Low-fiber Diet Research Articles

Effect of fiber source and carbohydrase enzyme on chukar partridge growth performance, blood characteristics, digestive enzyme activity, cecal microbial population and ileal morphology

Effects of fiber source with various particle size and carbohydrase enzyme on growth criteria, carcass and blood characteristics, digestive enzyme activity, cecal microbial population and ileal morphology of chukar partridge were evaluated for a total period of 90 days. 300 day-old partridge were randomly allotted to a 5 × 2 factorial arrangement with 4 different fiber inclusion with different mean particle size (MPS) (none; rice hulls (RH) (711 ± 1.8 μm); wheat straw (WS) Coarse (3211 ± 1.2 μm); wheat straw Fine (755 ± 1.9 μm); and wheat bran (WB) (767 ± 1.8 μm)) along with a low-fiber control diets and two levels of carbohydrase enzyme (0 or 50 mg/kg). There were 10 treatments and 5 pens with 6 partridge chicks per each treatment. The results indicated that fiber inclusion regardless of fiber source significantly increased body weight (BW) of birds during the whole experimental period (P < 0.01). Among the fiber sources, the highest BW attained when fine WS and WB was incorporated into the low fiber diet (P < 0.01). The effect of enzyme on body weight was significant on days 60 and 90. Moreover, there were interactive effects (P< 0.01) between fiber sources and enzyme on BW during the trial. Feed intake significantly (P< 0.001) increased at starter (30 days) phase of trial by inclusion of fiber to control diet, but no significant differences were noted after on days 60 and 90. Enzyme addition had no effect on feed intake and also no interactive effect was observed between fiber source and enzyme for feed intake. Feed conversion ratio (FCR) was reduced by inclusion of fiber into control low fiber diet especially at late stage of rearing period (P< 0.05). Plasma uric acid concentration was reduced by inclusion of fiber on day 28 (P< 0.05). Inclusion of fine WS increased plasma triglyceride and very low-density lipoprotein cholesterol (VLDL-C) concentration on day 90 (P< 0.05). There were interactive effects (P< 0.05) between fiber sources and enzyme on total cholesterol and very low-density lipoprotein cholesterol (LDL-C) cholesterol on day 90. Jejunum and ileum relative weight were reduced by inclusion of fiber to control diet and the effect was more pronounced for coarse wheat straw (P< 0.05). Duodenum and ileum weight were increased by addition of enzyme to diets (P< 0.05). Fiber inclusion regardless of fiber source and particle size significantly (P< 0.01) reduced duodenum, jejunum and ileum relative length. Addition of coarse WS and RH into the low fiber diet significantly increased alkaline protease, trypsin and α-amylase activity (P< 0.01). There were interactive effects (P< 0.05) between fiber sources and enzyme on digestive enzyme activity (P< 0.01). Enzyme addition reduced trypsin activity (P< 0.05). Ceca E. coli population was increased when fiber sources were incorporated into the low fiber diet (P< 0.05). Villi length, crypt depth and villi to crypt ratio were reduced (P< 0.01) considerably regardless of fiber source compared to the low fiber diet. Inclusion of coarse WS increased and RH reduced (P< 0.01) submucosa, lamina propria and epithelial cells layer thickness compared to the low fiber diet. The results confirmed that partridge growth performance was improved by inclusion of fiber. Results obtained from current trial suggest that the fiber is a very important part of partridge diets which could improve the performance with advancing age especially in long-lived partridge.

125 Effects of Dietary Fiber Supplementation in Late Gestation on Farrowing Characteristics and Sows and Litters Performance

Abstract Our objective was to evaluate the effects of dietary fiber supplementation in late gestation on farrowing characteristics and sow and piglet’s performance. On d 105 of gestation, a total of 420 sows were selected according to body condition score, caliper units and parity (0 to 6), and randomly assigned to one of two treatments in a completely randomized design. Treatments included 1) Low fiber diet (LF) with 2.02% crude fiber; and 2) High fiber diet (HF) with 5.12% crude fiber. The LF diet was based on corn and soybean meal with 3.26 Mcal of ME/kg and 0.60% SID Lys. The HF diet was corn-soybean meal-based with 10% soy hulls, containing 3.13 Mcal/kg and 0.60% SID Lys. Sows in both treatments were fed 1.8 kg/d. Fecal score was daily evaluated until farrowing. Farrowing duration and birth weight of born alive and stillborn piglets were recorded. The farrowing was manually assisted when the birth interval was longer than 30 min. Data were analyzed by the GLIMMIX procedure of SAS, and comparisons were performed with Student’s t-test at 5% of significance. Sows fed HF diet had fewer days with dry feces compared to those fed LF diet (P = 0.008). No evidence for treatment effects were observed on farrowing duration (P = 0.25) and farrowing assistance (P = 0.09). Sows fed HF diet had greater number of total piglets born (P = 0.01), but there was no evidence (P &amp;gt; 0.05) for treatment differences on the percentage of piglets born alive, stillborn piglets, or mummified fetuses. Piglets from sows fed LF diet had a greater birth weight than those from sows fed HF diet (P = 0.04). No evidence for differences were observed between treatments for pre-weaning mortality, number and weight of weaned pigs (P &amp;gt; 0.05). In conclusion, the HF diet did not show positive effects on farrowing duration, farrowing assistance, and sow and piglet performance.

