Diarrhoea in adults with coronavirus disease—beyond incidence and mortality: a systematic review and meta-analysis
Roman Maslennikov, Elena Poluektova, Vladimir Ivashkin, Andrey Svistunov
Diarrhoea is a relatively common manifestation of coronavirus disease (COVID-19), but there is no systematic review which comprehensively describes it beyond its incidence and impact on prognosis. This study aims to provide a detailed systematic review of diarrhoea in adults with COVID-19.
A PUBMED and Scopus search (until 7 September 2020) was performed. Studies that were limited to describing incidence of diarrhoea and its effect on prognosis were excluded.
Twenty-six papers including 7860 patients with COVID-19 were subjected to synthesis. Mean duration of diarrhoea was 4.2 (3.6–4.9) days (range 1–16 days), whereas mean bowel movement count was 4.6 (3.8–5.3) and maximum was 20 per day. Diarrhoea started on an average 5.1 (3.8–6.5) days after disease onset but was the first manifestation in 4.3% patients. Stool occult blood was detected in 6.8% of patients with diarrhoea, while 53.3% cases had watery diarrhoea. Patients with diarrhoea also had elevated faecal calprotectin. Viral genome in faeces was detected more often in patients with diarrhoea and most often in patients without respiratory symptoms. Fever, myalgia and respiratory symptoms were observed with the same incidence in patients with and without diarrhoea. Similarly, there were no differences noted in complete blood count and most inflammation biomarkers between patients with and without diarrhoea. However, nausea, vomiting abdominal pain, sneezing and headache were more common in patients with diarrhoea. Diarrhoea was the main manifestation of COVID-19 in 6.1% of cases and this form of the disease had specific features.
Diarrhoea in COVID-19 needs further investigation.
Keywords: COVID-19diarrhoeasystematic reviewmeta-analysis
For citation: Roman Maslennikov , Elena Poluektova , Vladimir Ivashkin & Andrey Svistunov (2021): Diarrhoea in adults with coronavirus disease—beyond incidence and mortality: a systematic review and meta-analysis, Infectious Diseases, DOI:10.1080/23744235.2021.1885733
Clinical validation of the “7 × 7” questionnaire for patients with functional gastrointestinal disorders
Vladimir Ivashkin, Arkady Sheptulin, Oleg Shifrin, Elena Poluektova, Chavdar Pavlov, Konstantin Ivashkin, Alexandra Drozdova, Olga Lyashenko, Alexandr Korolev
Background and Aim
Physicians use different scales and questionnaires to assess the severity of clinical symptoms in patients with functional gastrointestinal disorders. The current study aimed to validate the “7 × 7” questionnaire for assessment of severity of the symptoms as a tool for the efficacy of treatment of functional gastrointestinal disorders, using the Clinical Global Impressions scale as the reference standard.
Fifty inpatients aged from 18 to 64 with a confirmed diagnosis of irritable bowel syndrome (26 patients, 52%), functional dyspepsia (15 patients, 30%), or both (9 patients, 18%) were prospectively enrolled in the study. We used both the 7 × 7 questionnaire and the Clinical Global Impressions scale before and after 28 days of stable treatment.
Our study revealed a significant correlation between the 7 × 7 questionnaire and the Clinical Global Impressions scale results in assessment of severity of the clinical symptoms and their dynamics during treatment. The 7 × 7 questionnaire showed sensitivity of 74.5% and specificity of 54.1% for evaluating patients with mild to severe disease and 66.6% and 76%, respectively, for evaluating patients with moderate to severe disease. The Cronbach's alpha coefficient was 0.719. The intraclass correlation coefficient among participants in whom the condition remained the same was 0.973 (12 participants [24.5%]).
The 7 × 7 questionnaire is a convenient, sensitive, and reliable tool for assessing the severity of symptoms and treatment efficacy in people with functional gastrointestinal disorders.
