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Qiu S, Wang Z, Yang Q, Cai Y, Xie Y, Tang S, Zhang A. Integrative multi-omics reveals the metabolic and functional diversity of microbiomes in the gut microenvironment. Front Microbiol 2023; 14:1168239. [PMID: 37426021 PMCID: PMC10324652 DOI: 10.3389/fmicb.2023.1168239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Shi Qiu
- International Advanced Functional Omics Platform, Scientific Experiment Center, International Joint Research Center on Traditional Chinese and Modern Medicine, Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, Hainan General Hospital, College of Chinese Medicine, Hainan Medical University, Haikou, China
| | - Zhibo Wang
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qiang Yang
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Ying Cai
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yiqiang Xie
- International Advanced Functional Omics Platform, Scientific Experiment Center, International Joint Research Center on Traditional Chinese and Modern Medicine, Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, Hainan General Hospital, College of Chinese Medicine, Hainan Medical University, Haikou, China
| | - Songqi Tang
- International Advanced Functional Omics Platform, Scientific Experiment Center, International Joint Research Center on Traditional Chinese and Modern Medicine, Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, Hainan General Hospital, College of Chinese Medicine, Hainan Medical University, Haikou, China
| | - Aihua Zhang
- International Advanced Functional Omics Platform, Scientific Experiment Center, International Joint Research Center on Traditional Chinese and Modern Medicine, Key Laboratory of Tropical Cardiovascular Diseases Research of Hainan Province, Hainan General Hospital, College of Chinese Medicine, Hainan Medical University, Haikou, China
- Graduate School, Heilongjiang University of Chinese Medicine, Harbin, China
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Wang M, Wang WX. Accumulation Kinetics and Gut Microenvironment Responses to Environmentally Relevant Doses of Micro/Nanoplastics by Zooplankton Daphnia Magna. Environ Sci Technol 2023; 57:5611-5620. [PMID: 36995001 DOI: 10.1021/acs.est.2c08593] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Microplastics are emerging pollutants that have been widely reported in aquatic ecosystems. Based on the analysis of environmentally relevant concentrations of microplastics in global freshwater systems, herein, we employed aggregated-induced emission (AIE) microplastic fluorogens and imaged and quantified the bioaccumulation of differentially charged micro- (20 μm)/nano- (200 nm) plastics (MNPs) in zooplankton Daphnia magna. We found that all particles of different sizes and charges were readily ingested, especially larger-sized and positively charged MNPs, with over 50% of the ingested particles accumulating in the gut. Bioaccumulation of MNPs reached 50% of steady-state condition within 1 h. The presence of algae inhibited the ingestion and depuration of MNPs. To further demonstrate the effects of such accumulation on gut health, we further applied the AIE probes for visualizing the pH and esterase in the digestive tract, as well as the gut inflammation. An accumulation of MNPs in D. magna significantly and rapidly induced the acidification of gut pH while inducing esterase activity. The NPs apparently induced gut inflammation in contrast to the MPs, demonstrating the size-dependent effects on oxidative stress. Our results highlighted that MNP exposure at environmentally relevant concentrations perturbed the microenvironments of zooplankton guts, which may significantly affect their digestion and assimilation of food materials as well as contaminant uptake.
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Affiliation(s)
- Mengjing Wang
- School of Energy and Environment and State Key Laboratory of Marine Pollution, City University of Hong Kong, Kowloon, Hong Kong, China
- Research Centre for the Oceans and Human Health, City University of Hong Kong Shenzhen Research Institute, Shenzhen 518057, China
| | - Wen-Xiong Wang
- School of Energy and Environment and State Key Laboratory of Marine Pollution, City University of Hong Kong, Kowloon, Hong Kong, China
- Research Centre for the Oceans and Human Health, City University of Hong Kong Shenzhen Research Institute, Shenzhen 518057, China
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3
