Acidity Of Gastric Juice Research Articles

STATUS OF ORAL MUCOSA MICROBIOTOPE IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

In recent years, the issues of "extraesophageal manifestations" of gastroesophageal reflux disease has been receiving more attention from researchers and clinicians that can be explained by the complexity in diagnosis and treatment of the disease, and the necessity in collaboration between medical professional of different specialties as extra-esophageal manifestations can come to the fore imitating diseases of other organs. In the oral cavity there is a favourable environment for the development of beneficial, pathogenic and opportunistic microorganisms. The aim of this study is to investigate the state of oral mucosa microbiotope in patients with gastroesophageal reflux disease. The study included 90 individuals aged from 25 to 55 years, the two test groups involved 30 people in each who had clinically and laboratory confirmed diagnosis of gastroaesophageal reflux disease with hyperacidity and hypoacidity; control group consisted of 30 healthy individuals. The study has demonstrated that the number of microorganisms in the oral cavity differs significantly in sick and healthy people. The most significant changes have been found on the tongue (presence of a large number of opportunistic microorganisms and pathogens) and observed in patients with gastroesophageal reflux disease, especially with high gastric juice acidity. Changes in the micro-biotope on the tongue can be used for confirming diagnosis of gastrointestinal disorders (chronic gastritis, peptic ulcer disease, duodenitis), and gastroesophageal reflux disease in particular.

Encapsulation efficiency and oral delivery stability of chitosan–liposome‐encapsulated immunoglobulin Y

The degradation of acidic gastric juice on immunoglobulin Y (IgY) leads to destruction on the structural and loss of the bioactivity, limiting the bioavailability of oral IgY and its research or application in adjuvant treatment of diseases. In this work, it was surmounted with IgY-loaded chitosan-liposomes prepared by supercritical carbon dioxide-assisted method. A range of chitosan concentrations (0%, 0.5%, 0.8%, 1.1%, and 1.4%) were selected to explore the influence of chitosan concentration on the encapsulation effectiveness, stability, and in vitro-simulated digestive release properties of liposome-encapsulated IgY. The results displayed that owing to the robust interaction between chitosan and liposomes, the particle size, encapsulation efficiency, and stability of liposomes reached the optimal state at a chitosan concentration of 0.8%, with the encapsulation efficiency reaching 77.51%. Moreover, the liposomes could be stored at 4°C for 9 days without obvious sedimentation. The zeta potential of liposomes containing 0.8% chitosan was higher than that of samples without chitosan at high salt concentration treatment. In vitro release experiments demonstrated that liposomes fitted well in the Peppas equation. Chitosan-coated liposomes were capable of delaying the release of IgY in the stomach during simulated digestion, allowing more IgY to be released in the intestine. To sum up, Chitosan played a vital role in maintaining the stability and encapsulation of IgY, and the results of this work provide a theoretical basis for the development and utilization of chitosan and the protection of activity of IgY when administered orally. PRACTICAL APPLICATION: IgY serves as a bioactive substance with anti-inflammatory, antibacterial, and antioxidant functions. However, it is far from satisfactory for the oral delivery activity of IgY. Encapsulation of liposomes contributed to alleviate the release of IgY in the stomach. However, liposomes were less stable and not efficient enough to encapsulate IgY. This study demonstrated that the addition of 0.8% chitosan could effectively enhance the encapsulation efficiency of liposomes and improved the stability of liposomes. It might contribute to the solution of the oral delivery activity of IgY and provide a promising idea for the utilization of chitosan.

Evaluation of acute toxicity and antiulcer activity of Pepgard tablet: An Ayurvedic formulation.

