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Papadopoulos M, Mutalib M, Nikaki K, Volonaki E, Rybak A, Thapar N, Lindley K, Borrelli O, Das A, Crespi D, Cleeve S, Athanasakos E. Radiopaque marker colonic transit study in the pediatric population BSPGHAN Motility Working Group consensus statement. Neurogastroenterol Motil 2024; 36:e14776. [PMID: 38454312 DOI: 10.1111/nmo.14776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
Functional constipation (FC) is a common condition in childhood in the United Kingdom and worldwide. Various radiological approaches have been established for diagnostic purposes. The radiopaque marker study (ROMS) is universally accepted and used to assess colonic transit time (CTT) in children with FC. Despite being widely used, there is a lack of standardization with various technical protocols, reproducibility of different populations, the purpose for using investigation, variance in the number of markers used, the amount of study days and calculations, the need to empty the colon before performing the test, and whether to perform on medication or off, or the use of specific diets. As part of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) motility working group (MWG), we decided to explore further into the evidence, in order to provide guidance regarding the use of ROMS in dealing with FC in the pediatric population.
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Affiliation(s)
- M Papadopoulos
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - M Mutalib
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - K Nikaki
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - E Volonaki
- Department of Paediatric Gastroenterology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Rybak
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - N Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Queensland, Australia
- Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
| | - K Lindley
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - O Borrelli
- Gastroenterology Department, Great Ormond Street Hospital, London, UK
| | - A Das
- Paediatric Department, Broomfield Hospital, Broomfield, UK
| | - D Crespi
- Department of Paediatric Surgery, The Royal London Hospital, Barts Health NHS, London, UK
| | - S Cleeve
- Department of Paediatric Surgery, The Royal London Hospital, Barts Health NHS, London, UK
| | - E Athanasakos
- Department of Paediatric Surgery, The Royal London Hospital, Barts Health NHS, London, UK
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Garganese MC, Pizzoferro M. Gastrointestinal radionuclide imaging in pediatric age group. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:23-31. [PMID: 38587360 DOI: 10.23736/s1824-4785.24.03548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Pediatric gastrointestinal imaging plays a crucial role in evaluating and managing digestive system disorders in children. This comprehensive review dives into the nuances of pediatric gastrointestinal imaging techniques, focusing on three specific modalities: gastric emptying scintigraphy (GES), intestinal transit scintigraphy (ITS), and gastrointestinal bleeding scintigraphy. GES involves real-time monitoring of stomach emptying using radiotracers and gamma camera technology. While challenges exist in standardizing protocols due to age-specific meal compositions, GES remains pivotal in diagnosing motility disorders, gastroesophageal reflux, and abdominal pain in children. ITS, utilizing [67Ga], provides insights into gastrointestinal motility disorders such as Hirschsprung disease. It aids in whole-gut transit evaluation, guiding surgical interventions and improving long-term clinical outcomes. Gastrointestinal bleeding scintigraphy, employing [99mTc], assists in diagnosing conditions like Meckel's diverticulum and occult bleeding, offering continuous monitoring to pinpoint the bleeding site along the entire gastrointestinal tract. SPECT-CT improves the accuracy and the standards of care. Each technique's protocol details, clinical indications, and diagnostic capabilities are thoroughly discussed, highlighting the importance of these non-invasive, functional imaging modalities in pediatric gastroenterology.
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Affiliation(s)
- Maria C Garganese
- Nuclear Medicine Unit, Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy -
| | - Milena Pizzoferro
- Nuclear Medicine Unit, Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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Rabeh ME, Vora LK, Moore JV, Bayan MF, McCoy CP, Wylie MP. Dual stimuli-responsive delivery system for self-regulated colon-targeted delivery of poorly water-soluble drugs. BIOMATERIALS ADVANCES 2024; 157:213735. [PMID: 38154402 DOI: 10.1016/j.bioadv.2023.213735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
Inflammatory bowel disease (IBD) are chronic inflammatory conditions which cause significant patient morbidity. Local drug delivery to the colon can improve treatment efficacy and reduce side effects associated with IBD treatment. Smart drug delivery systems are designed to regulate the release of therapeutic agents at the desired site of action. pH-responsive drug carriers have been previously utilised for improved oral drug delivery beyond stomach harsh conditions. Additionally, the colon possesses a diverse microbiome secreting bioactive molecules e.g., enzymes, that can be exploited for targeted drug delivery. We herein synthesised and characterised a 2-hydroxyethyl methacrylate and methacrylic acid copolymer, crosslinked with an azobenzyl crosslinker, that displayed pH- and enzyme-responsive properties. The swelling and drug release from hydrogel were analysed in pH 1.2, 6.5 and 7.4 buffers, and in the presence of rat caecal matter using metronidazole and mesalamine as model BCS Class I and IV drugs, respectively. Swelling studies displayed pH-responsive swelling behaviour, where swelling was maximum at pH 7.4 and minimum at pH 1.2 (69 % versus 32 %). Consequently, drug release was limited in gastric and small intestinal conditions but increased significantly when exposed to colonic conditions containing caecal matter. This system displays promising capacity for achieving colon-targeted drug delivery with enhanced dissolution of poorly water-soluble drugs for local treatment of IBD and other colon-targeted therapies.
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Affiliation(s)
- Mohmmad E Rabeh
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | | | - Jessica V Moore
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | - Mohammad F Bayan
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK; Faculty of Pharmacy, Philadelphia University, P.O Box 1, Amman 19392, Jordan
| | - Colin P McCoy
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK.
| | - Matthew P Wylie
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK.
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Nejati S, Wang J, Sedaghat S, Balog NK, Long AM, Rivera UH, Kasi V, Park K, Johnson JS, Verma MS, Rahimi R. Smart capsule for targeted proximal colon microbiome sampling. Acta Biomater 2022; 154:83-96. [PMID: 36162763 PMCID: PMC9986838 DOI: 10.1016/j.actbio.2022.09.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/03/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
The gastrointestinal (GI) tract, particularly the colon region, holds a highly diverse microbial community that plays an important role in the metabolism, physiology, nutrition, and immune function of the host body. Accumulating evidence has revealed that alteration in these microbial communities is the pivotal step in developing various metabolic diseases, including obesity, inflammatory bowel disease (IBD), and colorectal cancer. However, there is still a lack of clear understanding of the interrelationship between microbiota and diet as well as the effectiveness of chemoprevention strategies, including pre and probiotic agents in modifying the colonic microbiota and preventing digestive diseases. Existing methods for assessing these microbiota-diet interactions are often based on samples collected from the feces or endoscopy techniques which are incapable of providing information on spatial variations of the gut microbiota or are considered invasive procedures. To address this need, here we have developed an electronic-free smart capsule that enables site-specific sampling of the gut microbiome within the proximal colon region of the GI tract. The 3D printed device houses a superabsorbent hydrogel bonded onto a flexible polydimethylsiloxane (PDMS) disk that serves as a milieu to collect the fluid in the gut lumen and its microbiome by rapid swelling and providing the necessary mechanical actuation to close the capsule after the sampling is completed. The targeted colonic sampling is achieved by coating the sampling aperture on the capsule with a double-layer pH-sensitive enteric coating, which delays fluid in the lumen from entering the capsule until it reaches the proximal colon of the GI tract. To identify the appropriate pH-responsive double-layer coating and processing condition, a series of systematic dissolution characterizations in different pH conditions that mimicked the GI tract was conducted. The effective targeted microbial sampling performance and preservation of the smart capsule with the optimized design were validated using both realistic in vitro GI tract models with mixed bacteria cultures and in vivo with pigs as an animal model. The results from 16s rRNA and WideSeq analysis in both in vitro and in vivo studies showed that the bacterial population sampled within the retrieved capsule closely matched the bacterial population within the targeted sampling region (proximal colon). Herein, it is envisioned that such smart sampling capsule technology will provide new avenues for gastroenterological research and clinical applications, including diet-host-microbiome relationships, focused on human GI function and health. STATEMENT OF SIGNIFICANCE: The colonic microbiota plays a major role in the etiology of numerous diseases. Extensive efforts have been conducted to monitor the gut microbiome using sequencing technologies based on samples collected from feces or mucosal biopsies that are typically obtained by colonoscopy. Despite the simplicity of fecal sampling procedures, they are incapable of preserving spatial and temporal information about the bacteria through the gastrointestinal (GI) tract. In contrast, colonoscopy is an invasive and impractical approach to frequently assess the effect of dietary and therapeutic intake on the microbiome and their impact on the health of the patient. Here, we developed a non-invasive capsule that enables targeted sampling from the ascending colon, thereby providing crucial information for disease prediction and monitoring.
