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Imdad S, Kim JH, So B, Jang J, Park J, Lim W, Lee YK, Shin WS, Hillyer T, Kang C. Effect of aerobic exercise and particulate matter exposure duration on the diversity of gut microbiota. Anim Cells Syst (Seoul) 2024; 28:137-151. [PMID: 38601060 PMCID: PMC11005883 DOI: 10.1080/19768354.2024.2338855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
Inhalation of ambient particulate matter (PM) can disrupt the gut microbiome, while exercise independently influences the gut microbiome by promoting beneficial bacteria. In this study, we analyzed changes in gut microbial diversity and composition in response to combined interventions of PM exposure and aerobic exercise, extending up to 12 weeks. This investigation was conducted using mice, categorized into five groups: control group (Con), exercise group (EXE), exercise group followed by 3-day exposure to PM (EXE + 3-day PM), particulate matter exposure (PM), and PM exposure with concurrent treadmill exercise (PME). Notably, the PM group exhibited markedly lower alpha diversity and richness compared to the Con group and our analysis of beta diversity revealed significant variations among the intervention groups. Members of the Lachnospiraceae family showed significant enhancement in the exercise intervention groups (EXE and PME) compared to the Con and PM groups. The biomarker Lactobacillus, Coriobacteraceae, and Anaerofustis were enriched in the EXE group, while Desulfovibrionaceae, Mucispirillum schaedleri, Lactococcus and Anaeroplasma were highly enriched in the PM group. Differential abundance analysis revealed that Paraprevotella, Bacteroides, and Blautia were less abundant in the 12-week PM exposure group than in the 3-day PM exposure group. Moreover, both the 3-day and 12-week PM exposure groups exhibited a reduced relative abundance of Bacteroides uniformis, SMB53, and Staphylococcus compared to non-PM exposure groups. These findings will help delineate the possible roles and associations of altered microbiota resulting from the studied interventions, paving the way for future mechanistic research.
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Affiliation(s)
- Saba Imdad
- Laboratory of Molecular Metabolism in Health & Disease, Sport Science Research Institute, Inha University, Incheon, South Korea
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju, South Korea
| | - Jin-Hee Kim
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju, South Korea
| | - Byunghun So
- Laboratory of Molecular Metabolism in Health & Disease, Sport Science Research Institute, Inha University, Incheon, South Korea
| | - Junho Jang
- Laboratory of Molecular Metabolism in Health & Disease, Sport Science Research Institute, Inha University, Incheon, South Korea
| | - Jinhan Park
- Laboratory of Molecular Metabolism in Health & Disease, Sport Science Research Institute, Inha University, Incheon, South Korea
| | - Wonchung Lim
- Department of Sports Medicine, College of Health Science, Cheongju University, Cheongju, South Korea
| | - Yoon-Kwang Lee
- Department of Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Woo Shik Shin
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Trae Hillyer
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Chounghun Kang
- Laboratory of Molecular Metabolism in Health & Disease, Sport Science Research Institute, Inha University, Incheon, South Korea
- Department of Physical Education, College of Education, Inha University, Incheon, South Korea
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Imdad S, So B, Jang J, Park J, Lee SJ, Kim JH, Kang C. Temporal variations in the gut microbial diversity in response to high-fat diet and exercise. Sci Rep 2024; 14:3282. [PMID: 38332014 PMCID: PMC10853223 DOI: 10.1038/s41598-024-52852-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
High-fat diet-induced obesity is a pandemic caused by an inactive lifestyle and increased consumption of Western diets and is a major risk factor for diabetes and cardiovascular diseases. In contrast, exercise can positively influence gut microbial diversity and is linked to a decreased inflammatory state. To understand the gut microbial variations associated with exercise and high-fat diet over time, we conducted a longitudinal study to examine the effect of covariates on gut microbial diversity and composition. Young mice were divided into four groups: Chow-diet (CHD), high-fat diet (HFD), high-fat diet + exercise (HFX), and exercise only (EXE) and underwent experimental intervention for 12 weeks. Fecal samples at week 0 and 12 were collected for DNA extraction, followed by 16S library preparation and sequencing. Data were analyzed using QIIME 2, R and MicrobiomeAnalyst. The Bacteroidetes-to-Firmicutes ratio decreased fivefold in the HFD and HFX groups compared to that in the CHD and EXE groups and increased in the EXE group over time. Alpha diversity was significantly increased in the EXE group longitudinally (p < 0.02), whereas diversity (Shannon, Faith's PD, and Fisher) and richness (ACE) was significantly reduced in the HFD (p < 0.005) and HFX (p < 0.03) groups over time. Beta diversity, based on the Jaccard, Bray-Curtis, and unweighted UniFrac distance metrics, was significant among the groups. Prevotella, Paraprevotella, Candidatus arthromitus, Lactobacillus salivarius, L. reuteri, Roseburia, Bacteroides uniformis, Sutterella, and Corynebacterium were differentially abundant in the chow-diet groups (CHD and EXE). Exercise significantly reduced the proportion of taxa characteristic of a high-fat diet, including Butyricimonas, Ruminococcus gnavus, and Mucispirillum schaedleri. Diet, age, and exercise significantly contributed to explaining the bacterial community structure and diversity in the gut microbiota. Modulating the gut microbiota and maintaining its stability can lead to targeted microbiome therapies to manage chronic and recurrent diseases and infections.
