Gastrointestinal Passage Research Articles

Use of allele specific PCR to investigate the presence of β-casein polymorphism in Holstein-Friesian cows

Following the ?one health? principle, we have conducted optimization of a protocol for ?-casein genotyping in cattle in order to select cows with exclusively the A2A2 genotype. Gastrointestinal proteolysis of A1 ?-casein in humans releases beta-casomorphin 7, which is believed to cause a number of diseases/conditions (diabetes mellitus type 1, ischemic heart disease, atherosclerosis, sudden infant death syndrome, autism, schizophrenia, gastrointestinal discomfort, and prolonged gastrointestinal passage time). On the contrary, A2 ?-casein does not cause similar effects on human health, due to its different metabolism. DNA extraction was conducted from blood samples belonging to the laboratory archive of the Department of Biology, Faculty of Veterinary Medicine, University of Belgrade. Determination of genotypes was performed using the Allele Specific Polymerase Chain Reaction (AS-PCR) method. The amplification was preceded by determination of proper primer annealing temperature (65.50 ?C), in order to ensure optimal genotyping results. The results obtained indicated a higher frequency of the A2 allele (0.56) compared to the A1 allele (0.44). Furthermore, in 7 out of 35 tested samples, the A1A1 genotype (20.00%) was found, in 17 samples, the A1A2 genotype (48.60%) was found, and in 11 samples, the A2A2 genotype (31.40%) was found. The molecular methods used ensured reliable ?-casein genotyping that would enable selection of cows with the A2A2 ?-casein genotype, implying production of.

Probiotic colonization dynamics after oral consumption of VSL#3® by antibiotic-treated mice.

Background: The ability of probiotic strains to provide health benefits to the host partially hinges on the survival of gastrointestinal passage and temporary colonization of the digestive tract. This study aims to investigate the colonization profile of individual probiotic strains comprising the commercial product VSL#3® and determine their impact on the host intestinal microbiota. Methods: Using a cefoperazone-treated mouse model of antibiotic treatment, we investigated the impact of oral gavage with ~108 CFU commercial VSL#3® product on the intestinal microbiota using 16S-based amplicon sequencing over 7 days. Results: Results showed that probiotic strains in the formulation were detected in treated murine fecal samples, with early colonization by Streptococcus thermophilus and Lactiplantibacillus plantarum subsp. plantarum, and late colonization by Lacticaseibacillus paracasei subsp. paracasei, Bifidobacterium breve and Bifidobacterium animalis subsp. lactis. Overall, VSL#3® consumption is associated with increased alpha diversity in the cecal microbial community, which is important in the context of antibiotic consumption. Probiotic supplementation resulted in an expansion of Proteobacteria, Bacteroidetes, and Actinobacteria, especially Bifidobacteriaceae and Lachnospiraceae, which are associated with Clostridioides difficile resistance in the murine gut. Conclusion: This study illustrates the need for determining the ability of probiotics to colonize the host and impact the gut microbiota, and suggests that multiple doses may be warranted for extended transient colonization. In addition, follow-up studies should determine whether VSL#3® can provide resistance against C. difficile colonization and disease in a mouse model.

Nanoencapsulation for Probiotic Delivery.

Gut microbiota dynamically participate in diverse physiological activities with direct impact on the host's health. A range of factors associated with the highly complex intestinal flora ecosystem poses challenges in regulating the homeostasis of microbiota. The consumption of live probiotic bacteria, in principle, can address these challenges and confer health benefits. In this context, one of the major problems is ensuring the survival of probiotic cells when faced with physical and chemical assaults during their intake and subsequent gastrointestinal passage to the gut. Advances in the field have focused on improving conventional encapsulation techniques in the microscale to achieve high cell viability, gastric and temperature resistance, and longer shelf lives. However, these microencapsulation approaches are known to have limitations with possible difficulties in clinical translation. In this Perspective, we present a brief overview of the current progress of different probiotic encapsulation methods and highlight the contemporary and emerging single-cell encapsulation strategies using nanocoatings for individual probiotic cells. Finally, we discuss the relative advantages of various nanoencapsulation approaches and the future trend toward developing coated probiotics with advanced features and health benefits.

