Increased Stool Frequency Research Articles

Glycemic response to low sugar apple juice treated with invertase, glucose oxidase and catalase.

Investigating the effect on post-prandial glycemic and venous serum insulin response of an apple drink following the conversion of its glucose to gluconate. In a double-blind randomized placebo-controlled clinical trial with cross-over design, 30 male adults with impaired fasting glucose (IFG) received a drink of 500 ml: 1. Verum: Apple juice treated with invertase, glucose oxidase/catalase (glucose 0.05 g; gluconate 18.2 g); 2. Untreated apple juice (free glucose 8.5 g; bound glucose 6.7 g; gluconate below detection limit). Postprandial fingerprick capillary blood glucose and venous serum insulin were measured twice at baseline and at times 0 (start of drink), 15, 30, 45, 60, 90 and 120 min. Gastrointestinal symptoms, stool consistency and satiety were also assessed. The incremental area under the curve (iAUC120) of glucose levels (primary parameter) was significantly lower after verum (mean ± SD: 63.6 ± 46.7 min × mmol/l) compared to control (mean ± SD: 198 ± 80.9 min × mmol/l) (ANOVA F = 137.4, p < 0.001; α = 0.05). Also, iAUC120 of venous serum insulin levels (secondary parameter) was significantly lower after verum (mean ± SD: 2045 ± 991 min × mmol/l) compared to control (3864.3 ± 1941 min × mmol/l), (ANOVA F = 52.94, p < 0.001; α = 0.025). Further parameters of glucose metabolism and ISI = 2/[AUC venous serum insulin × AUC glucose +1] were also improved after verum compared to control. Verum increased stool frequency and decreased stool consistency, as assessed by Bristol stool form scale. By enzymatic treatment of apple juice its sugar content could be reduced by 21% and postprandial glycemic and venous serum insulin response by 68 and 47%, respectively resulting in a reduction of glycemic load by 74.6% without any adverse gastrointestinal side-effects.

Long-term outcome after segmental colonic resection for slow transit constipation

PurposeColectomy with ileorectal anastomosis (IRA) is the most common surgical procedure for slow transit constipation (STC). A hemicolectomy has been suggested as an alternative to IRA with good short-term results. However, long-term results are unknown. The aim of this study was to evaluate the long-term results after hemicolectomy as a treatment for STC.MethodsFifty patients with STC were selected for right- or left-sided hemicolectomy after evaluation with colonic scintigraphy from 1993 to 2008. Living patients (n = 43) received a bowel function questionnaire and a questionnaire about patient-reported outcome.ResultsAfter a median follow-up of 19.8 years, 13 patients had undergone rescue surgery (n = 12) or used irrigation (n = 1) and were classified as failures. In all, 30 were evaluable for functional outcome and questionnaire data for 19 patients (due to 11 non-responding) could be analysed. Two reported deterioration after several years and were also classified as failures. Median stool frequency remained increased from 1 per week at baseline to 5 per week at long-term follow-up (p = 0.001). Preoperatively, all patients used laxatives, whereas 12 managed without laxatives at long-term follow-up (p = 0.002). There was some reduction in other constipation symptoms but not statically significant. In the patients’ global assessment, 10 stated a very good result, seven a good result and two a poor result.ConclusionsHemicolectomy for STC increases stool frequency and reduces laxative use. Long-term success rate could range between 17/50 (34%) and 35/50 (70%) depending on outcome among non-responders.

Interactions Between Commensal Bacteria and Enteric Neurons, via FPR1 Induction of ROS, Increase Gastrointestinal Motility inMice.

