Xylose Absorption Test Research Articles

The Effects of Oral Quercetin Supplementation on Splanchnic Glucose Metabolism in 1-Week-Old Calves Depend on Diet after Birth1–3

Background: Inadequate colostrum supply results in insufficient intake of macronutrients and bioactive factors, thereby impairing gastrointestinal development and the maturation of glucose metabolism in neonatal calves. The flavonoid quercetin has been shown to have health-promoting properties, including effects in diabetic animals. However, quercetin interacts with intestinal glucose absorption and might therefore exert negative effects in neonates.Objective: We evaluated the interaction between neonatal diet and quercetin feeding on splanchnic glucose metabolism in neonatal calves.Methods: Calves (n = 28) were assigned to 4 groups and fed either colostrum or a milk-based formula on days 1 and 2 and supplemented daily with 148 μmol quercetin aglycone/kg body weight [colostrum with quercetin (CQ+)/formula with quercetin (FQ+)] or without this substance [colostrum without quercetin (CQ−)/formula with quercetin (FQ−)] from days 2–8. From day 3 onward, all calves received milk replacer. A xylose absorption test was performed on day 3, and on day 7, blood samples were collected to study glucose first-pass uptake after [13C6]-glucose feeding and intravenous [6,6-2H2]-glucose bolus injection. Plasma concentrations of metabolites and hormones were measured by taking additional blood samples. A biopsy specimen of the liver was harvested on day 8 to measure the mRNA expression of gluconeogenic enzymes.Results: Higher postprandial plasma concentrations of glucose, lactate, urea, adrenaline, noradrenaline, insulin, and glucagon on day 7 in colostrum-fed calves indicate that metabolic processes were stimulated. Postabsorptive xylose and glucose plasma concentrations each increased by an additional 26%, and splanchnic glucose turnover decreased by 35% in colostrum-fed calves, suggesting improved glucose absorption and lower splanchnic glucose utilization in colostrum-fed calves. Quercetin supplementation resulted in higher noradrenaline concentrations and enhanced peak absorption and oxidation of [13C6]-glucose by 10%. Liver mitochondrial phosphoenolpyruvate carboxykinase mRNA abundance was reduced by 34% in colostrum-deprived calves.Conclusions: Feeding colostrum during the first 2 d of life is crucial for maturation of splanchnic glucose metabolism in calves. Supplementing quercetin improves gastrointestinal absorption capacity, particularly in colostrum-deprived calves.

Clinical parameters, intestinal function, and IGF1 concentrations in colostrum-deprived and colostrum-fed newborn pony foals

Colostrum (COL) contains cytokines and growth factors that may enhance intestinal development in neonates. The hypothesis of this study was that besides providing immunoglobulins, COL is important for intestinal function and meconium release in foals. Newborn foals were either fed COL (n = 5) or an equal amount of milk replacer (MR, n = 7) during the first 24 hours of life. To ensure passive immunity, all foals received 1 L plasma. Postnatal development, meconium release, intestinal motility, white blood cell count, insulin-like growth factor 1, and intestinal absorptive function (xylose absorption test) were evaluated. Clinical findings and meconium release were not affected by feeding of COL or MR. Ultrasonography revealed a slightly larger jejunum and stomach in group COL versus MR (P < 0.05). The percentage of polymorphonuclear leucocytes was higher in foals of group MR versus group COL (P < 0.05) and the percentage of lymphocytes was lower in MR compared with COL foals (P < 0.05). Plasma insulin-like growth factor 1 concentration increased during the first 14 days after birth in both groups. A xylose absorption test on Day 5 revealed similar increases in plasma xylose concentrations after oral intake. In conclusion, feeding of COL versus MR was without effect on meconium release and intestinal absorptive function. Differences between foals fed COL and MR with regard to intestinal function are apparently without clinical relevance. In foals that have not received maternal COL, there is no major risk of intestinal problems if they are fed MR and provided with immunoglobulins by transfusion of plasma.

Interaction of glimepiride with prokinetic drugs on some of gastrointestinal functions in STZ-induced diabetic mice

