Isenring, E. National Nutrition and Food Technology Research Institute, Further information on The Gut Microbiome and Digestive Health A New Frontier Tips to Get Published Watch our recent workshop presented by the AGA Journals' Editors on writing and publishing in the AGA journals! Lack of cough reflex in aspiration pneumonia. Appl. Reportedly, one of the benefits of these microflora is on mental health. Gastric residual volume in the ICU: Can we do without measuring it? Thank you for visiting nature.com. Gut microbiota composition correlates with diet and health in the elderly. Zheng P, Zeng B, Zhou C, et al. The human microbiome project: Exploring the microbial part of ourselves in a changing world. Heitmann, K. Bik EM. Benn A, Heng N, Broadbent JM, Thomson WM. Sheanakul, C. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest Hansen, M. Initial colonizers immediately after birth are called the pioneer species, for example, Streptococcus salivarius. Proc. Engraftment of spore-forming Firmicutes bacteria is a necessary first step for the production of microbe-associated metabolites, such as secondary bile acids, which inhibit C. difficile spore germination and vegetative growth.29,30 These compositional and functional changes reflect the pharmacokinetics and pharmacodynamics of this microbiome therapeutic.14 As expected, Firmicutes bacteria were gradually detected by week 8 among placebo recipients after discontinuation of antibiotic treatment.31 However, microbiome recovery was slower and insufficient to prevent C. difficile infection recurrence among some patients in this group. Sripramote, M. official website and that any information you provide is encrypted Amazonic Center for Research and Control of Tropical Diseases (CAICET), Puerto Ayacucho 7101, Amazonas, Venezuela, Division of Gastroenterology and Nutrition, The Childrens Hospital of Philadelphia, Philadelphia, 19104, Pennsylvania, USA, Department of Psychiatry, Washington University School of Medicine, St Louis, 63110, Missouri, USA, Department of Chemistry and Biochemistry, University of Colorado, Boulder, 80309, USA, Jens Reeder,Justin Kuczynski,Catherine A. Lozupone,Christian Lauber,Jose Carlos Clemente,Dan Knights&Rob Knight, Department of Computer Science, Northern Arizona University, Flagstaff, 86001, Arizona, USA, Howard Hughes Medical Institute, University of Colorado, Boulder, 80309, USA, You can also search for this author in Ho, C. T. (2015). , , , JournalMedical Association of Thailand, 90 (9), 1703. Ringel, Y. 6Shogaol induces apoptosis in human colorectal carcinoma cells via ROS production, caspase activation, and GADD 153 expression. In this context, the interactions among bifidobacteria, their human host, and other members of the human gut microbiota are far from completely understood, despite the crucial role they play in the development and maintenance of human physiology and immune system. The human microbiome project: A community resource for the healthy human microbiome. The study showed that stimulus on linguapalatal swallowing pressure and rising and releasing linguapalatal pressure duration were greater for carbonation + gingerol and carbonation than for water. Redeker, Y. (2008). Mazandaran University of Medical Sciences, The most common cause of nausea and vomiting is pregnancy. The authors have declared that no competing interests exist. Ruffin, M. T. , & It rests within biofilms throughout the oral cavity and forms an ecosystem that maintains health in This supports how the gut bacterial content's dysbiosis changes the behavior of the host [5]. Dewhirst FE, Chen T, Izard J, Paster BJ, Tanner AC, Yu WH, et al. Review 4 studies about this topic 19822003 (Grntved, Brask, Kambskard, & Hentzer, (940mg Gelatincapsules of ginger powder (2) +dimenhydrinate, Ginger was more effective than dimenhydrinate in reducing experimentally induced motion sickness, Consumption: 1hr before circular vection, Ginger at a dose of 1,000mg effectively reduced the severity of nausea, prolonged latency before the onset of nausea and shortening the recovery time from nausea after the cessation of vection. In maintaining the regulation of physiology, the host must keep a stable microbial community safely to say that these microbiomes have control in curbing depression [6]. Moghadamnia, A. , A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. The initiation of gender-affirming treatment before puberty is controversial; a Dutch study finds that the vast majority of adolescents who initiated this treatment continued it into adulthood, which may alleviate some concerns. , Tan, M. P. , Nature. Many research studies have directed their attention to understanding the interaction between the gut microbiome and the brain. Wright, B. D. With the brain and the gut working in a bi-directional manner, they could affect each other's functions and significantly impact stress, anxiety, depression, and cognition [3]. