Symptoms Of Gastrointestinal Discomfort Research Articles

Low doses of diarrhoeagenic E. coli induce enhanced monocyte and mDC responses and prevent development of symptoms after homologous rechallenge.

The experimental challenge with attenuated enterotoxigenic E. coli strain E1392/75-2A prevents diarrhea upon a secondary challenge with the same bacteria. A dose-response pilot study was performed to investigate which immunological factors are associated with this protection. Healthy subjects were inoculated with increasing E. coli doses of 1E6-1E10 CFU, and three weeks later, all participants were rechallenged with the highest dose (1E10 CFU). Gastrointestinal discomfort symptoms were recorded, and stool and blood samples were analyzed. After the primary challenge, stool frequency, diarrhea symptom scores, and E. coli-specific serum IgG (IgG-CFA/II) titer increased in a dose-dependent manner. Fecal calprotectin and serum IgG-CFA/II response after primary challenge were delayed in the lower dose groups. Even though stool frequency after the secondary challenge was inversely related to the primary inoculation dose, all E. coli doses protected against clinical symptoms upon rechallenge. Ex vivo stimulation of PBMCs with E. coli just before the second challenge resulted in increased numbers of IL-6+/TNF-α+ monocytes and mDCs than before the primary challenge, without dose-dependency. These data demonstrate that primary E. coli infection with as few as 1E6 CFU protects against a high-dose secondary challenge with a homologous attenuated strain. Increased serum IgG-CFA/II levels and E. coli-induced mDC and monocyte responses after primary challenge suggest that protection against secondary E. coli challenges is associated with adaptive as well as innate immune responses.

Acute enteric-coated sodium bicarbonate has negligible effect on anaerobic performance but affects metabolomics and attenuates the gastrointestinal response.

Sodium bicarbonate ingestion before exercise has a performance-enhancing effect on high-intensity exercise. However, gastrointestinal symptoms can be a problematic side-effect. Enteric-coated sodium bicarbonate can attenuate gastrointestinal symptoms following acute bicarbonate loading. In addition, the subsequent effects on exercise performance and metabolomics have not been investigated. The purpose of this study was to investigate the acute effect of enteric-coated sodium bicarbonate supplementation on the anaerobic performance, physiological profile, and symptoms of gastrointestinal discomfort after severe-intensity intermittent exercise. At the same time, targeted metabolomics was used to study the changes in urine metabolism after ingestion of enteric-coated sodium bicarbonate and to explore the characteristics of biological metabolism. In a randomized crossover design, twelve male college students completed four Wingate anaerobic 30-s cycling tests (WACT) after consuming a placebo (PL) and two experimental conditions: 0.2 g/kg body mass in enteric-coated sodium bicarbonate pills (ES) or general sodium bicarbonate pills (GS). Blood lactate (BLA), heart rate (HR), ratings of perceived exertion (RPE), and gastrointestinal–symptoms assessment questionnaire (GSAQ) were measured pre-exercise and post-exercise. In contrast, mean power (MP) and peak power (PP) were recorded immediately post-exercise. Urine samples were collected before formal tests and 50 min after the third WACT. Our findings indicate the following: 1) mean power and peak power showed no significant difference among conditions (MP: F2.0, 33 = 0.541, p = 0.587, η2 = 0.032; PP: F2.0, 33 = 0.526, p = 0.596, η2 = 0.031). The PP decline of the ES and GS after the third WACT was lower than that of the PL; 2) There were no significant differences in physiological responses, such as BLA (F2.0, 33.0 = 0.191, p = 0.827, η2 = 0.011) and heart rate (F2, 33 = 0.418, p = 0.662, η2 = 0.025), between the three conditions. Although blood lactate concentration after 10 min of the third WACT was lower with ES and GS than with placebo; 3) Fewer participants experienced gastrointestinal symptoms with enteric-coated than with general sodium bicarbonate; 4) The metabolites with differences among the three conditions 50 min after exercise were 3-phospho-d-glycerate, d-Glucose 6-phosphate, pyruvate, cis-aconitate, oxaloacetate, and citrate. ES had higher levels of 3-phospho-d-glycerate, d-Glucose 6-phosphate, pyruvate, and cis-aconitate than GS. The 3-phospho-d-glycerate, d-Glucose 6-phosphate, pyruvate, and cis-aconitate levels in GS were significantly lower than in PL. In contrast, the citrate level in GS was significantly higher than that in other experimental conditions. Compared to PL, the level of oxaloacetate was higher after exercise in ES. This data suggests that supplementation of enteric-coated and general sodium bicarbonate before exercise can alter energy metabolism following anaerobic exercise, involving the metabolism of 3-phospho-d-glycerate, D-Glucose 6-phosphate, pyruvate, cis-aconitate, oxaloacetate, citrate, and lactate. However, they do not affect anaerobic performance and blood lactate. The supplementation of acute enteric-coated sodium bicarbonate and general sodium bicarbonate can enhance some of the weak effects of blood lactate clearance during anaerobic exercise, which may be beneficial for glycolytic energy supply. In addition, enteric-coated sodium bicarbonate intake mitigates gastrointestinal symptoms compared to general sodium bicarbonate.

