Proximal Jejunum Research Articles

Atypical Double-Bubble in MRI of a Fetus with Double Atresia Involving Esophagus and Jejunum

Double-bubble sign is seen in fetuses with various alimentary tract obstructions, and typically with duodenal atresia. Atypically enlarged and clear double-bubble with enlarged distal esophagus on MRI was observed in a fetus with polyhydramnios at gestational week (GW) 27 suggesting double atresia of the esophagus and duodenum. Postnatal investigations and surgical procedures performed in this otherwise healthy male neonate weighing 2794 g at GW 36 revealed double atresia involving the esophagus (no fistula to trachea) and proximal jejunum. He transiently required tracheal intubation because an increased intra-abdominal pressure caused insufficient respiration. Following surgical repair, the patient left hospital at 69 days of age with excellent clinical course. Differential diagnoses should include a rare anomaly of double atresia in the esophagus and proximal jejunum in infants with double-bubble sign.

Investigation of Undetected Small Bowel Tumors on Capsule Endoscopy

AIM : The rate of undetected small bowel tumors when performing capsule endoscopy (CE) has been reported to be 44.1% to 83.3%. The aim of this study was to review the CE findings in patients with small bowel tumors and analyze the cases in which CE failed to detect tumors. METHODS : Twenty-one cases (18 males, 3 females) with small bowel tumors underwent CE and double-balloon enteroscopy at the Dokkyo Medical University Hospital and the Nikko Medical Center from February 2003 to March 2015. CE findings in the 21 patients were retrospectively reviewed on the basis of the lesion shape and location. RESULTS : Of the 21 patients, CE accurately diagnosed tumors in 12 patients (57.1%). However, tumors were not detected in 9 patients because of a poor endoscopic view due to visual obstruction caused by blood, bowel residue, or feces (n=5; 23.8%), the presence of ulcerated lesions (n=3; 14.3%), or angioectasia (n=1; 4.8%). The sources of bleeding were considered to be ulcerated lesions or angioectasia. Of the 9 patients, 7 patients had tumors in the duodenum or the proximal jejunum. CONCLUSION : On CE, small bowel tumors showed atypical features, including a smooth submucosal bulge and the presence of ulcerated lesions and of blood, bowel residue, or feces, probably due to regional transit abnormalities related to the tumor. In such cases, it may be necessary to perform computed tomography, positron emission tomography/computed tomography, other examinations, or repeat CE after performing colonic irrigation to remove bowel residue.

Successful Removal of a Screw Nail in the Jejunum Using Double-Balloon Enteroscopy.

The vast majority of foreign bodies (FBs) that enter the stomach pass through the gastrointestinal tract spontaneously. When the FB enters the small bowel-beyond the reach of conventional endoscopy-daily radiographs are needed to ensure its safe passage. However, endoscopic intervention is an appropriate management strategy for a sharp-pointed FB, because sharp FBs have a higher risk of intestinal perforation. We describe here a case in which a 1.5-cm, sharp-pointed screw nail in the proximal jejunum was removed successfully by double-balloon enteroscopy from a 19-year-old-male with autism. This case adds to the growing body of evidence demonstrating the value of therapeutic double-balloon enteroscopy in the field of FB ingestion

Surgical Intervention for Massive Inguino-Scrotal Herniae with an Obliterated Intra-Abdominal Cavity

A 63 year old male with a long standing history of large bilateral inguino-scrotal herniae presented as an emergency with increasing scrotal pain, and raised inflammatory markers. CT abdomen/pelvis confirmed the presence of ischaemic bowel, with herniation from proximal jejunum to sigmoid colon. Following a multi-disciplinary approach and discussion with the patient regarding surgical intervention, a laparotomy and scrotal exploration was undertaken. A subtotal colectomy with end ileostomy formation was performed, along with scrotal skin reduction to allow full return of abdominal viscera to the abdominal cavity without the need for component separation. Surgical options described in the literature include a staged procedure using large breast expanders to create space in the peritoneal cavity, following which a laparotomy and return of abdominal viscera to the abdominal cavity is undertaken. In the emergency setting however bowel sacrifice and component separation are usually employed.

