoe machen fast 50 Prozent aus. Berücksichtigt werden demographische Daten und Unterschiede in der finanziellen Lage der Haushalte. Erhebliche Probleme gibt es mit der Reinhaltuung des Trinkwassers, sanitären Anlagen und medizinischer Betreuung. (DÜI-Wsl)

A specific group of plant and animal oligosaccharides does not suffer enzymatic digestion in the human upper intestinal tract, achieving the colon microbial ecosystem in intact form. The reason for that is their diverse glycosidic bond structure, in comparison with common energetic polysaccharides as starch or glycogen. In this complex ecosystem, these molecules serve as energy sources, via fermentation, of distinctive beneficial bacterial groups, mainly belonging to the Anaerostipes, Bifidobacterium, Coprococcus, Faecalibacterium, Lactobacillus, Roseburia and other genera. The main catabolic products of these fermentations are short-chain fatty acids (SCFA) as acetate, propionate and butyrate, which appear in high concentrations in the lumen around the colon mucosa. Acetate and propionate are associated to energetic purposes for enterocytes, hepatocytes and other cells. Butyrate is the preferred energy source for colonocytes where it controls their cell cycle; butyrate is able to induce cell cycle arrest and apoptosis in tumor colonocytes. These oligosaccharides that increase beneficial colon bacterial populations and induce SCFA production in this ecosystem are called prebiotics. Here, different sources and chemical structures for prebiotics are described, as well as their modulatory effect on the growth of specific probiotic bacterial groups in the colon, and how their fermentation renders diverse SCFA, with beneficial effects in gut health ; AC acknowledges support by Junta de Andalucía (AGR2011-7626) and CSIC (i-link0827). FL wishes to thank MINECO (Ministerio de Economía y Competitividad, Grant MINECO-14-RTC-2014-1525-2) and CDTI (Centro para el Desarrollo Tecnológico e Industrial, Grants IDI-20120896 and IDI-20120897) for financial support to JF. We also thank European Union H2020 Program (Grant UE-15-NOMORFILM-634588) for financial support to SRB.

This study aimed to evaluate the hematologic response and the serum and peritoneal fluid (PF) proteinogram of cattle affected by digestive diseases. Twenty-seven animals were distributed in two groups: GI (intestinal diseases) and GII (traumatic reticuloperitonitis, TRP). The animals were previously submitted to a physical exam. Subsequently, blood samples were collected to perform the complete blood count, determine the plasma protein and fibrinogen, and obtain the serum for proteinogram in polyacrylamide gel (SDS-PAGE). Simultaneously, PF was collected to perform physical and chemical evaluation and the electrophoretic profile (SDS-PAGE). ANOVA at the 5% probability level was used to compare the groups. The animals showed signs of apathy, dehydration, and gastrointestinal hypomotility in both groups. However, GI animals showed more significant clinical changes. The blood count of both groups (P > 0.05) showed leukocytosis due to neutrophilia and a regenerative left shift with hyperfibrinogenemia. The proteinogram of both body fluids allowed the identification of proteins albumin (ALB), transferrin (TRF), ceruloplasmin, haptoglobin, ?1-acid glycoprotein (?1-AGP), MW 23000 Da, ?1-antitrypsin, IgA, and IgG. The [PT] PF/[PT] blood serum ratio of each of the identified proteins increased, showing statistical differences between groups (P < 0.05) regarding PT, ALB, TRF, ?1-AGP, and IgG values, with GI animals showing the highest ratio. Intestinal diseases and TRP triggered a systemic and local response characterized by clinical, hematological, and serum and PF proteinogram alterations. The proteins ?1-GPA, haptoglobin, and TRF measured in PF were good inflammation biomarkers and useful as an auxiliary tool for the diagnosis and prognosis of digestive diseases in cattle.

Proceedings of: IPA 2015 / SPIE Biophotonics South America. Rio de Janeiro, Brazil, 22-26 May, 2015 ; Endoscopy is frequently used in the diagnosis of several gastro-intestinal pathologies as Crohn disease, ulcerative colitis or colorectal cancer. It has great potential as a non-invasive screening technique capable of detecting suspicious alterations in the intestinal mucosa, such as inflammatory processes. However, these early lesions usually cannot be detected with conventional endoscopes, due to lack of cellular detail and the absence of specific markers. Due to this lack of specificity, the development of new endoscopy technologies, which are able to show microscopic changes in the mucosa structure, are necessary. We here present a confocal endomicroscope, which in combination with a wide field fluorescence endoscope offers fast and specific macroscopic information through the use of activatable probes and a detailed analysis at cellular level of the possible altered tissue areas. This multi-modal and multi-scale imaging module, compatible with commercial endoscopes, combines near-infrared fluorescence (NIRF) measurements (enabling specific imaging of markers of disease and prognosis) and confocal endomicroscopy making use of a fiber bundle, providing a cellular level resolution. The system will be used in animal models exhibiting gastro-intestinal diseases in order to analyze the use of potential diagnostic markers in colorectal cancer. In this work, we present in detail the set-up design and the software implementation in order to obtain simultaneous RGB/NIRF measurements and short confocal scanning times. ; The authors acknowledge support from EC FP7 IMI project PREDICT-TB, the EC FP7 CIG grant HIGH-THROUGHPUT TOMO, the Spanish MINECO project grant FIS2013-41802-R MESO-IMAGING, and TOPUS S2013/MIT-3024 project from the regional government of Madrid ; Publicado

