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Effect of Macronutrient Type and Gastrointestinal Release Site on PYY Response in Normal Healthy Subjects.
Mangan, AM, Al Najim, W, McNamara, N, Martin, WP, Antanaitis, A, Bleiel, SB, Kent, RM, le Roux, CW, Docherty, NG
The Journal of clinical endocrinology and metabolism. 2019;(9):3661-3669
Abstract
BACKGROUND AND AIMS Enteroendocrine L cells release satiety inducing hormones in response to stimulation by luminal macronutrients. We sought to profile the differential effect of macronutrient type and site of release on circulating concentrations of the L cell-derived enteroendocrine hormone peptide tyrosine tyrosine (amino acids 1 to 36) (PYY). MATERIALS AND METHODS Eight healthy volunteers were recruited to a randomized, double-blinded, six-way crossover study. At each visit, the participants consumed a 500-kcal drink containing carbohydrate, protein, or fat in either gastric or small intestinal release formulations. Plasma PYY concentrations and hunger ratings were assessed for 3 hours after consumption of the test drink. The food intake was recorded thereafter at an ad libitum lunch. RESULTS Microcapsular formulations targeting the distal small intestinal delivery of fat, but not carbohydrate or protein, markedly enhance PYY release relative to macronutrient delivery in gastric release formulations. Food intake at an ad libitum meal was lowest after consumption of the formulation releasing fat at the distal small intestine. CONCLUSION Targeting of fat to the distal small intestine in delayed release microcapsules enhanced PYY release and was associated with reductions in food intake.
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Ingestion bioaccessibility of indoor dust-bound PAHs: Inclusion of a sorption sink to simulate passive transfer across the small intestine.
Gao, P, Liu, D, Guo, L, He, C, Lin, N, Xing, Y, Yao, C, Wu, B, Zheng, Z, Wang, Y, et al
The Science of the total environment. 2019;:1546-1554
Abstract
In this study, we investigated the levels of 12 priority polycyclic aromatic hydrocarbons (PAH12) pollutants, bioaccessible PAH12, and sorption sink for PAH12 by a silicone sheet of indoor dust samples, which were collected from teachers' offices (n = 17), students' offices (n = 17), laboratory (n = 11), and experimental center (n = 9), using an in vitro digestive model. In PAH12, bioaccessible PAH12, and sorption sink PAH12, benzo[b]fluoranthene (BbF), phenanthrenes (Phe), and fluoranthene (FLA) were labeled respectively the most significant PAHs (6.61 ± 4.42 μg/g, 0.16 ± 0.11 μg/g, and 0.08 ± 0.06 μg/g) after indoor dust ingestion, whereas the proportions of anthracene (Ant), benzo(g,h,i)perylene (BghiP), and BghiP (0.34 ± 0.17, 0.03 ± 0.03 and 0.01 ± 0.01 μg/g) were low. Based on benzo[a]pyrene- equivalent carcinogenic concentrations, the mean daily exposure of bioaccessible PAH12 and sorption sink for PAH12 by indoor dust ingestion was 4.07 × 10-3 ± 1.73 × 10-3 and 3.23 × 10-3 ± 1.36 × 10-3 μg/day in the experimental center; 4.01 × 10-3 ± 2.05 × 10-3 and 1.46 × 10-3 ± 6.72 × 10-4 μg/day in students' offices; 8.25 × 10-4 ± 2.33 × 10-4 and 5.15 × 10-4 ± 1.37 × 10-4 μg/day in laboratory; and 7.05 × 10-4 ± 4.12 × 10-5 and 2.82 × 10-4 ± 4.36 × 10-5 μg/day in teachers' offices, respectively. Our results indicated that the passive transfer fraction of PAH12 (44.07%-67.36% in this case) is therefore large and needs to be considered in exposure and risk assessments.
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The role of small intestinal bacterial overgrowth in cystic fibrosis: a randomized case-controlled clinical trial with rifaximin.