Does caffeine enhance bowel recovery after elective colorectal resection? A prospective double-blinded randomized clinical trial.

Postoperative ileus is a common condition following abdominal surgery. Previous studies have shown the positive effects of coffee on gastrointestinal motility. The aim of this study was to assess whether caffeine is the stimulatory agent in coffee that triggers bowel motility and thus may reduce the duration of postoperative ileus. This was a single-centered, prospective, randomized controlled, double-blinded clinical trial. Patients scheduled to undergo elective laparoscopic colectomy between November 2017 and March 2019 were randomly assigned to receive either oral caffeine (100mg three times daily) or placebo following the procedure. Primary endpoints were time to first flatus and time to first bowel movement. Secondary endpoints were time to tolerate a solid, low-residue diet and length of hospital stay. Registration number: NCT03097900. Seventy patients were included, [35 males, median age 56years (range 19-79years)]. After the exclusion of 12 patients, there were 30 patients in the caffeine group and 28 patients in the placebo group. The first passage of stool in the caffeine group occurred 18h earlier than in the placebo group (p = 0.012); other endpoints did not reach statistical significance. No caffeine-related adverse events were observed. Caffeine consumption following colectomy is safe, leads to a significantly shorter time to first bowel movement, and may thus potentially lead to a shorter postoperative hospital stay.

Modified endoscopic ultrasound-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS): a pilot study

We recently developed a double-balloon device, using widely available existing technology, to facilitate endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). This was a single-center retrospective study of consecutive patients undergoing M-EPASS from January 2019 to August 2020. The double-balloon device consists of two vascular balloons that optimize the distension of a targeted small-bowel segment for EUS-guided stent insertion. The primary end point was the rate of technical success. 11 patients (45 % women; mean [standard deviation (SD)] age 64.9 [8.6]) with malignant gastric outlet obstruction were included. Technical and clinical success (ability to tolerate an oral diet) were achieved in 91 % (10/11) and 80 % (8/10) of patients, respectively. There was one adverse event (9 %) due to stent migration. Two patients (18 %) required re-intervention for stent obstruction secondary to food impaction. The mean (SD) time to a low residue diet was 3.5 (2.4) days. M-EPASS appears to facilitate the technique of EUS-GE, potentially enhancing its safety and clinical adoption. Larger studies are needed to validate this innovative approach to gastric outlet obstruction.

Metabolic Changes in Pediatric HIV-Positive Patients and Potential Lifestyle Interventional Strategies.

Metabolic changes in the HIV population have been well-studied, particularly after the advent of antiretroviral therapy. More notably, the emergence of the metabolic syndrome within the HIV population, due to prolonged survival, has led to an increasing rate of cardiovascular occurrence and mortality within the population in adult life. Importance of early intervention in HIV children, particularly lifestyle modifications, is necessary to reduce cardiovascular disease (CVD) risk and mortality in adulthood. Potential clinical interventions include routine anthropometric measurements as a measure of CVD risk, a low saturated fat and high fiber diet, and vigorous aerobic exercise have been shown to decrease CVD risk in the HIV population. The literature review found multiple knowledge gaps due to minimal studies completed on the HIV population and even less on HIV-positive children. Overall, a standardized protocol was required to better care for HIV-positive children and potential future CVD mortality.

