1
|
Tang S, Li J, Ma J, Li Y, Li Y, Wan J, Zhang R. Comparison of jejunal aspirate culture and methane and hydrogen breath test in the diagnosis of small intestinal bacterial overgrowth. Ir J Med Sci 2024; 193:699-703. [PMID: 37725319 DOI: 10.1007/s11845-023-03527-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) is still difficult to diagnose. Quantitative culture of small intestine aspirate is recommended to be the gold standard. The methane and hydrogen breath tests are easily repeatable, sufficiently sensitive and highly specific for SIBO diagnosis. Our goal is to contrast the diagnostic value of the breath tests with jejunal aspiration cultures. METHODS 40 adult outpatients (age < 60) were enrolled in our study. Randomly, within 2 days, both the methane and the hydrogen breath test and jejunal aspiration culture were performed on each patient and the results of both tests were evaluated and contrasted. RESULTS The jejunal culture was positive (105CFU / mL) in 14/40(35%) subjects, the lactulose breath test (LBT) was positive in 18/40 (45%) subjects, and the glucose breath test (GBT) was positive in 12/40 (30%). The GBT showed good agreement (κ = 0.659) and LBT showed poor agreement (κ = 0.588) with the jejunal aspirate culture. The sensitivity, specificity, positive and negative predictive values of LBT/GBT were 85.7/71.4%,76.9/92.3%, 66.6/83.3% and 90.9/85.7%, respectively. CONCLUSIONS 35% of patients with suspected SIBO are identified using jejunal aspirate cultures. For the identification of SIBO, GBT is more specific than LBT, but has a lower sensitivity. In individuals with suspected SIBO, the breath test should be initially due to its good agreement with the jejunal aspirate culture.
Collapse
Affiliation(s)
- Shuai Tang
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jia Li
- Department of Gastroenterology, The 983rd Hospital of Joint Logistic Support Force of PLA, Tianjin, China
| | - Jinxia Ma
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yi Li
- Department of Gastroenterology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yuying Li
- Hongyunrunze Medical Technology Company Limited, Shenzhen, Guangdong, China
| | - Jun Wan
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
| | - Ru Zhang
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
2
|
Kelly Souza Silveira B, Mayumi Usuda Prado Rocha D, Stampini Duarte Martino H, Grancieri M, Juste Contin Gomes M, Cuquetto Mantovani H, Bressan J, Hermana Miranda Hermsdorff H. Daily Cashew and Brazil Nut Consumption Modifies Intestinal Health in Overweight Women on Energy-Restricted Intervention: A Randomized Controlled Trial (Brazilian Nuts Study). J Nutr 2024; 154:962-977. [PMID: 38246355 DOI: 10.1016/j.tjnut.2023.12.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Increased intestinal permeability and dysbiosis are related to obesity. Nuts can provide nutrients and bioactive compounds that modulate gut microbiota and inflammation, enhancing the beneficial effects of weight loss. OBJECTIVES To evaluate the effect of consuming cashew nuts (Anacardium occidentale L.) and Brazil nuts (Bertholletia excelsa H.B.K) on intestinal permeability and microbiota, fecal SCFAs and pH, inflammation, and weight loss in energy restriction condition. METHODS In this 8-week randomized controlled trial, 40 women with overweight or obesity were assigned to energy-restricted groups (-500 kcal/d): control group (free of nuts) or Brazilian nuts group (BN: 30 g of cashew nuts and 15 g of Brazil nuts per day). Permeability was analyzed by the lactulose/mannitol test and the microbiota by sequencing the 16S gene in the V3-V4 regions. Plasma concentrations of inflammatory cytokines (TNF, IL-6, IL-10, IL-8, IL-17A) and C-reactive protein were analyzed. RESULTS In total, 25 women completed the intervention. Both groups lost weight without statistical differences. Lactulose excretion increased only in the control group (P < 0.05). The BN consumption increased fecal propionic acid and potentially beneficial bacteria, such as Ruminococcus, Roseburia, strains NK4A214 and UCG-002 from the Ruminococcaceae family, but also Lachnospiraceae family, Bacteroides, and Lachnoclostridium, when compared to the control group. Changes in intestinal permeability were correlated to a greater reduction in body fat (kg), and IL-8, and increases in Ruminococcus abundance. CONCLUSION Our findings demonstrate a positive impact of BN consumption within an energy-restricted context, linked to the augmentation of potentially beneficial bacteria and pathways associated with body fat reduction. Besides, BN consumption mitigated increased intestinal permeability, although its capacity to diminish permeability or enhance weight loss proved limited. This trial was registered at the Brazilian Registry of Clinical Trials as ReBEC (ID: RBR-3ntxrm).
Collapse
Affiliation(s)
- Brenda Kelly Souza Silveira
- Laboratory of Energy Metabolism and Body Composition, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Daniela Mayumi Usuda Prado Rocha
- Laboratory of Energy Metabolism and Body Composition, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | | | - Mariana Grancieri
- Experimental Nutrition Laboratory, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Mariana Juste Contin Gomes
- Experimental Nutrition Laboratory, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Hilário Cuquetto Mantovani
- Anaerobic Microbioloy Laboratory, Department of Microbiology, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Josefina Bressan
- Laboratory of Energy Metabolism and Body Composition, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil
| | - Helen Hermana Miranda Hermsdorff
- Laboratory of Energy Metabolism and Body Composition, Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, Brazil.
| |
Collapse
|
3
|
Das P, Thakur R. NFSI mediated C3-ether oxidation of glycals for the synthesis of hex-3-enuloses. Carbohydr Res 2024; 536:109032. [PMID: 38219634 DOI: 10.1016/j.carres.2024.109032] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
Hex-3-enuloses constitute a vital carbohydrate synthetic intermediate that provide access to wide range of chiral molecules through diverse derivatizations. Herein we report synthesis of these fascinating scaffolds by oxidation of C3-ether protections on glycals in presence of N-fluorobenzenesulfonimide (NFSI) under Cu(I) catalysed conditions. Benzyl, methyl and silyl ethers have been efficiently oxidized to the carbonyl group. The oxidation has been found to be highly regioselective where an array of protecting groups were tolerant to the reaction conditions. Pyranosyl glycals from various commercially available sugars have been studied in this work to evaluate the broad substrate scope.
Collapse
Affiliation(s)
- Pradip Das
- Department of Chemistry, National Institute of Technology Patna, Patna, 800005, Bihar, India
| | - Rima Thakur
- Department of Chemistry, National Institute of Technology Patna, Patna, 800005, Bihar, India.
| |
Collapse
|
4
|
Sujiyanto, White CS, Bauer LL, Dilger RN. The dual sugar test ( lactulose plus mannitol) is an unreliable indicator of feed withdrawal-associated changes in intestinal permeability in broiler chickens. Poult Sci 2024; 103:103336. [PMID: 38103531 PMCID: PMC10765102 DOI: 10.1016/j.psj.2023.103336] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023] Open
Abstract
Despite its importance in poultry research, there is lack of standardized and practical techniques to measure intestinal permeability in a noninvasive manner. Therefore, this research sought to standardize a procedure using lactulose (Lac) and mannitol (Man) to measure intestinal barrier function in broilers. Twenty-one-day-old male and female Ross 308 birds were orally gavaged (either 2 mL/kg BW or fixed 3 mL per bird) with a solution containing 5 to 25 g Lac and 1 to 5 g Man dissolved in pure water to reach 100 mL of final solution. Feed withdrawal (FW; 2-24-h duration) prior to dosing with Lac and Man (LacMan) was mainly used to induce graded intestinal permeability. Blood samples were collected at 60-, 90-, or 120-min after LacMan dosing using serum or plasma (K2EDTA and/or Na-Heparin) blood tubes. Lac and Man concentrations were quantified by HPLC. Plasma samples collected 90-min after LacMan dosing elicited the least variable response (22.4% vs. 22.8% or 23.4% CV when compared with 60- and 120-min sampling time-points, respectively), and both markers were detectable after administering a solution containing the lowest concentration of Lac and Man. However, analytical problems arose when using Na-Heparin anticoagulant as high glucose levels interfered with Lac quantification. Upon improving the chromatographic technique, it became evident that a 24-h FW increased (P < 0.01) Lac concentrations. In the last trial, a more severe glucose interference was observed, resulting in no Lac detection within an entire treatment group. Twelve hours of FW increased (P < 0.01) Man concentration in the plasma of birds receiving the solution containing 3 g Man, but had no effect on the birds receiving the solution containing 5 g Man. A 24-h FW did not affect the Man concentrations in birds receiving the solution containing either 3 or 5 g Man. With inconsistency of Lac detection throughout our trials, it was concluded that the combination of Lac and Man is an unreliable marker to predict intestinal barrier function in broilers.
Collapse
Affiliation(s)
- Sujiyanto
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Cameron S White
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Laura L Bauer
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Ryan N Dilger
- Division of Nutritional Sciences, University of Illinois, Urbana, IL 61801, USA; Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA.
| |
Collapse
|
5
|
Wang M, Wang L, Hua X, Yang R. Production of high-purity lactulose via an integrated one-pot boronate affinity adsorbent based adsorption-assisted isomerization and simultaneous purification. Food Chem 2023; 429:136935. [PMID: 37499512 DOI: 10.1016/j.foodchem.2023.136935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/02/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
High-purity lactulose is mandatory for its medical uses and food applications. This work developed an efficient lab-scale strategy for the synthesis of high-purity lactulose by combining lactose-to-lactulose isomerization with simultaneous recovery of lactulose, which was conducted concurrently and semi-continuously in a boronate affinity adsorbent-packed column. The first step covers the boronate affinity adsorbent-based adsorption-assisted lactose-to-lactulose isomerization. Under optimized conditions, in situ selectively binding of the newly formed lactulose onto the boronate affinity adsorbent enables a much-enhanced lactulose yield up to 80.20% with the lowest byproducts yield of 6.30%. Afterward, over 90% of the adsorbed lactulose can be recovered through sequential desorption with purity >98%. The net outcome of the applied strategy was the yield of high-purity lactulose up to 72.31%, the highest value ever reported. Moreover, the packed column displayed excellent operational stability. The encouraging results validate the high potential of this approach in the sustainable production of high-purity lactulose.
Collapse
Affiliation(s)
- Mingming Wang
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shangdong Province 266003, China; State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Lu Wang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Xiao Hua
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China
| | - Ruijin Yang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, Jiangsu Province 214122, China.
| |
Collapse
|
6
|
Maroto C, Fiz-López A, Pastor R, Bernardo D, Garrote JA, Arranz E, Fernández Salazar L. Plasma levels of intestinal fatty-acid binding protein (I-FABP), abdominal distension and hydrogen concentration after lactitol small intestinal bacterial overgrowth (SIBO) test. Rev Esp Enferm Dig 2023; 115:727-728. [PMID: 36926907 DOI: 10.17235/reed.2023.9578/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Breath tests with glucose, lactulose or lactitol are useful for diagnosis of small intestinal bacterial overgrowth (SIBO). Nevertheless, they have suboptimal sensitivity and specificity and, indeed, are positive in a considerable number of patients with irritable bowel syndrome (IBS). The complexity in the management of patients with functional intestinal disorders and the availability of these tests are leading to frequent diagnoses of SIBO. Intestinal Fatty-Acid Binding protein (I-FABP) is a protein present in the cytosol of intestinal epithelial cells. Its plasmatic levels have been related to different enteropathies and, therefore, could be a marker of early intestinal damage with unconfirmed clinical utility. Hence, we have studied the plasmatic I-FABP level of patients who are requested a lactitol test to confirm SIBO and related it to clinical and laboratory characteristics and SIBO test results.
Collapse
Affiliation(s)
- Carlos Maroto
- Gastroenterology , Hospital Clínico Universitario de Valladolid
| | - Aida Fiz-López
- Unit of Excellence , IBGM. Universidad de Valladolid-CSIC
| | - Raquel Pastor
- Medicine, Dermatology and Toxicology , School of Medicine. Universidad de Valladolid
| | - David Bernardo
- Unit of Excellence , IBGM. Universidad de Valladolid-CSIC
| | | | - Eduardo Arranz
- Unit of Excellence , IBGM. Universidad de Valladolid-CSIC
| | | |
Collapse
|
7
|
Odenwald MA, Lin H, Lehmann C, Dylla NP, Cole CG, Mostad JD, Pappas TE, Ramaswamy R, Moran A, Hutchison AL, Stutz MR, Dela Cruz M, Adler E, Boissiere J, Khalid M, Cantoral J, Haro F, Oliveira RA, Waligurski E, Cotter TG, Light SH, Beavis KG, Sundararajan A, Sidebottom AM, Reddy KG, Paul S, Pillai A, Te HS, Rinella ME, Charlton MR, Pamer EG, Aronsohn AI. Bifidobacteria metabolize lactulose to optimize gut metabolites and prevent systemic infection in patients with liver disease. Nat Microbiol 2023; 8:2033-2049. [PMID: 37845315 DOI: 10.1038/s41564-023-01493-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
Progression of chronic liver disease is precipitated by hepatocyte loss, inflammation and fibrosis. This process results in the loss of critical hepatic functions, increasing morbidity and the risk of infection. Medical interventions that treat complications of hepatic failure, including antibiotic administration for systemic infections and lactulose treatment for hepatic encephalopathy, can impact gut microbiome composition and metabolite production. Here, using shotgun metagenomic sequencing and targeted metabolomic analyses on 847 faecal samples from 262 patients with acute or chronic liver disease, we demonstrate that patients hospitalized for liver disease have reduced microbiome diversity and a paucity of bioactive metabolites, including short-chain fatty acids and bile acid derivatives, that impact immune defences and epithelial barrier integrity. We find that patients treated with the orally administered but non-absorbable disaccharide lactulose have increased densities of intestinal bifidobacteria and reduced incidence of systemic infections and mortality. Bifidobacteria metabolize lactulose, produce high concentrations of acetate and acidify the gut lumen in humans and mice, which, in combination, can reduce the growth of antibiotic-resistant bacteria such as vancomycin-resistant Enterococcus faecium in vitro. Our studies suggest that lactulose and bifidobacteria serve as a synbiotic to reduce rates of infection in patients with severe liver disease.