Furnari, M, De Alessandri, A, Cresta, F, Haupt, M, Bassi, M, Calvi, A, Haupt, R, Bodini, G, Ahmed, I, Bagnasco, F, et al
Journal of gastroenterology. 2019;(3):261-270
Abstract
BACKGROUND Scientific literature shows a high prevalence of Small Intestinal Bacterial Overgrowth (SIBO) in patients with Cystic Fibrosis (CF). The role of SIBO in nutritional status and gastrointestinal symptoms in CF is not known. Our aim was to study epidemiology and clinical impact of SIBO while assessing the efficacy of rifaximin in eradicating SIBO in CF patients. METHODS Symptoms questionnaire and Glucose Breath Test (GBT) were given to 79 CF patients (median age 19.6 years; 9.2-36.9). Subjects with a positive GBT were enrolled in a randomized controlled trial and received rifaximin 1200 mg for 14 days or no treatment. Questionnaire and GBT were repeated 1 month after the end of treatment or 45 days after the first negative GBT. RESULTS Out of 79 patients, 25 were affected by SIBO (31.6%) with a significant correlation with lower BMI, SDS-BMI (p < 0.05) and serum albumin levels (p < 0.05), independently from pancreas insufficiency. Twenty-three patients took part in the randomized trial, 13 patients (56.5%) in rifaximin group and 10 patients (43.5%) in control group. Eradication rate of SIBO was 9/10 (90%) in rifaximin group and 2/6 (33.3%) in control group (p < 0.05). In the rifaximin group, gastrointestinal symptom improvement was observed in 4/5 patients aged ≤ 14 years and in 0/5 patients aged > 14 years (p < 0.05); in 2/6 patients in the control group. CONCLUSIONS CF patients show a high prevalence of SIBO, related to a poorer nutritional status. Rifaximin therapy is well tolerated and the results are promising in terms of efficacy in eradicating small intestinal bacterial overgrowth in CF.
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4.
Microbial Profiles of Cirrhosis in the Human Small Intestine.
Dong, TS, Jacobs, JP, Hussain, SK
Current gastroenterology reports. 2019;(10):50
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize the recent literature on associations of small intestinal microbial and bile acid profiles with liver cirrhosis and its complications. RECENT FINDINGS Recent studies into the duodenal microbiome of patients with cirrhosis have linked the microbiome to certain etiologies of chronic liver disease as well as complications of cirrhosis. In particular, microbial differences in the duodenum of patients with cirrhosis have been linked to the presence of hepatic encephalopathy and varices. While the fecal microbiome of patients with liver cirrhosis is well characterized, the small intestinal microbiome of cirrhotic patients is an active area of research. This review focuses on the current understanding of the small intestinal microbiome in human cirrhosis as well as future directions of the field.
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Detecting the effects of a standardized meal challenge on small bowel motility with MRI in prepared and unprepared bowel.
de Jonge, CS, Menys, A, van Rijn, KL, Bredenoord, AJ, Nederveen, AJ, Stoker, J
Neurogastroenterology and motility. 2019;(2):e13506
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Abstract
OBJECTIVE MRI is increasingly used to evaluate small bowel contractility. The objective of this study was to validate a clinically practical stimulation test (300-kcal meal) for small bowel motility. METHODS Thirty-one healthy subjects underwent dynamic MRI to capture global small bowel motility after ±10h fasting, of which 15 underwent bowel preparation consisting of 1 L 2.5% mannitol solution and 16 did not. Each subject underwent (1) a baseline motility scan (2) a food challenge (3) a post-challenge scan, and (4) second post-challenge scan (after ±20 minutes). This protocol was repeated within 2 weeks. Motility was quantified using a validated motility assessment technique. KEY RESULTS Motility in prepared subjects at baseline was significantly higher than motility in unprepared subjects (0.36 AU vs 0.18 AU, P < 0.001). In the prepared group, the food challenge produced an 8% increase in motility (P = 0.33) while in the unprepared subjects a significant increase of 30% was observed (P < 0.001). Responses to food remained insignificant (P = 0.21) and significant (P = 0.003), for the prepared and unprepared subjects, respectively, ±20 minutes post food challenge. These results were confirmed in the repeated scan session. CONCLUSION & INFERENCES A significant response to a 300-kcal meal was measured within 10 minutes in unprepared bowel, supporting the clinical use of this challenge to provoke and assess motility changes. A caloric challenge did not produce an observable increase in motility in mannitol prepared subjects.
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Probiotic survival during a multi-layered tablet development as tested in a dynamic, computer-controlled in vitro model of the stomach and small intestine (TIM-1).
Venema, K, Verhoeven, J, Verbruggen, S, Espinosa, L, Courau, S
Letters in applied microbiology. 2019;(5):325-332
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Abstract
The aim of the research was to develop a galenical formulation for the combination of the three probiotic strains Lactobacillus gasseri PA 16/8, Bifidobacterium longum SP 07/3 and Bifidobacterium bifidum MF 20/5 that would lead to the presence of a high amount of viable cells in the small intestine, the presumed site of action of these strains. This was tested in a validated, dynamic in vitro model of the stomach and small intestine (TIM-1), simulating human adults after intake of a meal. Experiments were performed both in the gastric compartment of the model, as well as in the complete system (stomach + small intestine). Survival of the strains in an unformulated probiotic powder after transit through the gastric compartment was 5·3% for the bifidobacteria and 1% for L. gasseri. After transit through the complete gastrointestinal tract, this dropped to 2% for bifidobacteria and 0·1% for Lactobacillus. After several rounds of optimization, an enteric-coated tablet was developed that increased the delivery of viable cells reaching the small intestine to 72% (gastric survival) for bifidobacteria, and 53% (gastric) for L. gasseri. Also survival in the small intestine increased by about an order of magnitude. The final galenical formulation was tested in two applications: adults and elderly, both of which have their own physiological parameters. These experiments corroborated the results obtained in the development phase of the project. In conclusion, the developed enteric coating led to a 20- to 40-fold increase in the delivery of viable cells to the small intestine. SIGNIFICANCE AND IMPACT OF THE STUDY Predictive GI in vitro models are very helpful and reliable tools for the development of new galenical formula containing probiotics, and in the current example helped to deliver >10-fold higher numbers of viable cells to the small intestine, presumably leading to improved functionality of the strains.