Potassium carbonate as a supplement to improve milk fat concentration and yield in early-lactating dairy goats fed a high-starch, low-fiber diet

This study investigated the use of K2CO3 as dietary buffer to prevent or to recover from low milk fat production when early-lactating dairy goats are fed a high-starch, low-fiber (HSLF) diet. At kidding, 30 Alpine goats housed in pens with Calan gate feeders received a total mixed ration with a forage-to-concentrate ratio of 55:45 on a dry matter (DM) basis for a baseline period of 27 ± 4 d. Goats (milk yield, 4.14 ± 0.88 kg/d; milk fat, 4.28 ± 0.52%; mean ± SD) were then assigned to 1 of 10 blocks according to parity (first vs. second or more) and milk fat concentration, and fed a HSLF diet containing 45% forages and 55% concentrates for 2 experimental periods of 28 d. Treatments were identified as (1) control, in which the HSLF diet was fed throughout both periods; (2) preventive, in which the HSLF diet supplemented with K2CO3 (1.6% of DM) was fed during both periods; and (3) recovery, in which the HSLF diet was fed during the first period (P1) and the HSLF diet supplemented with K2CO3 was fed during the second period (P2). Data from P1 and P2 were analyzed separately. In P1, preplanned contrasts were used to evaluate the preventive effect of K2CO3 (control and recovery, both groups receiving the same diet during this period, vs. preventive), and in P2, to assess the potential of K2CO3 to alleviate an already existing state of low milk fat (control vs. recovery and preventive vs. recovery). Feeding the HSLF diet in P1 moderately decreased milk fat concentration (-16%) and yield (-13%) as compared with baseline. Dietary addition of K2CO3 decreased DM intake by 12 and 14% in P1 and P2, respectively. Ruminal pH was not different among treatments. There was also no significant difference in milk yield (4.13 and 3.71 kg/d on average in P1 and P2, respectively) for any tested contrasts. In P1, milk fat concentration and yield did not differ among goats fed control (3.58% and 151 g/d, respectively) and preventive (3.67% and 148 g/d, respectively) diets. In P2, milk fat concentration and yield did not differ among goats fed the control diet (3.38% and 137 g/d, respectively), and diets where K2CO3 was used as preventive (3.44% and 126 g/d, respectively) or recovery treatment (3.25% and 113 g/d, respectively). Supplementing a high-concentrate diet with 1.6% K2CO3 was therefore not effective in either preventing or suppressing already existing conditions of low milk fat production in dairy goats.

Interactive effect of corn particle size and insoluble fiber source on performance, nutrient utilization and intestine morphology in broilers fed pelleted diets.

The effects of corn particle size and dietary fibre on the performance, coefficient of apparent ileal digestibility (CAID) and intestinal characteristics in broiler starters fed pelleted diets were studied. The experiment included 10 treatments arranged as a 2×5 factorial with two corn particle sizes (GMD of 1071 [CGC] vs. 534 [FGC]) and five diets that consisted in a low-fibre diet and four extra diets resulting from the inclusion of insoluble fibre sources (10g/kg of lignocellulose (LC), and 30g/kg of oat hulls; OH, rice hulls; RH, and sunflower hulls; SFH). In coarse grinding, all-fibre sources improved body weight gain and feed intake compared to the control diet (p<0.01). Feed conversion ratio (FCR) improved with fibre supplementation (p<0.01) and fine grinding of corn (FGC) (p<0.01). Coarse grinding of corn (CGC) and inclusion of RH, SFH and OH reduced gizzard pH (p<0.01). Fibre inclusion increased ileal fat and Ca digestibility (p<0.01), gizzard weight (p<0.01), digesta transit time (p<0.01) and length of duodenum and small intestine (p<0.01). The CAID of phosphorus increased in CGC fed birds and inclusion of RH, SFH and OH (p<0.05). The weight of gizzard, proventriculus and pancreas (p<0.01) was greater in CGC fed birds. Feeding SFH, RH and OH (p<0.01), and CGC (p<0.01) increased the villus height (VH) of the duodenum. The OH, RH and SFH supplementation increased the caecal population of Lactobacillus spp. and total anaerobic bacteria (p<0.01) only in FGC fed birds. Overall, birds fed pelleted diets containing RH, OH and SFH (3%) exhibited improved performance, and increased nutrient digestibility, which may be caused by developed gizzards and intestine. Furthermore, coarse grinding of corn is beneficial to gizzard development.

Effects of dietary fibre level on rumen pH, total microbial count and methanogenic archaea in Bonsmara and Nguni steers