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Affiliation(s)
- Sina Nejati
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, United States; Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States
| | - Jiangshan Wang
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States; Department of Agricultural and Biological Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Sotoudeh Sedaghat
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, United States; Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States
| | - Nicole K Balog
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, United States; Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States
| | - Amanda M Long
- USDA-ARS Livestock Behavior Research Unit, West Lafayette, IN 47907, United States
| | - Ulisses Heredia Rivera
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, United States; Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States
| | - Venkat Kasi
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, United States; Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States
| | - Kinam Park
- Departments of Biomedical Engineering and Pharmaceutics, Purdue University, West Lafayette, IN 47907, United States
| | - Jay S Johnson
- USDA-ARS Livestock Behavior Research Unit, West Lafayette, IN 47907, United States
| | - Mohit S Verma
- Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States; Department of Agricultural and Biological Engineering, Purdue University, West Lafayette, IN 47907, United States; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Rahim Rahimi
- School of Materials Engineering, Purdue University, West Lafayette, IN 47907, United States; Birck Nanotechnology Center, Purdue University, West Lafayette, IN 47907, United States.
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Tsai A. Density map estimation with convolutional neural networks to count radiopaque markers on colonic transit studies. Pediatr Radiol 2022; 52:2178-2187. [PMID: 35505108 DOI: 10.1007/s00247-022-05371-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND A radiopaque marker study measures colonic transit time for work-up of primary constipation. It requires the patient to ingest multiple tiny radiopaque markers, which the radiologist must count manually on follow-up abdominal radiographs. Counting these markers is tedious but cognitively simple. OBJECTIVE To develop a convolutional neural network (CNN) capable of counting the number of radiopaque markers on abdominal radiographs. MATERIALS AND METHODS The image archive at a large tertiary children's hospital was searched to identify abdominal radiographs performed in children for the indication of a radiopaque marker study. To establish the ground truth, a radiologist manually labeled the coordinates of the radiopaque markers in each radiograph and thereby generated a density map for that radiograph. A CNN was trained to estimate this density map from its corresponding abdominal radiograph. Spatially integrating the output density map provided an estimate of the number of markers in the radiograph. To assess model accuracy, mean absolute error and root mean square error were calculated. RESULTS The study cohort consisted of 436 radiographs (mean number of markers per radiograph: 34). This cohort was randomly divided into training, validation and testing sets consisting of 306, 65 and 65 radiographs, respectively. Based on the testing set, the CNN accurately estimated the number of markers in each radiograph with mean absolute error=2.6 markers and root mean square error=3.9 markers. CONCLUSION The proposed CNN generated promising results in counting the number of radiopaque markers on abdominal radiographs and offers the potential of automating the interpretation of colonic transit studies.
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Affiliation(s)
- Andy Tsai
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
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Colonic Function Investigations in Children: Review by the ESPGHAN Motility Working Group. J Pediatr Gastroenterol Nutr 2022; 74:681-692. [PMID: 35262513 DOI: 10.1097/mpg.0000000000003429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disorders of colonic motility, most often presenting as constipation, comprise one of the commonest causes of outpatient visits in pediatric gastroenterology. This review, discussed and created by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Motility Working Group, is a practical guide, which highlights the recent advances in pediatric colonic motility testing including indications, technical principles of the tests, patient preparation, performance and basis of the results' analysis of the tests. classical methods, such as colonic transit time (cTT) with radiopaque markers and colonic scintigraphy, as well as manometry and novel techniques, such as wireless motility capsule and electromagnetic capsule tracking systems are discussed.
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Wollmer E, Ungell AL, Nicolas JM, Klein S. Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines. Adv Drug Deliv Rev 2022; 181:114084. [PMID: 34929252 DOI: 10.1016/j.addr.2021.114084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/13/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.
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Lee YM, Song KH, Koo HS, Lee CS, Ko I, Lee SH, Huh KC. Colonic Chicken Skin Mucosa Surrounding Colon Polyps Is an Endoscopic Predictive Marker for Colonic Neoplastic Polyps. Gut Liver 2022; 16:754-763. [PMID: 35000932 PMCID: PMC9474497 DOI: 10.5009/gnl210271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/13/2021] [Accepted: 10/21/2021] [Indexed: 12/03/2022] Open
Abstract
Background/Aims Narrow band imaging provides an accurate diagnosis of colonic polyps. However, these diagnostic modalities are not used as standard endoscopic tools in most institutions. This study aims to investigate whether the chicken skin mucosa (CSM) surrounding the colon polyp yields additional information about colorectal polyps, including histological differentiation of neoplastic and non-neoplastic polyps, under conventional white light colonoscopy. Methods This study prospectively observed 173 patients who underwent endoscopic polypectomy and reviewed the clinical data and pathologic reports of 313 polyps from a university hospital. Two endoscopists each performed colonoscopy and polypectomy and assessed the CSM. The association between CSM surrounding colorectal polyps and histology was analyzed. Results The majority (91.3%) of CSM-positive polyps were neoplastic (sensitivity, 37.90%; specificity, 86.15%; p<0.001). In logistic regression, the neoplastic polyps were associated with positive CSM (adjusted odds ratio [OR], 3.51; 95% confidence interval [CI], 1.45 to 9.25; p=0.007), protruded polyps (adjusted OR, 4.85; 95% CI, 1.65 to 17.23; p=0.008), and neoplastic histology–associated pit pattern (pit III, IV, and V) (adjusted OR, 10.14; 95% CI, 4.85 to 22.12; p=0.000). Furthermore, advanced adenomas were associated with positive CSM (adjusted OR, 5.64; 95% CI, 1.77 to 20.28; p=0.005), protruded polyps (adjusted OR, 3.30; 95% CI, 1.15 to 9.74; p= 0.026), and ≥10 cm polyp size (adjusted OR, 18.56; 95% CI, 3.89 to 147.01; p=0.001). Conclusions Neoplastic and advanced polyps were associated with CSM-positive polyps. These findings suggest that CSM is a useful marker in differentiating neoplastic polyps and advanced polyps under conventional white colonoscopy.
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Affiliation(s)
- Yu Mi Lee
- Health Screening and Promotion Center, Konyang University Hospital, Daejeon, Korea.,Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
| | - Kyung Ho Song
- Department of Gastroenterology, CHA University Ilsan Medical Center, Ilsan, Korea
| | - Hoon Sup Koo
- Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
| | - Choong-Sik Lee
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Korea
| | - Inseok Ko
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea
| | - Sang Hyuk Lee
- Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
| | - Kyu Chan Huh
- Department of Gastroenterology, College of Medicine, Konyang University, Daejeon, Korea
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Regional Gastrointestinal Motility in Healthy Children. J Pediatr Gastroenterol Nutr 2021; 73:306-313. [PMID: 34091540 DOI: 10.1097/mpg.0000000000003198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the safety and use of the 3D-Transit system (Motilis SA, Lausanne, Switzerland) and to describe regional gastrointestinal transit times, segmental colonic transit times, and colonic movement patterns in healthy children. METHODS Twenty-one healthy children (11 girls, median age 10.5 years, range 7-15 years) were included. For evaluation of gastrointestinal transit times and colonic movement patterns, we used the minimally invasive electromagnetic 3D-Transit system. A small electromagnetic capsule (21.5 mm × 8.3 mm) was ingested and tracked through the gastrointestinal tract by a body-worn detector. Regional gastrointestinal transit times were assessed as time between capsule passage of anatomical landmarks. Colonic movement patterns were described and classified based on capsule movement velocity, direction, and distance. RESULTS One child could not swallow the capsule and 20 children completed the study without any discomfort or side-effects. Median whole gut transit time was 33.6 (range 10.7-80.5) hours, median gastric emptying time was 1.9 (range 0.1-22.1) hours, median small intestinal transit time was 4.9 (range 1.1-15.1) hours, and median colonic transit time was 26.4 (range 6.8-74.5) hours. Median ascending colon/cecum transit time was 9.7 (range 0.3-48.1) hours, median transverse colon transit time was 5.6 (range 0.0-11.6) hours, median descending colon transit time was 2.6 (range 0.01-22.3) hours, and median sigmoid colon/rectum transit time was 7.5 (range 0.1-31.6) hours. Colonic movement patterns among children corresponded to those previously described in healthy adults. CONCLUSIONS The 3D-Transit system is a well-tolerated and minimally invasive method for assessment of gastrointestinal motility in children.
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Impact of gastrointestinal tract variability on oral drug absorption and pharmacokinetics: An UNGAP review. Eur J Pharm Sci 2021; 162:105812. [PMID: 33753215 DOI: 10.1016/j.ejps.2021.105812] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/19/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
The absorption of oral drugs is frequently plagued by significant variability with potentially serious therapeutic consequences. The source of variability can be traced back to interindividual variability in physiology, differences in special populations (age- and disease-dependent), drug and formulation properties, or food-drug interactions. Clinical evidence for the impact of some of these factors on drug pharmacokinetic variability is mounting: e.g. gastric pH and emptying time, small intestinal fluid properties, differences in pediatrics and the elderly, and surgical changes in gastrointestinal anatomy. However, the link of colonic factors variability (transit time, fluid composition, microbiome), sex differences (male vs. female) and gut-related diseases (chronic constipation, anorexia and cachexia) to drug absorption variability has not been firmly established yet. At the same time, a way to decrease oral drug pharmacokinetic variability is provided by the pharmaceutical industry: clinical evidence suggests that formulation approaches employed during drug development can decrease the variability in oral exposure. This review outlines the main drivers of oral drug exposure variability and potential approaches to overcome them, while highlighting existing knowledge gaps and guiding future studies in this area.