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Affiliation(s)
- Saba Imdad
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon, 22212, South Korea
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju, 28503, South Korea
| | - Byunghun So
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon, 22212, South Korea
| | - Junho Jang
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon, 22212, South Korea
| | - Jinhan Park
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon, 22212, South Korea
| | - Sam-Jun Lee
- Department of Sport Rehabilitation, College of Health, Welfare, and Education, Tong Myong University, Busan, 48520, South Korea
| | - Jin-Hee Kim
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju, 28503, South Korea.
| | - Chounghun Kang
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon, 22212, South Korea.
- Department of Physical Education, College of Education, Inha University, Incheon, 22212, South Korea.
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Imdad S, Lim W, Kim JH, Kang C. Intertwined Relationship of Mitochondrial Metabolism, Gut Microbiome and Exercise Potential. Int J Mol Sci 2022; 23:ijms23052679. [PMID: 35269818 PMCID: PMC8910986 DOI: 10.3390/ijms23052679] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023] Open
Abstract
The microbiome has emerged as a key player contributing significantly to the human physiology over the past decades. The potential microbial niche is largely unexplored in the context of exercise enhancing capacity and the related mitochondrial functions. Physical exercise can influence the gut microbiota composition and diversity, whereas a sedentary lifestyle in association with dysbiosis can lead to reduced well-being and diseases. Here, we have elucidated the importance of diverse microbiota, which is associated with an individual's fitness, and moreover, its connection with the organelle, the mitochondria, which is the hub of energy production, signaling, and cellular homeostasis. Microbial by-products, such as short-chain fatty acids, are produced during regular exercise that can enhance the mitochondrial capacity. Therefore, exercise can be employed as a therapeutic intervention to circumvent or subside various metabolic and mitochondria-related diseases. Alternatively, the microbiome-mitochondria axis can be targeted to enhance exercise performance. This review furthers our understanding about the influence of microbiome on the functional capacity of the mitochondria and exercise performance, and the interplay between them.
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Affiliation(s)
- Saba Imdad
- Molecular Metabolism in Health & Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon 22212, Korea;
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju 28503, Korea
| | - Wonchung Lim
- Department of Sports Medicine, College of Health Science, Cheongju University, Cheongju 28503, Korea;
| | - Jin-Hee Kim
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju 28503, Korea
- Correspondence: (J.-H.K.); (C.K.)
| | - Chounghun Kang
- Molecular Metabolism in Health & Disease, Exercise Physiology Laboratory, Sport Science Research Institute, Inha University, Incheon 22212, Korea;
- Department of Physical Education, College of Education, Inha University, Incheon 22212, Korea
- Correspondence: (J.-H.K.); (C.K.)