A study was conducted to evaluate the effect of the level of dietary fibre on rumen pH, total microbial count and methanogenic archaeacount of Bonsmara (225 ± 10.0 kg live weight) and Nguni (215 ± 10.0 kg live weight) steers. Nine steers per breed were used, aged 8 to 9 months. A 3 x 2 factorial experiment was executed with treatments allocated in a completely randomized design. The treatments were diets which included 64.3% neutral detergent fibre (NDF) for diet 1, 40.4% NDF for diet 2, and 29.9% NDF for diet 3. Steers were fed for 90 days and housed in individual pens. Rumen fluid was collected from steers using a stomach tube. Rumen fluid samples were taken immediately to the laboratory for microbial assay. Data were subjected to analysis of variance (ANOVA). The various levels of dietary fibre did not affect rumen pH and methanogenic archaea count. However, a low-fibre diet yielded high rumen total microbial count for Bonsmara steers and low rumen total microbial count for Nguni steers. Therefore, a low-fibre diet can be applied as a viable strategy to enhance rumen total microbial count in exotic beef breeds and crossbred cattle such as Bonsmara. Nguni steers fed a high NDF diet had higher rumen total microbial count than Nguni steers fed a low-fibre diet. Therefore, a high NDF diet can be used efficiently by feeding it to indigenous breeds and purebred cattle such as Nguni.

Functional Constipation in Children: Demography and risk factors analysis from a Tertiary Care Hospital of Bangladesh

Background: Constipation is not uncommon in childhood. This study was aimed to evaluate demography and probable/potential risk factors for functional constipation in Bangladeshi children.&#x0D; Materials &amp; Method: This cross-sectional study was carried out among 179 children from May 2018 to June 2019 in the department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka both indoor and outdoor basis. Collected data from children with constipation who fulfilled the Rome III criteria were analyzed by SPSS 20.&#x0D; Results: Among 179 children, 54.75% were boys, and 45.25% girls. It was found more in age group above 5 years (56.42%), then in 2 to 5 years (33.52%) and lower in below 2 years (10.6%). Constipation was more in urban areas (55.3%) than in rural (44.69%). Among potential risk factors, low fiber in diet (72.63%) was most common, other factors were ingestion of cow’s milk (32.96%), not having regular meals with parents (19.55%), consumption of junk foods (28.49%), Staying with grandparents (16.76%), living in hostel or madrasa / residential, religious institute (5.03%), long period of academic activity (7.26%), unhygienic toilet in school (6.14%) were also found to be probable risk factors in this study.&#x0D; Conclusion: Functional constipation was found more in boys &amp; above five-year age groups. Low dietary fiber, consumption of cow’s milk &amp; junk food, unwillingness to use toilets in school were found as potential underlying risk factors of constipation.&#x0D; Bangladesh J Child Health 2020; VOL 44 (3) :148-152

Preoperative Minimal-Residue Diet Versus Fasting Alone in Minimally Invasive Gynecologic Surgery

Objective: The present prospective randomized study compared the effects of a minimal-residue low fiber diet for 3 days preoperatively with fasting alone on surgical vision and efficiency during laparoscopic hysterectomy and myomectomy, as well as patient outcomes after these procedures were completed. Materials and Methods: The present study included 281 patients who underwent surgery between April 2012 and June 2015. Prior to surgery, the patients were assigned to 1 of 2 groups: (1) a fasting-alone group or (2) a minimal-residue diet group. The primary outcome was the visual quality of the surgical field. Results: Overall exposure of the surgical field was evaluated as “good” or “excellent” in 100 of 139 (71.9%) patients of the fasting-alone group and in 108 of 142 (76.0%) patients of the minimal-residue diet group, which was not statistically significant (p = 0.79). Conclusions: A preoperative minimal-residual diet does not improve the quality of surgical vision, compared to fasting alone. Accordingly, it may be reported that fasting alone is a safe and preferable alternative with no added complications in minimally invasive gynecologic surgery, such as laparoscopic hysterectomy and myomectomy. (J GYNECOL SURG 37:485)

An Enhanced High-Volume Preparation for Colonoscopy Is Not Better Than a Conventional Low-Volume One in Patients at Risk of Poor Bowel Cleansing: A Randomized Controlled Trial.

Objective: We tested the hypothesis that an enhanced bowel preparation strategy (EBS) improves colonic cleansing in patients at high risk for inadequate bowel cleansing (HRI).Methods: This prospective randomized clinical trial included consecutive HRI patients referred for outpatient colonoscopy between February and October 2019. HRI was considered if patients scored >1.225 according to a previously validated bowel-cleansing predictive score. HRI patients were randomized (1:1) to a low-volume conventional bowel cleansing strategy (CBS) (1-day low residue diet (LRD) plus 2 L of polyethylene glycol (PEG) plus ascorbic acid) or to an EBS (3-day LRD plus 10 mg oral bisacodyl plus 4 L PEG). The Boston Bowel Preparation Scale (BBPS) was used to assess the quality of cleanliness. Intention-to-treat (ITT) and per protocol (PP) analyses were performed. A sample size of 130 patients per group was estimated to reach a 15% difference in favor of EBP.Results: A total of 253 HRI patients were included (mean age 69.8 ± 9.5 years, 51.8% women). No statistically significant differences were found in the BBPS scale between the two groups in the ITT analysis (CBS 76.8% vs. EBS 79.7%, P = 0.58) or PP analysis (CBS 78% vs. EBS 84.3%, P = 0.21), risk difference 2.9% (95% CI−7.26 to 39.16) in the ITT analysis, or risk difference 6.3% (95% CI−3.48 to 16.08) in PP analysis. No differences in preparation tolerance, compliance, adverse effects, or colonoscopy findings were found.Conclusion: EBS is not superior to CBS in hard-to-prepare patients. (EUDRACT: 2017-000787-15, NCT03830489).Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03830489.