Neurofibroma of the appendix and multiple gastrointestinal stromal tumors of small bowel in neurofibromatosis type 1 patient

Neurofibromatosis type 1 (NF-1) is an autosomal dominant hereditary disease with association of tumorous condition of body. Although the pathogenesis of tumorous condition with NF-1 is unclear, there were several reports for gastrointestinal tumors (GISTs) of gastrointestinal tract or nervous system tumors. However, there are few reports of appendiceal neurofibroma in NF-1 patients. We report here a case of NF-1 patient with multiple jejunal GISTs and appendiceal neurofibroma. A 61-year-old man was referred to department of surgery for abnormal findings of appendix on abdominal computed tomography scan. He underwent the laparoscopic appendectomy and laparoscopy-assisted segmental resection of proximal jejunum and he had numerous masses on duodenum and proximal jejunum in the operative findings. The pathologic findings revealed the neurofibroma of appendix and multiple GISTs of the jejunum. Keywords: Neurofibromatoses, Jejunum, Gastrointestinal stromal tumors, Appendix, Neurofibroma

Várices ectópicas en yeyuno proximal asociadas a sangrado recurrente en paciente sin cirrosis hepática

Las várices ectópicas (VE) en yeyuno son alteraciones vasculares infrecuentes, asociadas en mayor medida a la hipertensión portal (5%). Cuando se presenta sin esta asociación son aún menos frecuentes.
 Presentamos un caso de sangrado crónico intestinal de varios años, sin hipertensión portal proveniente de várices localizadas en yeyuno proximal, su curso clínico, los elementos de diagnóstico empleados y terapia quirúrgica.

A combination of xylanase, amylase and protease influences growth performance, nutrient utilisation, starch and protein digestive dynamics in broiler chickens offered maize-, sorghum- and wheat-based diets

In order to examine the influence of an enzyme combination of xylanase, amylase and protease on growth performance and energy utilisation in boiler chickens offered maize-, sorghum- and wheat-based diets and also determine the impact of exogenous enzymes on digestive dynamics of starch and protein in the small intestine and their relativity to broiler performance, a 3 × 2 factorial array of dietary treatments were offered to 288 male Ross 308 chicks from 7 to 27 days post-hatch. Apparent digestibility coefficients of starch, protein and fat in the proximal jejunum, distal jejunum, proximal ileum and distal ileum were determined at Day 27. The digestion rates of starch, protein and energy were predicted by using exponential mathematical models to fit apparent digestibility coefficients with mean retention times in each small intestinal segment. Sorghum-based diets supported the highest weight gain (P < 0.05) and feed intake (P < 0.05) but feed conversion ratios (FCR) were similar across all three grain-based diets (P > 0.10). There were significant interactions between grain type and enzyme supplementation in FCR and the enzyme combination significantly improved FCR in maize-based diets only (P < 0.01). The enzyme combination significantly increased apparent metabolisable energy (AME) in all three grain-based diets (P < 0.05) and increased nitrogen-corrected apparent metabolisable energy (AMEn) in maize- and wheat-based diets (P < 0.05). Wheat-based diets had the lowest N retention (P < 0.01), relative gizzard weight (P < 0.001) and highest gizzard pH (P < 0.05). There were significant grain × enzyme supplementation interactions for starch (P < 0.01) and N (P < 0.05) digestibility coefficients in the four small intestinal segments. Starch digestibility responses to the enzyme combination were most pronounced in wheat-based diets with significant improvement in all segments. The enzyme combination significantly retarded starch digestion rates (P < 0.05) but did not influence protein (N) digestion rates (P > 0.25). In conclusion, feed conversion of sorghum-based diet (1.475) was significantly more efficient than those based on maize (1.518) and wheat (1.532) in non-supplemented diets. The enzyme combination significantly improved energy utilisation (AME) in all three grain-based diets and improved feed conversion efficiency in maize-based diets.

