Low-fiber Diet Research Articles

Association between Elevated Magnesium Intake and Reduced Risk of Recurrent Falls and Frailty in Osteoarthritis: Data from the Osteoarthritis Initiative.

The objective of this 8-year follow-up study was to investigate the relationship between magnesium intake and frailty, as well as recurrent falls, in individuals diagnosed with Osteoarthritis (OA) or those at a heightened risk for developing the condition. This study utilized data from the Osteoarthritis Initiative (OAI) database and conducted a prospective cohort study with a 8-year follow-up period. Total magnesium intake from both food sources and supplements was assessed using a food frequency questionnaire (FFQ), while frailty and recurrent falls were evaluated through established criteria and self-report, respectively. To account for potential confounding factors, various covariates were considered, and statistical analyses, including generalized additive mixed models (GAMMs), were employed to examine the associations. Among the 4,667 participants with OA, those with lower total magnesium intake were characterized by younger age, a higher proportion of African American individuals, higher body mass index (BMI), and lower dietary fiber intake (P<0.001). Notably, this group exhibited higher odds of experiencing recurrent falls and frailty (P = 0.034 and 0.006, respectively). Controlling for various factors, the GAMMs consistently revealed negative correlations between magnesium intake and the likelihood of frailty and recurrent falls, with each 1 mg/1000 kcal increase in magnesium intake associated with a 0.5% reduced frailty risk (p < 0.001) and a 0.2% decreased risk of recurrent falls (p = 0.001). Subgroup analyses suggested that increased total magnesium intake from both food sources and supplements may exert a more pronounced preventive effect on recurrent falls and frailty in men, older adults, individuals with normal BMI, and those with higher dietary fiber intake. Elevated total magnesium intake from both food sources and supplements was found to be associated with a decreased risk of recurrent falls and frailty in individuals diagnosed with OA or those at risk of developing the condition. These findings imply that increased total magnesium intake might be beneficial in managing the risk of these outcomes, particularly within specific subgroups, including men, older adults, those with a normal BMI, and those with higher dietary fiber intake.

THE EFFECT OF LOW-FIBER DIETS ON COLORECTAL CANCER INCIDENCE IN SOUTHEAST AND EAST ASIA: SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction : Colorectal cancer is a malignant tumor that grows in the colon tissue. In the Asian region, in 2018, cases and deaths from colorectal cancer are highest in East Asia (there were 736,573 cases and 325,128 of them died) and Southeast Asia (there were 95,223 cases and 52,475 of them died). Aims: Several studies have been conducted regarding the effect of a low-fiber diet and an increased risk of colorectal cancer, but it still shows mixed results. Methods: This study is an unobstrutive study with a systematic review and meta-analysis method. Data sources came from 14 primary studies with a case-control study design that met the inclusion criteria. Data analysis was performed using CMA software trial version 3.0 with a confidence level of α = 5%. Research with low-fiber diet variables shows heterogeneous variations in results so that the chosen model is random effect model. Result: The analysis states that there was a significant relationship between a low-fiber diet (CI: 0.421–0.867) and an increased risk of colorectal cancer due to the role of soluble and insoluble fiber. Lack of intake of soluble fiber can decrease insulin action and blood sugar control or the production of short-chain fatty acids, whereas insufficient intake of insoluble fiber can increase the potential for interactions between mutagens and colonic mucosa. Conclusion: The results of the study are expected to be an input for a proper diet so that there is no increase in cases of colorectal cancer.

Effects of milling degree on nutritional, sensory, gelatinization and taste quality of different rice varieties

The impact of variety and processing accuracy on nutritional, sensory and taste qualities of rice is studied. Husked rice yield and whole brown rice rate in japonica rice (Nanjing-No.5055) were higher than indica rice, they were 82.10% and 80.90%, respectively. Milling treatment resulting in low protein, ash, fat, dietary fiber, total phenols and oryzanol content and high starch content in rice. Four types of saturated fatty acids (C14:00, C16:00, C18:00, C20:00) and six types of unsaturated fatty acids (C14:1, C16:1, C18:1, C18:2, C18:3, C20:4, C22:1) were detected from rice fat, which content and compositional proportion varied with the increase of milling degree. The changes in composition content and bran integrity leads to increased whiteness, gel consistency and palatability and reduced yellowness and gelatinization temperature. Principal component analysis showed that the effect of milling on the quality characteristics of rice are different and finite. Yuzhenxiang in component index score was decreased most significantly, it drops from 10.03 to −5.24, while the improvement of sensory and taste quality in Nanjing-No.5055 is the most apparent. The research results will be benefit to provide more useful information and ideas in appropriate milling processing for different types of rice.