Environmental and Dietary Risk Factors for Colonic Diverticulosis and Diverticulitis.

Colonic diverticulosis (CD) is among the most common conditions of the large bowel. Several factors have been associated with an increased risk of CD and its complications, including advanced age, obesity, physical inactivity, and a low-fiber diet. Available data is conflicting and a comprehensive analysis of different bowel, dietary and environmental habits linked with CD is lacking. We aimed to investigate the relationship between potential risk factors and CD prevalence using full data from a colonoscopy-based cross-sectional study in Europe. The study was conducted at three tertiary referral centers in Germany and Lithuania. It included consecutive adult patients referred for routine colonoscopy who completed a detailed questionnaire on our considered multiple risk factors for diverticulosis and diverticulitis, including dietary and environmental factors, and bowel habits. The study included 1,333 patients, 696 women and 635 men. Colonic diverticulosis was diagnosed in 858 (64%) of patients. Multivariate analysis revealed that age (OR: 1.08, 95%CI: 1.06-1.10, p<0.001) and obesity (OR: 1.05, 95%CI: 1.02-1.09, p=0.004) were associated with CD. We also revealed new risk factors for CD: increased frequency of bowel movements (OR: 0.10, 95%CI: 0.03-0.33, p<0.001) and feeling of incomplete bowel emptying (OR: 2.05, 95%CI: 1.47-2.87, p<0.001). Older participants had reduced odds (OR: 0.921, 95 CI: 0.89-0.95, p<0.05) of diverticulitis compared to younger subjects. Feeling of incomplete bowel emptying after defecation was associated with increased odds (OR: 2.769, 95% CI 1.35-5.7, p<0.006) for diverticulitis. Moreover, participants with a higher educational status had increased odds (OR: 2.453, 95%CI: 1.31-4.59, p=0.005) for diverticulitis compared to the lower education group. Study shows that older age, obesity, frequency of bowel movements, and feeling of incomplete bowel emptying are associated with the risk of CD. Furthermore, older age, feeling of incomplete bowel emptying, and higher education were associated with the risk of diverticulitis among CD patients.

Plectin ensures intestinal epithelial integrity and protects colon against colitis

Plectin, a highly versatile cytolinker protein, provides tissues with mechanical stability through the integration of intermediate filaments (IFs) with cell junctions. Here, we hypothesize that plectin-controlled cytoarchitecture is a critical determinant of the intestinal barrier function and homeostasis. Mice lacking plectin in an intestinal epithelial cell (IEC; PleΔIEC) spontaneously developed colitis characterized by extensive detachment of IECs from the basement membrane (BM), increased intestinal permeability, and inflammatory lesions. Moreover, plectin expression was reduced in the colons of ulcerative colitis (UC) patients and negatively correlated with the severity of colitis. Mechanistically, plectin deficiency in IECs led to aberrant keratin filament (KF) network organization and the formation of dysfunctional hemidesmosomes (HDs) and intercellular junctions. In addition, the hemidesmosomal α6β4 integrin (Itg) receptor showed attenuated association with KFs, and protein profiling revealed prominent downregulation of junctional constituents. Consistent with the effects of plectin loss in the intestinal epithelium, plectin-deficient IECs exhibited remarkably reduced mechanical stability and limited adhesion capacity in vitro. Feeding mice with a low-residue liquid diet that reduced mechanical stress and antibiotic treatment successfully mitigated epithelial damage in the PleΔIEC colon.