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Jung F, Thurn M, Krollik K, Li D, Dressman J, Alig E, Fink L, Schmidt MU, Wacker MG. Sustained-release hot melt extrudates of the weak acid TMP-001: A case study using PBB modelling. Eur J Pharm Biopharm 2021; 160:23-34. [PMID: 33484866 DOI: 10.1016/j.ejpb.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/27/2022]
Abstract
Over the last 30 years, hot melt extrusion has become a leading technology in the manufacture of amorphous drug delivery systems. Mostly applied as an 'enabling formulation' for poorly soluble compounds, application in the design of sustained-release formulations increasingly attracts the attention of the pharmaceutical industry. The drug candidate TMP-001 is currently under evaluation for the early treatment of Multiple Sclerosis. Although this weak acid falls into class II of the Biopharmaceutics Classification System, the compound exhibits high solubility in the upper intestine resulting in high peroral bioavailability. In the present studies, four different formulation prototypes varying in their sustained-release behavior were developed, using L-arginine as a pore-forming agent in concentrations ranging between 0 and 20%. Initially, biorelevant release testing was applied to assess the dissolution behavior of the prototypes. For these formulations, a total drug release of 44.7%, 64.6%, 75%, and 90.5% was achieved in FaSSIF-v2 after 24 h. Two candidates were selected for further characterization considering the crystal structure and the physical stability of the amorphous state of TMP-001 in the formulations together with the release behavior in Level II biorelevant media. Our findings indicate L-arginine as a valuable excipient in the formulation of hot melt extrudates, as its presence led to a considerable stabilization of the amorphous state and favorably impacted the milling process and release behavior of TMP-001. To properly evaluate the proposed formulations and the importance of colonic dissolution and absorption on the overall bioavailability, a physiologically-based biopharmaceutics model was used.
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Affiliation(s)
- Fabian Jung
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Theodor-Stern-Kai 7, D-60596 Frankfurt, Germany; Institute of Pharmaceutical Technology, Goethe University, Max-von-Laue-Straße 9, D-60438 Frankfurt/Main, Germany
| | - Manuela Thurn
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Theodor-Stern-Kai 7, D-60596 Frankfurt, Germany
| | - Katharina Krollik
- Institute of Pharmaceutical Technology, Goethe University, Max-von-Laue-Straße 9, D-60438 Frankfurt/Main, Germany
| | - David Li
- Department of Pharmacy, Faculty of Science, National University of Singapore, 5 Science Drive 2, Singapore 117545, Singapore
| | - Jennifer Dressman
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Theodor-Stern-Kai 7, D-60596 Frankfurt, Germany; Institute of Pharmaceutical Technology, Goethe University, Max-von-Laue-Straße 9, D-60438 Frankfurt/Main, Germany
| | - Edith Alig
- Institute of Inorganic and Analytical Chemistry, Goethe University, Max-von-Laue-Straße 7, D-60438 Frankfurt/Main, Germany
| | - Lothar Fink
- Institute of Inorganic and Analytical Chemistry, Goethe University, Max-von-Laue-Straße 7, D-60438 Frankfurt/Main, Germany
| | - Martin U Schmidt
- Institute of Inorganic and Analytical Chemistry, Goethe University, Max-von-Laue-Straße 7, D-60438 Frankfurt/Main, Germany
| | - Matthias G Wacker
- Department of Pharmacy, Faculty of Science, National University of Singapore, 5 Science Drive 2, Singapore 117545, Singapore.
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Lee G, Son JS, Bae SH. Clinical Features of Severely Constipated Children: Comparison of Infrequent Bowel Movement and Fecal Soiling Groups. Pediatr Gastroenterol Hepatol Nutr 2020; 23:26-34. [PMID: 31988873 PMCID: PMC6966226 DOI: 10.5223/pghn.2020.23.1.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/23/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare the clinical features, diagnostic findings, and medications of children with infrequent bowel movements or fecal soiling. METHODS This study enrolled 333 children (189 male; age range, 1 month to 18 years) diagnosed with functional constipation by Rome III or IV criteria. We classified them into 3 groups (infrequent bowel movement without fecal soiling [G3-a], infrequent bowel movement with fecal soiling [G3-b], and fecal soiling only [G3-c]) and into 2 subgroups of fecal soiling (G2-b) or not (G2-a). Retrospective data on clinical characteristics, colon transit time (CTT) test results, and medications were collected. The Wilcoxon rank-sum test, Kruskal-Wallis test, Chi-square test, and Fisher's exact test were used for the statistical analysis. RESULTS The median age (months) and interquartile range (IQR) was 33 (45) in G3-a, 54 (40) in G3-b, and 73 (48) in G3-c (p<0.0001). G3-c had the latest onset (median, 18; IQR, 18; p=0.0219) and longest symptom duration (24 [24], p=0.0148). PEG 4000 was used in 60.6% (G3-a), 96.8% (G3-b), and 83.2% (G3-c) of patients (p<0.0001). The median age (months) and IQR were 33.0 (45.0) in G2-a and 63.5 (52.5) in G2-b (p<0.0001). G2-b had later onset (median, 12; IQR, 19.5; p=0.0062) and longer symptom duration than G2-a (24 [12], p=0.0070). PEG 4000 was used in 60.6% (G2-a) and 88.3% (G2-b) of children (p<0.0001). No statistically significant intergroup differences were seen in maintenance laxative dose, CTT, or CTT type. CONCLUSION Infrequent bowel movement and fecal soiling represent the advanced stage of chronic functional constipation.
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Affiliation(s)
- Gyung Lee
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Sung Son
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Hwan Bae
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
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Riahinezhad M, Taleb F, Saneian H, Kazemi S, Khademian M, Farghadani M. Predictive value of colonic transit time indices for differentiating nonnormal from normal sensation in children with chronic functional constipation identified by anorectal manometry. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2019; 24:106. [PMID: 31949457 PMCID: PMC6950359 DOI: 10.4103/jrms.jrms_460_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/23/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022]
Abstract
BACKGROUND Constipation is a common disorder in pediatrics, although the underlying pathogenesis is not fully understood. The current study aimed at evaluating the efficacy of different colonic transit time (CTT) indices for differentiating normal from nonnormal sensation in children with chronic functional constipation identified by anorectal manometry (ARM). MATERIALS AND METHODS In this cross-sectional study, 47 children with chronic idiopathic constipation, aged 5-15 years, were studied. The total and segmental CTTs were estimated by administering multiple radiopaque markers for 6 days and performing a single abdominal radiograph on day 7. Anorectal function was evaluated using manometry with an Arhan probe. The predictive value of CTT indices was evaluated by receiver operating characteristic curve analysis. Area under the curve (AUC) along with 95% confidence interval (CI) as well as sensitivity and specificity was calculated. RESULTS The mean age of the participants was 8.30 ± 2.99 years, with a mean constipation duration of 2.90 ± 0.46; 28 children were identified with nonnormal sensation. The mean values of CTT indices were statistically significantly longer in the nonnormal sensation patients than that in the normal group (P < 0.001). In addition, the mean values of manometry parameters were statistically significantly higher in nonnormal sensation patients than that in normal group (P < 0.01). Among CTT indices, rectosigmoid CTT (AUC [95% CI] =0.999 [0.99-1]; P < 0.001) with sensitivity = 100% and specificity = 94.7% and total CTT (AUC [95% CI] =0.972 [0.93-1] P < 0.001) with sensitivity = 82.3% and specificity = 100% had the highest predictive values for differentiating nonnormal from normal sensation patients. CONCLUSION CTT is a simple and noninvasive technique for classifying patients with constipation. It can be used for identifying children suffering from chronic constipation with nonnormal sensation reliably, instead of ARM. Colonic inertia may be a manifestation of global motility dysfunction. Children with delayed distal colonic transits are more likely to have abnormal defecation dynamics.
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Affiliation(s)
- Maryam Riahinezhad
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Taleb
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hosein Saneian
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shadi Kazemi
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Khademian
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Farghadani
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Rajindrajith S, Devanarayana NM, Benninga MA. Delayed or not delayed? That is the question in Indian children with constipation. Indian J Gastroenterol 2018; 37:385-387. [PMID: 30315493 DOI: 10.1007/s12664-018-0893-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Niranga M Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Academic Medical Center, Emma Children Hospital, Amsterdam, The Netherlands
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Assessment of stool frequency and colonic transit time in Indian children with functional constipation and healthy controls. Indian J Gastroenterol 2018; 37:410-415. [PMID: 30328091 DOI: 10.1007/s12664-018-0902-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/22/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Indian adults have higher stool frequency and shorter colonic transit time compared to the Western population. Colonic transit time has not been studied well in Indian children. We aimed to compare colonic transit time in normal and constipated children. METHODS In this prospective study, stool characteristics and colonic transit time by radio-opaque markers were studied in healthy children (group A, n = 39) and functional constipation patients (group B, n = 61). Twenty radio-opaque markers were ingested per orally at 0, 12, and 24 h followed by a single abdominal X-ray at 36 h. Total and segmental colonic transit times were calculated using the standard formula. RESULTS Stool frequency per week and consistency were significantly different between group A (9 [2.5-17] years) vs. group B (4.5 [2-14] years), 7 (7-14) vs.1 (1-2), and Bristol type 4 (3-5) vs. type 2 (1-3). Total colonic transit time of groups A and B was 16.2 (0.6-36) vs. 22.8 (1.8-35.4) hours; p = 0.003. Ninety-fifth percentile (upper limit of normal) cutoff derived from group A was 31.8 h. Ninety-two percent of group B had colonic transit < 95th percentile of normal healthy children. Despite 8% with colonic transit > 95th percentile, all group B patients responded well to standard therapy with laxatives. CONCLUSION Indian children have significantly higher stool frequency and shorter colonic transit time, which are different compared to the reported figures from the West. Most of the Indian children with functional constipation had normal colonic transit time.
