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Teaw S, Hinchcliff M, Cheng M. A review and roadmap of the skin, lung and gut microbiota in systemic sclerosis. Rheumatology (Oxford) 2021; 60:5498-5508. [PMID: 33734316 PMCID: PMC8643452 DOI: 10.1093/rheumatology/keab262] [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: 12/07/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 11/12/2022] Open
Abstract
As our understanding of the genetic underpinnings of SSc increases, questions regarding the environmental trigger(s) that induce and propagate SSc in the genetically predisposed individual emerge. The interplay between the environment, the immune system, and the microbial species that inhabit the patient's skin and gastrointestinal tract is a pathobiological frontier that is largely unexplored in SSc. The purpose of this review is to provide an overview of the methodologies, experimental study results and future roadmap for elucidating the relationship between the SSc host and his/her microbiome.
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Affiliation(s)
- Shannon Teaw
- Yale School of Medicine, Department of Medicine Section of Rheumatology, Allergy & Immunology, New Haven, CT, USA
| | - Monique Hinchcliff
- Yale School of Medicine, Department of Medicine Section of Rheumatology, Allergy & Immunology, New Haven, CT, USA
| | - Michelle Cheng
- Yale School of Medicine, Department of Medicine Section of Rheumatology, Allergy & Immunology, New Haven, CT, USA
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2
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Plichta DR, Somani J, Pichaud M, Wallace ZS, Fernandes AD, Perugino CA, Lähdesmäki H, Stone JH, Vlamakis H, Chung DC, Khanna D, Pillai S, Xavier RJ. Congruent microbiome signatures in fibrosis-prone autoimmune diseases: IgG4-related disease and systemic sclerosis. Genome Med 2021; 13:35. [PMID: 33648559 PMCID: PMC7919092 DOI: 10.1186/s13073-021-00853-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) and systemic sclerosis (SSc) are rare autoimmune diseases characterized by the presence of CD4+ cytotoxic T cells in the blood as well as inflammation and fibrosis in various organs, but they have no established etiologies. Similar to other autoimmune diseases, the gut microbiome might encode disease-triggering or disease-sustaining factors. METHODS The gut microbiomes from IgG4-RD and SSc patients as well as healthy individuals with no recent antibiotic treatment were studied by metagenomic sequencing of stool DNA. De novo assembly-based taxonomic and functional characterization, followed by association and accessory gene set enrichment analysis, were applied to describe microbiome changes associated with both diseases. RESULTS Microbiomes of IgG4-RD and SSc patients distinctly separated from those of healthy controls: numerous opportunistic pathogenic Clostridium and typically oral Streptococcus species were significantly overabundant, while Alistipes, Bacteroides, and butyrate-producing species were depleted in the two diseases compared to healthy controls. Accessory gene content analysis in these species revealed an enrichment of Th17-activating Eggerthella lenta strains in IgG4-RD and SSc and a preferential colonization of a homocysteine-producing strain of Clostridium bolteae in SSc. Overabundance of the classical mevalonate pathway, hydroxyproline dehydratase, and fibronectin-binding protein in disease microbiomes reflects potential functional differences in host immune recognition and extracellular matrix utilization associated with fibrosis. Strikingly, the majority of species that were differentially abundant in IgG4-RD and SSc compared to controls showed the same directionality in both diseases. Compared with multiple sclerosis and rheumatoid arthritis, the gut microbiomes of IgG4-RD and SSc showed similar signatures; in contrast, the most differentially abundant taxa were not the facultative anaerobes consistently identified in inflammatory bowel diseases, suggesting the microbial signatures of IgG4-RD and SSc do not result from mucosal inflammation and decreased anaerobism. CONCLUSIONS These results provide an initial characterization of gut microbiome ecology in fibrosis-prone IgG4-RD and SSc and reveal microbial functions that offer insights into the pathophysiology of these rare diseases.
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Affiliation(s)
| | - Juhi Somani
- Department of Computer Science, Aalto University, 02150, Espoo, Finland
| | | | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Clinical Epidemiology Program and Rheumatology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ana D Fernandes
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Cory A Perugino
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Harri Lähdesmäki
- Department of Computer Science, Aalto University, 02150, Espoo, Finland
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Hera Vlamakis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Daniel C Chung
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Cancer Risk Assessment, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Shiv Pillai
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Ramnik J Xavier
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Center for Computational and Integrative Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Department of Molecular Biology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Center for Microbiome Informatics and Therapeutics, MIT, Cambridge, MA, USA.
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3
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Zullo A, Bruzzese V, Pellegrino G, Scolieri P, Stefanantoni K, Angelelli C, Riccieri V. Helicobacter pylori and Upper Endoscopy in Systemic Sclerosis: A Cross-sectional Study in the Real World. J Clin Rheumatol 2021; 27:40-41. [PMID: 33347033 DOI: 10.1097/rhu.0000000000001502] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/AIMS A role for Helicobacter pylori in triggering systemic sclerosis (SSc) has been proposed, but data are conflicting. In previous studies, infection has been generally searched for by using serology. We designed this study to assess H. pylori prevalence in SSc patients with histology of gastric mucosa, considered the criterion standard for infection diagnosis. METHODS This cross-sectional study enrolled 30 SSc patients who complained of upper gastrointestinal symptoms. All underwent upper endoscopy with gastric biopsies. Endoscopic alterations were recorded, and gastric mucosa biopsies were used for both histological examination and searching for H. pylori. The role for proton-pump inhibitor (PPI) therapy was considered. Fisher exact test was used for statistical analysis. RESULTS Data of 28 SSc patients were available, 14 with ongoing PPI therapy. Helicobacter pylori infection at histology was detected in 14.3% patients, and it equally occurred in patients with or without PPI therapy. Erosive esophagitis/Barrett esophagus was detected in 26.6% of cases. Among patients with PPI therapy, 30% received half dose only. The prevalence of intestinal metaplasia was low (14.3%). Endoscopic esophageal alterations were significantly more frequent in those patients showing anti-Scl70 antibody positivity. CONCLUSIONS This study showed that prevalence of H. pylori is very low in SSc patients, so that it seems not having a role in triggering SSc. Management of gastroesophageal diseases in SSc patients needs to be improved, and looking to the autoimmune profile may be of help. Thus, collaboration between rheumatologist and gastroenterologist is highly recommended.