In traditional Indian medicine, several plants have been used to treat gastrointestinal disorders, including gastric ulcers. Pepgard tablet is an Ayurvedic compound formulation widely used in clinical practice as an antacid for treating nonulcer dyspepsia, gastroesophageal reflux, and drug-induced gastritis. Evaluation of acute toxicity of Pepgard tablet and antiulcer activity against gastric ulcer induced by aspirin plus pyloric ligation in albino rats. Acute toxicity was studied as per OECD 425 guideline at a limit dose of 2000 mg/kg in female albino rats. Antiulcer activity was assessed by aspirin plus pyloric ligation model at two dose levels (90 and 180 mg/kg, po). Gastric juice parameters, stomach tissue parameters, and histopathological study along with an assessment of ulcer index were assessed. Pepgard did not produce any toxicity or lethality at a limit dose of 2000 mg/kg and was found safe in female albino rats. Pepgard at both dose levels showed an antiulcer effect as evidenced by an increase in pH value, decreased acidity, and peptic activity of gastric juice along with a decrease in ulcer index and increased antioxidant status of damaged gastric mucosa as revealed by an increase in catalase, glutathione, etc., in stomach homogenate of albino rats. The present study of Pepgard tablet revealed its safety in acute toxicity studies and can be categorized as substances with low health hazard potential. Pepgard has been shown to be effective as an antacid, anti-ulcer, and to have gastroprotective effects against experimentally-induced ulcerogenesis in albino rats.

Bile acid linked β-glucan nanoparticles for liver specific oral delivery of biologics.

Oral delivery remains one of the most convenient routes for drug administration compared to intravenous, intramuscular, and via suppositories. However, due to the risk of degradation, and proteolysis of molecules in the acidic gastric medium, as well as the difficulty of transporting large molecules through the intestinal membrane, more than half of the therapeutic molecules are prohibited for oral administration. Moreover, most of the large molecules and biological therapeutics are not available in oral dosage form due to their instability in the stomach and inability of intestinal absorption. To achieve expected bioavailability, an orally administered therapeutic molecule must be protected within the stomach, and transportation facilitated via the small intestine. In this project, we have introduced a hybrid carrier, composed of Taurocholic Acid (TA) and β-Glucan (TAG), that is shown to be effective for the simultaneous protection of the biologics in acidic buffer and simulated gastric juice as well as facilitate enhanced absorption and transportation via the small intestine. In this project, we have used an eGFP encoded plasmid as a model biologic to prepare particles mediated with TAG. TAG show the potential of enhancing transfection and expression of eGFP as we have observed two fold higher expression in the cell upon coincubation for 4 h. In vivo studies on orally dosed mice showed that eGFP expression in the liver was significantly higher in TAG containing particles compared to particles without TAG. The findings suggest that the TAG carrier is capable of not only preserving biologics but also transporting them more efficiently to the liver. As a result, this strategy can be employed for a variety of liver-targeted therapeutic delivery to treat a variety of liver diseases.

Dual-network hydrogel based on ionic nano-reservoir for gastric perforation sealing

In recent years, remarkable progress has been made in the research of injectable hydrogel for internal tissue healing. However, the therapeutic outcome is usually limited when the hydrogel is used for the treatment of gastric perforation due to the high acidic gastric juice and violent deformation of the gastric wall. Regarding these challenges, we proposed an ionic nano-reservoir (INR)-based dual-network hydrogel, which has excellent adhesion and mechanical properties, and can be easily applied to the perforation site to block the perforation while promoting tissue repairing. The results showed that the first network made of polyacrylamide had cross-linked on the stomach tissue within 5 s under blue light, and enhanced the adhesion performance through mechanical interlock. The nano-hydroxyapatite acted as ionic INR, which can gradually release Ca2+ under acid environments to form the second network with sodium alginate and inhibit the swelling of hydrogel in gastric juice. Meanwhile, the adhesion was further enhanced through amide covalent bonds at the hydrogel-tissue interface with the presence of 1- ethyl-3-(3-dimethylaminopropyl)carbodiimide/N-hydroxysuccinimide (EDC/NHS). The dual network hydrogels obtained by the INR strategy could be employed as a potential therapeutic option for gastric perforation and other similar biomedical prolems.

