Orocecal Transit Research Articles

The role of small intestinal bacterial overgrowth and false positive diagnosis of lactose intolerance in southwest Hungary-A retrospective observational study.

BackgroundLactose intolerance is a frequent gastrointestinal disease affecting 47% of the Eastern European population. Small intestinal bacterial overgrowth (SIBO) leads to carbohydrate malabsorption and therefore to false results during lactose breath and tolerance tests.ObjectivesWe aimed to assess the prevalence of lactose maldigestion and intolerance in Hungary and to investigate the role of combined diagnostic method and testing for SIBO in reducing false results.MethodsWe retrospectively analyzed data from 264 adult symptomatic patients who underwent 50g lactose breath and tolerance tests in parallel over a one-year period at our center. A ≥20 ppm elevation of H2 or less than 1.1 mmol/l rise of blood glucose was diagnostic for lactose maldigestion. Patients with maldigestion who had symptoms during the test were defined as lactose intolerant. Patients with an early (≤90 min) significant (≥20 ppm) rise of H2 during lactose and/or lactulose breath tests were determined to have SIBO. Patients with slow/rapid oro-cecal transit and inappropriate preparation before the test were excluded.Results49.6% of the 264 patients had lactose maldigestion, and 29.5% had lactose intolerance. The most frequent symptom was bloating (22.7%), while 34.8% of the study population and 60% of the symptomatic patients had SIBO. In 9.1% and 9.8% of the patients, the lactose breath and tolerance test alone gave false positive result compared with the combined method. SIBO was present in 75% of the false positives diagnosed with breath test only.ConclusionsThe prevalence of lactose intolerance is lower in Hungary compared to the Eastern European value (29.5% vs 47%), so it is worth performing a population-based prospective analysis in this area. A combination of lactose breath and tolerance tests and the careful monitoring of results (with early H2 rise, lactulose breath test, etc.) can decrease the false cases caused by e.g. SIBO.

Chemical Characterization, Gastrointestinal Motility and Sensory Evaluation of Dark Chocolate: A Nutraceutical Boosting Consumers' Health.

We performed a comprehensive study encompassing chemical characterization and sensory evaluation of two types of dark chocolate, i.e., artisanal (Choco-A) and industrial (Choco-I), as well as an evaluation of onset of gastrointestinal symptoms and gastrointestinal motility in healthy subjects fed with dark chocolate. Proteomic, lipid and metabolite analysis were performed by LC-MS/MS analysis and the total phenol content and antioxidant activity were estimated in both types of chocolate. Fifty healthy volunteers joined the study of the sensory characteristics of both types of chocolate; another 16 subjects underwent the study of gallbladder and gastric emptying by functional ultrasonography and orocecal transit time by lactulose H2-breath test after ingestion of dark chocolate. Identification of polyphenols, amino acids and fatty acids was carried out in both types of chocolate analysed, and results confirmed their richness in polyphenols, amino acid derivatives and fatty acids (FAs) either saturated (stearic, myristic, palmitic, ecosanoic) or unsaturated (oleic and linolenic). For agreeability, Choco-A scored higher than Choco-I for smell, texture, and taste and they did not show significant differences in the gastrointestinal motility. In conclusion as for gastrointestinal motility studies, we report that the ingestion of a small amount of chocolate induced a mild gallbladder, gastric contraction and a fast transit time compared to the test meal in healthy subjects.

Sourdough Fermented Breads are More Digestible than Those Started with Baker's Yeast Alone: An In Vivo Challenge Dissecting Distinct Gastrointestinal Responses.

As a staple food, bread digestibility deserves a marked nutritional interest. Combining wide-spectrum characterization of breads, in vitro nutritional indices, and in vivo postprandial markers of gastrointestinal function, we aimed at comparing the digestibility of sourdough and baker’s yeast breads. Microbiological and biochemical data showed the representativeness of the baker´s yeast bread (BYB) and the two sourdough breads (SB and t-SB, mainly differing for the time of fermentation) manufactured at semi-industrial level. All in vitro nutritional indices had the highest scores for sourdough breads. Thirty-six healthy volunteers underwent an in vivo challenge in response to bread ingestion, while monitoring gallbladder, stomach, and oro-cecal motility. SB, made with moderate sourdough acidification, stimulated more appetite and induced lower satiety. t-SB, having the most intense acidic taste, induced the highest fullness perception in the shortest time. Gallbladder response did not differ among breads, while gastric emptying was faster with sourdough breads. Oro-cecal transit was prolonged for BYB and faster for sourdough breads, especially when made with traditional and long-time fermentation (t-SB), whose transit lasted ca. 20 min less than BYB. Differences in carbohydrate digestibility and absorption determined different post-prandial glycaemia responses. Sourdough breads had the lowest values. After ingesting sourdough breads, which had a concentration of total free amino acids markedly higher than that of BYB, the levels in blood plasma were maintained at constantly high levels for extended time.