Reduced gastrointestinal (GI) motility is a feature of disorders associated with intestinal dysbiosis and loss of beneficial microbes. It is not clear how consumption of beneficial commensal microbes, marketed as probiotics, affects the enteric nervous system (ENS). We studied the effects of the widely used probiotic and the commensal Lactobacillus rhamnosus GG (LGG) on ENS and GI motility in mice. Conventional and germ free C57B6 mice were gavaged with LGG and intestinal tissues were collected; changes in the enteric neuronal subtypes were assessed by real-time polymerase chain reaction, immunoblots, and immunostaining. Production of reactive oxygen species (ROS) in the jejunal myenteric plexi and phosphorylation (p) of mitogen-activated protein kinase 1 (MAPK1) in the enteric ganglia were assessed by immunoblots and immunostaining. Fluorescence in situ hybridization was performed on jejunal cryosections with probes to detect formyl peptide receptor 1 (FPR1). GI motility in conventional mice was assessed after daily gavage of LGG for 1 week. Feeding of LGG to mice stimulated myenteric production of ROS, increased levels of phosphorylated MAPK1, and increased expression of choline acetyl transferase by neurons (P < .001). These effects were not observed in mice given N-acetyl cysteine (a ROS inhibitor) or LGGΩSpaC (an adhesion-mutant strain of LGG) or FPR1-knockout mice. Gavage of mice with LGG for 1 week significantly increased stool frequency, reduced total GI transit time, and increased contractions of ileal circular muscle strips in exvivo experiments (P < .05). Using mouse models, we found that LGG-mediated signaling in the ENS requires bacterial adhesion, redox mechanisms, and FPR1. This pathway might be activated to increase GI motility in patients.

Mechanisms underlying effects of kiwifruit on intestinal function shown by MRI in healthy volunteers.

SummaryBackgroundChronic constipation affects approximately 17% of the population worldwide and remains an important unmet need since patients are often dissatisfied with treatment. Kiwifruit may offer an alternative to traditional laxatives and have been shown to increase stool volume, frequency and improve consistency.AimsUsing non‐invasive MRI techniques, we assessed the effect of ingestion of kiwifruit on fluid distribution in the intestines and bowel function.MethodsTwo period crossover trial of kiwifruit vs control in healthy adults. Intervention: two kiwifruits twice daily vs isocaloric control (maltodextrin) twice daily, consumed for a total of 3 days. Subjects underwent MRI scanning fasted and at hourly intervals for 7 hours on the third day. Primary outcome: T1 relaxation time of ascending colon (T1AC) using MRI. Secondary outcomes: Small bowel water content (SBWC), colonic volume, gut transit time, T1 of descending colon, stool frequency and form.ResultsFourteen volunteers completed the study. T1AC was higher after kiwifruit ingestion (P = 0.029) during the second half of the day (when meal residue would be expected to reach the AC, AUC T1 T240‐420 minutes; mean (SD) 137 (39) s*minute with kiwifruit versus 108 (40) s*minute with control. SBWC (P < 0.001), colon volumes (P = 0.004), as well as stool frequency (1.46 ± 0.66 with kiwifruit vs 1.14 ± 0.46 stools per day with control; P = 0.034) and stool form score (Bristol Stool Chart score 4.1 (0.9) with kiwifruit versus 3.4 (0.7) with control; P = 0.011) were markedly increased in participants consuming kiwifruit compared to control.ConclusionConsumption of kiwifruit in healthy volunteers increases water retention in the small bowel and ascending colon and increases total colonic volume. The data may explain the observed increase in stool frequency and looser stool consistencies, suggesting that kiwifruit could be used as a dietary alternative to laxatives in mild constipation.

Effects of β-Fructans Fiber on Bowel Function: A Systematic Review and Meta-Analysis.

The aim of this systematic review and meta-analysis was to assess the effects of β-fructan supplementation on bowel function in healthy volunteers and patients. The search process was based on the selection of publications listed in the Pubmed and EUPMC database until December 2017, plus two unpublished studies, to identify studies evaluating the impact of β-fructans on bowel movement and stool parameters. Forty-seven publications were selected for inclusion. Primary parameter was frequency of bowel movements, evaluated by the number of defecations per day during the study period. Secondary outcomes were stool consistency, stool dry and wet weights, and transit time. Short-chain (DP < 10) β-fructans contributed to increased stool frequency (0.36 defecation +/− 0.06 per day; p < 0.001), while no significant effect was reported with long-chain (DP ≥ 10) β-fructans (−0.03 +/− 0.11, p = 0.82). A minimal increase in stool wet weight was also statistically demonstrated with short-chain β-fructans. Moreover, the meta-analysis highlighted significant differences in stool consistency in contrast to fecal dry weight after β-fructan supplementation. This systematic review and meta-analysis indicates that short-chain β-fructan supplementation has a positive effect on bowel function by significantly increasing the frequency of bowel movements.