Treatment of anemia in mixedema. Lerman et Means (Pr. Med. 1933, 12)

Anemia often occurs with mixadema and is very often accompanied by a lack of hydrochloric acid in gastric juice. In some cases, thyroidin is enough to eliminate anemia, in others anemia persists and only the number of erythrocytes returns to normal.

Gastroprotective effects and metabolomic profiling of Chasteberry fruits against indomethacin-induced gastric injury in rats

Vitex agnus castus L. extract (VACE) was investigated for its gastroprotective properties and possible molecular mechanisms in rats. VACE (60 or 120 mg/kg) or Esomeprazole (20 mg/kg) were orally administered for 3 weeks before the induction of gastropathy using indomethacin (30 mg/kg, single oral dose). VACE ameliorated the indomethacin-induced gastric juice acidity and pathological changes. VACE significantly preserved GSH, SOD, NO and PGE2 contents, while decreased lipid-peroxide, TNF-α and MPO contents. Moreover, VACE downregulated NF-κB1, COX-2, Caspase-3 and upregulated Bcl-2 and HSP-70 expression. Ultra-high-performance liquid chromatography (UPLC) coupled with quadrupole high-resolution time of flight mass spectrometry (qTOF-MS) enabled the tentative identification of 87 compounds allocated in seven main classes including flavonoids, glycosylated iridoid and labdane diterpenes. Notably, different agnuside derivatives and diterpenoids were reported in VACE for the first time. In conclusion, VACE contains an arsenal of bioactive metabolites which may exhibit gastroprotection by inhibiting inflammation, oxidative stress, and apoptosis.

Critical Review on Kaidaryadi Kashaya in Irritable Bowel Syndrome w.s.r to Grahani

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by varying bowel habits and recurrent abdominal pain. An observational study conducted on 25 patients of IBS who attended the Kayachikitsa O.P.D, V.P.S.V Ayurveda college, Kottakkal noticed Muhurbadha muhurdrava varchas (Increased frequency of loose stools after meals)- 88%, Saruja malapravrithi (abdominal pain during defaecation)- 60%, Daha (burning sensation)- 60% and Sleshmasamsrishta mala (mucus in stools)- 52% as the common presentations. On assessing the symptoms, Grahani dushti, Agnimandya, Arsas and Tridosha involvement can be found predominating in the pathophysiology. Kaidaryadi kashayam is a well known traditional decoction formulation from the text Chikitsa manjari- Mahodara chikitsa. This yoga having Tridoshahara, Kleda soshana, Pachana deepana, Vatanulomana and Grahani balya property is found to be effective in reducing the symptoms of IBS, when administered along with suitable formulations. Kaidaryadi kashayam contain 4 drugs i.e., Zingiber officinale, Murraya koeinigii, Terminalia chebula and Tricosanthes dioica. The action of Kaidaryadi kashayam is evaluated for its action on IBS based on available clinical and research data here in this paper. The ingredients inhibits proton pump, thereby reducing the gastric secretion, helps in the protection of gastric mucosa, reduces the acidity of gastric juice and acts as a strong cytoprotective. So based on the available data we can say Kaidaryadi kashayam is an effective formulation in the management of Lower GIT pathology of IBS.

AQUEOUS EXTRACT OF WHOLE PLANT OF HYPTIS SUAVEOLENS (L.) POIT: AN ANTI-ULCER AGENT

The aim of current experimental study was to determine anti-ulcer potential of Watery extricate of Hyptis suaveolens entire plant (AEHS) on the Wister strain albino rats. The Watery extricate of Hyptis suaveolens entire plant (in two different doses, 250mg/kg and 500 mg/kg) was allowed for anti-ulcer activity against Pylorus ligation induced model in Wistar albino rats. Omeprazole (20mg/kg) was used as standard for the evaluation of activity. Parameters like Proportion of Ulcer protection was reckoned based on Ulcer index and Digestive juice volume, pH and acidity of gastric juice, Mucus production and Pepsin estimation, tensile strength. The AEHS with 500 mg/kg dose was shown significant anti-ulcer activity when compared with the control group.