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Affiliation(s)
- Angelo Zullo
- From the Gastronterology and Digestive Endoscopy
| | - Vincenzo Bruzzese
- Internal Medicine and Rheumatology, Nuovo Regina Margherita' Hospital
| | - Greta Pellegrino
- Department of Clinical, Internal, Anaesthesiologic, Cardiologic Sciences, University of Rome Sapienza, Rome, Italy
| | - Palma Scolieri
- Internal Medicine and Rheumatology, Nuovo Regina Margherita' Hospital
| | - Katia Stefanantoni
- Department of Clinical, Internal, Anaesthesiologic, Cardiologic Sciences, University of Rome Sapienza, Rome, Italy
| | - Carlotta Angelelli
- Department of Clinical, Internal, Anaesthesiologic, Cardiologic Sciences, University of Rome Sapienza, Rome, Italy
| | - Valeria Riccieri
- Department of Clinical, Internal, Anaesthesiologic, Cardiologic Sciences, University of Rome Sapienza, Rome, Italy
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Zhang S, Lv J, Ren X, Hao X, Zhou P, Wang Y. The efficacy and safety of fecal microbiota transplantation in the treatment of systemic sclerosis: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e21267. [PMID: 32664182 PMCID: PMC7360200 DOI: 10.1097/md.0000000000021267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is 1 of the most complex systemic autoimmune diseases.Accumulating evidence suggests that gut microbiota affect the development and function of the immune system and may play a role in the pathogenesis of autoimmune diseases. This new paradigm raises the possibility that many diseases result, at least partially, from microbiota-related dysfunction. This understanding invites the investigation of fecal microbiota transplantation (FMT) in the treatment of SSc. However, no study has specifically and systematically investigated the efficacy and safety of FMT in the treatment of SSc. Thus, this study will systematically and comprehensively appraise the efficacy and safety of FMT in the treatment of SSc. METHODS We will search the following sources without restrictions for date, language, or publication status: PubMed, Web of Science,Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Library, EMBASE and China National Knowledge Infrastructure. We will apply a combination of Medical Subject Heading (MeSH) and free-text terms incorporating database-specific controlled vocabularies and text words to implement search strategies. We will also search the ongoing trials registered in the World Health Organization's International Clinical Trials Registry Platform. Besides, the previous relevant reviews conducted on FMT for SSc and reference lists of included studies will also be searched. RESULTS This study will provide a reliable basis for the treatment of SSc with FMT. CONCLUSIONS The findings will be an available reference to evaluate the efficacy and safety of FMT in the treatment of SSc. REGISTRATION NUMBER INPLASY202060019.
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Affiliation(s)
| | - Jingjing Lv
- Hebei Province Hospital of Chinese Medicine, Shijiazhuang City, Hebei
| | | | - Xinyu Hao
- Hebei University of Chinese Medicine
| | | | - Yangang Wang
- Hebei Province Hospital of Chinese Medicine, Shijiazhuang City, Hebei
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García-Collinot G, Madrigal-Santillán EO, Martínez-Bencomo MA, Carranza-Muleiro RA, Jara LJ, Vera-Lastra O, Montes-Cortes DH, Medina G, Cruz-Domínguez MP. Effectiveness of Saccharomyces boulardii and Metronidazole for Small Intestinal Bacterial Overgrowth in Systemic Sclerosis. Dig Dis Sci 2020; 65:1134-1143. [PMID: 31549334 DOI: 10.1007/s10620-019-05830-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 09/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) affects up to 60% of patients with systemic sclerosis (SSc), and it improves with antibiotics. The addition of probiotics could lead to better results. AIMS To evaluate the efficacy and safety of Saccharomyces boulardii (SB) versus metronidazole (M) versus M + SB for 2 months, to reduce gastrointestinal symptoms and SIBO assessed with hydrogen breath test in SSc. METHODS An open pilot clinical trial performed in forty patients with SIBO and SSc (ACR-EULAR 2013) who signed informed consent. Three groups were assigned: M, SB, and M + SB, for 2 months. Hydrogen was measured in parts per million with a hydrogen breath test to evaluate SIBO. The National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH-PROMIS) questionnaire was applied to quantify gastrointestinal symptoms with a raw score of eight symptoms. This study is registered in ClinicalTrials.gov with the following ID: NCT03692299. RESULTS Baseline characteristics were similar between groups. The average age was 53.2 ± 9.3 years, and the evolution of SSc was 13.5 (1-34) years. After 2 months of treatment, SIBO was eradicated in 55% of the M + SB group: 33% of SB, and 25% of M. The SB and M + SB groups had decreased diarrhea, abdominal pain, and gas/bloating/flatulence, but M remained unchanged. Reductions in expired hydrogen at 45 to 60 min were as follows: M + SB 48% and 44%, M 18% and 20%, and SB 53% and 60% at the first and second months, respectively (p < 0.01). Adverse effects were epigastric burning and constipation in M (53%) and M + SB (36%), and flatulence/diarrhea in SB (22%). CONCLUSIONS Metronidazole treatment is partially effective in SIBO, but S. boulardii in monotherapy or in combination improves the gastrointestinal outcomes in SSc.
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Affiliation(s)
- Grettel García-Collinot
- Research Division, Clinical Research Training Center, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Postgraduate Section, Escuela Superior de Medicina (ESM), Instituto Politecnico Nacional, Mexico City, Mexico
| | | | - Michel A Martínez-Bencomo
- Research Division, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Seris y Zaachila SN, Colonia La Raza, Azcapotzalco, Mexico City, Mexico
| | - Rosa A Carranza-Muleiro
- Postgraduate Section, Escuela Superior de Medicina (ESM), Instituto Politecnico Nacional, Mexico City, Mexico
- Research Division, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Seris y Zaachila SN, Colonia La Raza, Azcapotzalco, Mexico City, Mexico
| | - Luis J Jara
- Direction of Education and Research, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Olga Vera-Lastra
- Internal Medicine Department, Hospital de Especialidades Centro Medico, 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Daniel H Montes-Cortes
- Emergency Department, Hospital General Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Research Division, Hospital Regional '1° de Octubre', (ISSSTE), Mexico City, Mexico
| | - Gabriela Medina
- Translational Research Unit, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - María Pilar Cruz-Domínguez
- Research Division, Hospital de Especialidades Centro Medico 'La Raza', Instituto Mexicano del Seguro Social, Seris y Zaachila SN, Colonia La Raza, Azcapotzalco, Mexico City, Mexico.
