Stool Output Research Articles

Effect of Neuromuscular Blockade Reversal on Postoperative Gastrointestinal Motility after Laparoscopic Cholecystectomy: Neostigmine / Atropine versus Sugammadex.

To compare sugammadex with neostigmine / atropine combination for reversal of neuromuscular blocker agents in terms of postoperative gastrointestinal motility in patients who underwent laparoscopic cholecystectomy. Experimental study. Place and Duration of the Study: University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkiye, between December 2020 and June 2021. Seventy-two patients undergoing laparoscopic cholecystectomy were included. At the end of the surgery, patients were antagonised for neuromuscular blockers either by atropine / neostigmine or sugammadex by an anaesthesiologist who was not involved in the study. Total anaesthesia time, pneumoperitoneum time, surgery time, number of postoperative opioid dose requirements and total opioid dose administered, number of medication requirements for postoperative nausea and vomiting, postoperative hospital stay, and first gas and stool output time of all the cases were evaluated by the researcher who was unaware of the medicines used for antagonisation. There were no statistically significant differences between the two groups in terms of their effects on postoperative gastrointestinal motility (first gas and stool output time), duration of anaesthesia, duration of surgery, duration of pneumoperitoneum, the number of postoperative opioid dose requirements, the number of drug requirements for postoperative nausea / vomiting, and the postoperative hospitalisation duration of the cases. Effects of reversal agents on postoperative gastrointestinal motility are still debated. Studies on this subject in the literature are both limited in number and have been conducted with different medicine combinations in a wide variety of patient populations. The authors thought that further prospective randomised studies are needed to interpret this effect more clearly. Sugammadex, Neostigmine / atropine, Gastrointestinal motility, Laparoscopic cholecystectomy.

The effect of early mobilization on constipation after abdominal surgery: A systematic review

Background/Aim: Constipation can occur after abdominal procedures. In this study, we investigated whether early mobilization after abdominal surgery is effective for treating constipation. Methods: We conducted a systematic review of studies implementing early and planned mobilization after abdominal surgical procedures. We extracted studies published from 2012–2022 from six electronic databases: PubMed, Google Scholar, Science Direct, Cochrane, TürkMedline, and Ulakbim. The data were collected by two reviewers following a pre-designed subtraction form. We made use of narrative synthesis when presenting our results. Results: We examined 10 articles that satisfied the inclusion criteria; patients underwent a cesarean section in four studies, bariatric surgery (gastric bypass) in one study, liver resection in one study, radical cystectomy in two studies, cholecystectomy in one study, and a kidney transplant in one study. The studies were characterized by differences in the early mobilization programs applied to patients after abdominal surgery. In two of the studies, the patients were mobilized accordingly to daily step goals; in five studies only early stimulation and walking attempts were utilized. In three of the studies, the patients were mobilized within the scope of mobilization programs prepared in detail after surgery, and the targets were determined in terms of distance walked. All of the studies stipulated that physical activity should gradually increase over time. Conclusion: Early and planned mobilization programs applied after surgery had positive effects on first gas/first stool output time, the severity of abdominal distension, the occurrence of nausea/vomiting, and the onset of oral intake.

Text Message System for the Prediction of Colonoscopy Bowel Preparation Adequacy Before Colonoscopy: An Artificial Intelligence Image Classification Algorithm Based on Images of Stool Output

Text Message System for the Prediction of Colonoscopy Bowel Preparation Adequacy Before Colonoscopy: An Artificial Intelligence Image Classification Algorithm Based on Images of Stool Output

A novel nutritional approach to infants and children with congenital diarrhea due to homozygous DGAT1 mutations.

Diacylglycerol acyltransferase (DGAT) catalyzes the final step in triglyceride synthesis. DGAT1 is expressed in human enterocytes and is essential for fat absorption. Homozygous DGAT1 deficiency often presents with severe diarrhea and protein-losing enteropathy (PLE) in the 1st weeks of life. Because severe restriction of fat intake controls diarrhea and decreases PLE, total parenteral nutrition (TPN) was the initial standard therapy in infants and children. We present tertiary center experience managing infants and children with DGAT1 deficiency resulting in the development of a nutritional approach that minimizes the use of TPN. From 2014 to 2020, 12 infants with DGAT1 deficiency were treated. Stool output, growth, and development, as well as essential fatty acid status, were monitored. This retrospective experience formed the basis for treatment recommendations, which include an ultralow fat formula with intermittent peripheral intravenous lipid infusions during the 1st year of life. All patients with prolonged intestinal fat exposure had PLE, which resolved when treated with the nutrition protocol. Essential fatty acid status as measured by triene:tetraene ratios normalized in all treated patients. Over time, early genetic diagnosis and prompt initiation of an ultralow fat diet with peripheral intravenous lipid infusions replaced the need for TPN. Children with DGAT1 deficiency respond to dietary restriction of lipids. Management with a novel nutritional approach provides effective treatment for infants with DGAT1 deficiency, treats diarrhea and PLE, promotes growth and development, avoids TPN dependency, and decreases the potential for essential fatty acid deficiency.