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Mahmood S, MacInnis RJ, English DR, Karahalios A, Lynch BM. Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis. Int J Epidemiol 2018; 46:1797-1813. [PMID: 29025130 DOI: 10.1093/ije/dyx137] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background Physical activity is associated with reduced risk of colorectal cancer, but most epidemiological studies have focused on occupational and recreational physical activity. The evidence for other domains of activity, and for sedentary behaviour, is limited. Methods Medline, Embase and Web of Science were searched from inception to December 2015 for studies examining domain-specific physical activity or sedentary behaviour and the risk of colon and/or rectal cancer. We extracted maximally adjusted relative risks (RRs) except when RRs not adjusted for body mass index, were also presented. We used random-effects meta-analysis to compute pooled RRs comparing the highest versus the lowest level of exposure. We used meta-regression to assess sources of heterogeneity in estimates. Results We identified 17 cohort and 21 case-control studies, of which 17 had occupational data, 23 had recreational data, three each had data on transport and household physical activity domains, and 6 studies had data on occupational sedentary behaviour. The pooled relative risks (RRs) for colon cancer were 0.74 (95% confidence interval (CI): 0.67, 0.82) for occupational activity, 0.80 (95% CI: 0.71, 0.89) for recreational activity, 0.66 (95% CI: 0.45, 0.98) for transport-related physical activity, 0.85 (95% CI: 0.71, 1.02) for household physical activity, and 1.44 (95% CI: 1.28, 1.62) for occupational sedentary behaviour. For rectal cancer, the pooled RRs were 0.88 (95% CI: 0.79, 0.98) for occupational activity, 0.87 (95% CI: 0.75, 1.01) for recreational activity, 0.88 (95% CI: 0.70, 1.12) for transport-related physical activity, 1.01 (95% CI: 0.80, 1.27) for household physical activity, and 1.02 (95% CI: 0.82, 1.28) for occupational sedentary behaviour. Conclusions In addition to increasing occupational and recreational physical activity, promoting physical activity during transport and reducing sedentary behaviour in the workplace may also be useful colorectal cancer prevention strategies.
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Affiliation(s)
- Shahid Mahmood
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
| | - Robert J MacInnis
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
| | - Brigid M Lynch
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia.,Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia.,Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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Klopper KB, Bester E, Deane SM, Wolfaardt GM, Dicks LMT. Survival of Planktonic and Sessile Cells of Lactobacillus rhamnosus and Lactobacillus reuteri upon Exposure to Simulated Fasting-State Gastrointestinal Conditions. Probiotics Antimicrob Proteins 2018; 11:594-603. [DOI: 10.1007/s12602-018-9426-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Nicolas JM, Bouzom F, Hugues C, Ungell AL. Oral drug absorption in pediatrics: the intestinal wall, its developmental changes and current tools for predictions. Biopharm Drug Dispos 2017; 38:209-230. [PMID: 27976409 PMCID: PMC5516238 DOI: 10.1002/bdd.2052] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 12/14/2022]
Abstract
The dissolution, intestinal absorption and presystemic metabolism of a drug depend on its physicochemical characteristics but also on numerous physiological (e.g. gastrointestinal pH, volume, transit time, morphology) and biochemical factors (e.g. luminal enzymes and flora, intestinal wall enzymes and transporters). Over the past decade, evidence has accumulated indicating that these factors may differ in children and adults resulting in age-related changes in drug exposure and drug response. Thus, drug dosage may require adjustment for the pediatric population to ensure the desired therapeutic outcome and to avoid side-effects. Although tremendous progress has been made in understanding the effects of age on intestinal physiology and function, significant knowledge gaps remain. Studying and predicting pharmacokinetics in pediatric patients remains challenging due to ethical concerns associated with clinical trials in this vulnerable population, and because of the paucity of predictive in vitro and in vivo animal assays. This review details the current knowledge related to developmental changes determining intestinal drug absorption and pre-systemic metabolism. Supporting experimental approaches as well as physiologically based pharmacokinetic modeling are also discussed together with their limitations and challenges. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jean-Marie Nicolas
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
| | - François Bouzom
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
| | - Chanteux Hugues
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
| | - Anna-Lena Ungell
- Non-Clinical Development Department, UCB Biopharma sprl, Braine-l'Alleud, Belgium
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Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients. Am J Gastroenterol 2016; 111:1456-1465. [PMID: 27644734 PMCID: PMC5059698 DOI: 10.1038/ajg.2016.439] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/24/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). Patients should be followed-up with dietary interviews and serology as CD markers to ensure adherence to the diet. However, none of these methods offer an accurate measure of dietary compliance. Our aim was to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of GFD adherence in CD patients and compare it with traditional methods of GFD monitoring. METHODS We performed a prospective, nonrandomized, multicenter study including 188 CD patients on GFD and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). Serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies were measured simultaneously. RESULTS Of the 188 celiac patients, 56 (29.8%) had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age (39.2% in subjects ≥13 years old) and with gender in certain age groups (60% in men ≥13 years old). No association was found between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, association was detected between GIP and anti-DGP antibodies, although 46 of the 53 GIP stool-positive patients were negative for anti-DGP. CONCLUSIONS Detection of gluten peptides in stools reveals limitations of traditional methods for monitoring GFD in celiac patients. The GIP ELISA enables direct and quantitative assessment of gluten exposure early after ingestion and could aid in the diagnosis and clinical management of nonresponsive CD and refractory CD. Trial registration number NCT02711397.
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Boland M. Human digestion--a processing perspective. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2016; 96:2275-2283. [PMID: 26711173 DOI: 10.1002/jsfa.7601] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 11/14/2015] [Accepted: 12/20/2015] [Indexed: 06/05/2023]
Abstract
The human digestive system is reviewed in the context of a process with four major unit operations: oral processing to reduce particle size and produce a bolus; gastric processing to initiate chemical and enzymatic breakdown; small intestinal processing to break down macromolecules and absorb nutrients; and fermentation and water removal in the colon. Topics are highlighted about which we need to know more, including effects of aging and dentition on particle size in the bolus, effects of different patterns of food and beverage intake on nutrition, changes in saliva production and composition, mechanical effects of gastric processing, distribution of pH in the stomach, physicochemical and enzymatic effects on nutrient availability and uptake in the small intestine, and the composition, effects of and changes in the microbiota of the colon. Current topics of interest including food synergy, gut-brain interactions, nutritional phenotype and digestion in the elderly are considered. Finally, opportunities for food design based on an understanding of digestive processing are discussed.
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Affiliation(s)
- Mike Boland
- Riddet Institute, Palmerston North, New Zealand
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Shashkova T, Popenko A, Tyakht A, Peskov K, Kosinsky Y, Bogolubsky L, Raigorodskii A, Ischenko D, Alexeev D, Govorun V. Agent Based Modeling of Human Gut Microbiome Interactions and Perturbations. PLoS One 2016; 11:e0148386. [PMID: 26894828 PMCID: PMC4760737 DOI: 10.1371/journal.pone.0148386] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/18/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Intestinal microbiota plays an important role in the human health. It is involved in the digestion and protects the host against external pathogens. Examination of the intestinal microbiome interactions is required for understanding of the community influence on host health. Studies of the microbiome can provide insight on methods of improving health, including specific clinical procedures for individual microbial community composition modification and microbiota correction by colonizing with new bacterial species or dietary changes. METHODOLOGY/PRINCIPAL FINDINGS In this work we report an agent-based model of interactions between two bacterial species and between species and the gut. The model is based on reactions describing bacterial fermentation of polysaccharides to acetate and propionate and fermentation of acetate to butyrate. Antibiotic treatment was chosen as disturbance factor and used to investigate stability of the system. System recovery after antibiotic treatment was analyzed as dependence on quantity of feedback interactions inside the community, therapy duration and amount of antibiotics. Bacterial species are known to mutate and acquire resistance to the antibiotics. The ability to mutate was considered to be a stochastic process, under this suggestion ratio of sensitive to resistant bacteria was calculated during antibiotic therapy and recovery. CONCLUSION/SIGNIFICANCE The model confirms a hypothesis of feedbacks mechanisms necessity for providing functionality and stability of the system after disturbance. High fraction of bacterial community was shown to mutate during antibiotic treatment, though sensitive strains could become dominating after recovery. The recovery of sensitive strains is explained by fitness cost of the resistance. The model demonstrates not only quantitative dynamics of bacterial species, but also gives an ability to observe the emergent spatial structure and its alteration, depending on various feedback mechanisms. Visual version of the model shows that spatial structure is a key factor, which helps bacteria to survive and to adapt to changed environmental conditions.