Risk Factors of Diarrhoea in Malnourished Children under Age of 5 Years

Abstract:&#x0D; Background: Acute infectious enteritis remains one of the commonest causes of death among infants and children in developing countries. Acute enteritis is defined as a loss of stool consistency with pasty or liquid stools, and/or an increase in stool frequency to more than three stools in 24 hours with or without fever or vomiting. Human survival depends on the secretion and reabsorption of fluid and electrolytes in the intestinal tract. The objective of the study is to evaluate the risk factors of diarrhoea in children under age of 5 years.&#x0D; Methodology: It was an observational study. Study was completed in about six months. Non-probability purposive sampling technique was used. In this study, 270 samples were taken from Diarrheal ward of The Children Hospital Lahore, Pakistan.&#x0D; Results: In this study, out of 270 patients, 58.52% were males and 41.48% were females. 90.37% patients were vaccinated. 54.81% had weaning history. 91.85% patients had feeding history. 29.26% had blood in stool. 96.67% patients were dehydrated. 95.56% patients had loose watery diarrhoea. 62.96% patients used boiled water. 58.52% patients consumed less than half litre of water, 30.00% patients consumed 1 litre of water and 11.48% patients consumed &gt; 1 litre of water. 49.18% patients had proper hygiene. 38.15% mothers of patients were well educated. 40.37% patients had model household condition. 57.41% patients lived in rural area and 42.59% patients lived in urban area.&#x0D; Conclusion: The variation in the level of diarrheal morbidity was well explained by maternal education, income, personal hygiene, refuse disposal system and the effect of health extension programme.

A Randomized Placebo-controlled Trial of an Oral Preparation of High Molecular Weight Fucoidan in Patients with Type 2 Diabetes with Evaluation of Taste Sensitivity

Fucoidan is derived from seaweed widely used in Japanese cuisine, but little is known about its influence on glucose metabolism. To obtain information about the physiological effects of fucoidan on glucose metabolism, the digestive system, and the gustatory system controlling taste sensation in patients with type 2 diabetes, we conducted a randomized, double-blind, placebo-controlled study. Thirty patients with type 2 diabetes on diet therapy were recruited from an outpatient clinic (22 men and 8 women aged 59.10 ± 13.24 years, body mass index: 25.18 ± 3.88, hemoglobin A1c: 7.04 ± 1.24%). They were divided into 2 groups and underwent 2 interventions with a 4-week interval. One group received fucoidan for 12 weeks (a daily 60 mL test beverage containing 1,620 mg of fucoidan) and then placebo (60 mL) for the subsequent 12-week period, while the order was reversed in the other group. Evaluation was performed just before and after each intervention. Taste sensitivity was measured for 5 basic tastes by the filter paper disk method and food intake was evaluated with a validated diet questionnaire. No adverse events occurred during the study period. Despite no change of the diet, stool frequency increased during fucoidan intake (from 7.78 ± 4.64/week in Week 1 to 9.15 ± 5.03/week in Week 5, P < 0.001), and it increased more in lean subjects. In 11 subjects whose stool frequency exceeded the mean value, the thresholds for sweet, salty, bitter and umami tastes were significantly reduced (enhancement of sensitivity) after fucoidan intake. In 14 subjects with normal HOMA-IR (homeostatic model assessment of insulin resistance, < 2.5), hemoglobin A1c decreased after fucoidan intake (from 6.73 ± 1.00 to 6.59 ± 1.00%, P < 0.05), as did the fasting plasma level of GLP-1 (glucagon-like peptide-1, from 6.42 ± 3.52 to 4.93 ± 1.88 pmol/L, P < 0.05). Sustained fucoidan intake led to alterations of gastrointestinal function, including increased stool frequency and enhanced taste sensitivity, which could contribute to better control of diabetes.