Assessment on In Vitro Probiotic Attributes of Lactobacillus plantarum Isolated From Horse Feces

This study was designed to assess in vitro probiotic attributes of potent bacterium isolated from the feces of healthy horse. Initially, a total of eight bacteria were isolated from the feces and evaluated their antibacterial activities against indicator bacterial pathogens using agar well diffusion assay. Results showed significant (P < .05) antibacterial property of Lactobacillus plantarum strain LF4 against pathogens tested with maximum growth inhibitory activity of 320.16 ± 3.4 AU/mL against Staphylococcus aureus. Further, in vitro probiotic properties of strain LF4 were determined using standard methodologies. Strain LF4 maintained its viability towards acidic condition (pH 2.0) and simulated gastric juice (pH 2.0) with total cell counts of 1.6 ± 0.18 and 1.7 ± 0.18 log cfu/mL, respectively. Moreover, the strain was observed resistant to oxgall (0.5% w/v) up to 36 hours. The isolate showed significant (P < .05) hydrophobicity property (60.3 ± 1.6%), auto-aggregation trait (41.31 ± 1.5%), and moderate proteolytic activity. Strain LF4 revealed significant (P < .05) rate of DPPH scavenging (15.3 ± 1.3-69.7 ± 1.3%) and hydroxyl radical scavenging (11.3 ± 1.3 to 56.4 ± 1.3%) in a concentration dependent manner. Additionally, the isolate was observed susceptible to all the conventional antibiotics tested, thereby indicating its safer utilization. In conclusion, findings suggested the colossal applications of L. plantarum strain LF4 as an ideal probiotic bacterium in equine industries.

Anti-Ulcerogenic and Cytoprotective Effects of Saharian (Sidr) Honey from Algeria.

This study aimed at investigating the gastro-protective effects of Algerian Sahara (Sidr) honey from Apis mellifera intermissa against HCl/Ethanol-induced gastric ulcers in rats. Total phenolic content, antioxidant activity and phenolic compounds were determined. Then, three groups of rats (control, HCl/ Ethanol-induced ulcer, and orally administered honey) were used for the determination of gastro-protective effect of Sidr honey. Total phenolic content, total flavonoid content, and DPPH activity of the honey sample were determined as 47.35±3.35 mg GAE/ 100 g, 2.13±0.17 mg QE/ 100 g, and 229.24±0.02 mg/mL, respectively. Oral pretreatment of rats with honey (1.2 g/Kg body weight orally at an interval of 2 days) protected gastric mucosa against HCl/Ethanol-induced damage by decreasing ulcer score, the volume and acidity of gastric juice and increasing pH. These results were confirmed by the histological assessment, which demonstrated a significant gastro-protective activity of Saharian (Sidr) honey against HCl/Ethanol-induced stomach ulcer. Plasma tumor necrosis factor-α, IL-6 and PGE2 were also measured. Sahara honey significantly decreased the plasma TNF-α, PGE2, and IL-6 concentrations.

Amelioration of alcohol‑induced gastric mucosa damage by oral administration of food‑polydeoxyribonucleotides