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In vitro Gastrointestinal Models for Prebiotic Carbohydrates: A Critical Review.
Hernandez-Hernandez, O
Current pharmaceutical design. 2019;(32):3478-3483
Abstract
BACKGROUND In the last decade, various consortia and companies have created standardized digestion protocols and gastrointestinal simulators, such as the protocol proposed by the INFOGEST Consortium, the simulator SHIME, the simulator simgi®, the TIM, etc. Most of them claim to simulate the entire human gastrointestinal tract. However, few results have been reported on the use of these systems with potential prebiotic carbohydrates. METHODS This critical review addresses the existing data on the analysis of prebiotic carbohydrates by different in vitro gastrointestinal simulators, the lack of parameters that could affect the results, and recommendations for their enhancement. RESULTS According to the reviewed data, there is a lack of a realistic approximation of the small intestinal conditions, mainly because of the absence of hydrolytic conditions, such as the presence of small intestinal brush border carbohydrases that can affect the digestibility of different carbohydrates, including prebiotics. CONCLUSION There is a necessity to standardize and enhance the small intestine simulators to study the in vitro digestibility of carbohydrates.
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Accelerated Colorectal Polyposis in an Immunosuppressed Patient With a Small Bowel Transplant Treated With Teduglutide: Case Report and Review of Literature.
George, AT, Leong, M, Shokouh-Amiri, M, Benedetti, E, Carroll, RE
Clinical colorectal cancer. 2019;(3):e275-e279
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Is SIBO A Real Condition?
Ruscio, M
Alternative therapies in health and medicine. 2019;(5):30-38
Abstract
CONTEXT Small intestinal bacterial overgrowth (SIBO) has gained popularity on the internet in addition to certain clinical and research circles. This interest has expanded awareness of important new dietary, nutraceutical, and pharmaceutical treatments in addition to laboratory evaluation assessment options. Concomitantly, there appears a loss of parsimony regarding how to use these tools resulting in an untenable degree of testing and treatment for this condition. OBJECTIVES A balanced review of the data regarding SIBO testing, treatment, and management with the goal of establishing non-biased best practices. DESIGN Non-systematic review. RESULTS The results for the review fall into two categories. Ineffective Action: Treat only SIBO labs; Treat for SIBO if no symptoms are exhibited; Recommending eating or avoiding foods because they might be good or bad for SIBO; Recommending treatments that are non-validated. Effective Action: Use SIBO breath results, in addition to history and current symptoms, to determine the best treatment; Find foods that work for patients based on dietary elimination and reintroduction; Apply validated treatment for SIBO and IBS in a logical 'step-up' like treatment approach. CONCLUSIONS Testing and treating for SIBO can offer patients clinically significant relief. However, these tests and treatments must be applied with circumspection to prevent over-testing, over-treatment, squandering resources, or creating a fear around certain foods.
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Magnetic resonance enterography.
Gatti, M, Allois, L, Carisio, A, Dianzani, C, Garcia Martinez, M, Ruggirello, I, Varello, S, Darvizeh, F, Faletti, R
Minerva gastroenterologica e dietologica. 2019;(4):319-334
Abstract
Crohn's disease is a condition of chronic inflammation that may involve any part of the gastrointestinal tract, although it more frequently affects the terminal ileum. Longstanding inflammation may lead to several bowel complications including obstruction, stricture, fistula and abscesses which often necessitate surgery. Cross-sectional imaging methods such as computed tomography and magnetic resonance imaging are being utilized more frequently to assess mural and extramural inflammatory bowel disease manifestations. Magnetic resonance enterography (MRE) for assessment of small bowel is optimal because of absence of ionizing radiation, better soft tissue contrast, development of motion-free sequences and high resolution images. A typical protocol includes pre and postcontrast sequences utilizing an enteric contrast agent for adequate bowel distention and an antiperistaltic agent. Overall, MRE allows the evaluation of disease activity, extraenteric complication and response to therapy with a great impact on patient management. In this review we discuss the features of MRE from patient's preparation and exam protocol to pathological findings.