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Lande R, Lee EY, Palazzo R, Marinari B, Pietraforte I, Santos GS, Mattenberger Y, Spadaro F, Stefanantoni K, Iannace N, Dufour AM, Falchi M, Bianco M, Botti E, Bianchi L, Alvarez M, Riccieri V, Truchetet ME, C.L. Wong G, Chizzolini C, Frasca L. CXCL4 assembles DNA into liquid crystalline complexes to amplify TLR9-mediated interferon-α production in systemic sclerosis. Nat Commun 2019; 10:1731. [PMID: 31043596 PMCID: PMC6494823 DOI: 10.1038/s41467-019-09683-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 03/23/2019] [Indexed: 01/17/2023] Open
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by fibrosis and vasculopathy. CXCL4 represents an early serum biomarker of severe SSc and likely contributes to inflammation via chemokine signaling pathways, but the exact role of CXCL4 in SSc pathogenesis is unclear. Here, we elucidate an unanticipated mechanism for CXCL4-mediated immune amplification in SSc, in which CXCL4 organizes "self" and microbial DNA into liquid crystalline immune complexes that amplify TLR9-mediated plasmacytoid dendritic cell (pDC)-hyperactivation and interferon-α production. Surprisingly, this activity does not require CXCR3, the CXCL4 receptor. Importantly, we find that CXCL4-DNA complexes are present in vivo and correlate with type I interferon (IFN-I) in SSc blood, and that CXCL4-positive skin pDCs coexpress IFN-I-related genes. Thus, we establish a direct link between CXCL4 overexpression and the IFN-I-gene signature in SSc and outline a paradigm in which chemokines can drastically modulate innate immune receptors without being direct agonists.
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Affiliation(s)
- Roberto Lande
- National Center for Drug Research and Evaluation, Pharmacological research and experimental therapy UNIT, Istituto Superiore di Sanità (ISS), 00161 Rome, Italy
| | - Ernest Y. Lee
- Department of Bioengineering, Department of Chemistry & Biochemistry, and California NanoSystems Institute, University of California, Los Angeles, CA 90095 USA
| | - Raffaella Palazzo
- National Center for Drug Research and Evaluation, Pharmacological research and experimental therapy UNIT, Istituto Superiore di Sanità (ISS), 00161 Rome, Italy
| | - Barbara Marinari
- Dermatology Unit, Department of Systems Medicine, University of Tor Vergata, Rome, 00133 Italy
| | - Immacolata Pietraforte
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giancarlo Santiago Santos
- Department of Bioengineering, Department of Chemistry & Biochemistry, and California NanoSystems Institute, University of California, Los Angeles, CA 90095 USA
| | - Yves Mattenberger
- Department of Microbiol and Molecular Medicine, University of Geneva, CH-1211 Geneva, Switzerland
| | - Francesca Spadaro
- Istituto Superiore di Sanità, Confocal Microscopy Unit, Core Facilities, Rome, 00161 Italy
| | - Katia Stefanantoni
- Division of Rheumatology, Internal Medicine and Medical Specialties, University La Sapienza, 00161 Rome, Italy
| | - Nicoletta Iannace
- Division of Rheumatology, Internal Medicine and Medical Specialties, University La Sapienza, 00161 Rome, Italy
| | - Aleksandra Maria Dufour
- Immunology & Allergy and Immunology & Pathology, University Hospital and School of Medicine, CH-1211 Geneva, Switzerland
| | - Mario Falchi
- Istituto Superiore di Sanità, National AIDS Center, Rome, 00161 Italy
| | - Manuela Bianco
- National Center for Drug Research and Evaluation, Pharmacological research and experimental therapy UNIT, Istituto Superiore di Sanità (ISS), 00161 Rome, Italy
| | - Elisabetta Botti
- Dermatology Unit, Department of Systems Medicine, University of Tor Vergata, Rome, 00133 Italy
| | - Luca Bianchi
- Dermatology Unit, Department of Systems Medicine, University of Tor Vergata, Rome, 00133 Italy
| | - Montserrat Alvarez
- Immunology & Allergy and Immunology & Pathology, University Hospital and School of Medicine, CH-1211 Geneva, Switzerland
| | - Valeria Riccieri
- Division of Rheumatology, Internal Medicine and Medical Specialties, University La Sapienza, 00161 Rome, Italy
| | - Marie-Elise Truchetet
- Division of Rheumatology and immunoConcept, University Hospital, Bordeaux, 33076 France
| | - Gerard C.L. Wong
- Department of Bioengineering, Department of Chemistry & Biochemistry, and California NanoSystems Institute, University of California, Los Angeles, CA 90095 USA
| | - Carlo Chizzolini
- Immunology & Allergy and Immunology & Pathology, University Hospital and School of Medicine, CH-1211 Geneva, Switzerland
| | - Loredana Frasca
- National Center for Drug Research and Evaluation, Pharmacological research and experimental therapy UNIT, Istituto Superiore di Sanità (ISS), 00161 Rome, Italy
- Immunology & Allergy and Immunology & Pathology, University Hospital and School of Medicine, CH-1211 Geneva, Switzerland
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Yong WC, Upala S, Sanguankeo A. Helicobacter pylori infection in systemic sclerosis: a systematic review and meta-analysis of observational studies. Clin Exp Rheumatol 2018; 36 Suppl 113:168-174. [PMID: 29745891] [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] [Received: 11/26/2017] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES It has been proposed that Helicobacter pylori (H.pylori) infection causes several extra-gastrointestinal disorders. However, the role of H.pylori infection in the pathogenesis of systemic sclerosis (SSc) is still debatable. This meta-analysis is aimed at exploring the association between SSc and H.pylori infection. METHODS A comprehensive search of the MEDLINE and EMBASE databases was performed from inception through February 2018. The inclusion criterion was observational studies evaluating H.pylori infection in SSc. The pooled odds ratio (OR) of H.pylori infection and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between SSc patients and healthy controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. RESULTS Data were extracted from 8 observational studies involving 1,446 subjects. The pooled results demonstrated an increased H.pylori infection in SSc compared with healthy controls (OR=2.10; 95% CI: 1.57-2.82, p value<0.01, I2=13%). Subgroup analysis showed an increased risk of H.pylori infection measured with H.pylori ELISA test (OR=2.49; 95% CI: 1.82-3.40, p value<0.01, I2=0%). CONCLUSIONS Our study has shown that patients with SSc have an increased prior existence of H.pylori infection. This finding implies that the role of previous infection may cause an abnormal immunological cascade in the pathogenesis of SSc. Further studies that could elucidate the inflammatory response in the pathogenesis of SSc are warranted.