Whole-colon investigation vs. flexible sigmoidoscopy for suspected colorectal cancer based on presenting symptoms and signs: a multicentre cohort study

BackgroundPatients with suspected colorectal cancer (CRC) usually undergo colonoscopy. Flexible sigmoidoscopy (FS) may be preferred if proximal cancer risk is low. We investigated which patients could undergo FS alone.MethodsCohort study of 7375 patients (≥55 years) referred with suspected CRC to 21 English hospitals (2004–2007), followed using hospital records and cancer registries. We calculated yields and number of needed whole-colon examinations (NNE) to diagnose one cancer by symptoms/signs and subsite. We considered narrow (haemoglobin <11 g/dL men; <10 g/dL women) and broad (<13 g/dL men; <12 g/dL women) anaemia definitions and iron-deficiency anaemia (IDA).ResultsOne hundred and twenty-seven proximal and 429 distal CRCs were diagnosed. A broad anaemia definition identified 80% of proximal cancers; a narrow definition with IDA identified 39%. In patients with broad definition anaemia and/or abdominal mass, proximal cancer yield and NNE were 4.8% (97/2022) and 21. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency (41% of cohort), proximal cancer yield and NNE were 0.4% (13/3031) and 234.ConclusionMost proximal cancers are accompanied by broad definition anaemia. In patients without broad definition anaemia and/or abdominal mass, with rectal bleeding or increased stool frequency, proximal cancer is rare and FS should suffice.

Role of Fecal Microbiota Transplantation in Treating Inflammatory Bowel Disease and Clostridium difficile Infection: Narrative Review

Introduction: Fecal microbiota transplantation (FMT) is a therapeutic method where fecal microbiota from a healthy donor is transferred to a patient in the hopes of restoring normal, healthy microbiota of the gut. FMT is a promising treatment option for patients with medical conditions causing dysbiosis such as inflammatory bowel disease (IBD), Clostridium Difficile infection (CDI), metabolic syndrome, obesity, and irritable bowel syndrome. Over the years, studies were conducted to test its efficacy in other clinical conditions associated with normal bowel microbiome depletion. Methods: This narrative review summarizes the available efficacy and safety data on the use of FMT in IBD and C. diff patients. We completed an extensive literature search on PubMed, Google Scholar, Scopus, and Cochrane library electronic databases. Results: In most studies, patients received antibiotics before FMT. In studies retrieved, donors were related to recipients (relatives, friends, partners), whereas stool from unrelated donors was used less frequently. Pre-transplant screening procedures include serological testing for viruses (e.g., hepatitis A/B/C viruses, EBV, CMV, and HIV) and stool testing for C. difficile toxins, parasites, ova, and common bacterial enteropathogens. According to our search, several routes of administration were reported: enema, colonoscopy in seven studies, gastroscopy, nasojejunal tube, and nasogastric tube. Data support a positive effect of FMT on the outcome of IBD in at least some patients. In the majority of studies reviewed, IBD patients showed decreasing rates of remission/response over time. Our search shows FMT was well tolerated. Most common adverse events were abdominal pain, cramping, bloating, flatulence, increased stool frequency, and fever within days of transplant. The majority were self-resolving. Stool preparation is required for FMT with the minimum amount of stool infusate needed being 50g. Conclusion: Low recurrence rates of CDI and successful restoration of gut microbiota has proven FMT an innovative and popular treatment. Infectious Diseases Society of America and Society for Healthcare Epidemiology of America made updated guidelines in 2017 to recommend FMT for treatment of people with >2 recurrences of CDI despite standard antibiotic treatment. Successful FMT procedures can save the healthcare system thousands of dollars with fewer hospitalizations and frequent antibiotic prescriptions. Further studies focused on long-term outcomes and safety are also warranted.2745 Figure 1. Preparation of fecal materials for fecal microbiota transplantation.

Family-Driven Goals to Improve Care for Children With Autism Spectrum Disorder.

