Abnormal Bowel Function Research Articles

Rethinking Fistula Preservation in Anorectal Malformation Surgery: A Histopathological Perspective.

This study aims to assess the histopathological characteristics of the fistulous tissue in males with anorectal malformation (ARM) to determine its suitability for use in constructing a neoanus. This prospective observational study included male ARM patients with recto-urethral fistula. All other types were excluded. The tissue specimens comprised 0.5-2.0 cm of the most distal part of the rectal pouch and the fistulous tissue. Hematoxylin and eosin-stained sections were prepared. Histological features viz. internal sphincter, anal grand and crypts, ganglion cells, presence of subepithelial fibrosis, thickened nerve trunks, and metaplasia were evaluated. Of 65 patients of ARM admitted, 24 met the inclusion criteria. Gross and microscopic internal sphincter was not found in any sample. The anal mucosa was visualized in all cases; however, crypts were irregular and distorted architecture was seen in 4 (16.67%) samples. Urothelial metaplasia was identified in 10 (41.67%) cases. Adequate ganglion cells were seen only in 6 (25%) samples. Significant submucosal fibrosis was seen in all samples. Thickened nerve trunks were identified in 4 (16.67%) samples. All normal anal histological features could not be found together in the fistula tissue. With the absence of normal features, such as internal anal sphincter muscles, and the presence of abnormal histopathological features, such as subepithelial fibrosis, thickened nerve trunks, and metaplasia there are high chances of abnormal bowel function like constipation if the fistulous tissue is used for neoanus construction. It may have an impact on the quality of life of patients.

Low Plasma Citrulline Guiding the Diagnosis of a Mitochondrial Disorder.

A 3-month-old male presented with generalized seizures in the setting of a viral upper respiratory tract infection. The newborn screen (NBS) collected at 27 hours of life was normal. Initial evaluation was notable for lactic acidosis (lactate 4.1 mmol/L, reference interval [RI] 0.5–2.2 mmol/L; bicarbonate 12 mmol/L, RI 18–28 mmol/L). Cerebrospinal fluid analysis was normal. Brain magnetic resonance imaging (MRI) revealed T2 hyperintensities involving bilateral deep gray nuclei and upper brainstem regions suggestive of genetic or metabolic etiologies. Diffuse lactate elevation was also observed by magnetic resonance spectroscopy, consistent with a diagnosis of Leigh syndrome (LS, OMIM# 256000). Due to concerns for LS, a metabolic evaluation was obtained. The plasma amino acid (PAA) profile was notable for reduced citrulline (3 µmol/L, RI 7–47 µmol/L) in the context of normal glutamine (444 µmol/L, RI 285–832 µmol/L), leading to an abnormal plasma glutamine/citrulline ratio (148, RI <25). Given normal plasma ammonia and glutamine, a proximal urea cycle defect was unlikely. Low citrulline is also observed with short intestinal length and impaired intestinal absorption; however, the patient did not exhibit abnormal bowel function. Urine organic acid (UOA) analysis revealed elevated propionate metabolites (i.e., propionylglycine and methylcitrate) along with lactate, ketones, and tricarboxylic acid cycle metabolites (Fig.1). 3-Hydroxyisovaleric acid was normal, while 3-hydroxypropionic acid and 3-methylcrotonylglycine were not detected. The plasma acylcarnitine (PAC) profile was notably normal. Given the clinical and biochemical presentation, mitochondrial complex V deficiency mitochondrial type 1 (MC5DM1) caused by variants in MT-ATP6 (OMIM# 500015) was highly suspected (1, 2). Subsequent mitochondrial genome analysis of the proband’s blood revealed a pathogenic variant (m.8993T>G) in MT-ATP6 at 96% heteroplasmy, confirming a diagnosis of MC5DM1.