Keywords: “7 × 7” questionnaire, Clinical Global Impressions scale, functional dyspepsia, irritable bowel syndrome, symptoms dynamics
For citation: Ivashkin V, Sheptulin A, Shifrin O, Poluektova E, Pavlov C, Ivashkin K, Drozdova A, Lyashenko O, Korolev A. Clinical validation of the “7 × 7” questionnaire for patients with functional gastrointestinal disorders. J Gastroenterol Hepatol. 2019;34(6):1042–8.
The Evolution of Human Probiotics: Challenges and Prospects
Elizaveta Trush, Elena Poluektova, Allan Beniashvilli, Oleg Shifrin, Yuri Poluektov, Vladimir Ivashkin
In recent years, the intestinal microbiota has been found to greatly influence a number of biological processes important for human health and longevity. Microbial composition changes easily in response to external factors, such as an unbalanced diet, lack of physical activity, and smoking. Probiotics are a key factor in maintaining the optimal composition of the intestinal microbiota. However, a number of important questions related to probiotics, such as indication for prescription, comparative efficacy of monostrain and multistrain probiotics, methods of delivery, and shelf life, remain unresolved. The aim of this review is to highlight existing issues regarding probiotic production and their prescription. The review presents the most recent findings regarding advantages and efficacy of monostrain and multistrain probiotics, preservation of probiotic strains in capsules and microcapsules, production of probiotics in the form of biofilms for improved efficacy and survival, and results of clinical studies evaluating the benefits of probiotics against different pathologies. We believe that this work will be of interest to physicians and researchers alike and will promote the development of new probiotics and ensuing regimens aimed at the treatment of various diseases.
Keywords:Biofilm, efficacy, monostrain and multistrain probiotics, planktonic cells.
For citation: Trush, E.A., Poluektova, E.A., Beniashvilli, A.G. et al. The Evolution of Human Probiotics: Challenges and Prospects. Probiotics & Antimicro. Prot. 12, 1291–1299 (2020). https://doi.org/10.1007/s12602-019-09628-4
Roman Maslennikov, Chavdar Pavlov, Andrey Kotzev, Vladimir Ivashkin
Small intestinal bacterial overgrowth (SIBO) and vasodilatation are common in cirrhosis. The aim is to study the influence of SIBO on the development of vasodilatation in cirrhosis. Fifty patients with cirrhosis and 15 healthy controls were enrolled in a pilot prospective study. All participants underwent lactulose hydrogen breath test for SIBO and echocardiography with simultaneous assessment of blood pressure and heart rate. Systemic vascular resistance was calculated. Blood C-reactive protein was measured. Systemic vascular resistance was lower in patients with SIBO in comparison with those without SIBO and healthy controls (1312 ± 352 dyn s cm-5 vs. 1704 ± 424 dyn s cm-5 and 1648 ± 272 dyn s cm-5; p = 0.001 and p = 0.006). There was no significant difference between patients without SIBO and healthy controls in systemic vascular resistance ( p = 0.874). Systemic inflammatory response was detected in 14/26 patients with SIBO and in 2/24 patients without SIBO ( p = 0.001). Among participants with cirrhosis, there was a negative correlation between blood C-reactive protein and systemic vascular resistance ( r = ‑0.367; p = 0.009). SIBO is associated with vasodilation in cirrhosis and may be a principal factor causing it through systemic inflammation.
Key words: cirrhosis, small intestinal bacterial overgrowth, vasodilation
For citation: Maslennikov R, Pavlov C, Kotzev A, Ivashkin V. Small intestinal bacterial overgrowth is associated with vasodilatation in cirrhosis. Comptes rendus de l’Acade'mie bulgare des Sciences, Vol 73, No4, pp.553-558
Small intestinal bacterial overgrowth in cirrhosis: systematic review and meta-analysis
Roman Maslennikov, Chavdar Pavlov, Vladimir Ivashkin
Small intestinal bacterial overgrowth (SIBO) was detected in cirrhosis in many studies. The aim is to perform a systematic review and meta-analysis on the prevalence of SIBO in cirrhosis and on the relationship of SIBO with features of cirrhosis.
PUBMED search (until 14 January 2018) was performed. Specific search terms were: ‘(cirrhosis) AND (SIBO OR bacterial overgrowth)’. Studies not relating to cirrhosis or SIBO, animal studies, and non-original articles were excluded. A meta-analysis of all studies was performed using a random-effects model.
