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Liptak P, Visnovcova Z, Ferencova N, Duricek M, Banovcin P, Tonhajzerova I. Abnormal Autonomic Nervous Regulation in Patients with Globus Pharyngeus. Dig Dis Sci 2024; 69:4405-4415. [PMID: 39487381 PMCID: PMC11602782 DOI: 10.1007/s10620-024-08694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 10/12/2024] [Indexed: 11/04/2024]
Abstract
BACKGROUND Globus pharyngeus could be described as a benign sensation of lump or foreign object in the throat. The etiology of the globus as a solitary syndrome is still unknown, but it is proposed that stress could have an important role in symptom emergence. AIMS To evaluate the autonomic nervous regulation in patients with globus compared to healthy controls in reaction to stress. METHODS Patients included in the study were diagnosed based on ROME IV criteria for Disorders of Gut Brain Interaction. Besides globus, the patients did not suffer any other substantial medical condition. As a control group, measurement of healthy volunteers was performed. Both groups underwent the same stress protocol assessment in the same laboratory settings. The protocol consist of two types of stressors: cold pressor test and mental arithmetic test to test different types of autonomic reactivity. RESULTS Baroreflex sensitivity was significantly decreased in patients compared to controls in all phases of the protocol. Low-frequency band of systolic blood pressure variability was significantly increased during both stress phases in patients compared to controls. High-frequency band of heart rate variability was significantly decreased in patients compared to controls during the both of the stress phases. CONCLUSION The results of this study shows discrete abnormalities in complex autonomic reflex control which are predominantly manifested in response to stressful stimuli indicating altered neurocardiac regulation as a reaction to stress associated with globus pharynegus. This fact could have an important role in the personalized management of globus patients such as biofeedback.
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Affiliation(s)
- Peter Liptak
- Clinic of Internal Medicine-Gastroenterology, University Hospital Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 03601, Martin, Slovakia
| | - Zuzana Visnovcova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Nikola Ferencova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
| | - Martin Duricek
- Clinic of Internal Medicine-Gastroenterology, University Hospital Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 03601, Martin, Slovakia
| | - Peter Banovcin
- Clinic of Internal Medicine-Gastroenterology, University Hospital Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 03601, Martin, Slovakia.
| | - Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Bratislava, Slovakia
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Chang JY, Jung HK, Moon CM, Kim SE, Shim KN, Jung SA, Min SK. Development of functional gastrointestinal disorder symptoms following laparoscopic cholecystectomy: a prospective cohort study. Front Med (Lausanne) 2023; 10:1248465. [PMID: 37869171 PMCID: PMC10587431 DOI: 10.3389/fmed.2023.1248465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Background The casual relationship between the role of cholecystectomy and functional gastrointestinal disorders (FGIDs) are a controversial clinical challenge. This study aimed to investigate: (1) the overlap of FGIDs before cholecystectomy and its long-term outcome after surgery in patients with symptomatic cholelithiasis, and (2) the incidence of new-onset FGIDs after cholecystectomy. Methods Patients with symptomatic gallstone disease who underwent elective, laparoscopic cholecystectomy were prospectively enrolled. Healthy populations who underwent medical check-ups were selected as age- and sex-matched controls. Questionnaires regarding sociodemographic characteristics, gastrointestinal symptoms and a somatization symptom checklist (SSC) were completed at baseline and 12 months thereafter. Results The prevalence of all FGID symptoms before cholecystectomy were significantly higher in the group of patients with symptomatic cholecystolithiasis compared to the control group. In cholecystectomy group, the preoperative FGID symptoms improved after surgery, except for chronic diarrhea. Compared to the controls, the new-onset FGIDs, including functional dyspepsia (14.8% vs. 6.9%; p = 0.040), functional diarrhea (6.6% vs. 0.2%; p < 0.001), and chronic abdominal pain (11.9% vs. 4.4%; p = 0.024), were more common at 1 year after cholecystectomy. Somatization was independent predictors of new-onset dyspepsia and abdominal pain, while newly occurring diarrhea was not realted to somatization. Conclusion Overlap of FGIDs was common in patients with symptomatic cholelithiasis before surgery and at follow-up 1 year after cholecystectomy. Furthermore, new-onset FGIDs could be occurred after cholecystectomy. Therefore, a delicate diagnostic approaches and appropriate treatments about co-existent FGIDs should be given in patients with cholelithiasis before and after cholecystectomy.
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Affiliation(s)
- Ji Young Chang
- Department of Health Promotion Medicine, Ewha Womans University Seoul Hostpial, Seoul, Republic of Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chang Mo Moon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seog Ki Min
- Department of Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Weng RX, Wei YX, Li YC, Xu X, Zhuang JB, Xu GY, Li R. Folic acid attenuates chronic visceral pain by reducing clostridiales abundance and hydrogen sulfide production. Mol Pain 2023; 19:17448069221149834. [PMID: 36550612 PMCID: PMC9830571 DOI: 10.1177/17448069221149834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Irritable bowel syndrome (IBS) related chronic visceral pain affects 20% of people worldwide. The treatment options are very limited. Although the scholarly reviews have appraised the potential effects of the intestinal microbiota on intestinal motility and sensation, the exact mechanism of intestinal microbiota in IBS-like chronic visceral pain remains largely unclear. The purpose of this study is to investigate whether Folic Acid (FA) attenuated visceral pain and its possible mechanisms. Chronic visceral hyperalgesia was induced in rats by neonatal colonic inflammation (NCI). 16S rDNA analysis of fecal samples from human subjects and rats was performed. Patch clamp recording was used to determine synaptic transmission of colonic-related spinal dorsal horn. Alpha diversity of intestinal flora was increased in patients with IBS, as well as the obviously increased abundance of Clostridiales order (a main bacteria producing hydrogen sulfide). The hydrogen sulfide content was positive correlation with visceral pain score in patients with IBS. Consistently, NCI increased Clostridiales frequency and hydrogen sulfide content in feces of adult rats. Notably, the concentration of FA was markedly decreased in peripheral blood of IBS patients compared with non-IBS human subjects. FA supplement alleviated chronic visceral pain and normalized the Clostridiales frequency in NCI rats. In addition, FA supplement significantly reduced the frequency of sEPSCs of neurons in the spinal dorsal horn of NCI rats. Folic Acid treatment attenuated chronic visceral pain of NCI rats through reducing hydrogen sulfide production from Clostridiales in intestine.
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Affiliation(s)
- Rui-Xia Weng
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, P. R. China,Institute of Neuroscience, Soochow University, Suzhou, P. R. China,Department of Gastroenterology, The People’s Hospital of Suzhou New District, Suzhou, P. R. China
| | - Ying-Xue Wei
- Institute of Neuroscience, Soochow University, Suzhou, P. R. China
| | - Yong-Chang Li
- Institute of Neuroscience, Soochow University, Suzhou, P. R. China
| | - Xue Xu
- Department of Gastroenterology, The People’s Hospital of Suzhou New District, Suzhou, P. R. China
| | - Jian-Bo Zhuang
- Department of Gastroenterology, The People’s Hospital of Suzhou New District, Suzhou, P. R. China
| | - Guang-Yin Xu
- Institute of Neuroscience, Soochow University, Suzhou, P. R. China,Guang-Yin Xu, Center for Translational Pain Medicine, Institute of Neuroscience, Soochow University, 199 Renai Rd, Suzhou 215123, P. R. China.
| | - Rui Li
- Guang-Yin Xu, Center for Translational Pain Medicine, Institute of Neuroscience, Soochow University, 199 Renai Rd, Suzhou 215123, P. R. China.