Effects of Peroral Microbiota Transplantation on the Establishment of Intestinal Microorganisms in a Newly-Hatched Chick Model

This study was carried out to compare gut microbial community composition, diversity, and function with and without microbiota transplantation in a newly-hatched chick model. Two hundred and forty newly-hatched Arbor Acre male broilers were assigned randomly to either a microbiota transplantation group or a control group (n = 120; 6 replicates per group, and 20 broilers per replicate). Both groups were fed a basal diet that met all nutritional requirements, composed of corn, soybean meal, cottonseed meal, vitamins, and minerals. The microbiota transplantation group was inoculated with the microbiota from the ceca of healthy adult chicks on day 1 and 2, respectively, over a trial period of 42 d. For both groups, the numbers of total bacteria, Lactobacillus and Escherichia coli, operational taxonomic unit partitioning and classification, taxonomic composition, comparative microbiota, and key bacterial species were identified by a 16S rRNA sequencing analysis. The results showed that Aestuariispira, Christensenella, Fervidicella, Gracilibacter, Haloferula, Mycoplasma, Novispirillum, and Pantoea were more abundant (p &lt; 0.05) in the microbiota transplantation group than those in the control group. This indicates that microbiota transplantation could directly influence the abundances of specific bacterial taxa in the ileum and cecum of broilers. These findings provide insight into the modulation of gut health for patients with abnormal bowel function, which should be of great interest to researchers in the area of gastroenterology, applied microbiology, and animal sciences.

Dissatisfaction with school toilets is associated with bladder and bowel dysfunction.

Poor quality of school toilets is reportedly an issue in many countries and has been correlated with toilet refusal in children. The aim of this study was to evaluate the association between perceived school toilet quality, behaviour regarding toilet visits, and symptoms of bladder and bowel dysfunction (BBD). Pupils in Danish schools were invited to complete online questionnaires regarding toilet behaviour, perception of school toilet standards/quality, and symptoms of BBD. Teachers at the same schools were asked about the quality of the toilets. We recruited 19,577 children from 252 different schools. More than half of the children (50% boys and 60% girls) were dissatisfied with the toilet facilities. One-fourth of the children (28% of girls, 23% of boys) reported avoiding the use of school toilets. We found a strong correlation between being dissatisfied with school toilets, toilet avoidance, and symptoms of BBD.Conclusion: The majority of Danish children are unhappy with their school toilet facilities. Symptoms of BBD are associated with subjective toilet dissatisfaction and toilet visit postponement. Because children spend a significant part of their day at school, access to satisfactory toilet facilities is of utmost importance for their well-being. What is Known • Bladder and bowel dysfunction is common in childhood with urinary incontinence, constipation, and faecal incontinence being cardinal symptoms. • Behaviour regarding toilet visits contributes to the aetiology, and we know that toilet avoidance can lead to abnormal bladder and bowel function. What is New • Most children are not satisfied with their school toilets, and many avoid toilet visits. • Dissatisfaction with the school toilets is related to toilet avoidance and bladder and bowel dysfunction in school children regardless of age and gender.

Development of abnormal bowel function after simple hysterectomy

Journals Journal of Men’s Health Frontiers in Bioscience-Elite Frontiers in Bioscience-Scholar Frontiers in Bioscience-Landmark Journal of Integrative Neuroscience Reviews in Cardiovascular Medicine Journal of Molecular and Clinical Medicine European Journal of Gynaecological Oncology Clinical and Experimental Obstetrics & Gynecology Resources For Authors For Reviewers For Editors Article Processing Charges Open Access Editorial Policies Publishing Ethic Copyright & License Digital Archive Privacy Policy Advertising Policies Peer Review Policy About Overview Management Team Contact Us Search Submit Home About Overview Aims & Scope Editorial Board Reviewer Board Indexing & Archiving Journal Awards Conferences Articles Forthcoming Issue Current Issue All Issues Special Issues Special Issues Edit a Special Issue Sections For Authors Submit Instructions for Authors Article Processing Charge Editorial Process Editorial Office Article Article Special Issue Advanced Section All sections Countries | Regions Countries | Regions Article Types Article Types Year — Volume Issue Pages — Search

The effect of vascular anatomy and gender on bowel function after right colectomy with extended D3-mesenterectomy