Constipation and insomnia are not consistently identified and treated in children with autism spectrum disorder (ASD) despite their high prevalence and deleterious impact in this population. To standardize care, a constipation practice pathway and an insomnia practice pathway were previously developed by Autism Treatment Network clinicians. Our objective was to implement and refine these practice pathways in clinical settings. Eleven Autism Treatment Network sites participated in a Learning Collaborative (ie, multidisciplinary quality improvement team) and chose to implement either the constipation or insomnia practice pathway in the clinical setting. Families set intervention goals (eg, increase stool frequency, decrease nighttime awakenings) before treatment. Each site began implementation with 1 patient and then increased implementation by factors of 5. Before each increase, the Learning Collaborative evaluated progress and refined the practice pathways. Process improvement was measured primarily by duration until goal attainment and by percentage of families who meet their goals. Across sites, 82 children with ASD and constipation and 101 children with ASD and insomnia were managed. Difficulties with intervention adherence and communication between providers and families were reported and were subsequently improved with parallel refinements to both practice pathways. The most notable modification was incorporating a goal-setting session in which families generated their own intervention goals (ie, family-driven goals). In this quality improvement initiative, 75% of families met at least 1 constipation or insomnia goal, with the median time to improvement being 6 weeks. By integrating a family-centered approach into the standardization of care, constipation and insomnia practice pathways may improve engagement, adherence, and management of medical conditions in children with ASD.

Irritable Bowel Syndrome with Diarrhea

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 figures, 6 tables and 42 references KEYWORDS: IBS-D, eluxadoline, rifaximin, probiotics, bloating, antidepressants, bile acid malabsorption, microscopic colitis, celiac

Irritable Bowel Syndrome with Diarrhea

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 highly rendered figures, 6 tables, and 99 references.

The Cologne pouch procedure for continent anal urinary diversion in children with bladder exstrophy–epispadias complex

In children who remain incontinent after reconstruction of bladder exstrophy-epispadias complex (BEEC), continent anal urinary diversion (CAD) is one option to achieve continence. Known problems after CAD are an increased stool frequency and ureterointestinal stenosis. We devised a new surgical technique of CAD that we named the "Cologne pouch procedure" (CPP) that renders the possibility of separate evacuation of urine and feces. Furthermore, we connect the bladder plate to the rectosigmoid pouch instead of performing a ureterosigmoidostomy to reduce the rate of ureterointestinal stenosis. In this study, we want to introduce the CCP and critically evaluate our results. In CPP a detubularized sigmoid-bladder pouch is created, which is naturally connected to the rectum. A retrospective study was performed including all patients with BEEC and CPP treated in our hospital between January 1, 2007, and December 31, 2016. Epidemiological and surgical key data, complications, and the need for alkaline supplementation were assessed. At follow-up examinations, we evaluated continence, ability of independent urine and feces evacuation, need for bicarbonate supplementation, status of the upper urinary tract, and complications such as urinary tract infections or urolithiasis. In total, 29 patients with BEEC and CPP were included. The mean age at surgery was 4.2±3.3 years (range 0.1-12.7 years). Overall, 14 short-term complications occurred in nine patients. Postoperatively, all patients were continent for urine and feces during daytime and only one child occasionally lost small portions of urine at night. An independent evacuation of urine and feces was accomplished in 22 patients (81.5%). Continued bicarbonate supplementation was necessary in 15 patients (55.6%). During the follow-up period six patients (22.2%) had a single urinary tract infection and four patients (14.8%) calculi of the urinary tract. No urinary tract abnormalities-especially no vesicoureteral reflux (VUR) or stenosis-were detected during follow-up ultrasound examination. In two children, a preoperatively known hydronephrosis decreased after CPP. CPP is a novel technique that yields excellent results concerning continence. In contrast to other forms of rectosigmoid urinary diversion, functional separation of defecation and urination can be achieved in most patients.