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Ma N, Chen X, Johnston LJ, Ma X. Gut microbiota-stem cell niche crosstalk: A new territory for maintaining intestinal homeostasis. IMETA 2022; 1:e54. [PMID: 38867904 PMCID: PMC10989768 DOI: 10.1002/imt2.54] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/04/2022] [Accepted: 08/14/2022] [Indexed: 06/14/2024]
Abstract
Intestinal epithelium undergoes rapid cellular turnover, relying on the local niche, to support intestinal stem cells (ISCs) function and self-renewal. Research into the association between ISCs and disease continues to expand at a rapid rate. However, the detailed interaction of ISCs and gut microbes remains to be elucidated. Thus, this review witnessed major advances in the crosstalk between ISCs and gut microbes, delivering key insights into (1) construction of ISC niche and molecular mechanism of how to jointly govern epithelial homeostasis and protect against intestinal diseases with the participation of Wnt, bone morphogenetic protein, and Notch; (2) differentiation fate of ISCs affect the gut microbiota. Meanwhile, the presence of intestinal microbes also regulates ISC function; (3) microbiota regulation on ISCs by Wnt and Notch signals through pattern recognition receptors; (4) how do specific microbiota-related postbiotics influence ISCs to maintain intestinal epithelial regeneration and homeostasis that provide insights into a promising alternative therapeutic method for intestinal diseases. Considering the detailed interaction is still unclear, it is necessary to further explore the regulatory role of gut microbiota on ISCs to utilize microbes to alleviate gut disorders. Furthermore, these major advances collectively drive us ever closer to breakthroughs in regenerative medicine and cancer treatment by microbial transplantation in the clinic.
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Affiliation(s)
- Ning Ma
- State Key Laboratory of Animal Nutrition, College of Animal Science and TechnologyChina Agricultural UniversityBeijingChina
| | - Xiyue Chen
- State Key Laboratory of Animal Nutrition, College of Animal Science and TechnologyChina Agricultural UniversityBeijingChina
| | - Lee J. Johnston
- West Central Research & Outreach CenterUniversity of MinnesotaMorrisMinnesotaUSA
| | - Xi Ma
- State Key Laboratory of Animal Nutrition, College of Animal Science and TechnologyChina Agricultural UniversityBeijingChina
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Skills or Pills: Randomized Trial Comparing Hypnotherapy to Medical Treatment in Children With Functional Nausea. Clin Gastroenterol Hepatol 2022; 20:1847-1856.e6. [PMID: 34718171 DOI: 10.1016/j.cgh.2021.10.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The potential effectiveness of gut-directed hypnotherapy (HT) is unknown for pediatric chronic nausea. This randomized controlled trial compared HT with standard medical treatment (SMT). METHODS One hundred children (ages, 8-18 y) with chronic nausea and fulfilling functional nausea (FN) or functional dyspepsia (FD) criteria were allocated randomly (1:1) to HT or SMT, with a 3-month intervention period. Outcomes were assessed at baseline, at the halfway point, after treatment, and at the 6- and 12-month follow-up evaluation. Children scored nausea symptoms in a 7-day diary. The primary outcome was treatment success, defined as a reduction in nausea of 50% or more, at the 12-month follow-up evaluation. Secondary outcomes included adequate relief of nausea. RESULTS After treatment and at the 6-month follow-up evaluation, there was a trend toward higher treatment success in the HT group compared with the SMT group (45% vs 26%, P = .052; and 57% vs 40%, P = .099, respectively). At 12 months, treatment success was similar in both groups (60% in the HT group and 55% in the SMT group; P = .667). In the FN group, significantly higher success rates were found for HT, but no differences were found in patients with FD. Adequate relief was significantly higher in the HT group than in the SMT group at the 6-month follow-up evaluation (children: 81% vs 55%, P = .014; parents: 79% vs 53%; P = .016), but not at the 12-month follow-up evaluation. CONCLUSIONS HT and SMT were effective in reducing nausea symptoms in children with FN and FD. In children with FN, HT was more effective than SMT during and after the first 6 months of treatment. Therefore, HT and SMT, applied separately or in combination, should be offered to children with FN as a treatment option (Clinical trials registration number: NTR5814).
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Fernandez J, Patel S, Hopson P, Safder S. Prospective Evaluation of Transanal Irrigation With a Validated Pediatric Neurogenic Bowel Dysfunction Scoring System. J Pediatr Gastroenterol Nutr 2022; 74:454-459. [PMID: 35045561 DOI: 10.1097/mpg.0000000000003383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To evaluate the efficacy of transanal irrigation (TAI) in pediatric patients with neurogenic bowel dysfunction (NBD) who were treatment naïve to catheter-based TAI using Peristeen device (Coloplast). METHODS Prospective recruitment of patients with NBD who were unsatisfied with their bowel regimen or had no bowel regimen in place, were assessed using the neurogenic bowel dysfunction score (NBDS) before initiating treatment (Time 0) with Peristeen. NBDS scores were reassessed twice: within the first 6 months (Time 1) of initiation of Peristeen and again after greater than 6 months of usage with Peristeen (Time 2). RESULTS Over a 26-month period, 104 patients with NBD were enrolled. Mean age was 10.6 years ± 4.7 (range 3-18 years). The NBDS at Time 1 had an average reduction of 14 points from the original score. A similar trajectory was seen at Time 2, with an average reduction of 13 points from original score. There was a statistically significant decrease of 14 points, P < 0.001 at Time 1 and this response was sustained at Time 2 with a statistically significant decrease in scores from initiation by 13 points, P < 0.001. Improved patient satisfaction and quality of life with Peristeen was seen at Time 1 and Time 2. CONCLUSION Our results suggest that Peristeen can improve quality of life in pediatric patients with NBD. Significant improvement in NBDS occurred in our pediatric patients with NBD when initiated on Peristeen. Lower scores were seen at both Time 1 and Time 2, which indicated an improvement in their overall NBD.
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Affiliation(s)
| | - Samit Patel
- Pediatric Gastroenterology and Nutrition of Tampa Bay, Tampa, FL
| | - Puanani Hopson
- Mayo Clinic, Division of Pediatric Gastroenterology and Hepatology, Rochester, MN
| | - Shaista Safder
- Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
- University of Florida, Gainesville, FL
- UCF College of Medicine, Orlando, FL
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Bor S, Lehert P, Chalbaud A, Tack J. Efficacy of pinaverium bromide in the treatment of irritable bowel syndrome: a systematic review and meta-analysis. Therap Adv Gastroenterol 2021; 14:17562848211033740. [PMID: 34539813 PMCID: PMC8447090 DOI: 10.1177/17562848211033740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/30/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Spasmolytic agents are an attractive first line treatment option for irritable bowel syndrome (IBS). Pinaverium bromide (pinaverium) has antispasmodic effects on gastrointestinal smooth muscle and can relieve major IBS symptoms, but an up-to-date meta-analysis comparing the efficacy of pinaverium with placebo is lacking. The aim is to perform a systematic review and meta-analysis to assess the efficacy of pinaverium compared with placebo for IBS treatment. METHODS All placebo-controlled trials evaluating pinaverium for IBS treatment were included, up to October 2019. Treatment efficacy was evaluated by overall patient IBS symptoms. Individual symptoms were also evaluated. The effect of pinaverium versus placebo was expressed as standardized mean difference (SMD) and risk ratio (RR). Odds ratio (OR) and number needed to treat (NNT) were also calculated. RESULTS Eight studies were included for analysis. Pinaverium treatment had a beneficial effect on overall IBS symptom relief with a positive SMD of 0.64 [95% confidence interval (CI) 0.45-0.82, p < 0.0001] and a positive RR of 1.75 (1.26-2.43, p < 0.0008). No significant difference was found by publication year, gender, age, methodological quality score (MQS), or sample size. No publication bias was detected. OR was 3.43 (2.00-5.88, p < 0.0001), and NNT was 4. Pinaverium also demonstrated a beneficial treatment effect for abdominal pain, stool change, and bloating improvement or resolution. CONCLUSION Pinaverium is superior to placebo for the treatment of IBS symptoms, irrespective of patient age or gender, study publication year, sample size, or MQS. The NNT in this meta-analysis is amongst the lowest for studies and meta-analyses of antispasmodics versus placebo in IBS.