Collapse
Affiliation(s)
- Matthew A Odenwald
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA.
| | - Huaiying Lin
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Christopher Lehmann
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Nicholas P Dylla
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Cody G Cole
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - Jake D Mostad
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Téa E Pappas
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | | | - Angelica Moran
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Alan L Hutchison
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Matthew R Stutz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Cook County Health, Chicago, IL, USA
| | - Mark Dela Cruz
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Emerald Adler
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jaye Boissiere
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Maryam Khalid
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jackelyn Cantoral
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Fidel Haro
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Rita A Oliveira
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Emily Waligurski
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Samuel H Light
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | | | | | | | - K Gautham Reddy
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Sonali Paul
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Anjana Pillai
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Helen S Te
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Mary E Rinella
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Michael R Charlton
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Eric G Pamer
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA.
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA.
- Department of Microbiology, University of Chicago, Chicago, IL, USA.
| | - Andrew I Aronsohn
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| |
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW This article aims to provide an up-to-date review of small intestinal bacterial overgrowth (SIBO), including etiology and risk factors, clinical manifestations, diagnostic evaluation for suspected SIBO, and therapeutic options. RECENT FINDINGS Recent advances in breath testing, capsule and urine-based testing have opened new avenues and improved diagnostic yield of SIBO. Nonantibiotic-based treatment strategies have shown promising results in initial trials. SUMMARY Small intestinal bacterial overgrowth (SIBO) is a condition defined by the excess bacteria or changes in bacterial composition of the small intestine. These are associated with various gastrointestinal (GI) symptoms such as bloating, abdominal distension, diarrhea, nutrient deficiencies, and even frank weight loss. Small bowel jejunal aspirate of >10 5 CFU/ml has traditionally been considered the gold standard for diagnosis. Glucose and lactulose breath testing have become more common in clinical practice as they are noninvasive, easily accessible, and have lower cost. Treatment focuses on the eradication of excess bacteria in the small bowel and is traditionally done with the use of oral antibiotics. Other emerging therapies may include probiotics, diet manipulation, and prokinetic agents.
Collapse
Affiliation(s)
- Hammad Zafar
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Florida, Weston, Florida, USA
| | | | | |
Collapse
|
9
|
Abdallah H, Khalil M, Farella I, JohnBritto JS, Lanza E, Santoro S, Garruti G, Portincasa P, Di Ciaula A, Bonfrate L. Ramadan intermittent fasting reduces visceral fat and improves gastrointestinal motility. Eur J Clin Invest 2023; 53:e14029. [PMID: 37203871 DOI: 10.1111/eci.14029] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ramadan is a model of intermittent fasting linked with possible beneficial effects. Scarce information, however, is available about the combined effects of Ramadan intermittent fasting (RIF) on anthropometric and metabolic indices, gastrointestinal symptoms, and motility. METHODS In 21 healthy Muslims, we assessed the impact of RIF on caloric intake, physical activity, gastrointestinal symptoms and motility (gastric/gallbladder emptying by ultrasonography, orocaecal transit time by lactulose breath test), anthropometric indices, subcutaneous and visceral fat thickness (ultrasonography), glucose and lipid homeostasis. RESULTS Mean caloric intake decreased from a median of 2069 kcal (range 1677-2641) before Ramadan to 1798 kcal (1289-3126) during Ramadan and increased again to 2000 kcal (1309-3485) after Ramadan. Although physical activity remained stable before, during, and after RIF, body weight, body mass index and waist circumference decreased in all subjects and in both genders, together with a significant decrease in subcutaneous and visceral fat thickness and insulin resistance. The postprandial gastric emptying speed was significantly faster after than before RIF. Fasting gallbladder volume was about 6% smaller after, than before Ramadan, with a stronger and faster postprandial gallbladder contraction. After RIF, lactulose breath test documented increased microbiota carbohydrate fermentation (postprandial H2 peak), and faster orocaecal transit time. RIF also significantly improved gastric fullness, epigastric pain and heartburn. CONCLUSIONS RIF generates, in healthy subjects, multiple systemic beneficial effects in terms of fat burden, metabolic profile, gastrointestinal motility and symptoms. Further comprehensive studies should assess the potential beneficial effects of RIF in diseased people.
Collapse
Affiliation(s)
- Hala Abdallah
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Mohamad Khalil
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Ilaria Farella
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Jerlin Stephy JohnBritto
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Elisa Lanza
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Sergio Santoro
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Gabriella Garruti
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Piero Portincasa
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Agostino Di Ciaula
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Leonilde Bonfrate
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), Clinica Medica "A. Murri", University of Bari "Aldo Moro" Medical School, Bari, Italy
| |
Collapse
|
10
|
Swansson WD, Anderson BM, Yeoh SW, Lewis DJ. Management of minimal and overt hepatic encephalopathy with branched-chain amino acids: a review of the evidence. Eur J Gastroenterol Hepatol 2023; 35:812-821. [PMID: 37395232 DOI: 10.1097/meg.0000000000002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Hepatic encephalopathy (HE) is a challenging complication of liver disease that is associated with substantial morbidity and mortality. Branched-chain amino acid (BCAA) supplementation in the management of HE is a debated topic. This narrative review aims to provide an up-to-date review of the topic and includes studies featuring patients with hepatocellular carcinoma. A review of the literature was performed using the online databases MEDLINE and EMBASE for studies between 2002 and December 2022. Keywords 'branched-chain amino acids', 'liver cirrhosis' and 'hepatic encephalopathy' were used. Studies were assessed for inclusion and exclusion criteria. Of 1045 citations, 8 studies met the inclusion criteria. The main outcomes reported for HE was changed in minimal HE (MHE) (n = 4) and/or incidence of overt HE (OHE) (n = 7). Two of the 4 studies reporting on MHE had improvement in psychometric testing in the BCAA group, but there was no change in the incidence of OHE in any of the 7 papers in the BCAA group. There were few adverse effects of BCAA supplementation. This review found weak evidence for BCAA supplementation for MHE, and no evidence for BCAAs for OHE. However, given the relative paucity and methodological heterogeneity of the current research, there is scope for future studies to examine the effects of varying timing, dosage, and frequency of BCAAs on outcomes such as HE. Importantly, research is also needed to examine BCAAs in conjunction with standard therapies for HE such as rifaximin and/or lactulose.
Collapse
Affiliation(s)
| | | | - Sern Wei Yeoh
- Melbourne Medical School, The University of Melbourne
- Department of Gastroenterology, Northern Health, Melbourne, VIC, Australia
| | - Diana J Lewis
- Melbourne Medical School, The University of Melbourne
- Department of Gastroenterology, Northern Health, Melbourne, VIC, Australia
| |
Collapse
|
11
|
Martínez Velasco S, González García A, Irastorza Terradillos IX, Bilbao Catalá JR. Intestinal permeability assessment using lactulose and mannitol in celiac disease. Methods Cell Biol 2023; 179:39-50. [PMID: 37625878 DOI: 10.1016/bs.mcb.2022.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Alterations in intestinal permeability can lead to increased uptake of luminal antigens, which has been linked to several intestinal diseases, such as inflammatory bowel diseases, celiac disease, and irritable bowel syndrome, but also to extra-intestinal diseases. Promising therapies that target intestinal permeability could be developed, for instance tight junction modulators. Consequently, permeability assays are increasingly being used as treatment endpoints in clinical studies. Therefore, reliable, reproducible, and feasible methods for measuring intestinal permeability in the clinical setting are necessary. Currently, a variety of in vivo, ex vivo, and in vitro tests are available, some of which are only applicable to basic research. Despite the various options available to measure gut permeability, their use in clinical setting is still limited because of their heterogeneity. Here, we describe a clinical method to measure intestinal permeability using two non-metabolizable sugars.
Collapse
Affiliation(s)
- Silvia Martínez Velasco
- Department of Pediatrics Donostia University Hospital, Biocruces Bizkaia Health Research Institute, Bizkaia, Spain.
| | - Azucena González García
- Phytotron and Ion Cromatography Technician, General Research Service (SGIker), Faculty of Science and Technology, University of the Basque Country, Leioa, Biscay, Spain
| | - Iñaki Xarles Irastorza Terradillos
- Department of Pediatrics Cruces University Hospital, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV-EHU, Leioa, Biscay, Spain
| | - José Ramón Bilbao Catalá
- Department of Genetics, Physical Anthropology, and Animal Physiology, Biocruces Bizkaia Health Research Institute, University of the Basque Country UPV-EHU, Leioa, Biscay, Spain
| |
Collapse
|
12
|
Steurbaut L, Levy EI, De Geyter C, Buyse S, Vandenplas Y. A narrative review on the diagnosis and management of constipation in infants. Expert Rev Gastroenterol Hepatol 2023; 17:769-783. [PMID: 37501219 DOI: 10.1080/17474124.2023.2242255] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Functional constipation is one of the common disorders of gut-brain interaction in infancy, and decreases the quality of life of infants and parents. AREAS COVERED Relevant articles up to November 2022 were reviewed. We searched in PubMed, Google Scholar, and MEDLINE for guidelines, position papers, reviews, and randomized controlled trials on infant constipation. EXPERT OPINION Randomized controlled trials in this specific age group are mostly limited to trials with infant formula. The prevalence of infant constipation in formula-fed infants is decreasing, and can be associated with adaptations in formula composition. While the supplementation of infant formula with pro-, pre- and/or synbiotics decreases the prevalence of constipation, their efficacy in constipated infants is disappointing. There is limited evidence to support the addition of magnesium to infant formula to treat constipation. The evidence for the efficacy and safety of polyethylene glycol in children < 2 years has expanded over the past years. The administration of lactulose or polyethylene glycol is the preferred medical management, in case nutritional management does result in insufficient improvement.
Collapse
Affiliation(s)
- Laurine Steurbaut
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Elvira Ingrid Levy
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
- Department of Pediatrics, C.H.U. Saint-Pieter, Free University of Brussels, Brussels, Belgium
| | - Charlotte De Geyter
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | | | - Yvan Vandenplas
- Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| |
Collapse
|
13
|
Regassa R, Tamiru D, Duguma M, Belachew T. Environmental enteropathy and its association with water sanitation and hygiene in slum areas of Jimma Town Ethiopia. PLoS One 2023; 18:e0286866. [PMID: 37352168 PMCID: PMC10289393 DOI: 10.1371/journal.pone.0286866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/25/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Environmental Enteropathy is an inflammatory condition of the gut that leads to intestinal barrier dysfunction. It is a common problem in resource-limited countries and results from exposure to larger quantities of fecal bacteria to poor personal hygiene and environmental sanitation. Due to poor intestinal permeability, there is a problem with absorption of nutrients, which in turn leads to growth faltering, poor cognitive development, and oral-vaccine failure. The aim of this study was to identify the children with an elevated lactulose to mannitol ratio (indicative of possible environmental enteropathy) and its association with water sanitation and hygiene in slum areas of Jimma Town so as to mitigate the problem of malnutrition in under-five children. METHODS A community-based cross-sectional study was carried out from January to April 2021. A Lactulose mannitol test was performed to determine the prevalence of elevated lactulose to mannitol ratio (possibly environmental enteropathy) in children aged 12 to 59 months. A pretested questionnaire was used to collect data on water sanitation and hygiene (WASH) indicators and sociodemographic characteristics. A multivariable logistic regression analysis was used to isolate independent predictors for possible environmental enteropathy. All tests were two-sided and statistical significance was declared at P<0.05. RESULTS The results of this study showed that 19.3% (95%CI: 14.8-23.7) of children had an increased lactulose to mannitol ratio (>0.15). On multivariable logistic regression analysis, the variables drinking water from unimproved water sources (AOR 3.741; 95%CI: 0.914-15.310,p = 0.048), unsafe coverage of water storage (AOR 0.363; 95%CI: 0.169-0.777, P = 0.009), public latrine utilization (AOR 0.139 95%CI: 0.024-0.816, P = 0.029),and hand washing less than 3 critical time of hand washing practices (AOR 4.369;95%CI: 1.411-13.524,P = 0.011) were significantly associated with an increased in lactulose mannitol ratio (possible indicative of intestinal permeability/environmental enteropathy). CONCLUSION This study showed that one fifth of under-five children in Jimma Town had an elevated lactulose to mannitol ratio (possibly environmental enteropathy). The WASH sectors and other governmental organizations should give emphasis to areas with poor water sanitation and hygiene to mitigate the problem of environmental enteropathy and related consequences like growth faltering, poor cognitive development, and oral-vaccine failure in the study area.