Effects of Ethanol-Precipitated Argan Press Cake on the Caecal Microbiome of Mice Fed a High-Sucrose Diet

Argan press cake (APC) is a by-product of argan oil extraction and is rich in cellulose, proteins, sucrose, phenolic compounds, and excessively bitter and acrid triterpenoids. Improvement in the antioxidant property of APC by fermentation (F-APC) with Lactiplantibacillus plantarum Argan-L2 has been reported. However, the bitter and acrid tastes remain in F-APC. Here, in order to determine the applicability of APC and F-APC as functional food materials by reducing its bitter taste, the effects of ethanol-precipitated APC and F-APC on mice fed a high-sucrose and low-fibre diet were determined. Compounds precipitated from 10% (w/v) APC and F-APC water suspensions with two volumes of ethanol were collected (APC-P, F-APC-P). The Institute of Cancer Research (ICR) mice were fed 50% (w/w) sucrose with no fibre (NF), 5% APC-P, or 5% F-APC-P for 14 days. The caecal microbiome was analysed via 16S rDNA (V4 region) sequencing. No bitter and acrid tastes were detected in the precipitates. Compared with those in the NF group, defaecation and the faecal weight were increased in the APC-P and F-APC-P groups. Additionally, blood lipid and glucose levels tended to be lower in the F-APC-P group. The abundance of caecal lactic acid-producing bacteria, such as Faecalibaculum rodentium and Lactobacillus johnsonii-like bacteria, was high in the APC-P group. In contrast, the abundance of indigenous L. plantarum-like bacteria was high in the F-APC-P group. APC-P and F-APC-P showed dietary fibre properties. Furthermore, APC-P and F-APC-P increased indigenous lactic acid bacteria OTUs, although the increased species were different in the two groups. These results suggest that both APC-P and F-APC-P have beneficial effects on the gut microbiome, environment, and host.

A132 ENDOSCOPIC ULTRASOUND-GUIDED GASTROENTEROSTOMY USING A NOVEL DOUBLE BALLOON DEVICE IN THE MANAGEMENT OF MALIGNANT GASTRIC OUTLET OBSTRUCTION

Abstract Background EUS-gastroenterostomy (EUS-GE) is a novel modality in the management of malignant gastric outlet obstruction (MGOO). It is, however, technically challenging limiting its widespread application. To facilitate EUS-GE, a double balloon catheter has been developed in Japan. While this tool is not available outside of Asia, we have conceived a similar device using a widely available vascular balloon catheter. We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD). Aims We aim to determine the clinical efficacy and safety of EUS-GE using this double balloon device (DBD). Methods This is a single-centre, retrospective study of consecutive patients who underwent DBD assisted EUS-GE for MGOO from January 2019-June 2020 (IRB approved). The DBD consists of two 60 mm vascular balloons (Coda, Cook Medical, USA) fashioned together with the balloons 10 cm apart (Figure 1). It is inserted across the obstruction over a wire to the ligaments of Treitz. Both balloons are then inflated followed by saline and contrast infusion into the occluded small bowel segment to facilitate EUS-guided insertion of a 15 mm cautery assisted lumen apposing metal stent (AxiosTM, Boston Scientific Inc, USA). The primary endpoint is the rate of technical success defined as adequate deployment of the stent. Secondary endpoints include rate of clinical success and adverse events. Results A total of 11 patients were included in this study. 45% were female with a mean age of 64.9 ± 8.6 years old. The etiology of MGOO was 73% pancreatic cancer, 9% gastric cancer, 9% duodenal cancer, and 9% metastatic cervical cancer. Procedures were performed under general anesthesia and conscious sedation in 82% and 18%, of patients respectively. The mean procedure time was 64.8 ± 25.8 minutes. Technical and clinical success (intention to treat) was 91%. The only technical failure was due to poor patient tolerance of the procedure under conscious sedation. There was one adverse event (9%) due to stent migration rated as severe. Two patients (18%) required re-intervention for stent obstruction secondary to food impaction associated with non-compliance to a low-residue diet. Following re-enforced instructions, no further obstruction occurred. All patients started a clear liquid diet within 1 day of the procedure with a mean time to a low residue diet of 3.25 days ± 2.5. The median length of hospital stay following the procedure was 5 days ± 13. The median follow-up time was 84 days (IQR 152). Conclusions DBD assisted EUS-GE is clinically effective and safe. This balloon device may greatly facilitate the technical aspect of EUS-GE while potential enhancing its safety and clinical use. Larger studies are needed to validate this approach to EUS-GE. Funding Agencies None

Qualitative and quantitative profiles of jejunal oligosaccharides and cecal short-chain fatty acids in broiler chickens receiving different dietary levels of fiber, protein and exogenous enzymes.