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Affiliation(s)
- Tatiana Shashkova
- Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya, 1a, Moscow, 119435, Russia
- Moscow Institute of Physics and Technology, Institutskiy pereulok 9, Dolgoprudny, 141700, Russian Federation
| | - Anna Popenko
- Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya, 1a, Moscow, 119435, Russia
| | - Alexander Tyakht
- Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya, 1a, Moscow, 119435, Russia
| | - Kirill Peskov
- “M&S Decisions” LLC, Narishkinskaya alleya, 5, Moscow, 125167, Russian Federation
| | - Yuri Kosinsky
- “M&S Decisions” LLC, Narishkinskaya alleya, 5, Moscow, 125167, Russian Federation
| | - Lev Bogolubsky
- Yandex LLC 16 Leo Tolstoy St., Moscow, 119021, Russian Federation
| | | | - Dmitry Ischenko
- Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya, 1a, Moscow, 119435, Russia
| | - Dmitry Alexeev
- Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya, 1a, Moscow, 119435, Russia
- Moscow Institute of Physics and Technology, Institutskiy pereulok 9, Dolgoprudny, 141700, Russian Federation
| | - Vadim Govorun
- Research Institute of Physical Chemical Medicine, Malaya Pirogovskaya, 1a, Moscow, 119435, Russia
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Lu L, Yan G, Zhao K, Xu F. Analysis of the Chaotic Characteristics of Human Colonic Activities and Comparison of Healthy Participants to Costive Subjects. IEEE J Biomed Health Inform 2016; 20:231-9. [DOI: 10.1109/jbhi.2014.2371073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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A study of human colonic motility in healthy and constipated subjects using the wireless capsule. Comput Biol Med 2015; 65:269-78. [PMID: 26238703 DOI: 10.1016/j.compbiomed.2015.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 02/07/2023]
Abstract
Constipation is a common and distressing condition that has been linked to major morbidity, burdens the health care system, and impacts patients׳ quality of life. However, there is no perfect method for diagnosing and treating constipation. The purpose of this paper is to develop an automatic algorithm to identify patients with constipation from healthy subjects. Data from 12 healthy subjects and 10 patients with constipation were analyzed. The key challenges for data processing were data filtering, feature extraction, information evaluation, and providing the reference conclusion; these were resolved by employing the phase space reconstruction (PSR), independent component analysis (ICA), dynamic feature extraction algorithm, and the Wilcoxon rank sum test. The contractile frequency (Fr), motility index per unit time (MIU), average peak of peristaltic wave (Pave) and variance (Var) were extracted as dynamic parameters and analyzed. Results between groups were compared with the Wilcoxon rank sum test. There were statistically significant differences between healthy subjects and patients with constipation for Fr and MIU (P<0.05), whereas there was no statistically difference for Var. Moreover, the Fr and MIU of patients with normal transit constipation (NTC) are significantly lower compared to healthy subjects, whereas patients with slow transit constipation (STC) did not show significant differences. The proposed algorithms were able to differentiate between healthy subjects and patients with constipation based on the colonic motility profiles.
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Oral drug delivery of therapeutic gases — Carbon monoxide release for gastrointestinal diseases. J Control Release 2014; 189:46-53. [DOI: 10.1016/j.jconrel.2014.06.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/14/2014] [Accepted: 06/16/2014] [Indexed: 01/27/2023]
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Abstract
Background Venous thromboembolism has been increasingly recognised as a clinical problem in the paediatric population. Guideline recommendations for antithrombotic therapy in paediatric patients are based mainly on extrapolation from adult clinical trial data, owing to the limited number of clinical trials in paediatric populations. The oral, direct Factor Xa inhibitor rivaroxaban has been approved in adult patients for several thromboembolic disorders, and its well-defined pharmacokinetic and pharmacodynamic characteristics and efficacy and safety profiles in adults warrant further investigation of this agent in the paediatric population. Objective The objective of this study was to develop and qualify a physiologically based pharmacokinetic (PBPK) model for rivaroxaban doses of 10 and 20 mg in adults and to scale this model to the paediatric population (0–18 years) to inform the dosing regimen for a clinical study of rivaroxaban in paediatric patients. Methods Experimental data sets from phase I studies supported the development and qualification of an adult PBPK model. This adult PBPK model was then scaled to the paediatric population by including anthropometric and physiological information, age-dependent clearance and age-dependent protein binding. The pharmacokinetic properties of rivaroxaban in virtual populations of children were simulated for two body weight-related dosing regimens equivalent to 10 and 20 mg once daily in adults. The quality of the model was judged by means of a visual predictive check. Subsequently, paediatric simulations of the area under the plasma concentration–time curve (AUC), maximum (peak) plasma drug concentration (Cmax) and concentration in plasma after 24 h (C24h) were compared with the adult reference simulations. Results Simulations for AUC, Cmax and C24h throughout the investigated age range largely overlapped with values obtained for the corresponding dose in the adult reference simulation for both body weight-related dosing regimens. However, pharmacokinetic values in infants and preschool children (body weight <40 kg) were lower than the 90 % confidence interval threshold of the adult reference model and, therefore, indicated that doses in these groups may need to be increased to achieve the same plasma levels as in adults. For children with body weight between 40 and 70 kg, simulated plasma pharmacokinetic parameters (Cmax, C24h and AUC) overlapped with the values obtained in the corresponding adult reference simulation, indicating that body weight-related exposure was similar between these children and adults. In adolescents of >70 kg body weight, the simulated 90 % prediction interval values of AUC and C24h were much higher than the 90 % confidence interval of the adult reference population, owing to the weight-based simulation approach, but for these patients rivaroxaban would be administered at adult fixed doses of 10 and 20 mg. Conclusion The paediatric PBPK model developed here allowed an exploratory analysis of the pharmacokinetics of rivaroxaban in children to inform the dosing regimen for a clinical study in paediatric patients. Electronic supplementary material The online version of this article (doi:10.1007/s40262-013-0090-5) contains supplementary material, which is available to authorized users.
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Nokhodchi A, Asare-Addo K. Drug release from matrix tablets: physiological parameters and the effect of food. Expert Opin Drug Deliv 2014; 11:1401-18. [DOI: 10.1517/17425247.2014.924498] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
PURPOSE The aims of this study are to describe normal colon transit time (CTT) in healthy children, correlate results with age, the Bristol stool scale, and stool frequency, and to evaluate intra- and interobserver variability. METHODS Inclusion criteria were as follows: healthy children between 3 and 18 years old with a normal defecation pattern, no history of abdominal surgery, and no medication use. Total and segmental CTT is measured by taking ten polythene radiopaque markers during six consecutive days followed by a single abdominal X-ray on day 7. Total and segmental CTT are calculated by multiplying the number of markers by 2.4 (Abrahamsson et al. Scand J Gastroenterol 32:72-80, 1988). RESULTS Fifty-four children and adolescents have participated: 30 boys and 24 girls (median age 10 years (3-18 years)). Median total CTT is 36 h (<2.4-86.4 h). There is no significant difference for age category (toddlers 31.2 h (<2.4-74.4 h), elementary school 36 h (2.4-79.2 h), and adolescents 43.2 h (14.4-86.4 h)). Segmental CTT reveals a median right colon CTT of 4.8 h (0-28.8 h); a median left colon CTT of 2.4 h (0-31.2 h); and a median rectosigmoidal CTT of 24 h (0-64.8 h). The Bristol stool scale correlates with total CTT (p = 0.031). The intra- and interobserver variability displays an ICC of 0.999 for the total CTT. CONCLUSION The CTT of normal healthy children is not sex- or age-related (above the age of 3 years). The Abrahamson method for CTT measurement by using bony landmarks for the determination of colon segments is easy to perform and well tolerated with a virtual inexistent rating difference between different observers.
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Hedsund C, Joensson IM, Gregersen T, Fynne L, Schlageter V, Krogh K. Magnet tracking allows assessment of regional gastrointestinal transit times in children. Clin Exp Gastroenterol 2013; 6:201-8. [PMID: 24399881 PMCID: PMC3875367 DOI: 10.2147/ceg.s51402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Data on small intestinal transit time in healthy children are lacking, and normal values for gastric emptying and colonic transit time are sparse. Conventional methods, including radiopaque markers, scintigraphy, and PillCam™ involve radiation or require the child to swallow a large pill. The minimally invasive, radiation-free Motility Tracking System-1 (MTS-1) has been introduced for description of gastrointestinal motility in adults. The aim of the study was to evaluate the MTS-1 for assessment of gastrointestinal transit times and motility patterns in healthy children. Methods Twenty-one healthy children (nine girls), median age 10 (range 7–12) years were included. For evaluation with MTS-1, a small magnetic pill was ingested and tracked through the gastrointestinal tract by a matrix of 16 magnetic sensors placed behind a nonmagnetic bed. The children were investigated for 8 hours after swallowing the magnetic pill and again for 4 hours the following morning. After leaving the unit, each child came back after every bowel movement to determine if the pill had been expelled. Results Nineteen children could swallow the pill. Characteristic contraction patterns were identified for the stomach (three per minute), small intestine (9–11 per minute), and colon (4–5 per minute). Median total gastrointestinal transit time was 37.7 (range 9.5–95.8) hours, median gastric emptying time was 37 (range 2–142) minutes, median small intestinal transit time was 302 (range 164 to >454) minutes, and median colorectal transit time was 38.1 (range 5.6–90.0) hours. Conclusion MTS-1 allows minimally invasive evaluation of gastrointestinal motility in children. Use of the method is, however, restricted by the nonambulatory setup.
