​A study published in the Gastroenterology journal by a Canadian research team documents that population and ratios of specific gut bacteria are uniquely different in those patients who develop Crohn’s disease as opposed to those who do not, and this gut bacteria differentiation can be identified years before Crohn’s Disease symptoms develop.
 
Dysbiosis involving five key bacteria contributed to subsequent Crohn’s Disease.  The five bacteria are:  “Ruminococcus torques, Blautia, Colidextribacter, an uncultured genus-level group from Oscillospiraceae, and Roseburia.”  (https://pubmed.ncbi.nlm.nih.gov/37263307/)
 
The discovery constitutes two important advances.  First, it provides clinicians with the ability to identify the bacteria populations that make one prone to development of Crohn’s Disease based upon identification of bacteria in one’s microbiome.  Second, with the specific bacteria now identified, clinicians can intervene in advance of symptoms to increase the population of good gut bacteria and decrease the population of the bacteria that instigate Crohn’s Disease.
 
One of the study’s authors, Dr. Kenneth Croitoru, told Crohn’s and Colitis Canada that “These years of effort led us to recently discover that a specific combination of gut bacteria is connected to the future development of Crohn’s disease. We’re starting to see the pattern of bacteria that may be triggering Crohn’s disease, moving us closer to better treatments for those with the disease or even preventing it for those at risk. I’m hopeful that within five years, patients will benefit through evidence-based treatments focused on the gut bacteria or diet modification.”   (https://crohnsandcolitis.ca/News-Events/News-Releases/Canadian-medical-research-breakthrough-Gut-bacteri).

​Traditionally it has been difficult for researches to study bacterial population changes in the small bowel, as they are only reachable during surgery or endoscopy.  Now, researchers led by Andrew Macpherson and Bahtiyar Yilmaz from the Department for Biomedical Research at the University of Bern and the University Clinic for Visceral Surgery and Medicine at the Inselspital have used patients with ileal ostomies as a means to survey the small bowel microbiome in real-time, leading to some interesting discoveries. 
 
Among the findings, ileal bacteria populations are highly variable, largely disappearing when individuals fast while sleeping overnight, only to bloom again when food is consumed at breakfast.  Interestingly, while the number of bacteria fluctuates significantly, the types of bacteria that comprise the microbiome do not.  The changes that occur in the bacterial populations also happen quickly, within hours of consuming a meal.  This differs from the bacteria in the large bowel, whose numbers and proportions remain stable.
 
The head of the study and its senior author, Andrew Macpherson, stated that "Because the system is so flexible, each bacterial species can adapt to a changing environment in the small intestine by changing the proportions of subspecies and thus prevent the species as a whole from dying out." As a result the ileal bacteria normally avoid species extinctions, unless there is an illness, malnutrition, or other environmental factor. 
 
These findings, and the use of small bowel ostomies as a research tool, will enable further research into the interaction of the small intestine microbiome and diseases like Crohn’s, Colitis, and celiac.  
 
(Plasticity of the Adult Human Small Intestinal Stoma Microbiota. Cell Host & Microbe, 2022; DOI: 10.1016/j.chom.2022.10.002).

​University of Gothenburg researchers have found a statistically significant risk of pre-term births to mothers who are Inflammatory Bowel Disease (IBD) patients.  IBD, including Crohn’s Disease and Colitis, causes visible inflammation and damage to the intestinal lining.  The new research indicates that even microscopic inflammation in a patient who might otherwise be considered to be in remission, has adverse implications for pre-term pregnancies.
 
Karl Mårild, the study's first author and corresponding author and an associate Professor of Pediatrics at Sahlgrenska Academy, University of Gothenburg, and senior consultant pediatrician at the Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, stated:  "Our results suggest that IBD treatment aimed at not merely alleviate symptoms of IBD, but also microscopically heal the intestine, can reduce the risk of giving birth preterm. If our results hold up in future studies, they may therefore be the basis for recommendations to confirm microscopic healing before pregnancy, to reduce such risks."

Being in the hospital is no fun, but the day is a little brighter when someone shows they care with a thoughtful gift. Any thing that makes the stay more comfortable or help pass the time is welcome.  After spending many months in the hospital I'm somewhat of an expert patient, so I'm sharing here some of the great gifts people sent.

While I was in the hospital my parents spent hours playing with dolls, but not for fun.  The doll was basically my stunt double, allowing my parents to practice the complicated process of changing my parenteral nutrition infusion, setting the dosage correctly on the pump, and changing the dressings the PICC line insertion in my arm.  The expectation is that once I was discharged, my parents would take over from the nurses and be responsible for this daily process at home. Fortunately for all of us, I was able to start eating solid food again before I went home, but we'll never forget PICC baby.

For more information about PICC lines visit https://www.mayoclinic.org/tests-procedures/picc-line/about/pac-20468748

The hospital images most people remember from COVID show patients overcrowding hallways, chaotic ICUs, and exhausted staff.  For me, being admitted to a pediatric hospital at the very start of the shutdowns was a brief calm before the storm.  Bracing for the worst, non-emergency procedures were put on hold and hospital rooms emptied out.  Downtown streets were deserted, shops closed, and hospital corridors were eerily quiet.  Of course all that changed quickly and tragically, but I won't ever forget what it was like to inhabit this quiet, foreboding space, when any contact with another human was a calculated risk that could mean life or death.