Efficacy of lactose-free formula in acute diarrheal management for children under 5 years: a systematic review and meta-analysis

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time. Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis. Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores. Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group. Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.

Effects of dietary fiber and biotic supplementation on apparent total tract macronutrient digestibility and the fecal characteristics, metabolites, and microbiota of healthy adult dogs.

Dietary fibers and biotics have been shown to support gastrointestinal health in dogs, but are usually tested individually. There is value in testing fiber-biotic combinations that are commonly used commercially. Therefore, this study was conducted to determine the apparent total tract macronutrient digestibility (ATTD) of diets supplemented with fibers or biotics and to evaluate their effects on the fecal characteristics, metabolites, microbiota, and immunoglobulin A (IgA) concentrations of dogs. Twelve healthy adult female beagle dogs (age= 6.2 ± 1.6 yr; body weight = 9.5 ± 1.1kg) were used in a replicated 3 x 3 Latin square design to test three treatments: 1) control diet based on rice, chicken meal, tapioca starch, and cellulose + a placebo treat (CT); 2) diet based on rice, chicken meal, garbanzo beans, and cellulose + a placebo treat (GB); 3) diet based on rice, chicken meal, garbanzo beans, and a functional fiber/prebiotic blend + a probiotic-containing treat (GBPP). In each 28-day period, a 22-day diet adaptation was followed by a 5-day fecal collection phase. Fasted blood samples were collected on day 28. Data were analyzed using the Mixed Models procedure of SAS 9.4, with P<0.05 being significant and P<0.10 being trends. ATTD of dry matter, organic matter, and energy were lower (P<0.001) and DM fecal output was higher (P<0.01) in dogs fed GBPP than CT or GB, whereas ATTD of crude protein was higher (P<0.001) in dogs fed CT and GBPP than GB. ATTD of fat was higher (P<0.001) and wet fecal output was lower (P<0.01) in dogs fed CT than GB or GBPP. Fecal DM% was higher (P<0.001) in dogs fed CT than GBPP or GB, and higher in dogs fed GBPP than GB. Fecal short-chain fatty acid concentrations were higher (P<0.001) in dogs fed GB than CT or GBPP, and higher in dogs fed GB than GBPP. Fecal IgA concentrations were higher (P<0.01) in dogs fed GB than CT. Fecal microbiota populations were affected by diet, with alpha diversity being higher (P<0.01) in dogs fed GB than CT, and beta diversity shifting following dietary fiber and biotic supplementation. The relative abundance of 24 bacterial genera were altered in dogs fed GB or GBPP than CT. Serum triglyceride concentrations were lower in dogs fed GB than GBPP or CT. Our results demonstrate that legume-based dietary fibers, with or without prebiotics and probiotics, reduce ATTD, increase stool output, beneficially shift fecal metabolites and microbiota, and reduce blood lipids of adult dogs.

Assessing safety and efficacy of a novel glucose-free amino acid oral rehydration solution for watery diarrhea management in children: a randomized, controlled, phase III trial

