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Extracorporeal Shock Wave Therapy (ESWT) is used clinically in various disorders including chronic wounds for its pro-angiogenic, proliferative, and anti-inflammatory effects. However, the underlying cellular and molecular mechanisms driving therapeutic effects are not well characterized. Macrophages play a key role in all aspects of healing and their dysfunction results in failure to resolve chronic wounds. We investigated the role of ESWT on macrophage activity in chronic wound punch biopsies from patients with non-healing venous ulcers prior to, and two weeks post-ESWT, and in macrophage cultures treated with clinical shockwave intensities (150–500 impulses, 5 Hz, 0.1 mJ/mm2). Using wound area measurements and histological/immunohistochemical analysis of wound biopsies, we show ESWT enhanced healing of chronic ulcers associated with improved wound angiogenesis (CD31 staining), significantly decreased CD68-positive macrophages per biopsy area and generally increased macrophage activation. Shockwave treatment of macrophages in culture significantly boosted uptake of apoptotic cells, healing-associated cytokine and growth factor gene expressions and modulated macrophage morphology suggestive of macrophage activation, all of which contribute to wound resolution. Macrophage ERK activity was enhanced, suggesting one mechanotransduction pathway driving events. Collectively, these in vitro and in vivo findings reveal shockwaves as important regulators of macrophage functions linked with wound healing. This immunomodulation represents an underappreciated role of clinically applied shockwaves, which could be exploited for other macrophage-mediated disorders. more...

Background Sequencing-based analysis has become a well-established approach to deciphering the composition of the gut microbiota. However, due to the complexity of accessing sufficient material from colonoscopic biopsy samples, most studies have focused on faecal microbiota analysis, even though it is recognised that differences exist between the microbial composition of colonic biopsies and faecal samples. We determined the suitability of colonic lavage samples to see if it had comparable microbial diversity composition to colonic biopsies as they are without the limitations associated with sample size. We collected paired colonic biopsies and lavage samples from subjects who were attending for colorectal cancer screening colonoscopy. Results Next-generation sequencing and qPCR validation were performed with multiple bioinformatics analyses to determine the composition and predict function of the microbiota. Colonic lavage samples contained significantly higher numbers of operational taxonomic units (OTUs) compared to corresponding biopsy samples, however, diversity and evenness between lavage and biopsy samples were similar. The differences seen were driven by the presence of 12 OTUs which were in higher relative abundance in biopsies and were either not present or in low relative abundance in lavage samples, whilst a further 3 OTUs were present in higher amounts in the lavage samples compared to biopsy samples. However, predicted functional community profiling based on 16S ribosomal ribonucleic acid (rRNA) data indicated minimal differences between sample types. Conclusions We propose that colonic lavage samples provide a relatively accurate representation of biopsy microbiota composition and should be considered where biopsy size is an issue. Electronic supplementary material The online version of this article (doi:10.1186/s40168-016-0207-9) contains supplementary material, which is available to authorized users. more...

The gastrointestinal microbiota is considered important in inflammatory bowel disease (IBD) pathogenesis. Discoveries from established disease cohorts report reduced bacterial diversity, changes in bacterial composition, and a protective role for Faecalibacterium prausnitzii in Crohn's disease (CD). The majority of studies to date are however potentially confounded by the effect of treatment and a reliance on established rather than de-novo disease.Microbial changes at diagnosis were examined by biopsying the colonic mucosa of 37 children: 25 with newly presenting, untreated IBD with active colitis (13 CD and 12 ulcerative colitis (UC)), and 12 pediatric controls with a macroscopically and microscopically normal colon. We utilized a dual-methodology approach with pyrosequencing (threshold10,000 reads) and confirmatory real-time PCR (RT-PCR).Threshold pyrosequencing output was obtained on 34 subjects (11 CD, 11 UC, 12 controls). No significant changes were noted at phylum level among the Bacteroidetes, Firmicutes, or Proteobacteria. A significant reduction in bacterial α-diversity was noted in CD vs. controls by three methods (Shannon, Simpson, and phylogenetic diversity) but not in UC vs. controls. An increase in Faecalibacterium was observed in CD compared with controls by pyrosequencing (mean 16.7% vs. 9.1% of reads, P=0.02) and replicated by specific F. prausnitzii RT-PCR (36.0% vs. 19.0% of total bacteria, P=0.02). No disease-specific clustering was evident on principal components analysis.Our results offer a comprehensive examination of the IBD mucosal microbiota at diagnosis, unaffected by therapeutic confounders or changes over time. Our results challenge the current model of a protective role for F. prausnitzii in CD, suggesting a more dynamic role for this organism than previously described. more...