Dietary supplemental carbohydrases are able to degrade non-starch polysaccharides and generate oligosaccharides in the gastrointestinal tract. This study was conducted to investigate the influence of dietary fiber and protein levels on growth performance, nutrient utilization, digesta oligosaccharides profile and cecal short-chain fatty acid (SCFA) profile in broilers receiving diets supplemented with xylanase or protease individually or in combination. Enzyme supplementation had no effect on growth performance. There was significant (P < 0.05) fiber × protein × xylanase interaction for ileal nitrogen digestibility and significant (P < 0.01) protein × xylanase × protease interaction for nitrogen-corrected apparent metabolizable energy. Birds fed high-fiber diets had higher (P < 0.05) jejunal oligosaccharides and cecal SCFA concentrations. Xylanase and protease combination produced the greatest pentose (Pent) levels in low fiber-adequate protein diets but lowest levels in highfiber-low protein diets. There was significant (P < 0.05) fiber × xylanase × protease interaction explained by the digesta concentrations of (Pent)3 , (Pent)4 and (Pent)5 being greatest (P < 0.5) in protease-only supplemented high-fiber diets but lowest in protease-only supplemented low-fiber diets. These results suggest that, of all the factors investigated, dietary fiber level had the greatest effect on modulating digesta concentration of oligosaccharides and cecal SCFA. Evidence points to the fact that there is considerable capacity for generating pentose oligosaccharides in the digestive tract of broilers receiving diets rich in fibrous feedstuffs, and that this may have a beneficial effect on microbial profile in the digestive tract. © 2021 Society of Chemical Industry.

Association between anxiety, depression, and bowel air bubbles at colonoscopy: a prospective observational study.

Psychological illness could affect the gut transmission. However, few studies have reported on the association between anxiety and depression and bowel preparation failure at colonoscopy. Bowel air bubbles have become an indispensable index to evaluate intestinal cleanliness. The aim of the present study was to investigate whether anxiety and depression are associated with the bowel air bubbles. The present study was a prospective observational study of patients who underwent colonoscopy in our hospital. Participants received the standard bowel preparation guidance, including split-dose polyethylene glycol and a low-fiber diet 1 day before colonoscopy. The primary outcome was degree of the bowel air bubble, measured by bubble scores. Univariate and multivariate logistic regression analyses were used to verify the association between anxiety and depression and bowel air bubbles. A total of 304 patients were enrolled in the present study between July 2019 and January 2020; 302 of these had complete data. The mean age was 48.74±11.73 years. Fifty six of 302 patients had anxiety. Age between 45 and 60 years [odds ratio (OR): 2.09, 95% confidence interval (CI): 1.13-3.87], age >60 years (OR: 1.99, 95% CI: 1.01-3.95), and anxiety (OR: 3.85, 95% CI: 2.12-6.97) were identified as risk factors for bowel air bubbles. A bachelor degree and above (OR: 0.27, 95% CI: 0.07-0.97) were identified as protective factors for bowel air bubbles. Anxiety is an independent risk factor of bowel air bubbles in colonoscopy diagnosis. Medical professionals should be mindful of this prior to performing colonoscopy.

Increasing the low residue diet to 3 days does not improve the bowel cleansing in hard to prepare patients: Post hoc analysis of a randomized controlled trial