Collapse
Affiliation(s)
- Rediet Regassa
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Markos Duguma
- Jimma University Laboratory of Drug Quality (JuLaDQ) and School of Pharmacy, Jimma, Ethiopia
| | - Tefera Belachew
- Nutrition and Dietetics Department, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
14
|
Galuppo B, Umano GR, Li Z, Van Name M, Samuels SL, Kien CL, Cline GW, Wagner DA, Barbieri E, Tricò D, Santoro N. Comparison of Metabolic Response to Colonic Fermentation in Lean Youth vs Youth With Obesity. JAMA Netw Open 2023; 6:e2312530. [PMID: 37159195 PMCID: PMC10170343 DOI: 10.1001/jamanetworkopen.2023.12530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 03/27/2023] [Indexed: 05/10/2023] Open
Abstract
Importance Pediatric obesity is a growing health care burden. Understanding how the metabolic phenotype of youth with obesity may modify the effect of intestinal fermentation on human metabolism is key to designing early intervention. Objective To assess whether adiposity and insulin resistance in youth may be associated with colonic fermentation of dietary fibers and its production of acetate, gut-derived hormone secretion, and adipose tissue lipolysis. Design, Setting, and Participants Cross-sectional study of youths aged 15 to 22 years with body mass index in the 25th to 75th percentile or higher than the 85th percentile for age and sex throughout the New Haven County community in Connecticut. Recruitment, studies, and data collection occurred from June 2018 to September 2021. Youths were assigned to a lean, obese insulin sensitive (OIS), or obese insulin resistant (OIR) group. Data were analyzed from April 2022 to September 2022. Exposure Participants consumed 20 g of lactulose during a continuous 10-hour sodium d3-acetate intravenous infusion to measure the rate of appearance of acetate in plasma. Main Outcomes and Measures Plasma was obtained hourly to measure acetate turnover, peptide tyrosine tyrosine (PYY), ghrelin, active glucagon-like peptide 1 (GLP-1), and free fatty acids (FFA). Results A total of 44 youths participated in the study (median [IQR] age, 17.5 [16.0-19.3] years; 25 [56.8%] were female; 23 [52.3%] were White). Consequent to lactulose ingestion, there was a reduction of plasma FFA, an improvement of adipose tissue insulin sensitivity index, an increase in colonic acetate synthesis, and an anorexigenic response characterized by an increased plasma concentration of PYY and active GLP-1 and a reduction of ghrelin in the subgroups. Compared with the lean and OIS groups, the OIR group showed a less marked median (IQR) rate of acetate appearance (OIR: 2.00 [-0.86 to 2.69] μmol × kg-1 × min-1; lean: 5.69 [3.04 to 9.77] μmol × kg-1 × min-1; lean vs OIR P = .004; OIS: 2.63 [1.22 to 4.52] μmol × kg-1 × min-1; OIS vs OIR P = .09), a blunted median (IQR) improvement of adipose insulin sensitivity index (OIR: 0.043 [ 0.006 to 0.155]; lean: 0.277 [0.220 to 0.446]; lean vs OIR P = .002; OIS: 0.340 [0.048 to 0.491]; OIS vs OIR P = .08), and a reduced median (IQR) PYY response (OIR: 25.4 [14.8 to 36.4] pg/mL; lean: 51.3 [31.6 to 83.3] pg/mL; lean vs OIR P = .002; OIS: 54.3 [39.3 to 77.2] pg/mL; OIS vs OIR P = .011). Conclusions and Relevance In this cross-sectional study, lean, OIS, and OIR youth demonstrated different associations between colonic fermentation of indigestible dietary carbohydrates and the metabolic response, with OIR youth showing minimal metabolic modifications as compared with the other 2 groups. Trial Registration ClinicalTrials.gov Identifier: NCT03454828.
Collapse
Affiliation(s)
- Brittany Galuppo
- Touro College of Osteopathic Medicine, Middletown, New York, New York
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Giuseppina Rosaria Umano
- Department of the Woman, the Child, and General and Specialized Surgery, University of Campania, Luigi Vanvitelli, Naples, Italy
| | - Zhongyao Li
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Michelle Van Name
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Gary W. Cline
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Emiliano Barbieri
- Scuola di Specializzazione in Pediatria Universita’ Federico II, Napoli, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola Santoro
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
- Kansas University Medical Center, Kansas City
- Department of Medicine and Health Sciences, “V. Tiberio” University of Molise, Campobasso, Italy
| |
Collapse
|
15
|
Plauzolles A, Uras S, Pénaranda G, Bonnet M, Dukan P, Retornaz F, Halfon P. Small Intestinal Bacterial Overgrowths and Intestinal Methanogen Overgrowths Breath Testing in a Real-Life French Cohort. Clin Transl Gastroenterol 2023; 14:e00556. [PMID: 36515897 PMCID: PMC10132713 DOI: 10.14309/ctg.0000000000000556] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Breath testing has become a widely used tool to diagnose small intestinal bacterial overgrowths (SIBOs) and intestinal methanogen overgrowths (IMOs) in clinical settings. Owing to the heterogeneity in clinical manifestations and lack of standardization among centers performing breath testing, SIBO and IMO can be easily overlooked by the clinician. We studied the prevalence and symptoms of SIBO/IMO in French patients referred for breath testing after seeking medical advice. METHODS Breath test data and symptoms of 331 patients were assessed for SIBO/IMO using the H 2 /CH 4 lactulose breath test (LBT). Wilcoxon test or χ 2 test were used to compare patients with SIBO/IMO with patients without SIBO/IMO. LBT positive patients (H 2 +, CH 4 +, and CH 4 +/H 2 +) were compared using Kruskal-Wallis test for continuous data or χ 2 test for categorical data. RESULTS Among the 186 (68.1%) patients tested positive for an overgrowth with 40.3%, 47.3%, and 12.4% for H 2 +, CH 4 + and CH 4 +/H 2 +, respectively, the presence of diarrhea was significantly increased in hydrogen type overgrowths ( P < 0.001). No significant difference according to age, gender, and symptoms was associated with a positive test except for joint pain that was less prevalent among LBT positive patients ( P = 0.038). In 86.5% of IMOs, positivity with CH 4 values ≥10 ppm could be identified at baseline. DISCUSSION There are little discriminating symptoms that can help the clinician to identify patients likely to have a SIBO/IMO. However, SIBO/IMOs remain a common disorder widely underdiagnosed that need further studies to better apprehend functional bowel disorders.
Collapse
Affiliation(s)
- Anne Plauzolles
- Clinical Research and R&D Department, Laboratoire Européen Alphabio Biogroup, Marseille, France
| | - Stella Uras
- Clinical Research and R&D Department, Laboratoire Européen Alphabio Biogroup, Marseille, France
- Faculty of Sciences, Aix-Marseille University, Marseille, France
| | - Guillaume Pénaranda
- Clinical Research and R&D Department, Laboratoire Européen Alphabio Biogroup, Marseille, France
| | - Marion Bonnet
- Clinical Research and R&D Department, Laboratoire Européen Alphabio Biogroup, Marseille, France
| | - Patrick Dukan
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
| | - Frédérique Retornaz
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
| | - Philippe Halfon
- Clinical Research and R&D Department, Laboratoire Européen Alphabio Biogroup, Marseille, France
- Infectious and Internal Medicine Department, Hôpital Européen Marseille, Marseille, France
| |
Collapse
|
16
|
Hashikura N, Murakami R, Sakurai T, Horigome A, Toda K, Xiao JZ, Odamaki T. Synbiotics of Bifidobacterium breve MCC1274 and lactulose enhances production of tryptophan metabolites in fermented human fecal communities. Food Res Int 2023; 163:112308. [PMID: 36596205 DOI: 10.1016/j.foodres.2022.112308] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
Probiotics and prebiotics have beneficial effects on host physiology via metabolites from the gut microbiota in addition to their own. Here, we used a pH-controlled single-batch fermenter as a human gut microbiota model. We conducted fecal fermentation with Bifidobacterium breve MCC1274 (probiotic), lactulose (prebiotic), or a combination of both (synbiotic) to evaluate their influence on the gut environment. Fecal inoculum without the probiotic and prebiotic was used as the control. Principal coordinate analysis (PCoA), based on the composition of gut microbiota, showed a significant difference among the groups. The relative abundance of Bifidobacterium was significantly higher in the synbiotic group, compared to that in the other three treatment groups. The relative abundance of Blautia was the highest in the control group among the four groups. CE-TOFMS and LC-TOFMS showed that the number of metabolites detected in the synbiotic group was the highest (352 in total); 29 of the 310 hydrophilic metabolites and 17 of the 107 lipophilic metabolites were significantly different among the four groups in the Kruskal-Wallis test. A clustering based on 46 metabolites indicated that tryptophan-metabolites such as indole-3-lactic acid (ILA), indole-3-ethanol, and indole-3-carboxaldehyde, were included in a sub cluster composed of metabolites enriched in the synbiotic group. Spermidine, a major polyamine, was enriched in the two groups supplemented with the probiotic whereas spermine was enriched only in the synbiotic group. Not all metabolites enriched in the probiotic and/or synbiotic groups were found in the monocultures of the probiotic strain with or without the prebiotics. This implies that some of the metabolites were produced through the interaction of the fecal microbiota with the inoculated probiotic strain. Co-abundance networking analysis indicated the differences in the correlations between the relative abundance of the fecal microbiota genus and the tryptophan metabolites in each group. There was a strong correlation between ldh4 gene abundance and ILA concentration in the fecal fermentation. The copy number of ldh4 gene was significantly higher in the groups with the probiotic than that in the control group. In conclusion, synbiotics could enhance the production of signaling molecules in the gut environment. Our results provide an insight into more effective administration of probiotics at the molecular level.
Collapse
Affiliation(s)
- Nanami Hashikura
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan
| | - Ryuta Murakami
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan
| | - Takuma Sakurai
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan
| | - Ayako Horigome
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan
| | - Kazuya Toda
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan
| | - Jin-Zhong Xiao
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan
| | - Toshitaka Odamaki
- Next Generation Science Institute, R&D Division, Morinaga Milk Industry Co., Ltd., 5-1-83 Higashihara, Zama, Kanagawa 252-8583, Japan.
| |
Collapse
|
17
|
Sikander A, Rana SV, Sinha SK, Prasad KK, Arora SK. Association of serotonin transporter promoter polymorphism (5-HTTLPR) with orocecal transit time in irritable bowel syndrome. Indian J Gastroenterol 2022; 41:610-617. [PMID: 36573962 DOI: 10.1007/s12664-022-01280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/25/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a multifactorial disorder with altered intestinal motility, secretion, and sensation. Serotonin (5-HT) stimulates gut motility and alters serotonin signaling that may lead to both intestinal and extraintestinal symptoms in IBS. AIM The aim of this study was to examine the association of serotonin transporter gene promoter polymorphism (5-HTTLPR) in IBS with orocecal transit time (OCTT) measured by lactulose hydrogen breath test. METHOD This prospective case-control study included 151 IBS patients (mean±SD 37.4±11.6 years, median 36, range 19-68). Ninety-two patients were diarrhea-predominant IBS (D-IBS), 44 constipation-predominant IBS (C-IBS), 15 alternating diarrhea and constipation IBS (M-IBS), and 100 healthy controls (mean±SD 37.2±11.4 years, median 36, range 20-64 years). 5-HTTLPR gene polymorphism was studied by polymerase chain reaction-based method. 5-HT levels were measured by enzyme-linked immunosorbent assay (ELISA). Orocecal transit time (OCTT) was measured by a non-invasive lactulose hydrogen breath test. OCTT was also compared with respect to 5-HTTLPR genotypes in different IBS phenotypes. RESULTS Serum serotonin levels were significantly higher in overall IBS patients (152±77 ng/mL, p<0.001), D-IBS (184±76 ng/mL, p<0.001), compared to healthy controls (129±56 ng/mL). There was no difference in 5-HT levels between C-IBS (124±53 ng/mL) and controls. In the case of M-IBS, 5-HT levels were (88±49 ng/mL p<0.05) significantly lower than that of controls. OCTT was significantly shorter in D-IBS patients (95±36 min) as compared to controls (112±41 min). In contrast, C-IBS showed significantly prolonged OCTT (136±54 min). There was a significant difference in OCTT between D-IBS and C-IBS patients (p<0.001). There was no significant association found between OCTT and 5-HTTLPR. CONCLUSIONS Serum serotonin concentrations were increased in D-IBS compared to controls and C-IBS. OCTT was shorter in D-IBS and delayed in C-IBS patients. There was no association of 5-HTLPR polymorphism with OCTT.
Collapse
Affiliation(s)
- Arbab Sikander
- Department of Biochemistry, Islamiah College (Autonomous), College Road, New Town, Vaniyambadi, Tirupathur District, 635 752, India.
| | - Satya Vati Rana
- Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, 249 202, India
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Saroj Kant Sinha
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kaushal Kishor Prasad
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Sunil K Arora
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| |
Collapse
|
18
|
Algera JP, Demir D, Törnblom H, Nybacka S, Simrén M, Störsrud S. Low FODMAP diet reduces gastrointestinal symptoms in irritable bowel syndrome and clinical response could be predicted by symptom severity: A randomized crossover trial. Clin Nutr 2022; 41:2792-2800. [PMID: 36384081 DOI: 10.1016/j.clnu.2022.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS Fermentable oligo-, di-, monosaccharides and polyols (FODMAPs) can provoke symptoms in patients with irritable bowel syndrome (IBS). We aimed to compare the effects of diets with low vs. moderate FODMAP content on gastrointestinal (GI) symptoms and bowel habits, and to identify possible predictors of clinical response to a low FODMAP diet and FODMAP sensitivity in IBS. METHODS Adult participants with IBS (Rome IV criteria, n = 29) were included and adhered to two 7-day diet periods, with either low (4 g/day) or moderate (23 g/day) amounts of FODMAPs, in this randomized, double-blind, crossover study. The periods were separated by a wash-out period (≥14 days). IBS-Severity Scoring System (IBS-SSS) and a stool diary (Bristol Stool Form) were completed before and after the diet periods. At baseline, severity of GI symptoms and gut microbial fermentation were assessed (every 15 min, 4 h) during the Lactulose Nutrient Challenge Test (LNCT). Clinical response and FODMAP sensitivity were defined by reduction after low FODMAP period, and increase after moderate FODMAP period in IBS-SSS (≥50 points), respectively. RESULTS Severity of GI symptoms (P = 0.04), stool consistency (P = 0.01), and stool frequency (P = 0.01) differed between the interventions, with reduced overall GI symptom severity, abdominal pain intensity and frequency, bowel habits dissatisfaction, and daily life interference (P < 0.05 for all), as well as more firm (P = 0.03) and less frequent (P < 0.01) stools after low FODMAP intervention, but not after moderate FODMAP intervention. A third (34%) responded clinically to the low FODMAP diet, and the response could be predicted by higher IBS-SSS at baseline (P = 0.02). Although modest associations between FODMAP sensitivity (22%) and GI symptoms during LNCT were observed, no independent predictors could be identified. CONCLUSIONS A diet low in FODMAPs reduces GI symptoms and affects bowel habits in IBS, compared with a moderate FODMAP diet. Assessment of IBS severity before the intervention may be used to predict clinical response to a low FODMAP diet. Trial registry (http://www. CLINICALTRIALS gov): Registered under Clinical Trial number NCT05182593.