Recently, two large genome-wide association studies, conducted in Chinese populations, have reported associations between upper gastrointestinal cancer and the rs2274223, rs13042395 and rs4072037 polymorphisms in PLCE1, C20orf54 and MUC1, respectively. We aimed to determine whether similar associations existed for Caucasian populations. We genotyped two population-based, case-control studies of upper gastrointestinal cancer; the first study included 290 gastric cancer (GC) cases and 376 controls and the second study included 306 GC cases, 107 oesophageal adenocarcinoma cancer cases, 52 oesphageal squamous cell cancer cases and 211 controls. Odds ratios (OR) and 95% confidence intervals (CIs) were computed from logistic models and adjusted for confounding variables. The rs4072037 polymorphism in MUC1 was associated with a reduced risk of GC of intestinal histological type (OR 0.4; 95% CI 0.2-0.9) and a reduced risk of oesophageal squamous cell cancer (OR 0.5; 95% CI 0.2-1.0), but not oesphageal adenocarcinoma. Similarly, rs2274223 in PLCE1 was associated with a reduced risk of oesophageal squamous cell cancer (OR 0.5; 95% CI 0.3-1.0), but not oesphageal adenocarcinoma. We observed no association between rs13042395 in Corf54 and the risk of gastric or oesphageal cancer in either of the two studies. Our findings for rs4072037 and the risk of GC are in agreement with one previous report for a Caucasian population. To the best of our knowledge, this is the first study to report an association between rs2274223 and rs4072037 and the risk of oesophageal squamous cell carcinoma in a Caucasian population. more...

Background\ud \ud Considerable effort has been made to categorise the bacterial composition of the human gut and correlate findings with gastrointestinal disease. The infant gut has long been considered sterile at birth followed by rapid colonisation; however, this view has recently been challenged. We examined first-pass meconium from healthy term infants to confirm or refute sterility.\ud \ud Methods\ud \ud Healthy mothers were approached following vaginal delivery. First-pass meconium stools within 24 hours of delivery were obtained from healthy, breastfed infants with tight inclusion/exclusion criteria including rejecting any known antibiotic exposure - mother within 7 days preceding delivery or infant after birth. Stools were processed in triplicate for fluorescent in-situ hybridisation (FISH) with 16S rRNA-targeted probes including Bifidobacterium; Bacteroides-Prevotella; Lactobacillaceae/Enterococcaceae; Enterobacteriaceae; Streptococcaceae; Staphylococcaceae and Enterococcaceae. Absolute counts of all bacteria and proportional identification of each bacterial group were calculated. Confirmation of bacterial presence by PCR was undertaken on FISH-positive samples.\ud \ud Results\ud \ud The mothers of 31 newborn infants were recruited, 15 met inclusion/exclusion criteria and provided a sample within 24 hours of birth, processed in the lab within 4 hours. All babies were 37–40 weeks gestation. 8/15 were male, mean birth weight was 3.4kg and mean maternal age was 32 years. Meconium samples from 10/15 (66%) infants had evidence of bacteria based on FISH analysis. Of these, PCR was positive in only 1. Positive FISH counts ranged from 2.2 - 41.8 x 104 cells/g with a mean of 15.4 x 104 cells/g. (The limit of detection for automated counting is 106 cells/g). Cell counts were too low to allow formal diversity analysis. Amplification by PCR was not possible despite positive spiked samples demonstrating the feasibility of reaction. One baby was dominated by Enterobacteriaceae. The others contained 2-5 genera, with Bifidobacterium, Enterobacteriaceae, Enterococcaceae and Bacteroides-Prevotella the most prevalent. There was no association between bacterial counts and rupture of membrane duration, time to passage of meconium or time to lab.\ud \ud Conclusion\ud \ud This study provides evidence that low numbers of bacteria are present in first-pass meconium samples from healthy, vaginally-delivered, breastfed term infants. Only two-thirds of meconium samples had detectable bacteria, though at levels too low for automated counting or for reliable confirmation by PCR. This study suggests that gut bacterial colonisation is extremely limited at birth and occurs rapidly thereafter. more...