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So B, Park J, Jang J, Lim W, Imdad S, Kang C. Effect of Aerobic Exercise on Oxidative Stress and Inflammatory Response During Particulate Matter Exposure in Mouse Lungs. Front Physiol 2022; 12:773539. [PMID: 35185596 PMCID: PMC8850364 DOI: 10.3389/fphys.2021.773539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022] Open
Abstract
Regular exercise provides several health benefits that can improve the cardiovascular and musculoskeletal systems, but clear evidence on the effect of exercise-induced hyperventilation in particulate matter (PM) exposure is still lacking. This study aimed to investigate the effects of exercise in PM exposure on reactive oxygen species (ROS) generation, inflammatory response, and mitochondrial integrity in human lung epithelial cells (A549), as well as in mouse lung tissue. In in vitro experiments, PM treatment was shown to significantly increased ROS production, and reduced cell viability and mitochondrial function in A549 cells. The mice were divided into four groups for an in vivo exercise experiment: control (CON), PM inhalation (PI), PM inhalation during exercise (PIE), and exercise (EX) groups. The PI and PIE groups were exposed to 100 μg/m3 of PM for 1 h per day for a week. The PIE and EX groups performed treadmill exercises every day for 1 h at 20 m/min for a week. The levels of pro-inflammatory markers (IL-6 and TNF-α) were significantly higher in the PI group than in the CON group (P < 0.001 and P < 0.01, respectively). The carbonyl protein level was decreased in EX vs. PI (P < 0.001). Mitochondrial fission (Drp1) content was significantly decreased in the EX vs. CON group (P < 0.01), but anti-mitochondrial fission (P-Drp1 Ser637) was increased in the EX vs. PI group (P < 0.05). Mitochondrial autophagy (mitophagy), which is an assessment of mitochondrial integrity, was markedly increased in PI vs. CON (P < 0.001), but the level was reversed in PIE (P < 0.05). Lung fibrosis was increased in PI vs. CON group (P < 0.001), however, the cells were rescued in the PIE (P < 0.001). The number of apoptotic cells was remarkably increased in the PI vs. CON group (P < 0.001), whereas the level was decreased in the PIE (P < 0.001). Taken together, these results showed that short-term exposure to PM triggers oxidative stress, pro-inflammatory responses, and apoptosis in the lungs, but the PM-induced adverse effects on the lung tissue are not exacerbated by exercise-induced PM hyperventilation but rather has a protective effect.
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Affiliation(s)
- Byunghun So
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Inha University, Incheon, South Korea
| | - Jinhan Park
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Inha University, Incheon, South Korea
| | - Junho Jang
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Inha University, Incheon, South Korea
| | - Wonchung Lim
- Department of Sports Medicine, College of Health Science, Cheongju University, Cheongju, South Korea
| | - Saba Imdad
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Inha University, Incheon, South Korea
- Department of Biomedical Laboratory Science, College of Health Science, Cheongju University, Cheongju, South Korea
| | - Chounghun Kang
- Molecular Metabolism in Health and Disease, Exercise Physiology Laboratory, Inha University, Incheon, South Korea
- Department of Physical Education, College of Education, Inha University, Incheon, South Korea
- *Correspondence: Chounghun Kang,
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Batool N, Yoon S, Imdad S, Kong M, Kim H, Ryu S, Lee JH, Chaurasia AK, Kim KK. An Antibacterial Nanorobotic Approach for the Specific Targeting and Removal of Multiple Drug-Resistant Staphylococcus aureus. Small 2021; 17:e2100257. [PMID: 33838013 DOI: 10.1002/smll.202100257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/06/2021] [Indexed: 06/12/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) causes diseases ranging from skin infections to lethal sepsis and has become a serious threat to human health due to multiple-drug resistance (MDR). Therefore, a resistance-free antibacterial therapy is necessary to overcome MDR MRSA infections. In this study, an antibacterial nanorobot (Ab-nanobot) is developed wherein a cell wall-binding domain (CBD)-endolysin, acting as a sensor, is covalently conjugated with an actuator consisting of an iron oxide/silica core-shell. The CBD-endolysin sensor shows an excellent specificity to detect, bind, and accumulate on the S. aureus USA300 cell surface even in a bacterial consortium, and in host cell infections. Ab-nanobot specifically captures and kills MRSA in response to medically approved radiofrequency (RF) electromagnetic stimulation (EMS) signal. When Ab-nanobot receives the RF-EMS signal on the cell surface, actuator induces cell death in MRSA with 99.999% removal within 20 min by cell-wall damage via generation of localized heat and reactive oxygen species. The in vivo efficacy of Ab-nanobot is proven using a mice subcutaneous skin infection model. Collectively, this study offers a nanomedical resistance-free strategy to overcome MDR MRSA infections by providing a highly specific nanorobot for S. aureus.