117 references were identified by the PUBMED search. 3 references were added after handsearching the reference lists of all the articles. 99 references were excluded. 21 studies (included in total 1264 cirrhotics and 306 controls) remained for qualitative analysis and quantitative synthesis. Prevalence of SIBO for cirrhosis was 40.8% (95% CI 34.8–47.1), while the prevalence of SIBO for controls was 10.7% (95% CI 5.7–19.0). OR 6.83 (95% CI 4.16–11.21; p < 0.001). Prevalence of SIBO for decompensated cirrhosis was higher than prevalence of SIBO for compensated cirrhosis (50.5% vs. 31.2%; p < 0.001). SIBO in cirrhosis was associated with ascites (p < 0.001), minimal hepatic encephalopathy (p = 0.001), bacterial translocation (p = 0.026), spontaneous bacterial peritonitis (p = 0.008), prolonged orocecal transit time (p < 0.001), and was not associated with hypocoagulation. Further studies are required to clarify the relationship of SIBO with hyperbilirubinemia, hypoalbuminemia, overt hepatic encephalopathy in past, esophageal varices and systemic inflammation.
Small intestinal bacterial overgrowth is more often detected in cirrhosis than in healthy persons and is associated with some features of cirrhosis.
Keywords: SIBO, Cirrhosis, Systematic review, Meta-analysis.
For citation: Maslennikov, R., Pavlov, C. & Ivashkin, V. Small intestinal bacterial overgrowth in cirrhosis: systematic review and meta-analysis. Hepatol Int 12, 567–576 (2018). https://doi.org/10.1007/s12072-018-9898-2
Roman Maslennikov, Chavdar Pavlov, Vladimir Ivashkin
Background/aims: Small intestinal bacterial overgrowth (SIBO) and hemodynamic changes are common in cirrhosis. We wanted to examine our hypothesis whether SIBO leads to hemodynamic changes in cirrhosis.
Materials and methods: A total of 50 patients with cirrhosis and 15 healthy controls were enrolled in a pilot prospective study. All participants underwent the lactulose hydrogen breath test for SIBO and echocardiography with a simultaneous assessment of blood pressure and heart rate. Cardiac output and systemic vascular resistance were calculated.
Results: Study participants with SIBO had a lower systolic blood pressure and systemic vascular resistance compared to those without SIBO and to healthy controls (110.2±12.3 mmHg vs. 126.2±21.0 mmHg and 121.2±9.8 mmHg; p=0.005 and p=0.011, respectively; 1312±352 dyn•s•cm-5 vs. 1704±424 dyn•s•cm-5 and 1648±272 dyn•s•cm-5; p=0.001 and p=0.006, respectively), but a higher cardiac output (5.38±1.41 l/min vs. 4.52±1.03 l/min and 4.40±0.68 l/min; p=0.034 and p=0.041, respectively) and C-reactive protein (10.5[1.2-16.5] mg/l vs. 2.8[0.6-9.1] mg/l; p=0.028; no comparison with healthy controls). There were no significant differences between patients without SIBO and healthy controls with regard to systolic blood pressure (p=0.554), systemic vascular resistance (p=0.874), and cardiac output (p=0.795). SIBO was associated with vasodilation and hyperdynamic circulation in decompensated cirrhosis (p=0.002; p=0.012), but not in compensated cirrhosis (p=1.000; p=0.474).
Conclusions: SIBO is associated with hyperdynamic circulation and other hemodynamic changes in cirrhosis and may be a principal factor causing these through systemic inflammation.
Keywords: Cirrhosis, vasodilation, gut microbiota, hemodynamics, systemic inflammation
For citation: Maslennikov R, Pavlov C, Ivashkin V. Is small intestinal bacterial overgrowth a cause of hyperdynamic circulation in cirrhosis? Turk J Gastroenterol 2019; 30(11):964-75.