Diarrhoeal disease poses a significant global health challenge, especially in children under three years old. Despite the effectiveness of oral rehydration therapy (ORT), its adoption remains low. Glucose-based ORS (GORS) is the standard, but novel formulations like glucose-free amino acid-based VS002A have emerged as potential alternatives. This study aimed to compare the safety and efficacy of VS002A against the standard WHO-ORS in treating non-cholera acute watery diarrhoea in children. A triple-blind, randomized trial enrolled 310 male infants and children aged 6-36 months, who were assigned to receive WHO-ORS or VS002A over a 16-month period, from June 2021 to September 2022. Both groups received standard of care, including zinc supplementation. The Primary study outcome measured was the duration of diarrhoea. Secondary outcomes included stool output, treatment failure and adverse events. Exploratory endpoints included urinary output, body weight changes, blood biochemistry, stool microbiology and gut health biomarkers. Both VS002A and WHO-ORS were well-tolerated with a low adverse event rate. While not different statistically (p=0.10), duration of diarrhoea was shorter in children treated with VS002A vs. WHO-ORS (65.4h vs. 72.6h). Similarly, stool output was also lower vs. WHO-ORS in children treated with VS002A, though not statistically different (p=0.40). Serum citrulline levels, an indicator of gut health, were higher in the VS002A group at 24h suggesting a potential protective effect (p=0.06). The findings of this study support the non-inferiority of VS002A, a glucose-free amino acid-based ORS compared to the WHO-ORS standard of care. VS002A was shown to be safe and effective in treating non-cholera acute watery diarrhoea in young children. VS002A may offer advantages in pathogen-driven diarrhoea, supported by trends toward a lower duration of diarrhoea and stool output within the per protocol group. Furthermore, individuals with prolonged diarrhoea, severe malnutrition, environmental enteric dysfunction or have issues with obesity or insulin resistance, could benefit from a glucose-free ORS. This research contributes to addressing the persistent challenge of childhood diarrhoea by presenting an alternative glucose-free ORS formulation with potential advantages in select scenarios, offering a promising avenue for improving paediatric diarrhoea management worldwide. The study was funded by Entrinsic Bioscience, LLC., Norwood, MA, USA.

A CASE OF SIGMOID VOLVULUS ASSOCIATED WITH CONSTIPATION

Sigmoid volvulus (SV) is a rare cause of intestinal obstruction in adolescents. Delay in diagnosis may lead to complications such as necrosis and perforation of the volvulated colon. Clinical presentations are non-specific and the diagnosis is based on high clinical suspicion. We report a 14-year-old male patient who presented to the emergency department with abdominal pain and no stool output. It was learned that the patient had these complaints for the last four years and had been receiving constipation treatment. In the standing abdominal X ray, the classic coffee bean finding seen in the sigmoid volvulus was found. A diagnostic laparotomy was performed, which revealed a 180-degree rotation of the mesentery and a significant diameter difference in the colon due to significant dilatation proximal to the volvulus. This case with SV without complications reminds us that SV should be considered as a differential in patients presenting with acute or recurrent abdominal pain and intestinal obstruction.

Pola Peresepan Obat Diare Pada Balita di Rawat Jalan Rumah Sakit Khusus Ibu dan Anak Sadewa Periode Januari – Juni 2022

Diarrhea is a condition in which a person has bowel movements with a soft or liquid consistency, it can even be just water and the frequency is more frequent in one day. Diarrheal disease in toddlers is ranked 2 out of the top 10 childhood diseases at the Sadewa Mother and Children Hospital (RSKIA) in May 2022. Knowing the pattern of prescribing diarrhea drugs in toddlers in outpatient care at the Sadewa Mother and Children Hospital for the period January - June 2022. The research conducted was a non-experimental descriptive research with a retrospective method. The study was conducted by taking prescription data from electronic medical records at the Sadewa RSKIA pharmacy and then recording them on a data collection sheet. Data were analyzed using tabulations in the form of percentages (%). The results showed that out of 130 samples, the profile of diarrhea patients under five was dominated by males, 77 children (59%), aged 2-3 years 65 children (50%), and the degree of dehydration of patients without dehydration, 120 children (92%). ). The most widely used drug class was zinc with 120 prescriptions (34.3%), zinc has a protective effect against diarrhea and can reduce recurrence and probiotics with 119 prescriptions (33.8%), probiotic bacteria will help the process of nutrient absorption and prevent disturbances in water absorption. The dominating combination was a combination of 3 drugs namely electrolytes, zinc and probiotics 69 prescriptions (57%), oralit functioned to replace fluids and electrolytes in the body that are wasted during diarrhea, zinc supplementation and probiotics in diarrhea effectively reduced stool output. The rule for using the treatment of diarrhea in toddlers is mostly 1 time a day with a total of 132 drugs (37.7%). The dominating drug was zinc with 117 prescriptions (88.6%) The pattern of prescribing diarrhea drugs in toddlers in this study was dominated by male patients, aged 2-3 years with a degree of dehydration, patients without dehydration. The most widely used drug classes are zinc and probiotic groups. The most common drug combination found is a combination of 3 drugs, namely electrolyte, zinc and probiotic group drugs. The rule for using the treatment of diarrhea in most toddlers is 1 time a day.