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Affiliation(s)
- Nayab Batool
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Graduate School of Basic Medical Sciences (GSBMS), Sungkyunkwan University School of Medicine, Suwon, 16419, South Korea
- Institute of Microbiology, University of Agriculture, Faisalabad, 38000, Pakistan
| | - Seokyoung Yoon
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, 16419, South Korea
| | - Saba Imdad
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Graduate School of Basic Medical Sciences (GSBMS), Sungkyunkwan University School of Medicine, Suwon, 16419, South Korea
| | - Minsuk Kong
- Department of Food Science and Technology, Seoul National University of Science and Technology, Seoul, 01811, South Korea
| | - Hun Kim
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Graduate School of Basic Medical Sciences (GSBMS), Sungkyunkwan University School of Medicine, Suwon, 16419, South Korea
| | - Sangryeol Ryu
- Department of Food and Animal Biotechnology, Department of Agricultural Biotechnology, Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 151-921, South Korea
| | - Jung Heon Lee
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, Suwon, 16419, South Korea
| | - Akhilesh Kumar Chaurasia
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Graduate School of Basic Medical Sciences (GSBMS), Sungkyunkwan University School of Medicine, Suwon, 16419, South Korea
| | - Kyeong Kyu Kim
- Department of Precision Medicine, Institute for Antimicrobial Resistance Research and Therapeutics, Graduate School of Basic Medical Sciences (GSBMS), Sungkyunkwan University School of Medicine, Suwon, 16419, South Korea
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Imdad S, Batool N, Pradhan S, Chaurasia AK, Kim KK. Identification of 2',4'-Dihydroxychalcone as an Antivirulence Agent Targeting HlyU, a Master Virulence Regulator in Vibrio vulnificus. Molecules 2018; 23:E1492. [PMID: 29925801 PMCID: PMC6099652 DOI: 10.3390/molecules23061492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022] Open
Abstract
The emergence of antimicrobial resistance and rapid acclimation allows Vibrio vulnificus to rapidly propagate in the host. This problematic pathological scenario can be circumvented by employing an antivirulence strategy, treating Vibrio infections without hindering the bacterial growth. We developed a genome-integrated orthogonal inhibitor screening platform in E. coli to identify antivirulence agents targeting a master virulence regulator of V. vulnificus. We identified 2′,4′-dihydroxychalcone (DHC) from the natural compound library and verified that it decreases the expression of the major toxin network which is equivalent to the ∆hlyU deletion mutant. 2′,4′-DHC also reduced the hemolytic activity of V. vulnificus which was tested as an example of virulence phenotype. The electrophoretic mobility shift assay confirmed that 2′,4′-DHC specifically targeted HlyU and inhibited its binding to PrtxA1 promoter. Under in vivo conditions, a single dose of 2′,4′-DHC protected ~50% wax-worm larvae from V. vulnificus infection at a non-toxic concentration to both V. vulnificus and wax-worm larvae. In the current study, we demonstrated that an orthogonal reporter system is suitable for the identification of antivirulence compounds with accuracy, and identified 2′,4′-DHC as a potent antivirulence agent that specifically targets the HlyU virulence transcriptional regulator and significantly reduces the virulence and infection potential of V. vulnificus.
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Affiliation(s)
- Saba Imdad
- Department of Molecular Cell Biology, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Suwon 16419, Korea.
| | - Nayab Batool
- Department of Molecular Cell Biology, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Suwon 16419, Korea.
| | - Subhra Pradhan
- Department of Molecular Cell Biology, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Suwon 16419, Korea.
| | - Akhilesh Kumar Chaurasia
- Department of Molecular Cell Biology, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Suwon 16419, Korea.
| | - Kyeong Kyu Kim
- Department of Molecular Cell Biology, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Suwon 16419, Korea.