Collapse
Affiliation(s)
- Joost P Algera
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Dagsu Demir
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sanna Nybacka
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Center for Functional GI & Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stine Störsrud
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
19
|
Zhu D, Wang XL, Dai Y, Li SY, Wang WH. [Influence of Helicobacter pylori infection and its eradication treatment on small intestinal bacterial overgrowth]. Zhonghua Yi Xue Za Zhi 2022; 102:3382-3387. [PMID: 36372768 DOI: 10.3760/cma.j.cn112137-20220316-00551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objectives: To analyze the effects of Helicobacter pylori (H. pylori) infection and eradication therapy on small intestinal bacterial overgrowth (SIBO). Methods: From September to December 2021, patients with abdominal symptoms who received 13C urea breath test at the Department of Gastroenterology in Peking University First Hospital were enrolled.13C urea breath test was used to detect H. pylori infection and patients were divided into H. pylori positive and negative groups accordingly. Lactulose hydrogen methane breath test was performed to determine SIBO. H. pylori positive patients were treated with quadruple therapy including amoxicillin, metronidazole, rabeprazole and bismuth potassium citrate. 13C urea breath test and lactulose hydrogen methane breath test were reexamined 6 weeks after the treatment. Results: A total of 102 patients (49 males and 53 females) were enrolled, with a mean age of (42.1±9.9) years. Among them, 49 patients were H. pylori negative and 53 were H. pylori positive. Moreover, 47 patients were SIBO positive and 55 were SIBO negative. There was no significant difference in age, sex, body mass index, abdominal symptoms and the diagnosis of chronic atrophic gastritis between H. pylori positive and negative patients at the enrollment (all P>0.05). The detection rate of SIBO in H. pylori infected patients was higher than that in uninfected patients, and the difference was statistically significant (60.4% vs 30.6%, P=0.003). Patients with SIBO had significantly more frequent abdominal distension (36.2% vs 10.9%, P=0.002) and constipation (27.7% vs 1.8%, P<0.001) than patients without SIBO. The rate of SIBO after H. pylori eradication treatment was significantly lower than that before treatment (20.8% vs 60.4%, P<0.001). The remission rate of SIBO after eradication therapy was 66.7% (20/30). Besides, patients had obvious improvement of constipation (6.0% vs 18.9%, P=0.008), and the incidence of other abdominal symptoms decreased to various degrees including diarrhea, abdominal pain, abdominal distention and poor appetite. Conclusion: H. pylori infection increases the risk of SIBO, and the quadruple regimen containing amoxicillin and metronidazole has a therapeutic effect for patients with H.pylori infection and concomitant SIBO.
Collapse
Affiliation(s)
- D Zhu
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - X L Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - Y Dai
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| | - S Y Li
- Department of Gastroenterology, Beijing Hospital, Beijing 100730, China
| | - W H Wang
- Department of Gastroenterology, Peking University First Hospital, Beijing 100034, China
| |
Collapse
|
20
|
Sharpton SR, Oh TG, Madamba E, Wang C, Yu RT, Atkins AR, Huan T, Downes M, Evans RM, Loomba R. Gut metagenome-derived signature predicts hepatic decompensation and mortality in NAFLD-related cirrhosis. Aliment Pharmacol Ther 2022; 56:1475-1485. [PMID: 36164267 PMCID: PMC9746351 DOI: 10.1111/apt.17236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/14/2022] [Accepted: 09/15/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND There are limited data on the diagnostic accuracy of gut microbial signatures for predicting hepatic decompensation in patients with cirrhosis. AIMS To determine whether a stool metagenome-derived signature accurately detects hepatic decompensation and mortality risk in cirrhosis secondary to non-alcoholic fatty liver disease (NAFLD) METHODS: Shotgun metagenomic sequencing was performed on faecal samples collected at study entry from a prospective cohort of adults with NAFLD-related cirrhosis. A Random Forest machine learning algorithm was utilised to identify a metagenomic signature of decompensated cirrhosis (defined by ascites, hepatic encephalopathy or variceal haemorrhage) and subsequently validated in an external cohort. A Cox proportional hazards regression model was used to examine predictors of all-cause mortality. RESULTS In all, 25 adults with NAFLD-related cirrhosis (training cohort) were included. Among the 16 participants with decompensated cirrhosis, 33% had ascites, 56% had hepatic encephalopathy and 22% had experienced a variceal haemorrhage (not mutually exclusive). We identified a stool metagenomic signature comprising 13 discriminatory species that reliably distinguished decompensated NAFLD-related cirrhosis (diagnostic accuracy, 0.97, 95% confidence interval [CI] 0.96-0.99). Diagnostic accuracy of the 13-species signature remained high after adjustment for lactulose (area under the curve [AUC] 0.99) and rifaximin use (AUC 0.93). The discriminative ability of 13-species metagenomic signature was robust in an independent test cohort (AUC 0.95, 95% CI 0.81-1.00). The 13-species metagenomic signature (hazard ratio [HR] 1.54, 95% CI 1.10-2.15, p = 0.01) was a stronger predictor of mortality than the Model for End-Stage Liver Disease score (HR 1.25, 95% CI 1.03-1.53, p = 0.03). CONCLUSIONS This study provides evidence for a gut metagenome-derived signature with high diagnostic accuracy for hepatic decompensation that predicts risk of mortality in NAFLD-related cirrhosis.
Collapse
Affiliation(s)
- Suzanne R. Sharpton
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California, USA
- NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Tae Gyu Oh
- Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Egbert Madamba
- NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Chenjingyi Wang
- Faculty of Science, Department of Chemistry, University of British Columbia, Vancouver, Canada
| | - Ruth T. Yu
- Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Annette R. Atkins
- Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Tao Huan
- Faculty of Science, Department of Chemistry, University of British Columbia, Vancouver, Canada
| | - Michael Downes
- Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Ronald M. Evans
- Gene Expression Laboratory, Salk Institute for Biological Studies, La Jolla, California, USA
| | - Rohit Loomba
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California, USA
- NAFLD Research Center, Department of Medicine, University of California San Diego, La Jolla, California, USA
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
21
|
Hart TL, Townsend JR, Grady NJ, Johnson KD, Littlefield LA, Vergne MJ, Fundaro G. Resistance Exercise Increases Gastrointestinal Symptoms, Markers of Gut Permeability, and Damage in Resistance-Trained Adults. Med Sci Sports Exerc 2022; 54:1761-1770. [PMID: 35612399 DOI: 10.1249/mss.0000000000002967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the influence of acute resistance exercise (RE) and biological sex on subjective gastrointestinal (GI) symptoms, GI epithelial damage, and GI permeability in resistance-trained males and females. METHODS Thirty resistance-trained men ( n = 15) and women ( n = 15) completed an RE bout and a nonexercise control (CON) session in a randomized counterbalanced design. The RE protocol used a load of 70% one-repetition maximum for 4 sets of 10 repetitions with a 90-s rest period length between sets and a 120-s rest period between exercises (squat, seated shoulder press, deadlift, bent-over row, and leg press). Blood samples were collected before exercise (PRE), immediately postexercise (IP), and 15-, 30-, and 60-min postexercise. Participants completed GI symptom questionnaires to assess subjective GI symptoms PRE, IP, and 60-min postexercise. Blood samples were assayed to quantify small intestine damage (I-FABP) and GI permeability (lactulose-rhamnose [L/R] ratio). Data were analyzed via separate repeated-measures ANOVA, and area under the curve (AUC) analyses were completed via one-way ANOVA. RESULTS Participants reported greater GI symptoms in RE at IP compared with CON ( P < 0.001) with 70% of participants reporting at least one GI symptom with no differences between sexes. Nausea was the most reported GI symptom (63.3%), followed by vomiting (33.3%). I-FABP and L/R ratio did not exhibit differential responses between conditions. However, L/R ratio AUC was greater in males after RE than male CON ( P = 0.002) and both conditions for females ( P < 0.05). Furthermore, I-FABP AUC in the male RE condition was greater than both female conditions ( P < 0.05). CONCLUSIONS Resistance-trained individuals experience GI distress after RE, with males incurring the greatest increases in markers of GI damage and permeability.
Collapse
Affiliation(s)
| | - Jeremy R Townsend
- Exercise and Nutrition Science Graduate Program, Lipscomb University, Nashville, TN
| | - Natalie J Grady
- Exercise and Nutrition Science Graduate Program, Lipscomb University, Nashville, TN
| | - Kent D Johnson
- Exercise and Nutrition Science Graduate Program, Lipscomb University, Nashville, TN
| | - Laurel A Littlefield
- Exercise and Nutrition Science Graduate Program, Lipscomb University, Nashville, TN
| | - Matthew J Vergne
- Department of Pharmaceutical Sciences, Lipscomb University, Nashville, TN
| | | |
Collapse
|
22
|
Jobe M, Agbla SC, Todorcevic M, Darboe B, Danso E, de Barros JPP, Lagrost L, Karpe F, Prentice AM. Possible mediators of metabolic endotoxemia in women with obesity and women with obesity-diabetes in The Gambia. Int J Obes (Lond) 2022; 46:1892-1900. [PMID: 35933445 PMCID: PMC9492538 DOI: 10.1038/s41366-022-01193-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022]
Abstract
AIMS/HYPOTHESIS Translocation of bacterial debris from the gut causes metabolic endotoxemia (ME) that results in insulin resistance, and may be on the causal pathway to obesity-related type 2 diabetes. To guide interventions against ME we tested two hypothesised mechanisms for lipopolysaccharide (LPS) ingress: a leaky gut and chylomicron-associated transfer following a high-fat meal. METHODS In lean women (n = 48; fat mass index (FMI) 9.6 kg/m2), women with obesity (n = 62; FMI 23.6 kg/m2) and women with obesity-diabetes (n = 38; FMI 24.9 kg/m2) we used the lactulose-mannitol dual-sugar permeability test (LM ratio) to assess gut integrity. Markers of ME (LPS, EndoCAb IgG and IgM, IL-6, CD14 and lipoprotein binding protein) were assessed at baseline, 2 h and 5 h after a standardised 49 g fat-containing mixed meal. mRNA expression of markers of inflammation, macrophage activation and lipid metabolism were measured in peri-umbilical adipose tissue (AT) biopsies. RESULTS The LM ratio did not differ between groups. LPS levels were 57% higher in the obesity-diabetes group (P < 0.001), but, contrary to the chylomicron transfer hypothesis, levels significantly declined following the high-fat challenge. EndoCAb IgM was markedly lower in women with obesity and women with obesity-diabetes. mRNA levels of inflammatory markers in adipose tissue were consistent with the prior concept that fat soluble LPS in AT attracts and activates macrophages. CONCLUSIONS/INTERPRETATION Raised levels of LPS and IL-6 in women with obesity-diabetes and evidence of macrophage activation in adipose tissue support the concept of metabolic endotoxemia-mediated inflammation, but we found no evidence for abnormal gut permeability or chylomicron-associated post-prandial translocation of LPS. Instead, the markedly lower EndoCAb IgM levels indicate a failure in sequestration and detoxification.
Collapse
Affiliation(s)
- Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
| | - Schadrac C Agbla
- Department of Health Data Sciences, University of Liverpool, Liverpool, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Bakary Darboe
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Ebrima Danso
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | | | - Laurent Lagrost
- Plateforme de Lipidomique-uBourgogne, INSERM UMR1231/LabEx LipSTIC, Dijon, France
- University Hospital of Dijon, Dijon, France
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
- NIHR Oxford Biomedical Research Centre, OUH Foundation Trust, Oxford, UK
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| |
Collapse
|
23
|
Nalyotov AV, Svistunova NA. [Assessment of the state of the small intestine microbiota in children on a long-term dairy-free diet]. Vopr Pitan 2022; 91:15-20. [PMID: 35596631 DOI: 10.33029/0042-8833-2022-91-2-15-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/14/2022] [Indexed: 06/15/2023]
Abstract
An overview of recent outcomes of studies indicates an imbalance in the diet of children. Quantitative and qualitative malnutrition of children is the basis of a number of childhood diseases. The aim of the research was to study the prevalence of small intestine bacterial overgrowth syndrome (SIBO) in children on a long-term dairy-free diet. Material and methods. 40 children aged 7-11 years following a long-term dairy-free diet (average 3 years and 5 months, from 0.5 to 6.3 years) were examined (main group). 30 children who did not follow restrictive diets were consisted control group. In all children, SIBO was determined using a hydrogen breath test with a load of lactulose using a digital analyzer of exhaled hydrogen. Results. The proportion of children with intolerance to dairy products was 32.5%: 10.0% with allergy to cow's milk proteins, and 22.5% with lactose intolerance. 27.5% children followed a dairy-free diet according to an unjustified prescription by physician. 30.0% of children did not consume dairy products because of their unwillingness. 10.0% of children did not consume dairy products due to the unwillingness of their parents. An imbalance in the microbiota of the small intestine during the hydrogen breath test with lactulose loading was detected in 55.0% of children following a long-term dairy-free diet. 22.5% of children complained of recurrent abdominal pain, diarrhea was determined in 10.0%, constipation - in 7.5%, nausea - in 10.0%. In the control group, the SIBO during the hydrogen breath test with lactulose loading was found in 20.0%. Periodic abdominal pain was determined in 10.0%, nausea - in 6.7%, diarrhea - in 10.0%, constipation - in 3.3% children. Conclusion. Thus, among children of primary school age who follow a long-term dairyfree diet, SIBO is significantly more often recorded relative to children who are on a traditional type of diet.