The real-world nutrition management of high stool output in patients with short Bowel syndrome: An international multicenter survey

The real-world nutrition management of high stool output in patients with short Bowel syndrome: An international multicenter survey

Use of a Tissue-Targeting Recombinant Human Interleukin-22 Fusion Molecule (F-652) for the Treatment of Advanced Refractory Lower GI Acute Gvhd

Background: Steroid-refractory (SR) gastrointestinal acute GVHD (GI aGVHD) is a serious complication after allogeneic hematopoietic transplantation (allo-HCT), and subsequent lines of treatment following steroid failure are often ineffective. The JAK 1/2 inhibitor ruxolitinib is the only FDA-approved treatment for SR aGVHD, and patients for whom ruxolitinib is not effective or not tolerated have limited therapeutic options and high mortality. Interleukin-22 (IL-22) is a tissue-protective IL-10-family cytokine that has been shown to support intestinal mucosa after damage, directly signaling to the intestinal epithelium and promoting its survival, regeneration, and production of innate antimicrobial molecules. F-652, a recombinant human (rh)IL-22 fusion protein composed of an IL-22 dimer and IgG2 Fc fragment, has recently been studied in a phase 2 trial for patients with newly diagnosed lower GI aGVHD, demonstrating a promising day 28 treatment response rate and improved gut microbial health. Given this, we examined F-652 administration in 3 patients with severe SR GI aGVHD. Methods: Three patients with hematologic malignancies underwent MUD allo-HCT with tacrolimus and methotrexate GVHD prophylaxis ( Table). The patients were initially treated for GI aGVHD with methylprednisolone at a dose of 2 mg/kg/day without response. All patients presented with or progressed to stage 4 gut aGVHD and failed several lines of therapy, including ruxolitinib. All patients also had multiple episodes of bacteremia and at least some degree of GVHD-associated GI bleeding. F-652 treatment was initiated under single-patient-use authorization as the 5 th-7 th line of therapy and was administered at a dose of 45 mcg/kg IV weekly. In vitro cultures suggested that rho kinase inhibition did not interfere with trophic effects of IL-22 on intestinal epithelium, so patients were permitted to continue belumosidil upon F-652 initiation. While there was concern that JAK inhibition could compromise the activity of IL-22, continuation of ruxolitinib was considered on a case-by-case basis. C-reactive protein (CRP) is an acute phase reactant induced by IL-22, and circulating CRP levels served as a pharmacodynamic marker of in vivo biologic activity of F-652. Results: Consistent CRP elevations were observed 3 days after F-652 dosing in patients A and C, both of whom demonstrated a reduction in GVHD symptoms following F-652 treatment. These CRP elevations occurred despite concurrent use of belumosidil in Patient A and ruxolitinib in Patient C. CRP levels increased in Patient B after the first two doses, but not the third ( Figure). By day 28 following F-652 initiation, 2-of-3 patients (A and C) achieved a partial response, with decreased stool output and resolution of GI bleeding. Patient A had experienced 21 episodes of bacteremia prior to initiating rhIL-22 therapy but continued to demonstrate a partial response at day 56 and resolutiuon of bacteremias. Further improvement during the continued treatment (12 total doses) allowed for hospital discharge after 14 months of hospitalization. Patient B received 4 failed lines of therapy beyond ruxolitinib and was experiencing GI bleeding necessitating frequent transfusions prior to F-652 initiation. The symptoms persisted following F-652 treatment, and the patient passed at day 149 post-HCT. Patient C continues on active F-652 treatment and remains in a partial response as of this submission (&amp;gt; 50 days after treatment initiation). Overall, F-652 treatment has been well tolerated, and no significant adverse events attributable to the drug were observed. Conclusions: This is the first report of IL-22 therapy in SR aGVHD. Treatment was well tolerated, and 2-of-3 patients achieved a response following rhIL-22 administration after failing multiple previous therapies. Whereas most treatments for GVHD target immune cells and deepen immunosuppression, IL-22 is understood to act directly upon epithelial cells where it can support tissue recovery, improve barrier function, and promote innate antimicrobial immunity. CRP elevations post-treatment suggest that IL-22 administration may be able to exert these effects even with concurrent use of a JAK inhibitor. Our findings support further development of this approach and provide proof-of-concept for the use of tissue-supportive strategies to enhance the recovery of damaged gastrointestinal mucosa in advanced lower GI aGVHD.