Maternal dietary fiber intake during pregnancy and child development: the Japan Environment and Children's Study.

Animal studies have shown that maternal low-fiber diets during pregnancy may impair brain development and function in offspring, but this has not been validated by epidemiological studies. The aim of this study was to investigate the link between maternal dietary fiber intake during pregnancy and neurodevelopmental delay in offspring using a large birth cohort. A total of 76,207 mother-infant pairs were analyzed using data from the Japan Environment and Children's Study, a nationwide prospective cohort study. Maternal dietary fiber intake was estimated using the food frequency questionnaire in mid-pregnancy. Maternal dietary fiber intake was adjusted for energy and classified into quintiles. Developmental delay was assessed in five domains using the Japanese version of the Ages and Stages Questionnaire, Third Edition at the age of 3 years. The logistic regression analysis was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the link between dietary fiber intake during pregnancy and developmental delay at the age of 3 years. The lowest intake group of total dietary fiber had a higher risk of delayed communication [adjusted OR (aOR), 1.51; 95% CI, 1.32-1.74], fine motor (aOR, 1.45; 95% CI, 1.32-1.61), problem-solving (aOR, 1.46; 95% CI, 1.32-1.61), and personal-social skills (aOR, 1.30; 95% CI, 1.12-1.50) than did the highest intake group. An analysis that excluded the effects of insufficient folic acid intake during pregnancy also showed a similar trend. This study showed that maternal dietary fiber deficiency during pregnancy might influence an increased risk of neurodevelopmental delay in offspring.

Moringa oleifera Lam. Leaf improves constipation of rats induced by low-fiber-diet: A proteomics study

Ethnopharmacological relevanceThe leaf of Moringa oleifera Lam., a medicinal and edible herb for thousands of years in Ayurveda, is used as Pancha (na) karma (purgative) during and after the body cleansing process, to treat constipation, reduce cholesterol and body weight. Aim of studyThe aim was to investigate the diarrhea effects and possible mechanism of M. oleifera leaves in constipation rats. Materials and methodsThe hot water extract of M. oleifera leaves (WEMOL) was prepared and analyzed using LC-20AT HPLC system. The constipated rat model was induced by feeding with low fiber diet for 21 days. After oral administration of WEMOL for 7 days, the excretion parameter analysis, gastro-intestinal propulsion, histological analysis by HE and Alcian blue staining, and gastrointestinal hormone in rat's digestive tract through ELISA were used to evaluate the laxative effect of WEMOL. Label-free quantitation (LFQ) with LC-MS/MS, bioinformatics and Western blot were used to discover and verify the signal pathways and key proteins of WEMOL related to diarrhea. ResultsThe contents of isoquercitrin and astragalin were 2.7 mg/g and 1.7 mg/g, respectively in WEMOL. The stool number, weight, and water content of constipation rats were significantly reduced, indicating model had been established successfully. WEMOL (1.25 and 2.5 g/kg) increased water content of feces and the levels of Gas, MTL, NPY in gastric antrum and VIP, SP in colon of constipation rats, improved the muscle layer thickness and mucin secretion of colon. The proteomics revealed a total of 1731 differential proteins and 9 signaling pathways, WEMOL increased the expression of Vamp2, Gnai3, and Prkacb. ConclusionsThe laxative mechanism of WEMOL maybe modulate the signaling pathways mediated by 5-HT and Ach receptors, related to gastrointestinal motility and intestinal fluid secretion. It can be considered as the scientific connotation of Pancha (na) karma of M. oleifera leaves in ayurveda.