Oxana Zolnikova, Inna Komkova, Nino Potskherashvili, Alexander Trukhmanov, Vladimir Ivashkin
We have reviewed the currently published results on a role of the gut microflora in a prevention of acute respiratory infections. The main biological properties of probiotic bacteria are presented in a context of their modulating activity on an inflammatory immune response. Available data on the reduction of a possible risk, duration, and severity of respiratory infection symptoms during a probiotic medication intake were analyzed. Potential antiviral probiotic mechanisms have been reviewed and discussed.
Keywords: Acute respiratory infections, lung microbiome, intestinal microbiome, immunomodulation, probiotic.
For citation: Zolnikova, O., Komkova, I., Potskherashvili, N., Trukhmanov, A., & Ivashkin, V. (2018). Application of probiotics for acute respiratory tract infections. Italian Journal of Medicine, 12(1), 32-38. https://doi.org/10.4081/itjm.2018.931
Vladimir Ivashkin, Oxana Zolnikova, Nino Potskherashvili, Alexander Trukhmanov, Natalia Kokina, Natiya Dzhakhaya
The efficacy of a gut microbiota control was investigated for patients with atopic asthma. 45 patients with atopic asthma were included in the study. The results of our clinical and lab tests, pulmonary function tests and the lactulose hydrogen breath tests have been presented to evaluate small intestine bacterial overgrowth (SIBO). Under the standard SIBO’s therapy (long-acting beta-agonists, inhaled glucocorticoids), the first group (15 patients) had being tested with Rifaximin for the SIBO therapy during 7 days. The second group (15 patients) had been tested with Rifaximin and with a succeeding probiotics therapy for three months (B. bifidum, B. longum, B. infantis, L. rhamnosus). SIBO was diagnosed for 30 (67%) patients. We have detected a higher IgE level (P<0.01), a higher eosinophils level (P<0.001) in sputum and more significant decrease of FEV1 (P<0.01) in SIBO(+). The IgE level in patients was decreased (P<0.01) after the complex SIBO therapy both for the Rifaximin therapy group (P<0.05) and for the Rifaximin + Probiotic therapy group (P<0.05). A dramatic decrease of the IgE level (P<0.05) had been induced by probiotics and it was confirmed by the control testing results with a high statistical accuracy for the observed groups of patients. We did not detect any changes for the patients without SIBO (P=0.46), those who had been treated with a standard therapy. A decrease in the number of patient hospitalization was defined by the treatment with probiotics after SIBO therapy (P<0.05). So, SIBO is a significant factor aggravating the atopic asthma in patients. The gut microflora correction with probiotics therapy has been accompanied by a statistical reliability improvement for the immune response and spirometry, as well as by a decrease in the number of hospitalizations for these patients during the year.
Keywords: Gut microbiota, atopic asthma, small intestine bacterial overgrowth, immunomodulation, probiotic.
For citation: Ivashkin, V., Zolnikova, O., Potskherashvili, N., Trukhmanov, A., Kokina, N., & Dzhakhaya, N. (2018). A correction of a gut microflora composition for the allergic bronchial asthma complex therapy. Italian Journal of Medicine, 12(4), 260-264. https://doi.org/10.4081/itjm.2018.1040
Vladimir Ivashkin, Maria Fadeeva, Manana Skhirtladze, Oxana Zolnikova
In this review, we have considered and discussed the existing data to achieve a deeper understanding of the role of intestinal microbiota in the development and progression of chronic heart failure (CHF). The key moments of the CHF pathogenesis (an imbalance of neurohumoral systems, inflammatory theory and metabolic disorders) and the respective changes of the intestinal microflora composition were compared. Here, we also present the latest results of the positive influence of the microflora modulations on the course and prognosis of CHF with the prescribing antibiotics, probiotics and prebiotics.
Keywords: Intestinal microbiota, chronic heart failure, probiotics, cytokines.
For citation: Ivashkin, V., Fadeeva, M., Skhirtladze, M., & Zolnikova, O. (2020). Intestinal microbiota in the pathogenesis of chronic heart failure. Italian Journal of Medicine, 14(1), 1-8. https://doi.org/10.4081/itjm.2020.1185