Collapse
Affiliation(s)
- A V Nalyotov
- M. Gorky Donetsk National Medical University, 283003, Donetsk, Donetsk People's Republic
- Medical Centre Gastro-Line LLC, 283003, Donetsk, Donetsk People's Republic
| | - N A Svistunova
- M. Gorky Donetsk National Medical University, 283003, Donetsk, Donetsk People's Republic
| |
Collapse
|
24
|
Gan J, Nazarian S, Teare J, Darzi A, Ashrafian H, Thompson AJ. A case for improved assessment of gut permeability: a meta-analysis quantifying the lactulose:mannitol ratio in coeliac and Crohn's disease. BMC Gastroenterol 2022; 22:16. [PMID: 35012471 PMCID: PMC8751358 DOI: 10.1186/s12876-021-02082-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A widely used method in assessing small bowel permeability is the lactulose:mannitol test, where the lactulose:mannitol ratio (LMR) is measured. However, there is discrepancy in how the test is conducted and in the values of LMR obtained across studies. This meta-analysis aims to determine LMR in healthy subjects, coeliac and Crohn's disease. METHODS A literature search was performed using PRISMA guidance to identify studies assessing LMR in coeliac or Crohn's disease. 19 studies included in the meta-analysis measured gut permeability in coeliac disease, 17 studies in Crohn's disease. Outcomes of interest were LMR values and comparisons of standard mean difference (SMD) and weighted mean difference (WMD) in healthy controls, inactive Crohn's, active Crohn's, treated coeliac and untreated coeliac. Pooled estimates of differences in LMR were calculated using the random effects model. RESULTS Pooled LMR in healthy controls was 0.014 (95% CI: 0.006-0.022) while pooled LMRs in untreated and treated coeliac were 0.133 (95% CI: 0.089-0.178) and 0.037 (95% CI: 0.019-0.055). In active and inactive Crohn's disease, pooled LMRs were 0.093 (95% CI: 0.031-0.156) and 0.028 (95% CI: 0.015-0.041). Significant differences were observed in LMR between: (1) healthy controls and treated coeliacs (SMD = 0.409 95% CI 0.034 to 0.783, p = 0.032), (2) healthy controls and untreated coeliacs (SMD = 1.362 95% CI: 0.740 to 1.984, p < 0.001), (3) treated coeliacs and untreated coeliacs (SMD = 0.722 95% CI: 0.286 to 1.157, p = 0.001), (4) healthy controls and inactive Crohn's (SMD = 1.265 95% CI: 0.845 to 1.686, p < 0.001), (5) healthy controls and active Crohn's (SMD = 2.868 95% CI: 2.112 to 3.623, p < 0.001), and (6) active Crohn's and inactive Crohn's (SMD = 1.429 (95% CI: 0.580 to 2.278, p = 0.001). High heterogeneity was observed, which was attributed to variability in protocols used across different studies. CONCLUSION The use of gut permeability measurements in screening and monitoring of coeliac and Crohn's disease is promising. LMR is useful in performing this function with significant limitations. More robust alternative tests with higher degrees of clinical evidence are needed if measurements of gut permeability are to find widespread clinical use.
Collapse
Affiliation(s)
- Jonathan Gan
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK.
| | - Scarlet Nazarian
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Julian Teare
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
| | - Alex J Thompson
- Department of Surgery and Cancer, Institute of Global Health Innovation, St Mary's Hospital, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother WingSouth Wharf Road, London, W2 1NY, UK
- Hamlyn Centre for Robotic Surgery, St Mary's Hospital, Imperial College London, Level 3 Paterson BuildingSouth Wharf Road, London, W2 1NY, UK
| |
Collapse
|
25
|
Pitcher CK, Farmer AD, Haworth JJ, Treadway S, Hobson AR. Performance and Interpretation of Hydrogen and Methane Breath Testing Impact of North American Consensus Guidelines. Dig Dis Sci 2022; 67:5571-5579. [PMID: 35366119 PMCID: PMC9652228 DOI: 10.1007/s10620-022-07487-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hydrogen and methane breath tests (HMBT) are widely used clinical investigations but lack standardization. To address this, the North American Consensus (NAC) group published evidence-based recommendations for HMBT. AIMS To evaluate results obtained using NAC recommendations for HMBT, compared to retrospective data that utilized guidelines previously recommended. METHODS HMBT data from 725 patients referred for small intestinal bacterial overgrowth (SIBO) and/or carbohydrate malabsorption (CM) testing were analyzed. Data were compared regarding dose of substrate for SIBO testing (16 vs. 10 g lactulose, and 50 vs. 75 g glucose) and the effect of post-ingestion sampling period for malabsorption testing. The effect of different recommended cut-off values for SIBO were examined. RESULTS Substrate dose did not affect methane production. 10 g lactulose significantly reduced positive SIBO results compared to 16 g lactulose (42 vs. 53%, p = 0.04). 75 g glucose significantly increased positive results compared to 50 g glucose (36 vs. 22%, p = 0.04). Provoked symptoms were significantly more prevalent in patients testing positive by both North American Consensus and Ledochowski cut-off values. 34.5% of patients tested positive for CM at 180-min compared to 28% at 120-min (not significant, p = 0.19). CONCLUSIONS AND INFERENCES 10 g lactulose substrate produces fewer positive SIBO results than 16 g lactulose, while 75 g glucose dose produces more positive SIBO results than 50 g. Performing CM breath tests for 180 min increases number of positive results when compared to 120 min. SIBO cut-off timings require further investigation, but our findings broadly support the NAC recommendations for SIBO and CM testing.
Collapse
Affiliation(s)
| | - Adam D Farmer
- The Functional Gut Clinic, 22 Upper Wimpole Street, London, UK
- Institute of Applied Clinical Sciences, Keele University, Staffordshire, UK
- Neurogastroenterology Group, Centre for Neuroscience and Trauma, Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Gastroenterology, University Hospitals of North Midlands, Stoke on Trent, UK
| | | | - Sam Treadway
- The Functional Gut Clinic, 22 Upper Wimpole Street, London, UK
| | - Anthony R Hobson
- Functional Gut Diagnostics, Manchester, UK.
- The Functional Gut Clinic, 22 Upper Wimpole Street, London, UK.
| |
Collapse
|
26
|
Schindler V, Hente J, Murray FR, Hüllner M, Becker AS, Giezendanner S, Schnurre L, Bordier V, Pohl D. Adding a liquid test meal to a standardized lactulose hydrogen breath test significantly influences abdominal symptom generation and hydrogen values. Eur J Gastroenterol Hepatol 2021; 33:1485-1494. [PMID: 34609811 DOI: 10.1097/meg.0000000000002042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE While single sugar tests are controversially discussed, combination tests with meals are gaining more attention. The aim of this study was to analyze the impact of adding a test meal to lactulose hydrogen breath tests (LHBT) on hydrogen values and abdominal symptoms in patients with functional gastrointestinal disorders (FGIDs). METHODS Data of 81 FGID patients between 2014-2018 were analyzed. Patients underwent LHBT with 30 g lactulose + 300 mL water and a nutrient challenge test (NCT) including 400 mL liquid test meal + 30 g lactulose. To statistically assess the effect of a test meal on abdominal symptoms and H2, mixed-effect models were used. RESULTS Adding a test meal to LHBT showed a significant increase in nausea [odds ratio (OR) 1.4; 95% confidence interval (CI), 1.1-1.7], decrease in abdominal pain (OR 0.7; 95% CI, 0.6-0.9), borborygmi (OR 0.5; 95% CI, 0.4-0.6), diarrhea (OR 0.4; 95% CI, 0.3-0.6), and H2 production (estimate -5.3, SE 0.7, P < 0.001). The effect on bloating was only significant in functional dyspepsia, irritable bowel syndrome-functional dyspepsia mixed type and functional abdominal pain/bloating (OR 0.1; 95% CI, 0.0-0.2; OR 1.7; 95% CI, 1.2-2.3 resp OR 4.4; 95% CI, 1.8-10.6). CONCLUSIONS Significant effects on abdominal symptoms and H2 production by adding a test meal to LHBT in FGID patients are shown. Increased occurrence of nausea may be caused by gastric/duodenal hypersensitivity; decreased H2, diarrhea and borborygmi by slower and more physiologic gastric emptying resulting in later arrival of the test substance in the bowel. We recommend NCTs instead of LHBT to more physiologically represent FGID patients' meal-induced burden.
Collapse
Affiliation(s)
| | | | | | | | - Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich
| | | | | | | | | |
Collapse
|
27
|
Ramírez N, Ubilla C, Campos J, Valencia F, Aburto C, Vera C, Illanes A, Guerrero C. Enzymatic production of lactulose by fed-batch and repeated fed-batch reactor. Bioresour Technol 2021; 341:125769. [PMID: 34416660 DOI: 10.1016/j.biortech.2021.125769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
The effects of the most significant operational variables on reactor performance of fed-batch and repeated fed-batch were evaluated in the lactulose production by enzymatic transgalactosylation. Feed flowrate in the fed stage (F) and fructose to lactose molar ratio (Fr/L) were the variables that mostly affected the values of lactulose yield (YLu), lactulose productivity (πLu) and selectivity of transgalactosylation (SLu/TOS). Maximum YLu of 0.21 g lactulose per g lactose was obtained at 50% w/w inlet carbohydrates concentration (IC) of, 50 °C, Fr/L 8, F 1 mL⋅min-1, 200 IU∙gLactose-1 reactor enzyme load and pH 4.5. At these conditions the selectivity was 7.4, productivity was 0.71 gLu∙g-1∙h-1and lactose conversion was 0.66. The operation by repeated fed batch increases the efficiency of use of the biocatalysts (EB) and the accumulated productivity compared to batch and fed batch operation with the same biocatalyst. EB obtained was 4.13 gLu∙mgbiocatalyst protein-1, 10.6 times higher than in fed-batch.
Collapse
Affiliation(s)
- Nicolás Ramírez
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Claudia Ubilla
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Javiera Campos
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Francisca Valencia
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Carla Aburto
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Carlos Vera
- Department of Biology, Faculty of Chemistry and Biology, Universidad de Santiago de Chile (USACH), Santiago, Chile
| | - Andrés Illanes
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Cecilia Guerrero
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile.
| |
Collapse
|
28
|
Rattanasupar A, Chang A, Akarapatima K, Chaojin T, Piratvisuth T. Role of lactulose for prophylaxis against hepatic encephalopathy in cirrhotic patients with upper gastrointestinal bleeding: A randomized trial. Indian J Gastroenterol 2021; 40:621-629. [PMID: 34129159 DOI: 10.1007/s12664-021-01150-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/18/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to assess the efficacy of lactulose as prophylaxis against hepatic encephalopathy (HE) in cirrhotic patients with acute upper gastrointestinal bleeding (AUGIB). METHODS We conducted a randomized, double-blinded, placebo-controlled, multicenter study from October 2012 to February 2014. Cirrhotic patients presenting with AUGIB (aged 18-80 years, without HE at the time of admission) were enrolled and randomized to receive blinded medications (both physically indistinguishable), labeled "Lactulose A" and "Lactulose B" for 5 days along with standard treatment depending on the type of bleeding (variceal and nonvariceal). The primary endpoint was the development of overt HE according to the West-Haven criteria. Modified intention-to-treat analysis was performed. RESULTS Forty-six patients completed the protocol: Lactulose A (placebo, n = 22) and Lactulose B (lactulose, n = 24). There was no significant difference in baseline characteristics and clinical outcomes between the two groups. Nine (19.6%) patients developed HE: five (22.7%) in the placebo group and four (16.7%) in the lactulose group (p = 0.718). One patient (2.2%) died in lactulose group. All patients tolerated the medication and no significant difference in adverse effects was detected (59.1% in placebo vs. 50.0% in lactulose group, p = 0.536). On multivariate analysis, increased baseline Child-Turcotte-Pugh (CTP) score (odds ratio [OR] 2.176; 95% confidence interval [CI] 1.012-4.681, p = 0.047) and presence of diarrhea (OR 16.261; 95% CI 1.395-189.608, p = 0.026) were independent risk factors for the development of HE. CONCLUSION Five-day lactulose is ineffective as prophylaxis against HE in cirrhotic patients with AUGIB. Unnecessary treatment with laxatives should be avoided in these patients. TRIAL REGISTRATION Clinical trial registry number TCTR20200526003 (retrospectively registered).
Collapse
Affiliation(s)
- Attapon Rattanasupar
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, 182 Ratthakanl Road, Hatyai, Songkhla, 90110, Thailand
| | - Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, 182 Ratthakanl Road, Hatyai, Songkhla, 90110, Thailand.
| | - Keerati Akarapatima
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, 182 Ratthakanl Road, Hatyai, Songkhla, 90110, Thailand
| | - Thanongsak Chaojin
- Division of Gastroenterology, Department of Internal Medicine, Yala Hospital, Yala, Thailand
| | - Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| |
Collapse
|
29
|
Gokcen P, Ozturk O, Adali G, Tosun I, Dogan HO, Kara H, Yalman Y, Doganay HL, Ozdil K. A novel therapeutic approach to NASH: Both polyethylene glycol 3350 and lactulose reduce hepatic inflammation in C57BL/6J mice. ADV CLIN EXP MED 2021; 30:1167-1174. [PMID: 34549558 DOI: 10.17219/acem/140506] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The gut-liver axis is one of the most emphasized topics in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Intestinal microbiota dysbiosis has been shown to be a predictor of disease severity and progression to fatty liver disease. Therefore, research addressing gut-based therapies has become popular. OBJECTIVES To investigate the effect of lactulose and polyethylene glycol 3350 (PEG 3350) in mice with induced obesity and NAFLD at a non-diarrheal dose. MATERIAL AND METHODS Thirty-six C57BL/6J male mice were divided into 6 groups. The first 2 groups (n = 6 each) were used as an induced obesity model (group A) and NAFLD model (group B) for 8 weeks. The remaining 24 animals were categorized into control diet group, high-fat diet (HFD) group, HFD + lactulose group, and HFD + PEG 3350 group. Serum and liver tissue samples were obtained for biochemical and histopathological analyses, respectively. RESULTS The HFD + lactulose treatment group displayed a significant decrease in liver weight (1.3 (1.3-1.4) kg compared to 1.8 (1.6-1.9) kg) and NAFLD activity score (NAS) (1.5 (1.0-3.0) compared to 5.0 (4.0-5.0), respectively; p = 0.0043, p = 0.0021) when compared with the HFD group. However, a decrease in body weight (35.0 (34.6-36.0) kg compared to 40.9 (34.7-41.9) kg) and hepatosteatosis (HS) rate (33.3% compared to 100.0%) were not statistically significant (p = 0.1796, p = 0.0606, respectively). The HFD + PEG 3350 treatment group showed a statistically significant decrease in body weight (32.4 (30.2-33.9) kg compared to 40.9 (34.7-41.9) kg), liver weight (1.5 (1.3-1.5) kg compared to 1.8 (1.6-1.9) kg), HS rate (16.7% compared to 100.0%) and NAS (0.5 (0.0-1.0) compared to 5.0 (4.0-5.0); p = 0.0086, p = 0.0086, p = 0.0151, and p = 0.0021, respectively) when compared with the HFD group. CONCLUSIONS We demonstrated that non-diarrheal dose of lactulose and PEG 3350 reduced hepatic inflammation in mice with induced NAFLD. It was also observed that PEG 3350 decreased HS and body weight. We believe these mechanisms can be utilized as novel therapeutic approaches in NAFLD in prospective human studies.