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Khalili, H. Turgeon, D. K. [23], Oral microbiome may show large and rapid changes in composition and activity both spatially and temporally and are developmentally dynamic with the host. Ginger and its polyphenols have been shown to target multiple signaling molecules that provide a basis for its use against multifactorial human diseases such as cancer. Appl. 2012 Jun 14; 486 (7402):21521. J. Appl. Van Ameringen M, Turna J, Patterson B, Pipe A, Mao RQ, Anglin R, Surette MG. Brain-gut-microbiota axis: challenges for translation in psychiatry. The gut-brain axis (GBA) consists of bidirectional communication between the central and the enteric nervous system, linking emotional and cognitive centers of the brain with peripheral intestinal functions. Research findings showed that healthy gut microflora transmits brain signals through the pathways involved in neurogenesis, neural transmission, microglial activation, and behavioral control under stable or stressful conditions. , , Wu, K.L. Micklefield, G. In this study, ginger group showed significantly lowered gastrointestinal pain and no change in dyspepsia but esophagogastroduodenoscopy showed significantly increased levels of prostaglandins (PGs) PGE1, PGE2, and PGF2a in the stomach mucosa. , & The impact of microbiota-related phenolic metabotypes on cardiometabolic health is becoming evident, although the picture is still incomplete, and data are absent for some classes of (poly)phenols. The Comparison of ginger with vitamin B6 in relieving nausea and vomiting during pregnancy. Open Access articles citing this article. New initiatives aimed at reducing the burden of diabetes are laudable, but they will have to account for the diseases complexity and heterogeneity to be truly effective and equitable at a global scale. However, the power to detect differences among SER-109 lots was limited by the small numbers of patients who received each lot (range, 12 to 33 patients). Herrstedt, J. has shown to reduce ruminant enteric methane (CH4) production up to 99% in vitro. Immunosuppressive activity of 8gingerol on immune responses in mice. , While human microbiota-associated models were initially employed to study obesity, an increasing number of studies have applied this approach in the context of IBD and CRC over the past decade. Complete understanding of the link of the MGB axis and neuroimmune systems directs the future to more successful depression management [15]. Resilience and immunity. Alavian, S. M. More than 6000 institutes have online or print (or both) access to this journal - the largest specialist journal in the field, with the largest , Nature 2016;533:543-546. The observed safety profile of SER-109 was similar to that of placebo. , Johnson S, Louie TJ, Gerding DN, et al. Both conditions involve immune-inflammatory, oxidative (IO), and nitrosative stress (NS) pathways. Ulcerative colitis (UC) and Crohn's disease (CD), collectively known as Inflammatory Bowel Diseases (IBD), are caused by a complex interplay between genetic, immunologic, microbial and environmental factors. Gevers D, Knight R, Petrosino JF, Huang K, McGuire AL, Birren BW, et al. , Functional dyspepsia is defined as postprandial fullness, early satiety, or epigastricpain/burning or discomfort centered in the upper abdomen in the absence of any known structural cause and without features of irritable bowel syndrome or gastroesophageal reflux; symptoms are frequently correlated to meals and may include abdominal pain, bloating, early satiety, fullness, belching, and nausea (Talley etal., 1999). Morikawa, M. Introduction and background. Nature (Nature) All four lots of SER-109 led to less frequent recurrence than did placebo. Recent advances in dietary supplementation, in treating nonalcoholic fatty liver disease. Chem. Identifying the microbiome in health is the first step of human microbiome research, after which it is necessary to understand the role of the microbiome in the alteration of functional and metabolic pathways associated with the diseased states. Next-generation sequencing technologies allow accomplishing massive DNA sequencing, uncovering the microbial composition of many different Next-generation sequencing technologies allow accomplishing massive DNA sequencing, uncovering the microbial composition