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Affiliation(s)
- Serhat Bor
- Division of Gastroenterology, Department of
Medicine, Ege University School of Medicine, Ege Üniversitesi Tıp Fakültesi
Gastroenteroloji Bilim Dali, Bornova Izmir, 35100, Turkey
| | - Philippe Lehert
- Statistics Department, Faculty of Economics,
Louvain University, Louvain, Belgium Faculty of Medicine, Department of
Community Health, University of Melbourne, Australia
| | | | - Jan Tack
- TARGID, University of Leuven, Leuven,
Belgium
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Impact of food-derived bioactive peptides on gut function and health. Food Res Int 2021; 147:110485. [PMID: 34399481 DOI: 10.1016/j.foodres.2021.110485] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022]
Abstract
The gastrointestinal tract (GIT) is the largest interface between our body and the environment. It is an organ system extending from the mouth to the anus and functions for food intake, digestion, transport and absorption of nutrients, meanwhile providing protection from environmental factors, like toxins, antigens, and pathogens. Diet is one of the leading factors modulating the function of the GIT. Bioactive peptides presenting naturally in food or derived from food proteins during digestion or processing have been revealed multifunctional in diverse biological processes, including maintaining gut health and function. This review summarizes the available evidence regarding the effects of food-derived bioactive peptides on gut function and health. Findings and insights from studies based on in vitro and animal models are discussed. The gastrointestinal mucosa maintains a delicate balance between immune tolerance to nutrients and harmful components, which is crucial for the digestive system's normal functions. Dietary bioactive peptides positively impact gastrointestinal homeostasis by modulating the barrier function, immune responses, and gut microbiota. However, there is limited clinical evidence on the safety and efficacy of bioactive peptides, much less on the applications of dietary peptides for the treatment or prevention of diseases related to the GIT. Further study is warranted to establish the applications of bioactive peptides in regulating gut health and function.
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9
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Abnormalities in the thalamo-cortical network in patients with functional constipation. Brain Imaging Behav 2021; 15:630-642. [PMID: 32314199 DOI: 10.1007/s11682-020-00273-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Functional constipation (FCon) is a common functional gastrointestinal disorder (FGID); neuroimaging studies have shown brain functional abnormalities in thalamo-cortical regions in patients with FGID. However, association between FCon and topological characteristics of brain networks remains largely unknown. We employed resting-state functional magnetic resonance imaging (RS-fMRI) and graph theory approach to investigate functional brain topological organization in 42 patients with FCon and 41 healthy controls (HC) from perspectives of global, regional and modular levels. Results showed patients with FCon had a significantly lower normalized clustering coefficient and small-worldness, implying decreased brain functional connectivity. Regions showed altered nodal degree and efficiency mainly located in the thalamus, rostral anterior cingulate cortex (rACC), and supplementary motor area (SMA), which are involved in somatic/sensory, emotional processing and motor-control. For the modular analysis, thalamus, rACC and SMA had an aberrant within-module nodal degree and nodal efficiency, and thalamus-related network exhibited abnormal interaction with the limbic network (amygdala and hippocampal gyrus). Nodal degree in the thalamus was negatively correlated with difficulty of defecation, and nodal degree in the rACC was negatively correlated with sensation of incomplete evacuation. These findings indicated that FCon was associated with abnormalities in the thalamo-cortical network.
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Yarullina DR, Shafigullin MU, Sakulin KA, Arzamastseva AA, Shaidullov IF, Markelova MI, Grigoryeva TV, Karpukhin OY, Sitdikova GF. Characterization of gut contractility and microbiota in patients with severe chronic constipation. PLoS One 2020; 15:e0235985. [PMID: 32678865 PMCID: PMC7367488 DOI: 10.1371/journal.pone.0235985] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic constipation (CC) is one of the most common gastrointestinal disorders worldwide. Its pathogenesis, however, remains largely unclear. The purpose of the present work was to gain an insight into the role of contractility and microbiota in the etiology of CC. To this end, we studied spontaneous and evoked contractile activity of descending colon segments from patients that have undergone surgery for refractory forms of CC. The juxta-mucosal microbiota of these colon samples were characterized with culture-based and 16S rRNA sequencing techniques. In patients with CC the spontaneous colonic motility remained unchanged compared to the control group without dysfunction of intestinal motility. Moreover, contractions induced by potassium chloride and carbachol were increased in both circular and longitudinal colonic muscle strips, thus indicating preservation of contractile apparatus and increased sensitivity to cholinergic nerve stimulation in the constipated intestine. In the test group, the gut microbiota composition was assessed as being typically human, with four dominant bacterial phyla, namely Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria, as well as usual representation of the most prevalent gut bacterial genera. Yet, significant inter-individual differences were revealed. The phylogenetic diversity of gut microbiota was not affected by age, sex, or colonic anatomy (dolichocolon, megacolon). The abundance of butyrate-producing genera Roseburia, Coprococcus, and Faecalibacterium was low, whereas conventional probiotic genera Lactobacillus and Bifidobacteria were not decreased in the gut microbiomes of the constipated patients. As evidenced by our study, specific microbial biomarkers for constipation state are absent. The results point to a probable role played by the overall gut microbiota at the functional level. To our knowledge, this is the first comprehensive characterization of CC pathogenesis, finding lack of disruption of motor activity of colonic smooth muscle cells and insufficiency of particular members of gut microbiota usually implicated in CC.