Irritable Bowel Syndrome with Diarrhea

Irritable bowel syndrome (IBS) is a complex, functional gastrointestinal condition characterized by abdominal pain and alteration in bowel habits without an organic cause. One of the subcategories of this disorder is IBS with diarrhea (IBS-D). Clinically, patients who present with more than 3 months of abdominal pain or discomfort associated with an increase in stool frequency and/or loose stool form are defined as having IBS-D. This review addresses IBS-D, detailing the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, clinical manifestations and physical examination findings, differential diagnosis, treatment, emerging therapies, complications, and prognosis. Figures show potential mechanisms and pathophysiology of IBS, IBS-D suspected by clinical assessment and Rome III criteria, pharmacologic and nonpharmacologic treatment options, potential mechanisms of action of probiotics, and potential treatment modalities. Tables list the Rome criteria for IBS, alarm signs and symptoms suggestive of alternative diagnoses, IBS criteria, differential diagnosis of IBS-D, dietary advice options for IBS-D, and alternative and emerging therapies in IBS-D. This review contains 5 highly rendered figures, 6 tables, and 99 references.

Saturated long-chain fatty acid-producing bacteria contribute to enhanced colonic motility in rats

BackgroundThe gut microbiota is closely associated with gastrointestinal (GI) motility disorder, but the mechanism(s) by which bacteria interact with and affect host GI motility remains unclear. In this study, through using metabolomic and metagenomic analyses, an animal model of neonatal maternal separation (NMS) characterized by accelerated colonic motility and gut dysbiosis was used to investigate the mechanism underlying microbiota-driven motility dysfunction.ResultsAn excess of intracolonic saturated long-chain fatty acids (SLCFAs) was associated with enhanced bowel motility in NMS rats. Heptadecanoic acid (C17:0) and stearic acid (C18:0), as the most abundant odd- and even-numbered carbon SLCFAs in the colon lumen, can promote rat colonic muscle contraction and increase stool frequency. Increase of SLCFAs was positively correlated with elevated abundances of Prevotella, Lactobacillus, and Alistipes. Functional annotation found that the level of bacterial LCFA biosynthesis was highly enriched in NMS group. Essential synthetic genes Fabs were largely identified from the genera Prevotella, Lactobacillus, and Alistipes. Pseudo germ-free (GF) rats receiving fecal microbiota from NMS donors exhibited increased defecation frequency and upregulated bacterial production of intracolonic SLCFAs. Modulation of gut dysbiosis by neomycin effectively attenuated GI motility and reduced bacterial SLCFA generation in the colon lumen of NMS rats.ConclusionsThese findings reveal a previously unknown relationship between gut bacteria, intracolonic SLCFAs, and host GI motility, suggesting the importance of SLCFA-producing bacteria in GI motility disorders. Further exploration of this relationship could lead to a precise medication targeting the gut microbiota for treating GI motility disorders.

Abstract O-29: ENTERAL PROTEIN SUPPLEMENTATION IN CRITICALLY ILL CHILDREN: A RANDOMIZED CONTROLLED PILOT STUDY

Aims & Objectives: Protein supplementation may be associated with improved clinical outcomes in critically ill children. The aim of this study was to assess the safety and tolerance of protein supplementation, and its impact on clinical outcomes in critically ill children on enteral nutrition (EN). Methods Pilot, three-arm, controlled trial in critically ill children. Children on mechanic ventilation and on EN therapy were randomized to one of 2 interventional groups; polymeric and oligomeric protein supplementation, or control group receiving standard nutritional therapy. In the interventional groups, the protein supplement was administered to reach the prescribed protein goal by Day 4. Demographic characteristics and clinical outcomes were recorded. EN interruptions, increase in stool frequency and abdominal distension were evaluated as signs of intolerance of the intervention. Blood urea and creatinine values were recorded. Results Among 363 patients admitted, 70 were eligible, and 34 were. At baseline there were no differences between the groups (Table 1). The number of EN interruption and ≥3 defecations/day were similar between groups. Abdominal distension was present in 30% of the control, 12.5% of the polymeric and 0% of the oligomeric group. There were no increases in serum urea and creatinine values in all 3 groups. There were no differences in clinical outcomes between the 3 groups (Table 2).Conclusions Enteral protein supplementation with oligomeric or polymeric modules is safe and well tolerated in critically ill children. Multicenter study with larger sample size is necessary to examine the impact of protein supplementation on clinical outcomes. Trial registration: Brazilian Registry of Clinical Trials n°RBR-3h4x97