of many different ecological niches. or the microbiome. Palsson, O. S. We thank S. Wagoner and J. Manchester for superb technical assistance, plus B. Muegge, A. Grimm, A. Hsiao, N. Griffin and P. Tarr for suggestions, and M. Ndao, T. Tinnin and R. Mkakosya for patient recruitment and/or technical assistance. There are specialised areas within the pancreas called islets of Langerhans (the term insulin comes from the Latin insula that means island). The impact of ginger consumption as an antiemetic in nausea and vomiting of pregnancy has been extensively investigated in clinical studies for at least 30years (Giacosa, Morazzoni, etal., 2015). PMC legacy view J Infect Dis 2016;214:173-181. The gut microbiota plays a major role in this process. Rahimlou, Yari, Hekmatdoost, Alavian, & Keshavarz (2016) conducted the first randomized, doubleblind clinical trial study that examined the effects of ginger supplementation with lifestyle intervention on liver enzymes, inflammatory markers, steatosis, and hepatic fibrosis scores in patients with nonalcoholic fatty liver disease (NAFLD). Journal of Oral and Maxillofacial Pathology : JOMFP, https://www.ncbi.nlm.nih.gov/books/NBK54006/. ); Seres Therapeutics, Cambridge, MA (E.E.L.W., L.D., J.A.B., C.B.F., M.-J.L., K.D.L., J.R.W., H.W., J.G.A., C.W.J.M., J.A.W., B.H.M., M.T., M.R.H., L.M. Jeffrey I. Gordon. Pongrojpaw, D. [28] The oral microbiome usually exists in the form of a biofilm. Grassi, M. The infant gut microbiota is the set of microorganisms colonizing the babys intestine. The percentage of patients with recurrence of C. difficile infection was 12% in the SER-109 group and 40% in the placebo group (relative risk, 0.32; 95% confidence interval [CI], 0.18 to 0.58; P<0.001 for a relative risk of <1.0; P<0.001 for a relative risk of <0.833). Food and Drug Administration. However, ginger did not alter 15hydroxyprostaglandin dehydrogenase (PGDH) protein expression in either increased or normal risk participants (Jiang etal., 2013). The IO and NS processes of both depression and IBD overlap, insinuating a causal relationship. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. , This journal is participating in a pilot of NISO/STM's Working Group on Peer Review Taxonomy, to identify and standardize definitions and terminology in peer review practices in order to make the peer review process for articles and journals more transparent. Stradling, H. PMC legacy view 8600 Rockville Pike Bombardelli, E. Jiang, Y. The suite of genes provided by microorganisms, or the microbiota, living in and on the human body is known as the human microbiome [].As the microbiome interacts dynamically with its host and environment, its composition varies markedly over time and between individuals [].The bacterial genes The primary efficacy objective was to show the superiority of SER-109 as compared with placebo in reducing the risk of C. difficile infection recurrence up to 8 weeks after dosing (the primary efficacy end point). , A reduction in the risk of recurrence among patients 65 years of age or older is clinically important, since patients in this age group are at increased risk for recurrent disease and hospital readmission.25 SER-109 also reduced the risk of recurrence regardless of the selected antibiotic. Leelakusolvong, S. , Abujamel T, Cadnum JL, Jury LA, et al. It rests within biofilms throughout the oral cavity and forms an ecosystem that maintains health in a state of equilibrium. Nature Medicine explores the latest translational and clinical research news, with a clinical trial of an intranasal ChAdOx1 vaccine. evaluated the application of ginger orally disintegrating (OD) tablets, which prepared by mixing the excipients with the same amount of mannitol and sucrose to a concentration of 1% ginger, on improvement of swallowing function in eighteen healthy older adult aged 6390. Sunita, V. Dakhil, S. R. Sci. will also be available for a limited time. Iranian Journal of Pharmaceutical Research. Here, we highlight the ecological as well as genetic and functional features of bifidobacteria residing in the human gut using genomic and ecology-based information. Gastroenterology is the most prominent journal in the field of gastrointestinal disease. (2015). There is an amplified inflammatory process when several factors, including geneticrisks, pathogens, and environmental stressors, co-occur. , & Sasaki, H. (2007). There were no statistically significant differences between the two groups in terms of live births spontaneous abortions, therapeutic abortions, birth weight, or gestational age (Portnoi etal., 2003). By modulating gut microbiome composition