Association Between Dietary Fiber Intake and Cardiometabolic Risk Factors in Adolescents in the United States

To determine the association between dietary fiber intake and markers of cardiometabolic risk in adolescents, with blood pressure (BP) as the primary outcome of interest and secondary outcome measures including other established markers of childhood cardiometabolic risk, such as obesity, lipids, albuminuria, estimated glomerular filtration rate (eGFR), and uric acid. Dietary fiber intake was assessed by two 24-hour dietary recall interviews, which were averaged and corrected for body weight. Logistic and linear regression models were used to analyze the cross-sectional association between dietary fiber and cardiometabolic markers. Participants aged 13-17 years in the National Health and Nutritional Examination Survey 2009-2018 who completed a 24-hour dietary recall survey were included. Exclusion criteria included pregnancy, small for gestational age status, and history of major health comorbidities. In fully adjusted regression models, low dietary fiber intake was significantly associated with greater diastolic blood pressure (β=-13.29; 95% CI, -20.66 to -5.93), body mass index z-score (β=-0.91; 95% CI, -1.47 to -0.34), and uric acid (β=-0.80; 95% CI, -1.44 to -0.16). The association found between low dietary fiber intake and poor childhood cardiometabolic risk markers indicate a need for prospective studies using fiber intake as a dietary intervention in childhood and as a tool for prevention of many chronic conditions.

Effects of roasted burdock root tea, drink, and the residue on caecal microbiota of mice fed low-dietary fibre diet

Burdock (Arctium lappa) root has been traditionally consumed in Japan since ancient times. Roasted burdock tea (BT) is gaining popularity worldwide as a health drink as it is rich in inulin and chlorogenic acid, and has been reported to have health benefits, including inhibitory and ameliorative effects on constipation and bowel inflammation. However, the underlying mechanism remains unclear. To determine the effects of BT on gut microbiota, diet without cellulose (no fibre: NF), 5% (w/w) whole roasted burdock root powder (WB) diet, 5% (w/v) BT as drinking liquid, or 1.7% (w/w) residue of BT (BR) diet was fed to mice. Microbiota analysis was performed using 16S rRNA (V4) gene amplicon sequencing. The abundance of microbial groups related to obesity and inflammation, such as Allobaculum, was decreased by feeding burdock root preparations, particularly BT (0.6%) compared with NF (25%). Conversely, the abundance of Muribaculaceae, which are gut commensals that correlate with anti-inflammation, immunomodulation, and longevity, in the three burdock groups was 2–3-times higher than that in the NF group. The levels of tumour necrosis factor-α, a pro-inflammatory cytokine, were 2.5-fold decreased in the BT group. In conclusion, BT may affect gut microbiota composition and, thereby, impact the host immune system.

679-P: Impact of Diabetes Distress on Glycemic Control, Diet Behaviors, and Diabetic Complications in Type 2 Diabetes Mellitus

Background: We investigated the clinical features of patients with high diabetes distress, focusing on changes in glycemic control, dietary behaviors, and risk of diabetic complications. Methods: From the Korean National Diabetes Program data, we investigated 1,862 individuals with type 2 diabetes mellitus (T2DM) who completed the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score ≥40 was considered indicative of high distress. Results: Individuals with high distress (n=589) had significantly higher levels of glycated hemoglobin (HbA1c) than those without distress, and this trend persisted for three years. In a subgroup of individuals with HbA1c &amp;lt;6.5% at baseline, patients with high distress were less likely to maintain HbA1c &amp;lt;6.5% after three years of follow-up (41.2% vs. 60.6%, p=0.007). Higher PAID-K scores were associated with younger age, longer duration of diabetes, higher HbA1c level, higher carbohydrate intake, and lower fiber intake (all p&amp;lt;0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p=0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque. Conclusion: High diabetes distress was associated with uncontrolled hyperglycemia, a high-carbohydrate and low-fiber diet, and higher odds of diabetic neuropathy. Disclosure Y.Cho: None. Y.Kim: None. D.Seo: None. S.Ahn: None. S.Hong: None. S.Kim: None.