Epidural analgesia is associated with earlier gastrointestinal transit after radical cystectomy but does not reduce the incidence of postoperative ileus: A retrospective cohort study

Objective: To compare the effect of combined epidural thoracic analgesia and general anaesthesia (CEGA) in radical cystectomy (RC) with respect to the return of gastrointestinal passage, the incidence of paralytic postoperative ileus (POI) compared to general anaesthesia (GA) only. Patients and methods: We conducted a retrospective review using the electronic medical records of 236 patients who underwent RCs between July 2011 and September 2018 at the Medical Center – University of Freiburg. Results: A CEGA was administered to 202 patients, while 34 patients received only GA. The baseline characteristics of patients with and without CEGA showed no significant differences. CEGA will decrease the time required for return of gastrointestinal transit as measured by time to first defecation by about 13 hours. In the first 90 days after surgery, 82 (34.7%) patients had a POI. There was no significant difference between complications in the CEGA and GA groups. Conclusion: A CEGA accelerates the return of the gastrointestinal transit but does not reduce the incidence of postoperative ileus. Level of evidence: 2b

Protection and Controlled Gastrointestinal Release of Bromelain by Encapsulating in Pectin-Resistant Starch Based Hydrogel Beads.

Hybrid pectin and resistant starch–based hydrogel beads loaded with bromelain using the extrusion gelation method were prepared and evaluated to enhance the activity of bromelain during gastrointestinal passage and thermal processing. The solutions of pectin–resistant starch with bromelain were dropped into the gelation bath containing calcium chloride (0.2 M) solution to develop various types of hydrogel beads. The physicochemical characteristics of the synthesized hydrogel beads were evaluated. The ratio (4.5:1.5 w/w) of pectin and resistant starch concentration significantly (p < 0.05) enhanced the encapsulation efficiency (80.53%). The presence of resistant starch resulted in increased entrapment of bromelain, improved swelling properties with sustained release behavior, and improved gastric stability than pectin hydrogels alone. The swelling of hydrogel beads was higher at pH 7.4 than pH 1.2. Optimized batch of hybrid pectin/resistant starch exhibited a spherical shape. Optical and scanning electron microscopy showed a more packed and spherical shape from the pectin/resistant starch hydrogel bead network. Fourier transformation infrared spectroscopy was also used to confirm the presence of bromelain in the hydrogel beads. The encapsulated bromelain in the pectin/hi-maize starch beads produced at a pectin/hi-maize ratio of 4.5:1.5 (percent w/w; formulation P4) obtained the highest relative bromelain activity in all heat treatments including at 95°C, whereas the highest activity of free bromelain was found only at 30°C. Bromelain encapsulated in hydrogels released at a faster rate at simulated intestinal fluid (SIF, pH 7.4) than at simulated gastrointestinal fluid (SGF, pH 1.2).

Feed digestibility, digesta passage and faecal microbial biomass in desert-adapted goats exposed to mild water restriction.

In arid and semi-arid environments, extensively managed ruminants regularly experience drinking water shortage, especially in the dry season. The present study therefore investigated the effects of mild drinking water restriction on feed intake, feed digestibility, solid digesta passage and composition of faeces including faecal microbial biomass. A feeding trial was conducted in Oman, during the dry summer months. Nine adult male Batinah goats were subjected to three watering regimes in a 3×3 Latin Square design. Treatments were (1) water offered ad libitum (100%, W100); (2) water restricted to 85% ad libitum consumption (W85); and (3) water restricted to 70% ad libitum consumption (W70). Animals were offered Rhodes grass hay and whole barley grains (1:1 ratio) at 1.3 times maintenance energy requirements. Each of the three experimental periods comprised 16days of adaptation and 8days of measurements. During the latter, feed offered and refused as well as faeces were sampled and quantified. Gastrointestinal digesta passage was determined using ytterbium-labelled Rhodes grass hay. Ergosterol and amino sugars were used as markers for faecal microbial biomass, that is the sum of fungi and bacteria. Water restriction had no effect on feed intake and digesta passage. However, feed dry matter, organic matter and fibre digestibility increased (p<0.05) in W70 compared with W85, and the excreted amount of faecal dry matter, organic matter, nitrogen and neutral detergent fibre decreased (p<0.05) in W70 compared with W85. Even though water restriction did not affect total faecal microbial biomass carbon (C) concentration, that of fungal biomass C increased (p<0.05) in W70 compared with W85. Therefore, mild water restriction seems unproblematic from a physiological and nutrient utilization perspective as it increases feed digestibility without compromising feed intake.