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Affiliation(s)
- Wai Chung Yong
- Department of Internal Medicine, Greenfield Family Medicine, Baystate Franklin Medical Center, Greenfield, MA, USA
| | - Sikarin Upala
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, IL, USA, and Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anawin Sanguankeo
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, and Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Andréasson K, Alrawi Z, Persson A, Jönsson G, Marsal J. Intestinal dysbiosis is common in systemic sclerosis and associated with gastrointestinal and extraintestinal features of disease. Arthritis Res Ther 2016; 18:278. [PMID: 27894337 PMCID: PMC5126986 DOI: 10.1186/s13075-016-1182-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/11/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Recent evidence suggests a link between autoimmunity and the intestinal microbial composition in several rheumatic diseases including systemic sclerosis (SSc). The objective of this study was to investigate the prevalence of intestinal dysbiosis in SSc and to characterise patients suffering from this potentially immunomodulatory deviation. METHODS This study consisted of 98 consecutive patients subject to in-hospital care. Stool samples were analysed for intestinal microbiota composition using a validated genome-based microbiota test (GA-map™ Dysbiosis Test, Genetic Analysis, Oslo, Norway). Gut microbiota dysbiosis was found present as per this standardised test. Patients were examined regarding gastrointestinal and extraintestinal manifestations of SSc by clinical, laboratory, and radiological measures including esophageal cineradiography, the Malnutrition Universal Screening Tool (MUST), levels of plasma transthyretin (a marker of malnutrition) and faecal (F-) calprotectin (a marker of intestinal inflammation). RESULTS A majority (75.5%) of the patients exhibited dysbiosis. Dysbiosis was more severe (rs = 0.31, p = 0.001) and more common (p = 0.013) in patients with esophageal dysmotility. Dysbiosis was also more pronounced in patients with abnormal plasma levels of transthyretin (p = 0.045) or micronutrient deficiency (p = 0.009). In 19 patients at risk for malnutrition according to the MUST, 18 exhibited dysbiosis. Conversely, of the 24 patients with a negative dysbiosis test, only one was at risk for malnutrition. The mean ± SEM levels of F-calprotectin were 112 ± 14 and 45 ± 8 μg/g in patients with a positive and negative dysbiosis test, respectively. Dysbiosis was more severe in patients with skin telangiectasias (p = 0.020), pitting scars (p = 0.023), pulmonary fibrosis (p = 0.009), and elevated serum markers of inflammation (p < 0.001). However, dysbiosis did not correlate with age, disease duration, disease subtype, or extent of skin fibrosis. CONCLUSIONS In this cross-sectional study, intestinal dysbiosis was common in patients with SSc and was associated with gastrointestinal dysfunction, malnutrition and with some inflammatory, fibrotic and vascular extraintestinal features of SSc. Further studies are needed to elucidate the potential causal relationship of intestinal microbe-host interaction in this autoimmune disease.
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Affiliation(s)
- Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Zaid Alrawi
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anita Persson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Göran Jönsson
- Section of Infectious Diseases, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jan Marsal
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Immunology Section, Lund University, Lund, Sweden
- Department of Gastroenterology, Skåne University Hospital, Lund, Sweden
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Abstract
Autoimmune skin diseases are characterized by dysregulation of the immune system resulting in a loss of tolerance to skin self-antigen(s). The prolonged interaction between the bacterium and host immune mechanisms makes Helicobacter pylori (H. pylori) a plausible infectious agent for triggering autoimmunity. Epidemiological and experimental data now point to a strong relation of H. pylori infection on the development of many extragastric diseases, including several allergic and autoimmune diseases. H. pylori antigens activate cross-reactive T cells and induce autoantibodies production. Microbial heat shock proteins (HSP) play an important role of in the pathogenesis of autoimmune diseases because of the high level of sequence homology with human HSP. Eradication of H. pylori infection has been shown to be effective in some patients with chronic autoimmune urticaria, psoriasis, alopecia areata and Schoenlein-Henoch purpura. There is conflicting and controversial data regarding the association of H. pylori infection with Behçet’s disease, scleroderma and autoimmune bullous diseases. No data are available evaluating the association of H. pylori infection with other skin autoimmune diseases, such as vitiligo, cutaneous lupus erythematosus and dermatomyositis. The epidemiological and experimental evidence for a possible role of H. pylori infection in skin autoimmune diseases are the subject of this review.
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10
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Mancarella L, De Santis M, Magarelli N, Ierardi AM, Bonomo L, Ferraccioli G. Septic sacroiliitis: an uncommon septic arthritis. Clin Exp Rheumatol 2009; 27:1004-1008. [PMID: 20149323] [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: 05/28/2023]
Abstract
Septic sacroiliitis is an uncommon joint infection and the diagnosis is often delayed. We present the first case of a septic arthritis of the shoulder and of the sacroiliac joint in a woman affected by systemic sclerosis, and we reviewed the medical literature since 1997 to 2008 on septic sacroiliitis with a specific microbiological diagnosis other than Mycobacteria and Brucella species.Evidence shows that antibiotic therapy should be continued until full clinical and radiological resolution is achieved.
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Affiliation(s)
- L Mancarella
- Department of Rheumatology, Catholic University, Rome, Catholic University, Rome, Italy
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Romanov VA, Shilkina NP, Gul'neva MI, Ivanov DV. [Microflora in patients with systemic connective tissue diseases]. Vestn Ross Akad Med Nauk 2008:10-14. [PMID: 18488449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The study of microflora of skin, mucous tunic of nose and mouth, and the quantitative and qualitative structure of the intestinal and urinal microflora in cases of systemic connective tissues diseases, are reproduced. The decrease of the dominant state of typical representatives, and the increase of the role of pseudopathogenic bacteria in various biotypes, were observed. The frequency of S. aureus detection increased in skin, mucous tunic of nose and mouth. Pseudopathogenic microbes acquired greater significance in the forming of microbiocenosis of intestine, while the number of E. coli, Bifidobacterium and Lactobacterium decreased. The frequency of detection of microbes in urine decreased. The comparative analyses of the microflora in patients with systemic lupus erythromatosis and progressive systemic sclerosis demonstrated the common peculiarities for microflora character change.