Cytokine gene polymorphisms modify expression and their circulating protein levels reflect inflammatory response. Chronic inflammation plays a key role in the pathogenesis of colorectal neoplasia (CRN) associated with inflammatory bowel disease, but it is not clear whether inflammation is a cause or an effect of tumours in sporadic CRN. We therefore investigated the association of cytokine gene polymorphisms and circulating cytokine levels on the risk of CRN in Northeast Scotland, which has a high incidence of CRN. We recruited two groups of patients from a screening colonoscopy cohort, either preprocedure or 3-24 months postprocedure. Participants with CRN were compared with participants with no evidence of CRN (controls). Blood-derived DNA was used to genotype polymorphisms in IL1B, IL1-RN, IL6, IL8, IL10, PTGS2 and TNFA genes. Circulating levels of high-sensitivity C-reactive protein and six cytokines [interleukin-1β (IL-1β), IL-4, IL-6, IL-8, IL-10 and tumour necrosis factor-α (TNF-α)] were measured. To examine the effect of CRN resection on marker levels, we used propensity score matching. A total of 884 patients were eligible for analysis, including 388 CRN cases and 496 controls. Cases were older (mean age 64 vs. 62 years, P0.01) and more likely to be men (67 vs. 55%, P0.001). Controls were more likely to be regular users of NSAID (P0.0001). Compared with homozygous carriage of respective common alleles, proinflammatory CC genotypes of IL1B-31CT [odds ratio (OR) (95% confidence interval (CI) 1.68 (1.03-2.73)] and PTGS2-765 CG [OR (95% CI) 2.97 (1.05-8.46)] were each associated with an increased risk of CRN. Conversely, carriage of the A allele of IL8-251AT was associated with a lower risk of CRN compared with the TT genotype [ORs (95% CI) 0.60 (0.41-0.86) for heterozygous, 0.88 (0.57-1.37) for homozygous, and 0.68 (0.48-0.95) for heterozygous and homozygous combined]. Compared with postprocedure cases, IL8, TNF-α and C-reactive protein levels were significantly higher in preprocedure cases, but IL4 and IL10 protein levels were significantly lower. Proinflammatory cytokine gene polymorphisms in IL1B-31 and PTGS2-765 increase the risk of developing CRN. Levels of proinflammatory IL8, TNF-α and C-reactive protein markers are significantly higher while CRN is in situ. Along with the NSAID findings, these data point to inflammation as an underlying pathogenetic mechanism in CRN. more...

Host genetic factors play an important role in modifying the risk of human disease, including cancers of the upper gastrointestinal tract, with increasing interest in Toll-like receptor (TLR) signaling and the impact of genetic polymorphisms in these systems. The CD14-159C/T and the TLR9-1237T/C promoter polymorphisms have previously been shown to be associated with various inflammatory conditions including Helicobacter pylori-induced gastritis in Caucasian populations. In this study, we assessed the association of these two functional single nucleotide polymorphisms with gastric cancer in two independent Caucasian population-based case–control studies of upper gastrointestinal tract cancer, initially in 312 noncardia gastric carcinoma cases and 419 controls and then in 184 noncardia gastric carcinomas, 123 cardia carcinomas, 159 esophageal cancers, and 211 frequency-matched controls. Odds ratios were computed from logistic models and adjusted for potential confounding factors. No significant association was found between the CD14-159C/T and the TLR9-1237T/C promoter polymorphisms and increased risk of gastric cancer. Neither single nucleotide polymorphism has been assessed in a Caucasian gastric cancer case–control study before; although the CD14-159C/T polymorphism has been reported to show no apparent association with H. pylori-related gastric malignancy in a Taiwanese Chinese population. In conclusion, although our earlier preliminary studies suggested that the CD14-159C/T and the TLR9-1237T/C promoter polymorphisms increase the risk of precancerous outcomes, they do not seem to increase the risk of gastric cancer itself. This discrepancy merits further examination. more...