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Affiliation(s)
- Caroline Hedsund
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark ; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tine Gregersen
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark
| | - Lotte Fynne
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark
| | | | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus, Denmark
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29
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Abstract
The autonomic nervous system controls a variety of fundamental physiological processes in the human body including regulation of breathing, heart rate, blood pressure, temperature, and gastrointestinal motility. Although, methods of testing autonomic function have been developed and normative data have been collected in adults, development of child-friendly testing and the field of pediatric autonomic medicine is just beginning. These noninvasive testing methods serve to identify changes in autonomic functioning and to clarify whether dysfunction is isolated or crosses into multiple systems. Methods for testing cardiovagal, adrenergic, sudomotor, pupillary, enteric, and bladder function need to be refined and made more child friendly at the same time that age and gender appropriate normative values are developed for children.
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Affiliation(s)
- Nancy L Kuntz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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30
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Zihler A, Gagnon M, Chassard C, Lacroix C. Protective effect of probiotics on Salmonella infectivity assessed with combined in vitro gut fermentation-cellular models. BMC Microbiol 2011; 11:264. [PMID: 22171685 PMCID: PMC3295705 DOI: 10.1186/1471-2180-11-264] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 12/15/2011] [Indexed: 02/12/2023] Open
Abstract
Background Accurate assessment of probiotics with targeted anti-Salmonella activity requires suitable models accounting for both, microbe-microbe and host-microbe interactions in gut environments. Here we report the combination of two original in vitro intestinal models closely mimicking the complex in vivo conditions of the large intestine. Effluents from continuous in vitro three-stage fermentation colonic models of Salmonella Typhimurium infection inoculated with immobilized child microbiota and Salmonella were directly applied to confluent mucus-secreting HT29-MTX cell layers. The effects of Salmonella, addition of two bacteriocinogenic strains, Bifidobacterium thermophilum RBL67 (thermophilicin B67) and Escherichia coli L1000 (microcin B17), and inulin were tested on Salmonella growth and interactions with epithelial cell layers. Salmonella adhesion and invasion were investigated and epithelial integrity assessed by transepithelial electrical resistance (TER) measurements and confocal microscopy observation. Data from complex effluents were compared with pure Salmonella cultures. Results Salmonella in effluents of all reactors of the colonic fermentation model stabilized at mean values of 5.3 ± 0.8 log10 cfu/ml effluent. Invasion of cell-associated Salmonella was up to 50-fold lower in complex reactor samples compared to pure Salmonella cultures. It further depended on environmental factors, with 0.2 ± 0.1% being measured with proximal, 0.6 ± 0.2% with transverse and 1.3 ± 0.7% with distal reactor effluents, accompanied by a similar high decrease of TER across cell monolayers (minus 45%) and disruption of tight junctions. Subsequent addition of E. coli L1000 stimulated Salmonella growth (6.4 ± 0.6 log10 cfu/ml effluent of all 3 reactors) and further decreased TER, but led to 10-fold decreased invasion efficiency when tested with distal reactor samples. In contrast, presence of B. thermophilum RBL67 revealed a protective effect on epithelial integrity compared to previous E. coli L1000 periods, as reflected by a significant mean increase of TER by 58% in all reactors. Inulin addition enhanced Salmonella growth and invasion when tested with distal and proximal reactor samples, respectively, but induced a limited decrease of TER (minus 18%) in all reactors. Conclusions Our results highlight the benefits of combining suitable cellular and colonic fermentation models to assess strain-specific first-level host protection properties of probiotics during Salmonella infection, providing an efficient system biology tool for preclinical development of new antimicrobials.
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Affiliation(s)
- Annina Zihler
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Schmelzbergstrasse 7, 8092 Zürich, Switzerland
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31
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Kim KS, Seo JH, Ryu SH, Kim MH, Song CG. Estimation algorithm of the bowel motility based on regression analysis of the jitter and shimmer of bowel sounds. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2011; 104:426-434. [PMID: 21429614 DOI: 10.1016/j.cmpb.2011.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 02/10/2011] [Accepted: 02/21/2011] [Indexed: 05/30/2023]
Abstract
Bowel sound (BS) signals can be used clinically as useful indicators of bowel motility. In this study, we devised a modified iterative kurtosis-based detector algorithm, in order to enhance the de-noising performance of BS signals, and an estimation algorithm of bowel motility based on the regression modeling of the jitter and shimmer of BS signals obtained by auscultation. The correlation coefficient, coefficient of determination and errors between the colon transit times measured by a conventional radiograph and the corresponding values estimated by our method were 0.987, 0.974 and 3.5 ± 3.3h, respectively. These results demonstrated that our method could be used as a complementary tool for the non-invasive diagnosis and monitoring of bowel motility, instead of conventional radiography.
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Affiliation(s)
- Keo Sik Kim
- School of Electronics and Information Engineering, Chonbuk National University, 664-14 Deokjin-dong, Jeonju, Jeonbuk 561-756, Republic of Korea
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32
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Dinning PG, Di Lorenzo C. Colonic dysmotility in constipation. Best Pract Res Clin Gastroenterol 2011; 25:89-101. [PMID: 21382581 DOI: 10.1016/j.bpg.2010.12.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 11/23/2010] [Accepted: 12/13/2010] [Indexed: 01/31/2023]
Abstract
Constipation is a common and distressing condition with major morbidity, health care burden, and impact on quality of life. Colonic motor dysfunction remains the leading hypothesis to explain symptom generation in the most severe cases of chronic constipation and physiological testing plays a role in identifying the colonic dysmotility and the subsequent patient management. Measurement of colonic motor patterns and transit has enhanced our knowledge of normal and abnormal colonic motor physiology. The scope of this review encompasses the latest findings that improve our understanding of the motility disorders associated with colonic dysfunction in both the paediatric and adult population suffering from constipation.
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Affiliation(s)
- Philip G Dinning
- Department of Gastroenterology, University of New South Wales, St George Hospital, Gray St, Kogarah, NSW 2217, Sydney, Australia.
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33
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Rajindrajith S, Devanarayana NM. Constipation in children: novel insight into epidemiology, pathophysiology and management. J Neurogastroenterol Motil 2011; 17:35-47. [PMID: 21369490 PMCID: PMC3042216 DOI: 10.5056/jnm.2011.17.1.35] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 12/24/2010] [Accepted: 12/31/2010] [Indexed: 12/12/2022] Open
Abstract
Constipation in children is a common health problem affecting 0.7% to 29.6% children across the world. Exact etiology for developing symptoms is not clear in children and the majority is considered to have functional constipation. Alteration of rectal and pelvic floor function through the brain-gut axis seems to play a crucial role in the etiology. The diagnosis is often a symptom-based clinical process. Recently developed Rome III diagnostic criteria looks promising, both in clinical and research fields. Laboratory investigations such as barium enema, colonoscopy, anorectal manometry and colonic transit studies are rarely indicated except in those who do not respond to standard management. Treatment of childhood constipation involves several facets including education and demystification, toilet training, rational use of laxatives for disimpaction and maintenance and regular follow-up. Surgical options should be considered only when medical therapy fails in long standing constipation. Since most of the management strategies of childhood constipation are not evidence-based, high-quality randomized controlled trials are required to assess the efficacy of currently available or newly emerging therapeutic options. Contrary to the common belief that children outgrow constipation as they grow up, a sizable percentage continue to have symptoms beyond puberty.
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Affiliation(s)
- Shaman Rajindrajith
- Department of Pediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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34
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Morowitz MJ, Denef VJ, Costello EK, Thomas BC, Poroyko V, Relman DA, Banfield JF. Strain-resolved community genomic analysis of gut microbial colonization in a premature infant. Proc Natl Acad Sci U S A 2011; 108:1128-33. [PMID: 21191099 PMCID: PMC3024690 DOI: 10.1073/pnas.1010992108] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The intestinal microbiome is a critical determinant of human health. Alterations in its composition have been correlated with chronic disorders, such as obesity and inflammatory bowel disease in adults, and may be associated with neonatal necrotizing enterocolitis in premature infants. Increasing evidence suggests that strain-level genomic variation may underpin distinct ecological trajectories within mixed populations, yet there have been few strain-resolved analyses of genotype-phenotype connections in the context of the human ecosystem. Here, we document strain-level genomic divergence during the first 3 wk of life within the fecal microbiota of an infant born at 28-wk gestation. We observed three compositional phases during colonization, and reconstructed and intensively curated population genomic datasets from the third phase. The relative abundance of two Citrobacter strains sharing ~99% nucleotide identity changed significantly over time within a community dominated by a nearly clonal Serratia population and harboring a lower abundance Enterococcus population and multiple plasmids and bacteriophage. Modeling of Citrobacter strain abundance suggests differences in growth rates and host colonization patterns. We identified genotypic variation potentially responsible for divergent strain ecologies, including hotspots of sequence variation in regulatory genes and intergenic regions, and in genes involved in transport, flagellar biosynthesis, substrate metabolism, and host colonization, as well as differences in the complements of these genes. Our results demonstrate that a community genomic approach can elucidate gut microbial colonization at the resolution required to discern medically relevant strain and species population dynamics, and hence improve our ability to diagnose and treat microbial community-mediated disorders.