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Abstract
A 25-year old woman visited the hospital because of a painful swelling for 20 days in the midposterior portion of her right thigh. She had been diagnosed with systemic sclerosis and treated for 10 months. An MRI scan of the right thigh showed diffuse fascial thickening and involved the superficial portion of thigh muscles, which were hyperintense on the T(2)-weighted image. A biopsy of the involved muscles revealed chronic granulomatous inflammation with several acid-fast bacilli on a Ziehl-Neelsen stain. We here report a case of tuberculous fasciitis manifest with painful swelling of the midposterior muscles of the right thigh without pulmonary tuberculosis in a patient with scleroderma.
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Affiliation(s)
- Chan-Hee Lee
- Department of Internal Medicine, Inje University College of Medicine, 85, 2-Ka, Jeo-Dong, Jung-Gu, Seoul, Korea.
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13
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Abstract
Over the past few years, increasing evidence has accumulated to implicate infectious agents in the etiology of systemic sclerosis (SSc) and Raynaud phenomenon. Infection rates in patients with SSc compared with those in control populations do not provide clear support for any specific pathogen. However, increased antibody titers, a preponderance of specific strains in patients with SSc, and evidence of molecular mimicry inducing autoimmune responses suggest mechanisms by which infectious agents may contribute to the development and progression of SSc. Here we review studies examining the potential involvement of, cytomegalovirus, and parvovirus B19 in SSc pathogenesis.
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Affiliation(s)
- Damir Hamamdzic
- Department of Microbiology and Immunology Medical University of Southa Carolina, Charleston, 29425, USA.
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Sulli A, Seriolo B, Savarino V, Cutolo M. Lack of correlation between gastric Helicobacter pylori infection and primary or secondary Raynaud's phenomenon in patients with systemic sclerosis. J Rheumatol 2000; 27:1820-1. [PMID: 10914880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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15
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Danese S, Zoli A, Cremonini F, Gasbarrini A. High prevalence of Helicobacter pylori type I virulent strains in patients with systemic sclerosis. J Rheumatol 2000; 27:1568-9. [PMID: 10852299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Abstract
OBJECTIVE Pneumonia due to Pneumocystis carinii has been increasingly reported in patients with connective tissue diseases, but the frequency of this complication is not known. We sought to determine the frequency of P carinii pneumonia (PCP) in patients with connective tissue diseases, and to determine the role that a hospital's acquired immunodeficiency syndrome (AIDS)-related experience may have in the diagnosis of PCP in these patients. METHODS We used a state hospitalization registry to identify all patients with PCP and either rheumatoid arthritis, systemic lupus erythematosus, Wegener's granulomatosis, polymyositis, dermatomyositis, polyarteritis nodosa, or scleroderma who had an emergent or urgent hospitalization in California from 1983 to 1994. We compared patient and hospital characteristics between these patients and patients with connective tissue diseases hospitalized with other types of pneumonia. RESULTS Two hundred twenty-three patients with connective tissue diseases were diagnosed with PCP in the 12-year study period. The frequency of PCP ranged from 89 cases/10,000 hospitalizations/year in patients with Wegener's granulomatosis to 2 cases/10,000 hospitalizations/year in patients with rheumatoid arthritis. Compared with 5,457 patients with connective tissue diseases and pneumonia due to other organisms, patients with PCP were more likely to be younger, to be male, to have private medical insurance, and to have systemic lupus erythematosus, Wegener's granulomatosis, inflammatory myopathy, or polyarteritis nodosa rather than rheumatoid arthritis, and were less likely to be African American. Hospital size, teaching status, urban/rural location, proportion of admissions due to AIDS or PCP, and proportion of patients with pneumonia undergoing bronchoscopy were each associated with the likelihood of diagnosis of PCP in univariate analyses, but only the number of patients with PCP being treated at a hospital (odds ratio [OR] 1.03 for each additional 10 cases/year, 95% confidence interval [95% CI] 1.01-1.05) was associated with the likelihood of diagnosis of PCP in multivariate analyses. Patients were also somewhat more likely to be diagnosed with PCP if there had previously been a case of PCP in a patient with a connective tissue disease at the same hospital (OR 135, 95% CI 0.98-1.85). In-hospital mortality was 45.7%, and was unrelated to hospital characteristics. CONCLUSION PCP is an uncommon, but often fatal, occurrence in patients with connective tissue disease. A hospital's prior experience with patients with PCP is associated with the likelihood that this condition is diagnosed in patients with connective tissue diseases who present with pneumonia, suggesting that diagnostic suspicion is an important factor in the correct identification of affected patients.
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Affiliation(s)
- M M Ward
- Department of Veterans Affairs Palo Alto Health Care System, California, USA
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17
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Shindo K, Machida M, Koide K, Fukumura M, Yamazaki R. Deconjugation ability of bacteria isolated from the jejunal fluid of patients with progressive systemic sclerosis and its gastric pH. Hepatogastroenterology 1998; 45:1643-50. [PMID: 9840121] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND/AIMS Our goal was to demonstrate the role of bacteria in altered bile acid metabolism, which overgrow in the upper small intestine of patients with progressive systemic sclerosis. We identified the bacterial species, isolated from the jejunal fluid obtained from patients with progressive systemic sclerosis, who had previously shown an increase in 14CO2, specific activity on breath test, and normal controls. After which, we investigated the deconjugation ability of the isolated bacteria and the relationship between 14CO2, specific activity and gastric pH. METHODOLOGY Bile acid breath tests were performed on 12 patients, and 19 normal controls using 5 microCi of oral glycine-1-(14)C-labeled glycocholate. Jejunal fluid was aspirated through a double lumen-tube with a rubber cover on the tip. Deconjugation ability was examined by thin-layer chromatography using conjugated bile acids in ox gall. RESULTS The following species were identified in jejunal fluid samples obtained from patients: Bacteroides vulgatus, Eubacterium lentum, enterococcus, Lactobacillus bifidus, Escherichia (E) coli, Aerobacter (A) aerogenes. Except for E. coli and A. aerogenes, these species were capable of hydrolyzing conjugated bile acids in ox gall. The administration of chloramphenicol (1 g orally per day for 14 days in divided doses) significantly reduced the 14CO2, specific activity (p<0.05) in the patients with progressive systemic sclerosis. On the other hand, nineteen healthy control subjects demonstrated no increase in CO2 excretion, and 16 of the 19 had no bacteria isolated from jejunal fluid. The remaining healthy man showed an overgrowth of E. coli and Pseudomonas (P) aeruginosa, but the E. coli and P. aeruginosa did not have the ability of deconjugation. CO2 specific activity of expired breath samples in the patients with progressive systemic sclerosis was correlated with gastric pH (n=12, r=0.588, p<0.05). CONCLUSIONS Our results demonstrated that some of the bacterial species that overgrow in the upper small intestine of patients with progressive systemic sclerosis can deconjugate bile acids, and that a shift to neutral pH in gastric juice, may promote the bacterial overgrowth related to their impaired peristaltic activity.