EUS-guided gastroenterostomy with a lumen apposing self-expandable metallic stent relieves gastric outlet obstruction – a Scandinavian case series

Background EUS-guided gastroenterostomy (EUS-GE) with lumen-apposing metallic stents (LAMS) in patients with gastric outlet obstruction (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. In severely ill patients, the method can provide improved quality of life (QoL) and symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine. Aim To assess the technical and clinical success and safety of EUS-GE. Material and methods A dual center retrospective case series of 33 consecutive patients with GOO due to malignant (n = 28) or non-malignant conditions (n = 5). The patients were treated with EUS-GE using cautery enhanced LAMS. Procedures were performed guided by EUS and fluoroscopy in general anesthesia or conscious sedation. Results Technical success was achieved in all patients. The median procedure time was 71 min and the median hospital stay was three days. Thirty (91%) patients were able to resume oral nutrition after the procedure. Ten patients (30%) experienced adverse events (AEs), including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12%). All stent-related AEs were handled endoscopically. Five patients (15%) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5–76), and 13 patients with obstructing malignancies lived 12 weeks or longer. Conclusion EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The method has potential hazards and should only be offered in expert centers that regularly perform the procedure.

Palliative endoscopy

Endoscopy is the leading method in the diagnostics of gastrointestinal malignancies. With the increasing incidences of various tumor entities, a palliative treatment situation is already present in many patients despite an increasing number of screening strategies. Palliative endoscopy can make an essential contribution to alleviation of tumor-related symptoms, such as dysphagia, malnutrition, cholestasis, ileus and pain. Various approaches can be offered to safeguard the nutrition, e.g. percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ), for maintenance of the gastrointestinal passage (stents) and secretion drainage or to drain congested hollow organs. Furthermore, in cases of inaccessibility or impassability of stenoses due to tumors, endosonographically assisted punctures offer the possibility to guarantee new drainage options or continuities by stent placement. In all interventions possible contraindications and complications must be taken into account.

Impact of oral galenic formulations of Lactobacillus salivarius on probiotic survival and interactions with microbiota in human in vitro gut models.

Health benefits of probiotics in humans essentially depend on their ability to survive during gastrointestinal (GI) transit and to modulate gut microbiota. To date, there is few data on the impact of galenic formulations of probiotics on these parameters. Even if clinical studies remain the gold standard to evaluate the efficacy of galenic forms, they stay hampered by technical, ethical and cost reasons. As an alternative approach, we used two complementary in vitro models of the human gut, the TNO gastrointestinal (TIM-1) model and the Artificial Colon (ARCOL), to study the effect of three oral formulations of a Lactobacillus salivarius strain (powder, capsule and sustained-release tablet) on its viability and interactions with gut microbiota. In the TIM-1 stomach, no or low numbers of bacteria were respectively released from the capsule and tablet, confirming their gastro-resistance. The capsule was disintegrated in the jejunum on average 76 min after administration while the core of sustained-release tablet was still intact at the end of digestion. Viability in TIM-1 was significantly influenced by the galenic form with survival percentages of 0.003±0.004%, 2.8±0.6% and 17.0±1.8% (n=3) for powder, capsule and tablet, respectively. In the ARCOL, the survival of the strain tended to be higher in the post-treatment phase with the tablet compared to capsule, but gut microbiota composition and activity were not differently modulated by the two formulations. In conclusion, the sustained-release tablet emerged as the formulation that most effectively preserved viability of the tested strain during GI passage. This study highlights the usefulness of in vitro gut models for the pre-screening of probiotic pharmaceutical forms. Their use could also easily be extended to the evaluation of the effects of food matrices and age on probiotic survival and activity during GI transit.

