Aims: An antibiotic combination of amoxicillin, tetracycline and metronidazole (ATM) is effective for ulcerative colitis (UC), but this regimen is discontinued in some cases due to adverse events. This study aimed to assess a revised combination, namely, amoxicillin, fosfomycin and metronidazole (AFM), in UC patients with the goal of reducing side effects while maintaining therapeutic efficacy. Methods: A prospective open-label trial was undertaken in 104 adult UC patients. A combination of oral amoxicillin (1500 mg), fosfomycin (3000 mg) and metronidazole (750 mg) was administered to patients daily for 2–4 weeks in addition to their conventional medication. Clinical assessment was performed using the Lichtiger index before treatment and at 0, 3, 6, 9 and 12 months and 2 and 3 years. Endoscopic evaluation was performed using the Mayo score before treatment and at 3 and 12 months. Results: The compliance rate was 99.2%. Response and remission rates were 80.8% and 63.5% at completion, 73.1% and 64.4% at 3 months, and 39.4% for both at 12 months, respectively. Of the 41 patients who were in remission at 12 months, 63.4% maintained that status until the 2-year follow-up. Similarly, 69.2% of those in remission at 2 years remained relapse free at the 3-year follow-up. Side effects were observed in 44.2% of the participants. Fever occurred in one patient (1.0%), which was lower than the rate observed with ATM therapy. Conclusion: These results indicate that AFM therapy induces remission and is appropriate for long-term maintenance of UC while producing fewer and milder adverse events than ATM therapy. Clinical trials: This study was registered in the University Hospital Medical Information Network (No. R000046546).

Background/Objectives: Sarcopenia (SA), an age-related impairment in skeletal muscle mass and function, is related to gut microbiota (GM) through inflammation and short-chain fatty acid (SCFA) generation. However, data on this relationship in older Japanese adults remain limited. We investigated the relationship of GM composition with SA, based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, among elderly Japanese outpatients. Methods: Between June 2022 and January 2023, this prospective cross-sectional study enrolled 356 community-dwelling outpatients aged ≥ 65 years at the Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center. SA was determined based on the AWGS 2019 consensus criteria. GM was analyzed using 16S rRNA gene sequencing, and alpha/beta diversity, taxonomic composition, detection rates, and correlations with skeletal muscle mass index (SMI), grip strength, and gait speed were investigated. Results: Among 356 (144 males, 212 females) participants, 50 (35 males, 15 females) had SA. Differences in GM diversity and composition were primarily noted among male participants. Men with SA had lower alpha diversity and distinct beta diversity profiles. Six bacterial genera—Eubacterium I, Fusicatenibacter, Holdemanella, Unclassified Lachnospira, Enterococcus H, and Bariatricus—had lower abundances in the SA group. Several of these genera showed positive correlations with SMI, grip strength, and gait speed. Conversely, no differences in GM characteristics were seen among females. Conclusions: GM composition was associated with SA among older Japanese men. These sex-specific differences emerged consistently, highlighting the potential of microbiota-based strategies for SA prevention in older males.

Background: Oral probiotic intake is suggested to have positive effects on skin. We aimed to elucidate the effects of oral Bifidobacterium breve M-16V intake on skin by analyzing facial images, the skin myco/microbiota, and the gut microbiota. Methods: We conducted a randomized, double-blind, placebo-controlled study in Japan. Healthy women aged over 30 years were randomly allocated to either the B. breve (1 × 1010 colony-forming units (CFU)/sachet, two sachets daily) or the placebo group and consumed the corresponding study food for 12 weeks. Facial images were taken at weeks 0, 4, 8, and 12 using VISIA evolution. Stool and skin samples were collected at weeks 0 and 12. The primary outcome was the change in the total VISIA score from baseline. Results: A total of 120 females aged 30–79 years were assigned to the B. breve (n = 59) or placebo (n = 61) group. The total VISIA score worsened in the placebo group at week 8 (p = 0.029) but not in the B. breve group. Compared with that of the placebo group, the VISIA brown spot score of the B. breve group improved at weeks 4 (p = 0.013) and 8 (p = 0.041). The VISIA pore score improved at weeks 4 (p = 0.013), 8 (p = 0.041), and 12 (p = 0.004) within the B. breve group. Genus-level analysis of the gut microbiota revealed a significant increase in Blautia abundance in the B. breve group. The frequency of adverse events was not different between the groups. Conclusions: Oral B. breve M-16V administration may suppress skin deterioration, including the appearance of brown spots, on the faces of adult females.

Dysbiosis of the gut microbiota has recently been identified as a therapeutic target for ulcerative colitis. We reported the effectiveness of antibiotic combination therapy (ATM therapy) for the induction and maintenance of ulcerative colitis remission. In this study, we aimed to investigate the long-term effectiveness of ATM therapy in a larger cohort. A prospective open-label trial was undertaken with 311 adult ulcerative colitis patients. The combination of oral amoxicillin 500 mg t.i.d., tetracycline 500 mg t.i.d. and metronidazole 250 mg t.i.d. was administered to patients daily for 2–4 weeks in addition to their conventional medication. Clinical assessments were performed using the partial Mayo score at baseline; at treatment completion; and at 3, 6, 9 and 12 months. Endoscopic evaluations were performed using the Mayo endoscopic score at baseline, 3 months, and 12 months. The compliance rate was 95.7%. The response and remission rates were 75.2% and 30.9% at completion, 62.7% and 29.6% at 3 months, 48.2% and 27.7% at 6 months, 37.9% and 24.4% at 9 months, and 35.4% and 24.4% at 12 months. The most frequent adverse events were diarrhea and fever. No life-threatening adverse events were observed during the trial. ATM therapy effectively led to long-term clinical response and remission in patients with active ulcerative colitis symptoms. However, further investigations are needed for the standardization of antibiotic therapy for ulcerative colitis in the future.