999-P: Liraglutide Treatment in Obese Diabetic Patients Modulates Gut Microbiota

Recent studies in mouse models showed that Liraglutide can modulate gut microbiota suggesting this as one of the factors favoring the drug-induced weight loss. We here aimed to observationally evaluate the effect of Liraglutide on gut microbiota composition in obese diabetic humans. 11 obese diabetic subjects (age 59.6 ± 9.8; HbA1C 7.7 ± 2.7%; weight: 95.5 ± 17 kg), candidates to receive GLP-1-analogs, were included. All subjects underwent, before (B) and after 6 weeks of treatment (PT) with Liraglutide 1.2 mg, metabolic evaluation (BMI, glucose, HbA1c and LDL-cholesterol). Lactulose Breath Test (LBT) was performed to characterize gut microbiota, measuring hydrogen (H2) and methane (CH4) production; while gastric emptying time (t/2) was assessed by Octanoic Acid Breath Test. All subjects experienced a significant weight loss (BMI B: 33.9 ± 4.5 kg/m2, PT: 29.9 ± 4.2 kg/m2, p 0,001), and a significant reduction of fasting plasma glucose (FPG) (FPG B: 146.4 ± 31.5 mg/dl, PT: 118.6 ± 33.1 mg/dl p 0.02), Hb1Ac (HbA1C B: 7.7 ± 2.7%, PT: 6.2 ± 1% p 0.001) and LDL-cholesterol (LDL B: 89.5 ± 39.3 mg/dl; PT: 68.4 ± 35.9 mg/dl, p 0.006). Methane and Hydrogen production (AUC) were significantly reduced by Liraglutide in the post-treatment group (H2 B: 5093.8 ± 933 ppm, PT: 2495.5 ± 525 ppm, p 0.02; CH4 B: 1887.9 ± 286.3, PT: 1212.3 ± 334 ppm, p 0.02); moreover, the LBT revealed that Liraglutide is able to significantly slow down the Oro-cecal Transit Time (OTT). As expected, gastric emptying was significantly delayed after Liraglutide treatment (t/2 B: 72.6 ± 8.2 min, PT: 118.2 ± 25 min p 0.05). We, here, show that Liraglutide reduces intestinal gases production, which is an indirect measure of changes in gut microbiota. In conclusion, we highlight the close relationship between glucose lowering effect of Liraglutide and the intestinal microbiota composition, suggesting that the treatment effect may be potentially mediated by changes in gut microbiota, which could in turn represent a new therapeutic target for treatment of type 2 diabetes. Disclosure S. Moffa: None. V. Tesori: None. T. Mezza: None. C. Cefalo: None. F. Cinti: None. G. Sorice: None. A. Giaccari: Advisory Panel; Self; Sanofi. Board Member; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Merck Sharp & Dohme Corp., Sanofi.

Chronic functional constipation is strongly linked to vitamin D deficiency.

BACKGROUNDFew studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not well-defined.AIMTo investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.METHODSWe performed a prospective case-control study, from May-June to November 2017. Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis were used to assess colonic and oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life (IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D).RESULTSWe enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests (IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group (P < 0.001), which significantly correlated with low vitamin D levels (r = - 0.57, P < 0.001; r = 0.21, P = 0.01; r = - 0.48, P < 0.001; r = - 0.57, P < 0.001; r = - 0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).CONCLUSIONVitamin D deficiency, anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders. Vitamin D serum levels should be routinely measured in these patients.

Gastrointestinal defects in gallstone and cholecystectomized patients.

Several gallstone patients complain of dyspeptic symptoms, irrespective of the presence of typical colicky pain. Symptoms often persist after a cholecystectomy. Systematic studies on dyspepsia and dynamic gastrointestinal motor function are missing in gallstone patients with preserved gallbladder or after a cholecystectomy. Forty-six gallstone patients (age 55±2years; 15M, 31F) and 24 cholecystectomized patients (age 57±2years; 6M, 18F) (no difference in type and volume of gallstones between the two groups) were compared against a group of 65 healthy controls (age 51±2years; 30M, 35F). Dyspepsia occurring in the prior months was assessed by a questionnaire, gastric and gallbladder emptying by functional ultrasonography and orocecal transit time by a hydrogen breath test using a lactulose-enriched standard liquid meal. Gallstone patients had significantly greater dyspepsia, fasting and residual gallbladder volumes, and slower gallbladder emptying, gastric emptying and small intestinal transit time than controls. In cholecystectomized patients, gastric emptying further delayed, compared to gallstone patients and controls. Gallstone patients with the gallbladder "in situ" or after a cholecystectomy display dyspeptic symptoms. Symptoms are associated with multiple gastrointestinal motility defects involving the gallbladder, stomach and small intestine. After cholecystectomy, gastric emptying worsens.