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Imdad S, Chaurasia AK, Kim KK. Identification and Validation of an Antivirulence Agent Targeting HlyU-Regulated Virulence in Vibrio vulnificus. Front Cell Infect Microbiol 2018; 8:152. [PMID: 29868508 PMCID: PMC5958221 DOI: 10.3389/fcimb.2018.00152] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/23/2018] [Indexed: 12/19/2022] Open
Abstract
Antimicrobial resistance (AMR) in pathogens is the result of indiscriminate use of antibiotics and consequent metabolic/genetic modulation to evolve survival strategies and clonal-selection in AMR strains. As an alternative to antibiotic treatment, antivirulence strategies are being developed, not only to combat bacterial pathogenesis, but also to avoid emerging antibiotic resistance. Vibrio vulnificus is a foodborne pathogen that causes gastroenteritis, necrotizing wound infections, and sepsis with a high rate of mortality. Here, we developed an inhibitor-screening reporter platform to target HlyU, a master transcriptional regulator of virulence factors in V. vulnificus by assessing rtxA1 transcription under its control. The inhibitor-screening platform includes wild type and ΔhlyU mutant strains of V. vulnificus harboring the reporter construct PrtxA1::luxCDABE for desired luminescence signal detection and control background luminescence, respectively. Using the inhibitor-screening platform, we identified a small molecule, fursultiamine hydrochloride (FTH), that inhibits the transcription of the highly invasive repeat-in-toxin (rtxA1) and hemolysin (vvhA) along with other HlyU regulated virulence genes. FTH has no cytotoxic effects on either host cells or pathogen at the tested concentrations. FTH rescues host cells from the necrotic cell-death induced by RtxA1 and decreases the hemolytic activity under in vitro conditions. The most important point is that FTH treatment does not induce the antivirulence resistance. Current study validated the antivirulence strategy targeting the HlyU virulence transcription factor and toxin-network of V. vulnificus and demonstrated that FTH, exhibits a potential to inhibit the pathogenesis of deadly, opportunistic human pathogen, V. vulnificus without inducing AMR.
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Affiliation(s)
- Saba Imdad
- Department of Molecular Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Akhilesh Kumar Chaurasia
- Department of Molecular Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Kyeong Kyu Kim
- Department of Molecular Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, South Korea
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Joarder AI, Faruque MS, Nur-E-Elahi M, Jahan I, Siddiqui O, Imdad S, Islam MS, Ahmed HS, Haque MA. Dieulafoy's lesion: an overview. Mymensingh Med J 2014; 23:186-194. [PMID: 24584397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dieulafoy's lesion accounts for 1-5.8% of cases of acute upper GI bleeding. The two largest retrospective series, both from North America, found Dieulafoy's lesion as the source of hemorrhage in 1.9% and 1.2% of all endoscopies performed for acute GI bleeding. In the prospective study of Chung et al., Dieulafoy's Lesion was found in 3.4% of all patients with acute GI bleeding referred to their unit. The Dieulafoy's Lesion accounted for up to 40% of all causes of nonvariceal upper GI bleeding not caused by gastric or duodenal ulceration or esophageal varices in the prospective study of Matsui et al. In the study of Schmulewitz and Bailli, colonic Dieulafoy's Lesion were only found in 0.09% of all colonoscopies performed for lower GI bleeding. The actual incidence of both upper and lower GI bleeding from Dieulafoy's Lesion is likely higher than estimated because the diagnosis remains difficult. Recent advances in endoscopy have led to an increased detection of Dieulafoy's lesions. Initial GI endoscopy is effective in diagnosing up to 70% of patients. Several endoscopies may be required with 6% of patients, requiring three or more to establish the diagnosis. Angiography and/or red cell scanning can be used when endoscopy fails to diagnose a doubtful case. There is no definite unique policy for the treatment of Dieulafoy's lesions. Therapeutic endoscopy remains the first line of treatment option for controlling the bleeding while angiography is considered as a valuable alternative. Surgical intervention is kept for failure cases where it should be guided by preoperative localization. The mortality rate has decreased dramatically from 80% to 8.6% in recent times due to advancement in both diagnostic and therapeutic tools.
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Affiliation(s)
- A I Joarder
- Dr Aminul Islam Joarder, Assistant Professor, Department of Surgery, Bangbandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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