"Jodhpur bezoar": giant polyurethane bezoar.

Acute upper gastrointestinal obstruction due to foreign body ingestion is rare (<6% of all small intestinal obstruction). Bezoars tend to grow slowly and only thereafter cause obstruction, if any. Rapid formation of a bezoar within hours of ingestion of the offending substance is a unique entity. Here, we present a case of a 22-year-old Indian male who was brought in the emergency department with history of ingesting chemicals used for refrigerator insulation, with suicidal intent. Within hours, he was operated for suspected perforation. And on the operation table, we came across surprisingly a cast extending from the whole of the esophagus to as far as 2ft of proximal jejunum! Probably the first of its kind ever known! And no breach in the gut could be found in spite of free gas under the dome of diaphragm, probably due to the chemicals sealing the rent as it solidified!

Simultaneous pancreas and kidney transplantation for liver transplant recipients with diabetes and uremia

Chronic kidney disease (CKD) has become a critical problem due to immunosuppressant related nephrotoxicity in liver transplant (LTx) recipients, especially in patients with pre-transplant risk factors. LTx recipients with uraemia and diabetes have poor prognosis even when treated with dialysis and insulin. Simultaneous pancreas and kidney transplantation (SPK) has been proven to be an effective treatment for patients with diabetic uraemia, but rarely performed in patients after LTx. Two cases of SPK after LTx were performed in our centre and we present our experience here. Two patients received LTx because of HBV related liver cirrhosis; both of them had pre-transplant diabetes mellitus (DM), which worsened after the administration of immunosuppressive drugs. These two patients suffered from CKD and developed uraemia due to diabetic nephropathy and immunosuppressive drugs induced renal toxicity years after LTx. They relied on dialysis and insulin injection. SPK were performed years after LTx and the clinical data was retrospectively analyzed. SPK was successfully performed in these two patients. Pancreatic fluid drainage was achieved via a side-to-side duodenojejunostomy into the proximal jejunum. No serious surgical complications, including pancreatitis or pancreatic fistula were observed postoperatively. In both cases, kidney and pancreatic grafts were functioning well as evidenced by euglycemia without the need for insulin injections and normal serum-creatinine level 7days after the operation. One of the patients presented with renal graft impairment 1week after the operation. FK506 was tapered and rapamycin was used when the renal graft biopsy indicated drug toxicity. The patient's kidney graft function recovered gradually after the adjustment. Both patients have good function of liver, kidney and pancreas grafts during a 60-month and 30-month period of follow up. SPK could serve as an effective option for patients with diabetes and uremia after LTx. Perioperative management, especially the immunosuppressive strategy is crucial to improve the outcome of this procedure.

Phytase supplementation of maize-, sorghum- and wheat-based broiler diets with identified starch pasting properties influences phytate (IP6) and sodium jejunal and ileal digestibility