Introduction Rotaviruses (RV) are the leading cause of severe gastroenteritis in children less than five years of age worldwide. Rotarix®, a live attenuated monovalent vaccine containing a RV strain of G1P[8] specificity has been included in the routine childhood immunisation schedule from June 2013 in Scotland and is offered to infants under the age of four months in two doses. This study aimed to characterise the prevalent rotavirus strains in Scotland prior to the introduction of the vaccine. Method Rotavirus positive faecal samples from various Scottish regional virology laboratories covering the years 2012–2013, before the introduction of the vaccine, were genotyped. Viral RNA was extracted from faecal suspensions using guanidine isothiocyanate – silica gel extraction method. VP7 and VP4 gene specific multiplex hemi-nested PCRs were used for genotyping. Surveillance systems were established by Health Protection Scotland to monitor the impact of the vaccine. Results A total of 387 samples were genotyped from the regional virology laboratories in Aberdeen, Dundee, Inverness, Glasgow and Edinburgh. The commonest strain in Scotland was G1P[8] accounting for 72.1% of cases. The other strains that were identified were G2P[4] in 7.2%, G4P[8] in 6.9%, G9P[8] in 3.4% and G3P[8] in a further 2.3% of cases. Single cases of G12P[8] and G9P[4] were also found (0.26% respectively). Mixed infections were seen in 5.4% of cases. The provisional uptake for the first dose of Rotarix® vaccine in Scotland for children born between 1 st of July to 30 th Sept 2013 was 92.7%% for the completed course by 12 months. The laboratory confirmed cases of RV reported to HPS via ECOSS (The Electronic Communication of Surveillance in Scotland) showed a marked reduction in confirmed reports of RV compared to a three year average of the years 2011–13. Surrogate markers, e.g. calls to NHS24 and GP consultations with childhood diarrhoea and vomiting, have also shown a downward trend. Conclusion The pre-vaccine surveillance of RV strains confirms that G1P[8] is the predominant strain in Scotland. There has been a promising reduction in laboratory confirmed cases of RV in Scotland following the introduction of the vaccine. The baseline genotyping data will be used to ascertain cross protection against strains and also identify vaccine induced RV strain shifts and an overall evaluation of the programme. Disclosure of interest None Declared. more...

Introduction Drug transporter expression in the colorectal epithelium is likely to play a role in the mucosal disposition of anti-retrovirals (ARVs) in rectal microbicidal preparations and impact their efficacy in prevention of HIV-1 infection. However, there is limited information on expression levels available. This study aims to assess expression of 84 drug transporter genes in human colorectal tissue and representative cell lines pre and post ARV exposure. Method Drug transporter mRNA expression was quantified from colorectal biopsies (n = 12) and 6 colorectal cell lines using real time PCR. Relative mRNA expression was quantified in Caco-2 cells after induction with tenofovir (TFV; 5 mM), dapivirine (DPV; 10 µM) and darunavir (DRV; 250 µM) for up to 3 days. Data were analysed using Pearson’s correlation (r), hierarchical clustering and principal component analysis. Results Fifty-eight of the 84 transporters were expressed in colorectal tissue. SLC28A2/CNT2 was the most expressed uptake transporter (>25 fold increase) followed by efflux transporters ABCB1/P-gp and ABCC3/MRP3 (4–5 fold increase). No difference was noted between individual patients, either sexes or biopsy sites (rectum or sigmoid) (r = 0.95–0.99). Similarities between tissue and cell lines were low (r values 0.67–0.81). Principal component analysis showed distinct clustering of colorectal tissue and cell lines with Caco-2 cells showing least variance with tissues. Immunohistochemical staining of 7 colorectal biopsy sections confirmed high expression of Pgp and CNT2 drug transporters. TFV stimulation of Caco-2 cells resulted in > 2 fold increase in expression of MRP5, LAT2, OATPE and GLUT1 mRNA. DPV stimulation resulted in > 2 fold increase in expression of GLUT1, PEPT1 and ABCA1. DRV stimulation resulted in > 2 fold increase in expression of SLC3A2, OATPE and MCT3 mRNA. Conclusion This study has enumerated drug transporter mRNA expression in colorectal tissue and cell lines. There was partial correlation between cell lines and tissue limiting cell line use as in vivo surrogate. TFV and DPV did not induce majority of efflux transporters in Caco-2 cells. This would entail increased retention of drug within the mucosa and as a result enhanced delivery to CD4 T cells. Further studies will elucidate whether combination of ARVs will be similarly effective. Disclosure of interest None Declared. more...