Small intestinal bacterial overgrowth in cirrhosis: systematic review and meta-analysis.

Small intestinal bacterial overgrowth (SIBO) was detected in cirrhosis in many studies. The aim is to perform a systematic review and meta-analysis on the prevalence of SIBO in cirrhosis and on the relationship of SIBO with features of cirrhosis. PUBMED search (until 14 January 2018) was performed. Specific search terms were: '(cirrhosis) AND (SIBO OR bacterial overgrowth)'. Studies not relating to cirrhosis or SIBO, animal studies, and non-original articles were excluded. A meta-analysis of all studies was performed using a random-effects model. 117 references were identified by the PUBMED search. 3 references were added after handsearching the reference lists of all the articles. 99 references were excluded. 21 studies (included in total 1264 cirrhotics and 306 controls) remained for qualitative analysis and quantitative synthesis. Prevalence of SIBO for cirrhosis was 40.8% (95% CI 34.8-47.1), while the prevalence of SIBO for controls was 10.7% (95% CI 5.7-19.0). OR 6.83 (95% CI 4.16-11.21; p < 0.001). Prevalence of SIBO for decompensated cirrhosis was higher than prevalence of SIBO for compensated cirrhosis (50.5% vs. 31.2%; p < 0.001). SIBO in cirrhosis was associated with ascites (p < 0.001), minimal hepatic encephalopathy (p = 0.001), bacterial translocation (p = 0.026), spontaneous bacterial peritonitis (p = 0.008), prolonged orocecal transit time (p < 0.001), and was not associated with hypocoagulation. Further studies are required to clarify the relationship of SIBO with hyperbilirubinemia, hypoalbuminemia, overt hepatic encephalopathy in past, esophageal varices and systemic inflammation. Small intestinal bacterial overgrowth is more often detected in cirrhosis than in healthy persons and is associated with some features of cirrhosis.

Type 1 diabetes mellitus: Complex interplay of oxidative stress, cytokines, gastrointestinal motility and small intestinal bacterial overgrowth.

Oxidative stress is risk factor in progression of diabetes. It can increase cytokine production via several different mechanisms. Inflammation can affect gut neural apparatus that may lead to dysmotility which may exaggerate occurrence of bacterial overgrowth in intestine. Thus, a study was planned to understand the complex interplay of oxidative stress, inflammatory cytokines, gut motility and small intestinal bacterial overgrowth in type 1 diabetes mellitus (T1DM) patients. Seventy-five T1DM patients and 75 healthy controls were enrolled. Small intestinal bacterial overgrowth (SIBO) and orocecal transit time (OCTT) were measured using noninvasive glucose and lactulose hydrogen breath tests, respectively. Plasma levels of interleukin-6 (IL-6), tissue necrosis factor-alfa (TNF-α) and interleukin-10 (IL-10) were measured in all subjects by ELISA. Oxidative stress and anti-oxidant parameters were measured by standard methods. Out of 75 T1DM patients, 36 were males with Mean±SD age 22.3±5.2years, IL-6, TNF-α and IL-10 were significantly higher (P<0.05) in T1DM patients as compared to controls. Lipid peroxidation (LPO) was significantly increased (P<0.001), while reduced glutathione (GSH) significantly decreased (P<0.01), whereas superoxide dismutase (SOD) and catalase significantly higher (P<0.05) in T1DM patients as compared to controls. Positive correlation was observed between glycated haemoglobin (HbA1c) levels with LPO and negative correlation with GSH. Further, there was positive correlation between LPO and inflammatory cytokines (IL-6 & IL-10). OCTT was delayed and SIBO significantly higher in patients as compared to controls. On comparison of T1DM based on duration of disease, effect of all parameters was more pronounced in disease duration ≥5years. This study indicates that there is association between hyperglycaemia, oxidative stress (LPO), anti-oxidants (GSH, SOD and catalase), inflammatory cytokines, gut motility (OCTT), and small intestinal overgrowth in type 1 diabetes mellitus patients. This association is intensified as duration of disease increases.

Role of oxidative stress and inflammatory cytokines in Type 2 Diabetes Mellitus patients with and without small intestinal bacterial overgrowth