Collapse
Affiliation(s)
- Pinar Gokcen
- Department of Gastroenterology, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Oguzhan Ozturk
- Department of Gastroenterology, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Gupse Adali
- Department of Gastroenterology, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ilkay Tosun
- Department of Pathology, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Halef Okan Dogan
- Department of Biochemistry, Sivas Cumhuriyet University School of Medicine, Turkey
| | - Haki Kara
- Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Turkey
| | - Yucel Yalman
- Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Turkey
| | - Hamdi Levent Doganay
- Department of Gastroenterology, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Kamil Ozdil
- Department of Gastroenterology, Health Sciences University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
30
|
Jamil Z, Iqbal NT, Idress R, Ahmed Z, Sadiq K, Mallawaarachchi I, Iqbal J, Syed S, Hotwani A, Kabir F, Ahmed K, Ahmed S, Umrani F, Ma JZ, Aziz F, Kalam A, Moore SR, Ali SA. Gut integrity and duodenal enteropathogen burden in undernourished children with environmental enteric dysfunction. PLoS Negl Trop Dis 2021; 15:e0009584. [PMID: 34264936 PMCID: PMC8352064 DOI: 10.1371/journal.pntd.0009584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 08/09/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
Environmental enteric dysfunction (EED) is a subclinical condition of intestinal inflammation, barrier dysfunction and malabsorption associated with growth faltering in children living in poverty. This study explores association of altered duodenal permeability (lactulose, rhamnose and their ratio) with higher burden of enteropathogen in the duodenal aspirate, altered histopathological findings and higher morbidity (diarrhea) that is collectively associated with linear growth faltering in children living in EED endemic setting. In a longitudinal birth cohort, 51 controls (WHZ > 0, HAZ > −1.0) and 63 cases (WHZ< -2.0, refractory to nutritional intervention) were recruited. Anthropometry and morbidity were recorded on monthly bases up to 24 months of age. Dual sugar assay of urine collected after oral administration of lactulose and rhamnose was assessed in 96 children from both the groups. Duodenal histopathology (n = 63) and enteropathogen analysis of aspirate via Taqman array card (n = 60) was assessed in only cases. Giardia was the most frequent pathogen and was associated with raised L:R ratio (p = 0.068). Gastric microscopy was more sensitive than duodenal aspirate in H. pylori detection. Microscopically confirmed H. pylori negatively correlated with HAZ at 24 months (r = −0.313, p = 0.013). Regarding histopathological parameters, goblet cell reduction significantly correlated with decline in dual sugar excretion (p< 0.05). Between cases and controls, there were no significant differences in the median (25th, 75th percentile) of urinary concentrations (μg/ml) of lactulose [27.0 (11.50, 59.50) for cases vs. 38.0 (12.0, 61.0) for controls], rhamnose [66.0 (28.0, 178.0) vs. 86.5 (29.5, 190.5)] and L:R ratio [0.47 (0.24, 0.90) vs. 0.51 (0.31, 0.71)] respectively. In multivariable regression model, 31% of variability in HAZ at 24 months of age among cases and controls was explained by final model including dual sugars. In conclusion, enteropathogen burden is associated with altered histopathological features and intestinal permeability. In cases and controls living in settings of endemic enteropathy, intestinal permeability test may predict linear growth. However, for adoption as a screening tool for EED, further validation is required due to its complex intestinal pathophysiology. EED is a subclinical condition of compromised gut integrity secondary to frequent and repeated exposure to enteropathogens in global settings with a high prevalence of undernutrition. In this study, we reported association of gut mucosal architecture with a dual sugar intestinal permeability assay (lactulose-rhamnose) in Pakistani children. In the presence of duodenal enteropathogens, features such as chronic inflammation, intra-epithelial lymphocytosis, enterocyte injury and Paneth cell reduction were consistently observed. When comparing undernourished cases and controls living in the same setting, we found urinary excretion of the sugars was similar among groups; however, variability in HAZ among children at 24 months was partially explained by a model that includes excretion values.
Collapse
Affiliation(s)
- Zehra Jamil
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Najeeha Talat Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Romana Idress
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zubair Ahmed
- Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Kamran Sadiq
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Junaid Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sana Syed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Kumail Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sheraz Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fayaz Umrani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jennie Z. Ma
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Fatima Aziz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Adil Kalam
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sean R. Moore
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition; Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
- * E-mail: (SRM); (SAA)
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail: (SRM); (SAA)
| |
Collapse
|
31
|
Setiawan EA, Rianda D, Kadim M, Meilianawati, Susanto F, Kok FJ, Shankar AH, Agustina R. Tenth year reenrollment randomized trial investigating the effects of childhood probiotics and calcium supplementation on height and weight at adolescence. Sci Rep 2021; 11:11860. [PMID: 34088920 PMCID: PMC8178317 DOI: 10.1038/s41598-021-88819-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
Microbiota and its modification with specific probiotics in early life could provide long term health benefits. Probiotics and calcium strengthen intestinal integrity and may support linear growth. This study investigated the long-term effects of childhood probiotics and calcium supplementation on growth in adolescence. We re-enrolled 238 adolescents aged 11-18 years from 494 children 10-years after 6-months of supplementation with either low-lactose milk fortified with low levels of calcium (LC, ∼50 mg/day, n = 53/124), with regular levels of calcium (RC, ∼440 mg/day, n = 70/126), or with regular calcium + 5 x 108 CFU/day Lactobacillus reuteri DSM 17938 (Reuteri, n = 55/124), or regular calcium + 5 x 108 CFU/day L. casei CRL 431 (Casei, n = 60/120). Changes in height-for-age z-score (HAZ) and body mass index-for-age z-score (BMIZ) were determined from the end of intervention to re-enrollment. General linear models were used to assess the effects on HAZ and BMIZ of group, gender, living area, maternal education, family income, physical activity, diet quality, nutritional status, and gut integrity as determined by urinary lactulose/mannitol ratio (L:M). Adolescent mean age was 15.3 years, mean HAZ was - 1.11, mean BMIZ was - 0.2 and median L:M (n = 155) was 0.23. Changes in HAZ and BMIZ were not significantly different between Casei, Reuteri, LC compared to RC. However, a significant decrease in BMIZ was observed among female adolescents in the Casei compared to RC group (- 0.5 SD, 95% CI - 0.8 to - 0.003, p = 0.048). Childhood probiotic and calcium supplementation may therefore selectively affect female adolescents.Clinical trial registration: This follow-up study has been registered at www.clinicaltrials.gov , Registry name: Rina Agustina, Registration number: NCT04046289, First Registration Date 06/08/19. web link: https://www.clinicaltrials.gov/ct2/show/NCT04046289 .
Collapse
Affiliation(s)
- Evania Astella Setiawan
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia
| | - Davrina Rianda
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muzal Kadim
- Department of Pediatric, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Meilianawati
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia
| | - Fenny Susanto
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia
| | - Frans J Kok
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Anuraj H Shankar
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jl. Salemba Raya No.6, Jakarta, 10430, Indonesia.
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| |
Collapse
|
32
|
Lee YS, Lai DM, Huang HJ, Lee-Chen GJ, Chang CH, Hsieh-Li HM, Lee GC. Prebiotic Lactulose Ameliorates the Cognitive Deficit in Alzheimer's Disease Mouse Model through Macroautophagy and Chaperone-Mediated Autophagy Pathways. J Agric Food Chem 2021; 69:2422-2437. [PMID: 33617267 DOI: 10.1021/acs.jafc.0c07327] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 06/12/2023]
Abstract
Lactulose, as a prebiotic, can be utilized by human gut microbiota and stimulate their growth. Although microbiota modulation has become an emerging approach to manage many diseases and can be achieved by the administration of prebiotics, fewer investigations have been carried out on the therapeutic mechanism of lactulose. Two trehalose analogs, lactulose and melibiose, were identified as having a neuroprotective effect in polyglutamine and Parkinson disease models. In this study, we examined lactulose and melibiose in a mouse primary hippocampal neuronal culture under the toxicity of oligomeric Aβ25-35. Lactulose was further tested in vivo because its effective concentration is lower than that of melibiose. Lactulose and trehalose were applied individually to mice before a bilateral intrahippocampal CA1 injection of oligomeric Aβ25-35. The administration of lactulose and trehalose attenuated the short-term memory and the learning retrieval of Alzheimer's disease (AD) mice. From a pathological analysis, we found that the pretreatment of lactulose and trehalose decreased neuroinflammation and increased the levels of the autophagic pathways. These results suggest that the neuroprotective effects of both lactulose and trehalose are achieved through anti-inflammation and autophagy. In addition, lactulose was better than trehalose in the enhancement of the synaptic protein expression level in AD mice. Therefore, lactulose could potentially be developed into a preventive and/or therapeutic disaccharide for AD.
Collapse
Affiliation(s)
- Yan-Suan Lee
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hei-Jen Huang
- Department of Nursing, Mackay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan
| | - Guey-Jen Lee-Chen
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Ching-Hwa Chang
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Hsiu Mei Hsieh-Li
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| | - Guan-Chiun Lee
- Department of Life Science, National Taiwan Normal University, Taipei 116, Taiwan
| |
Collapse
|
33
|
Chojnacki C, Mikulska P, Knopik-Dąbrowicz A, Kaczka A, Chojnacki J, Konrad P. [The role of intraepithelial lymphocytes in pathogenesis of small intestinal bacterial overgrowth syndrome]. Pol Merkur Lekarski 2021; 49:23-27. [PMID: 33713088] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Small intestinal bacterial overgrowth (SIBO) is a frequent cause of chronic abdominal complaints. So far, a lot information has been gathered on its pathogenesis but are still doubts that raise question why its causes chronic diarrhea in some and constipation in other patients. AIM The aim of the study was to assess the number of endothelial lymphocytes (IELs) in the duodenal and ileum mucosa in patients with SIBO with dominant diarrhea (SIBO-D) and dominant constipation (SIBO-C). MATERIALS AND METHODS The study was performed in 30 healthy patients (group I) and 40 patients with SIBO and diarrhoea (group II), and in 4o patients with constipation (group III). To diagnose SIBO the lactulose hydrogen breath test (LHBT) was performed. To determine the number of intraepithelial lymphocytes in duodenal and jejunal mucosa the histological assessment was performed using haematoxylin-eosin staining. Moreover, immunochistochemical method was used to assess the number of enterochromatoffin cells (EC, chromogranin A - LK-2H10) in these some parts of the gut. RESULTS The results of LHBT were similar in group II and III - 75,6±18,1 ppm and 66,9±16,2 ppm(p>0,05). The number of IELs in duodenal mucosa in controls was 14,6±4,1/100 EN, in group II - 28,3±6,8/100 EN (p<0.01), and in group III - 23,0±9,9/100 EN (p<0,05), and similar differences were in jejunal mucosa. The number of EC in both parts of the gut was higher in SIBO compared to controls. Furthermore, in patients with SIBO-D the number of IELs in duodenum, as well as in jejunum, was positively correlated with the number of EC cells ( p<0,05, p=0,056, respectively). CONCLUSIONS In patients with SIBO, particularly with SIBO-D, increased number of IELs I EC cells may be a cause of diverse abdominal symptoms.
Collapse
Affiliation(s)
- Cezary Chojnacki
- Medical University of Lodz, Poland: Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Paulina Mikulska
- Medical University of Lodz, Poland: Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Alina Knopik-Dąbrowicz
- Medical University of Lodz, Poland: Department of Pathomorphology and Clinical Cytopathology
| | - Aleksandra Kaczka
- Medical University of Lodz, Poland: Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Jan Chojnacki
- Medical University of Lodz, Poland: Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Paulina Konrad
- Medical University of Lodz, Poland: Department of Clinical Nutrition and Gastroenterological Diagnostics
| |
Collapse
|
34
|
Wang L, Gu J, Feng Y, Wang M, Tong Y, Liu Y, Lyu X, Yang R. Enhancement of the Isomerization Activity and Thermostability of Cellobiose 2-Epimerase from Caldicellulosiruptor saccharolyticus by Exchange of a Flexible Loop. J Agric Food Chem 2021; 69:1907-1915. [PMID: 33541071 DOI: 10.1021/acs.jafc.0c07073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/12/2023]
Abstract
Cellobiose 2-epimerase (CE) offers a promising enzymatic approach to produce lactulose. However, its application is limited by the unsatisfactory isomerization activity and thermostability. Our study attempted to optimize the catalytic performances of CEs by flexible loop exchange, for which four mutants were constructed using CsCE (CE from Caldicellulosiruptor saccharolyticus) as a template. As a result, all mutants maintained the same catalytic directions as the templates. Mutant RmC displayed a 2.2- and 1.34-fold increase in the isomerization activity and catalytic efficiency, respectively. According to the results of molecular dynamics (MD) simulations, it was revealed that the loop exchange in RmC enlarged the entrance of the active site for substrate binding and benefited proton transfer involved in the isomerization process. Besides, the t1/2 of mutant StC at 70 °C was increased from 29.07 to 38.29 h, owing to the abundance of rigid residues (proline) within the flexible loop of StC. Our work demonstrated that the isomerization activity and thermostability of CEs were closely related to the flexible loop surrounding the active site, which provides a new perspective to engineer CEs for higher lactulose production.
