Oral conditions are relatively common in patients with inflammatory bowel disease (IBD). However, the contribution of oral maladies to gut inflammation remains unexplored. Here, we investigated the effect of periodontitis on disease phenotypes of patients with IBD. In all, 60 patients with IBD (42 with ulcerative colitis [UC] and 18 with Crohn’s disease [CD]) and 45 healthy controls (HCs) without IBD were recruited for this clinical investigation. The effects of incipient periodontitis on the oral and gut microbiome as well as IBD characteristics were examined. In addition, patients were prospectively monitored for up to 12 months after enrollment. We found that, in both patients with UC and those with CD, the gut microbiome was significantly more similar to the oral microbiome than in HCs, suggesting that ectopic gut colonization by oral bacteria is increased in patients with IBD. Incipient periodontitis did not further enhance gut colonization by oral bacteria. The presence of incipient periodontitis did not significantly affect the clinical outcomes of patients with UC and CD. However, the short CD activity index increased in patients with CD with incipient periodontitis but declined or was unchanged during the study period in patients without periodontitis. Thus, early periodontitis may associate with worse clinically symptoms in some patients with CD.

Background: Although there is evidence about the beneficial effects of probiotics, their effects on aspirin-induced small bowel injuries have not been well examined. We evaluated the effects of the probiotic Lactobacillus gasseri OLL2716 (LG) on aspirin-induced small intestinal lesions, such as ulcers, erosions, reddened lesions, and bleeding. Summary: This study enrolled 64 patients who received aspirin for more than 1 month and provided written informed consent to be part of the study. The patients received 112 ml of yogurt containing LG or placebo twice daily for 6 weeks. Small bowel injuries were evaluated by capsule endoscopy before and after consuming the yogurt. The effect of LG on patient symptoms was also assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires before and after 6 weeks of treatment. There was no significant difference in any baseline characteristics and the number of small bowel mucosal breaks between the 2 groups. In contrast with the placebo group, the LG group had significantly fewer small bowel mucosal breaks and reddened lesions after 6 weeks (p < 0.01). The FSSG and GSRS scores were also significantly improved in the LG group but not in the placebo group. Key Messages: This double-blind, placebo-controlled study found that LG may be useful in reducing aspirin-induced small bowel injuries and in mitigating gastrointestinal symptoms.

Eosinophil phenotypes were investigated in peripheral blood and skin lesions from eight patients with bullous pemphigoid (BP). By Nycodenz density gradients fractionation, blood eosinophils were divided into two phenotypes; normodense (greater than 1.080 g/ml) and hypodense (less than or equal to 1.080 g/ml). Increased numbers of hypodense eosinophils were observed in the blood from all patients with BP. Immunocytochemical observations, using an EG2 monoclonal antibody to react with the secretion form of eosinophil cationic protein (ECP), revealed that EG2 was expressed in 86 +/- 3% of hypodense phenotypes and 3 +/- 2% of normodense phenotypes. Ultrastructurally, hypodense eosinophils were characterized by numerous spheroidal granules, each with a lytic crystalloid core. These indicate that the hypodense phenotype represents a cell in an activated state. Only eosinophils with immunocytochemical and morphological characteristics similar to hypodense phenotypes infiltrated around the basement membrane zone in involved skin of BP. Furthermore, direct adherence of eosinophils associated with degranulation into basal keratinocytes was seen at the sites of blistering lesions. Bullous fluids contained higher concentrations of ECP than sera as determined by a radioimmunosorbent assay; thus hypodense (activated) eosinophils may directly damage the basal keratinocytes by releasing their granule proteins, subsequently leading to dermo-epidermal separation.

Eosinophil cationic protein (ECP), one of the eosinophil granule proteins, is released during allergic reactions. We investigated the possibility of correlations among the serum levels of ECP, clinical activity, and eosinophil number in patients with atopic dermatitis (AD). Forty-four patients with AD and 25 normal, non-atopic subjects were studied. ECP was quantitated by a double antibody radioimmunoassay. The levels of serum ECP correlate with the grading of severity of clinical evaluations in AD. The patients with severe and moderate AD had significantly higher ECP concentrations than normal controls (p less than 0.001); mild AD had levels identical with those of control groups. A positive correlation was observed between the number of peripheral blood eosinophils and serum ECP levels in the severe cases (r = 0.67, p less than 0.05). Furthermore, these ECP levels significantly decreased in response to either improvement of clinical severity of AD or decreased numbers of blood hypodense eosinophils in anti-allergic drug-treated patients. No coefficient of correlation was observed between serum ECP and IgE levels. These findings indicate that eosinophils may release their granular contents, including ECP, into the peripheral circulation and/or inflammatory skin lesions and subsequently provoke a clinical exacerbation by stimulating allergic reactions.

A 62‐year‐old Japanese man had visited Rondonia in central Brazii on May 28, 1994, at which time he suffered insect bites on the left axiila and ieft chest regions. Three bites persisted and became tender and painfui. These areas developed into tender nodules with moderate serous drainage from a central pore. Malaise and an intermediate‐grade fever accompanied the eruption. The tender nodules continued after he returned to Japan on July 7. The diagnosis of furunculosis was made by his family physician, but treatment with oral cefdinir (300 mg per day) and naproxen (600 mg per day) for 2 days and application of ointment containing 0.1% gentamicin sulfate failed to resolve the lesions. The patient complained of a crawling sensation under the skin. Since a maggot was removed from the axillary lesion with the aid of the patient's fingers, he was referred to the Dermatology Clinic of the Kurume University Hospital on August 1, for evaluation of parasitic diseases. Physical examination revealed two firm furuncle‐like erythematous nodules, 2.0 cm in diameter, with a centrally placed 4 mm punctum on the left side of the chest (Fig. 1). There was serous drainage from each punctum and a motile larva was seen in each cavity. A lesion on the axilla had healed spontaneously. Laboratory tests were normal. Two florid lesions on the chest were surgically removed under local anesthesia with 0.5% lidocaine hydrochloride. Histologic examination revealed a mixed cell inflammatory infiltrate throughout the dermis with a tract containing a larva. Examination of the larva revealed a segmented ovoid organism, 1.5 × 0.5 cm in size (Fig. 2). The lesions healed completely within 2 weeks without further treatment. The larva removed by the patient was forwarded to the Department of Medical Zoology, Faculty of Medicine, Tokyo Medical and Dental University, and was identified as third instar larvae of Dermatobia hominis, the human botfly. The other two of the third instar larvae were transplanted under the skin of a rat and a mouse to obtain pupae or adults, but they failed to pupate and died.