#2715 AN EXPLORATORY STUDY OF GUT PERMEABILITY IN SUBJECTS ON HAEMODIALYSIS: RESPONSE TO AN ORAL BETA-D-GLUCAN LOAD

Abstract Background and Aims End stage kidney disease (ESKD) is associated with chronic inflammation. A combination of increased gut permeability and impaired hepatic clearance of gut-derived toxins are likely contributory factors to chronic inflammation in ESKD. Gut permeability assessment in kidney impairment is complex as traditional gut permeability probe concentrations are significantly influenced by residual kidney function. (1-3)-β-D glucans (BDG) are glucose polymers found in dietary plant material and also fungi and bacteria. BDG predominantly undergo reticuloendothelial (primarily hepatic) clearance. BDG ingested in the form of fibre are not well absorbed from the small intestine. Elevated serum BDG levels have been previously observed in chronic kidney disease and may reflect systemic translocation of dietary and gut derived microbial fragments from the portal system. This study aimed to establish if there were differences in serum BDG concentrations in individuals with normal kidney function and ESKD following ingestion of a BDG rich meal. Method 20 participants with ESKD receiving haemodialysis via an arteriovenous fistula with evidence of inflammation (a median baseline serum C-reactive protein (CRP) ≥5mg/L over the previous 3 months) and 20 participants with normal kidney function (NKF) were studied. Participants with active infection, autoimmune disease, gastrointestinal disease and hyperkalaemia were excluded. All participants followed a low fibre diet for 48 hours and fasted for 12 hours prior consuming a BDG-rich drink that delivered approximately 10μg/gram of BDG. In the ESKD cohort, the drink was consumed immediately prior to a dialysis session following a 1-day interdialytic gap. In addition to standard of care blood tests, serum BDG levels were measured at baseline, 0.5 hours, 1 hour, 1.5 hours, 2 hours, 3 hours, 4 hours, 6 hours and 48 hours. Serum BDG measurements were analysed with the Fungitell® assay (Associates of Cape Cod, Inc). Faecal calprotectin and faecal alpha-1-antitrypsin were also analysed. Results 20 participants with ESKD receiving haemodialysis (mean age 66.8 years) and 20 participants with NKF (mean age 44.6 years) were recruited. Serum BDG levels were significantly higher at baseline in the ESKD group (29.6pg/ml in the NKF group versus 67.1pg/ml in the ESKD group, p = 0.001) and at all other timepoints throughout the study period (see Fig. 1). There were no significant difference in change from baseline BDG levels between groups. Individual BDG levels taken post meal ingestion are shown in Fig. 2. Baseline serum BDG levels correlated strongly with median baseline high sensitivity CRP over 3 months (p = 0.001) however this relationship was not present when the two groups were examined separately. Faecal calprotectin and faecal alpha-1-antitrypsin did not correlate with baseline serum BDG measurements (p = 0.93, p = 0.78, respectively). Conclusion Elevated BDG levels are observed in ESKD and increase both during and immediately following dialysis after ingestion of a BDG load. In addition to dietary BDG, translocation of gut-derived microbial BDG into the systemic circulation may play an important role in contributing to systemic inflammation observed in advanced kidney disease. Elevated BDG may reflect increased gut permeability which may be secondary to uraemic toxin related gut barrier dysfunction or splanchnic ischaemia related to ultrafiltration.

Combined association of dietary fibre and cognitive function with all-cause and cause-specific mortality in older adults

Background Dietary fibre and cognitive function are associated with the risk of mortality, respectively. Inadequate dietary fibre intake and cognitive impairment frequently co-occur in older adults, but the combined effect of dietary fibre and cognitive function on mortality remains unknown. The study was to investigate the combined effect of dietary fibre and cognitive function on mortality over a 13-year follow-up in a representative of older adults from the U.S. Methods We analyzed data from two cycles of the National Health and Nutrition Examination Survey (NHANES) 1999–2000 and 2001–2002 with mortality follow-up data through 13 December 2015 obtained from Public-use Linked Mortality Files. Low dietary fibre intake was defined as the lowest quartile of dietary fibre intake. Cognitive impairment was defined as below the median of Digit Symbol Substitution Test. The separate and combined effects of low dietary fibre intake and cognitive impairment on all-cause and cause-specific mortality were assessed in older adults using weighted Cox proportional hazard models adjusting for potential confounders. Results A total of 2012 participants (weighted sample was 32,765,094) aged 60 years and older were enrolled in the study. After a median follow-up of 13.4 years, 1017 participants (50.4%) were identified as all-cause deaths, including 183 (9.1%) participants dying from cancer, 199 (9.9%) participants dying from cardiovascular disease, and 635 (31.5%) participants dying from non-cancer/non-cardiovascular disease. Participants with low dietary fibre intake and cognitive impairment had nearly twice the risk of all-cause (HR, 2.030; 95% CI, 1.406-2.931) and non-cancer/non-cardiovascular (HR, 2.057; 95% CI, 1.297–3.262) mortality, and over triple cancer (HR, 3.334; 95% CI, 1.685–6.599) mortality, compared to those without both. Conclusions The combination of low dietary fibre intake and cognitive impairment was associated with an increased risk of all-cause, cancer and non-cancer/non- cardiovascular mortality in older adults.