Collapse
Affiliation(s)
- Lu Wang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Jiali Gu
- College of Life Sciences, Huzhou University, Huzhou 313000, China
| | - Yinghui Feng
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Mingming Wang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Yanjun Tong
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Yingjie Liu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Xiaomei Lyu
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| | - Ruijin Yang
- State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi 214122, China
| |
Collapse
|
35
|
|
36
|
McOmber M, Rafati D, Cain K, Devaraj S, Weidler EM, Heitkemper M, Shulman RJ. Increased Gut Permeability in First-degree Relatives of Children with Irritable Bowel Syndrome or Functional Abdominal Pain. Clin Gastroenterol Hepatol 2020; 18:375-384.e1. [PMID: 31100459 PMCID: PMC6854304 DOI: 10.1016/j.cgh.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Increased gut permeability might contribute to the pathogenesis of irritable bowel syndrome or functional abdominal pain (IBS or FAP). We investigated whether siblings and parents of children with IBS or FAP have increased gut permeability. METHODS We performed permeability tests (using sucrose, lactulose, mannitol, and sucralose) on 29 siblings and 43 parents of children with IBS or FAP, and 43 children (controls) and 42 parents of controls, from primary and secondary care. Permeability studies were repeated in 7 siblings and 37 parents of children with IBS or FAP and 23 controls and 36 parents of controls following ingestion of 400 mg of ibuprofen. Percent recovery of sucrose was calculated based on analyses of urine collected overnight; the lactulose/mannitol ratio and percent recovery of sucralose were based on analyses of urine samples collected over a 24-hour period. RESULTS When we controlled for age, sex, and family membership, siblings of children with IBS or FAP had increased small bowel permeability (urinary lactulose/mannitol ratio) vs controls (P = .004). There was no difference in gastroduodenal (percent sucrose recovery) or colonic (percent sucralose recovery) permeability between groups. Similarly, parents of children with IBS or FAP also had increased small bowel permeability, compared with parents of controls (P = .015), with no differences in gastric or colonic permeability. After administration of ibuprofen, gastroduodenal and small bowel permeability tended to be greater in IBS or FAP siblings (P = .08) and gastroduodenal permeability tended to be greater in IBS or FAP parents (P = .086). CONCLUSIONS Siblings and parents of children with IBS or FAP have increased baseline small intestinal permeability compared with control children and their parents. These results indicate that there are familial influences on gastrointestinal permeability in patients with IBS or FAP.
Collapse
Affiliation(s)
- Mark McOmber
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona
| | - Danny Rafati
- Cook Children's Health Care System, Fort Worth, Texas
| | - Kevin Cain
- University of Washington, Seattle, Washington
| | - Sridevi Devaraj
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Erica M Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas; Children's Nutrition Research Center, Houston, Texas
| | | | - Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Hospital, Houston, Texas; Children's Nutrition Research Center, Houston, Texas.
| |
Collapse
|
37
|
Pilipenko VI, Isakov VA, Vlasova AV, Naidenova MA, Morozov SV. [The role of dietary diversity in the formation of syndrome intestinal bacterial overgrowth]. Vopr Pitan 2020; 89:54-63. [PMID: 32083825 DOI: 10.24411/0042-8833-2020-10006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/24/2020] [Indexed: 02/05/2023]
Abstract
UNLABELLED Small intestinal bacterial overgrowth (SIBO) is a widespread disease characterized by a significant decrease of the quality of life. Antibiotic treatment of SIBO is usually effective, however, the recurrence rate is high. Microbiota is dependent on dietary pattern of the patient and specific nutrients, therefore the diversity of dietary patterns may be one of the major factor promoting SIBO or its relapses after treatment. The aim of the study was to compare nutritional diversity in patients with SIBО-H2 and in healthy controls. MATERIAL AND METHODS Оne thousand twenty three patients with suspected SIBО were examined. Hydrogen-methane breath test with lactulose was performed in 973 patients, the results of which identified groups with SIBO-H2 (n=522), with SIBO-CH4 (n=340) and without signs of SIBO (n=108). Data on food intake was collected with 24 h recall from all participants. Dietary diversity was assessed using method of calculation of unique values (count base diversity) for 11 groups of food: cereals, meat and eggs, fish and non-fish seafood, fat containing products, dairy products, nuts, vegetables, fruits and berries, confectionery, drinks, sauces and spices. The pattern of food diversity for each patient was obtained by counting the items in each of the studied food groups. Comparison of the mean values of the number of items in each of the studied food groups was used to compare food diversity in patients with and without SIBО-H2. RESULTS AND DISCUSSION A comparison of nutritional diversity in patients with SIBO-H2 revealed a lower count base diversity in the groups of dairy products (2.70±1.37 vs 3.19±1.34, p<0.001), vegetables (5.50±2.22 vs 6.29±1.90, p<0.001), fruits (1.54± 1.38 vs 1.99±1.69, p=0.018) in compare with controls. Count base diversity in grains, meats, fishes, fat products, nuts and legumes and sweets did not demonstrate significant differences. CONCLUSION Significant differences in the diversity of dietary patterns in patients with SIBО were found in dairy products, vegetables and fruits and berries. The obtained data may be used to develop diet for SIBO patients additionally to the treatment and prevention of its relapses.
Collapse
Affiliation(s)
- V I Pilipenko
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 115446, Moscow, Russian Federation
| | - V A Isakov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 115446, Moscow, Russian Federation
| | - A V Vlasova
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 115446, Moscow, Russian Federation
| | - M A Naidenova
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 115446, Moscow, Russian Federation
| | - S V Morozov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 115446, Moscow, Russian Federation
| |
Collapse
|
38
|
Pilipenko VI, Isakov VA, Vlasova AV, Lantseva MA, Morozov SV. [Association of thermal food processing methods and small intestinal bacterial overgrowth syndrome]. Vopr Pitan 2020; 89:106-113. [PMID: 32790263 DOI: 10.24411/0042-8833-2020-10034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023]
Abstract
Small intestinal bacterial overgrowth (SIBO) is a widespread disease which antibiotic therapy is not effective enough and the relapse rate is high. Microbiota is dependent on dietary pattern of the patient and specific nutrients, therefore the diversity of dietary patterns may be one of the major factor promoting SIBO or its relapses after treatment. The aim: to compare the patterns of thermal food processing methods in patients with and without SIBO. Material and methods. We performed retrospective single center database search to identify unique depersonalized records of patients with SIBO and the data of lactulose breath test and nutritional assessment with the use of 24-hours dietary recall. Inclusion criteria were complete data on patient's demography, adequate data of nutritional assessment and the lactulose breath test, absence of previous history of SIBO treatment in a special form of the database. In accordance with the results of lactulose breath test, patients were assigned into groups with the presence of SIBO with excess production of hydrogen (H2), methane (CH4), both gases (CH4-H2) or without SIBO (control group). According to the data of 24 h dietary recall, we divided all dishes and products consumed by a patient to 6 categories (Cat) depending on thermal food processing method: those that were not processed (raw) (Cat-r), boiled (Cat-bl), fried (Cat-f), stewed (Cat-s), baked in the oven (Cat-bk) or grilled (Cat-g). To analyze the structure of thermal food processing, we divided the weight of all products or dishes that underwent specific method of processing to the total weight of the food eaten. We did not take into the account the weight of thermally stable components like water and salt. The pattern of thermal food processing within each patients group was obtained as a quotient of the total percentage (by weight) of the food processed with the certain method by the number of patients in the group. Results and discussion. The data of 1108 patients were available for the final analysis: 602 patients in the SIBO-H2 group, 140 in the SIBO-CH4 group, 248 in the SIBO-CH4-H2 group, and 118 patients in the control group. The distribution of thermal food processing categories was in patients with SIBO-H2 as follows: Cat-r - 45.8±17.3%, Cat-bl - 31.9±15.7%, Cat-s - 3.5±7.7%, Cat-f - 6.3±10.4%, Cat-bk - 12.2±10.2%, Cat-g - 0.3±3.3%); in patients with SIBO-CH4: Cat-r - 47.9±17.4%, Cat-bl - 29.6±15.6%, Cat-s - 4.4±7.6%, Cat-f - 5.8±9.8%, Cat-bk - 12.3±10.4%, Cat-g - 0,2±2,7%; in patients with SIBO-CH4-H2: Cat-r - 45.6±16.3%, Catbl - 31.5±16.2%, Cat-s - 4.0±8.0%, Cat-f - 5.1±9.3%, Cat-bk - 13.4±10.8%, Cat-g - 0.4±2.3%. Similar results were obtained in the control group (Cat-r - 44.7±17.0%, Cat-bl - 32.6±16.5%, Cat-s - 2.7±6.0%, Cat-f - 5.5±8.0%, Cat-bk - 14.2±10.6%, Cat-g - 0.3±2.0%). There were no significant differences between the SIBO and control groups by mean percentage of raw, boiled, stewed, fried, baked and grilled food intake. Conclusion. We found no association between thermal food processing patterns and SIBO. It seems that thermal food processing patterns has no influence on SIBO and its variants.
Collapse
Affiliation(s)
- V I Pilipenko
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 109240, Moscow, Russian Federation
| | - V A Isakov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 109240, Moscow, Russian Federation
| | - A V Vlasova
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 109240, Moscow, Russian Federation
| | - M A Lantseva
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 109240, Moscow, Russian Federation
| | - S V Morozov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety, 109240, Moscow, Russian Federation
| |
Collapse
|
39
|
Reilev M, Lund LC, Hallas J. [Christmas article: CO2 footprint of lactulose in Scandinavia]. Ugeskr Laeger 2019; 181:V70780. [PMID: 31908259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Lactulose is a popular osmotic laxative, and it is metabolised in the large intestine by Escherichia coli resulting in CO2 production. METHODS Our aim was to calculate the potential CO2 footprint of lactulose in the Scandinavian countries in 2010-2017, to see if a reduction of the use of lactulose would influence the global CO2 emission. RESULTS We found a value of up to 6,729 tons of CO2, corresponding to 67 million kilometers of air travel or 1,665 flights around the globe. CONCLUSION Such CO2 emission is non-trivial and adds to other arguments against the use of lactulose. FUNDING none. TRIAL REGISTRATION not relevant.
Collapse
|
40
|
Pilipenko VI, Isakov VA, Morozov SV, Vlasova AV, Naydenova MA. [Association of food patterns with different forms of small intestinal bacterial overgroth syndrome and treatment efficacy]. TERAPEVT ARKH 2019; 91:82-90. [PMID: 32598636 DOI: 10.26442/00403660.2019.10.000496] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 02/07/2023]
Abstract
AIM To assess food patterns in patients with different types of SIBO and their impact onto the course and treatment outcomes. MATERIALS AND METHODS The data of 988 patients who signed informed consent surved as a source data. On the basis of lactulose breath test (LBT; GastroCH4eck, Bedfont, UK), the patients were selected into one of the studied groups: SIBO-H2, SIBO-CH4, SIBO-CH4-H2 and control. Twenty - four hours food recall test was used to analyze nutritional habits. In patients with SIBO-H2, standard treatment with Tilichinol 100 mg/Tilbrochinol 200 mg (Intetrix, Beaufour-Ipsen International, France) 2 caps BID for 10 days) was provided. Efficacy of treatment was assessed on the bass of the result of LBT 2 month after treatment completion. Mann-Whitney T test (Statistica 10, StatSoft, USA) was used to compare nutritional patterns in patients with or without SIBO, in different types of SIBO and in accordance to the results of treatment. RESULTS AND DISCUSSION Nine hundred eighty eight patients were enrolled. On the basis of hydrogene breath test they were divided into 4 main groups: SIBO of hydrogen - producing flora (SIBO-H2, n=526), methane - producing flora (SIBO-CH4, n=129), SIBO with hyperproduction of methane and hydrogene (SIBO-CH4-H2, n=225). The control group consisted of 108 patients with no no excessive gas production on LBT. In contrast to controls, nutritional patterns of patients with SIBO were characterized by low dietary fiber and amount of red meat dishes in the rations. Those with SIBO-CH4 consumed more fruits (p=0.03), vegetables (p=0.003), and fish (p=0.026), compared to those with other variants of SIBO and the control group. Nutritional patterns of SIBO-H2 group were characterized by larger amount of poultry meat consumption (p=0.026) compared to other SIBO groups and controls. In SIBO-H2 "cured" group greater amounts of buckwheat (p.
Collapse
Affiliation(s)
- V I Pilipenko
- Federal Research Centre of Nutrition and Biotechnology
| | - V A Isakov
- Federal Research Centre of Nutrition and Biotechnology
| | - S V Morozov
- Federal Research Centre of Nutrition and Biotechnology
| | - A V Vlasova
- Federal Research Centre of Nutrition and Biotechnology
| | - M A Naydenova
- Federal Research Centre of Nutrition and Biotechnology
| |
Collapse
|
41
|
Konrad P, Błońska A, Chojnacki J, Mikulska P, Mędrek-Socha M, Chojnacki C. [Zaburzenia czynnościowe przewodu pokarmowego u osób z przerostem bakteryjnym jelita cienkiego]. Pol Merkur Lekarski 2019; 46:239-242. [PMID: 31260431] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED Small intestinal bacterial overgrowth (SIBO) is a frequent cause of chronic abdominal complaining. AIM The aim of this study was to assess the prevalence of the functional disorders in this group patients. MATERIALS AND METHODS The study was conducted in a group of 426 subjects, aged 22-65, including 294 women and 132 men with intestinal functional diseases, as defined in Rome IV Criteria. Small intestinal bacterial overgrowth was evaluated using the Gastrolyzer (Bedfont), assuming an increase of hydrogen concentration in the breath samples over 20 ppm in relation to the baseline value within 90 minutes after consumption of 10 g lactulose (LHBT test). In 185 subjects (group I) results of this test was negative, and in 241 patients (group II) was positive. RESULTS On the whole the prevalence of functional disorders are similar in both groups (p > 0,05). However, in the group with a positive LHBT score, the diarrheal form of the irritable bowel syndrome was more often diagnosed (21,1% vs 28,2%; OR -1,47, 95% Cl - 0,94-2,31) as well as functional diarrhea (22,1% vs 17,8%; OR - 1,22; Cl 95% - 0,78-1,92). Less differences were determined in evaluation of the constipation and bloatedness. CONCLUSIONS The LHBT is useful in the diagnosis of functional disorders of the gastrointestinal tract.