BackgroundIn type 2 diabetes mellitus (T2DM), insufficient insulin or resistance to insulin in body results in reduced uptake of glucose causing hyperglycemia. This may lead to oxidative stress and further may increase cytokine production. Inflammation may affect gut neural apparatus that may lead to gastrointestinal dysmotility which may amplify occurrence of small intestinal bacterial overgrowth in these patients.AimTo study role of oxidative stress, inflammatory cytokines, gut motility(orocecal transit time: OCTT) and small intestinal bacterial overgrowth (SIBO) in T2DM patientsMaterials and Methods150 T2DM patients and 150 age and sex matched healthy controls were enrolled. SIBO and OCTT were measured using noninvasive glucose and lactulose hydrogen breath tests respectively. Plasma levels of IL‐6, TNF‐α and IL‐10 were measured by ELISA. Oxidative stress (lipid per‐oxidation (LPO) and anti‐oxidant parameters such as reduced glutathione (GSH), Super‐oxide dismutase(SOD) and catalase were measured by standard methods.ResultsOut of 150 T2DM patients, 72 (48%) were males with Mean ± SEM age 56.7±0.74 years. IL‐6, TNF‐α and IL‐10 in T2DM patients were significantly higher(p&lt;0.05) as compared to controls. LPO in T2DM patients was significantly increased(p&lt;0.05) while GSH was significantly decreased(p&lt;0.001). Moreover, SOD and Catalase were significantly higher as compared to controls. OCTT was delayed and SIBO was significantly higher in patients as compared to controls. Furthermore, SIBO +ve patients showed delayed OCTT and inflammatory cytokines were higher in SIBO +ve patients as compared to SIBO –ve patients. Also, LPO, SOD and Catalase were higher whereas GSH lower in SIBO +ve patients as compared to SIBO –ve patientsConclusionIn T2DM patients, oxidative stress would have caused inflammation in gut wall. leading to delayed OCTT and SIBO.Support or Funding InformationDepartment of Biotechnology, New Delhi, India vide no BT/PR8369/MED/30/996/2013This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Risk of small intestinal bacterial overgrowth in patients receiving proton pump inhibitors versus proton pump inhibitors plus prokinetics.

Background and AimIntestinal dysmotility is considered a risk factor for small intestinal bacterial overgrowth (SIBO). Prokinetics improve intestinal motility and are often prescribed with proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD) and/or functional dyspepsia. The present study aimed to evaluate the prevalence of SIBO and the orocecal transit time (OCTT) in patients taking PPI compared with those taking PPI plus prokinetics.MethodsThe study is a single‐center, cross‐sectional study. Enrolled patients (with age > 12 years) were divided into two groups: patients taking PPIs for more than 3 months (Group A) and those taking PPIs with prokinetics for more than 3 months (Group B) for various indications. Lactulose breath test (LBT) for OCTT and glucose breath test (GBT) for SIBO were conducted for all patients.ResultsOf the 147 enrolled patients, SIBO was documented in 13.2% patients in Group A versus 1.8% in Group B, P = 0.018. Median OCTT in Group A was 130 (105–160) min compared with 120 (92.5–147.5) min in Group B (P = 0.010). Median OCTT among SIBO‐positive patients was 160 (140–172.5) min compared with SIBO‐negative patients, where it was 120 (103.75–150) min (P = 0.002). The duration and type of PPI used were not associated with the occurrence of SIBO in our study.ConclusionThe use of prokinetics in patients on PPI may reduce the risk of SIBO by enhancing intestinal motility and may reduce SIBO risk associated with long‐term PPI use.

The effect of arabinoxylooligosaccharides on upper gastroduodenal motility and hunger ratings in humans.

Prebiotics such as Arabinoxylooligosaccharides (AXOS) are non-digestible, fermentable food ingredients stimulating growth/activity of colonic bacteria with enhanced carbohydrates fermentation (CF) in humans. The migrating motor complex (MMC) of the gastrointestinal tract has been recently identified as an important hunger signal, but no data are available yet on the role of acute CF on MMC activity and related hunger ratings. Thus, we aimed to study the effect of acute AXOS CF on MMC and hunger in humans. A total of 13 healthy volunteers were randomized in a single-blind crossover placebo-controlled study where 9.4g of AXOS or 10g of maltodextrin and 1g of unlabelled lactose ureide (LU) were given 12hours prior to the study and, in the next morning, together with a pancake containing 500mg of 13 C-LU. In 10 hours after the meal, 13 CO2 and hydrogen excretion were determined every 15minutes while hunger/appetite ratings every 2minutes through a VAS questionnaire. Five hours after the meal, antroduodenal motility was measured using HRM. AXOS significantly increased CF (158±81 vs 840±464 H2 ppm*minute, placebo vs AXOS, P<.05) without affecting the orocecal transit time (OCTT). AXOS had no significant effect on the occurrence, origin, and duration of phase III and on the total number, origin, and duration of phases I and II. Hunger and appetite scores prior and after phase III were not affected by AXOS. AXOS acutely increases colonic fermentation, but this neither affects OCTT, activity of the MMC, nor interdigestive hunger scores in man.