Background: Extended D3-mesenterectomy for right-sided colon cancer, removes all tissue around the superior mesenteric vessels beneath pancreas leading to transection of superior mesenteric plexus. In a previous study, the denervation was associated with 0.48 more stools/day. The study aims are to examine how presence of arterial branches proximal to the dissection area, gender and prolonged observation time after surgery affect bowel function following denervation. Methods: The study compares bowel function and Quality of Life in two groups undergoing right colectomy with extended D3-mesenterectomy and traditional D2-mesenterectomy. For further comparison, the denervated group was divided into groups with and without arterial branches arising proximal to the denervation. Instruments used were Gastrointestinal Quality of Life Index (0–144; 144= best) (GIQLI), Diarrhea Assessment Scale (0–12; 0= best) (DAS) and 3 additional questions (Ability to postpone defecation, night defecation, degree of distress). A second interview with prolonged observation time was performed for patients with abnormal bowel habits, defined as a) having 4 or more stools/day or b) being much or very much bothered. Results: Eighty-three D3-patients and 61 D2-patients, comparable for age and sex with shorter follow-up in the D3-group. In the D3-group 67 patients (80.7%) had one or more arteries proximal to the denervation. Sixteen patients (19.3%) had no proximal arteries. Regression analysis (correcting for confounding factors) revealed 0.30 (P=0.012) lower consistency score (increased consistency) and 0.27 (P=0.096) fewer stools/day in the D2- than the D3-group. DAS subscores, DAS, GIQLI and GIQLI-subscales revealed no differences between the groups. Within the D3-group, the estimated differences between patients with and without proximal arteries (adjusted for age, gender and time between surgery and interview) were significant for DAS and subscores; DAS: −1.526 (P=0.012), stool frequency: −0.653 (P=0.007), stool consistency: −0.432 (P=0.054), stool urgency: −0.595 (0.009). Negative scores represent lower (better) scores in the group with proximal arteries. GIQLI scores and subscales showed no difference. When genders were compared separately, the T-test revealed significantly lower (better) DAS and subscores for D2-females than D3-females, a difference not found in the male group. When controlled for observation time and age (regression) the difference disappears. A second interview with prolonged observation time (1. interview: 15.1 months, 2. interview: 56.4 months) for patients with abnormal bowel function reveals reduced (better) Extended DAS score (DAS + additional questions) in 8 of the 10 patients interviewed. 7 had no longer abnormal bowel function. Conclusions: D3-patients without arteries proximal to the nerve transection have significantly higher (worse) DAS-scores and subscores. The allover difference between the D2 and the D3 patients is small and only significant for consistency. Normalizing of the bowel function takes longer than assumed and continues for months and even years. Women are less able to compensate for the altered bowel habits during normalization.

Analysis of Recurrent Sacrococcygeal Teratoma in Children: Clinical Features, Relapse Risks, and Anorectal Functional Sequelae.

BackgroundSacrococcygeal teratoma (SCT) is a relatively uncommon tumor. Recurrence with poor survival and anorectal dysfunction are the 2 leading problems for patients. Here, we would review the clinic features of patients with SCTs in our hospital to identify risk factors of recurrent SCTs and to analyze anorectal functional sequelae.Material/MethodsA retrospective review of all patients with SCTs in our center between 2007 and 2013 was performed. We analyzed the recorded data on each patient and performed follow-up through phone calls.ResultsOur study included 105 inpatients (78 girls and 27 boys); 104 cases underwent surgical resection, and 62.5% cases had a mature histopathology. The proportion of malignant teratomas rose with increasing age. Fifteen children developed recurrent SCTs with a median of 11.5 months, and most of them had an elevation of AFP levels. Four recurrent children experienced a second tumor relapse. We observed a statistically significant difference in survival rate through Kaplan-Meier method between relapsed (66.7%) and non-relapsed (94.4%) patients. In univariate analysis, incomplete primary resection and malignant histology were proven to increase recurrence risks. Nearly half of patients had at least 1 of the parameters reflecting abnormal bowel function (e.g., involuntary bowel movements, fecal incontinence, and constipation). For those recurrent SCTs patients, difficulty defecating was a major problem.ConclusionsTumor recurrence affected the prognosis of children with SCT. In our research, incomplete resection and malignant histology were considered risk factors. Constipation was the main problem in anorectal functional sequelae for children who had recurrence.