Revisiting bowel preparation: The quest for the optimal low‐residue diet duration

Revisiting bowel preparation: The quest for the optimal <scp>low‐residue</scp> diet duration

A NORMOCALORIC, LOW-FIBER DIET FOR COLONOSCOPY PREPARATION IS MORE ACCEPTABLE AND NON-INFERIOR TO A LIQUID, LOW-CALORIE DIET: A RANDOMIZED CONTROLLED TRIAL.

•This is the first study in Brazil about diets to prepare for colonoscopy. •The normocaloric diet was not inferior to the liquid diet regarding the quality of the colonoscopy preparation. •Both diets were well tolerated, but the normocaloric diet was more accepted than the liquid diet. Background - Several publications have shown greater acceptance of less restrictive diets for colonoscopy preparation, without impairing the quality of the preparation, when compared to the clear liquid diet. Objective - To evaluate the quality, tolerance and preference regarding the colonoscopy preparation of a low-fiber, normocaloric diet compared with a hypocaloric liquid diet. Methods - This is a randomized, controlled, observer-blind study to compare two low-fiber colonoscopy preparation diets (hypocaloric liquid diet vs. normocaloric diet). The Boston Bowel Preparation Scale was used to evaluate the qua-lity of the preparations, being considered adequate BBPS ≥6 in the global assessment and ≥2 in each segment. The same laxative was used in both groups as well as the "split-dose" regimen. Results - A total of 136 individuals were enrolled in each group. Adequate preparation was achieved in 90.4% of the individuals allocated to the liquid diet group and 92.6% to the normocaloric group. There was no significant difference in the quality of preparation and tolerance between groups. A higher patient acceptance to repeat the procedure if necessary was observed in the normocaloric diet group compared with the liquid diet group (P=0.005). Conclusion - The normocaloric diet has shown to be not inferior to the liquid diet regarding the quality of the colonoscopy preparation. Patient tolerance rates were similar between both diets, but a higher accep-tance rate was observed with the normocaloric diet as compared with the liquid diet.

Checkpoint Inhibitor-Induced Colitis: An Update.

Immunotherapy with immune checkpoint inhibitors (ICIs) nowadays has indications for several solid tumors. The current targets for ICIs are CTLA-4, PD-1, and PD-L1 receptors. Despite the clinical advantages derived from ICIs, a variety of side effects are linked to overstimulation of the immune system. Among these, ICI-related colitis is one of the most common, with a disabling impact on the patient. Diarrhea, abdominal pain, abdominal distension, cramping, and hematochezia are the most common ICI enterocolitis presenting symptoms. The most frequently used grading system for assessment of the severity of ICI enterocolitis is called the Common Terminology Criteria for Adverse Events (CTCAE) grading. With regard to the histological picture, there is no specific feature; however, microscopic damage can be classified into five types: (1) acute active colitis, (2) chronic active colitis, (3) microscopic colitis-like, (4) graft-versus-host disease-like, and (5) other types. Supportive therapy (oral hydration, a bland diet without lactose or caffeine, and anti-diarrheal agents) is indicated in mild colitis. Symptomatic treatment alone or with loperamide, a low-fiber diet, and spasmolytics are recommended for low-grade diarrhea. In more severe cases, corticosteroid treatment is mandatory. In refractory cases, off-label use of biological therapies (infliximab or vedolizumab) was proposed.