Young Investigator: Frequency of Small Intestinal Bacterial Overgrowth (SIBO) in Patients With Ulcerative Colitis Using Hydrogen and Methane-Based Breath Tests With Lactulose

BACKGROUND: Small Intestinal Bacterial Overgrowth (SIBO) is present in different gastrointestinal diseases, especially in the presence of predisposing conditions. The variety of clinical manifestations that comes with SIBO can be similar to irritable bowel syndrome or even an UC relapse. Its frequency appears to be higher in patients with IBD compared to non-inflamed controls, which has been partially attributed to inflammation. There are no previous studies regarding SIBO in Mexican patients with UC, which may differ because of the diet habits, genetic and ethnic background. Thus, hypothesizing no difference between the frequency of SIBO in UC in remission and non-inflamed controls, the goal of this study was to evaluate the frequency of SIBO by means of breath tests in patients with active and remission UC compared to non-inflamed controls. METHODS: Cross-sectional study in patients with histopathological diagnosis of UC in clinical, biochemical and endoscopic remission (May 0-1) who met criteria for carrying out a hydrogen and methane breath test and were not under antibiotic treatment, 30 cases of UC and 26 non-inflamed controls. Hydrogen increase of 20 parts per million or more from the baseline or a methane increase of 10 parts per million or more and a double peak in the graph of exhalation of hydrogen and methane) were considered SIBO. Demographic and clinical variables were collected. Statistical analysis was performed with SPSS software version 24. RESULTS: A total of 30 patients with remission UC was studied; mean age 42.5 years with a median of 5 years of UC evolution (range 3 - 9.5); 23 (62.2%) women, 14 (37.8%) men. UC extension by Montreal was E1 in 3 (10%) cases and E3 in 27 (90%). The median fecal calprotectin was 106 μg / g (range: 47.25 to 255.25 μg / g). The frequency of SIBO in remission UC was 50% (15 of 30 patients), with a mean orocecal transit of 120 microparticles per million which is classified as normal. Starting from a baseline of 76.6%, the frequency of methanogenesis was finally universal (100%), nevertheless, none of them reached by this criteria SIBO. There was a significant correlation between gastrointestinal symptoms and gas increase in patients with SIBO (P=0.006). There was no statistically significant difference regarding pharmacological treatment between UC patients with and without SIBO. CONCLUSION(S): The frequency of SIBO was of 50% in patients with UC in remission, methanogenesis was observed in all patients, which interestingly differs from what has been reported in other countries. Orocecal transit of this sample was normal. It is important to consider SIBO as a cause of gastrointestinal symptoms in patients with UC in clinical remission.

The relationship between small intestinal bacterial overgrowth and irritable bowel syndrome.

To explore the relationship between small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS). Fifty IBS patients in the hospital from January 2015 to December 2015 were assigned to the treatment group, and 50 healthy persons were assigned to the control group. Lactulose hydrogen and methane breath test were performed to measure the percentage of SIBO and oro-cecal transit time (OCTT) in treatment group and control group. These subjects were further assigned to negative SIBO group and positive SIBO group to analyze the scores of symptoms. The percentage of positive SIBO in the treatment group (72%, 36/50) was significantly higher (p<0.05) than the control group (38%, 19/50). The scores of symptoms on the episode of IBS were not significantly different between the positive SIBO subgroup and the negative SIBO subgroup. The scores of symptoms in breath test were not significantly different between the positive SIBO subgroup and the negative SIBO subgroup. The OCTT in the treatment group (69.34±1.27 min) was significantly lower (p<0.05) than the control group (85.16±1.75 min). The OCTT in the positive SIBO group (88.57±4.62 min) was significantly higher (p<0.05) than the control group (73.42±5.25 min). The results of lactulose hydrogen and methane breath test in the treatment group were positively correlated (r = 0.987, p<0.01). The results of lactulose hydrogen and methane breath test in the control group after oral administration of lactulose were also positively correlated (r = 0.736, p<0.01). SIBO was related to IBS and could prolong OCTT, yet not worsen IBS.

Preliminary safety and efficacy profile of prucalopride in the treatment of systemic sclerosis (SSc)-related intestinal involvement: results from the open label cross-over PROGASS study