Nocturia in women.

Nocturia in women is a notable health concern, associated with significant morbidity and decreases in health-related quality of life. It is implicated in daytime somnolence and poor sleep quality, and has been found to negatively impact household activities, work, exercise, and sexual activity. This review is intended to relay new information regarding the prevalence, cause, risk factors, ramifications, and treatment options for nocturia in women as it gains traction as a clinical entity in and of itself. New literature exposes the prevalence and burden of nocturia among young, healthy nulliparous women; reveals its presence in women without daytime symptoms; suggests its relationship with abnormal bowel function; and supports its association with obesity, cardiac burden and poor sleep. The link between nocturia and menopause has been challenged, and recent nomenclature describing the genitourinary symptoms of menopause excludes it from the list. Desmopressin and tamsulosin trials in women have demonstrated safety and efficacy in limiting nocturia frequency and severity, as well as in improving sleep parameters. Nocturia is an impactful health issue at risk of being missed, especially in younger female patients. Open dialogue, purposeful questioning, and screening surveys can help elicit this symptom in women who are embarrassed or who accredit it to normal aging and therefore do not seek medical attention. In light of a growing geriatric population, nocturia is a clinical entity of increasing importance as it can be a clue to underlying systemic disorder or it can be an isolated symptom with significant clinical implications if left unaddressed.

Residual neurological function after sacral root resection during en-bloc sacrectomy: a systematic review.

Sacrectomy is a highly demanding surgery representing the main treatment for primary tumors arising in the sacrum and pelvis. Unfortunately, it is correlated with loss of important function depending on the resection level and nerve roots sacrificed. The current literature regarding residual function after sacral resection comes from several small case series. The goal of this review is to appraise residual motor function and gait, sensitivity, bladder, bowel, and sexual function after sacrectomies, with consideration to the specific roots sacrificed. An exhaustive literature search was conducted. All manuscripts published before May 2015 regarding residual function after sacrectomy were considered; if a clear correlation between root level and functioning was not present, the paper was excluded. The review identified 15 retrospective case series, totaling 244 patients; 42 patients underwent sacrectomies sparing L4/L4, L4/L5 and L5/L5; 45 sparing both L5 and one or both S1 roots; 8 sparing both S1 and one S2; 48 sparing both S2; 11 sparing both S2 and one S3, 54 sparing both S3, 9 sparing both S3 and one or both S4, and 27 underwent unilateral variable resection. Patients who underwent a sacrectomy maintained functionally normal ambulation in 56.2% of cases when both S2 roots were spared, 94.1% when both S3 were spared, and in 100% of more distal resections. Normal bladder and bowel function were not present when both S2 were cut. When one S2 root was spared, normal bladder function was present in 25% of cases; when both S2 were spared, 39.9%; when one S3 was spared, 72.7%; and when both S3 were spared, 83.3%. Abnormal bowel function was present in 12.5% of cases when both S1 and one S2 were spared; in 50.0% of cases when both S2 were spared; and in 70% of cases when one S3 was spared; if both S3 were spared, bowel function was normal in 94% of cases. When even one S4 root was spared, normal bladder and bowel function were present in 100% of cases. Unilateral sacral nerve root resection preserved normal bladder function in 75% of cases and normal bowel function in 82.6% of cases. Motor function depended on S1 root involvement. Total sacrectomy is associated with compromising important motor, bladder, bowel, sensitivity, and sexual function. Residual motor function is dependent on sparing L5 and S1 nerve roots. Bladder and bowel function is consistently compromised in higher sacrectomies; nevertheless, the probability of maintaining sufficient function increases progressively with the roots spared, especially when S3 nerve roots are spared. Unilateral resection is usually associated with more normal function. To the best of our knowledge, this is the first comprehensive literature review to analyze published reports of residual sacral nerve root function after sacrectomy.