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Iribarren C, Magnusson MK, Vigsnæs LK, Aziz I, Amundsen ID, Šuligoj T, Juge N, Patel P, Sapnara M, Johnsen L, Sørensen N, Sundin J, Törnblom H, Simrén M, Öhman L. The Effects of Human Milk Oligosaccharides on Gut Microbiota, Metabolite Profiles and Host Mucosal Response in Patients with Irritable Bowel Syndrome. Nutrients 2021; 13:nu13113836. [PMID: 34836092 PMCID: PMC8622683 DOI: 10.3390/nu13113836] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Human milk oligosaccharide supplementation safely modulates fecal bifidobacteria abundance and holds the potential to manage symptoms in irritable bowel syndrome (IBS). Here, we aimed to determine the role of a 4:1 mix of 2′-O-fucosyllactose and lacto-N-neotetraose (2′FL/LNnT) on the modulation of the gut microbiota composition and host mucosal response, as well as the link between the bifidobacteria abundance and metabolite modulation, in IBS patients. Methods: Biological samples were collected from IBS patients (n = 58) at baseline and week 4 post-supplementation with placebo, 5 g or 10 g doses of 2′FL/LNnT. The gut microbiota composition, metabolite profiles and expression of genes related to host mucosal response were determined. Results: Moderate changes in fecal, but not mucosal, microbial composition (β-diversity) was observed during the intervention with higher dissimilarity observed within individuals receiving 10g 2′FL/LNnT compared to placebo. Both fecal and mucosal Bifidobacterium spp. increased after 2′FL/LNnT intake, with increased proportions of Bifidobacterium adolescentis and Bifidobacterium longum. Moreover, the intervention modulated the fecal and plasma metabolite profiles, but not the urine metabolite profile or the host mucosal response. Changes in the metabolite profiles were associated to changes in bifidobacteria abundance. Conclusion: Supplementation with 2′FL/LNnT modulated the gut microbiota, fecal and plasma metabolite profiles, but not the host mucosal response in IBS. Furthermore, the bifidogenic effect was associated with metabolite modulation. Overall, these findings support the assertion that 2′FL/LNnT supplementation modulate the intestinal microenvironment of patients with IBS, potentially related to health.
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Affiliation(s)
- Cristina Iribarren
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (C.I.); (M.K.M.); (M.S.); (J.S.)
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (I.A.); (P.P.); (H.T.); (M.S.)
| | - Maria K. Magnusson
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (C.I.); (M.K.M.); (M.S.); (J.S.)
| | - Louise K. Vigsnæs
- DSM, Kogle Alle 4, 2970 Hørsholm, Denmark; (L.K.V.); (I.D.A.)
- Department of Technology, Faculty of Health, University College Copenhagen, 1799 Copenhagen, Denmark
| | - Imran Aziz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (I.A.); (P.P.); (H.T.); (M.S.)
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2JF, UK
| | | | - Tanja Šuligoj
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK; (T.Š.); (N.J.)
| | - Nathalie Juge
- Quadram Institute Bioscience, Norwich Research Park, Norwich NR4 7UQ, UK; (T.Š.); (N.J.)
| | - Piyush Patel
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (I.A.); (P.P.); (H.T.); (M.S.)
| | - Maria Sapnara
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (C.I.); (M.K.M.); (M.S.); (J.S.)
| | | | | | - Johanna Sundin
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (C.I.); (M.K.M.); (M.S.); (J.S.)
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (I.A.); (P.P.); (H.T.); (M.S.)
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (I.A.); (P.P.); (H.T.); (M.S.)
- Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Lena Öhman
- Department of Microbiology and Immunology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (C.I.); (M.K.M.); (M.S.); (J.S.)
- Correspondence: ; Tel.: +46-317-866-214
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Marion-Letellier R, Leboutte M, Amamou A, Raman M, Savoye G, Ghosh S. Diet in Intestinal Fibrosis: A Double-Edged Sword. Nutrients 2021; 13:nu13093148. [PMID: 34579023 PMCID: PMC8470259 DOI: 10.3390/nu13093148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
The natural history of inflammatory bowel diseases, especially Crohn’s disease, is frequently complicated by intestinal fibrosis. Because of the lack of effective treatments for intestinal fibrosis, there is an urgent need to develop new therapies. Factors promoting intestinal fibrosis are currently unclear, but diet is a potential culprit. Diet may influence predisposition to develop intestinal fibrosis or alter its natural history by modification of both the host immune response and intestinal microbial composition. Few studies have documented the effects of dietary factors in modulating IBD-induced intestinal fibrosis. As the mechanisms behind fibrogenesis in the gut are believed to be broadly similar to those from extra-intestinal organs, it may be relevant to investigate which dietary components can inhibit or promote fibrosis factors such as myofibroblasts progenitor activation in other fibrotic diseases.
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Affiliation(s)
- Rachel Marion-Letellier
- UNIROUEN, INSERM UMR 1073 Nutrition, Inflammation and Gut-Brain Axis, Normandie University, 76183 Rouen, France; (M.L.); (G.S.)
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, 76183 Rouen, France
- Correspondence:
| | - Mathilde Leboutte
- UNIROUEN, INSERM UMR 1073 Nutrition, Inflammation and Gut-Brain Axis, Normandie University, 76183 Rouen, France; (M.L.); (G.S.)