The effects of phytase supplementation on growth performance, nutrient utilisation, starch and protein digestive dynamics in broiler chickens offered maize-, sorghum- and wheat-based diets were determined in a previous study (Liu et al., 2014). Responses to phytase were most pronounced in maize-based diets, which suggest that more phytate was degraded in these diets. Relevant retained samples of grain, diets and digesta from four small intestinal segments were retrospectively analysed for concentrations of phytate, sodium and starch pasting properties to investigate the hypothesis that phytate in maize-based diets was more completely degraded by exogenous phytase. Exogenous phytase significantly (P<0.001) degraded dietary phytate in the proximal jejunum, distal jejunum, proximal ileum and distal ileum and increased distal ileal phytate digestibility coefficients from 0.238 to 0.631. There were significant differences (P<0.001) between diets based on maize (0.515), wheat (0.449) and sorghum (0.340) for distal ileal phytate digestibility coefficients. Phytase accelerated phytate disappearance rates from all four segments and increased distal ileal phytate disappearance rates from 201 to 535mg/bird/day. This was significantly more pronounced in maize (459mg/bird/day) than in diets based on sorghum (301mg/bird/day) and wheat (343mg/bird/day). Sodium digestibility coefficients were significantly improved (P<0.01) by exogenous phytase in proximal jejunum, distal jejunum and proximal ileum. Exogenous phytase significantly influenced starch properties of experimental diets determined by rapid visco-analysis (RVA). There were significant negative correlations between RVA setback viscosity of starch in experimental diets and starch digestibility coefficients at the distal jejunum (r=−0.438; P<0.01) and proximal ileum (r=−0.591; P<0.001) determined in the Liu et al. (2014) study. Distal ileal phytate digestibility coefficients appeared to be higher in non-supplemented, maize-based diets (0.349) than in diets based sorghum (0.128) and wheat (0.239) thus the likelihood is that phytate in maize-based diets was more readily degraded by endogenous, mucosal phytase in the small intestine. Consideration is given to the possibilities that location of phytate within grains influences phytate degradation and that the relatively low sodium concentrations in maize-based diets may have contributed to the more robust responses to exogenous phytase observed.

Protein-Losing Enteropathy: An Uncommon Presentation of Celiac Disease

Introduction: Protein-losing enteropathy (PLE) is an abnormal loss of protein from the gastrointestinal tract resulting in hypoproteinemia, and is usually not a single disease, but an atypical manifestation of other diseases. The primary causes of PLE can be divided into 3 broad etiologies, including erosive mucosal disease, non-erosive, and disorders involving increased interstitial pressures. Celiac disease is a non-erosive gastrointestinal disorder associated with protein-losing enteropathy. Case Report: A 30-year-old white male with no significant past medical history presented with chronic diarrhea for 8 months and progressively worsening generalized swelling for 3 months. The diarrhea initially started while he was incarcerated, and was described as 7 episodes of loose watery, non-bloody stool per day. The diarrhea partially improved with fasting, and there was no abdominal pain. Physical examination was notable for bibasilar rales and significant pitting edema involving bilateral lower extremities, scrotum, anterior abdominal wall, and lower chest. Labs were significant for total protein of 4.3 g/dL, albumin of 1.0 g/dL, normal creatinine, and no proteinuria. On push enteroscopy, diffuse scalloping and fissures of the duodenum and proximal jejunum were visualized. Duodenal and jejunal biopsies showed marked villous blunting with increased intra-epithelial lymphocytes, an increase in lamina propria chronic inflammatory infiltrate, and hyperplasia of the Brunner glands compatible with celiac disease. Celiac serologies were also elevated, including antigliadin Ab IgA 105 U/mL, t-Transglutaminase IgA >100 U/mL, and endomysial Ab IgA positive. A diagnosis of celiac disease presenting as protein-losing enteropathy was made, and the patient was initiated on a gluten-free diet. Discussion: In a patient presenting with hypoproteinemia, protein-losing enteropathy should be suspected in the absence of proteinuria, liver disease, and malnutrition. Celiac disease should be considered as one of the underlying causes of PLE. The mechanism of protein loss in celiac disease is not well described; however, it is likely a combination of decreased absorptive surface area from villous atrophy, paracellular protein loss, and increased mucosal cell turn over. Treatment of PLE should be focused on targeting the underlying disease.

Massive GI Bleeding Due to Jejunal Diverticulosis: A Rare Diagnostic Dilemma Highlighting the Importance of Endoscopic Timing and Multidisciplinary Care