Protocol of a randomized, double-blind, placebo-controlled study of the effect of probiotics on the gut microbiome of patients with gastro-oesophageal reflux disease treated with rabeprazole

BackgroundFor patients with gastro-oesophageal reflux symptoms, the preferred treatment is proton pump inhibitor (PPI) administration for approximately 8 weeks. However, long-term use of PPIs can cause gut microbiome (GM) disturbances. This study is designed to evaluate the effect of probiotics combined with a PPI on the GM and gastrointestinal symptoms of patients with gastro-oesophageal reflux disease (GERD).MethodThis is a randomized, double-blind, placebo-controlled trial. A total of 120 eligible patients with GERD will be randomized into the experimental group or the control group. The treatment includes two phases: the initial treatment period lasts 8 weeks (weeks 1–8), and the maintenance treatment period lasts 4 weeks (weeks 9–12). During the initial treatment period, the experimental group will take rabeprazole and LiHuo probiotics, and the control group will take rabeprazole and a probiotic placebo; during the maintenance treatment period, the experimental group will take LiHuo probiotics, and the control group will take a probiotic placebo. The primary measure is the change in the GM. The secondary measures are the Reflux Disease Questionnaire (RDQ) score, Gastrointestinal Symptom Rating Scale (GSRS) score, faecal metabolome (FM), body mass index, Los Angeles grade of oesophagitis, adverse event (AE) rate and treatment compliance. Each outcome indicator will be assessed at day 0 (before administration), day 28 and/or 56 (during administration), and day 84 (end of administration) to reveal intragroup differences. AEs will be monitored to assess the safety of LiHuo probiotics.DiscussionThis will be the first trial to use the intestinal flora metagene method to analyse the effects of probiotics on patients with GERD receiving long-term PPI treatment. The goal is to provide evidence for the use of probiotics to reduce intestinal flora disorders and other symptoms of gastrointestinal discomfort in patients with GERD who have used PPIs for a long period.Trial registrationChinese Clinical Trial Registry (ChiCTR) (NO. ChiCTR2000038409). Registered on November 22, 2020, http://www.chictr.org.cn/showproj.aspx?proj=56358.

The Impact of Sodium Alginate Hydrogel on Exogenous Glucose Oxidation Rate and Gastrointestinal Comfort in Well-Trained Runners.