Introduction Dysbiosis may contribute to inflammatory bowel disease (IBD) pathogenesis along with a reduced bacterial diversity. Limited bacterial diversity studies have been performed at the onset of disease in adults but rarely in children. High-throughput, parallel sequencing technology (next-generation sequencing) provides the means of assessing microbial diversity in samples from diverse ecosystems such as the colonic mucosa. Methods Paediatric patients undergoing colonoscopy were recruited to two groups: those with a new diagnosis of IBD at their first presentation and controls with a macroscopically normal colon and no evidence of IBD on biopsy. All subjects were free from systemic antibiotics, steroids and immunosuppression for 3 months. 5 extensive UC patients (E3) by Montreal criteria and 5 controls with macroscopically/microscopically normal colons were selected for assessment. The median age was 11.5 years in the UC group and 10.7 years in the controls. All patients were male. Colonic mucosal biopsies were taken from the rectum/sigmoid. DNA extraction was performed by a modified Qiagen QiAMP mini-kit method. The presence of bacteria was confirmed by universal eubacterial primers before next-generation PCR utilising V3 Forward/V6 Reverse primers. Bacterial diversity was assessed by 454 Titanium sequencing. Sequencing data was filtered, chimera and error checked and denoised before rarefaction to 13 000 reads per sample. Statistical comparisons were made by Mann–Whitney U tests using Sigma Plot 11. Results All biopsies were positive for bacterial DNA with universal eubacterial primers. The most commonly identified bacterial phyla (comprising 95.4% of sequence reads) were Bacteroidetes (45.3%), Firmicutes (40.5%) and Proteobacteria (9.7%). Bacteroidetes were significantly more common in the control colon than in UC (7641 median reads versus 4062, p=0.032) whereas Firmicutes were significantly more common in the UC colon than in controls (5471 median reads versus 3892, p=0.016). The difference between Proteobacteria was not significant (p=0.421). Bacterial diversity assessed by the Shannon index was similar in both groups (Medians of 6.1 in UC and 6.5 in controls, p=0.841). Conclusion Colonic mucosal bacteria differ between paediatric patients with extensive UC at diagnosis and controls. UC microbiota was typified by a reduction in Bacteroidetes and an increase in Clostridia . Surprisingly, a reduction in bacterial diversity is not present in extensive UC at diagnosis. This is contrary to findings from previous studies in established disease and warrants further investigation. more...

Introduction Children presenting for the first time with inflammatory bowel disease (IBD) offer a unique opportunity to study etiological agents before the confounders of treatment. Microaerophilic bacteria can exploit the ecological niche of the intestinal epithelium; Helicobacter and Campylobacter are previously implicated in IBD pathogenesis. The aim of the study was to assess these and other microaerophilic bacteria in de-novo paediatric IBD. Methods 100 children undergoing colonoscopy were recruited including 44 treatment naive de-novo IBD patients and 42 with normal colons. Colonic biopsies were subjected to microaerophilic culture with Gram-negative isolates then identified by sequencing. Biopsies were also PCR screened for the specific microaerophilic bacterial groups: Helicobacteraceae, Campylobacteraceae and Sutterella wadsworthensis. Results 129 Gram-negative microaerophilic bacterial isolates were identified from 10 genera. The most frequently cultured was S. wadsworthensis (32 distinct isolates). Unusual Campylobacter were isolated from 8 subjects (including 3 C. concisus, 1 C. curvus, 1 C. lari, 1 C. rectus, 3 C. showae). No Helicobacter were cultured. When comparing IBD vs. normal colon control by PCR the prevalence figures were not significantly different (Helicobacter 11% vs. 12%, p = 1.00; Campylobacter 75% vs. 76%, p = 1.00; S. wadsworthensis 82% vs. 71%, p = 0.312). Conclusion This study offers a comprehensive overview of the microaerophilic microbiota of the paediatric colon including at IBD onset. Campylobacter appear to be surprisingly common, are not more strongly associated with IBD and can be isolated from around 8% of paediatric colonic biopsies. S. wadsworthensis appears to be a common commensal. Helicobacter species are relatively rare in the paediatric colon. Disclosure of Interest None Declared more...