Clinical and manometric evaluations of anorectal function in patients after transanal endorectal pull-through operation for Hirschsprung's disease: A multicentre study

Aim Transanal endorectal pull-through (TEPT) operation is one the most popular operations for Hirschsprung's disease. This aim of the present study was to evaluate its outcome by clinical and manometric assessments. Patients and Methods This study was a multicentred study involving all three paediatric surgical centres under the Hospital Authority in Hong Kong. All patients, over the age of 3 years, who had undergone primary TEPT operation for more than 1 year, were included in the present study. Clinical evaluation with bowel function score (BFS) and anorectomanometry were carried out. A BFS > 18 and sphincter resting pressure between 30 mmHg and 60 mmHg were considered normal. Those with concomitant anorectal/neurological anomaly or who could not cooperate were excluded. Results A total of 37 patients were enrolled in this study. The median age was 60 months (range: 36–144 months), and the median age at the time of operation was 3 months (range: 0.5–60 months). With respect to functional outcomes, six patients (16.2 per cent) suffered from constipation, but more than two-thirds of patients had satisfactory stool consistency, as well as frequency. Sixteen patients (43.2 per cent) had no report of any soiling. For the BFS, 26 patients had a BFS above 18, with the median value being 16 (range: 7–20). Manometric assessment revealed that 27 patients (72.9 per cent) had sphincteric resting pressure within the normal value, and the median value was 45 mmHg (range: 14–79 mmHg). Rectoanal inhibitory reflex was present in six patients (16.2 per cent), and the median value for the volume of air to elicit the first anal sensation was 41 mL (range: 18–126 mL). Using univariate analysis, long segment disease was identified as a risk factor for developing soiling of more than two times per week [relative risk (RR): 1.87, 95 per cent confidence interval (CI):1.03–2.22, P = 0.05], whereas the creation of stoma (RR: 1.69, 95 per cent CI: 1.41–2.14, P = 0.04) and occurrence of postoperative enterocolitis (RR: 1.58, 95 per cent CI: 1.36–1.0, P = 0.04) were risk factors for abnormal bowel function score. There was no significant risk factor identified for abnormal manometric results. Lastly, patients with abnormal sphincter resting pressure detected in the anorectomanometry study were also more likely to have an abnormal BFS. Conclusion Most patients have satisfactory clinical and manometric outcomes after primary TEPT operation. Anorectomanometry findings can predict clinical outcomes. Patients with long segment disease, development of enterocolitis and stoma creation before operation will need more attention, as they are prone to develop abnormal bowel function. Early interventions, such as manometric assessment and proper bowel management, are recommended in order to correct bowel dysfunction, as well enabling patients to have a better quality of life.

Dietary requirement for serum-derived bovine immunoglobulins in the clinical management of patients with enteropathy.

A variety of human disease conditions are associated with chronic intestinal disorders or enteropathies that are characterized by intestinal inflammation, increased gut permeability, and reduced capacity to absorb nutrients. Such disruptions in the homeostasis of the gastrointestinal (GI) tract can lead to symptoms of abdominal pain and discomfort, bloating, abnormal bowel function, and malabsorption of nutrients. While significant advances have been made in understanding the factors that influence the complex and fragile balance between the gut microbiota, intestinal epithelial cell integrity, and the underlying immune system, effective therapies for restoring intestinal balance during enteropathy are still not available. Numerous studies have demonstrated the ability of oral immunoglobulins to improve weight gain, support gut barrier function, and reduce the severity of enteropathy in animals. More recently, studies in humans provide evidence that serum-derived bovine immunoglobulin/protein isolate is safe and improves nutritional status and GI symptoms in patients with enteropathy associated with irritable bowel syndrome or infection with the human immunodeficiency virus. This review summarizes studies showing the impact of enteropathy on nutritional status and how specially formulated bovine immunoglobulins may help restore intestinal homeostasis and nutritional status in patients with specific enteropathies. Such protein preparations may provide distinct nutritional support required for the dietary management of patients who, because of therapeutic or chronic medical needs, have limited or impaired capacity to digest, absorb, or metabolize ordinary foodstuffs or certain nutrients, or other special medically determined nutrient requirements that cannot be satisfied by changes to the normal diet alone.

