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        Relationship between the gut microbiota and bile acid composition in the ileal mucosa of Crohn’s disease

        Shigeki Bamba,Osamu Inatomi,Atsushi Nishida,Masashi Ohno,Takayuki Imai,Kenichiro Takahashi,Yuji Naito,Junichi Iwamoto,Akira Honda,Naohiro Inohara,Akira Andoh 대한장연구학회 2022 Intestinal Research Vol.20 No.3

        Background/Aims: Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD).Methods: Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing.Results: The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (<i>P</i>=0.039). The relative abundance of <i>Escherichia</i> was significantly higher and that of <i>Faecalibacterium</i> and <i>Roseburia</i> was significantly lower in CD samples than in non-CD controls. The increased abundance of <i>Escherichia</i> was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera <i>Escherichia</i> and <i>Lactobacillus</i> were positively correlated with the proportion of conjugated bile acids. On the other hand, <i>Roseburia</i>, <i>Intestinibacter</i>, and <i>Faecalibacterium</i> were negatively correlated with the proportion of conjugated bile acids.Conclusions: Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.

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        Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine

        ( Yasuhiro Morita ),( Shigeki Bamba ),( Osamu Inatomi ),( Kenichiro Takahashi ),( Takayuki Imai ),( Masaki Murata ),( Masashi Ohno ),( Masaya Sasaki ),( Tomoyuki Tsujikawa ),( Akira Andoh ) 대한장연구학회 2020 Intestinal Research Vol.18 No.2

        Background/Aims: We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE. Methods: Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points. Results: The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test). Conclusions: In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102) (Intest Res 2020;18:229-237)

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        Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series

        ( Kenichiro Takahashi ),( Shigeki Bamba ),( Masahiro Kawahara ),( Atsushi Nishida ),( Osamu Inatomi ),( Masaya Sasaki ),( Tomoyuki Tsujikawa ),( Ryoji Kushima ),( Mitsushige Sugimoto ),( Katsuyuki Kit 대한장연구학회 2018 Intestinal Research Vol.16 No.4

        The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying single-balloon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma. (Intest Res 2018;16:628-634)

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