BackgroundProkinetics are used to treat enteric dismotility symptoms in systemic sclerosis (SSc) patients, but they often lack adequate efficacy. The most effective prokinetics belonging to the serotonin (5-HT4) receptor agonists class were withdrawn due to cardiac toxicity in relation to modest 5-HT4 receptor affinity. Prucalopride is a high-affinity 5-HT4 receptor agonist with no major cardiac issues, for which the efficacy in SSc has not yet been assessed.MethodsForty patients with self-reported mild to moderately severe enteric symptoms were enrolled in a cross-over 2 × 2 study. Subjects were randomized 1:1 to prucalopride 2 mg/day or no treatment for one month and vice versa after a 2-week washout period. Before and after each sequence the patients compiled the University of California Los Angeles gastrointestinal tract (UCLA GIT) 2.0 questionnaire and the numbers of complete intestinal movements were recorded. Oro-cecal transit time (OCTT) was evaluated by lactulose breath test in a subgroup of patients. Data were evaluated by mixed linear models corrected for the number of laxatives used during the study periods.ResultsThere were 29 subjects who completed the study; 7 subjects withdrew due to side-effects and 4 subjects were not compliant with the study procedures. As compared to dummy treatment, prucalopride was associated with more intestinal evacuations (p < 0.001), improvement of UCLA GIT constipation (-0.672 ± 0.112 vs 0.086 ± 0.115; p < 0.001), reflux (-0.409 ± 0.094 vs 0.01 ± 0.096; p < 0.005) and bloating (-0.418 ± 0.088 vs -0.084 ± 0.09; p = 0.01) scores. Treatment was ranked moderately to more than moderately effective by 22 patients (72.4%). OCTT was significantly reduced during prucalopruide consumption (prucalopride: -20.1 ± 20.1 vs no treatment: 45.8 ± 21.3 minutes; treatment effect = -65.9 minutes; p = 0.035).ConclusionsThe safety profile of prucalopride in SSc is similar to what is known from the literature. In patients with mild to severe gastrointestinal problems, prucalopride may be effective in treating dismotility symptoms, increasing the number of complete bowel movements and improving bowel transit, reducing reflux disease and bloating.Trial registrationEU Clinical Trial Registry, EudraCT2012-005348-92. Registered on 19 February 2013.

Can psychobiotics intake modulate psychological profile and body composition of women affected by normal weight obese syndrome and obesity? A double blind randomized clinical trial

BackgroundEvidence of probiotics effects on gut function, brain activity and emotional behaviour were provided. Probiotics can have dramatic effects on behaviour through the microbiome–gut–brain axis, through vagus nerve. We investigated whether chronic probiotic intake could modulate psychological state, eating behaviour and body composition of normal weight obese (NWO) and preobese–obese (PreOB/OB) compared to normal weight lean women (NWL).Methods60 women were enrolled. At baseline and after a 3-week probiotic oral suspension (POS) intake, all subjects underwent evaluation of body composition by anthropometry and dual X-ray absorptiometry, and psychological profile assessment by self-report questionnaires (i.e. EDI-2, SCL90R and BUT). Statistical analysis was carried out using paired t test or a non-parametric Wilcoxon test to evaluate differences between baseline and after POS intake, one-way ANOVA to compare all three groups and, where applicable, Chi square or t test were used to assess symptoms.ResultsOf the 48 women that concluded the study, 24% were NWO, 26% were NWL and 50% were PreOB/OB. Significant differences in body composition were highlighted among groups both at baseline and after a POS (p < 0.05). After POS intake, a significant reduction of BMI, resistance, FM (kg and %) (p < 0.05), and a significant increase of FFM (kg and %) (p < 0.05) were observed in all subjects in NOW and PreOB/OB. After POS intake, reduction of bacterial overgrowth syndrome (p < 0.05) and lower psychopathological scores (p < 0.05) were observed in NWO and PreOB/OB women. At baseline and after POS intake, all subjects tested were negative to SCL90R_GSI scale, but after treatment subjects positive to BUT_GSI scale were significantly reduced (8.33%) (p < 0.05) compared to the baseline (33.30%). In NWO and PreOB/OB groups significant differences (p < 0.05) in response to the subscales of the EDI-2 were observed. Significant improvement of the orocecal transit time was observed (p < 0.05) after POS intake. Furthermore, significant differences were observed for meteorism (p < 0.05) and defecation frequency (p < 0.05).ConclusionsA 3-week intake of selected psychobiotics modulated body composition, bacterial contamination, psychopathological scores of NWO and PreOB/OB women. Further research is needed on a larger population and for a longer period of treatment before definitive conclusions can be made.Trial registration ClinicalTrials.gov Id: NCT01890070

Relationship of body weight with gastrointestinal motor and sensory function: studies in anorexia nervosa and obesity

BackgroundWhether gastrointestinal motor and sensory function is primary cause or secondary effect of abnormal body weight is uncertain. Moreover, studies relating continuous postprandial sensations of satiation to measurable pathology are scarce. This work assessed postprandial gastrointestinal function and concurrent sensations of satiation across a wide range of body weight and after weight change.MethodsPatients with anorexia nervosa (AN) and obesity (OB) were investigated in reference to normal weight controls (HC). AN were additionally investigated longitudinally. Gastric emptying, antral contractions and oro-cecal transit after ingestion of a solid meal were investigated by MRI and 13C-lactose-ureide breath test. The dependency of self-reported sensations of satiation on the varying degree of stomach filling during gastric emptying was compared between groups.Results24 AN (BMI 14.4 (11.9–16.0) kg/m2), 16 OB (34.9 (29.6–41.5) kg/m2) and 20 HC (21.9 (18.9–24.9) kg/m2) were studied. Gastric half-emptying time (t50) was slower in AN than HC (p = 0.016) and OB (p = 0.007), and a negative association between t50 and BMI was observed between BMI 12 and 25 kg/m2 (p = 0.007). Antral contractions and oro-cecal transit were not different. For any given gastric content volume, self-reported postprandial fullness was greater in AN than in HC or OB (p < 0.001). After weight rehabilitation, t50 in AN tended to become shorter (p = 0.09) and postprandial fullness was less marked (p < 0.01).ConclusionsA relationship between body weight and gastric emptying as well as self-reported feelings of satiation is present. AN have slower gastric emptying and heightened visceral perception compared to HC and OB. Longitudinal follow-up after weight rehabilitation in AN suggests these abnormalities are not a primary feature, but secondary to other factors that determine abnormal body weight.Trial registrationRegistered July 20, 2009 at ClinicalTrials.gov (NCT00946816).