Disintegration stability of extruded fish feed affects gastric functions in Atlantic salmon (Salmo salar)

In the present study, two salmon feeds with different disintegration stabilities were produced by impacting extruder viscous heat dissipation with the use of different lipid levels in the feed mix. The feeds were then dried and coated to similar final lipid levels (30-31%) and nutritional composition. Both feeds were produced as 4 and 6-mm pellets. Feeds extruded with 20% lipid had a lower disintegration stability compared with those with 8% lipid. The feeds were used in two feeding studies using Atlantic salmon (Experiments 1 and 2) and an in vitro gastric study (Experiment 3). In Experiment 1, salmon postsmolts (370 g starting weight) fed the 4-mm pellets showed the fastest gastrointestinal (GI) passage rate when fed feeds with a lower disintegration stability. This was due to a faster transport of content from the stomach to the gut at 30 min and 1.5 h after a meal, and faster passage through the distal gut 9–24 h after a meal. The 6-mm pellets were used in a 100-day feeding study (Experiment 2) in which salmon fed high and low disintegration stability feeds grew from 572 to 1542 and 1604 g, respectively. There was a higher total feed intake in salmon fed diets with lower disintegration stability, but only tendencies towards higher growth and final body weight compared with salmon fed diets with a higher disintegration stability. The in vitro gastric experiment showed that pellets with a lower disintegration stability required a larger supply of stomach acid to maintain a stable pH of 4.5, which also gave a lower content viscosity. The in vitro study also showed an increased release of water-soluble components from these pellets and hydrolysis of larger peptides increased the pool of intermediate-sized peptides (4–6 kDa) available for easy transportation, hydrolyzation, and absorption in the proximal intestine. Although lower pellet disintegration stability increases feed intake. The GI passage rate combined with an increased GI filling can affect the ability to hydrolyze and absorb nutrients. This may explain why an increased feed intake did not result in increased growth in Experiment 2, despite observing no significant differences in nutrient digestibility or feed conversion ratio. Our results highlight the importance of the quality of extruded fish feed.

Probiotic and Functional Properties of Limosilactobacillus reuteri INIA P572.

Limosilactobacillus reuteri INIA P572 is a strain able to produce the antimicrobial compound reuterin in dairy products, exhibiting a protective effect against some food-borne pathogens. In this study, we investigated some probiotic properties of this strain such as resistance to gastrointestinal passage or to colonic conditions, reuterin production in a colonic environment, and immunomodulatory activity, using different in vitro and in vivo models. The results showed a high resistance of this strain to gastrointestinal conditions, as well as capacity to grow and produce reuterin in a human colonic model. Although the in vitro assays using the RAW 264.7 macrophage cell line did not demonstrate direct immunomodulatory properties, the in vivo assays using a Dextran Sulphate Sodium (DSS)-induced colitic mice model showed clear immunomodulatory and protective effects of this strain.

Identification of Streptococcus thermophilus Genes Specifically Expressed under Simulated Human Digestive Conditions Using R-IVET Technology.

Despite promising health effects, the probiotic status of Streptococcus thermophilus, a lactic acid bacterium widely used in dairy industry, requires further documentation of its physiological status during human gastrointestinal passage. This study aimed to apply recombinant-based in vivo technology (R-IVET) to identify genes triggered in a S. thermophilus LMD-9 reference strain under simulated digestive conditions. First, the R-IVET chromosomal cassette and plasmid genomic library were designed to positively select activated genes. Second, recombinant clones were introduced into complementary models mimicking the human gut, the Netherlands Organization for Applied Scientific Research (TNO) gastrointestinal model imitating the human stomach and small intestine, the Caco-2 TC7 cell line as a model of intestinal epithelium, and anaerobic batch cultures of human feces as a colon model. All inserts of activated clones displayed a promoter activity that differed from one digestive condition to another. Our results also showed that S. thermophilus adapted its metabolism to stressful conditions found in the gastric and colonic competitive environment and modified its surface proteins during adhesion to Caco-2 TC7 cells. Activated genes were investigated in a collection of S. thermophilus strains showing various resistance levels to gastrointestinal stresses, a first stage in the identification of gut resistance markers and a key step in probiotic selection.