SymbolIntroduction: Jejunal diverticula form as a result of increased intraluminal pressure at the weakest points of the jejunum, usually near the site of entry of blood vessels into the bowel wall, leading to herniation of mucosa/submucosa through the muscle layer. Patients present with melena and obscure GI bleeding. Once the diagnosis is established, the treatment of choice is surgical resection of the jejunal segment and primary anastomosis. A 77-year-old man presented to an outside institution with 3 days of shortness of breath and melena. Hemoglobin was 7.6 g/dL on admission. Transfused 3 units of pRBC and incremented to 9.2 g/dL, but fell to 7.2 g/dL the following day. EGD was normal. Colonoscopy with TI intubation showed pan-colonic diverticulosis without active bleeding. Melena continued and small bowel enteroscopy performed showing diverticula in the duodenum and proximal jejunum without any blood or clots. Melena continued and an abdominal CT angiography was performed. No bleeding seen. Patient transferred to our institution and capsule endoscopy was performed. Findings suggested a jejunal source of bleeding and a double balloon-assisted enteroscopy was performed. Surgical consultation obtained and stated that since multiple diverticula were found in the duodenum/jejunum but no active bleeding was seen, any surgical intervention in this area would be technically difficult and a targeted resection could not be performed; UGI series with small bowel follow-through performed to assess number and extent of diverticula. Multiple diverticula noted in the second/third portions of the duodenum, proximal/mid-jejunal loops and distal ileum. On hospital day 7, the patient began to have maroon-stools. Taken for urgent enteroscopy with a cap-fitted pediatric colonoscope. Cap used to carefully examine small bowel mucosa and interrogate diverticula. Actively bleeding jejunal diverticula located but no targets for endoscopic treatment identified. Area tattooed and patient sent for surgical resection. Patient did well following surgical resection of jejunal segment. No additional episodes of melena/hematochezia occurred. He was discharged from the hospital and no further GI hemorrhage at 6 months of follow-up.In summary, massive gastrointestinal hemorrhage from jejunal diverticulosis is extremely rare and preoperative localization of the bleeding intestinal segment is challenging. This case illustrates the importance of endoscopic timing in reaching the appropriate diagnosis and the multidisciplinary approach used in its successful management. Urgent endoscopy at the time of active bleeding may be the key to establishing the diagnosis and allow for targeted surgical resection and definitive hemostasis.Symbol

A Rare Case of Malignant Melanoma to the Jejunem, Diagnosed on Small Bowel Enteroscopy

Introduction: A 63-year-old male was transferred to our center from an outside hospital after presenting with complaints of left hand numbness and dizziness, which had been ongoing for a few days. A head CT revealed 2 masses, which led to his transfer in order to evaluate for a likely malignancy and subsequently, a metastatic work-up. The patient denied any nausea, vomiting, diarrhea, constipation, abdominal pain, fevers, melena, and hematochezia. He also denied any prior endoscopic procedures. The patient had a contrast CT of the chest, abdomen, and pelvis, which revealed a 4 x 5-cm right atrial mass (later thought to be a thrombus based on MRI), and a 9 x 7-cm mid small bowel mass with surrounding lymphadenopathy and fat stranding, concerning for a primary small intestinal malignancy. Small bowel enteroscopy was performed and a large circumferential, fungating, ulcerated, and infiltrated mass with no bleeding was found in the proximal jejunum at 50-60 cm from the pylorus. This was biopsied and pathology returned positive for metastatic melanoma. After further evaluation, the patient was also found to have a lesion on the skin of his back, which was also biopsied and returned positive for melanoma in situ. The patient was then started on whole brain radiation and trametinib for palliative therapy. The patient underwent a complicated hospital course, which ultimately resulted in comfort care measures and ultimately, expiration. Small bowel tumors only account for 3-6% of all GI tumors, and only 1.5-4% of GI metastases from cutaneous melanoma are ever diagnosed in a patient’s lifetime. Our case highlights a rare presentation that lent itself to diagnosis via push enteroscopy. While there is some suggestion of the possibility for primary GI melanoma, some authors have suggested that there is no such entity and that they all result from a non-GI primary site, such as a regressed cutaneous source. The gold standard for therapy at this time remains surgical resection of metastatic bowel, but as a means of palliation and not cure. Newer systemic chemotherapies and immunotherapies are being FDA-approved in recent years, which may show promise in the coming future.