Recent evidence suggests that the number of low residue diet (LRD) days does not influence the bowel cleansing quality in non-selected patients. However, there are not data in the subgroup of patients with risk factors of inadequate bowel cleansing. The aim of this study was to assess whether a 3-day LRD improved the bowel cleansing quality in patients with risk factors of poor bowel cleansing. Post hoc analysis of a randomized controlled trial carried out between December 2017 and March 2018 in a tertiary care hospital. Patients with high risk of poor bowel cleansing were selected following a validated score. The patients were randomized to the 1-day LRD or 3-day LRD groups. All patients received a 2-L split-dose of polyethylene glycol plus ascorbic acid. Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the main outcome. 135 patients (1-day LRD group = 67, 3-day LRD = 68) were included. The rate of adequate cleansing quality was not significantly different between the groups in the ITT analysis: 76.1%, 95% CI: [64.6–84.8] vs. 79.4%, 95% CI: [68.2–87.4]; odds ratio (OR) 1.2, 95% CI [0.54–2.73]) or in the PP analysis: 77.3%, 95% CI: [65.7–85.8] vs. 80.3%, 95% CI: [69.0–88.3]; OR 1.2, 95% CI [0.52–2.77]). Compliance with the diet or cleansing solution, satisfaction or difficulties with the LRD and the polyp/adenoma detection rates were not significantly different. Our results suggest that 1-day LRD is not inferior to 3-day LRD in patients with risk factors of inadequate bowel cleansing. La evidencia reciente sugiere que el número de días de dieta baja en residuos (DBR) no influye en la calidad de la limpieza intestinal en pacientes no seleccionados. Sin embargo, no hay datos en el subgrupo de pacientes con factores de riesgo de una limpieza intestinal insuficiente. El objetivo de este estudio fue evaluar si una DBR de 3 días mejoraba o no la calidad de la limpieza intestinal en pacientes con factores de riesgo de limpieza intestinal deficiente. Análisis post-hoc de un ensayo controlado aleatorizado realizado entre diciembre de 2017 y marzo de 2018 en un hospital de atención terciaria. Los pacientes con alto riesgo de limpieza intestinal deficiente se seleccionaron mediante una puntuación validada. Los pacientes se aleatorizaron a los grupos de DBR de un día o DBR de 3 días. Todos los pacientes recibieron una dosis dividida de 2 l de polietilenglicol más ácido ascórbico. Se realizaron análisis por intención de tratar (IdT) y por protocolo (PP) para el criterio principal de valoración. Se incluyeron 135 pacientes (grupo DBR de un día = 67, DBR de 3 días = 68). No se observaron diferencias significativas en la tasa de calidad de limpieza suficiente entre los grupos en el análisis por IdT (76,1%; IC del 95%: [64,6-84,8] frente al 79,4 7%, IC del 95%: [68,2-87,4]; razón de posibilidades (OR): 1,2; IC del 95%: [0,54-2,73]) o en el análisis PP: (77,3%; IC del 95 %: [65,7-85,8] frente al 80,3%, IC del 95%: [69,0-88,3]; OR: 1,2; IC del 95% [0,52 -2,77]). No se observaron diferencias significativas en el cumplimiento de la dieta o con la solución limpiadora, en la satisfacción o las dificultades con la DBR y en las tasas de detección de pólipos/adenomas. Nuestros resultados sugieren que la DBR de un día no es inferior a la DBR de 3 días en pacientes con factores de riesgo de limpieza intestinal insuficiente.

Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy: A Meta-analysis.

This meta-analysis aimed to evaluate the impact of prepackaged low-residue diet (PLRD) on bowel preparation for colonoscopy. We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases from inception to August 2020. Randomized controlled trials (RCTs) comparing PLRD with clear liquid diet (CLD) or self-prepared LRD were considered for inclusion. The analysis calculated the odds ratio (OR) for the rate of adequate bowel preparation, patient tolerance, willingness to repeat bowel preparation, tolerability of bowel preparation, and overall adverse effects. Five RCTs published between 2006 and 2019 (N = 561) were included in our meta-analysis. Compared with the traditional CLD or self-prepared LRD, PLRD showed significantly higher rates of adequate bowel preparation (OR, 2.16; 95% confidence interval [CI], 1.18-3.98; p = .01), patient tolerance (OR, 1.99; 95% CI, 1.30-3.07; p = .002), and willingness to repeat the bowel preparation (OR, 1.68; 95% CI, 1.05-2.70; p = .03), with no differences in adverse events (OR, 0.93; 95% CI, 0.59-1.46; p = .75). Prepackaged low-residue diet improved bowel preparation quality, patient tolerance, and willingness to repeat bowel preparations. Importantly, PLRD does not increase the incidence of adverse events. This suggests that it is effective and safe to use PLRD for bowel preparation before colonoscopy.

Western Diet Aggravated Carbon Tetrachloride-Induced Chronic Liver Injury by Disturbing Gut Microbiota and Bile Acid Metabolism.

The high-fat, high-sucrose, and low-fiber Western diet (WD) is popular in many countries and affects the onset and progression of many diseases. This study is aimed to explore the influence of the WD on chronic liver disease (CLD) and its possible mechanism. C57BL/6 mice are given a control diet (CD) or WD and CLD is induced by intraperitoneally injecting carbon tetrachloride (CCL4 ) twice a week for 8 weeks. The WD aggravated CCL4 -induced chronic liver injury, as evidenced by increased serum transaminase levels, worsened hepatic inflammatory response, and fibrosis. Gut microbiota is disturbed in mice treated with CCL4 +WD (WC group), manifested as the accumulation of Fusobacteria, Streptococcaceae, Streptococcus, Fusobacterium, and Prevotella and the depletion of Firmicutes, Lachnospiraceae, and Roseburia. Additionally, increased hepatic taurocholic acid in the WC group activated sphingosine-1-phosphate receptor 2, which is positively correlated with hepatic fibrosis and inflammation parameters. Mice in the WC group have higher fecal primary bile acid (BA) levels and lower fecal secondary/primary BA ratios. Serum FGF15 levels are also elevated in the WC group, which is positively correlated with hepatic inflammation. WD accelerates the progression of CLD which is associated with changes in the gut microbiota and BA metabolism.