Whey protein isolate-lignin complexes as encapsulating agents for enhanced survival during spray drying, storage, and in vitro gastrointestinal passage of Lactobacillus reuteri KUB-AC5

This study aimed to investigate the effect of encapsulant weight ratios of whey protein isolate (WPI)-lignin complex (10:0, 9.5:0.5, 9:1, 8.5:1.5, and 8:2) on survival of Lactobacillus reuteri KUB-AC5 during spray drying, storage, and passage through simulated gastrointestinal tract. Change in the secondary structure of WPI indicated its interaction with lignin. Higher lignin amounts resulted in higher yields and lower moisture contents. After spray drying and 2-month storage, the highest and lowest malondialdehyde contents were found in 10:0 and 9:1 formulations, respectively. After drying, the lowest and highest numbers of viable cells, 8.70 and 9.34 log CFU/g, were found in 10:0 and 9:1 formulations, respectively. After storage at 4 and 37 °C, the lowest and highest survival rates were also observed in these two formulations. At higher lignin concentrations, inactivation rate constants were reduced. After passage through simulated gastrointestinal tract, the highest and lowest cell viability was observed in 9:1 formulation and free cells, respectively. The results showed that microencapsulation using WPI-lignin complexes at 9:1 ratio offered the best protection. Lignin improved survival of spray-dried probiotics through improving the structure and antioxidant properties of WPI.

Pectin/lignocellulose nanofibers/chitin nanofibers bionanocomposite as an efficient biosorbent of cholesterol and bile salts

A new biosorbent Ca-crosslinked pectin/lignocellulose nanofibers/chitin nanofibers (PLCN) was synthesized for cholesterol and bile salts adsorption from simulated intestinal fluid during gastric-intestinal passage. The physico-chemical properties of PLCN were studied using SEM, FTIR, XRD, DSC and BET. Before gastrointestinal passage, PLCN had an amorphous single-phase, compact structure formed via hydrogen and van der Waals bonds that revealed an irregular shape with the shriveled surface but watery condition and enzymatic digestion led to create a porous structure without destruction because of the water-insoluble nanofibers, therefore increasing the adsorption capacity. The maximum adsorption capacity reached 37.9 and 5578.4 mg/g for cholesterol and bile salts, respectively. Freundlich isotherm model indicated the reversible heterogeneous adsorption of both cholesterol and bile salts on PLCN. Further, their adsorption followed pseudo-second order kinetic model. These results suggest that PLCN has potential as a gastrointestinal-resistant biosorbent for cholesterol and bile salts adsorption applicable in medicine and food industry.

Intestinal and hepatic effects of iron oxide nanoparticles

Iron oxide nanoparticles gain increasing attention due to their broad industrial use. However, safety concerns exist since their effects on human cells are still under investigation. The presence of iron oxide nanoparticles in the food pigment E172 has been shown recently. Here, we studied four iron oxide nanoparticles, one food pigment E172 and the ionic control FeSO4 regarding dissolution in biological media, uptake and transport, and cellular effects in vitro in human intestinal Caco-2 and HepaRG hepatocarcinoma cells. The iron oxide nanoparticles passed the gastrointestinal passage without dissolution and reached the intestine in the form of particles. Minor uptake was seen into Caco-2 cells but almost no transport to the basolateral site was detected for any of the tested particles. HepaRG cells showed higher particle uptake. Caco-2 cells showed no alterations in reactive oxygen species production, apoptosis, or mitochondrial membrane potential, whereas two particles induced apoptosis in HepaRG cells, and one altered mitochondrial membrane potential at non-cytotoxic concentrations. No correlation between physicochemical particle characteristics and cellular effects was observed, thus emphasizing the need for case-by-case assessment of iron oxide nanoparticles.

Enhancing the storage and gastrointestinal passage viability of probiotic powder (Lactobacillus Plantarum) through encapsulation with pickering high internal phase emulsions stabilized with WPI-EGCG covalent conjugate nanoparticles

In this study, we demonstrated the role of Pickering high internal phase emulsions (HIPEs) stabilized with the whey protein isolate (WPI)/(-)-epigallocatechin-3-gallate (EGCG) covalent conjugates on the storage and GIT passage viability of probiotics powder (Lactobacillus Plantarum). At pH 9 value, the WPI-EGCG covalent conjugates by free-radical induction reaction formed hydroxyquinone or hydroxyquinone dimers with better wettability, and digestive enzyme inhibition effect and smaller particle size. Then, the WPI-EGCG covalent conjugates were used to stabilize the O/W type Pickering emulsion. The oil fraction (ϕ) addition led to an increase in the droplet size and modulus of Pickering emulsions toward to generate gel-like structure. On the other hand, at a constant ϕ value, the droplet size of these Pickering HIPEs reduced with increasing particle concentration (c) from 0.5% to 5%, indicating that high c can stabilize more oil droplets. Encapsulation of Lactobacillus Plantarum powder with the Pickering HIPEs was successful to enhance the viable cell count after 14 days storage and GIT digestion. The protective effect of Pickering emulsions was improved with the addition of the c and/or ϕ value. Therefore, Pickering HIPEs can be applied as a promising carrier for enhancing the viability of probiotic powder during storage and GIT digestion by reason of the high oil phase fraction and the adsorption of the WPI-EGCG covalent conjugates on the droplet interface.