Risk Factors for Fecal Urgency Among Individuals With and Without Diarrhea, Based on Data From the National Health and Nutrition Examination Survey

Fecal urgency is a common symptom among patients with gastrointestinal disorders, but can also occur in healthy individuals with normal bowel habits. There have been few studies of fecal urgency in the general population. We performed a cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES) to analyze the prevalence of and risk factors for this symptom. We analyzed data from 4676 persons who completed the Bowel Health Questionnaire from the NHANES, from 2009 through 2010. The NHANES sampled a nationally representative group of adults in the United States and provides information on demographics, medical comorbidities, and dietary habits of survey participants. The Bowel Health Questionnaire provided additional information about bowel symptoms such as urgency, incontinence, constipation, and diarrhea. We identified individuals with fecal urgency and calculated differences in fecal urgency among subgroups using chi-squared analysis. We used logistic regression to identify factors associated with urgency. In our study population, the prevalence of fecal urgency was 3.3%; 29.5% of individuals with fecal urgency had diarrhea. The prevalence of fecal urgency was significantly higher in individuals who had diarrhea (14.8%) than in individuals without diarrhea (3.1%). Older age, female sex, poverty, urinary urge incontinence, diarrhea, and increased stool frequency were all associated with fecal urgency on multivariable analysis. Decreased fiber intake and increased carbohydrate intake were associated with urgency among individuals with diarrhea. In an analysis of data from 4676 individuals who completed a Bowel Health Questionnaire from the NHANES, we found a significantly higher proportion of individuals with diarrhea to have fecal urgency. However, most individuals with fecal urgency do not have diarrhea. Factors associated with fecal urgency vary among individuals with and without diarrhea.

Is Fibre an Effective Strategy to Improve Laxation in Long-Term Care Residents?

The high prevalence of constipation in long-term care (LTC) residents has been a long-standing issue for caregivers, attending health professionals, and the residents themselves. The traditional medical response has been to utilize pharmaceutical laxatives, enemas, and suppositories for treatment. The purpose of this review was to determine if fibre supplementation (including fibre added to foods) is effective in increasing stool frequency, improving stool consistency, and decreasing laxative use in LTC residents. A systematic search was conducted using PubMed and CINAHL databases, inclusive to March 2017. Search terms included: "long-term care" or "nursing home" AND "fiber (fibre)," "bran," "psyllium," "inulin," or "prebiotic." Intervention trials of fibre supplementation with ≥5 LTC residents were included. The search generated 456 articles following removal of duplicates; 8 studies met the inclusion criteria. Three additional trials were identified through a hand search of references of pertinent articles. Current evidence suggests that added fibre may be effective in increasing stool frequency and/or decreasing laxative use in LTC residents and, thus, may lessen the burden of constipation. However, randomized controlled trials are needed to clearly demonstrate the effects of adding fibre to foods, particularly insoluble and less fermentable sources, on constipation in LTC residents.

Outcomes of Bismuth Subsalicylate Treatment in Patients With Microscopic Colitis

Introduction: Bismuth subsalicylate (BSS) is commonly used to treat microscopic colitis (MC) with limited data on response and recurrence rates from small clinical trials. We aimed to evaluate clinical response and recurrence to BSS for MC. Methods: Patients with collagenous colitis (CC) or lymphocytic colitis (LC) treated with BSS at a single tertiary care institution from 12/31/2001 to 12/31/2016 were included. MC was defined by presence of diarrhea with normal endoscopy and compatible histopathology. Complete response to BSS was defined as normalization of stool frequency and partial response was defined as at least 50% reduction in stool frequency from baseline at 8±2 weeks. Recurrence was defined by return of increased stool frequency with no alternative etiology after complete resolution. Results: Overall, 94 patients (91.4% female, median age 69.4 years; 49 (52%) had LC and 45 (48%) had CC) were treated with BSS with a median duration of follow-up of 2 years (range, 0.1-11 years). Fifty four (57.4%) had complete response, 20 (21.2%) had partial response, and 20 (21.2%) had no response. Of the 54 patients with complete response, 28 (51.8 %) had recurrence. The median time to recurrence was 12.5 weeks after stopping BSS. Of the patients with recurrence, 23 (82.1%) were retreated successfully with BSS, 3 (10.7%) with loperamide and 2 (7.1%) were treated with budesonide. There were no serious adverse events reported with BSS.On univariate analysis, there was evidence for a dose response, with a higher dose being associated with a higher rate of complete response (P=0.0025, Table 1). Moreover, response rates varied by MC subtype (with LC more likely to have a complete response than CC (67.3% vs 48.8%, P=0.003)), but not by age or diarrhea severity.On multivariate analysis after adjusting for age and gender, both a higher dose (P=0.0044) and presence of LC (P=0.03) were associated with a higher response to BSS. Recurrence rates were not dependent on dose (Table 1), number of baseline bowel movements per day or type of MC.Table: Table. Dose response and recurrence for BSS for MCConclusion: Patients with microscopic colitis treated with BSS have a high clinical response rate but also have a high risk of recurrence. A higher dose is associated with a higher response rate and patients with LC are more likely to respond compared to CC. A large prospective clinical trial is needed to evaluate the efficacy of BSS for MC patients.