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Affiliation(s)
- Dina R. Yarullina
- Department of Microbiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
- * E-mail: ,
| | - Marat U. Shafigullin
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
| | - Kirill A. Sakulin
- Department of Surgical Diseases, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation
| | - Anastasiia A. Arzamastseva
- Department of Microbiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
| | - Ilnar F. Shaidullov
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
| | - Maria I. Markelova
- "Omics Technologies" Laboratory, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
| | - Tatiana V. Grigoryeva
- "Omics Technologies" Laboratory, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
| | - Oleg Yu. Karpukhin
- Department of Surgical Diseases, Kazan State Medical University, Kazan, Republic of Tatarstan, Russian Federation
| | - Guzel F. Sitdikova
- Department of Human and Animal Physiology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, Russian Federation
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Shavandi A, Saeedi P, Gérard P, Jalalvandi E, Cannella D, Bekhit AED. The role of microbiota in tissue repair and regeneration. J Tissue Eng Regen Med 2020; 14:539-555. [PMID: 31845514 DOI: 10.1002/term.3009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/15/2019] [Accepted: 10/28/2019] [Indexed: 12/22/2022]
Abstract
A comprehensive understanding of the human body endogenous microbiota is essential for acquiring an insight into the involvement of microbiota in tissue healing and regeneration process in order to enable development of biomaterials with a better integration with human body environment. Biomaterials used for biomedical applications are normally germ-free, and the human body as the host of the biomaterials is not germ-free. The complexity and role of the body microbiota in tissue healing/regeneration have been underestimated historically. Traditionally, studies aiming at the development of novel biomaterials had focused on the effects of environment within the target tissue, neglecting the signals generated from the microbiota and their impact on tissue regeneration. The significance of the human body microbiota in relation to metabolism, immune system, and consequently tissue regeneration has been recently realised and is a growing research field. This review summarises recent findings on the role of microbiota and mechanisms involved in tissue healing and regeneration, in particular skin, liver, bone, and nervous system regrowth and regeneration highlighting the potential new roles of microbiota for development of a new generation of biomaterials.
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Affiliation(s)
- Amin Shavandi
- BioMatter-BTL, École interfacultaire de Bioingénieurs (EIB), Université Libre de Brussels, Brussels, Belgium
| | - Pouya Saeedi
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Philippe Gérard
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, 78350, Jouy-en-Josas, France
| | - Esmat Jalalvandi
- School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh, UK
| | - David Cannella
- PhotoBioCatalysis Unit - BTL - École interfacultaire de Bioingénieurs (EIB), Université Libre de Brussels, Brussels, Belgium
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Abstract
Irritable bowel syndrome (IBS) is an umbrella term for a common range of symptoms such as abdominal pain, distension (bloating), diarrhoea and constipation. Nurses will often encounter patients with IBS in their day-to-day practice. As well as patients who present to healthcare services seeking assistance in managing their IBS, nurses may also encounter patients who were initially seeking assistance for other conditions, but were also found to be exhibiting symptoms of IBS. This article outlines the causes of IBS and the range of symptoms that people with IBS may experience. It details the pharmacological therapies available for IBS, and examines the range of management interventions that nurses can use to ameliorate the underlying factors that contribute to IBS.
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Affiliation(s)
- Alison Coutts
- School of Health Sciences, Division of Nursing, City, University of London, London, England
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13
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Browne PD, den Hollander B, Speksnijder EM, van Wering HM, Tjon A Ten W, George EK, Groeneweg M, Bevers N, Wessels MMS, van den Berg MM, Goede J, Teklenburg-Roord STA, Frankenhuis C, Benninga MA, Vlieger AM. Gut-directed hypnotherapy versus standard medical treatment for nausea in children with functional nausea or functional dyspepsia: protocol of a multicentre randomised trial. BMJ Open 2019; 9:e024903. [PMID: 30975672 PMCID: PMC6500305 DOI: 10.1136/bmjopen-2018-024903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The treatment of chronic functional nausea or nausea due to functional dyspepsia in children is generally symptomatic. Moreover, these disorders pose a risk for worse psychosocial and health outcomes in children. Hypnotherapy (HT), by its ability to positively influence gastrointestinal and psychosocial functioning, may be an effective treatment for chronic nausea. METHODS AND ANALYSIS To test efficacy, this multicentre, parallel, randomised controlled, open label trial evaluates whether gut-directed HT is superior to standard medical treatment (SMT) for reducing nausea. The study will be conducted at eleven academic and non-academic hospitals across the Netherlands. A total of 100 children (8-18 years), fulfilling the Rome IV criteria for chronic idiopathic nausea or functional dyspepsia with prominent nausea, will be randomly allocated (1:1) to receive HT or SMT. Children allocated to the HT group will receive six sessions of HT during 3 months, while children allocated to the SMT group will receive six sessions of SMT+supportive therapy during the same period. The primary outcome will be the difference in the proportion of children with at least 50% reduction of nausea, compared with baseline at 12 months' follow-up. Secondary outcomes include the changes in abdominal pain, dyspeptic symptoms, quality of life, anxiety, depression, school absences, parental absence of work, healthcare costs and adequate relief of symptoms, measured directly after treatment, 6 and 12 months' follow-up. If HT proves effective for reducing nausea, it may become a new treatment strategy to treat children with chronic functional nausea or functional dyspepsia with prominent nausea. ETHICS AND DISSEMINATION Results of the study will be publicly disclosed to the public, without any restrictions, in peer-reviewed journal and international conferences. The study is approved by the Medical Research Ethics Committees United (MEC-U) in the Netherlands. TRIAL REGISTRATION NUMBER NTR5814.
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Affiliation(s)
- Pamela D Browne
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bibiche den Hollander
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Esther M Speksnijder
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Walther Tjon A Ten
- Department of Pediatrics, Maxima Medical Center, Veldhoven, The Netherlands
| | - Elvira K George
- Department of Pediatrics, Northwest Clinics, Alkmaar, The Netherlands
| | - Michael Groeneweg
- Department of Pediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Nanja Bevers
- Department of Pediatrics, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | - Joery Goede
- Department of Pediatrics, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Carla Frankenhuis
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, The Netherlands
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14
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First experience of the Egyptian National Cancer Institute using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer. J Egypt Natl Canc Inst 2018; 30:61-67. [PMID: 29691094 DOI: 10.1016/j.jnci.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 11/21/2022] Open
Abstract
AIM OF WORK Robotics in surgery led to an improvement of visualization, a better handling of tissues and better suturing. This study aimed to document the first experience of the Egyptian National Cancer Institute (NCI) using the robot-assisted laparoscopic approach in radical hysterectomies for cervical cancer and to highlight observed advantages, disadvantages, morbidity and oncological outcomes. PATIENTS AND METHODS Data of cases that had either early cervical cancer (stage IB-IIA1 with a tumor ≥2 cm) or locally advanced cervical cancer (Stage IIA2-IIB after chemo-radiotherapy) were collected prospectively. Study patients underwent robotic radical hysterectomies for their cervical cancers at the NCI, Cairo University, between January 1, 2015 and December 31, 2016. For each patient, duration of surgery, amount of blood loss, and intra-operative complications were recorded. Similarly, the duration of postoperative hospital-stay, analgesia used and post-operative gastrointestinal recovery were documented. Pathological assessment of safety margins and the lymph nodes number yield were also assessed. RESULTS Twenty patients underwent robotic radical hysterectomy during the study period. Twelve cases had early cervical cancer while 8 suffered locally advanced disease. The mean procedure time was 319 (range 240-560) minutes; the mean blood loss was 309 (range 150-600) ml. Three cases had bladder injuries during their procedures. The median hospital stay was 6 (range 4-10) days. One case had a positive margin. The median of lymph nodes yield number was 15 (range 10-25). Follow-up ranged 9-31 months, with only one case developing local recurrence. CONCLUSION Robotic radical hysterectomy is a feasible approach with a tolerable rate of complications.