through proper nutrition and probiotics, we also help decrease anxiety and depression [4]. However, they found a significant decrease in PGE2 and 5hydroxyeicosatetraenoicacid (HETE) and a trend toward significant decrease in 12HETE and 15HETE normalized to free arachidonic acid (Zick etal., 2011). Comparative metagenomics revealed commonly enriched gene sets in human gut microbiomes. A novel microbiome therapeutic increases gut microbial diversity and prevents recurrent Clostridium difficile infection. Several of the pathways are neuroimmune, neuroendocrine, and sensory-neural. , Matthews, A. Knowing the identity of the microbiome and the neighbors with which they commonly interact is necessary for mechanistic understanding of the key players. R: A Language and Envirnoment for Statistical Compuiting (R Foundation for Statistical Computing, 2010), Liaw, A. Marital distress, depression, and a leaky gut: Translocation of bacterial endotoxin as a pathway to inflammation. Gastroenterology is the most prominent journal in the field of gastrointestinal disease. Irritable bowel syndrome (IBS) is a common functional chronic gastrointestinal disorder, consisting of abdominal discomfort with changes in bowel habits. 8600 Rockville Pike The oral cavity has two types of surfaces on which bacteria can colonize: the hard and the soft tissues of teeth and the oral mucosa, respectively. Relative risk is defined as the percentage of patients with recurrence in the SER-109 group divided by the percentage in the placebo group; analyses were performed with the CochranMantelHaenszel estimate of the common relative risk, stratified according to age group (<65 years or 65 years) and antibiotic regimen received for the qualifying acute episode (vancomycin or fidaxomicin). , The .gov means its official. The gastric emptying was compared by differences between gastric volumes. J. Clin. Thiago Carvalho News 03 Nov 2022 Cha, I. H. We conducted ECOSPOR III (SER-109 versus Placebo in the Treatment of Adults with Recurrent Clostridium difficile Infection), a double-blind, placebo-controlled trial, in accordance with Good Clinical Practice guidelines at 56 U.S. and Canadian sites from July 2017 through September 2020. Interventions for nausea and vomiting in early pregnancy. Dubberke ER, Olsen MA. A review of the gastroprotective effects of ginger (. 49, 20672075 (2003), Martens, E. C., Chiang, H. C. & Gordon, J. I. Mucosal glycan foraging enhances fitness and transmission of a saccharolytic human gut bacterial symbiont. Although the trial had a planned sample size of 188 patients, the last patient underwent randomization on April 13, 2020, after 182 patients had been enrolled, because of the coronavirus disease 2019 (Covid-19) pandemic. , This literature review also found the importance of an individual's resilience in maintaining one's immunity. Math. , The transfer of 15N from urea to lysine in the human infant. 2012 Jun 14; 486 (7402):21521. Proc. , , Fahimi, F. They affect the promotion of gastrointestinal digestion, food absorption, and maintenance of intestinal integrity. On the other hand, the exclusion criteria were fully non-human studies and non-English language. Gut microbial communities represent one source of human genetic and metabolic diversity. Thus, reduction of TNF and other inflammatory factors resulted in improvement of the NAFLD characteristics. Through week 8, SER-109 had an observed safety profile similar to that of placebo. The multivariate model for multiple imputation included age (<65 years or 65 years), sex (male or female), number of C. difficile infection episodes (two, three, or more than three), antibiotic regimen (vancomycin or fidaxomicin), and use of proton-pump inhibitors (yes or no). or the microbiome. Haas, D. , A microbiome consists of microbes and their genomes, encompassing bacteria, viruses, fungi, protozoa, archaea, and A microbiome consists of microbes and their genomes, encompassing bacteria, viruses, fungi, protozoa, archaea, and eukaryotes. Moon JH, Lee JH. R News 2, 1822 (2002). 83, 505512 (2000), Meakins, T. S. & Jackson, A. , & , Martin-Subero M, Anderson G, Kanchanatawan B, Berk M, Maes M. Food and mood: how do diet and nutrition affect mental wellbeing? Patients who were lost to follow-up, who left the trial prematurely, or who died without a recorded recurrence before the end of 8 weeks were assumed to have had a recurrence. 