AimTo investigate the effects of metoclopramide, domperidone and erythromycin on blood glucose and serum insulin levels, gastrointestinal motility and carbohydrate absorption in streptozotocin-induced diabetic mice treated with glimepiride. Design and methodsEffects of the individual as well as combined drugs were studied in diabetic mice via estimation of the blood glucose and serum insulin levels, small intestinal transit, gastric emptying, xylose and glucose absorption tests. Diabetic groups were treated with glimepiride (10mg/kg p.o.), metoclopramide (20mg/kg p.o.), domperidone (20mg/kg p.o.) or erythromycin (6mg/kg p.o.) individually or in combination. ResultsThe test prokinetic drugs metoclopramide (20mg/kg), domperidone (20mg/kg) and erythromycin (6mg/kg) were effective in decreasing small intestinal transit, enhancing gastric emptying and increasing xylose absorption from the GIT in STZ-induced diabetic mice as compared to diabetic control value. Metoclopramide or erythromycin potentiated the effect of glimepiride (10mg/kg) on blood glucose level and serum insulin level after repeated dose administration in diabetic mice. Glimepiride (10mg/kg) significantly decreased small intestinal transit and enhanced gastric emptying in diabetic mice as compared to the diabetic control group. Administration of metoclopramide, domperidone or erythromycin with glimepiride partially antagonized the action of glimepiride on small intestinal transit and gastric emptying in diabetic mice. Administration of metoclopramide, domperidone or erythromycin along with glimepiride significantly increased xylose and glucose absorption as compared to the glimepiride treated group. ConclusionUse of metoclopramide, domperidone or erythromycin with glimepiride may guard against the risk of gastrointestinal motility disturbance associated with glimepiride treated diabetic patients and may enhance the absorption of carbohydrates. The dose of glimepiride may be safely decreased when combined with erythromycin or metoclopramide.

Interaction of insulin with prokinetic drugs in STZ-induced diabetic mice

To study the possible interactions of metoclopramide, domperidone and erythromycin in streptozotocin-induced diabetic mice treated with insulin by various parameters. Effects of the individual as well as combined drugs were studied in diabetic mice via estimation of the blood glucose and serum insulin levels, small intestinal transit (SIT), gastric emptying (GE), xylose absorption and glucose tolerance tests. Groups were given insulin 2 IU/kg s.c., metoclopramide 20 mg/kg p.o., domperidone 20 mg/kg p.o. and erythromycin 6 mg/kg p.o. individually and in combination. There were also normal and diabetic control groups. The first set of experiments was carried out to investigate the subchronic effect on blood glucose and serum insulin levels in diabetic mice of one week of daily dose administration of the tested drugs individually as well as the combination of insulin with each prokinetic drug. The other five sets of experiments were carried out to investigate the acute effect of a single dose of each drug individually and in combination on blood glucose and serum insulin levels, SIT, GE, oral xylose absorption and glucose tolerance tests. The study included the prokinetic drugs metoclopramide (20 mg/kg), domperidone (20 mg/kg) and erythromycin (6 mg/kg), as well as insulin (2 IU/kg), which was individually effective in decreasing SIT, enhancing GE and increasing xylose absorption significantly in diabetic mice. Erythromycin tended to decrease blood glucose level and increase serum insulin level after 1 wk of daily administration in diabetic mice. Erythromycin potentiated the effect of insulin on blood glucose level and serum insulin level whereas other prokinetic agents failed to do so after repeated dose administration in diabetic mice. Metoclopramide or erythromycin in combination with insulin significantly decreased SIT, in diabetic mice, to lower levels than with insulin alone. Administration of prokinetic drugs along with insulin antagonized the action of insulin on xylose absorption. These combinations also increased the rate of glucose absorption from the gut. The present study suggests that prokinetic drugs could potentially improve glycemic control in diabetic gastroparesis by allowing a more predictable absorption of nutrients, matched to the action of exogenous insulin. The use of prokinetics, such as erythromycin, may be interesting in the clinic in decreasing the need for insulin in diabetic patients. The dose of insulin may be safely decreased with erythromycin in chronic treatments.

TLR9 Agonist Protects Mice from Radiation-Induced Gastrointestinal Syndrome

PurposeRadiation-induced gastrointestinal syndrome (RIGS) is due to the clonogenic loss of crypt cells and villi depopulation, resulting in disruption of mucosal barrier, bacterial invasion, inflammation and sepsis. Intestinal macrophages could recognize invading bacterial DNA via TLR9 receptors and transmit regenerative signals to the neighboring crypt. We therefore investigated whether systemic administration of designer TLR9 agonist could ameliorate RIGS by activating TLR9.Methods and MaterialsMale C57Bl6 mice were distributed in four experimental cohorts, whole body irradiation (WBI) (8.4–10.4 Gy), TLR9 agonist (1 mg/kg s.c.), 1 h pre- or post-WBI and TLR9 agonist+WBI+iMyd88 (pretreatment with inhibitory peptide against Myd88). Animals were observed for survival and intestine was harvested for histological analysis. BALB/c mice with CT26 colon tumors in abdominal wall were irradiated with 14 Gy single dose of whole abdominal irradiation (AIR) for tumor growth study.ResultsMice receiving pre-WBI TLR9 agonist demonstrated improvement of survival after 10.4 Gy (p<0.03), 9.4 Gy (p<0.008) and 8.4 Gy (p<0.002) of WBI, compared to untreated or iMyd88-treated controls. Post-WBI TLR9 agonist mitigates up to 8.4 Gy WBI (p<0.01). Histological analysis and xylose absorption test demonstrated significant structural and functional restitution of the intestine in WBI+TLR9 agonist cohorts. Although, AIR reduced tumor growth, all animals died within 12 days from RIGS. TLR9 agonist improved the survival of mice beyond 28 days post-AIR (p<0.008) with significant reduction of tumor growth (p<0.0001).ConclusionsTLR9 agonist treatment could serve both as a prophylactic or mitigating agent against acute radiation syndrome and also as an adjuvant therapy to increase the therapeutic ratio of abdominal Radiation Therapy for Gastro Intestinal malignancies.