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15
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Fan H, Zheng L, Lai Y, Lu W, Yan Z, Xiao Q, Li B, Tang M, Huang D, Wang Y, Li Z, Mei Y, Jiang Z, Liu X, Tang Q, Zuo D, Ye J, Yang Y, Huang H, Tang Z, Xiao J. Tongxie Formula Reduces Symptoms of Irritable Bowel Syndrome. Clin Gastroenterol Hepatol 2017. [PMID: 28634136 DOI: 10.1016/j.cgh.2017.06.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is the most common chronic gastrointestinal disorder, yet few drugs are effective in reducing symptoms. Approximately 50% of patients with IBS attempt herbal therapy at least once. We performed a randomized controlled trial to compare the efficacy of the herb formulation tongxie vs placebo or pinaverium (an antispasmodic agent) in reducing symptoms of IBS. METHODS We performed a trial of 1044 adult patients with IBS (based on Rome III criteria) at 5 hospitals in China, from August 2012 through January 2015. Subjects were randomly assigned (1:1:1) to groups given tongxie (a combination of A macrocephalae, P lactiflora, C reticulata, S divaricata, C pilosula, C wenyujin, C medica, and P cocos, along with other herbs, based on patient features), placebo, or pinaverium (50 mg tablets) 3 times daily for 4 weeks. Primary end points were significantly greater reductions in abdominal pain and Bristol stool score (before vs after the 4-week study period) in patients given tongxie compared with patients given placebo or pinaverium. Secondary end points were reductions in pain and stool frequencies and abdominal discomfort and its frequency. RESULTS Subjects given tongxie had significant reductions, before vs after the study period, in all 6 symptoms assessed, compared to patients given placebo (P < .001). A significantly higher proportion of patients given tongxie had increased stool consistency (75.6%) than patients given pinaverium (50.6%), and a significantly higher proportion of patients given tongxie had fewer daily stools (72.7%) than subjects given pinaverium (58.3%) (P < .001 for both). However, significantly higher proportions of patients given pinaverium had reduced pain (63.5%) and pain frequency (69.5%) than patients given tongxie (51.4% and 58.6%, respectively; P < .005 for both). CONCLUSIONS In a randomized controlled trial of patients with IBS in China, we found 4 weeks of tongxie to produce significantly greater reduction in symptoms than placebo, and greater increases in stool consistency and reductions in stool frequency, than patients given pinaverium. Tongxie can therefore be considered an effective alternative therapy for patients with IBS who do not respond well to conventional therapies. Clinicaltrials.gov no: NCT01641224.
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Affiliation(s)
- Heng Fan
- Department of Integrated Traditional Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Zheng
- Department of Gastroenterology, The Second Jiangsu Provincial Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yaoliang Lai
- Department of Gastroenterology, Beijing Xuanwu Hospital of Chinese Medicine, Beijing, China
| | - Weimin Lu
- Department of Internal Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhixiang Yan
- Institute of Chinese Medical Sciences, the University of Macau, Taipa, Macao, SAR, China
| | - Qi Xiao
- School of Medicine, Washington University, St. Louis, Missouri
| | - Baiwen Li
- Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Hongkou, Shanghai, China
| | - Min Tang
- School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing, China
| | - Dawei Huang
- Department of Gastroenterology, Beijing Xuanwu Hospital of Chinese Medicine, Beijing, China
| | - Yuanyuan Wang
- Department of Gastroenterology, The Second Jiangsu Provincial Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhen Li
- Department of Gastroenterology, The Second Jiangsu Provincial Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuwei Mei
- Department of Gastroenterology, The Second Jiangsu Provincial Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhengyan Jiang
- Department of Gastroenterology, The Second Jiangsu Provincial Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xingxing Liu
- Department of Integrated Traditional Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Tang
- Department of Integrated Traditional Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongmei Zuo
- Department of Integrated Traditional Chinese Medicine and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingyi Ye
- Macrohard Institute of Health, Roseville, Michigan
| | | | - Huisuo Huang
- Macrohard Institute of Health, Roseville, Michigan
| | - Zongxiang Tang
- School of Medicine and Life Sciences, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Jun Xiao
- Macrohard Institute of Health, Roseville, Michigan.
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Malagelada C, Nieto A, Mendez S, Accarino A, Santos J, Malagelada JR, Azpiroz F. Effect of prucalopride on intestinal gas tolerance in patients with functional bowel disorders and constipation. J Gastroenterol Hepatol 2017; 32:1457-1462. [PMID: 28090679 DOI: 10.1111/jgh.13733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Patients with functional bowel disorders develop gas retention and symptoms in response to intestinal gas loads that are well tolerated by healthy subjects. Stimulation of 5HT-4 receptors in the gut has both prokinetic and antinociceptive effects. The aim of this study is to determine the effect of prucalopride, a highly selective 5HT-4 agonist, on gas transit and tolerance in women with functional bowel disorders complaining of constipation. METHODS Twenty-four women with functional bowel disorders complaining of constipation were included in the study. Patients were studied twice on separate days in a cross-over design. On each study day, an intestinal gas challenge test was performed. During the five previous days, prucalopride (2 mg/day) or placebo was administered. Abdominal symptoms, stool frequency, and stool consistency were recorded during the treatment period on daily questionnaires. RESULTS During the gas challenge test, prucalopride did not decrease the volume of gas retained in the subset of patients who had significant gas retention (≥ 200 mL) while on placebo. However, in those patients who had increased symptoms during the gas test (≥ 3 on a 0 to 6 scale) when on placebo, prucalopride did significantly reduce the perception of symptoms (2.3 ± 0.5 mean score vs 3.5 ± 0.3 on placebo; P = 0.045). During the treatment period with prucalopride, patients exhibited an increase in the total number of bowel movements and decreased stool consistency compared with placebo. CONCLUSION Prucalopride reduces abdominal symptoms without modifying gas retention when patients with functional bowel disorders are challenged with the gas transit and tolerance test. European Clinical Trials Database (EudraCT2011-006354-86).
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Affiliation(s)
- Carolina Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Adoración Nieto
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Sara Mendez
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Javier Santos
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan-R Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Center for Biomedical Research in the Network of Liver and Digestive Diseases, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Azpiroz F, Molne L, Mendez S, Nieto A, Manichanh C, Mego M, Accarino A, Santos J, Sailer M, Theis S, Guarner F. Effect of Chicory-derived Inulin on Abdominal Sensations and Bowel Motor Function. J Clin Gastroenterol 2017; 51:619-625. [PMID: 27680592 PMCID: PMC5499961 DOI: 10.1097/mcg.0000000000000723] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022]
Abstract
GOAL To determine the effect of a prebiotic chicory-derived inulin-type fructan on the tolerance of intestinal gas. BACKGROUND Subjects with gas-related complaints exhibit impaired handling of intestinal gas loads and we hypothesized that inulin would have a beneficial effect. STUDY Placebo-controlled, parallel, randomized, double-blind trial. Subjects with abdominal symptoms and reduced tolerance of intestinal gas (selected by a pretest) received either inulin (8 g/d, n=18) or maltodextrin as a placebo (8 g/d, n=18) for 4 weeks. A gas challenge test (4 h jejunal gas infusion at 12 mL/min while measuring abdominal symptoms and gas retention for 3 h) was performed before and at the end of the intervention phase. Gastrointestinal symptoms and bowel habits (using daily questionnaires for 1 wk) and fecal bifidobacteria counts were measured before and at the end of the intervention. RESULTS Inulin decreased gas retention during the gas challenge test (by 22%; P=0.035 vs. baseline), while the placebo did not, but the intergroup difference was not statistically significant (P=0.343). Inulin and placebo reduced the perception of abdominal sensations in the gas challenge test to a similar extent (by 52% and 43%, respectively). Participants reported moderate gastrointestinal symptoms and normal bowel habits during baseline examination, and these findings remained unchanged in both groups during the intervention. Inulin led to a higher relative abundance of bifidobacteria counts (P=0.01 vs. placebo). CONCLUSIONS A daily dose of inulin that promotes bifidobacteria growth and may improve gut function, is well tolerated by subjects with gastrointestinal complaints.