Collapse
Affiliation(s)
- Paulina Konrad
- Medical University of Lodz, Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Aleksandra Błońska
- Medical University of Lodz, Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Jan Chojnacki
- Medical University of Lodz, Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Paulina Mikulska
- Medical University of Lodz, Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Marta Mędrek-Socha
- Medical University of Lodz, Department of Clinical Nutrition and Gastroenterological Diagnostics
| | - Cezary Chojnacki
- Medical University of Lodz, Department of Clinical Nutrition and Gastroenterological Diagnostics
| |
Collapse
|
42
|
Bhatnagar S. Polyethylene Glycol vs. Lactulose in Infants and Children with Functional Constipation: Pediatric Gastroenterologist's Viewpoint. Indian Pediatr 2019; 56:418-419. [PMID: 31102383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
43
|
Mathew JL. Polyethylene Glycol vs. Lactulose in Infants and Children with Functional Constipation: Evidence-Based Medicine Viewpoint. Indian Pediatr 2019; 56:415-418. [PMID: 31102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
44
|
Kvit KB, Kharchenko NV, Kharchenko VV, Chornenka OI, Chornovus RI, Dorofeeva US, Draganchuk OB, Slaba OM. The role of small intestinal bacterial overgrowth in the pathogenesis of hyperlipidemia. Wiad Lek 2019; 72:645-649. [PMID: 31055549] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Introduction: Small intestinal bacterial overgrowth may cause the hyperlipidemia appearance by enterohepatic circulation disturbance which evolves on the background of the early bile acids deconjugation with further endotoxin production and oxidative stress in the liver with hyperproduction of cholesterol and atherogenic lipoproteins. The aim: the determination of prevalence and features of SIBO in a series of patients with hyperlipidemia and in control subjects. PATIENTS AND METHODS Materials and methods: Nineteen patients with hyperlipidemia and ten control subjects were studied. Small intestinal bacterial overgrowth was assessed by a lactulose breath test. Such biochemical markers as CRP, ALT, AST, GGTP, apolipoprotein B, bilirubin, cholesterol and lipid profile were determined. Except the routine interpretation of lactulose breath test, which contains the SIBO detection, small intestinal transit time and hydrogen level evaluation with next comparison between groups of patients was realized. RESULTS Results: Small intestinal bacterial overgrowth was present in 78.9% of patients with hyperlipidemia and 40% in control subjects. The maximal dose of H2 was particularly higher in patients with hyperlipidemia in comparison with control group (94,7±13,69 vs. 36,13±5,4). There was a strong correlation between AST level and SIBO existence in both groups (r=1). Positive connection between LDL, TG, VLDL and the dose of exhaled hydrogen on 120 minute (r=0.6, r= 0.62, r=0.7 respectively) and strong negative correlation between HDL and 120 minute dose (r=-0.74) in main group was marked. CONCLUSION Conclusions: Patients with hyperlipidemia have a higher prevalence of small intestinal bacterial overgrowth and there is a relationship between H2 rate and LDL, TG, VLDL.
Collapse
Affiliation(s)
- Khrystyna B Kvit
- Department Of Therapy №1 And Medical Diagnostics, Faculty Postgraduate Teaching, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine, Medical Department, "Medicover Ukraine", Lviv, Ukraine
| | - Natalya V Kharchenko
- Department Of Gastroenterology, Dietology And Endoscopy, Shupyk National Medical Academy Of Postgraduate Teaching, Kyiv, Ukraine
| | - Vyacheslav V Kharchenko
- Department Of Gastroenterology, Dietology And Endoscopy, Shupyk National Medical Academy Of Postgraduate Teaching, Kyiv, Ukraine
| | | | | | | | | | - Oksana M Slaba
- Department Of Therapeutic Dentistry, Faculty Postgraduate Teaching, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| |
Collapse
|
45
|
Silvério SC, Macedo EA, Teixeira JA, Rodrigues LR. New β-galactosidase producers with potential for prebiotic synthesis. Bioresour Technol 2018; 250:131-139. [PMID: 29161572 DOI: 10.1016/j.biortech.2017.11.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
β-Galactosidases (EC 3.2.1.23) are interesting enzymes with potential application in the pharmaceutical and food industry. In this work, a screening study was carried out to identify new fungal sources of β-galactosidase. A total of 50 fungi were evaluated using a chromogenic test performed in agar plates. The most promising microorganisms were validated as effective β-galactosidase producers under submerged fermentation conditions. The crude β-galactosidases were characterized regarding their optimal pH (3.0-5.5) and temperature (45-65 °C). All enzymes showed ability to synthesize lactose-based prebiotics, namely lactulose (maximal yield 3.3%) and a galacto-oligosaccharide (GOS) (maximal yield 20%). Additionally, some enzymatic extracts with fructosyltransferase activity allowed to produce other type of prebiotics, namely fructo-oligosaccharides (FOS). This work, reports for the first time the simultaneous synthesis of different mixtures of GOS (2-15% yield and 0.07-0.5 g/L·h-1 productivity) and FOS (4-30% yield and 0.1-1 g/L·h-1 productivity) by crude extracts exhibiting dual enzymatic activity.
Collapse
Affiliation(s)
- Sara C Silvério
- CEB-Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Eugénia A Macedo
- Laboratory of Separation and Reaction Engineering - Laboratory of Catalysis and Materials (LSRE-LCM), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - José A Teixeira
- CEB-Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Lígia R Rodrigues
- CEB-Centre of Biological Engineering, Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| |
Collapse
|
46
|
Sakai Y. [Milk, Daily products and Bone health.The effect of lactulose on bone health.]. Clin Calcium 2018; 28:513-517. [PMID: 29593138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lactulose is a non-digestible oligosaccharide, consisting of galactose and fructose. Bifidobacteria in the large intestine assimilate and metabolize lactulose, which has not been degraded or absorbed by humans, and they subsequently proliferate. Predominant bifidobacteria release short chain fatty acids, such as acetic acid and lactic acid, into the intestinal tract by lactulose metabolization, which lowers the intraluminal pH. As a result, the calcium that has flowed into the large intestine without absorption in the small intestine is solubilized and absorbed in the large intestine. So that means continuous ingestion of lactulose might contribute to bone health by increasing the absorption efficiency of calcium.
Collapse
Affiliation(s)
- Yohei Sakai
- Food Ingredients & Technology Institute, R&D Division, Morinaga Milk Industry Co., Ltd., Zama, Japan
| |
Collapse
|
47
|
Guerrero C, Vera C, Illanes A. Fed-batch operation for the synthesis of lactulose with β-galactosidase of Aspergillus oryzae. Bioresour Technol 2017; 237:126-134. [PMID: 28162924 DOI: 10.1016/j.biortech.2017.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Abstract
Fed-batch synthesis of lactulose from lactose and fructose with Aspergillus oryzae β-galactosidase was evaluated, obtaining a concentration of 40.4g·L-1, which is 20% higher than obtained in batch, while the concentration of transgalactosylated oligosaccharides (TOS) was reduced by 98%. Therefore, selectivity of lactulose synthesis can be significantly higher by operating in fed-batch mode. The enzyme-limiting substrate mass ratio (E/S) is a critical variable in fed-batch operation. Higher values favor lactose hydrolysis over transgalactosylation, being 400IU/g the limit for proper lactulose synthesis in fed-batch operation. Selectivity of lactulose synthesis increased with E/S being quite high at 800IUH·g-1 or higher. However, this increase was obtained at the expense of lactulose yield. Lactulose synthesis in fed-batch operation was a better option than conventional batch synthesis, since higher product concentration and selectivity of lactulose over TOS synthesis were obtained.
Collapse
Affiliation(s)
- Cecilia Guerrero
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile
| | - Carlos Vera
- Department of Biology, Faculty of Chemistry and Biology, Universidad de Santiago de Chile (USACH), Santiago, Chile
| | - Andrés Illanes
- School of Biochemical Engineering, Pontificia Universidad Católica de Valparaíso (PUCV), Valparaíso, Chile.
| |
Collapse
|
48
|
McIntosh K, Reed DE, Schneider T, Dang F, Keshteli AH, De Palma G, Madsen K, Bercik P, Vanner S. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut 2017; 66:1241-1251. [PMID: 26976734 DOI: 10.1136/gutjnl-2015-311339] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To gain mechanistic insights, we compared effects of low fermentable oligosaccharides, disaccharides and monosaccharides and polyols (FODMAP) and high FODMAP diets on symptoms, the metabolome and the microbiome of patients with IBS. DESIGN We performed a controlled, single blind study of patients with IBS (Rome III criteria) randomised to a low (n=20) or high (n=20) FODMAP diet for 3 weeks. Symptoms were assessed using the IBS symptom severity scoring (IBS-SSS). The metabolome was evaluated using the lactulose breath test (LBT) and metabolic profiling in urine using mass spectrometry. Stool microbiota composition was analysed by 16S rRNA gene profiling. RESULTS Thirty-seven patients (19 low FODMAP; 18 high FODMAP) completed the 3-week diet. The IBS-SSS was reduced in the low FODMAP diet group (p<0.001) but not the high FODMAP group. LBTs showed a minor decrease in H2 production in the low FODMAP compared with the high FODMAP group. Metabolic profiling of urine showed groups of patients with IBS differed significantly after the diet (p<0.01), with three metabolites (histamine, p-hydroxybenzoic acid, azelaic acid) being primarily responsible for discrimination between the two groups. Histamine, a measure of immune activation, was reduced eightfold in the low FODMAP group (p<0.05). Low FODMAP diet increased Actinobacteria richness and diversity, and high FODMAP diet decreased the relative abundance of bacteria involved in gas consumption. CONCLUSIONS IBS symptoms are linked to FODMAP content and associated with alterations in the metabolome. In subsets of patients, FODMAPs modulate histamine levels and the microbiota, both of which could alter symptoms. TRIAL REGISTRATION NUMBER NCT01829932.
Collapse
Affiliation(s)
- Keith McIntosh
- GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
- St. Joseph's Hospital, Western University, London, Ontario, Canada
| | - David E Reed
- GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Theresa Schneider
- GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Frances Dang
- GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Giada De Palma
- Farmcombe Institute, McMaster University, Hamilton, Ontario, Canada
| | - Karen Madsen
- University of Alberta, Edmonton, Alberta, Canada
| | - Premysl Bercik
- Farmcombe Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Vanner
- GI Diseases Research Unit, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| |
Collapse
|
49
|
Ojetti V, Petruzziello C, Migneco A, Gnarra M, Gasbarrini A, Franceschi F. Effect of Lactobacillus reuteri (DSM 17938) on methane production in patients affected by functional constipation: a retrospective study. Eur Rev Med Pharmacol Sci 2017; 21:1702-1708. [PMID: 28429333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Constipation is a common symptom affecting up to 30% of the Western population and is strongly associated with the presence of intestinal methanogens, which may directly inhibit motor activity. Two recent studies performed on adult and children affected by chronic constipation showed that the supplementation with L. reuteri significantly improved bowel movements. Whether its action is related to a decreasing of methane (CH4) production has never been tested. We have therefore designed a study aimed at testing this hypothesis. PATIENTS AND METHODS Data of 20 adults (12 females, mean age 36.2 ± 13.7) affected by functional constipation, treated with the probiotic L. reuteri (DSM 17938) for 4 weeks who performed a H2/CH4 lactulose breath test (LBT) in our institution showing a CH4 production higher than 5 ppm were retrospectively analyzed from March to June 2015. Data recorded in their stool diary, reporting the frequency of defecations and stool consistency were also analysed, as well as the result of the LBT performed at the end of the treatment with L. reuteri. RESULTS Four weeks of L. reuteri administration was associated with a significant decrease of mean CH4 production determined by LBT (from 20.8 ± 15 to 8.9 ± 8.6; p < 0.0001 CI 95%) and of AUC value (from 5101.5 ± 3571.13 to 2128.4 ± 2110.8; p < 0.0001 CI 95%). Moreover, a total disappearance of CH4 production (< 5 ppm at LBT) was observed in 11 patients, while, we did not observe any significant decrease of H2 production (from 13.2 ± 8.8 to 11.4 ± 7.3, CI 95%, n.s.). CONCLUSIONS This study highlights for the first time the beneficial effect of Lactobacillus reuteri (DSM 17938) on chronic constipation, via a significant decrease of CH4 production.
Collapse
Affiliation(s)
- V Ojetti
- Department of Medical Sciences, Division of Gastroenterology, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
50
|
Błońska A, Konrad P, Chojnacki J, Chojnacki C. [Evaluation of oro-cecal transit time in patients with irritable bowel syndrome with cereal products intolerance]. Pol Merkur Lekarski 2017; 42:116-120. [PMID: 28333903] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The main symptoms of irritable bowel syndrome (IBS) include abnormal frequency of bowel movements. On this basis, three main clinical types of the disease have been distinguished, i.e.: constipation (IBSC), diarrhea (IBS-D) and mixed-type (IBS-M) in accordance with the Rome III criteria. These disorders mainly affect the colon, but symptoms related to upper gastrointestinal tract are also often observed. AIM The aim of the study was to assess the oro-caecal transit time in patients with irritable bowel syndrome with IgG-dependent hypersensitivity to cereal products. MATERIALS AND METHODS The study was performed in three 30-person groups, aged 27-48 years (38.3 ± 10.4), in whom three types of IBS were diagnosed basing on the Rome III criteria . The control group consisted of 30 subjects without gastrointestinal symptoms. Orocaecal transit time was measured by hydrogen breath test using lactulose and Gastro + Gastrolyzer (Bedfont). RESULTS The mean oro-caecal transit time was respectively in the groups: controls - 86,3 ± 5,95 min., IBS-C - 95,8 ±10,9 min. (p<0,05), IBS-D - 77,8 ± 8,21 min (p<0,01) and IBS-M - 80,6 ± 14,2 (p>0,05). There was a positive correlation between the transit time and disorder severity in IBS-C (p=0,05) group and negative in IBS-D (p<0,001) group. No significant correlation was found in IBS-M group (p=0,864). CONCLUSIONS Disturbed digestic passage in the upper gastrointestinal tract may affect the clinical manifestation of irritable bowel syndrome.
Collapse
Affiliation(s)
- Aleksandra Błońska
- Department of Clinical Nutrition and Gastroenterology Diagnostics Medical University of Łódź, Poland
| | - Paulina Konrad
- Department of Clinical Nutrition and Gastroenterology Diagnostics Medical University of Łódź, Poland
| | - Jan Chojnacki
- Department of Clinical Nutrition and Gastroenterology Diagnostics Medical University of Łódź, Poland
| | - Cezary Chojnacki
- Department of Clinical Nutrition and Gastroenterology Diagnostics Medical University of Łódź, Poland
| |
Collapse
|