The effect of sedation on D(+)‐xylose absorption tests in 6 normal horses

D(+)-xylose absorption tests are commonly performed when investigating suspected small intestinal malabsorption in the horse. The test involves the administration of a D(+)-xylose solution via a nasogastric tube followed by serial blood sampling to determine its rate of absorption. In some horses, nasogastric intubation cannot be safely performed without prior administration of a sedative. Due to its short duration of action, the α(2) agonist xylazine is commonly used for this purpose. However, α(2) agonists have also been reported to influence the rate of gastric emptying as well as small intestinal motility patterns. To evaluate if prior sedation with xylazine would influence the rate of absorption of D(+)-xylose in 6 normal Standardbred horses in a randomised cross-over study. D(+)-xylose was administered by nasogastric intubation at a dose rate of 0.5 g/kg bwt given as a 10% solution with water while xylazine was administered iv at a dose rate of 0.5 mg/kg bwt. A heparinised blood sample was collected prior to administration of D(+)-xylose (and xylazine when used) and then at 30, 45, 60, 75, 90, 120, 150, 180 and 240 min following administration. Samples were immediately analysed using a modified colorimetric micro method. The cumulative amount of D(+)-xylose absorbed at each time point with and without prior sedation were. The significance rate was set at P<0.05. The study failed to demonstrate a statistically significant difference in the amount of D(+)-xylose absorbed between sedated and unsedated animals, although there was a tendency for a less rapid initial uptake with prior sedation. This study suggests that prior sedation with xylazine will not significantly affect the result of a D(+)-xylose absorption test in the normal horse.

Abstract 1393: Transplantation of Bone marrow-derived adherent stem cells mitigates radiation-induced gastrointestinal syndrome

Abstract Radiation-induced gastrointestinal syndrome (RIGS) results from a combination of direct cytocidal effects on intestinal crypt and endothelial cells and subsequent loss of the mucosal barrier, resulting in diarrhea, microbial infection and septic shock. While growth factors, such as, R-spondin1 and KGF can protect mice from RIGS, mitigation is rare, following exposure to lethal doses of irradiation (IR). We hypothesized that IR-induced depletion and injury of intestinal stem cells (ISC) and stromal cells of the ISC niche induces RIGS. Since stromal cells provide critical growth factor/signals for ISC regeneration, we examined whether transplantation of bone marrow (BM)-derived adherent stem cells (BMASC) containing mesenchymal stem cells (MSC), endothelial progenitor cells (EPC) and macrophages would mitigate RIGS. Harvested BM cells, from C57Bl/6 mice, were cultured in MSCBM (Cambrex-Lonza) for 4 days, followed by collection of adherent cells from culture plates as BMASC. C57Bl/6 mice received a single fraction of either whole body irradiation (WBI; 8-12 Gy) or total abdominal irradiation (AIR; 16-20 Gy), followed by transplantation of BMASC (1×106 cells/mice) 24 and 72 hours after exposure to IR via tail vein injection. Irradiated controls received MSC culture medium. To evaluate the mitigating effect of myeloid cells, BMASC were fractionated with anti-CD11b-magnetic beads (MACS), followed by transplantation of CD11b+ and CD11b- BMASC cells in irradiated mice as above, respectively. Animals were observed for survival (Kaplan-Meier) and histopathological evaluation (Hematoxylin-eosin, TUNEL and BrdU immunohistochemistry). Xylose absorption test was performed to assess the functional integrity of intestinal mucosal barrier. Flow cytometry demonstrated 48% + 2.1 MSC (CD105+CD45-), 8.1% + 0.53 EPC (CD133+ CD45-) and 17.3% + 1.8 myeloid/macrophages in BMASC donor cells. In contrast to irradiated controls, 100% of the mice that received BMASC transplantation survived a lethal dose of WBI (10.4 Gy) and AIR (18Gy) (p&amp;lt;0.002 and p&amp;lt;0.004 respectively in Kaplan-Meier analysis) for up to 30 days. Transplantation of either CD11b+ myeloid cells or CD11b-CD105+ MSC could mitigate 30-40% of animals, indicating that both MSC and macrophages are necessary for RIGS mitigation. Immunohistological analysis demonstrated significant increase in proliferation rate (p&amp;lt;0.004), crypt depth and villi length (p&amp;lt;0.001) and decrease in apoptotic crypt cells (p&amp;lt;0.003) in transplanted animals on 3.5 days after IR. Xylose absorption was higher in these animals indicating a rapid intestinal regeneration following BMASC transplantation. In conclusion, this is the first demonstration that transplantation of BMASC could mitigate RIGS after exposure to lethal doses of IR. Further studies are underway to characterize the factors and signaling pathways responsible for RIGS mitigation. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1393.