27. Ruffin, M. T. Stool specimens for whole metagenomic sequencing and targeted bile-acid analyses were obtained at baseline (within 3 days after completion of the antibiotic regimen) and at weeks 1, 2, and 8. , This literature would like to establish the role of the gut microbiome in depression. A molecular sensor that allows a gut commensal to control its nutrient foundation in a competitive ecosystem. Diagnosis by toxin testing was performed at trial entry, and randomization was stratified according to age and antibiotic agent received. (2012). Demmitt BA, Corley RP, Huibregtse BM, Keller MC, Hewitt JK, McQueen MB, et al. Kalstein, A. Drozdov, V. N. Wu etal. (2008). Differences in fecal microbiota in different European study populations in relation to age, gender, and country: a cross-sectional study. Deuson, R. R. Goodrich JK, Di Rienzi SC, Poole AC, Koren O, Walters WA, Caporaso JG, et al. Israel Journal of Health Policy Research; Italian Journal of Pediatrics; Journal of Activity, Sedentary and Sleep Behaviors; Journal of Cannabis Research; Journal of Cardiothoracic Surgery Open peer review; Journal of Cardiovascular Magnetic Resonance; Journal of Ethnobiology and Ethnomedicine; Journal of Foot and Ankle Research Open peer review Appl. Sci. There are still parts that need to be delved deeper and to be understood. Greene, R. A. , Other reasons for exclusion before randomization included an inability to adhere to the protocol (5 patients), concurrent receipt of antibiotics for infection other than Clostridioides difficile (5), inability to receive SER-109 or placebo within 4 days after completion of antibiotic therapy (5), admission to an intensive care unit (4), investigator discretion (2), absence of informed consent (2), suspected toxic megacolon or small-bowel ileus (1), gastrointestinal surgery within 3 months (1), history of fecal microbiota transplantation (1), and patient preference to continue receiving probiotics (1). PLoS One 2018;13(11):e0205064-e0205064. , , Heading, R. McCarthy, F. P. Postoperative or druginduced nausea and vomiting. , NEW! No serious adverse events that were assessed by the site investigator as being related to SER-109 were observed through week 8 (Table S1). , Presented at Digestive Disease Week, virtual, May 2123, 2021 (https://www.serestherapeutics.com/wp-content/uploads/2021/07/Bryant-J-DDW-2021-Rapid-Conversion-of-Primary-to-Secondary-Bile-Acids.pdf). Missing data: our view of the state of the art. Gastroenterology is the most prominent journal in the field of gastrointestinal disease. , Van Tilburg, M. A. In using several Medical Subject Heading (MeSH) keywords, relevant literature was selected. J. Nutr. Of the 182 enrolled patients, 149 (82%) completed 8 weeks of follow-up. Inflammation: depression fans the flames and feasts on the heat. The effects of ginger supplementation on chemotherapyinduced nausea and vomiting. Proc. O'Mathna, D. official website and that any information you provide is encrypted The objective of this study was to determine the effect of Asparagopsis taxiformis on CH4 production (g/day per animal), yield (g CH4/kg dry matter intake (DMI)), and intensity (g CH4/kg ADG); average daily gain (ADG; kg gain/day), feed Insulin is a hormone made by an organ located behind the stomach called the pancreas. Baliga, M. S. Chemosphere is an international journal designed for the publication of original communications as well as review articles on chemicals in the environment. This phenomenon and, in particular, dysphagia are associated with reduced cough reflex leading to increased risk of aspiration pneumonia (Hirata etal., 2016). Pediatric Crohn disease patients exhibit specific ileal transcriptome and microbiome signature. Soc. Previous studies have shown that a diet rich in antioxidants and antiinflammatory agents can be effective in the treatment of NAFLD (Eslamparast, Eghtesad, Poustchi, & Hekmatdoost, 2015). Antibiotic-induced alterations of the gut microbiota alter secondary bile acid production and allow for Clostridium difficile spore germination and outgrowth in the large intestine. In this review, we summarized the current evidence on the effects of ginger consumption on gastrointestinal disorders based on clinical trials. 19, 94105 (2007), Dominguez-Bello, M. G. et al. Marsh PD. Ginger essence effect on nausea and vomiting after open and laparoscopic nephrectomies. 2019;7:96108. (2013). Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Most recurrences of C. difficile infection during this 8-week time frame were observed within days to 2 weeks after the completion of antibiotic treatment, which highlights the need for early microbiome intervention. Kelly JR, Clarke G, Cryan JF, Dinan TG. Lekhyananda, N. Ahmadloo, N. , Although promising, gut microbiome studies have a long way to go. Arsenault, M. A. Salvage of exogenous urea nitrogen enhances nitrogen balance in normal men consuming marginally inadequate protein diets. , The evolution of bacterial genome assemblies - where do we need to go next? HHS Vulnerability Disclosure, Help PubMedGoogle Scholar. Parts of this work used the Janus supercomputer, which is supported by National Science Foundation grant CNS-0821794, the University of Colorado, Boulder, the University of Colorado, Denver, and the National Center for Atmospheric Research. government site. Changchien, C.S. Intricate relationships of the individual gene and the surroundings are pointed out to contribute to the development of MDD. Nemmar, A. Nakamura, Y. Received 2020 Aug 9; Accepted 2020 Aug 22. Depression is a serious mental illness caused by multiple factors [4]. , Demographic and Clinical Characteristics of the Patients at Baseline (Intention-to-Treat Population). Ahearn, T. Many limitations have been overcome thanks to shotgun sequencing, allowing a reliable taxonomic classification of microbial communities at the species level. (2015). Pham, J. T. , Successful resolution of recurrent Clostridium difficile infection using freeze-dried, encapsulated fecal microbiota; pragmatic cohort study. Ginger extract reduces delayed gastric emptying and nosocomial pneumonia in adult respiratory distress syndrome patients hospitalized in an intensive care unit. March 23, 2020 (https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/safety-alert-regarding-use-fecal-microbiota-transplantation-and-additional-safety-protections). Oral microbiome studies: Potential diagnostic and therapeutic implications. , & , In understanding the interplay of inflammation leading to depression, and depression worsening cytokine responses, it is essential to fully understand the process to stop this vicious cycle [16]. Delayed gastric emptying and gastrointestinal motility disorder are the main gastrointestinal problem in the severely ill patients undergoing mechanical ventilation. Active compounds in ginger can enhance the antioxidant defense systems such as glutathione peroxidase and glutathione Stransferase, and reduce levels of malondialdehyde (MDA) and hepatic steatosis. Moon HJ. Researchers agree that a persons unique microbiome is created within the first 1,000 days of life, but there are things you can do to alter your gut environment throughout your life. analyse the impact of both factors on the composition and functional repertoire of the fecal microbiota. 40, 303309 (1984), Metges, C. C. et al. , & *Plusminus values are means SD. Department of Clinical Nutrition and Dietetics, Objective To explore the faecal and salivary microbiota as potential diagnostic biomarkers. Prodigest is the standardized combination of ginger extracts and artichoke extract. In this study, the baseline area of gastric volume was determined by ultrasonography 10min before the main meal. Zaura E, Nicu EA, Krom BP, Keijser BJ. volume486,pages 222227 (2012)Cite this article. Lot of research is being done, and data are added continuously. , Mood and microbes: gut to brain communication in depression. , The role of microbiota and inflammation in self-judgement and empathy: implications for understanding the brain-gut-microbiome axis in depression. Nausea and vomiting affect up to 80% of women during the first trimester of pregnancy that range from morning sickness to hyperemesis gravidarum (HG) (Lete & Allu, 2016; McCarthy, Lutomski, & Greene, 2014; Palatty, Haniadka, Valder, Arora, & Baliga, 2013). , In the case of rodents, depression developed in fecal transplant recipients after receiving fecal samples from MDD patients. [Google Scholar] Pongrojpaw, D. , Somprasit, C. , & Chanthasenanont, A. In both groups, patients were advised to follow a balanced diet and physical activity program and resulted in a significant decrease in inflammatory marker levels, liver enzymes, hepatic steatosis, and insulin resistance (that is one of the major risk factors in the pathogenesis of NAFLD) in ginger group. , Notably, these obscure adverse interactions may be related to host-associated microbiome damage occurring from antimicrobial effects, rather than the presumed toxic effects of pesticides on host tissue. 2. The trial included patients 18 years of age or older who had had three or more episodes of C. difficile infection within 12 months, inclusive of the qualifying acute episode, which was defined as three or more unformed bowel movements over 2 consecutive days, a positive C. difficile toxin test, and resolution of symptoms while receiving 10 to 21 days of standard-of-care antibiotic therapy.
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