The long-term outcome of patients diagnosed with sacrococcygeal teratoma in childhood. A study of a national cohort

Background/PurposeThe improved survival of sacrococcygeal teratoma (SCT) has led to increased awareness of its long-term sequelae. Our aim was to assess the long-term outcome of a national cohort using detailed...

Prevalence and effectiveness of laxative use among elderly residents in a regional hospital affiliated nursing home in hsinchu county.

Long-term care residents are susceptible to constipation and one-half to three quarter of older nursing home residents receive laxatives regularly. The purpose of this study was to evaluate the factors related to abnormal bowel function and explore the effectiveness of laxative treatment among the elderly residents of a nursing home. A total of 110 residents older than 65 years old was enrolled in this study. The following variables were gathered: age, gender, body mass index (BMI), length of stay, daily fluid intake, type of food, functional level, cognitive ability, physical therapy status, somatic and psychiatric diseases, number of medications, and medication use. The use and dosage of laxatives were recorded by means of Anatomical Therapeutic Chemical (ATC) classification system. Normal bowel function was defined as defecation frequency from three defecations per day to three defecations per week and stool consistency score of three to five on Bristol Stool Form Scale. A comparison between groups with normal and abnormal bowel function was drawn. Low BMI, increased fluid intake, liquid food intake, poor functional level, poor cognition, and a history of stroke were significantly associated with altered bowel function (P < 0.05). The most frequently used laxatives were glycerol, senna glycoside, and magnesium oxide. There were significant differences in laxative regimens between residents with normal and altered bowel function; those with altered bowel function tended to take more laxatives than those with normal bowel function. This study suggested that treatment of constipation in the nursing home was unsatisfactory. To improve treatment outcomes in those susceptible to altered bowel function, a coordinated approach with involvement of physicians, nursing staff, and other professionals including dieticians and pharmacists seems necessary.

Bovine immunoglobulin protein isolates for the nutritional management of enteropathy.

The gastrointestinal tract is responsible for a multitude of digestive and immune functions which depend upon the balanced interaction of the intestinal microbiota, diet, gut barrier function, and mucosal immune response. Disruptions in one or more of these factors can lead to intestinal disorders or enteropathies which are characterized by intestinal inflammation, increased gut permeability, and reduced capacity to absorb nutrients. Enteropathy is frequently associated with human immunodeficiency virus (HIV) infection, inflammatory bowel disease, autoimmune enteropathy, radiation enteritis, and irritable bowel syndrome (IBS), where pathologic changes in the intestinal tract lead to abdominal discomfort, bloating, abnormal bowel function (e.g., diarrhea, urgency, constipation and malabsorption). Unfortunately, effective therapies for the management of enteropathy and restoring intestinal health are still not available. An accumulating body of preclinical studies has demonstrated that oral administration of plasma- or serum-derived protein concentrates containing high levels of immunoglobulins can improve weight, normalize gut barrier function, and reduce the severity of enteropathy in animal models. Recent studies in humans, using serum-derived bovine immunoglobulin/protein isolate, demonstrate that such protein preparations are safe and improve symptoms, nutritional status, and various biomarkers associated with enteropathy. Benefits have been shown in patients with HIV infection or diarrhea-predominant IBS. This review summarizes preclinical and clinical studies with plasma/serum protein concentrates and describes the effects on host nutrition, intestinal function, and markers of intestinal inflammation. It supports the concept that immunoglobulin-containing protein preparations may offer a new strategy for restoring functional homeostasis in the intestinal tract of patients with enteropathy.