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Affiliation(s)
- Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Laura Molne
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Sara Mendez
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Adoración Nieto
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Chaysavanh Manichanh
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Marianela Mego
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Anna Accarino
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | - Javier Santos
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
| | | | | | - Francisco Guarner
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
- Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
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Pribic T, Kilpatrick L, Ciccantelli B, Malagelada C, Accarino A, Rovira A, Pareto D, Mayer E, Azpiroz F. Brain networks associated with cognitive and hedonic responses to a meal. Neurogastroenterol Motil 2017; 29:10.1111/nmo.13031. [PMID: 28116817 PMCID: PMC6615895 DOI: 10.1111/nmo.13031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND We recently reported interrelated digestive, cognitive, and hedonic responses to a meal. The aim of this study was to identify brain networks related to the hedonic response to eating. METHODS Thirty-eight healthy subjects (20-38 age range) were evaluated after a 5-hour fast and after ingestion of a test meal (juice and warm ham and cheese sandwich, 300 mL, 425 kcal). Perceptual and affective responses (satiety, abdominal fullness, digestive well-being, and positive mood), and resting scans of the brain using functional MRI (3T Trio, Siemens, Germany) were evaluated immediately before and after the test meal. A high-order group independent component analysis was performed to investigate ingestion-related changes in the intrinsic connectivity of brain networks, with a focus on thalamic and insular networks. KEY RESULTS Ingestion induced satiation (3.3±0.4 score increase; P<.001) and abdominal fullness (2.4±0.3 score increase; P<.001). These sensations included an affective dimension involving digestive well-being (2.8±0.3 score increase; P<.001) and positive mood (1.8±0.2 score increase; P<.001). In general, thalamo-cortical connectivity increased with meal ingestion while insular-cortical connectivity mainly decreased. Furthermore, larger meal-induced changes (increase/decrease) in specific thalamic connections were associated with smaller changes in satiety/fullness. In contrast, a larger meal-induced decrease in insular-anterior cingulate cortex connectivity was associated with increased satiety, fullness, and digestive well-being. CONCLUSIONS AND INFERENCES Perceptual and emotional responses to food intake are related to brain connectivity in defined functional networks. Brain imaging may provide objective biomarkers of subjective effects of meal ingestion.
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Affiliation(s)
- T Pribic
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Madrid, Spain,Departament de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - L Kilpatrick
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - B Ciccantelli
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Madrid, Spain,Departament de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - C Malagelada
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Madrid, Spain,Departament de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - A Accarino
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Madrid, Spain,Departament de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - A Rovira
- Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - D Pareto
- Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - E Mayer
- G Oppenheimer Center for Neurobiology of Stress and Resilience, Division of Digestive Diseases, UCLA, Los Angeles, CA, USA
| | - F Azpiroz
- Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Madrid, Spain,Departament de Medicina, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
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Hou Q, Ye L, Huang L, Yu Q. The Research Progress on Intestinal Stem Cells and Its Relationship with Intestinal Microbiota. Front Immunol 2017; 8:599. [PMID: 28588586 PMCID: PMC5440531 DOI: 10.3389/fimmu.2017.00599] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022] Open
Abstract
The intestine is home to trillions of microorganisms, and the vast diversity within this gut microbiota exists in a balanced state to protect the intestinal mucosal barrier. Research into the association of the intestinal microbiota with health and disease (including diet, nutrition, obesity, inflammatory bowel disease, and cancer) continues to expand, with the field advancing at a rapid rate. Intestinal stem cells (ISCs) are the fundamental component of the mucosal barrier; they undergo continuous proliferation to replace the epithelium, which is also intimately involved in intestinal diseases. The intestinal microbiota, such as Lactobacillus, communicates with ISCs both directly and indirectly to regulate the proliferation and differentiation of ISCs. Moreover, Salmonella infection significantly decreased the expression of intestinal stem cell markers Lgr5 and Bmi1. However, the detailed interaction of intestinal microbiota and ISCs are still unclear. This review considers the progress of research on the model and niches of ISCs, as well as the complex interplay between the gut microbiota and ISCs, which will be crucial for explaining the mechanisms of intestinal diseases related to imbalances in the intestinal microbiota and ISCs.
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Affiliation(s)
- Qihang Hou
- College of veterinary medicine, Nanjing Agricultural University, Nanjing, China
| | - Lulu Ye
- College of veterinary medicine, Nanjing Agricultural University, Nanjing, China
| | - Lulu Huang
- College of veterinary medicine, Nanjing Agricultural University, Nanjing, China
| | - Qinghua Yu
- College of veterinary medicine, Nanjing Agricultural University, Nanjing, China
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Dimidi E, Christodoulides S, Scott SM, Whelan K. Mechanisms of Action of Probiotics and the Gastrointestinal Microbiota on Gut Motility and Constipation. Adv Nutr 2017; 8:484-494. [PMID: 28507013 PMCID: PMC5421123 DOI: 10.3945/an.116.014407] [Citation(s) in RCA: 285] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Constipation is a common and burdensome gastrointestinal disorder that may result from altered gastrointestinal motility. The effect of probiotics on constipation has been increasingly investigated in both animal and human studies, showing promising results. However, there is still uncertainty regarding the mechanisms of action of probiotics on gut motility and constipation. Several factors are vital to normal gut motility, including immune and nervous system function, bile acid metabolism and mucus secretion, and the gastrointestinal microbiota and fermentation; an imbalance or dysfunction in any of these components may contribute to aberrant gut motility and, consequently, symptoms of constipation. For example, adults with functional constipation have significantly decreased numbers of bifidobacteria (with one study showing a mean difference of 1 log10/g) and lactobacilli (mean difference, 1.4 log10/g) in stool samples, as well as higher breath methane, compared with control subjects. Modifying the gut luminal environment with certain probiotic strains may affect motility and secretion in the gut and, hence, provide a benefit for patients with constipation. Therefore, this review explores the mechanisms through which probiotics may exert an effect on gut motility and constipation. Nevertheless, the majority of current evidence is derived from animal studies, and therefore, further human studies are needed to determine the mechanisms through specific probiotic strains that might be effective in constipation.