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, 76183 Rouen, France
| | - Asma Amamou
- APC Microbiome Ireland, Biosciences Building, University College Cork, Cork, Ireland; (A.A.); (S.G.)
| | - Maitreyi Raman
- Division of Gastroenterology, University of Calgary, Calgary, AB T2N 4N1, Canada;
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Guillaume Savoye
- UNIROUEN, INSERM UMR 1073 Nutrition, Inflammation and Gut-Brain Axis, Normandie University, 76183 Rouen, France; (M.L.); (G.S.)
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, 76183 Rouen, France
- Department of Gastroenterology, Rouen University Hospital, 76031 Rouen, France
| | - Subrata Ghosh
- APC Microbiome Ireland, Biosciences Building, University College Cork, Cork, Ireland; (A.A.); (S.G.)
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Ding G, Gong Q, Ma J, Liu X, Wang Y, Cheng X. Immunosuppressive activity is attenuated by Astragalus polysaccharides through remodeling the gut microenvironment in melanoma mice. Cancer Sci 2021; 112:4050-4063. [PMID: 34289209 PMCID: PMC8486201 DOI: 10.1111/cas.15078] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/11/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Astragalus polysaccharides (APS), the main effective component of Astragalus membranaceus, can inhibit tumor growth, but the underlying mechanisms remain unclear. Previous studies have suggested that APS can regulate the gut microenvironment, including the gut microbiota and fecal metabolites. In this work, our results showed that APS could control tumor growth in melanoma-bearing mice. It could reduce the number of myeloid-derived suppressor cells (MDSC), as well as the expression of MDSC-related molecule Arg-1 and cytokines IL-10 and TGF-β, so that CD8+ T cells could kill tumor cells more effectively. However, while APS were administered with an antibiotic cocktail (ABX), MDSC could not be reduced, and the growth rate of tumors was accelerated. Consistent with the changes in MDSC, the serum levels of IL-6 and IL-1β were lowest in the APS group. Meanwhile, we found that fecal suspension from mice in the APS group could also reduce the number of MDSC in tumor tissues. These results revealed that APS regulated the immune function in tumor-bearing mice through remodeling the gut microbiota. Next, we focused on the results of 16S rRNA, which showed that APS significantly regulated most microorganisms, such as Bifidobacterium pseudolongum, Lactobacillus johnsonii and Lactobacillus. According to the Spearman analysis, the changes in abundance of these microorganisms were related to the increase of metabolites like glutamate and creatine, which could control tumor growth. The present study demonstrates that APS attenuate the immunosuppressive activity of MDSC in melanoma-bearing mice by remodeling the gut microbiota and fecal metabolites. Our findings reveal the therapeutic potential of APS to control tumor growth.
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Affiliation(s)
- Guiqing Ding
- Institute of Clinical Immunology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qianyi Gong
- Institute of Clinical Immunology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jinyun Ma
- Institute of Clinical Immunology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojun Liu
- Institute of Clinical Immunology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanhua Wang
- Institute of Clinical Immunology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaodong Cheng
- Institute of Clinical Immunology, Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Zhang Z, Chen X, Zhao J, Tian C, Wei X, Li H, Lin W, Jiang A, Feng R, Yuan J, Zhao X. Effects of a Lactulose-Rich Diet on Fecal Microbiome and Metabolome in Pregnant Mice. J Agric Food Chem 2019; 67:7674-7683. [PMID: 31132256 DOI: 10.1021/acs.jafc.9b01479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Lactulose, a safe and beneficial molecule, can be used in food as a prebiotic and as an osmotic laxative during pregnancy. This work evaluated the effects of dietary lactulose on the gut microenvironment of pregnant mice using the fecal microbiota and metabolomic profiling. After 2 weeks of feeding, the Bifidobacterium and Bacteroides abundances in the mouse feces were significantly increased in the LAC-high (the diet supplemented with 15% lactulose) group. A total of 15 metabolites, including 1-monoolein, glucose-6-phosphate, and short-chain fatty acids, were increased significantly in the LAC-high group. The serum glucose and total cholesterol concentrations were significantly decreased, while the progesterone level was significantly increased in the lactulose-fed mice. In the LAC-high group, the colonic pH and intestinal permeability were decreased, while the immunoglobulins in the colonic epithelial cells and the small intestinal absorption capacity were significantly increased. These findings indicated that lactulose supplementation benefitted pregnancy performance in mice.