Healthy Subjects Experience Bowel Changes on Enteral Diets

Tube-fed patients frequently suffer from abnormal bowel function that affects intestinal bacteria and quality of life. Dietary fiber affects laxation and can be fermented by gut bacteria to metabolites that influence gut health and fecal moisture. The aim of this study was to compare the effects of a fiber-blend fortified enteral formula (FB, 15 g/L), a fiber-free formula (FF), and habitual diet on bowel function, fecal bacteria, and quality of life. In a randomized, double-blind, crossover design, 20 healthy subjects consumed both FF and FB for 14 days with a 4-week washout. A 5-day fecal collection was used to assess stool output, whole-gut transit time (WGTT), total bacteria, bifidobacteria, lactobacilli, clostridia, and bacteroides. Subject gastrointestinal quality of life index (GIQLI) and side effects were also measured. On formula diets, 5-day fecal output decreased by >55% from habitual diet, but was 38% higher on FB than FF (P = .0321). WGTT was approximately 1.5 times longer on formula diets than habitual diet (P < .0004). Total bacteria declined from habitual diet on FF (P < .004), but not on FB. Numbers of bifidobacteria and lactobacilli declined from habitual diet on both formula diets, but bifidobacteria was higher on FB compared with FF (P < .0001). Bacteroides and clostridia numbers did not change between diets. GIQLI and incidence of gas symptoms did not differ between formulas. Addition of a fiber blend moderated changes in bowel function and gut bacteria observed in healthy subjects consuming FF. These results support adding mixed fiber sources to enteral nutrition if no contraindication exists.

A 50:50 blend of insoluble and soluble fibers added to enteral formula increases fermentation and prevents decline in gut bacteria

Fermentation of fiber in the gut increases bacterial mass and short chain fatty acid (SCFA) production. Patients receiving fiber‐free enteral nutrition frequently suffer from abnormal bowel function and may benefit from the addition of fiber. The objective of this study was to compare the effects of fiber‐free enteral formula (FF), a fiber blend‐fortified formula (FB; 15g/L: fructooligosaccharides, inulin, acacia gum, outer pea fiber) and habitual diet on the gut bacteria population and fermentation metabolites in 20 healthy subjects. Formula was exclusively consumed by subjects for 2 weeks in a randomized, crossover, double‐blind design, with a 4 week washout. Stool samples were collected to measure pH, SCFA (acetate, propionate, butyrate) and total bacteria. Mean fecal pH for both formulas was 7.5; higher than habitual diet pH 6.5 (p&lt;0.0001). Mean total SCFA during FB was significantly higher than FF (43.5 vs. 39.7 umol/ml fecal water; p=0.029), and both formulas yielded lower SCFA than habitual diet (80.9 umol/ml; both p&lt;0.0001). Total fecal bacteria did not differ between FF and FB (11.28 and 11.38 log10 cells/g feces, respectively; p=0.4865). Compared to habitual diet (11.58 log10 cells/g feces), FF had fewer bacteria (p=0.0045), while FB was not different (p=0.0570). Adding fiber to enteral formula positively affects gut fermentation by increasing SCFA production and attenuating decreases in bacteria.Grant Funding Source: Nestle Health Science S.A.

Psychological interventions for irritable bowel syndrome: A nursing perspective

Irritable bowel syndrome (IBS) is a common functional bowel disorder. It accounts for up to 50% of all referrals to gastrointestinal departments and to this day it remains a mysterious and poorly understood condition. IBS patients can suffer from abnormal bowel function and a range of unexplained abdominal symptoms, which can have a detrimental affect on their psychological wellbeing and health-related quality of life. In this article, Graeme D Smith outlines the psychological management of IBS from a nursing perspective.

Anomalies cutanées des sinus dermiques communicants : à propos de 2 cas

Skin abnormalities in the spinal lumbosacral region of infants are not infrequent. Physicians should look for underlying spinal malformations. We report 2 cases of dermal sinus in infants revealed by severe, acute meningitis. The dermal sinus is an abnormal tract between the skin and underlying neural structures, most often located in the lumbosacral region. It may end blindly in the subcutaneous tissues, or it may extend into the medullary space. The diagnosis should be suspected in patients with other skin findings: localized hypertrichosis, subcutaneous lipomas, hyperpigmented lesions, etc. It must be distinguished from the very frequent coccygeal pits (4% of newborns), which require no treatment. Magnetic resonance imaging should be done every time the diagnosis is suspected. Recurrent bacterial meningitis or meningitis caused by unusual bacteria is frequently associated with dermal sinus. A variety of neurologic abnormalities have been described: sensory changes, motor weakness, reflex changes, abnormal bowel and bladder function, etc. Infants generally have few neurologic symptoms, such as delayed walking or sphincter control. Orthopaedic abnormalities are rare. The dermal sinus tract needs to be detected at an early stage in order to avoid these complications, which can be prevented by early surgery.