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Affiliation(s)
- Eirini Dimidi
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King’s College London, London, United Kingdom; and,Centre for Neuroscience and Trauma, Neurogastroenterology Group and GI Physiology Unit, Queen Mary University of London, London, United Kingdom
| | - Stephanos Christodoulides
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King’s College London, London, United Kingdom; and,Centre for Neuroscience and Trauma, Neurogastroenterology Group and GI Physiology Unit, Queen Mary University of London, London, United Kingdom
| | - S Mark Scott
- Centre for Neuroscience and Trauma, Neurogastroenterology Group and GI Physiology Unit, Queen Mary University of London, London, United Kingdom
| | - Kevin Whelan
- Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, King's College London, London, United Kingdom; and
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Improved health-related quality of life after surgical management of severe refractory constipation-dominant irritable bowel syndrome. Int Surg 2016; 100:63-9. [PMID: 25594641 DOI: 10.9738/intsurg-d-13-00212.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Irritable bowel syndrome (IBS) is the most common of the functional gastrointestinal disorders (FGIDs). Despite its prevalence and health-care costs, there are few effective therapies for patients with severe symptoms. Our objective was to determine whether surgical management would improve health-related quality of life (HRQOL) in severe refractory constipation-dominant FGIDs. From 2003 to 2005, 6 patients underwent total colectomy with end ileostomy or primary anastomosis. They completed Short Form 36 (SF-36) and IBS-36 questionnaires preoperatively and postoperatively. HRQOL was compared with age- and sex-matched Canadian norms using Welch's unpaired t test. Preoperative SF-36 physical and mental health summary scores were significantly lower than Canadian norms (P < 0.0001), while postoperative scores were not significantly different than Canadian norms (P = 0.50 and P = 0.57, respectively). After surgical management, HRQOL in patients with severe constipation-dominant IBS improved from drastically below that of Canadian norms to a comparable level. This finding questions the convention of avoiding operations in IBS patients and demonstrates that surgical management may be suitable for the appropriately screened patient.
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Bendezú RA, Barba E, Burri E, Cisternas D, Accarino A, Quiroga S, Monclus E, Navazo I, Malagelada JR, Azpiroz F. Colonic content in health and its relation to functional gut symptoms. Neurogastroenterol Motil 2016; 28:849-54. [PMID: 26871593 DOI: 10.1111/nmo.12782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 12/26/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gut content may be determinant in the generation of digestive symptoms, particularly in patients with impaired gut function and hypersensitivity. Since the relation of intraluminal gas to symptoms is only partial, we hypothesized that non-gaseous component may play a decisive role. METHODS Abdominal computed tomography scans were evaluated in healthy subjects during fasting and after a meal (n = 15) and in patients with functional gut disorders during basal conditions (when they were feeling well) and during an episode of abdominal distension (n = 15). Colonic content and distribution were measured by an original analysis program. KEY RESULTS In healthy subjects both gaseous (87 ± 24 mL) and non-gaseous colonic content (714 ± 34 mL) were uniformly distributed along the colon. In the early postprandial period gas volume increased (by 46 ± 23 mL), but non-gaseous content did not, although a partial caudad displacement from the descending to the pelvic colon was observed. No differences in colonic content were detected between patients and healthy subjects. Symptoms were associated with discrete increments in gas volume. However, no consistent differences in non-gaseous content were detected in patients between asymptomatic periods and during episodes of abdominal distension. CONCLUSIONS & INFERENCES In patients with functional gut disorders, abdominal distension is not related to changes in non-gaseous colonic content. Hence, other factors, such as intestinal hypersensitivity and poor tolerance of small increases in luminal gas may be involved.
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Affiliation(s)
- R A Bendezú
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Barba
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Burri
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain
| | - D Cisternas
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain
| | - A Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Quiroga
- Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - E Monclus
- Departamento de Lenguajes y Sistemas Informáticos, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - I Navazo
- Departamento de Lenguajes y Sistemas Informáticos, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - J-R Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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23
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Prins A. The brain-gut interaction: the conversation and the implications. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2011.11734373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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24
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Distrutti E, Monaldi L, Ricci P, Fiorucci S. Gut microbiota role in irritable bowel syndrome: New therapeutic strategies. World J Gastroenterol 2016; 22:2219-2241. [PMID: 26900286 PMCID: PMC4734998 DOI: 10.3748/wjg.v22.i7.2219] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 12/05/2015] [Accepted: 12/30/2015] [Indexed: 02/07/2023] Open
Abstract
In the last decade the impressive expansion of our knowledge of the vast microbial community that resides in the human intestine, the gut microbiota, has provided support to the concept that a disturbed intestinal ecology might promote development and maintenance of symptoms in irritable bowel syndrome (IBS). As a correlate, manipulation of gut microbiota represents a new strategy for the treatment of this multifactorial disease. A number of attempts have been made to modulate the gut bacterial composition, following the idea that expansion of bacterial species considered as beneficial (Lactobacilli and Bifidobacteria) associated with the reduction of those considered harmful (Clostridium, Escherichia coli, Salmonella, Shigella and Pseudomonas) should attenuate IBS symptoms. In this conceptual framework, probiotics appear an attractive option in terms of both efficacy and safety, while prebiotics, synbiotics and antibiotics still need confirmation. Fecal transplant is an old treatment translated from the cure of intestinal infective pathologies that has recently gained a new life as therapeutic option for those patients with a disturbed gut ecosystem, but data on IBS are scanty and randomized, placebo-controlled studies are required.
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25
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Kim JH. Diet and Nutritional Management in Functional Gastrointestinal Disorder: Irritable Bowel Syndrome. ACTA ACUST UNITED AC 2016. [DOI: 10.3904/kjm.2016.90.2.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Lobo B, Serra J, D'Amato M, Rovati L, Malagelada JR, Santos J, Azpiroz F. Effect of selective CCK1 receptor antagonism on accommodation and tolerance of intestinal gas in functional gut disorders. J Gastroenterol Hepatol 2016; 31:288-93. [PMID: 26416485 DOI: 10.1111/jgh.13177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/04/2015] [Accepted: 09/16/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Participants with functional gut disorders develop gas retention and symptoms in response to intestinal gas loads that are well tolerated by healthy subjects. To determine the role of cholecystokinin (CCK1 ) receptors on gas transit and tolerance in women with functional gut disorders. METHODS In 12 healthy women, and 24 women with functional gut disorders (12 dyspepsia and 12 constipation-predominant irritable bowel syndrome) gas was infused into the jejunum at 12 mL/min for 3 h with simultaneous duodenal lipid infusion (intralipid 1 kcal/min), while measuring anal gas evacuation and abdominal symptoms on a 0-6 score scale. Triple-blind paired studies during iv infusion of dexloxiglumide (2.5 mg/kg bolus plus 5 mg/kg h continuous infusion), a selective CCK1 inhibitor, or saline (control) were performed in random order. RESULTS During saline infusion participants with functional gut disorders developed significantly greater gas retention and abdominal symptoms than healthy subjects (394 ± 40 mL vs 265 ± 35 mL and 2.8 ± 0.3 vs 1.9 ± 0.4 highest abdominal symptom score, respectively; P < 0.05 for both). Dexloxiglumide increased gas retention in both groups (514 ± 35 mL and 439 ± 60 mL, respectively; P = 0.033 vs saline for both); however, despite the larger retention, dexloxiglumide reduced abdominal symptoms (2.3 ± 0.2 score and 0.8 ± 0.3 score, respectively; P = 0.05 vs saline for both). Post-hoc analysis showed that, the decrease in abdominal symptoms was more pronounced in those participants with functional gut disorders with higher basal abdominal symptoms than in the rest (P = 0.037). CONCLUSION Inhibition of CCK1 receptors by dexloxiglumide increases intestinal gas retention and reduces abdominal symptoms in response to by intestinal gas loads. European Clinical Trials Database (EudraCT 2005-003338-16).