199 Effects of Dietary Fiber and Biotic Supplementation on Apparent Total Tract Macronutrient Digestibility, Fecal Characteristics, and Fecal Metabolites of Healthy Adult Dogs

Abstract Synbiotics, or mixtures of live microorganisms and substrates selectively utilized by host microorganisms, may confer complementary or synergistic health benefits to the host. Although synbiotics have demonstrated the potential to modulate the gut microbiome and improve gastrointestinal health in many host species, research trials in companion animal diets are limited. Therefore, this study was conducted to determine the apparent total tract macronutrient digestibility (ATTD) of diets supplemented with fibers or biotics and to evaluate their effects on the fecal characteristics, metabolites, microbiota, and immunoglobulin (Ig) A concentrations of dogs consuming them. Healthy adult female beagles (n = 12; age= 6.2 ± 1.6 yr; BW = 9.5 ± 1.1 kg) were used in a replicated 3 x 3 Latin square design to test three dietary treatments: 1) basal diet based on rice, chicken meal, tapioca starch, and cellulose and without probiotics or prebiotics + a placebo treat (control, CT); 2) diet based on rice, chicken meal, garbanzo beans, and cellulose + placebo treat (GB); 3) diet based on rice, chicken meal, and garbanzo beans, and functional fiber/prebiotic blend (mannanoligosaccharides; fructooligosaccharides, inulin, pea fiber, alfalfa meal, Saccharomyces cerevisiae fermentation product) + probiotic-containing treat (synbiotic treatment, SYN). The probiotic treat contained Bacillus subtilus and Bacillus amyloliquefaciens (2 x 109 CFU/d). In each 28-day period, a 22-day diet adaptation was followed by a 5-day fecal collection phase for measurement of ATTD and fecal characteristics, metabolites, microbiota, and IgA concentrations. Fasted blood samples were collected on day 28 for serum chemistry and complete blood count. All data were analyzed using the Mixed Models procedure of SAS 9.4, with P &amp;lt; 0.05 being significant. ATTD of dry matter (DM), organic matter, and energy were less and DM fecal output was greater in dogs fed SYN than those fed CT or GB, whereas ATTD of crude protein was greater in dogs fed CT and SYN than those fed GB. ATTD of fat was higher and wet fecal output was less in dogs fed CT than those fed GB or SYN. Fecal DM% was greater in dogs fed CT than those fed SYN or GB, and greater in dogs fed SYN than those fed GB. Fecal short-chain fatty acids (SCFA; acetate, propionate, total SCFA) were higher in dogs fed GB than those fed CT or SYN, and higher in dogs fed GB than those fed SYN. Fecal IgA concentrations were greater in dogs fed GB than those fed CT. Serum triglycerides were less in dogs fed GB than those fed SYN or CT. Our results demonstrate that legume-based dietary fibers, with or without prebiotics and probiotics, slightly reduce nutrient digestibility, increase stool output, beneficially shift fecal metabolites, and reduce blood lipids of adult dogs.

Systematic review and meta-analysis: Foods, drinks and diets and their effect on chronic constipation in adults.

Dietary approaches are recommended for the management of chronic constipation. Until now, there has been no systematic review and meta-analysis on foods, drinks and diets in constipation. To investigate the effect of foods, drinks and diets on response to treatment, stool output, gut transit time, symptoms, quality of life, adverse events and compliance in adults with chronic constipation via a systematic review and meta-analysis. Studies were identified using electronic databases (12th July 2023). Intervention trials (randomised controlled trials [RCTs], non-randomised, uncontrolled) were included. Risk of bias was assessed using Cochrane 2.0 (RCTs) or JBI Critical Appraisal (uncontrolled trials). Data from RCTs only were synthesised using risk ratios (RRs), mean differences (MDs), standardised mean differences (95% CI) using random-effects. We included 23 studies (17 RCTs, 6 uncontrolled; 1714 participants): kiwifruit (n = 7), high-mineral water (n = 4), prunes (n = 2), rye bread (n = 2), mango, fig, cereal, oat bran, yoghurt, water supplementation, prune juice, high-fibre diet, no-fibre diet (n = 1). Fruits resulted in higher stool frequency than psyllium (MD: +0.36 bowel movements [BM]/week, [0.25-0.48], n = 232), kiwifruits in particular (MD: +0.36 BM/week, [0.24-0.48], n = 192); there was no difference for prunes compared with psyllium. Rye bread resulted in higher stool frequency than white bread (MD: +0.43 BM/week, [0.03-0.83], n = 48). High-mineral water resulted in higher response to treatment than low-mineral water (RR: 1.47, [1.20-1.81], n = 539). Fruits and rye bread may improve certain constipation-related outcomes. There is a scarcity of evidence on foods, drinks and diets in constipation and further RCTs are needed.