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Affiliation(s)
- Michael J. Morowitz
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637
| | | | | | | | - Valeriy Poroyko
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637
| | - David A. Relman
- Department of Microbiology and Immunology
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305; and
- Veteran's Affairs Palo Alto Heath Care System, Palo Alto, CA 94304
| | - Jillian F. Banfield
- Departments of Earth and Planetary Science, and
- Environmental Science, Policy, and Management, University of California, Berkeley, CA 94720
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35
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Zihler A, Gagnon M, Chassard C, Hegland A, Stevens MJA, Braegger CP, Lacroix C. Unexpected consequences of administering bacteriocinogenic probiotic strains for Salmonella populations, revealed by an in vitro colonic model of the child gut. Microbiology (Reading) 2010; 156:3342-3353. [DOI: 10.1099/mic.0.042036-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
New biological strategies for the treatment of Salmonella infection are needed in response to the increase in antibiotic-resistant strains. Escherichia coli L1000 and Bifidobacterium thermophilum RBL67 were previously shown to produce antimicrobial proteinaceous compounds (microcin B17 and thermophilicin B67, respectively) active in vitro against a panel of Salmonella strains recently isolated from clinical cases in Switzerland. In this study, two three-stage intestinal continuous fermentation models of Salmonella colonization inoculated with immobilized faeces of a two-year-old child were implemented to study the effects of the two bacteriocinogenic strains compared with a bacteriocin-negative mutant of strain L1000 on Salmonella growth, as well as gut microbiota composition and metabolic activity. Immobilized E. coli L1000 added to the proximal colon reactor showed a low colonization, and developed preferentially in the distal colon reactor independent of the presence of genetic determinants for microcin B17 production. Surprisingly, E. coli L1000 addition strongly stimulated Salmonella growth in all three reactors. In contrast, B. thermophilum RBL67 added in a second phase stabilized at high levels in all reactors, but could not inhibit Salmonella already present at a high level (>107 c.f.u. ml−1) when the probiotic was added. Inulin added at the end of fermentation induced a strong bifidogenic effect in all three colon reactors and a significant increase of Salmonella counts in the distal colon reactor. Our data show that under the simulated child colonic conditions, the microcin B17 production phenotype does not correlate with inhibition of Salmonella but leads to a better colonization of E. coli L1000 in the distal colon reactor. We conclude that in vitro models with complex and complete gut microbiota are required to accurately assess the potential and efficacy of probiotics with respect to Salmonella colonization in the gut.
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Affiliation(s)
- Annina Zihler
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
| | - Mélanie Gagnon
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
| | - Christophe Chassard
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
| | - Anita Hegland
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
| | - Marc J. A. Stevens
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
| | - Christian P. Braegger
- Division of Gastroenterology and Nutrition, University Children's Hospital, Zürich, Switzerland
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland
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36
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Abrahamsson H, Antov S. Accuracy in assessment of colonic transit time with particles: how many markers should be used? Neurogastroenterol Motil 2010; 22:1164-9. [PMID: 20584262 DOI: 10.1111/j.1365-2982.2010.01543.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonic transit time (CTT) is often measured with particle methods in clinical practice, but few studies have evaluated the role of particle amounts for the results obtained. METHODS Colonic transit time was studied in 28 subjects taking radiopaque particles for six consecutive days followed by an abdominal radiograph on day 7. Four distinguishable marker types were ingested simultaneously in an amount of 5, 10, 15, and 20 daily, respectively, and CTT calculated for each type as the number of retained markers divided by the daily intake. Reference values were based on 50 markers daily. KEY RESULTS Accuracy measured as median deviation of CTT from reference was for 20 markers day(-1) 0.08 days, for 15 markers day(-1) 0.10 days, for 10 markers day(-1) 0.12 days, and for 5 markers day(-1) 0.20 days. The CTT values obtained with 5 markers day(-1) deviated significantly more from the reference value than CTT values obtained with 10 markers day(-1) (P < 0.05) and with 15 and 20 markers day(-1) (P < 0.01). Colonic transit times obtained with 20, 15, or 10 markers day(-1) did not differ significantly (P > 0.1). CONCLUSIONS & INFERENCES Colonic transit time can be assessed with reasonable accuracy after repeated ingestion of particles. For clinical use, a daily amount of 10 or 12 markers is proposed for reporting CTT in days or hours, respectively. Doses below 10 daily yield a steeply increasing deviation from reference values.
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Affiliation(s)
- H Abrahamsson
- Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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37
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Wilson CG. The transit of dosage forms through the colon. Int J Pharm 2010; 395:17-25. [PMID: 20576492 DOI: 10.1016/j.ijpharm.2010.04.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
Abstract
Colonic transit is a subject of great relevance when considering in vivo/in vitro relationships for oral controlled release dosage forms. Our knowledge of colonic motility has first come from the clinic, where measurement of the whole gut transit of different excreted markers was used as a method of discriminating pathologies. X-ray contrast, although widely available, was used sparing due to the accumulating dosimetry associated with each exposure. Although such methods were used for swallowing studies, gamma scintigraphy allowed physicians to measure colon function with a more moderate radiation burden. The ability to label meal and dosage form separately and to measure dispersion with more certainty, prompted the use in pharmaceutical sciences; finally, the relationship between blood concentrations and transit of different sized dosage began to be understood. This mini-review considers the development of colon transit measurements and how different designs of clinical assessment assist in elucidating size and shape influence on colon transit in man.
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Affiliation(s)
- Clive G Wilson
- Strathclyde Institute of Pharmacy & Biomedical Sciences, Glasgow G4 0NR, Scotland, UK.
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38
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Bowles A, Keane J, Ernest T, Clapham D, Tuleu C. Specific aspects of gastro-intestinal transit in children for drug delivery design. Int J Pharm 2010; 395:37-43. [PMID: 20478372 DOI: 10.1016/j.ijpharm.2010.04.048] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 01/04/2023]
Abstract
This mini-review discusses relevant aspects of gastro-intestinal transit in different ages of paediatric patients with an attempt to highlight factors which should be considered in oral dosage form design, in particular multi-particulate dosage forms. This emphasis is due to multi-particulates possessing many of the benefits of liquid oral formulations (such as ease of swallowing and dose adaptability) without many of their drawbacks (such as stability issues and lack of enteric or modified release functionalities). It is commonly stated that children are not merely small adults with regards to medicines. However, there has been very little research regarding how different dosage forms transit through the gastro-intestinal tract in children compared to adults, due to both ethical and practical hurdles. Due to this lack of studies on dosage form transit in children, information which was available on the transit of food, milk and liquids (often dependent upon the age of the patient) has been used to look at how various aspects of transit vary with age and, where possible, when they reach adult values and how these may affect the fate of dosage forms in vivo: swallowability, oesophageal transit, gastric emptying and pH, intestinal and colonic transit are discussed.
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Affiliation(s)
- Alexandra Bowles
- Department of Pharmaceutics, The School of Pharmacy, University of London, United Kingdom
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39
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Sutcliffe JR, King S, Hutson JM, Southwell B. What is new in radiology and pathology of motility disorders in children? Semin Pediatr Surg 2010; 19:81-5. [PMID: 20307844 DOI: 10.1053/j.sempedsurg.2009.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Disorders affecting colorectal motility lead to significant morbidity in children with surgical conditions. Etiology is frequently unknown, which in turn makes treatment empiric and compromises outcome. A thorough understanding of the normal mechanisms of control and the ability to recognize and manage defects is an important goal for clinicians. This article reviews recent advances made in the investigation of children with colorectal motility disorders, including the role of transit studies (marker studies and scintigraphy), options for assessing anatomy (ultrasound, contrast enema, and sectional imaging) and the use of manometry, both anorectal and colonic. Current concepts in microscopic evaluation are outlined.
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Affiliation(s)
- Jonathan R Sutcliffe
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom.
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40
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Abstract
Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a bowel management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process.