Introduction The gut microbiota plays a key role in Inflammatory Bowel Disease (IBD) pathogenesis and is also involved in colorectal neoplastic progression. In particular, the “dysbiosis” theory has evolved from work which has shown IBD sufferers to have different microbiologic profiles to normal controls. There is strong evidence to demonstrate that individuals harbour a unique microbiota with faecal and mucosal ecosystems being distinct. This would indicate that faecal samples are not appropriate surrogate markers for mucosal samples and other alternative sampling options should be considered. The aim of the study was to assess the microbial diversity of paired biopsies and faecal aspirates to determine whether faecal aspirate can be used as a suitable surrogate for colonic biopsies. Methods Bacterial DNA was extracted from 21 paired mucosal biopsies and faecal aspirates, and subjected to denaturing gradient gel electrophoresis (DGGE) and q-PCR analysis to quantify the relative abundance of the following major bacterial groups: Bacteroidetes, Ruminococcaceae , Lachnospiraceae and Enterobacteriaceae . The relative abundance of bacterial groups was expressed as a percentage of total bacteria. Results Increased variation was found across the faecal aspirates compared to biopsies with regards to relative abundance of the four bacterial groups analysed by q-PCR (Table 1). This indicates that microbial diversity of faecal aspirates is more variable than mucosal biopsies. When the mean abundance of each bacterial group across the biopsies and across the faecal aspirates was compared using a Paired t-test, there was a significant difference in levels of Bacteroides (62.3% vs 44.4%; p = Conclusion Substantial microbial diversity differences exist between faecal aspirate and biopsy samples. Faecal aspirates demonstrate considerably more variation than biopsies, and there would appear to be no correlation between paired samples. These results suggest that faecal aspirate is not a suitable microbiological surrogate for mucosal biopsies. Disclosure of Interest None Declared. more...

Introduction Helicobacter species can initiate animal colitis similar to human ulcerative colitis (UC). Campylobacter concisus has been linked to paediatric Crohn9s disease (CD). Microaerophilic organisms such as Helicobacter and Campylobacter may be involved in the initiation of IBD. Methods Paediatric patients undergoing colonoscopy were recruited to two groups: those with a new diagnosis of IBD at their first presentation and controls with a macroscopically normal colon and no evidence of IBD on biopsy. All subjects were free from systemic antibiotics, steroids and immunosuppression for 3 months. 24 IBD patients and 26 controls were studied. The IBD cohort comprised 12 (50%) CD, 8 (33.3%) UC and 4 (16.7%) IBD unspecified (IBD-U) patients. 15 (62.5%) of the IBD and 20 (77.8%) of the control groups were male with median ages of 12.4 and 11.0 years, respectively. 5–6 Colonic mucosal biopsies were taken: in controls largely from the sigmoid/rectum and in IBD from the most distal inflamed site. 3 biopsies were stored at −80°C for subsequent DNA extraction and PCR. 1–2 biopsies were used for culture. 5 selective plates were used alongside blood agar. Cultures were incubated in microaerophilic conditions (Anoxomat) at 37°C. Plates were reviewed twice weekly for up to 1 month. Isolates deemed Gram-negative and microaerophilic underwent PCR of the 16S rRNA gene for phylogenetic identification. Results No Helicobacter were cultured. 3 Campylobacter spp. were isolated: C concisus from a subject with CD, Campylobacter curvus and Campylobacter showae from controls. Sutterella wadsworthensis was isolated from 13 subjects: 8 controls and 5 IBD. All biopsies were positive for bacterial DNA with universal primers. Nested PCR for Helicobacter genus was positive in 5 (10%) subjects, comprising 3 (12.5%) IBD and 2 (7.7%) controls. PCR for Campylobacter genus was positive in 38 (76%) subjects, comprising 19 (79.2%) IBD and 19 (73.1%) controls. Nested PCR for C concisus was positive in 25 (50%) subjects, comprising 14 (58.3%) IBD (8/12 CD, 3/8 UC and 3/4 IBD-U) and 11 (42.3%) controls. In response to frequent isolation of the organism, PCR for S wadsworthensis was positive in 48 (96%) subjects, comprising 23 (95.8%) IBD and 25 (96.2%) controls. Conclusion Campylobacter spp. and Sutterella wadsworthensis are commonly identified in the paediatric colon. C concisus appears more prevalent in CD although this was not significant. Helicobacter spp. are uncommon. PCR and culture methodology have revealed no significant distinction between the microaerophilic microbiota of paediatric IBD versus controls. It is unlikely that these organisms have a role in the initiation of paediatric IBD. more...