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Affiliation(s)
- K Shindo
- The First Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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Yazawa N, Fujimoto M, Kikuchi K, Kubo M, Ihn H, Sato S, Tamaki T, Tamaki K. High seroprevalence of Helicobacter pylori infection in patients with systemic sclerosis: association with esophageal involvement. J Rheumatol 1998; 25:650-3. [PMID: 9558164] [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: 02/07/2023]
Abstract
OBJECTIVE To determine the prevalence and clinical relevance of Helicobacter pylori infection in patients with systemic sclerosis (SSc). METHODS Serum samples were obtained from 124 patients with SSc (67 with limited cutaneous SSc, 57 with diffuse cutaneous SSc). Fifty samples from age and sex matched individuals were used as controls. IgG antibodies to H. pylori infection were measured by ELISA. RESULTS IgG antibodies to H. pylori were found in 55.6% (69 of 124) of the patients with SSc, significantly more than in the controls. There was a significant correlation of the presence of antibodies to H. pylori with the prevalence of esophageal hypomotility in the patients with SSc (p < 0.02). CONCLUSION Patients with SSc have H. pylori infection at a higher prevalence than the general population. H. pylori might play a role in the development of esophageal dysfunction in SSc.
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Affiliation(s)
- N Yazawa
- Department of Dermatology, Faculty of Medicine, Tokyo University, Japan
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Teh LS, Johns CW, Shaffer JL, Booth EJ, Aarons L, Bennett RJ, Herrick AL, Jayson MI. Ascorbic acid absorption in patients with systemic sclerosis. J Rheumatol 1997; 24:2353-7. [PMID: 9415641] [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: 02/05/2023]
Abstract
OBJECTIVE To investigate whether reduced circulating levels of ascorbic acid in patients with systemic sclerosis (SSc) are a result of malabsorption. METHODS Eight patients with SSc, but with no evidence of bacterial overgrowth, and 8 healthy controls were recruited. On the first day of study, each subject was given orally an aliquot of [14C] ascorbic acid, which was then "flushed out" by oral intake of unlabeled ascorbic acid for the following 7 days. Plasma samples were collected at specified intervals and urine was collected continuously over the 8 day study period. [14C] content of plasma and urine were measured by scintillation counting. For each subject, a plasma [14C] decay curve was drawn. Each subject's ascorbic acid absorption was assessed using the area under the curve (AUC) and the apparent renal clearance (CLr[app]). Ascorbic acid intake was assessed using dietary history and food composition tables. RESULTS There were no differences in the dietary intake of vitamin C (p = 0.16) and body mass indices (p = 0.91) between patients and controls. The plasma [14C] AUC and CLr(app) were similar between patients and controls [AUC patient mean (standard deviation, SD) = 37.1 (6.8), AUC control mean (SD) = 38.6 (9.9), p = 0.74; CLr(app) patient mean (SD) = 0.57 (0.24), CLr(app) control mean (SD) = 0.47 (0.27), p = 0.45]. CONCLUSION There was no evidence of impaired absorption of ascorbic acid in patients with SSc without bacterial overgrowth compared to healthy controls.
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Affiliation(s)
- L S Teh
- Rheumatic Diseases Centre, Radioisotope Department, University of Manchester, UK
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Dillon WI, Saed GM, Fivenson DP. Borrelia burgdorferi DNA is undetectable by polymerase chain reaction in skin lesions of morphea, scleroderma, or lichen sclerosus et atrophicus of patients from North America. J Am Acad Dermatol 1995; 33:617-20. [PMID: 7673495 DOI: 10.1016/0190-9622(95)91281-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Borrelia burgdorferi has been linked to the pathogenesis of morphea and lichen sclerosus et atrophicus (LSA). However, considerable controversy still exists as to the actual role, if any, that this spirochete plays in the development of these diseases. Antibody titer determinations have been inconclusive and polymerase chain reaction (PCR) studies have yielded conflicting results. OBJECTIVE We sought to show whether PCR analysis detected B. burgdorferi in archival tissue specimens from the involved skin of 20 North American patients with morphea, 10 patients with LSA, and four patients with scleroderma. METHODS We used two different sets of PCR primers for the B. burgdorferi flagellin gene, one specific for European strains of B. burgdorferi, and another common to both European and American strains. A subset of these samples were further amplified with nested PCR primers. RESULTS None of the samples showed PCR products with either primer sets, whereas purified B. burgdorferi DNA and lesional erythema chronicum migrans tissues, which were used as positive controls, yielded easily detectable products with all primer sets. CONCLUSION These data suggest that B. burgdorferi infection plays no role in the development of morphea, LSA, or scleroderma in North American patients; these findings further support the recent observations that B. burgdorferi strain variability is associated with differential spectra of disease in North America compared with that found in various parts of Europe.
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Affiliation(s)
- W I Dillon
- Department of Dermatology, Henry Ford Health Sciences Center, Detroit, MI, USA
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Wang J, Bei L, Pan G. [Lactulose hydrogen breath test in small intestinal bacterial overgrowth]. Zhonghua Nei Ke Za Zhi 1995; 34:381-4. [PMID: 8582184] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Lactulose hydrogen breath test (LHBT) was evaluated in 21 patients suspected of having small intestinal bacterial overgrowth syndrome and 10 healthy volunteers as control. After dietary preparation and a 12-hour fast, subjects received 15g of lactulose mixed with 40% barium sulfate. The purpose of the barium meal was to reveal the position of lactulose in the intestines. End-expiratory samples of breath were taken at 15 minutes intervals at least for 4 hours. Breath hydrogen was measured with gas chromatography. A positive LHBT was defined as increase of hydrogen concentration in the breath more than 10 x 10(-6) above the baseline value before barium reached the sixth group of small intestine. Cultures were considered positive for bacterial overgrowth when anaerobic counts > or = 10(6) CFU/ml of aspirate. The procedure was carried out under sterile condition. Compared with the bacteriologic culture, LHBT has a sensitivity of 71.4%, specificity of 88.2% and accuracy of 80.6%. These results show that the LHBT is a simple, non-invasive and relatively reliable method for diagnosis of small intestinal bacterial overgrowth.