A yeast fermentate improves gastrointestinal discomfort and constipation by modulation of the gut microbiome: results from a randomized double-blind placebo-controlled pilot trial

BackgroundConstipation and symptoms of gastrointestinal discomfort such as bloating are common among otherwise healthy individuals, but with significant impact on quality of life. Despite the recognized contribution of the gut microbiome to this pathology, little is known about which group(s) of microorganism(s) are playing a role. A previous study performed in vitro suggests that EpiCor® fermentate has prebiotic-like properties, being able to favorably modulate the composition of the gut microbiome. Therefore, the aim of this study was to investigate the effects of EpiCor fermentate in a population with symptoms of gastrointestinal discomfort and reduced bowel movements and to evaluate its effect at the level of the gut microbiome.MethodsThis pilot study was performed according to a randomized, double-blind, placebo-controlled parallel design. Eighty subjects with symptoms of gastrointestinal discomfort and constipation were allocated to one of two trial arms (placebo or EpiCor fermentate). Randomization was done in a stratified manner according to symptom severity, resulting in two subgroups of patients: severe and moderate. Daily records of gastrointestinal symptoms were assessed on a 5-point scale, and also stool frequency and consistency were documented during a 2-week run-in and a 6-week intervention phases. Averages over two-week intervals were calculated. Constipation-associated quality of life and general perceived stress were assessed at baseline and after 3 and 6 weeks of intervention. Fecal samples were also collected at these same time points.ResultsEpiCor fermentate led to a significant improvement of symptoms such as bloating/distension (p = 0.033 and p = 0.024 after 2 and 4 weeks of intervention, respectively), feeling of fullness (p = 0.004 and p = 0.023 after 2 and 4 weeks of intervention, respectively) and general daily scores (p = 0.046 after 2 weeks of intervention) in the moderate subgroup. A significant improvement in stool consistency was observed for the total population (p = 0.023 after 2 weeks of intervention) as well as for the severe subgroup (p = 0.046 after 2 weeks of intervention), and a nearly significant increase in stool frequency was detected for the total cohort (p = 0.083 and p = 0.090 after 2 and 4 weeks of intervention, respectively). These effects were accompanied by an improvement in constipation-associated quality of life and general perceived stress, particularly in the moderate subgroup. Members of the families Bacteroidaceae and Prevotellaceae, two groups of bacteria that have been previously reported to be deficient in constipated patients, were found to increase with EpiCor fermentate in the severe subgroup. In the moderate subgroup, a significant increase in Akkermansia muciniphila was observed.ConclusionsDespite the relatively low dose administered (500 mg/day), particularly when comparing to the high recommended doses for prebiotic fibers, EpiCor fermentate was able to modulate the composition of the gut microbiome, resulting in improvement of constipation-associated symptoms. Conversely, the reported increase in bowel movements may have altered the gut microbial community by increasing those groups of bacteria that are better adapted to a faster gastrointestinal transit time.Trial registrationNCT03051399 at ClinicalTrials.gov. Retrospectively registered. Registration date: 13 February 2017.