PurposeThe purpose of this study is to quantify the effect of adding sodium alginate and pectin to a carbohydrate (CHO) beverage on exogenous glucose (ExGluc) oxidation rate compared with an isocaloric CHO beverage.MethodsFollowing familiarization, eight well-trained endurance athletes performed four bouts of prolonged running (105 min; 71 ± 4% of VO2max) while ingesting 175 mL of one of the experimental beverages every 15 min. In randomized order, participants consumed either 70 g.h−1 of maltodextrin and fructose (10% CHO; NORM), 70 g.h−1 of maltodextrin, fructose, sodium alginate, and pectin (10% CHO; ENCAP), 180 g.h−1 of maltodextrin, fructose, sodium alginate, and pectin (26% CHO; HiENCAP), or water (WAT). All CHO beverages had a maltodextrin:fructose ratio of 1:0.7 and contained 1.5 g.L−1 of sodium chloride. Total substrate oxidation, ExGluc oxidation rate, blood glucose, blood lactate, serum non-esterified fatty acid (NEFA) concentration, and RPE were measured for every 15 min. Every 30 min participants provided information regarding their gastrointestinal discomfort (GID).ResultsThere was no significant difference in peak ExGluc oxidation between NORM and ENCAP (0.63 ± 0.07 and 0.64 ± 0.11 g.min−1, respectively; p > 0.5), both of which were significantly lower than HiENCAP (1.13 ± 0.13 g.min−1, p < 0.01). Both NORM and HiENCAP demonstrated higher total CHO oxidation than WAT from 60 and 75 min, respectively, until the end of exercise, with no differences between CHO trials. During the first 60 min, blood glucose was significantly lower in WAT compared with NORM and HiENCAP, but no differences were found between CHO beverages. Both ENCAP and HiENCAP demonstrated a higher blood glucose concentration from 60–105 min than WAT, and ENCAP was significantly higher than HiENCAP. There were no significant differences in reported GID symptoms between the trials.ConclusionsAt moderate ingestion rates (i.e., 70 g.h−1), the addition of sodium alginate and pectin did not influence the ExGluc oxidation rate compared with an isocaloric CHO beverage. At very high ingestion rates (i.e., 180 g.h−1), high rates of ExGluc oxidation were achieved in line with the literature.

Acute Effect of Sodium Bicarbonate Supplementation on Symptoms of Gastrointestinal Discomfort, Acid-Base Balance, and Performance of Jiu-Jitsu Athletes.

The purpose of the present study was to verify the acute effect of sodium bicarbonate supplementation on symptoms of gastrointestinal discomfort, acid-base balance and intermittent isometric handgrip test performance in Jiu-Jitsu athletes. Ten male (22.2 ± 3.9 years; 174 ± 0.07 cm; 74.5 ± 8.9 kg) jiu-jitsu athletes participated in this counterbalanced double-blind crossover study. Two protocols, a) supplementation with 0.3 g.kg-1 of body weight of sodium bicarbonate, and b) supplementation with 0.045 g.kg-1 of body weight of placebo substance, were employed. Gastrointestinal tolerability was assessed by the questionnaire. Blood samples were collected at three time points (baseline, pre-ISO, and post-ISO) to determine the responses of potential hydrogenionic (pH), bicarbonate (HCO3-), base excess (EB) and lactate concentrations. The maximum voluntary contraction test and the intermittent isometric contraction test were also performed. As a result, none of the athletes reported significant gastrointestinal discomfort (p > 0.05). HCO3-, pH, and EB at the pre-ISO and post-ISO moments were significantly higher for the sodium bicarbonate protocol. Lactate concentrations were significantly higher for both post-ISO protocols (p = 0.000). There was no significant difference in the performance of the maximum voluntary contraction test and the intermittent isometric contraction test (p > 0.05). Thus, we conclude that sodium bicarbonate supplementation does not generate adverse responses resulting in gastrointestinal discomfort, and does not benefit performance yet promotes a state of metabolic alkalosis.

A prospective, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of SNZ TriBac, a three-strain Bacillus probiotic blend for undiagnosed gastrointestinal discomfort.

This prospective, randomized, double-blind, placebo-controlled, parallel-group study aimed to determine the efficacy and safety of a multistrain (Bacillus coagulans [SNZ 1969], Bacillus clausii [SNZ 1971], and Bacillus subtilis [SNZ 1972]) probiotic blend (SNZ TriBac) in managing symptoms of gastrointestinal (GI) discomfort in the absence of specific pathologies. Sixty adults with symptoms of GI discomfort were enrolled (mean age, 34.89 ± 9.95 years) and randomized to receive either SNZ TriBac or placebo. Changes from baseline in Severity of Dyspepsia Assessment (SODA), Gastrointestinal Symptom Rating Scale (GSRS), and Quality of Life (QoL) scales over the course of product use were determined at baseline and on days 30 and 37 as study outcomes. On day 30, significant improvement with SNZ TriBac was noted in SODA burping/belching (P = 0.025), bloating (P = 0.048), sour taste (P = 0.025), and total (P = 0.007) scores as well as pain (P = 0.003), non-pain (P = 0.04), and satisfaction (P = 0.03) subscores. Significant improvement with SNZ TriBac was also observed in SODA burping/belching (P = 0.011), sour taste (P = 0.011), and total SODA scores (P < 0.001), and in SODA pain (P = 0.005), non-pain (P = 0.06), and satisfaction (P = 0.004) subscores on day 37. No adverse events were reported. Significant improvement in final SODA scores and subscores with SNZ TriBac versus placebo indicates improvement in several symptoms of gastrointestinal discomfort. This multistrain probiotic blend was well tolerated and could be an effective option for treatment of GI discomfort. Clinical Trials Registry of India (CTRI/2018/05/014071).