Gastritis refers to inflammation caused by injury to the gastric epithelium, which is usually due to excessive alcohol consumption and prolonged use of nonsteroidal anti-inflammatory drugs. Millions of individuals worldwide suffer from this disease. However, the lack of safe and promising treatments makes it urgent to explore and develop leads from natural resources. Therefore, food as medicine may be the best approach for the treatment of these disorders. The present study described the protective effects of food-polydeoxyribonucleotides (f-PDRNs) in a rat model of gastric mucosal injury induced by HCl-EtOH. Administration of f-PDRN was performed with low-PRF002 (26 mg/kg/day), medium-PRF002 (52 mg/kg/day) and high-PRF002 (78 mg/kg/day) on the day of autopsy. The site of damage to the mucous membrane was also analysed. In addition, an increase in gastric juice pH, total acidity of gastric juice and decrease in gastric juice secretion were confirmed, and gastric juice secretion-related factors corresponding to the administration of f-PDRN were analysed. Administration of f-PDRN reduced the mRNA expression of histamine H2 receptor, muscarinic acetylcholine receptor M3, cholecystokinin 2 receptor and H+/K+ ATPase related to gastric acid secretion and downregulation of histamine, myeloperoxidase and cyclic adenosine monophosphate. In addition, it was histologically confirmed that the loss of epithelial cells and the distortion of the mucosa were recovered in the group in which f-PDRN was administered compared to the model group with gastric mucosa damage. In summary, the present study suggested that f-PDRN has therapeutic potential and may have beneficial effects if taken regularly as a food supplement.

On the formation of hydrochloric acid in gastric juice

Dr. G. Semenov [*], working in 1924 in the laboratory of the Zheleznovodsk resort, where he used rich material on gastric juice from resort patients (up to 1000 cases), discovered a gradual increase in the acidity of the juice he extracted as the latter stood.

Gastrobodies are engineered antibody mimetics resilient to pepsin and hydrochloric acid

Protein-based targeting reagents, such as antibodies and non-antibody scaffold proteins, are rapidly inactivated in the upper gastrointestinal (GI) tract. Hydrochloric acid in gastric juice denatures proteins and activates pepsin, concentrations of which reach 1 mg/mL in the mammalian stomach. Two stable scaffold proteins (nanobody and nanofitin), previously developed to be protease-resistant, were completely digested in less than 10 min at 100-fold lower concentration of pepsin than found in the stomach. Here we present gastrobodies, a protein scaffold derived from Kunitz soybean trypsin inhibitor (SBTI). SBTI is highly resistant to the challenges of the upper GI tract, including digestive proteases, pH 2 and bile acids. Computational prediction of SBTI’s evolvability identified two nearby loops for randomization, to create a potential recognition surface which was experimentally validated by alanine scanning. We established display of SBTI on full-length pIII of M13 phage. Phage selection of gastrobody libraries against the glucosyltransferase domain of Clostridium difficile toxin B (GTD) identified hits with nanomolar affinity and enzyme inhibitory activity. Anti-GTD binders retained high stability to acid, digestive proteases and heat. Gastrobodies show resilience to exceptionally harsh conditions, which should provide a foundation for targeting and modulating function within the GI tract.

A simplified method for titrating gastric juice.

Since the discovery of methods for accurately determining the acidity of gastric juice and until recently, it was considered extremely important for diagnostic purposes, extremely pedantic and accurate determination, through titration and other methods, of the factors that determine the acidity of gastric juice.

Role of Low Environmental Temperature in Peptic Ulcer Development

Peptic ulcers are described as acid-induced lesions found in the stomach and duodenum caused bythe imbalance between the defending factors of the mucosa and the attacking factors such ashydrochloric acid in gastric juice, with Helicobacter Pylori (H. Pylori) and Non-Steroidal Anti-Inflammatory Drugs NSAIDs. They exhibit seasonal patterns in their occurrence, with higheroccurrence in winter and spring and a low occurrence in summer. Temperature plays a major role intheir occurrence, some of which have resulted in increased morbidity in some number of diseases,such as gastrointestinal bleeding, caused by an increase in air pressure, dry air (relative humidity)occurring from cold air, and also its actions on the protective effect helicobacter pylori in the humanbody. Their actions excite the adrenal gland marrow and the sympathetic nerve, causing rapidsecretion of adrenaline and non-adrenaline, angiotensin II and endothelin, resulting in damage tothe mucosa epithelial, caused by the contraction effect of the adrenal agents on the duodenalmucosa and blood vessel. It causes low expression of Epidermal Growth Factor Receptor (EGFR),Epidermal Growth Factor (EGF), Heat Shock Protein (HSP) 70, Occludin, Nitric Oxide Synthase(NOS), in the gastric mucosa, in extremely cold temperature than those in extremely hottemperature, increasing the gastric acid secretion in extremely cold temperature than in extremelyhot temperature. Therefore, this review aims to give general insight into the role of low temperaturein peptic ulcer development and further consideration in the treatment of peptic ulcer diseases.