Protective Role of R-spondin1, an Intestinal Stem Cell Growth Factor, against Radiation-Induced Gastrointestinal Syndrome in Mice

BackgroundRadiation-induced gastrointestinal syndrome (RIGS) results from a combination of direct cytocidal effects on intestinal crypt and endothelial cells and subsequent loss of the mucosal barrier, resulting in electrolyte imbalance, diarrhea, weight loss, infection and mortality. Because R-spondin1 (Rspo1) acts as a mitogenic factor for intestinal stem cells, we hypothesized that systemic administration of Rspo1 would amplify the intestinal crypt cells and accelerate the regeneration of the irradiated intestine, thereby, ameliorating RIGS.Methods and FindingsMale C57Bl/6 mice received recombinant adenovirus expressing human R-spondin1 (AdRspo1) or E.coli Lacz (AdLacz), 1–3 days before whole body irradiation (WBI) or abdominal irradiation (AIR). Post-irradiation survival was assessed by Kaplan Meier analysis. RIGS was assessed by histological examination of intestine after hematoxilin and eosin staining, immunohistochemical staining of BrdU incorporation, Lgr5 and β-catenin expression and TUNEL staining. The xylose absorption test (XAT) was performed to evaluate the functional integrity of the intestinal mucosal barrier. In order to examine the effect of R-spondin1 on tumor growth, AdRspo1 and AdLacZ was administered in the animals having palpable tumor and then exposed to AIR. There was a significant increase in survival in AdRspo1 cohorts compared to AdLacZ (p<0.003) controls, following WBI (10.4 Gy). Significant delay in tumor growth was observed after AIR in both cohorts AdRspo1 and AdLacZ but AdRspo1 treated animals showed improved survival compared to AdLacZ. Histological analysis and XAT demonstrated significant structural and functional regeneration of the intestine in irradiated animals following AdRspo1 treatment. Immunohistochemical analysis demonstrated an increase in Lgr5+ve crypt cells and the translocation of β-catenin from the cytosol to nucleus and upregulation of β-catenin target genes in AdRspo1-treated mice, as compared to AdLacz-treated mice.ConclusionRspo1 promoted radioprotection against RIGS and improved survival of mice exposed to WBI. The mechanism was likely related to induction of the Wnt-β-catenin pathway and promotion of intestinal stem cell regeneration. Rspo1 has protective effect only on normal intestinal tissue but not in tumors after AIR and thereby may increase the therapeutic ratio of chemoradiation therapy in patients undergoing abdominal irradiation for GI malignancies.

Assessing the effect of diclazuril on the intestinal absorptive capacity of broilers infected with experimental coccidiosis, using d‐xylose absorption test

Assessing the effect of diclazuril on the intestinal absorptive capacity of broilers infected with experimental coccidiosis, using <scp>d</scp>‐xylose absorption test

13C-xylose and 14C-xylose breath tests for the diagnosis of coeliac disease

Objectives. Xylose absorption testing has traditionally involved measurement of serum xylose and/or measurement of excreted xylose in urine. However, by enriching xylose with a 13C- or 14C-isotope, absorption of an oral xylose load will be reflected in the time-dependent pattern of 13CO2 or 14CO2 exhaled in breath. Our objectives were to evaluate the diagnostic properties of 13C-xylose and 14C-xylose breath tests in coeliac disease, and to develop a diagnostic breath test index. Material andmethods. We reviewed data from 41 coeliac patients who underwent the 14C-xylose breath test before and after commencement of a gluten-free diet, and 60 coeliac patients who underwent the 13C-xylose breath test, 37 of whom repeated the test after starting a gluten-free diet. Coeliac patients were compared with healthy control subjects. Results. Coeliac patients exhaled significantly less 13CO2 or 14CO2 than healthy controls during the first hour of the test and more isotope-labelled CO2 than control subjects after 3 h. Diagnostic accuracy was optimal with test duration of 210 min combining gas measurements at 30 min and 210 min in a simple fraction. This gas fraction index (30 min/210 min) distinguished between coeliac patients and healthy control subjects with 84–95% sensitivity and 87–94% specificity. After commencement of a gluten-free diet, the gas fraction index increased in most coeliac patients, but remained lower than that in healthy control subjects. Conclusions.13C-xylose- and 14C-xylose breath tests discriminate between coeliac patients and healthy control subjects with high sensitivity and specificity. The stable isotope 13C-xylose breath test has comparable diagnostic accuracy to the radioactive isotope 14C-xylose breath test and should be the preferred alternative to traditional xylose absorption tests.

