No abstract

The gastric microbiota in Crohn’s disease (CD) has not been studied. The purpose of the study was to evaluate differences of stomach microbiota between CD patients and controls. DNA was extracted from gastric mucosal and fluid samples, from 24 CD patients and 19 controls. 16S rRNA gene sequencing identified 1511 operational taxonomic units (OTUs), of which 239 passed the low abundance and low variance filters. All but one CD patients were HP negative. Fifteen bacterial phyla were identified in at least one mucosal or fluid site. Of these, Bacteroidota and Firmicutes accounted for 70% of all phyla. Proteobacteria, Actinobacteriota, and Fusobacteriota combined accounted for 27%. There was significant difference in the relative abundance of Bacteroidota, Proteobacteria, Fusobacteriota, and Campilobacterota between CD patients and controls only in gastric corpus samples. In gastric liquid, there was a significant difference only in Actinobacteriota. Pairwise comparison identified 67 differentially abundant OTUs in at least one site. Of these, 13 were present in more than one comparison, and four differentiating OTUs (Neisseriaceae, Neisseria, Absconditabacteriales, and Microbacteriaceae) were identified at all tested sites. The results reveal significant changes in gastric microbial profiles (beta diversity, phylum, and individual taxa levels) between H. pylori-negative CD patients and controls.

Crohn’s disease (CD) may affect the entire gastrointestinal tract including its upper part. However, this aspect is poorly addressed in scientific literature and considered a rare finding. Here we aimed to prospectively investigate the prevalence, characteristics and clinical significance of upper gastrointestinal tract involvement in patients with CD, with particular focus on stomach bamboo joint-like appearance (BJA), Helicobacterpylori status and presence of microscopic changes. 375 prospectively recruited patients were included. In CD patients the prevalence of gastric and duodenal, but not esophageal, mucosal lesions, such as gastric mucosal inflammation, duodenal edema, ulcerations, and duodenal bulb deformation was significantly higher (at least p < 0.01 for all). Similar results were found when only H.pylori negative individuals were analyzed. Moreover, BJA of the stomach and in case of H.pylori negative patients also duodenal bulb deformation were detected exclusively in CD patients. Presence of BJA lesion was not significantly associated with neither duration of the disease nor use/history of biologic treatment. Despite absence of H.pylori infection microscopic features of chronic gastritis were found in almost all (93.5%) patients, and in 31% of controls (p < 0.00001). Our analysis outlines that upper gastrointestinal tract involvement in CD is a very common event and frequently manifests with a highly specific BJA lesion. Furthermore, our study reveals that in almost all CD patients features of H.pylori negative gastritis are present.

Background Scientific data indicates that in the course of Crohn’s disease (CD), certain endoscopic abnormalities in the upper gastrointestinal tract (UGIT), such as bamboo joint-like appearance (BJA) in the stomach, may be frequently present. However, there are not many clinical analyses available, in which prevalence of various endoscopic UGIT lesions would be comprehensively evaluated. The purpose of the study was to investigate the characteristic of UGIT involvement in CD, with a particular focus on the Helicobacter pylori (Hp) status, BJA lesions and presence of microscopic changes in the stomach. Methods A total of 565 consecutive patients were prospectively recruited into the study (98 with CD and 467 controls). All individuals underwent upper esophagogastroduodenoscopy (EGD) with biopsy using a high definition endoscope with narrow band image. Chi-square and t-student tests were used for statistical analysis. Results The majority of CD patients (n=77; 79%) were found to have different abnormalities in EGD. Most commonly these were found in the stomach (n = 73; 74%), followed by duodenum (n= 39; 40%) and oesophagus (n=6; 6%). Mucosal redness/edema, BJA in the proximal part of the body and/or fundus, as well as antral erosions were the most prevalent gastric lesions. BJA was present in 44 (45%) of CD patients, and in one individual from the control group (0.002%), p&lt;0.00001. BJA presence among CD patients was irrespective of sex, age, location, duration, intensity or course of the disease, as well as medications taken. Ulcerations and erosions were most commonly found lesions in the duodenum. Most of the CD patients were Hp negative (n = 94; 95.9%), while in the control group the majority of individuals were infected with Hp (57,1%), p&lt;0.0001. Comparison between Hp negative patients with CD and controls revealed that gastric BJA lesions, duodenal ulcers and erosions were present exclusively in CD. These lesions were accompanied by chronic microscopic gastritis in all cases. Finally, the prevalence of microscopic HP negative gastritis was significantly higher in patients with CD than in controls (95.7% vs 15%, p&lt;0.0002). Conclusion Our results demonstrated that chronic Hp negative gastritis is present in nearly all CD patients, and is strongly associated with presence of gastric BJA lesions, as well as ulcerations and erosions of the duodenum. Furthermore, the results of our study support previously reported observations that BJA is a specific lesion for CD and may be used as an endoscopic diagnostic marker. This work was financed by the Program of the Minister of Science and Higher Education - “Regional Initiative of Excellence” in 2019–2022, no. 002/RID/2018/19.

The case of a 76-year-old patient, with a history of melanoma, admitted to the department of gastroenterology with symptoms of hypovolemic shock, caused by massive  gastrointestinal bleeding. Clot-covered melanoma metastases were detected in both gastroduodenoscopy and colonoscopy. Gastrointestinal melanoma metastases are found in the majority of patients with advanced melanoma during autopsy; however, they are rarely detected in intravital studies and can be misdiagnosed as other benign lesions in endoscopy. In cases of patients with history of melanoma, metastases should be considered as the cause of non-specific abdominal symptoms, anemia, or bleeding from the gastrointestinal tract.