Carcinosarcoma of pancreas with liver metastasis combined with gastrointestinal stromal tumour of the stomach: is there a good prognosis with the complete resection?

We report a carcinosarcoma of the pancreas with liver metastasis combined with gastrointestinal stromal tumour (GIST) of the stomach in a 72-year-old woman who presented with right upper quadrant pain, nausea and vomiting. A radical resection including pancreaticoduodenectomy, left hepatic lobe resection and local resection of the gastric mass was performed. The tumour in the head of pancreas was found to be grossly yellow-white, and it infiltrated the common bile duct and duodenum; the mass of the liver metastasis is solitary. Pathologic examination showed two components separated from each other: one component was a conventional infiltrating pancreatic ductal adenocarcinoma, and the other component showed sarcomatous growth pattern composed of pleomorphic spindle cells. The neoplasm of the stomach was confirmed a low malignant potential GIST by histology and immunohistochemistry. The patient was obliged to be in hospital because of abnormal bowel function; moreover, surveillance CT scans performed at 1.5 months post-operatively showed multiple liver metastasis and recurrence in the tail of pancreas. Unfortunately, the patient died of multiple organ failure at 2 months post-operatively. To our knowledge, this is the first experience report about surgical treatment of carcinosarcoma of pancreas with liver metastasis combined with GIST of the stomach. The patient performed a radical surgery for the metastatic carcinosarcoma even if that could be resected completely did not have a good consequence.

IL1β‐ and LPS‐induced serotonin secretion is increased in EC cells derived from Crohn’s disease

Gut mucosal enterochromaffin (EC) cells are regarded as key regulators of intestinal motility and fluid secretion via secretion of serotonin (5HT), are increased in numbers in mucosal inflammation and located in close proximity to immune cells. We examined whether interleukin (IL)1beta and Escherichia coli lipopolysaccharide (LPS) induced EC cell 5HT release through Toll-like/IL-1 (TIL) receptor activation, nuclear factor kappa B (NFkappaB) and mitogen-activated protein kinase (MAPK) phosphorylation and evaluated whether somatostatin could inhibit this phenomenon. Pure (>98%) human intestinal EC cells were isolated by fluorescent activated cell sorting from preparations of normal (n = 5) and Crohn's colitis (n = 6) mucosa. 5HT release was measured (ELISA), and NFkappaB and ERK phosphorylation quantitated (ELISA) in response to IL1beta and LPS. 5HT secretion was increased by both E. coli LPS (EC(50) = 5 ng mL(-1)) and IL1beta (EC(50) = 0.05 pmol L(-1)) >2-fold (P < 0.05) in Crohn's EC cells compared with normal EC cells. Secretion was reversible by the TLR4 antagonist, E. coli K12 LPS (IC(50) = 12 ng mL(-1)) and the IL1beta receptor antagonist (ILRA; IC(50) = 3.4 ng mL(-1)). IL1beta caused significant (P < 0.05) NFkappaB and MAPK phosphorylation (40-55%). The somatostatin analogue, lanreotide inhibited IL1beta-stimulated secretion in Crohn's (IC(50) = 0.61 nmol L(-1)) and normal EC cells (IC(50) = 1.8 nmol L(-1)). Interleukins (IL1beta) and bacterial products (E. coli LPS) stimulated 5HT secretion from Crohn's EC cells via TIL receptor activation (TLR4 and IL1beta). Immune-mediated alterations in EC cell secretion of 5HT may represent a component of the pathogenesis of abnormal bowel function in Crohn's disease. Inhibition of EC cell-mediated 5HT secretion may be an alternative therapeutic strategy in the amelioration of inflammatory bowel disease symptomatology.