The diagnostic accuracy of serologic tests for celiac disease: A systematic review

Clinicians are increasingly utilizing noninvasive serologic tests for the diagnosis and screening of celiac disease (CD). The aim of this study was to conduct a systematic review of the diagnostic performance of serologic tests for the diagnosis and screening of CD. Standard systematic review methodology was used. A literature search was conducted in MEDLINE (1966 to October 2003) and EMBASE (1974 to December 2003) databases. A weighted mean of the sensitivity and specificity along with 95% confidence intervals and summary receiver operating characteristic (ROC) curves were calculated. The pooled specificity of endomyseal antibody (EMA)-monkey esophagus (ME) or EMA-human umbilical cord (HU) was close to 100% in adults and children. The pooled specificity of transglutaminase antibody (tTG)-guinea pig (GP) and tTG-human recombinant (HR) were between 95% and 99%. IgA-EMA-ME demonstrated sensitivities of 96% and 97% in children and adults, respectively. EMA-HU demonstrated a similar sensitivity of 97% in children but 90% in adults. The pooled sensitivity of tTG-GP in adults and children was 90% and 93%, respectively. The sensitivity of tTG-HR was 98% and 96%, respectively. The performance of antigliadin antibody was inferior to that of EMA and tTG. EMA and tTG offer high sensitivity and specificity. The sensitivity of these tests appears to be lower than reported when milder histologic grades are used to define CD (below 90%). If true, the nearly perfect negative predictive value of these tests would drop. The positive predictive value of these tests is likely lower than reported when the tests are applied in low-prevalence populations.

P0784 INTESTINAL FUNCTION TESTS IN INTESTINAL FAILURE

Introduction: Intestinal failure (IF) is a complex condition requiring parenteral nutrition (PN). The outcome of IF is associated with its primary etiology (1) but individual prognostic factors are not available to predict weaning from PN. We tested the hypothesis that non-invasive intestinal function tests could predict weaning from PN in children with IF. Methods: IF was defined as need for total PN for at least 4 weeks or for supportive PN for at least 3 months. In children with IF we retrospectively evaluated the following non-invasive intestinal function tests: fecal steatocrit, d-xylose oral load, fecal alpha1-antitrypsin. At least 3 determinations for fecal steatocrit and 2 for d-xylose oral load were obtained. Results were analysed in relation with the primary etiology of IF. Statistical analysis was performed with non parametric and logistic regression tests, and X2 test. Results: 10 children with short bowel syndrome (SBS) and 5 with various causes of IF (NSBS) were enrolled. Fecal alpha1-antitrypsin was normal in all cases. Mean values of steatocrit were abnormal in both groups, 17 (range 0–55) and 13 (range 0–53) in children with SBS and non SBS, respectively. Xylose absorption test was significantly different in children with SBS (mean 14, range 3–35.5) versus children with NSBS (mean 26, range 16–44) (p<0.01). When we analysed steatocrit and xylose absorption in children that were eventually weaned from PN, and in those who were not, a difference was detected in SBS and NSBS children. In the latter no statistical correlation was observed between functional tests and gaining of intestinal sufficiency. In children with SBS, at enrolment, xylose absorption was statistically associated with intestinal length and weaning from PN (p<0.05), whereas such correlation was not observed for fecal steatocrit. Among functional tests, fecal steatocrit was normal in all patients weaned from PN and in 1/3 patients who could not be weaned (p=0.08). Xylose test was normal in all but 1 weaned children, and abnormal in all children who did not reach intestinal sufficiency (p<0.05). Conclusion: In children with IF and SBS fecal steatocrit and xylose absorption are markedly abnormal, and the latter correlates with residual intestinal length. Functional tests may help predicting weaning from PN. In NSBS children, only fecal steatocrit is impaired but is not associated with intestinal function.