Chronic alcoholics retain dyspeptic symptoms, pan-enteric dysmotility, and autonomic neuropathy before and after abstinence.

To carry out a comprehensive study on gastrointestinal symptoms, motility and autonomic neuropathy in chronic alcoholics before and one year after abstinence. Dyspeptic symptoms (questionnaires), fasting and postprandial gallbladder and gastric motility (ultrasonography), oro-cecal transit time (lactulose H2 -breath test), stool form score (indirect marker of colonic transit), and autonomic neuropathy (sweat spot test, R-R ratio) were assessed at baseline in 268 subjects (136 chronic alcoholics and 132 healthy controls). A subgroup of 39 patients was re-evaluated after 12 months of abstinence. Chronic alcoholics had increased dyspepsia, delayed gastric emptying and oro-cecal transit time but faster gallbladder emptying, with slightly accelerated colonic transit. Sympathetic, but not parasympathetic, autonomic dysfunction was found. Dyspeptic symptoms and functional alterations of gastric emptying and oro-cecal transit tests were still present after 12-month abstinence, whereas gallbladder motility, stool form score and sympathetic function improved. Chronic alcoholics exhibit combined and interdependent presence of dyspeptic symptoms, impaired motility at different levels of the gastrointestinal tract, with sympathetic dysfunction. Only a few of these abnormalities improve after one year of abstinence from alcohol.

Gastrointestinal Dysfunction in Patients with Duchenne Muscular Dystrophy.

BackgroundIn adult patients with Duchenne muscular dystrophy (DMD) life-threatening constipation has been reported. Since gastrointestinal function in DMD has not been rigorously studied we investigated objective and subjective manifestations of gastrointestinal disturbances in DMD patients.MethodsIn 33 patients with DMD, age 12–41 years, eating behavior and gastrointestinal symptoms were evaluated by questionnaires. Gastric emptying half time (T1/2) and oro-cecal transit time (OCTT) were evaluated by analyzing 13CO2 exhalation curves after ingestion of 13C labeled test meals. Colonic transit time (CTT) was measured by abdominal radiography following ingestion of radiopaque markers.ResultsThe median (quartiles) T1/2 was 187 (168, 220) minutes, the OCTT was 6.3 (5.0, 7.9) hours, both substantially longer than normal data (Goetze 2005, T1/2: 107±10; Geypens 1999, OCTT 4.3±0.1 hours). The median CTT was 60 (48, 82) hours despite extensive use of laxative measures (Meier 1995, upper limit of normal: 60 hours). T1/2 and OCTT did not correlate with symptoms evaluated by the Gastroparesis Cardinal Symptom Index (GCSI) (Spearman r = -0.3, p = 0.1; and r = -0.15, p = 0.4, respectively). CTT was not correlated with symptoms of constipation assessed by ROME III criteria (r = 0.12, p = 0.5).ConclusionsDMD patients have a markedly disturbed gastrointestinal motor function. Since objective measures of impaired gastrointestinal transport are not correlated with symptoms of gastroparesis or constipation our findings suggest that measures assuring adequate intestinal transport should be taken independent of the patient’s perception in order to prevent potentially life threatening constipation, particularly in older DMD patients.

Is There a Best Criteria to Use When Interpreting Lactulose Hydrogen Breath Testing with Nuclear Medicne Validation for the Diagnosis of Small Intestinal Bacterial Overgrowth?: 2016 ACG Fellows-In-Training Award (Functional Bowel Disease Category) 2016 ACG Presidential Poster Award