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Affiliation(s)
- J Wang
- Peking Union Medical College Hospital, Beijing
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Kaye SA, Lim SG, Taylor M, Patel S, Gillespie S, Black CM. Small bowel bacterial overgrowth in systemic sclerosis: detection using direct and indirect methods and treatment outcome. Br J Rheumatol 1995; 34:265-9. [PMID: 7728404 DOI: 10.1093/rheumatology/34.3.265] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty-four patients with proven systemic sclerosis and with symptoms suggestive of malabsorption (i.e. chronic diarrhoea and weight loss) were investigated for small bowel bacterial overgrowth. Of the patients selected, six were suffering from the diffuse form of the disease. Jejunal aspiration was performed in all patients, and in nine normal volunteers. A specially designed double-lumen sterile catheter was used for this purpose and was introduced via a gastroscope. Twenty of these patients underwent a glucose hydrogen breath test. Eight patients (33%) had significant bacterial counts: > 10(5) colony forming units per ml (cfu/ml) of jejunal fluid. Less than 10(2) cfu/ml were found in the jejunal fluid from the nine control subjects. Glucose hydrogen breath testing was positive in seven patients, all of whom had significant jejunal bacterial growth. Diarrhoea rather than weight loss was shown to be the symptom which correlated best with the presence of bacterial overgrowth. Ciprofloxacin was used in six patients whose diarrhoeal symptoms ceased dramatically within 48 h of commencing the antibiotic. Trimethoprim produced a partial response despite bacterial sensitivity. A disadvantage of the hydrogen breath test is that subsequent antibacterial therapy cannot be specific, as bacterial species, antibiotic sensitivity and resistance are unknown. Systemic sclerosis involving the small intestine in the past has been said to more prevalent in patients with diffuse disease, whereas this study showed a preponderance of patients with long-standing limited cutaneous systemic sclerosis and small bowel involvement.
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Affiliation(s)
- S A Kaye
- Department of Rheumatology, Royal Free Hospital, Hampstead, London
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Reinauer S, Goerz G, Ruzicka T, Susanto F, Humfeld S, Reinauer H. Helicobacter pylori in patients with systemic sclerosis: detection with the 13C-urea breath test and eradication. Acta Derm Venereol 1994; 74:361-3. [PMID: 7817672 DOI: 10.2340/0001555574361363] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
In patients with systemic sclerosis peristaltic abnormalities may delay gastric emptying, giving rise to bacterial overgrowth, including possibly Helicobacter pylori (HP). Infection with Helicobacter is an important risk factor for esophageal and gastric diseases, including esophagitis, gastritis and gastric cancer. The purpose of this prospective study was to assess gastric HP infection in patients with systemic sclerosis. In 12 patients with systemic sclerosis the newly introduced breath test with 13C-labelled urea was used for indirect detection of gastric urease activity due to HP infection. Five out of 12 patients gave Helicobacter-positive results (42%); 7 patients were negative for Helicobacter colonization (58%). Thus, the risk for gastric diseases caused by HP infection is enhanced in patients with systemic sclerosis compared with white healthy, asymptomatic persons examined in other studies. Helicobacter-positive patients were treated with 2 x 20 mg omeprazole and 4 x 500 mg amoxicillin over 14 days. Afterwards the 13C-urea breath test was repeated and showed negative results for Helicobacter in all systemic sclerosis patients treated. Dual therapy with omeprazole and amoxicillin therapy effectively eradicated HP. The 13C-urea breath test did not cause any side-effects and is therefore considered to be a non-invasive, non-toxic and safe method for the diagnosis and therapeutic control of Helicobacter-status.
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Affiliation(s)
- S Reinauer
- Department of Dermatology, Diabetes Research Institute, Heinrich-Heine-University of Düsseldorf, Germany
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Kaye SA, Seifalian AM, Lim SG, Hamilton G, Black CM. Ischaemia of the small intestine in patients with systemic sclerosis: Raynaud's phenomenon or chronic vasculopathy? QJM 1994; 87:495-500. [PMID: 7922302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We investigated duodenal and gastric mucosal blood flow by endoscopic laser Doppler flowmetry (LDF) in ten patients with systemic sclerosis (SSc) and in ten healthy volunteers. In addition, we tested for the presence of small bowel bacterial overgrowth by jejunal aspiration. Jejunal aspiration and LDF were done consecutively, via a gastroscope, using a flexible catheter and laser Doppler probe. Following these procedures, two duodenal biopsies were obtained for light and electron microscopy. Mean duodenal and gastric blood flow were significantly lower in patients with SSc than in normal subjects (516 flux units vs. 240, 521 vs. 202, both p < 0.001). There was no correlation between age and blood flow in patients or volunteers. Four of the ten patients had evidence of significant bacterial overgrowth on jejunal aspiration (> 10(5) colony-forming units/ml). These findings support the hypothesis that within the small intestine of patients with SSc, factors independent of bacterial overgrowth may be responsible for malabsorption. The observed reduction in small-intestine mucosal blood flow may play an important contributory role. Further studies are required to determine whether this represents reversible or chronic progressive ischaemia, and its effect on nutrient absorption.