Clinical Quiz

A 5-year-old child had a history of chronic diarrhea starting from the first month of life. His parents were related, and three other siblings were in good health. During the pregnancy, dilated bowel loops without polyhydramnios were demonstrated by ultrasound. After 37 weeks' gestation the baby was delivered by caesarean section with an Apgar score of 8/9 and a birth weight of 3200 g. At two weeks of age, meconium absence led to suspicion of Hirschsprung's disease. Thus, anal manometry and histochemical stains of rectal biopsy for acetylcholinesterase were performed showing normal results. Subsequently, in the following months and years, he developed chronic diarrhea (10–12 evacuations of liquid stool daily), without abdominal pain or rectal bleeding. Most bowel movements were associated with urgency or incontinence, and the child could not attend school because of diarrhea. By the age of 5 years, the family had moved to our city and the patient was re-evaluated. More recently, he had been admitted two times to an emergency department for severe dehydration due to gastroenteritis. Except for moderate abdominal distension and mild dehydration, the physical examination was normal. Laboratory tests showed normal erythrocyte sedimentation rate, and electrolytes, immunoglobulin, urea, creatinine, alkaline phosphatase, and albumin levels. Fecal quantitative fat measurement was not performed because of stool liquid consistency. Reducing substances were absent in feces and lactose hydrogen breath test, fecal alfa-1-antitrypsin, xylose absorption, and stool microbiologic tests were normal. Fecal osmotic gap was 64. Jejunal biopsy by endoscopy was performed. Endoscopic and histologic pictures were normal. X-ray evaluation of the intestine was also normal. Electron microscopy of jejunal biopsy specimen is shown in Figure 1.FIG. 1.: Electron microscopy of jejunal biopsy specimen.what is the etiology of diarrhea? A. Glucose and galactose malabsorption B. Congenital chloride diarrhea D. Primary bile acid malabsorption E. Intestinal epithelial dysplasia F. Small bowel overgrowth The electron microscopy of jejunal biopsy specimen was normal, thus excluding intestinal epithelial dysplasia. The patient was affected by congenital chloride diarrhea (B). In fact, fecal Cl−, Na+, and K+ concentrations were 180, 48, and 60 mmol/l respectively. Comment: The two diagnostic criteria of congenital chloride diarrhea (CCD) were fulfilled by the measurement of fecal electrolytes: Cl− content >90 mmol/L and > Na+ + K+ content (1). CCD is an inherited congenital defect of intestinal ion transport due to a mutation in the solute carrier family 26, member 3 (SLC26A3) gene at chromosomal location 7q31, close to the cystic fibrosis transmembrane conductance regulator (CFTR) gene (1,2). In CCD, the Cl−/HCO3− exchanger is absent or defective, causing severe intestinal Cl− malabsorption. Massive losses of Cl− in stools and the related defect in HCO3− secretion induce an acidification of intestinal lumen, which in turn further inhibits Na+ absorption through Na+/H+ exchanger activity. Thus, in the intestinal lumen high electrolyte content leads to osmotic diarrhea (2). Frequently the affected patients do not pass meconium and Hirschsprung's disease could be suspected. Our case is a sporadic form. Sporadic patients from different populations usually have two previously unrecognized unique mutations in their SLC26A3 alleles with no previous suspicion of CCD in the family, that suggests that mutations in the SLC26A3 gene are relatively frequent, and that the actual number of patients may be underestimated. The clinical picture and outcome of the disease could vary significantly from severe neonatal disease with fulminant hypoelectrolytemia and dehydration, to a relatively mild chronic form which remains undiagnosed for long time. Finally, early diagnosis is essential because hyponatremic episodes in infancy may result in mental and psychomotor impairment, and the chronic contraction of the intravascular space could induce renal impairment and gout. Many therapeutic strategies to reduce diarrhea, including cholestyramine and omeprazole, have proven to be ineffective (1,3). Therapy consists of oral supplements of sodium and potassium chloride. Ideally, the intestinal ion concentrations should be only slightly higher than in plasma, enabling net absorption of both electrolytes and water.

Influence of feeding different amounts of first colostrum on metabolic, endocrine, and health status and on growth performance in neonatal calves.

Colostrum intake is important for health and postnatal development of neonatal calves. We studied the effects of enhanced first colostrum feeding on growth, health status, and metabolic and endocrine traits in calves during their 1st wk of life. Calves of group CL (GrCL; n = 7) were fed colostrum of milkings 1 to 6 twice daily during the first 3 d of life, followed by milk replacer (MR) up to d 7. Calves of group CH (GrCH; n = 7) were fed colostrum of the first milking during the first 3 d and then colostrum (of the first milking) twice daily, which on d 4, 5, 6, and 7 was diluted with 25, 50, 75, and 75 parts of MR, respectively. Pre- and postprandial blood samples were taken on d 1, 2, 3, and 7 for the determination of various metabolic and endocrine traits, and on d 5 intestinal absorption capacity was measured using the xylose absorption test. Rectal temperatures and fecal scores were higher (P < .05) in GrCH than in GrCL. Plasma concentrations of total protein and albumin were higher (P < .05) on d 7, IgG on d 2 and 3, and urea on d 2, 3, and 7 in GrCH than in GrCL. Plasma concentrations of triglycerides were higher (P < .05) on d 2 and of phospholipids and cholesterol were higher (P < .01) on d 7 in GrCH than in GrCL. Plasma insulin and glucagon concentrations were higher (P < .05) in GrCH than in GrCL, whereas prolactin and growth hormone concentrations were higher (P < .05) in GrCL than in GrCH. Enhanced colostrum intake had no effects on xylose absorption on d 5. Higher plasma protein, urea, and lipid concentrations in GrCH partly mirrored higher protein and fat intake but additionally pointed to higher protein synthesis and lipid turnover.