Recurrent Acute Pancreatitis Following Roux-en-Y Gastric Bypass (RYGB): The Afferent Loop Syndrome

Introduction: Creation of a surgical gastrojejunostomy leaves a segment of small intestine (usually containing duodendum and proximal jejunum) proximal to the anastomosis called the afferent loop. Mechanical obstruction of the proximal limb leads to afferent loop syndrome. In this case, we describe a case of acute pancreatitis caused by afferent loop syndrome. Case Report: A 75-year-old male presented to the emergency department with nausea, vomiting, and abdominal pain. Past medical history was significant for gastroparesis, for which he underwent subtotal gastrectomy with a roux-en-Y gastric bypass (RYGB) in 2011. Since gastric bypass, the patient experienced 3 episodes of acute pancreatitis, all requiring inpatient management. On initial evaluation, his abdomen was tender and distended with a palpable right-sided abdominal mass. Laboratory evaluation showed lipase >6000 U/L, ALT 566 U/L, AST 738 U/L, total bilirubin 1.4 mg/dL, direct bilirubin 1 mg/dL, alkaline phosphatase 95 U/L, white blood cell count 13.4 k/uL. CT abdomen/pelvis with IV and oral contrast showed homogenous enhancement of pancreas with diffuse peripancreatic fat stranding. There was marked dilatation of the biliopancreatic duodenal limb up to 10 cm with transition in the distal duodenum (see image). He was diagnosed with afferent loop syndrome and “secondary” acute pancreatitis due to mechanical pressure-obstruction of the major papilla. The patient subsequently underwent exploratory laparotomy with lysis of adhesions, and duodenojejunostomy. Following this, the patient improved symptomatically with normalization in lipase and transaminases. No other cause of acute pancreatitis was identified. There have been no further episodes of acute pancreatitis at follow-up (4 months post-op). Discussion: Acute pancreatitis due to afferent loop syndrome is rare following RYGB. However, prompt diagnosis is crucial since relief from mechanical obstruction by surgery facilitates resolution of acute pancreatitis and is thus the treatment of choice.Figure 1

Intestinal lengthening in an innovative rodent surgical model

PurposeCurrent animal models of mechanical lengthening separate intestinal segments from enteric continuity. Such models are difficult to use for repeated lengthening procedures and result in intestinal tissue loss during restoration into continuity. We sought to create a novel surgical model to allow multiple lengthening procedures for the purpose of maximizing the net increase in tissue after intestinal lengthening. MethodsA Roux-en-y jejunojejunostomy with a 6-cm blind-ended Roux limb was created in the proximal jejunum of rats. Encapsulated 1-cm polycaprolactone springs were placed into the closed end of the roux limb and secured with a vessel loop. After 4weeks, lengthened segments and normal jejunum were retrieved for histologic analysis. ResultsJejunal segments were lengthened from 1.0cm to 3.0cm. Lengthened segments had increased smooth muscle thickness, fewer submucosal ganglia, and similar numbers of myenteric ganglia compared to normal intestine. When compared to normal jejunal mucosa, lengthened segments demonstrated unchanged villus height and increased crypt depth. ConclusionsWe created an innovative surgical model for intestinal lengthening and successfully lengthened jejunal segments with a degradable spring. The Roux-en-y model may allow the use of a degradable spring for the treatment of short bowel syndrome.

Effect of dietary zinc oxide on jejunal morphological and immunological characteristics in weaned piglets.