Intestinal microbiome characterization of adult Brazilian men with psoriasis compared to omnivore and vegetarian controls

BackgroundPsoriasis is a chronic inflammatory disease associated with systemic inflammation and comorbidities. Changes in the composition of the intestinal microbiome are involved in the pathogenesis of inflammatory diseases and metabolic syndrome. Characterizing the intestinal microbiome of patients with psoriasis may be relevant for the understanding of its clinical course and comorbidity prevention. ObjectiveTo characterize the intestinal microbiome of men with psoriasis compared to omnivore and vegetarian controls (without psoriasis). MethodCross-sectional study of 42 adult males: 21 omnivores with psoriasis; and controls: 14 omnivores and 7 vegetarian individuals. The characterization of the intestinal microbiome was performed by metagenomic analysis. Serum levels of lipopolysaccharide-binding protein (LPB) and C-reactive protein (CRP) were evaluated. ResultsThe groups differed from each other regarding nutritional aspects and microbiome; individuals with psoriasis had a higher consumption of protein and lower consumption of fibers. Levels of LPB, CRP, and the Firmicutes/Bacteroidetes ratio were higher in the group with psoriasis than in the vegetarian group (p<0.05). The genera Prevotella, Mogibacterium, Dorea, Bifidobacterium and Coprococcus, differed in the group with psoriasis compared to vegetarians; the genera Mogibacterium, Collinsella and Desulfovibrio differed from omnivores. A microbiome pattern linked to psoriasis (plsPSO) was identified, which was associated with higher LPB levels (rho=0.39; p=0.02), and lower dietary fiber intake (rho=−0.71; p<0.01). Study limitationsOnly adult men were evaluated. ConclusionA difference was identified in the intestinal microbiome of adult men with psoriasis when compared to healthy omnivores and vegetarian controls. The identified microbiome pattern was correlated with dietary fiber intake and serum levels of LPB.

Dietary fiber during gestation improves lactational feed intake of sows by modulating gut microbiota

BackgroundThe feed intake of sows during lactation is often lower than their needs. High-fiber feed is usually used during gestation to increase the voluntary feed intake of sows during lactation. However, the mechanism underlying the effect of bulky diets on the appetites of sows during lactation have not been fully clarified. The current study was conducted to determine whether a high-fiber diet during gestation improves lactational feed intake (LFI) of sows by modulating gut microbiota.MethodsWe selected an appropriate high-fiber diet during gestation and utilized the fecal microbial transplantation (FMT) method to conduct research on the role of the gut microbiota in feed intake regulation of sows during lactation, as follows: high-fiber (HF) diet during gestation (n = 23), low-fiber (LF) diet during gestation (n = 23), and low-fiber diet + HF-FMT (LFM) during gestation (n = 23).ResultsCompared with the LF, sows in the HF and LFM groups had a higher LFI, while the sows also had higher peptide tyrosine tyrosine and glucagon-like peptide 1 on d 110 of gestation (G110 d). The litter weight gain of piglets during lactation and weaning weight of piglets from LFM group were higher than LF group. Sows given a HF diet had lower Proteobacteria, especially Escherichia-Shigella, on G110 d and higher Lactobacillus, especially Lactobacillus_mucosae_LM1 and Lactobacillus_amylovorus, on d 7 of lactation (L7 d). The abundance of Escherichia-Shigella was reduced by HF-FMT in numerically compared with the LF. In addition, HF and HF-FMT both decreased the perinatal concentrations of proinflammatory factors, such as endotoxin (ET), lipocalin-2 (LCN-2), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β). The concentration of ET and LCN-2 and the abundance of Proteobacteria and Escherichia-Shigella were negatively correlated with the LFI of sows.ConclusionThe high abundance of Proteobacteria, especially Escherichia-Shigella of LF sows in late gestation, led to increased endotoxin levels, which result in inflammatory responses and adverse effects on the LFI of sows. Adding HF during gestation reverses this process by increasing the abundance of Lactobacillus, especially Lactobacillus_mucosae_LM1 and Lactobacillus_amylovorus.