A yeast fermentate improves gastrointestinal discomfort and constipation by modulation of the gut microbiome: results from a randomized double-blind placebo-controlled pilot trial

BackgroundConstipation and symptoms of gastrointestinal discomfort such as bloating are common among otherwise healthy individuals, but with significant impact on quality of life. Despite the recognized contribution of the gut microbiome to this pathology, little is known about which group(s) of microorganism(s) are playing a role. A previous study performed in vitro suggests that EpiCor® fermentate has prebiotic-like properties, being able to favorably modulate the composition of the gut microbiome. Therefore, the aim of this study was to investigate the effects of EpiCor fermentate in a population with symptoms of gastrointestinal discomfort and reduced bowel movements and to evaluate its effect at the level of the gut microbiome.MethodsThis pilot study was performed according to a randomized, double-blind, placebo-controlled parallel design. Eighty subjects with symptoms of gastrointestinal discomfort and constipation were allocated to one of two trial arms (placebo or EpiCor fermentate). Randomization was done in a stratified manner according to symptom severity, resulting in two subgroups of patients: severe and moderate. Daily records of gastrointestinal symptoms were assessed on a 5-point scale, and also stool frequency and consistency were documented during a 2-week run-in and a 6-week intervention phases. Averages over two-week intervals were calculated. Constipation-associated quality of life and general perceived stress were assessed at baseline and after 3 and 6 weeks of intervention. Fecal samples were also collected at these same time points.ResultsEpiCor fermentate led to a significant improvement of symptoms such as bloating/distension (p = 0.033 and p = 0.024 after 2 and 4 weeks of intervention, respectively), feeling of fullness (p = 0.004 and p = 0.023 after 2 and 4 weeks of intervention, respectively) and general daily scores (p = 0.046 after 2 weeks of intervention) in the moderate subgroup. A significant improvement in stool consistency was observed for the total population (p = 0.023 after 2 weeks of intervention) as well as for the severe subgroup (p = 0.046 after 2 weeks of intervention), and a nearly significant increase in stool frequency was detected for the total cohort (p = 0.083 and p = 0.090 after 2 and 4 weeks of intervention, respectively). These effects were accompanied by an improvement in constipation-associated quality of life and general perceived stress, particularly in the moderate subgroup. Members of the families Bacteroidaceae and Prevotellaceae, two groups of bacteria that have been previously reported to be deficient in constipated patients, were found to increase with EpiCor fermentate in the severe subgroup. In the moderate subgroup, a significant increase in Akkermansia muciniphila was observed.ConclusionsDespite the relatively low dose administered (500 mg/day), particularly when comparing to the high recommended doses for prebiotic fibers, EpiCor fermentate was able to modulate the composition of the gut microbiome, resulting in improvement of constipation-associated symptoms. Conversely, the reported increase in bowel movements may have altered the gut microbial community by increasing those groups of bacteria that are better adapted to a faster gastrointestinal transit time.Trial registrationNCT03051399 at ClinicalTrials.gov. Retrospectively registered. Registration date: 13 February 2017.