Effect of malabsorption on nutritional status and resting energy expenditure in HIV-infected patients.

To assess the influence of malabsorption on nutritional status and energy expenditure in patients at different stages of HIV infection. Fifty HIV patients were classified into three groups: Group 1, HIV asymptomatic patients (n=17); Group 2, AIDS without opportunistic infection (n=16); Group 3, AIDS patients with active infection (n=17). Clinically-healthy subjects (n=19) were used as controls. Parameters measured were: anthropometry, body composition by tetrapolar bioelectrical impedance; resting energy expenditure (REE) by open-circuit indirect calorimetry; malabsoption by D-xylose absorption and triolein breath tests. Malabsorption (defined as abnormality of xylose and/or fat absorption test) was found in 34 (68%) of patients: 9 (53%) Group 1; 11 (69%) Group 2; 14 (82%) Group 3. Twenty-seven (54%) had sugar malabsorption and 21 (42%) fat malabsorption. A significant relationship was observed between malabsorption and weight loss. REE measured was significantly lower in malabsorptive patients than in non-malabsorptive patients and controls (6006.3+/-846.5 versus 6443.4 + 985.5 versus 6802.1+/-862.7 kJ/day, respectively; P < 0.05). The REE adjusted for fat-free mass was lower in malabsorptive than in non-malabsorptive patients and slightly higher than in controls, although the differences were not statistically significant. The results suggest that malabsorption is a frequent feature in HIV infection and is related to the HIV-related weight loss. Hypermetabolism is not a constant phenomenon in HIV infection since, in the presence of malabsorption, our patients show an appropriate metabolic response with a compensatory decrease in REE.

A study of malabsorption in pancreatic cancer.

The type, incidence, and severity of malabsorption in patients with pancreatic cancer were investigated. The following absorption tests were performed; pancreatic function diagnostant (PFD) test, measurement of serum carotene levels, and 5 g D-xylose absorption test. Rates of abnormality in the tests were 75.7% of 37, 54.2% of 48, and 54% of 50 patients with pancreatic cancer, respectively. In particular, a marked decrease of values in the xylose absorption test was characteristic and more often recognized in patients with carcinoma of the pancreas with occlusion of the superior mesenteric vein. The presence of malabsorption (disturbed transport through the portal vein), in addition to maldigestion of nutrients, is suggested to induce severe malnutrition in patients with pancreatic cancer.

Effects of processing methods for soybean meal used in milk replacers on intestinal xylose uptake and serum antibody to soybean antigen when fed to calves of various ages

Milk replacer containing either heated soybean meal (commercial soybean meal), extruded soybean meal, ethanol-extracted soybean meal, fermented soybean meal or skim milk powder replacer (SMPR) was fed for 20 d to preruminant calves from either 6, 18 or 30 d of age (age groups 1, 2 and 3, respectively). Effects of these diets on intestinal absorption efficiency (using the xylose absorption test), serum antibody titres to the soybean allergens, and concentrations of immunoglobulin isotypes (IgG1, IgG2, IgM and IgA) were determined. Peak plasma xylose concentrations were highest in calves receiving SMPR; these values were 45.8, 56.3 and 54.0 mg dL−1 for calves in the three age groups, respectively. Calves in age group 1, fed the extruded soybean meal replacer, had the lowest peak plasma xylose concentration (32.8 mg dL−1). Increases in peak plasma xylose concentration were not observed in calves in age groups 2 and 3 relative to those in age group 1 for the heated soybean meal replacer unlike those noted in calves receiving the other milk replacers. Antibodies to the soybean antigens glycinin and β-conglycinin were detected in serum of all the calves, but those receiving the heated or extruded soybean meal appeared to have higher serum titres than those receiving the ethanol extracted or the fermented soybean meal. Key words: Processed soybean meal, calves, milk replacers, xylose absorption, antibody titres, glycinin, β-conglycinin