Successful Endoscopic Closure of the Appendiceal Orifice

Introduction: Colocutaneous fistulas are severe complications that traditionally are repaired surgically with resection of the fistula followed by end-to-end anastomosis of the bowel. Given the high morbidity of surgery, an alternative approach to consider is endoscopic fistula closure with clips, which is a minimally invasive approach and is safe with high success rates.1–5 Currently, there are no reports in the literature describing endoscopic closure of the appendiceal orifice. This video case report describes a technique for placement of an over the endoscope clip at the appendiceal orifice to effectively close a colocutaneous fistula. Materials and Methods: The patient was a 69-year-old male with Marfan's syndrome who was 5 months status post primary repair of a duodenal perforation with feculent peritonitis. His early postoperative course was complicated by a persistent leak from an unknown source. One month postoperatively, imaging showed a large retroperitoneal abscess that required percutaneous drain placement. At that time, surgical endoscopy was consulted for duodenal evaluation and found no clear evidence of a leak from the duodenum. A percutaneous endoscopic gastrostomy tube with a jejunal feeding extension was placed. Four months after his index operation, he presented to the clinic with a change in drain output character that was suspicious for an enterocutaneous fistula. Fistulogram with contrast injected into the patient's percutaneous drainage catheter demonstrated continuity with the colon in the right lower quadrant. He was taken for a colonoscopy and fluoroscopy for further evaluation of the colocutaneous fistula. After injection of saline at the drain site, saline was seen trickling into the cecum from the appendiceal orifice. The decision was made to close the orifice with a 12/6T over-the-endoscope clip. The percutaneous retroperitoneal drain was removed 5 days postoperatively and he was discharged home 7 days postoperatively on a low residue diet. Results: At 1 month follow-up, the patient was doing well on a regular diet with no abdominal pain or fevers. A routine imaging scan performed 7 weeks postoperatively showed no recurrent retroperitoneal fluid collection. His gastrojejunal feeding tube was removed. Conclusion: Over-the-endoscope clipping of the appendiceal orifice to repair a colocutaneous fistula is technically feasible and appears safe. Endoscopic therapy spared this patient from a potential ileocecectomy. To date, no other similar procedures have been performed by our department in other patients. Further study is necessary to establish the safety of this procedure before its implementation as standard practice. A.H. has no disclosures. E.M.P. is a lecturer for BD, Medtronic, Ovesco, and Boston Scientific. E.M.P. is a consultant for Boston Scientific, Actuated Biomedical, Baxter, Wells Fargo, Cook Biotech, Neptune Medical, Surgimatrix, CMR Surgical, Boehringer Laboratories, Allergan, and Noah Medical. J.S.W. is a consultant for Boston Scientific. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 5 mins 20 secs This video was accepted as a video presentation at the 2023 Society of Gastrointestinal and Endoscopic Surgery on March 29 to April 1, 2023.

Intake of low dietary fiber changes microbiota composition and reduces IL-10 production from small intestinal T cells

Abstract Regulatory immune responses are crucial for intestinal homeostasis against stimuli like diet and microbiota. The microbiota influences the regulatory immune response by inducing colonic Foxp3+ regulatory T cells and other lymphocytes by metabolizing diet-derived products. For example, fiber-fermenting microbiota process fermentable fiber into metabolites like short-chain-fatty-acids (SCFA) and help activate IL-10-producing T cells. However, studies showed that high-fat (low-fiber) diet alters the abundance of Treg-inducing commensal bacteria promoting intestinal inflammation. Previous studies in our lab showed that low fermentable fiber affects the generation of many intestinal T cells, especially intraepithelial CD4+CD8aa+ T cells (DP IELs) and CD8aa IELs. However, it is still uncertain how dietary fiber affects small intestinal T cell function, including IL-10 production. To address this, we fed IL-10-GFP reporter mice with a regular chow diet or an isocaloric isonitrogenous diet that replaced fiber with non-fermentable fiber (LFF). After four weeks, the lymphocytes and microbiota from the small intestine were analyzed. Our preliminary findings show that IL-10 mRNA expression and IL-10-GFP production from intestinal lymphocytes was lower in mice fed LFF diet when compared to the control. Moreover, 16S RNA sequencing of intestinal contents showed changes in relative frequencies of several OTUs between diets. These results suggests that certain bacterial species affected by the diet could be significant in promoting IL-10 production by small intestinal T cells. Further studies will seek to understand how fiber plays a role in orchestrating the host-microbiota interactions to maintain intestinal tolerance. These studies were conducted at Emory University and funded by the following NIH grants: 1R01DK129950-01 (NIDDK-NIH from LCB); 5T32AI106699-08 (NIDDK-NIH from Antimicrobial Resistance and Therapeutic Discovery Training Program)

The Colonoscopy Cookbook: Analysis of effect of a recipe resource on quality and experience of bowel preparation in colonoscopy.