Effect of Simulated Gastrointestinal Tract Conditions on Survivability of Probiotic Bacteria Present in Commercial Preparations.

Probiotics are recommended, among others, in the diet of children who are under antibiotic therapy, or that suffer from food allergies or travel diarrhea, etc. In the case of toddlers taking probiotic preparations, it is highly recommended to first remove the special capsule, which normally protects probiotic strains against hard conditions in the gastrointestinal tract. Otherwise, the toddler may choke. This removal can impair probiotic survival and reduce its efficacy in a toddler’s organism. The aim of this study was to evaluate the survivability of five strains of lactic acid bacteria from the commercial probiotics available on the Polish market under simulated conditions of the gastrointestinal tract. Five probiotics (each including one of these strains: Bifidobacterium BB-12, Lactobacillus (Lb.) rhamnosus GG, Lb. casei, Lb. acidophilus, Lb. plantarum) were protective capsule deprived, added in a food matrix (chicken–vegetable soup) and subjected under simulated conditions of the gastric and gastrointestinal passage. Strain survivability and possibility to growth were evaluated. Obtained results showed that, among all analyzed commercial probiotic strains, the Lb. plantarum was the most resistant to the applied conditions of the culture medium. They showed a noticeable growth under both in vitro gastric conditions at pH 4.0 and 5.0, as well as in vitro intestinal conditions at all tested concentrations of bile salts.

Reconstruction following gastrectomy

Minimally invasive surgical techniques with respect to the treatment of gastric cancer have progressed rapidly over the last few years. Especially in Asia, where the incidence of gastric cancer is ten times higher than in Europe, surgery for gastric cancer is steadily evolving, especially regarding laparoscopic and robot-assisted procedures. This review first discusses the different options for reconstruction of the gastrointestinal passage after gastrectomy, ranging from Billroth procedures to the latest developments, such as the double tract reconstruction. In particular, the possibility of function-preserving partial gastrectomy, such as proximal and distal gastric resection and the corresponding reconstruction techniques are presented. The latest studies and technical developments are presented, especially with respect to laparoscopically assisted, completely laparoscopic and robot-assisted gastrectomies.

Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients. Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, isolated parenteral and mixed types of nutritional support in the early postoperative period. Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI). Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient. Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

A Review on Updates to Increase the Residence Time of Drug in the Stomach for Gastro Retentive Drug Delivery System

Orally-administered controlled-release drug delivery systems are associated with the shortcomings of relatively short residence times in the human stomach as well as highly variable gastrointestinal (GI) transit times. Thus, considerable intra-individual and inter-individual differences in the bioavailability of drugs are observable. There are numerous drug substances which may benefit from prolonged and controlled GI passage times. As a solution to the problem, gastroretentive drug delivery systems (GRDDS), which feature an enhanced gastric residence time (GRT), were developed. Several approaches are currently used including Floating Drug Delivery System (FDDS), swelling and expanding system, polymeric bioadhesive systems, modified-shape systems, high density system and other delayed gastric emptying devices. The drugs having absorption window in the upper part of Gastro Intestinal Tract (GIT) have enhanced bioavailability when formulated through these techniques. The recent technological development for enhancing GRT including the physiological and formulation variables affecting gastric retention, patented delivery systems, approaches to design single-unit and multiple-unit floating systems, and their classification and formulation aspects are covered in detail. Despite the extensive research performed in the field of GRDDS, the development, the production, and the evaluation of floating devices are still challenging. The purpose of writing this review was to compile recent literature on pharmaceutical approaches used in enhancing the Gastric Residence Time (GRT). Enhancing the GRT may explore new potentials of stomach as drug-absorbing organ. © 2020 iGlobal Research and Publishing Foundation. All rights reserved.