EFFICACY OF LACTOSE-FREE FORMULA AS A 24-HOUR MANAGEMENT APPROACH FOR ACUTE DIARRHEA AMONG CHILDREN

Background: Diarrhea continues to be a prominent contributor to morbidity and mortality among young children under five years, especially in developing nations. Secondary lactose intolerance is a significant complication that can arise from acute diarrhea. However, it can be effectively managed with lactose-free formula.&#x0D; Objective: This study aimed to compare the rate of diarrhea resolution within a 24-hour period among children receiving lactose-free formula and those receiving lactose-containing formula.&#x0D; Methods: This retrospective cohort study took place at Naresuan University Hospital and included 153 children aged between one month and five years admitted with acute diarrhea. Participants with bloody mucous diarrhea suspected to be bacterial in nature, positive stool culture, breastfeeding and chronic diarrhea (including cow’s milk protein allergy and inflammatory bowel disease) were excluded. We compared the effectiveness of lactose-free formula (n=48) and lactose-containing formula in improving clinical diarrhea within a 24-hour (n=105).&#x0D; Results: The study findings indicated the lactose-free formula group demonstrated a statistically significant increase in efficacy, with a 3.90 fold improvement in diarrhea within 24 hours compared with that of the group receiving lactose-containing formula. These results were obtained after the confounding factors were adjusted using multivariable regression analysis. The adjusted relative risk (RR) for a 24-hour improvement in diarrhea was 3.90 (95% CI: 1.91-7.95). However, this study encountered limitations regarding the sample size and accurate measurement of stool output.&#x0D; Conclusion: Lactose-free formula showed the potential for greater effectiveness in improving acute diarrhea within a 24-hour timeframe compared with lactose-containing formula.

Optimizing educational methods for the low FODMAP diet in disorders of gut-brain interaction: A feasibility randomized controlled trial.

A diet low in fermentable oligo-saccharides, di-saccharides, mono-saccharides and polyols (low FODMAP diet) is complex and clinical effectiveness is achieved with dietitian-led education, although dietitian availability in clinical practice varies. This study aimed to assess the feasibility of undertaking a trial to investigate the clinical and cost-effectiveness of different education delivery methods of the low FODMAP diet in patients with disorders of gut-brain interaction (DGBI). In this feasibility randomized controlled trial, patients with DGBI requiring the low FODMAP diet were randomized to receive one of the following education delivery methods: booklet, app, or dietitian. Recruitment and retention rates, acceptability, symptoms, stool output, quality of life, and dietary intake were assessed. Fifty-one patients were randomized with a recruitment rate of 2.4 patients/month and retention of 48 of 51 (94%). Nobody in the booklet group strongly agreed that this education delivery method enabled them to self-manage symptoms without further support, compared to 7 of 14 (50%) in the dietitian group (p = 0.013). More patients reported adequate relief of symptoms in the dietitian group (12, 80%) compared with the booklet group (7, 39%; p = 0.026), but not when compared to the app group (10, 63%, p > 0.05). There was a greater decrease in the IBS-SSS score in the dietitian group (mean -153, SD 90) compared with the booklet group (mean -90, SD 56; p = 0.043), but not when compared with the app group (mean -120, SD 62; p = 0.595). Booklets were the least acceptable education delivery methods. Dietitian-led consultations led to high levels of clinical effectiveness, followed by the app, while the dietitian was superior to booklets alone. However, an adequately powered clinical trial is needed to confirm clinical effectiveness of these education delivery methods.

The effect of food, vitamin, or mineral supplements on chronic constipation in adults: A systematic review and meta-analysis of randomized controlled trials.