Background High-quality bowel preparation for a colonoscopy improves identification of early lesions in the large bowel, decreases procedure time and increases intervals between colonoscopies. Current recommendations advise a low-residue diet in the days leading up to colonoscopy to improve quality of preparation. This study prepared and provided a recipe resource to patients undergoing colonoscopy and assessed the quality of bowel preparation and patient experience. Patients and methods A "Colonoscopy Cookbook" resource of recipes that comply with the preoperative diet recommendations was created and added to routine preoperative information given to patients undergoing elective colonoscopies at a regional Australian hospital over a 12-month period. Endoscopic reports were reviewed for each case and quality of bowel preparation was classified as "adequate'' or "inadequate". Data collected were compared to a representative local cohort from 2019. Results Procedure reports from 96 patients who were provided with the resource were compared with 96 patients who were not. Adequate bowel preparation was nine times as likely when the resource was available (odds ratio 8.54, 95 % confidence interval: 2.85 to 25.60, P < 0.001) compared to when it was not. The patient experience was assessed using a post-procedure survey, which demonstrated a positive experience in recipe preparation. Most patients would use the resource prior to future colonoscopies. Conclusions Further randomized controlled trials are required to validate this scoping review. Pre-procedure recipe resources may improve quality of bowel preparation in patients undergoing colonoscopy.

The efficacy of preoperative low-residue diet on postoperative ileus following cesarean section

Objective To evaluate the efficacy of preoperative low-residue diet on postoperative ileus in women undergoing elective cesarean section (CS). Methods This is a surgeon-blind, randomized controlled trial enrolling pregnant women at ≥39 weeks of gestation undergoing elective CS. Patients were preoperatively randomized to receive either low-residue diet (arm A) or free diet (arm B) starting from three days before surgery. The primary outcome was the postoperative ileus. The secondary outcomes were the postoperative pain (assessed through VAS scale), the quality of the surgical field (scored using a 5-point scale, from poor to excellent), postoperative complications, and the length of hospital stay. Perioperative data were collected and compared between groups. Results A total of 166 patients were enrolled and randomized in arm A (n = 83) and arm B (n = 83). Postoperative ileus over 24 h was significantly shorter in arm A, compared to arm B (19.3% vs 36.2%). The surgical evaluation of small intestine was scored ≥3 in 96.4% of arm A patients versus 80.7% in arm B, while evaluation of large intestine, respectively, in 97.7% and 81.9%. Postoperative pain after 12 h from CS was significantly lower in arm A (VAS, 3.4 ± 1.7) compared to arm B (VAS, 4.1 ± 1.8). There were no significant differences as regards postoperative pain at 24 and 48 h, nausea/vomit, surgical complications, and hospital stay. Conclusions Implementation of a preoperative low-residue diet for women scheduled for elective CS would reduce postoperative ileus and pain. Further large-scale studies are required before translating these research findings into routine obstetrical practice.

Diagnosis and Management of Constipation: A Narrative Literature Review

Constipation can occur as a primary or secondary condition. This literature review aimed to describe the diagnosis and management of constipation. Primary constipation is generally classified into three categories. Normal transit (functional) constipation involves a normal rate of passage of stool, but there is difficulty with the evacuation of the stool. Functional constipation is most common and is associated with a sedentary lifestyle, a low-residue diet (consumption of very refined foods), or low fluid intake, which decreases stool volume and bulk and can lead to constipation. Lack of access to toilet facilities, consistent suppression of the urge to empty the bowels, and dehydration are other causes. Slow transit constipation involves impaired motor activity of the colon with infrequent bowel movements, straining to have a bowel movement, mild abdominal distention, and palpable stool in the sigmoid colon. Pelvic floor dysfunction (pelvic floor dyssynergia-anismus), or outlet dysfunction, is difficulty passing stool due to failure of the pelvic floor muscles or anal sphincter to relax with a bowel movement.