Modern Research in the Field of Microencapsulation (Review)

Introduction.Microencapsulation is one of the promising areas for obtaining new dosage forms. The peculiarity of microencapsulated forms is that the substance is protected from the effects of various environmental factors that can cause their destruction (acidity of gastric juice, the effect of food, joint intake of other drugs, diseases of the gastrointestinal tract, etc.). This method is used for various groups of drugs, such as antibiotics, nootropics, vitamins, probiotics, anticonvulsants, enzymes. Particular attention should be paid to antibacterial drugs, since the possibility of microencapsulation solves one of the most important problems in antibiotic therapy – the resistance of microorganisms.Text.The purpose of the review is to analyze modern research in the field of microencapsulation, to study trends and directions for the creation of microcapsules with high activity and bioavailability and with minimal side effects. The article provides brief information and main conclusions on the development of techniques and selection of conditions for microencapsulation of individual medicinal substances, on the study of polymers of various natures for use as carriers, on the methods of forming double shells of microcapsules, and also investigated the efficiency of microencapsulation of biologically active substances, such as antibacterial preparations, substances of plant and animal origin and preparations from various pharmacological groups. Variants of microencapsulation techniques for specific compounds that are suitable for substances similar in composition and action, as well as methods for creating microcapsules with double shells for compounds insoluble in water, are presented.Conclusion.The article shows the achievements and prospects of using microencapsulation of medicinal substances and their advantages over standard dosage forms. The active introduction of the developed methods into production will allow the creation of new dosage forms with known medicinal substances that have a prolonged effect, which will reduce the frequency of use of the drug, as well as retain their activity under the influence of negative factors of the internal environment of the body. Also, in the form of microcapsules, the substances are more active in comparison with non-encapsulated substances.

A previously unknown way of heme detoxification in the digestive tract of cats

Free heme is a highly toxic molecule for a living organism and its detoxification is a very important process, especially for carnivorous animals. Here we report the discovery of a previously unknown process for neutralizing free heme in the digestive tract of domestic cats. The cornerstone of this process is the encapsulation of heme into carbonated hydroxyapatite nanoparticles, followed by their excretion with faeces. This way of heme neutralization resembles the formation of insoluble heme-containing particles in the digestive tracts of other hematophagous species (for example, the formation of insoluble hemozoin crystals in malaria-causing Plasmodium parasites). Our findings suggest that the encapsulation of heme molecules into a hydroxyapatite matrix occurs during the transition from the acidic gastric juice to the small intestine with neutral conditions. The formation of these particles and their efficiency to include heme depends on the bone content in a cat’s diet. In vitro experiments with heme-hydroxyapatite nanoparticles confirm the proposed scenario.

Determination of antimicrobial, pH, bile salt, and gastric juice tolerance properties of Lactobacilli isolated from human milk