The aim of this study was to evaluate age-related changes and the effect of dietary Zn concentration on morphological and immunological characteristics in the gastrointestinal tract of piglets. A total of 96 purebred Landrace piglets were weaned at the age of 26 ± 1 d, and randomly allocated into 3 treatment groups fed with low (57 mg Zn/kg), medium (164 mg Zn/kg), and high (2425 mg Zn/kg) dietary Zn (ZnO). Piglets (4 males and 4 females per treatment group) were killed at 33 ± 1, 40 ± 1, 47 ± 1, and 54 ± 1 d of age. In the jejunum, villus height, crypt depth, and the number of goblet cells producing neutral, acidic, sulfated, and sialylated mucins were measured. Intraepithelial lymphocytes were characterized by flow cytometry and the gene expression of mucin 2 (MUC2), mucin 20 (MUC20), β-defensin 3, and trefoil factor 3 (TFF3) was determined by reverse transcription quantitative PCR. Villus height and crypt depth in the jejunum showed age related differences (P < 0.01), whereas the dietary concentrations of Zn had no effect. The mucin types were modified mainly by age, and dietary Zn had no effect in the proximal jejunum. In the distal jejunum, age and Zn had effects on the mucin types. The abundance of sulfomucins decreased (P < 0.001) and sialomucins increased with age (P < 0.001), while high dietary ZnO reduced the sulfomucins (P < 0.001) and increased the sialomucins (P < 0.05) in the crypts. The phenotypes of lymphocytes in the epithelium of the proximal jejunum showed relatively constant percentages of T-cells, as well as natural killer cells. High dietary Zn treatment led to a reduced abundance of CD8(+) γδ T-cells (P < 0.05). The apportionment of different cytotoxic T-cell was age dependent. Although the percentage of CD4(-)CD8β(+) increased (P < 0.01), the relative amount of CD4(+)CD8β(+) decreased with age (P < 0.05). The expression of MUC2 and MUC20 was not influenced by age or dietary Zn concentration. High Zn intakes resulted in a reduced gene expression of β-defensin 3 (P < 0.05), but did not affect the expression of TFF3. It is concluded that Zn in the form of ZnO appears to have specific effects on the innate and adaptive gut associated immune system of piglets. These might contribute to the positive effects of Zn on the prevention of postweaning diarrhea.

Effects of duration of moderate increases in grain feeding on endotoxins in the digestive tract and acute phase proteins in peripheral blood of yearling calves

Effects of duration of grain feeding on the concentration of endotoxic lipopolysaccharide (LPS) in digesta throughout the digestive tract and on acute phase proteins and LPS in peripheral blood were determined in Holstein yearling calves. Twenty-five Holstein yearling steer calves received either a forage-based diet containing 92% hay and 8% of a mineral and vitamin pellet on a dry matter basis (CON) or a moderate-grain diet, obtained by replacing 41.5% of the hay in the forage-based diet with barley grain, for 3 (MG3), 7 (MG7), 14 (MG14), or 21 d (MG21) before slaughter. Immediately before slaughter, blood samples were collected from the jugular vein. Immediately after slaughter, digesta samples were collected from the rumen, jejunum, ileum, cecum, colon, and rectum. Rumen liquid digesta, digesta from the intestines, and peripheral blood plasma were analyzed for LPS. Peripheral blood plasma and serum were analyzed for the acute phase proteins amyloid A, haptoglobin, and LPS-binding protein. Feeding the grain diet increased the LPS concentration in rumen fluid linearly from 15,488 endotoxin units (EU)/mL for CON to 70,146 EU/mL for MG7. Concentrations of LPS in rumen fluid in MG14 and MG21 were 61,944 and 56,234 EU/mL, respectively, and did not differ. The LPS concentrations in jejunal digesta were much lower than that in digesta elsewhere in the digestive tract, which suggests that ruminal LPS is broken down in the abomasum or proximal jejunum. The concentration of digesta LPS in the ileum was higher than that of digesta elsewhere in the intestines and similar to that in rumen fluid. The duration of grain feeding increased the LPS concentration in digesta in the ileum and cecum and tended to increase that in the colon cubically. Concentrations of LPS in this part of the digestive tract were highest in the MG3 and MG21 groups. The highest concentrations of LPS in digesta in the cecum, colon, and rectum were 3.7, 3.8, and 5.6 times higher than that in CON, respectively. Grain feeding and the increase in LPS in digesta were not accompanied by an acute phase response or a detectable concentration of LPS in peripheral blood. The absence of LPS in peripheral blood and the lack of increase in acute phase proteins indicated that the grain feeding protocol used in the current study and the accompanying changes in LPS concentrations of the digesta did not result in systemic inflammation.