Introduction: The hydrogen breath test (HBT) is frequently used to diagnose Small Intestinal Bacterial Overgrowth (SIBO). It is measured by a rise in hydrogen at particular time intervals. Lactulose if the most common carbohydate utilized as glucose is thought to be absorbed in the stomach. Many criteria have been proposed to help diagnose SIBO, but those criteria have been defined without much validity. There are three main patterns of hydrogen that have been used to define an abnormal test; a single rise in hydrogen before a certain time frame, a single rise in hydrogen over a baseline before a certain time frame; and rise in hydrogen followed by a subsequent rise in hydrogen before a certain time. We combined nuclear medicine transit scan (NMT) to detect oro-cecal transit time (OCTT) with lactulose hydrogen breath testing (LHBT) in 345 patients to determine the validity of each criteria by positive predictive value. We aim to assess if there is a best criteria. Methods: A retrospective review of 841 patients who underwent HBT at our institution was performed. Of these patients, 345 patients also underwent NMT with measured OCTT. A LHBT was considered positive if it adhered to previously used criteria (figure 1). A combined analysis of HBT with NMT was considered positive only when the respective criteria were fulfilled before the substrate reached the cecum, indicating that the rise in hydrogen was likely due to bacterial fermentation of the substrate in the small intestine. A total of 9 patterns of hydrogen excretion were evaluated and compared by the rate of positive predictive values.Figure 1Results: Of the 345 patients who underwent NMT and HBT, false positives ranged from 53 - 72% for the 9 criteria. Positive predictive values ranged from 27 - 48% (Table 1). The average oro-cecal transit time given by NMT was 72± 42 minutes, with a range of 8-240 minutes.Table 1: Positive Predictive Values for Various Lactulose Hydrogen Breath Test CriteriaConclusion: Our findings reveal that there are no good patterns of rise in Hydrogen by LHBT validated by NMT. However, it appears that a rise in hydrogen > 12 ppm over baseline before 120 min has the highest positive predictive value. In addition, it appears that more patients will meet true positive criteria if a lower ppm threshold is used. Further data and analysis is still needed to determine how to best use the LHBT and NMT.Figure 2

Clinical features of irritable bowel syndrome with small intestinal bacterial overgrowth and a preliminary study of effectiveness of Rifaximin

To investigate the prevalence and clinical features of small intestinal bacterial overgrowth (SIBO) in diarrhea-predominant irritable bowel syndrome (IBS-D) patients detected by hydrogen and methane in lactulose breath test (LBT), and to study the effects of rifaximin in IBS-D patients. Consecutive patients with IBS-D who met Rome Ⅲ criteria, and gender- and age-matched healthy volunteers were enrolled from March 2015 to January 2016 in Peking University Third Hospital. All the ISB-D patients underwent LBT to detect the prevalence of SIBO. The clinical and LBT features of IBS with SIBO (IBS-P group) and without SIBO (IBS-N group) were analyzed. The effects of rifaximin therapy (0.4 g, twice per day for 4 weeks) in IBS-D patients were evaluated by comparing changes in clinical features and LBT results after treatment. (1) Eighty-four IBS-D patients and 22 healthy controls were enrolled. The prevalence of SIBO in IBS-D patients was 41.67% (35/84), with 27 (77.14%) only hydrogen-positive, 5 (14.29%) methane-positive, and 3 (8.57%) both methane- and hydrogen-positive. (2) The body mass index (BMI) in the IBS-P group was lower than in the IBS-N group [(21.61±0.57) vs (23.44±0.54) kg/m(2,) P<0.05], the maximum stool frequency was also less than in the IBS-N group [(3.85±0.23) vs (4.88±0.35) times/day, P<0.05]. (3) No significant difference was found in oro-cecal transit time (OCTT) among IBS-P, IBS-N and healthy controls. The hydrogen concentration in small intestinal and colonic sections in breath of the IBS-P group was higher than that of both healthy controls and the IBS-N group, while methane concentration in small intestinal and colonic sections (160 min) was higher than that of the IBS-N group (all P<0.05). (4) There was no linear relationship between mean hydrogen and methane concentrations in LBT among the IBS-P, the IBS-N and healthy control groups (all r<0.35, P>0.05). (5) Totally 13 IBS-P patients received rifaximin therapy, in whom the symptoms of abdomen pain, bloating, fecal consistency, stool frequency, and stool satisfactory were significantly improved after treatment (all P<0.05); 8 IBS-N patients received rifaximin therapy, in whom fecal consistency, stool frequency, and satisfactory were significantly improved (all P<0.05). (6) And 5/13 of the IBS-P patients receiving rifaximin presented negative LBT results after rifaximin therapy, with lower hydrogen concentration at all the time points, especially in colonic section (120 min) [(34.54±7.32) ×10(-6) vs (52.23±9.40) ×10(-6,) P<0.05] and lower methane concentration especially in small intestinal section (80 min) [(8.54±0.95) ×10(-6) vs (11.31±0.94) ×10(-6,) P<0.05]. About 41.67% of the IBS-D patients meeting Rome Ⅲ criteria have SIBO, which can be better screened by combining hydrogen and methane in LBT compared with only hydrogen in LBT. SIBO can affect nutritional status in IBS-D patients. Rifaximin can improve the systematic symptoms of IBS-D patients with SIBO, also reduce hydrogen and methane concentration in breath, while only improving diarrhea in IBS-D patients without SIBO. Some differences in gut microbiota may exist between IBS-D with and without SIBO.