OBJETIVO: Determinar la asociación causal entre parasitosis intestinal y artritis reactiva (ARe). MATERIAL Y MÉTODOS: Estudio de casos y controles. El grupo de casos comprendió 31 pacientes con diagnóstico de ARe internados en el Hospital Militar Central de Lima durante los años 1994-1995. El grupo control abarcó a 31 pacientes sin ARe. La información se recogió de las historias clínicas que correspondían tanto a personal civil como militar. RESULTADOS: En el grupo de casos, 11 pacientes (35,48%) tuvieron parasitosis intestinal; 12 pacientes (38,71%) presentaron eosinofilia que remitió con albendazol y/o metronidazol, con mejoría evidente del cuadro clínico; y 8 pacientes (25,81%) no tuvieron parasitosis ni eosinofilia. En el grupo control la proporción fue 7 (22,58%), 5 (16,13%) y 19 pacientes (61,29%), respectivamente. CONCLUSIÓN: Existe una fuerte asociación entre la exposición a parásitos intestinales y ARe (OR = 4,5; p <0,05), pudiendo existir un sinergismo en el efecto artritogénico debido a poliparasitismo. Los parásitos más frecuentemente hallados fueron Ascaris lumbricoides (7/11) y Ancylostoma duodenale (5/11). ; OBJECTIVE: To determine the causal relationship existent between intestinal parasitic infestations and reactive arthritis (ReA). MATERIAL AND METHODS: A case-control trial with patients admitted to the Hospital Militar Central of Lima, 31 of them were diagnosed as having ReA between 1994 and 1995 (control group) and 31 ReA-free patients. Data were obtained from medical records. RESULTS: In the case group, 11 patients (35,48%) had intestinal parasites; 12 (38,71%) presented albendazol- and/or metronidazol-sensitive eosinophilia decreasing with clinical improvement after treatment; and 8 (25,81%) had neither parasites diseases nor eosinophilia. In the control group, the distribution was 7 (22,58%), 5 (16,13%) and 19 patients (61,29%), respectively. CONCLUSION: We found a strong correlation between intestinal parasitic infestations and ReA (OR = 4,5; p <0,05), and parasitic infections may have a synergic arthritogenic effect. Ascaris lumbricoides (7/11) and Ancylostoma duodenale (5/11) were the commonest parasites.

The gut microbiota – the collection of micro-organisms in the gut – can best be viewed as a newly discovered organ, defined as a group of adjacent cells with a function. The gut microbiota, in fact, fulfils a number of important functions: it digests our food, synthesizes amino acids, trains our immune system, and helps resist gastrointestinal infections. The composition and functions of the gut microbiota can therefore have a large impact on our health. In this thesis the role of the gut microbiota in intestinal disorders is systematically analysed using DNA sequencing techniques. The intestinal disease we focus on most is inflammatory bowel disease (IBD), a recurrent remittent inflammatory disease of the gut that comprises Crohn's disease and ulcerative colitis. However, irritable bowel syndrome (IBS), traditionally characterized as a functional disorder consisting of a combination of gut complaints, and bacterial gastroenteritis, a bacterial infection often leading to diarrhoea, were also investigated. One of the most important discoveries of this thesis is the relationship between use of proton pump inhibitors (PPIs), one of most prescribed drugs in Europe and the United States, and the gut microbiota. PPIs work by reducing stomach acid, normally an important barrier to bacteria entering the intestinal tract, and we observed that bacteria normally found in the mouth were now present in the gut of PPI users. PPI users also have a more pro-inflammatory gut microbiota, showing a decrease in favourable butyrate-producing bacteria and an increase in the Enterobacteriaceae that can produce toxin. As a consequence, PPI users are more susceptible to both bacterial gastroenteritis, e.g. that caused by Salmonella spp, and to Clostridium difficile infections. After these results were published in 2016, government officials began to question whether PPIs should remain available as over-the-counter drugs in grocery stores, and this debate was still ongoing as of the writing of this thesis. This discovery received a lot of media attention in the written press: De Telegraaf, Reuters and Scientific American, on the radio: RTV Noord and BNR Nieuwsradio and on the television show Kassa. Another important discovery, the gut metagenomes of IBD and IBS are compared to those of population controls and are described in great detail using the metagenomic sequencing technique. With this technique, we were able to both determine the composition of the gut microbiome and infer its function, strain diversity, the level of virulence and the level of antibiotic resistance, leading to thousands of new results. We also present a computer algorithm that uses gut metagenomes to reliably distinguish IBD from IBS (AUC=0.93), performing much better than faecal calprotectin, which is currently used as a marker to distinguish between the two conditions. In the future, a gut microbiome-based test could reduce the number of painful and costly colonoscopies. This discovery was published in the renowned journal Science Translation Medicine and the Dutch television programme Editie NL on RTL4 discussed its importance for patients with irritable bowel syndrome. The results of this thesis allow us to better understand intestinal disesases and to work towards microbiota-based diagnostics and therapeutics.