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Affiliation(s)
- Andrea Bischoff
- Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229 USA
| | - Marc A. Levitt
- Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229 USA
| | - Alberto Peña
- Colorectal Center for Children, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 2023, Cincinnati, OH 45229 USA
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41
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Southwell BR, Clarke MCC, Sutcliffe J, Hutson JM. Colonic transit studies: normal values for adults and children with comparison of radiological and scintigraphic methods. Pediatr Surg Int 2009; 25:559-72. [PMID: 19488763 DOI: 10.1007/s00383-009-2387-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2009] [Indexed: 12/17/2022]
Abstract
The sitz or plastic marker study for colonic transit has been around for many years. It is applicable where an X-ray machine exists, is widely used and is accepted as the gold standard for diagnosing constipation. Recently, radiopharmaceutical methods have been developed. The theme of this review is their possible roles in the assessment of paediatric bowel motility disorders in patients presenting to paediatric surgeons. This review presents data on total and segmental transit in normal adults and children and comparing the two techniques in adults. Reliability and reproducibility are presented. Normative data for colonic transit in adults and children are discussed and parameters for assessing abnormal transit are reviewed. Normal colonic transit takes 20-56 h. Plastic marker studies are more readily accessible, but the assessment may be misleading with current methods. Plastic markers show faster transit than scintigraphy. It is difficult to compare the two techniques because methods of reporting are different. Using scintigraphy, repeatability is good. Separation of normal from slow transit in the ascending colon is apparent at 24 and 48 h, but the determination of transit through the distal colon/rectum in adults may require studies of more than 7 days. In conclusion, plastic marker studies and scintigraphy show similar transit rates in young adults and children. However, scintigraphy has advantages of allowing transit through the stomach and small intestine to be measured and has proved useful in the diagnostic workup of children with intractable constipation.
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Affiliation(s)
- Bridget R Southwell
- Surgical Research Group, Gut Motility Laboratory, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia.
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42
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Nilsen TIL, Romundstad PR, Petersen H, Gunnell D, Vatten LJ. Recreational physical activity and cancer risk in subsites of the colon (the Nord-Trøndelag Health Study). Cancer Epidemiol Biomarkers Prev 2008; 17:183-8. [PMID: 18199723 DOI: 10.1158/1055-9965.epi-07-0746] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Physical activity may reduce colon cancer risk, but the underlying mechanisms remain unclear. Relating physical activity to cancer risk in anatomic segments of the colon may advance our understanding of possible mechanisms. We conducted a prospective study of 59,369 Norwegian men and women who were followed up for cancer incidence and mortality. Cox proportional hazards models were used to estimate multivariably adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). All statistical tests were two sided. During 17 years of follow-up, 736 colon cancers and 294 rectal cancers were diagnosed. Overall, we found an inverse association between recreational physical activity and colon cancer risk, but subsite analyses showed that the association was confined to cancer in the transverse and sigmoid colon. The adjusted HR, comparing people who reported high versus no physical activity, was 0.44 (95% CI, 0.25-0.78) for cancer in the transverse colon and 0.48 (95% CI, 0.31-0.75) for cancer in the sigmoid colon. The corresponding HR for cancer mortality was 0.33 (95% CI, 0.14-0.76) for the transverse colon and 0.29 (95% CI, 0.15-0.56) for the sigmoid colon. For rectal cancer, there was no association with physical activity in these data. In conclusion, the inverse association of recreational physical activity with cancer risk and mortality in the transverse and sigmoid segments of the colon may point at increased colon motility and reduced fecal transit time as possible underlying mechanisms.
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Affiliation(s)
- Tom I L Nilsen
- Human Movement Science Programme, Norwegian University of Science and Technology, Trondheim, Norway.
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43
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Omar S, Aldosari B, Refai H, Gohary OA. Colon-specific drug delivery for mebeverine hydrochloride. J Drug Target 2008; 15:691-700. [PMID: 18041637 DOI: 10.1080/10611860701603281] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Mebeverine Hydrochloride (MB-HCl), an effective spasmolytic drug, was formulated as CODES. A colon-specific drug delivery technology CODES was designed to avoid the inherent problems associated with pH- or time-dependent systems. To achieve more protection and control of drug release, MB-HCl was prepared as microspheres and compressed as core tablets of CODES (modified CODES). The core tablets contained the drug either in free form [Formula 1 (F(1))], or as microspheres with 2 different polymer:drug:lactulose ratios (1:1:0.5 [Formula 2 (F(2))] and 2:1:0.5 [Formula 3 (F(3))]. The release profiles of the coated CODES systems were compared with uncoated compressed tablets. The uncoated tablet showed a drug release of 94% after 1 h in simulated gastric condition (pH = 1.2). The release characteristics of the coated systems revealed that the enteric coating (Eudragit L(100)) prevented any drug release in simulated gastric or duodenal conditions in the first 3 h (pH 1.2-6.1), after which drug was slightly liberated in simulated intestinal fluid (pH 7.4) {Phase 1 (P1)}. After 4 h the pH was adjusted to 7 and beta-glucose-oxidase was added, which is an enzyme produced by enterobacteria present in the colon. The acid-soluble coat (Eudragit)E(100)) dissolved and the drug release suddenly increased to reach 95, 72 and 60.4% for F(1)-F(3), respectively. IR spectrum study showed a covalent bond between the drug and the polymer in the formulae F(2) and F(3) resulting in the sustained drug release from the microspheres with a significant difference (p>0.05) to F(1). The findings were confirmed by in vivo investigation using X-ray images for Guinea pigs ingested tablets containing barium sulphate (F(4)), where the tablet began to disintegrate after 10 h of tablet intake. The results of the study indicated that MB-HCl CODES colon-specific drug delivery can act as a successful trigger for drug targeting in the colon. Furthermore, a sustained release of the drug can be achieved from modified CODES containing the drug in the form of microspheres.
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Affiliation(s)
- Samia Omar
- Department of Pharmaceutics, Faculty of Pharmacy, King Saud University, Riyadh KSA, Saudi Arabia.
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DeSesso JM, Williams AL. Contrasting the Gastrointestinal Tracts of Mammals: Factors that Influence Absorption. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 2008. [DOI: 10.1016/s0065-7743(08)00021-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Lundin E, Graf W, Garske U, Nilsson S, Maripuu E, Karlbom U. Segmental colonic transit studies: comparison of a radiological and a scintigraphic method. Colorectal Dis 2007; 9:344-51. [PMID: 17432988 DOI: 10.1111/j.1463-1318.2006.01153.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Colonic transit studies are used to diagnose slow transit constipation (STC) and to evaluate segmental colonic transit before segmental or subtotal colectomy. The aim of the study was to compare a single X-ray radio-opaque marker method with a scintigraphic technique to assess total and segmental colonic transit in patients with STC. METHOD Thirty-one female patients (median age 46 years) with severe constipation and a prolonged or borderline prolonged colonic transit time on radio-opaque marker study were included in the study. They were subsequently investigated with (111)Indium-DTPA colonic transit scintigraphy, with a median time between the investigations of 4(range 1-27) months. Normal values of healthy female controls were used for comparison. RESULTS There was no difference between the two methods in terms of prolonged or normal total colonic transit time. Twenty-nine of 31 female patients had a prolonged transit time only in one or two segments on the marker study. On scintigraphy, the transit time was prolonged for patients in the left (P < 0.05 to P < 0.001), but not in the right colon. With respect to prolonged or normal segmental transit time, there was a significant difference between the two methods only in the descending colon (P = 0.02). However, the results varied considerably for individual patients. CONCLUSION Segmental colonic delay was a common finding. The two methods gave similar results for groups of patients, except in the descending colon. The variation of the results for individuals suggests that a repeated transit test may improve the assessment of total and segmental transit.
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Affiliation(s)
- E Lundin
- Department of Surgery, University Hospital, Uppsala, Sweden.
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Abstract
Constipation is a common problem throughout the world. It occurs in about 10-20% of adults in Western Countries and 0.3% to 28% of children worldwide. Most childhood constipation results from intentional withholding of stool following a painful experience with defecation. Thus, an extensive evaluation is often not necessary in a child presenting with constipation. Treatment should include education, evacuation of the rectum with oral or rectal laxatives if an impaction is present, laxatives to ensure soft stools and behavior modification.
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Affiliation(s)
- Joseph M Croffie
- Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202-5225, USA.
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Bongers MEJ, Voskuijl WP, van Rijn RR, Benninga MA. The value of the abdominal radiograph in children with functional gastrointestinal disorders. Eur J Radiol 2006; 59:8-13. [PMID: 16632293 DOI: 10.1016/j.ejrad.2006.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 02/24/2006] [Accepted: 03/01/2006] [Indexed: 01/20/2023]
Abstract
Functional gastrointestinal disorder is a common problem in childhood. The symptoms vary from a relative mild gastrointestinal problem such as abdominal pain or infrequent defecation to severe problems with fecal impaction and fecal incontinence. The aim of this review is to describe and evaluate the value of the different existing methods to assess fecal loading on an abdominal radiograph with or without the use of radio-opaque markers in the diagnosis of functional abdominal pain, functional constipation and functional non-retentive fecal incontinence. In our opinion, the abdominal radiograph has limited value in the diagnostic work-up of children with functional gastrointestinal disorders.
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Affiliation(s)
- Marloes E J Bongers
- Department of Pediatric Gastroenterology and Nutrition, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
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