Acute Ingestive Effects of Agave Nectar Versus Sucrose in Healthy Young Adults

Less refined sweeteners may impact metabolism differently from their more refined counterparts. We have demonstrated that agave nectar may beneficially alter metabolism in mice in comparison to sucrose. Since agave nectar is particularly rich in fructose, we hypothesized that it would promote lower acute glycemic responses but may promote gastrointestinal (GI) discomfort in comparison to sucrose. We also assessed satiety responses to the sweeteners. Healthy young adults (n=21) between the ages of 20‐45 years completed two randomly ordered feeding trials in which they consumed 200 ml of a test beverage providing 50 grams of carbohydrate from sucrose or raw agave nectar mixed in water. Glycemic responses were examined by finger prick at baseline and 15, 30, 45, 60, 90 and 120 minutes post‐feeding. Symptoms of GI discomfort (nausea, cramping, distention and flatulence) were self‐reported using visual analogue scales at the same timepoints. Satiety was assessed by visual analogue scale at baseline and every 15 minutes for two hours. Agave nectar consumption elicited significantly (p&lt;0.05) lower blood glucose concentrations over time compared to sucrose. Although the magnitude of nausea was relatively low for both trials, greater (p&lt;0.05) nausea was reported during the agave nectar trial. No other symptom of GI discomfort was differentially affected. No significant differences were observed for satiety responses between the two sweeteners. Results suggest that raw agave nectar as a less refined sweetener promoted lower blood glucose responses in young healthy adults as well as modest GI discomfort. Future research should assess the acute and chronic ingestive effects of this sweetener in healthy individuals and those with metabolic disorders.

Effects of probiotics supplementation on gastrointestinal permeability, inflammation and exercise performance in the heat

This study aimed to investigate the effects of multi-strain probiotics supplementation on gastrointestinal permeability, systemic markers of inflammation and running performance when exercising in the heat. Ten male runners were randomized to 4 weeks of daily supplementation with a probiotics capsule (45 billion CFU of Lactobacillus, Bifidobacterium and Streptococcus strains) or placebo, separated by a washout period (double-blind, cross-over trial). After each treatment, the runners exercised to fatigue at 80% of their ventilatory threshold at 35 °C and 40% humidity. To assess gastrointestinal permeability, runners ingested lactulose and rhamnose before exercise and post-exercise urine was collected to measure sugar concentrations. Venous blood samples were collected before, immediately after and 1 h after exercise, and core temperature was monitored during exercise. Probiotics supplementation significantly increased run time to fatigue (min:s 37:44 ± 2:42 versus 33:00 ± 2:27; P = 0.03, d = 0.54). Average core temperature during exercise was similar between trials (probiotic 38.1 ± 0.2 °C, placebo 38.1 ± 0.1 °C; P = 0.77, d = 0.13). Serum lipopolysaccharide concentration increased post-exercise (P < 0.001), while there was a moderate to large reduction in pre-exercise (d = 0.70) and post-exercise (d = 1.24) concentration following probiotics supplementation. Plasma concentrations of IL-6, IL-10 and IL-1ra increased after exercise (P < 0.01), but there was no significant difference between trials (P > 0.05). There was a small to moderate reduction (d = 0.35) in urine lactulose:rhamnose and a small reduction (d = 0.25) in symptoms of gastrointestinal discomfort following probiotics supplementation (both P = 0.25). Four weeks of supplementation with a multi-strain probiotic increased running time to fatigue in the heat. Further studies are required to elucidate the exact mechanisms for this performance benefit.

Symptomatic features and psychosocial factors in patients with belching disorders

To explore the symptomatic features and psychosocial factors in patients with belching disorders. At Peking Union Medical College Hospital Outpatient Clinic from September 2010 to January 2011, 21 consecutive patients with repetitive belching were profiled by symptom questionnaires, including general demographics, spectrum of symptoms, disease course, predisposing factors, previous treatment, psychosocial factors, mental status and personality traits, etc. Pearson's correlation analysis and exact probability were used. Among them, 20 patients fulfilled the Rome III criteria of belching disorders. There were 5 males and 15 females with an age range of (49 ± 10) years. Among them, the belching patterns were daily (n = 18), meal-related (n = 16), spontaneous (n = 15), controllable (n = 16) and symptomatic overlapping (n = 17). The most common symptoms were functional dyspepsia (FD) (n = 13) and gastroesophageal reflux disease (GERD) (n = 11). Sixteen patients experienced mental stimulation/negative events and 13 patients were related to family tension, work stress and overwork. There were 12 patients with anxiety and/or depression and 8 with neurotic personality. The number of overlapping symptoms was related to anxiety states (r = 0.47, t = 2.14, P < 0.05). But the severity of belching was unrelated to with or without depression and anxiety state (P = 0.096). There are a variety of clinical manifestations in patients with belching disorders. Belching disorders is often related to emotional change and environmental stress and accompanied by abnormal mental and personality characteristics. Belching may be an abnormal behavior reaction to gastrointestinal discomfort symptoms. The psychological and social factors probably play an important role in the pathogenesis of belching disorders.