Human milk is a complex biological fluid, and a source of nutrients and probiotics which plays a vital role in the growth and development of infants. Probiotics are helpful bacteria which are good for human health. The primary bacterial genera which are gaining status as probiotics are Lactobacillus, Lactococcus, and Bifidobacterium. The present work aimed to isolate, identify, and determine the probiotic potential of Lactobacillus bacteria from human milk. A total of 70 samples of human milk were collected from different lactating mothers. The milk samples were inoculated on the De Man, Rogosa, and Sharpe (MRS) agar plates to observe the growth of Lactobacillus bacteria. The bacteria were identified based on their morphology, culture characteristics, and biochemical properties. Isolated bacteria were evaluated for probiotic properties in which, tolerance to acidic pH, bile salts, and gastric juice as well as antibacterial activity and antibiotic susceptibility were determined. Out of the 70 milk samples, 57 were positive for Lactobacillus. Out of the positive sample, 10.5% of the samples tolerated acidic pH and high bile salt concentration, but a significant difference was obtained for gastric juice. In the antibacterial activity, Pseudomonas showed no action against Lactobacillus. In antibiotic susceptibility, the test isolates were resistant to penicillin. The present work proved the presence of beneficial bacteria in the human milk. Isolated Lactobacillus exhibited significant antibacterial activity against pathogenic bacteria, and tolerance to acidic pH, bile salt, and gastric juice. Therefore, human milk could be a good source of probiotics for infants.

POS-695 INTESTINAL OBSTRUCTION COMPLICATING CAMPYLOBATER COLI ENTERITIS IN RENAL TRASNPLANTATION PATIENT

A 30 year old male, with cadaveric renal transplantation 2 years ago , his primary disease was anti-GBM disease diagnosed one year prior to transplantation and treated with 14 sessions of plasma exchange, steroids and cyclophosphamide shortly after that he was initiated on hemodialysis followed by renal transplantation. Two months post renal transplantation his course was complicated by biopsy proven mixed rejection (T-Cell mediated rejection type IA) and active Antibody medicated rejection , however ,C4d negative. The patient received pulsed steroids, 3 sessions Plasma-exchange and IVIG 2g/kg. He completed 2 doses of Rituximab and his serum creatinine was stable at 200-220 micromole/L. The patient was admitted after 3 weeks with persistent vomiting and abdominal pain and abdominal distention, his serum creatinine 304 micromole/L, abdominal x-ray showed multiple air fluid levels with dilatation of small bowel loops. CT scan with oral contrast showed multiple dilated small bowel loops down to the terminal ileum with caliber of 3.5 mm with multiple air-fluid levels and fecal loading in distal ileum loop with collapsed colon. The contrast media reached into the small bowel in left mid abdomen at mid jejunal loop. Stool culture grew campylobacter coli, BK PCR was positive of 371,000 copies. Other infectious causes of diarrhea were excluded. The patient completed 7 days of ciprofloxacin and treated with intravenous immunoglobulins (IVIG) . His mycophenolic acid was stopped, and he was maintained on dual immunosuppression therapy in form of tacrolimus and steroids. The patient was booked for upper endoscopy and colonoscopy in outpatient setting. View Large Image Figure ViewerDownload Hi-res image Download (PPT) Diarrhea is a common symptom in renal transplant patient population. The main causes of diarrhea after transplantation include infections, immunosuppressive drugs, antibiotics, and other drugs. Viral causes of diarrhea are the most frequently reported and usually last up to 3 days. Patients have tendency to develop Clostridium difficile after antibiotics. Other enteric bacteria responsible for diarrhea are Shigella, Salmonella typhi, Salmonella typhimurium and Campylobacter. CMV can cause enterocolitis, with or without fever, gastrointestinal bleeding, perforation, and toxic megacolon are possible complications. Incidence of diarrhea with mycophenolate mofetil dose of 2 g/day was higher than in other immunosuppressants like azathioprine. Campylobacter infection has prominent features like terminal ileitis, cecitis and mesenteric adenitis. Proton pump inhibitors are main risk factor for campylobacter enteritis as it lowers the gastric juice acidity allowing for pathogen survival. Campylobacter was detected in stool culture of a 31-year-old male patient diagnosed with immunoproliferative small intestinal disease (IPSID) and it was positive in tissue biopsy samples. Antibiotics treatment is enough to eradicate campylobacter and reduce the risk of IPSID. Diarrhea is a common symptom post renal transplantation, Campylobacter coli can be one of the main causes of ileocecal enteritis and may cause small bowel obstruction, treatment is usually conservative with antibiotics.