A preliminary study on the effects of jejunocaecostomy in horses

SummaryIleal bypass by re‐section and jejunocaecostomy is a commonly performed surgery in horses, but has a reportedly lower success rate than other small intestinal surgeries. Lower success rates and chronic problems with diarrhoea, weight loss, protein, sugar and fat malabsorption, and Ca/P imbalance occur in man. The purpose of this study was to investigate changes in bodyweight, nutrient digestion and absorption, and serum and urine composition in horses before and 3, 12 and 27 weeks after ileal resection and side‐to‐side jejunocaecostomy. Four adult, healthy horses had a baseline CBC; serum creatinine, cholesterol, Na, K, Cl, Mg, Ca, P; digestion trial; xylose and fat absorption test; and serum total bile acid test. Digestion of dry matter, crude protein, total plant cell wall, cellulose, hemicellulose, and lignin; and urinary fractional excretions of Na, K, Cl, P and Ca were calculated. A one‐way analysis of variance compared baseline values to those obtained after caeliotomy and jejunocaecostomy (P&lt;0.05). Results include a significant decrease in serum calcium and total protein 27 weeks after surgery and a significant increase in FENa, FECa, and faecal metabolic organic matter 27 weeks after surgery. Bodyweight decreased significantly 3 weeks after surgery, but increased to greater than baseline values at 12 and 27 weeks after surgery. Vitamin A absorption curves were normal (sigmoid) before surgery and linear at all times after surgery. Serum cholesterol was significantly lower 27 weeks after surgery and a trend (P&lt;0.1) for a lower serum cholesterol was observed 3 weeks after surgery. No significant differences were apparent in serum electrolytes, faecal water, protein or fibre digestibility, xylose absorption or serum bile acid measurements. In summary, ileal bypass affected the horses minimally, but derangements of Ca metabolism, fat (fat soluble vitamin) absorption and microbial flora need further study.

The Bacterial Overgrowth Syndrome is Uncommon in Pernicious Anaemia: Results of a Follow-up Study

It is still uncertain whether upper gastrointestinal bacterial overgrowth in patients with permanent achlorhydria causes malassimilation in more than just the occasional case. In an attempt to clarify this, 19 patients with pernicious anaemia who had undergone a thorough investigation 6.6 y (mean) previously, were reinvestigated with clinical history, upper GI endoscopy including multiple duodenal biopsies, microbial cultures of gastric juice and duodenal mucosa, a xylose absorption test, and estimation of duodenal disaccharidase activity. At the present examination 58 per cent of the patients had mild abdominal symptoms. Mean Broca's index was 98.4 per cent. Eight of 19 patients had mild or moderate histological duodenitis. Faecal-type bacteria were found in gastric juice and/or duodenal mucosa in 10/19 cases. Xylose absorption was impaired in three patients. Low duodenal lactase activity was found in four patients, one of whom also showed low sucrase and maltase activities. No significant correlations were found among the variables: clinical symptoms, histological, microbiological and biochemical findings. In this consecutive group of patients with pernicious anaemia malassimilation of major clinical significance was rare despite frequent upper gastrointestinal colonisation with faecal-type bacteria. Keywords: Bacterial overgrowth; Disaccharidases; Malassimilation; Pernicious anaemia; Xylose absorption test.

Investigation of seemingly pathogen-negative diarrhoea in patients infected with HIV1.

Thirty three consecutive patients infected by human immunodeficiency virus type 1 (HIV1) with persistent diarrhoea which remained undiagnosed after microbiological examination of six stool samples and rectal histology were investigated for malabsorption. All had xylose and Schilling tests, distal duodenal biopsy, comprehensive barium studies, microbiological examination of six further stool samples, and repeat rectal histology. A microbiological or histological diagnosis of infection was made in 12 patients (multiple organisms in three). Cryptosporidia were identified on five occasions, cytomegalovirus on four, Giardia lamblia on two, and herpes simplex, Campylobacter jejuni, Salmonella enteritidis, and Entamoeba histolytica once each. No organism was found when weight loss was less than 5 kg or stool volume less than 400 ml/day (n = 9). Pathogens were identified in nine of 13 patients (69%) with weight loss greater than 10 kg and stool volume more than 800 ml/day. Barium studies were normal except for ileal flocculation in two patients with cryptosporidiosis. Evidence for malabsorption existed in 24 patients--impaired xylose absorption (n = 19) and abnormal Schilling test (n = 21). Of the patients with a severely abnormal Schilling test, a pathogen was identified in 11 (79%) (including all five with cryptosporidia, and two of the patients with only moderate diarrhoea and weight loss). A simple scoring system based on degree of weight loss and Schilling test result may help to identify the HIV positive patient with seemingly pathogen-negative diarrhoea in whom further investigations are likely to show a specific cause.