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Affiliation(s)
- S A Kaye
- Department of Rheumatology, Royal Free Hospital and School of Medicine, Hampstead, London, UK
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Affiliation(s)
- S A Jimenez
- Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107
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Abstract
BACKGROUND Patients with scleroderma may have abnormal motility of the small intestine, with pseudoobstruction and bacterial overgrowth. Standard stimulatory agents are often ineffective in such patients. Because the somatostatin analogue octreotide evokes intestinal motor activity in normal subjects, we hypothesized that it might increase motility in patients with scleroderma. METHODS We studied the effects of octreotide on intestinal motility and plasma motilin concentrations in five fasting patients with scleroderma who had bacterial overgrowth and in six fasting normal subjects. The motor effects of octreotide were correlated with its effects on abdominal symptoms and bacterial overgrowth as determined by the level of breath hydrogen excretion. RESULTS In the normal subjects, octreotide (10 micrograms subcutaneously) increased the mean (+/- SD) frequency of intestinal migrating complexes, which reflect intestinal motility, from 1.5 +/- 1.0 to 4.1 +/- 1.1 every three hours. In the patients with scleroderma, who had no spontaneous migrating complexes, octreotide (100 micrograms) induced 3.6 +/- 2.3 complexes every three hours. These complexes propagated at the same velocity and had two-thirds the amplitude of the spontaneous complexes in normal subjects. Plasma motilin concentrations, which were higher in the patients with scleroderma (229 +/- 74 pmol per liter) than in the normal subjects (112 +/- 37 pmol per liter), were inhibited by octreotide, suggesting that intestinal activity evoked by octreotide is independent of motilin. Treatment of the patients with scleroderma with octreotide (50 micrograms every evening) for three weeks reduced breath hydrogen excretion while they were fasting from 25 +/- 5 to 4 +/- 2 ppm (P = 0.001) and breath hydrogen excretion after they ingested 50 g of glucose from 46 +/- 24 to 8 +/- 7 ppm (P = 0.015); these reductions were accompanied by a significant decrease in nausea, bloating, and abdominal pain and by less frequent emesis. CONCLUSIONS Octreotide stimulates intestinal motility in normal subjects and in patients with scleroderma. In such patients, the short-term administration of octreotide reduces bacterial overgrowth and improves abdominal symptoms. This agent may be useful for the treatment of intestinal dysmotility in patients with scleroderma.
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Affiliation(s)
- H C Soudah
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109
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Geirsson AJ, Akesson A, Gustafson T, Elner A, Wollheim FA. Cineradiography identifies esophageal candidiasis in progressive systemic sclerosis. Clin Exp Rheumatol 1989; 7:43-6. [PMID: 2706818] [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: 01/02/2023]
Abstract
Cineradiography of the esophagus showed signs of esophageal candidiasis in 11 out of 71 patients with progressive systemic sclerosis (PSS) - both in diffuse scleroderma and the CREST syndrome. Culture of esophageal brushings confirmed the presence of Candida albicans in eight of these 11 patients. Antimycotic treatment decreased the cineradiographic signs of candidiasis and the degree of dysphagia. Since impaired esophageal motility and treatment with immunosuppressive drugs may predispose to candida esophagitis, and since dysphagia will decrease after antimycotic treatment esophageal mycosis should always be sought in patients with PSS.
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Affiliation(s)
- A J Geirsson
- Department of Rheumatology, University Hospital, Lund, Sweden
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Abstract
Variably acid-fast coccoid forms, suggestive of cell wall deficient forms of mycobacteria, were observed in the dermis in microscopic sections of skin from six patients with generalized scleroderma, 10 patients with localized scleroderma (morphea), and four patients with lichen sclerosus et atrophicus (LSA). These coccoid forms were found within the collagen bundles, around the adnexae (hair shafts, pilosebaceous units, eccrine glands), and less commonly around the blood vessels and nerves. These coccoid forms may be related to cocci and also to granular coccoid elements of corynebacteria-like coccobacilli, which, on occasion, can be cultured from the skin of these three diseases. The findings in this study support the three-decade old hypothesis concerning the constant association of pleomorphic acid-fast bacteria with scleroderma. The study also suggests that closely related diseases, such as morphea and LSA, are also associated with the presence of similar appearing microbes.
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Abstract
Microscopic tissue sections stained for bacteria were studied from autopsy material from a fatal case of scleroderma (progressive systemic sclerosis). Extra- and intracellular, variable-sized, pleomorphic but predominantly coccoid bacteria were observed in some organs such as in heart, lungs, adrenals, kidneys, pancreas, skin, and in the connective tissue. An attempt is made to correlated the ante-mortem skin culture material with the post-mortem histopathologic finding of bacteria. It is hypothesized that these microbes observed in tissue might represent in vivo, cell wall deficient L forms, which may be implicated in the pathogenesis of scleroderma.
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Giordano M, Ruggiero G, Tirri G, Andreana A, Ara M, Giusti G. [Distribution of HBs-(Australia) antigen in progressive systemic scleroderma and other connective tissue disorders]. Z Rheumatol 1976; 35:397-402. [PMID: 1007636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Of 173 patients, mostly suffering from collagen diseases and rheumatoid disease, the HBs antigen (HBsAg) was present in 1.73%. This figure is no higher than that observed among blood donors from the same area (Naples and surroundings). One HBsAg positive patient suffered from chronic active hepatitis and rheumatoid arthritis; another from chronic active hepatitis and a secondary type of reticuloendotheliosis; the third was one of seven patients with psoriatic arthritis. HBsAg was not found in any of 48 patients with other collagen diseases, including 22 patients with Progressive Systemic Sclerosis. These data do not support the hypothesis based on observations of polyarteritis nodosa that HBsAg plays an ethiopathogenetic role in collagen diseases with serious vasculitis.
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Sapico FL, Emori H, Smith LD, Bluestone R, Finegold SM. Absence of relationship of fecal Clostridium perfringens to rheumatoid arthritis and rheumatoid variants. J Infect Dis 1973; 128:559-62. [PMID: 4355210 DOI: 10.1093/infdis/128.4.559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Kerl H, Auböck L. [Virus-like endoplasmatic structures in lupus erythematosus and in various other diseases of unknown etiology]. Hautarzt 1973; 24:95-105. [PMID: 4713269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Fite GL. Acid-fast bacteria in scleroderma. Arch Dermatol 1971; 104:560. [PMID: 5120184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Cantwell AR, Kelso DW. Acid-fast bacteria in scleroderma and morphea. Arch Dermatol 1971; 104:21-5. [PMID: 5120159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Gorbach SL. Intestinal microflora. Gastroenterology 1971; 60:1110-29. [PMID: 4933894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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41
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Meihoff WE, Hirschfield JS, Kern F. Small intestinal scleroderma with malabsorption and pneumatosis cystoides intestinalis. Report of three cases. JAMA 1968; 204:854-8. [PMID: 5694734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Krylov IA, Fomichev IK. [Identification of bacteria of the Klebsiella genus by the immunofluorescence method]. Zh Mikrobiol Epidemiol Immunobiol 1968; 45:117-21. [PMID: 4892086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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DELMOTTE N, VAN DER MEIREN L. [Bacteriological and histological investigations regarding scleroderma]. Dermatologica 1953; 107:177-82. [PMID: 13116683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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