Over-the-counter supplements are commonly used to manage chronic constipation; however, their efficacy remains unclear. We aimed to investigate the effect of food, vitamin or mineral supplements on stool output, gut transit time, symptoms, and quality of life in adults with chronic constipation via a systematic review and meta-analysis of randomized controlled trials (RCTs). Studies were identified using electronic databases, backward citation, and hand-searching abstracts. RCTs reporting administration of food supplements (e.g., fruit extract supplements), vitamin or mineral supplements in adults with chronic constipation were included. Studies administering whole foods (e.g., fruits) were excluded. Risk of bias (RoB) was assessed with Cochrane RoB 2.0. Relative risks (RR), mean differences (MD), or standardized mean differences (95% confidence intervals [CI]) were calculated using a random-effects model. Eight RCTs (787 participants) were included, investigating kiwifruit (n = 3 RCTs), senna (n = 2), magnesium oxide (n = 2), Ziziphus jujuba (n = 1), and Malva Sylvestris (n = 1) supplements. Kiwifruit supplements did not impact stool frequency (MD 0.24 bowel movements/week [-0.32, 0.80]; p = 0.40) or consistency (MD -0.11 Bristol points [-0.31, 0.09], p = 0.29). Overall, 61% responded to senna and 28% to control; however, this did not reach statistical significance (RR 2.78, [0.93, 8.27]; p = 0.07). Overall, 68% responded to magnesium oxide and 19% to control (RR 3.32 [1.59, 6.92]; p = 0.001). Magnesium oxide improved stool frequency (MD 3.72 bowel movements/week [1.41, 6.03]; p = 0.002) and consistency (MD 1.14 Bristol points [0.48, 1.79]; p = 0.0007). Magnesium oxide supplements are effective at improving cardinal symptoms of chronic constipation. Senna and kiwifruit supplements did not impact symptoms; however, findings were based on a small number of studies. Further research is required to investigate the effect of food supplements (e.g., kiwifruit supplements), as well as their whole food equivalents (e.g., whole kiwifruits) in chronic constipation.

Dietary Fibers Differ in Their Effects on Large Bowel Epithelial Proliferation and Fecal Fermentation-Dependent Events in Rats

The effects of different fiber types and processing on putative protective mechanisms for colorectal cancer were evaluated. Rats were fed diets of similar nutrient balance containing either no added fiber or 10% fiber from various sources. The rate of distal colonic epithelial proliferation, measured by the metaphase arrest method, was dependent on fiber type; ranking of fibers from highest to lowest yielded the following order: methylcellulose > coarse wheat bran > fine wheat bran ≈ parboiled and extruded rice brans > no fiber (P = 0.012). Effect on stool output ranked identically. Ranking of effect on fecal pH, from most to least acidic was as follows: coarse wheat bran ≈ the rice brans > fine wheat bran > no fiber ≈ methylcellulose (P = 0.00001). Coarse wheat bran gave significantly higher fecal butyrate concentrations than did the rice brans, which in turn gave higher levels than fine wheat bran, methylcellulose and the no-fiber diet. Proximal colon epithelial proliferation was unaffected by diet although cecal short-chain fatty acid concentrations and pH were affected. Different fibers have different effects on events in the fecal environment and distal colonic epithelium. Putative protective events (increased output, low fecal pH, high butyrate, low proliferation) are not equally affected and are unlikely in themselves to allow prediction of the protective effect of a fiber.

The Stressed Gut: Region-specific Immune and Neuroplasticity Changes in Response to Chronic Psychosocial Stress

Chronic psychological stress affects gastrointestinal physiology which may underpin alterations in the immune response and epithelial transport, both functions are partly regulated by enteric nervous system. However, its effects on enteric neuroplasticity are still unclear. This study aims to investigate the effects of chronic unpredictable psychological stress on intestinal motility and prominent markers of enteric function. Adult male C57BL/6J mice were exposed to 19 day of unpredictable stress protocol schedule of social defeat and overcrowding. We investigated the effects on plasma corticosterone, food intake, and body weight. In vivo gastrointestinal motility was assessed by fecal pellet output and by whole-gastrointestinal transit (using the carmine red method). Tissue monoamine level, neural and glial markers, neurotrophic factors, monoamine signaling, and Toll-like receptor expression in the proximal and distal colon, and terminal ileum were also assessed. Following chronic unpredictable psychological stress, stressed mice showed increased food intake and body weight gain (P < 0.001), and reduced corticosterone levels (P < 0.05) compared to control mice. Stressed mice had reduced stool output without differences in water content, and showed a delayed gastrointestinal transit compared to control mice (P < 0.05). Stressed mice exhibited decreased mRNA expression of tyrosine hydroxylase (Th), brain-derived neurotrophic factor (Bdnf) and glial cell-derived neurotrophic factor (Gdnf), as well as Toll-like receptor 2 (Tlr2) compared to control (P < 0.05), only proximal colon. These molecular changes in proximal colon were associated with higher levels of monoamines in tissue. Unpredictable psychological chronic stress induces region-specific impairment in monoamine levels and neuroplasticity markers that may relate to delayed intestinal transit.