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Affiliation(s)
- Zheng Zhang
- College of Food Science , South China Agricultural University , Guangzhou , Guangdong 510642 , People's Republic of China
| | - Xiao Chen
- College of Food Science , South China Agricultural University , Guangzhou , Guangdong 510642 , People's Republic of China
| | - Jiangtao Zhao
- Department of Histology and Embryology, School of Basic Medical Sciences , Zhengzhou University , Zhengzhou , Henan 450001 , People's Republic of China
| | - Changyu Tian
- Institute of Disease Control and Prevention , Chinese People's Liberation Army (PLA) , Beijing 100071 , People's Republic of China
| | - Xiao Wei
- Institute of Disease Control and Prevention , Chinese People's Liberation Army (PLA) , Beijing 100071 , People's Republic of China
| | - Huan Li
- Institute of Disease Control and Prevention , Chinese People's Liberation Army (PLA) , Beijing 100071 , People's Republic of China
| | - Weishi Lin
- Institute of Disease Control and Prevention , Chinese People's Liberation Army (PLA) , Beijing 100071 , People's Republic of China
| | - Aimin Jiang
- College of Food Science , South China Agricultural University , Guangzhou , Guangdong 510642 , People's Republic of China
| | - Ruo Feng
- Department of Histology and Embryology, School of Basic Medical Sciences , Zhengzhou University , Zhengzhou , Henan 450001 , People's Republic of China
| | - Jing Yuan
- Institute of Disease Control and Prevention , Chinese People's Liberation Army (PLA) , Beijing 100071 , People's Republic of China
| | - Xiangna Zhao
- Institute of Disease Control and Prevention , Chinese People's Liberation Army (PLA) , Beijing 100071 , People's Republic of China
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Mazzawi T, Hausken T, Hov JR, Valeur J, Sangnes DA, El-Salhy M, Gilja OH, Hatlebakk JG, Lied GA. Clinical response to fecal microbiota transplantation in patients with diarrhea-predominant irritable bowel syndrome is associated with normalization of fecal microbiota composition and short-chain fatty acid levels. Scand J Gastroenterol 2019; 54:690-699. [PMID: 31190584 DOI: 10.1080/00365521.2019.1624815] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: Irritable bowel syndrome (IBS) may be associated with disturbances in gut microbiota composition and functions. We recently performed a study of fecal microbiota transplantation (FMT) in diarrhea-predominant IBS (IBS-D) and found that IBS symptoms improved and the gut microbiota profile changed following FMT. We now aimed to explore the effects of FMT on the gut microenvironment in further detail by using 16S rRNA sequencing for more extended microbiota profiling and analyzing bacterial fermentation products (SCFAs: short chain fatty acids). Materials and methods: The study included 13 patients (four females and nine males) with IBS-D according to Rome III criteria and 13 healthy donors. Freshly donated feces were administered into duodenum via gastroscopy. The patients completed symptom and quality of life (QoL) questionnaires and delivered feces before and 1, 3, 12 and 20/28 weeks after FMT. Microbiota analysis was performed by sequencing 16S rRNA gene with Illumina Miseq technology. Fecal concentrations of SCFAs were analyzed by vacuum distillation followed by gas chromatography. Results: Several gut microbiota taxa and SCFAs were significantly different in the patients at baseline compared to their donors. These differences normalized by the third week following FMT in parallel with significant improvement in symptoms and QoL. Responders had different gut microbiota profile and SCFAs than nonresponders. Significant correlations were found between the gut microenvironment and IBS symptoms. No adverse effects were reported. Conclusions: FMT restores alterations of the gut microenvironment in IBS-D patients during the first 3 weeks and improves their symptoms for up to 28 weeks. ClinicalTrials.gov ID: NCT03333291.
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Affiliation(s)
- Tarek Mazzawi
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Center for Nutrition, Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Trygve Hausken
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Center for Nutrition, Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Johannes R Hov
- Norwegian PSC Research Center and Section of Gastroenterology and Research Institute of Internal Medicine, Oslo University Hospital and University of Oslo , Oslo , Norway
| | - Jørgen Valeur
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital , Oslo , Norway
| | - Dag André Sangnes
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway
| | - Magdy El-Salhy
- Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Division of Gastroenterology, Department of Medicine, Stord Hospital, Helse-Fonna , Stord , Norway
| | - Odd Helge Gilja
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Center for Nutrition, Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Jan Gunnar Hatlebakk
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Center for Nutrition, Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Gülen Arslan Lied
- Division of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Norwegian Competence Center for Functional Gastrointestinal Disorders, Section of Gastroenterology, Department of Medicine, Haukeland University Hospital , Bergen , Norway.,Center for Nutrition, Department of Clinical Medicine, University of Bergen , Bergen , Norway
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