Protein abundance of clinically relevant multidrug transporters along the entire length of the human intestine.

Intestinal transporters are crucial determinants in the oral absorption of many drugs. We therefore studied the mRNA expression (N = 33) and absolute protein content (N = 10) of clinically relevant transporters in healthy epithelium of the duodenum, the proximal and distal jejunum and ileum, and the ascending, transversal, descending, and sigmoidal colon of six organ donors (24-54 years). In the small intestine, the abundance of nearly all studied proteins ranged between 0.2 and 1.6 pmol/mg with the exception of those of OCT3 (<0.1 pmol/mg) and PEPT1 (2.6-4.9 pmol/mg) that accounted for ∼50% of all measured transporters. OATP1A2 was not detected in any intestinal segment. ABCB1, ABCG2, PEPT1, and ASBT were significantly more abundant in jejunum and ileum than in colon. In contrast to this, the level of expression of ABCC2, ABCC3, and OCT3 was found to be highest in colon. Site-dependent differences in the levels of gene and protein expression were observed for ABCB1 and ASBT. Significant correlations between mRNA and protein levels have been found for ABCG2, ASBT, OCT3, and PEPT1 in the small intestine. Our data provide further physiological pieces of the puzzle required to predict intestinal drug absorption in humans.

Effects of phytase supplementation on growth performance, nutrient utilization and digestive dynamics of starch and protein in broiler chickens offered maize-, sorghum- and wheat-based diets

To investigate the effects of phytase supplementation on growth performance, nutrient utilization and digestive dynamics of starch and protein, a study was conducted using 288 male Ross 308 chicks (6 treatments with 8 replicate cages of 6 birds). Birds were offered steam-pelleted diets based on maize, sorghum or wheat, without or with phytase supplementation, from 7 to 27 days post-hatch. Experimental diets were formulated to be equivalent for energy, protein/amino acids and were P-adequate. Digesta samples from proximal jejunum, distal jejunum, proximal ileum and distal ileum were collected in their entirety at day 27. Digestion rates of starch and protein were determined by fitting exponential mathematical model to apparent digestibility coefficients with mean retention times in each small intestinal segment. The growth performance of birds offered maize and sorghum were comparable but those offered wheat-based diets were inferior. Phytase improved weight gain (P<0.001), feed intake (P<0.001) and feed conversion (P<0.05) in maize-, sorghum- and wheat- based diets, although the most pronounced improvements tended to be for maize. There were grain type-phytase interactions (P<0.01) for nutrient utilization (AME, N retention, AMEn) where substantial phytase responses were observed for maize but not for sorghum- and wheat-based diets. Phytase did not influence digestion rates of starch and protein (P>0.05), but it significantly increased disappearance rates of starch in maize-based diets (P<0.05). In conclusion, phytase improved weight gain and feed conversion efficiency in maize-, sorghum- and wheat-based diets with more pronounced response in maize-based diets. Moreover, phytase also significantly enhanced nutrient utilization in maize-based diets.

La TEP des tumeurs neuroendocrines de l’intestin grêle

This article focuses on the indication and the choice of tracer for PET/CT in case of neuroendocrine tumours (NET) of the small intestine, which are the most common digestive NETs. PET/CT can be used to search for the primary NET in case of detection of a metastasis, for staging and determination of resectability, for restaging, for optimising and determining the efficacy of therapeutic modalities in extended or recurrent forms. Currently, three types of PET tracers are routinely used: FDG can be useful in the case of aggressive NET especially the duodenum and proximal jejunum, FDOPA is the best tracer in the case of NET of distal jejunum or of ileum, the labeled somatostatin analogues 68Ga in the case of well-differentiated NET from the duodenum or proximal jejunum, or irrespective of the location of primary NET if treatment with somatostatin analogue is intended, to confirm the overexpression of somatostatin receptors by lesions.