Citrulline and kynurenine to tryptophan ratio: potential EED (environmental enteric dysfunction) biomarkers in acute watery diarrhea among children in Bangladesh

Two emerging biomarkers of environmental enteric dysfunction (EED) include plasma citrulline (CIT), and the kynurenine (KYN): tryptophan (TRP)/ (KT) ratio. We sought to investigate the plasma concentration of CIT and KT ratio among the children having dehydrating diarrhea and examine associations between concentrations of CIT and KT ratio with concurrent factors. For this analysis, we used cross-sectional data from a total of 102, 6–36 months old male children who suffered from non-cholera acute watery diarrhea and had some dehydration admitted to an urban diarrheal hospital, in Bangladesh. CIT, TRP, and KYN concentrations were determined at enrollment from plasma samples using ELIZA. At enrollment, the mean plasma CIT concentration was 864.48 ± 388.55 µmol/L. The mean plasma kynurenine, tryptophan concentrations, and the KT ratio (× 1000) were 6.93 ± 3.08 µmol/L, 33.44 ± 16.39 µmol/L, and 12.12 ± 18.10, respectively. With increasing child age, KYN concentration decreased (coefficient: − 0.26; 95%CI: − 0.49, − 0.04; p = 0.021); with increasing lymphocyte count, CIT concentration decreased (coef.: − 0.01; 95% CI: − 0.02,0.001, p = 0.004); the wasted child had decreased KT ratio (coef.: − 0.6; 95% CI: − 1.18, − 0.02; p = 0.042) after adjusting for potential covariates. The CIT concentration was associated with blood neutrophils (coef.: 0.02; 95% CI: 0.01, 0.03; p < 0.001), lymphocytes (coef.: − 0.02; 95% CI: − 0.03, − 0.02; p < 0.001) and monocyte (coef.: 0.06; 95% CI: 0.01, 0.11; p = 0.021); KYN concentration was negatively associated with basophil (coef.: − 0.62; 95% CI: − 1.23, − 0.01; p = 0.048) after adjusting for age. In addition, total stool output (gm) increased (coef.: 793.84; 95% CI: 187.16, 1400.52; p = 0.011) and also increased duration of hospital stay (hour) (coef.: 22.89; 95% CI: 10.24, 35.54; p = 0.001) with increasing CIT concentration. The morphological changes associated with EED may increase the risk of enteric infection and diarrheal disease among children. Further research is critically needed to better understand the complex mechanisms by which EED biomarkers may impact susceptibility to dehydrating diarrhea in children.

Effects of phytoestrogens combined with cold stress on sperm parameters and testicular proteomics in rats.

Phytoestrogens and cold negatively influence male fertility. However, the combined effects of these two factors on male reproduction remain unknown. Herein, we studied the changes of sperm parameters and identify potential biomarkers involved in testis of rats, which were intervened by phytoestrogens combined with cold stress. Male Sprague-Dawley rats were randomly divided into control and model groups. The rats in the model group were fed an estrogen diet and placed in a climate chamber [10 ± 2°C; humidity of 75 ± 5%] for 12 h/daily. When compared with the control group after 24 weeks, the rats in the model group showed increased food intake, urine and stool outputs, and higher estradiol and follicle-stimulating hormone levels. However, lower sperm concentration, motility, and viability, and reduced testosterone levels were detected. The epithelial cells of the seminiferous tubules and epididymal ducts presented morphological abnormalities. Proteomic analysis showed that 24 testicular proteins were upregulated and 15 were downregulated. The identified proteins were involved in reticulophagy and stress response. Our findings suggest that the phytoestrogens combined with cold stress had negative effects on the reproductive function of male rats and provide the basis for the establishment of "course simulation" type of oligospermia animal model.