Two articles published earlier this year in the International Journal of Epidemiology [1,2] have re-ignited the debate over the World Health Organizations long-held recommendation of mass-treatment of intestinal helminths in endemic areas. In this note, we discuss the content and relevance of these articles to the policy debate, and review the broader research literature on the educational and economic impacts of deworming. We conclude that existing evidence still indicates that mass deworming is a cost-effective health investment for governments in low-income countries where worm infections are widespread.

Vasoactive intestinal peptide (VIP) is a neuropeptide with potent immunoregulatory properties. Reduced serum VIP levels and alterations in VIP receptors/signaling on immune cells have been associated with different inflammatory/autoimmune diseases. However, its role in autoimmune thyroid diseases (AITD) remains unknown. This study examined the interrelationship between VIP system, autoimmune background and thyroid hormones in peripheral immune cells in patients with AITD. Only Graves' disease (GD) patients showed significantly lower serum VIP levels when compared to healthy subjects and to Hashimoto's thyroiditis patients. Serum VIP levels were lower at the onset of GD, showing a significant negative correlation with thyroid hormone levels. The expression of VIP receptors, VPAC1 and VPAC2, was significantly upregulated in peripheral blood mononuclear cells (PBMC) from GD patients. There was an impairment of VIP signalling in these patients, probably attributable to a dysfunction of VPAC1 with preservation of VPAC2. The correlation between VPAC1 and thyroid hormone receptor expression in PBMC from healthy subjects was lost in GD patients. In summary, the VIP system is altered in peripheral immune cells of GD patients and this finding is associated with different thyroid hormone receptor patterns, showing a dynamic inter-regulation and a prominent role of VIP in this setting. ; This work has been supported by Instituto de Salud Carlos III, Spain, cofinanced by FEDER, European Union: RETICS program, Red de Investigación en Inflamación y Enfermedades Reumáticas (RD16/0012/0008, PI17/00027, PI16-02091, PIE13-0004) and from Consejería de Educación, Juventud y Deporte, Comunidad de Madrid: B2017/BMD3724

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in a spectrum of clinical presentations. Evidence from Africa indicates that significantly less COVID-19 patients suffer from serious symptoms than in the industrialized world. We and others previously postulated a partial explanation for this phenomenon, being a different, more activated immune system due to parasite infections. Here, we aimed to test this hypothesis by investigating a potential correlation of co-infection with parasites with COVID-19 severity in an endemic area in Africa. Methods: Ethiopian COVID-19 patients were enrolled and screened for intestinal parasites, between July 2020 and March 2021. The primary outcome was the proportion of patients with severe COVID-19. Ordinal logistic regression models were used to estimate the association between parasite infection, and COVID-19 severity. Models were adjusted for sex, age, residence, education level, occupation, body mass index, and comorbidities. Findings: 751 SARS-CoV-2 infected patients were enrolled, of whom 284 (37.8%) had intestinal parasitic infection. Only 27/255 (10.6%) severe COVID-19 patients were co-infected with intestinal parasites, while 257/496 (51.8%) non-severe COVID-19 patients were parasite positive (p<0.0001). Patients co-infected with parasites had lower odds of developing severe COVID-19, with an adjusted odds ratio (aOR) of 0.23 (95% CI 0.17–0.30; p<0.0001) for all parasites, aOR 0.37 ([95% CI 0.26–0.51]; p<0.0001) for protozoa, and aOR 0.26 ([95% CI 0.19–0.35]; p<0.0001) for helminths. When stratified by species, co-infection with Entamoeba spp., Hymenolepis nana, Schistosoma mansoni, and Trichuris trichiura implied lower probability of developing severe COVID-19. There were 11 deaths (1.5%), and all were among patients without parasites (p = 0.009). Interpretation: Parasite co-infection is associated with a reduced risk of severe COVID-19 in African patients. Parasite-driven immunomodulatory responses may mute hyper-inflammation associated with severe COVID-19. Funding: European and Developing Countries Clinical Trials Partnership (EDCTP) – European Union, and Joep Lange Institute (JLI), The Netherlands.