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Affiliation(s)
- Beatriz Lobo
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Serra
- Rottapharm Biotech (formerly Rotta Research Laboratorium), Monza, Italy
| | - Massimo D'Amato
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lucio Rovati
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan-R Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Santos
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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27
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Bendezú RA, Barba E, Burri E, Cisternas D, Malagelada C, Segui S, Accarino A, Quiroga S, Monclus E, Navazo I, Malagelada JR, Azpiroz F. Intestinal gas content and distribution in health and in patients with functional gut symptoms. Neurogastroenterol Motil 2015; 27:1249-57. [PMID: 26095329 DOI: 10.1111/nmo.12618] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The precise relation of intestinal gas to symptoms, particularly abdominal bloating and distension remains incompletely elucidated. Our aim was to define the normal values of intestinal gas volume and distribution and to identify abnormalities in relation to functional-type symptoms. METHODS Abdominal computed tomography scans were evaluated in healthy subjects (n = 37) and in patients in three conditions: basal (when they were feeling well; n = 88), during an episode of abdominal distension (n = 82) and after a challenge diet (n = 24). Intestinal gas content and distribution were measured by an original analysis program. Identification of patients outside the normal range was performed by machine learning techniques (one-class classifier). Results are expressed as median (IQR) or mean ± SE, as appropriate. KEY RESULTS In healthy subjects the gut contained 95 (71, 141) mL gas distributed along the entire lumen. No differences were detected between patients studied under asymptomatic basal conditions and healthy subjects. However, either during a spontaneous bloating episode or once challenged with a flatulogenic diet, luminal gas was found to be increased and/or abnormally distributed in about one-fourth of the patients. These patients detected outside the normal range by the classifier exhibited a significantly greater number of abnormal features than those within the normal range (3.7 ± 0.4 vs 0.4 ± 0.1; p < 0.001). CONCLUSIONS & INFERENCES The analysis of a large cohort of subjects using original techniques provides unique and heretofore unavailable information on the volume and distribution of intestinal gas in normal conditions and in relation to functional gastrointestinal symptoms.
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Affiliation(s)
- R A Bendezú
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - E Barba
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - E Burri
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - D Cisternas
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - C Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - S Segui
- Computer Vision Center, Bellaterra, Spain
| | - A Accarino
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - S Quiroga
- Radiology Department, University Hospital Vall d'Hebron, Barcelona, Spain
| | - E Monclus
- Departamento de Lenguajes y Sistemas Informáticos, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - I Navazo
- Departamento de Lenguajes y Sistemas Informáticos, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - J-R Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - F Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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28
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Malagelada C, Accarino A, Molne L, Mendez S, Campos E, Gonzalez A, Malagelada JR, Azpiroz F. Digestive, cognitive and hedonic responses to a meal. Neurogastroenterol Motil 2015; 27:389-96. [PMID: 25557693 DOI: 10.1111/nmo.12504] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gut dysfunctions may be associated to digestive symptoms. We hypothesized that the gut can also originate pleasant sensations, and wished to demonstrate the hedonic component of the digestive response to a meal. METHODS Healthy subjects (n = 42) were evaluated during basal fasting conditions and during experimentally induced fullness sensation (either by gastric distension or duodenal nutrient infusion). In each set of studies, a 240 mL test meal (12 kcal broth) and water, as inert control meal, were administered on separate days in a randomized, cross-over design. Gastric accommodation, the cognitive response and the hedonic dimension (both by 10 score scales) were measured 9 min before and 60 min after the meal. KEY RESULTS In basal conditions, the test meal induced a significantly greater gastric relaxation than the control meal (166 ± 28 mL isotonic volume increase 67 ± 14 mL; p = 0.002). Both meals induced epigastric fullness (3.8 ± 0.7 score and 3.2 ± 0.8 score, respectively; p = 0.740), but contrary to the inert meal, with the active meal this conscious sensation had a pleasant dimension (digestive comfort increase by 1.3 ± 0.6 score with active meal vs -1.1 ± 0.6 decrease with inert meal; p = 0.015). Experimentally induced fullness was associated to a decrease in digestive well-being or abdominal discomfort, which improved only after the active meal but not the inert meal. CONCLUSIONS & INFERENCES When appropriate conditions are met, the response to a meal includes a hedonic dimension involving pleasant sensation of digestive well-being.
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Affiliation(s)
- C Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
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Association Between Joint Hypermobility and Gastroesophageal Reflux Disease: An Observational Analytical Cross Sectional Study. Arch Rheumatol 2015; 31:188-191. [PMID: 29900943 DOI: 10.5606/archrheumatol.2016.5742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/28/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to assess the association between joint hypermobility (JHM) and gastroesophageal reflux disease (GERD). Patients and methods This cross sectional study included 100 consecutive Iraqi patients (43 males, 57 females; mean age 30±6.6 years; range 18 to 40 years) with GERD diagnosed by a gastroenterologist according to the guidelines for diagnosis and management of GERD and age and sex matched 100 healthy controls (36 males, 64 females; mean age 30±5.2 years; range 20 to 40 years). JHM was measured using Beighton score method by a blinded observer. A score of 4 or more was considered hypermobile. Results Joint hypermobility values were significantly higher in GERD patients than in controls [46 (71.9%) vs 18 (28.1%), p<0.001, odds ratio=3.88; 95% confidence interval=2.04-7.39]. Multiple logistic regression analysis to detect predictors of GERD in JHM patients revealed that patients with high total mobility score (7- 9) had the highest risk for developing GERD [about 41 fold compared to those with normal mobility score (<4), P model <0.001, and overall prediction accuracy of 68%]. Conclusion There is a significant association between JHM and GERD. The high total mobility score (7-9) was associated with a significantly high risk for developing GERD, indicating that early recognition of JHM may assist in early diagnosis and treatment of GERD.
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Iovino P, Bucci C, Tremolaterra F, Santonicola A, Chiarioni G. Bloating and functional gastro-intestinal disorders: Where are we and where are we going? World J Gastroenterol 2014; 20:14407-14419. [PMID: 25339827 PMCID: PMC4202369 DOI: 10.3748/wjg.v20.i39.14407] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome III criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course.
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Azpiroz F, Hernandez C, Guyonnet D, Accarino A, Santos J, Malagelada JR, Guarner F. Effect of a low-flatulogenic diet in patients with flatulence and functional digestive symptoms. Neurogastroenterol Motil 2014; 26:779-85. [PMID: 24548289 DOI: 10.1111/nmo.12324] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diets rich in fermentable residues increase intestinal gas production. Our aim was to demonstrate the potential effects of diet on gas-related symptoms. METHODS The effect of a low-flatulogenic test diet (restricted to foodstuffs low in fermentable residues; n = 15) was compared to that of a balanced control diet (Mediterranean type; n = 15) in 30 patients complaining of flatulence and other abdominal symptoms using a randomized parallel design. The following outcomes were measured daily: number of anal gas evacuations by an event marker, severity of gas-related symptoms by 0-10 scales, and sensation of digestive comfort by a -5 (unpleasant) to +5 (pleasant) scale. Measurements were taken pretreatment for 3 days on their habitual diet and for 7 days during the treatment phase. KEY RESULTS No pretreatment differences were detected between patients allocated to the control or test diets. The test diet significantly reduced the number of gas evacuations (by 54 ± 10%; p = 0.002 vs basal diet) whereas the control diet had a lesser effect (reduction by 28 ± 9%; p = 0.059 vs basal diet; p = 0.089 vs test diet). Compared to the control diet, the test diet significantly reduced flatulence (by 48 ± 7% vs 27 ± 8%, respectively; p = 0.018), abdominal distension (by 48 ± 4% vs 22 ± 12%, respectively; p = 0.038), and enhanced digestive well-being (by 149 ± 18% vs 58 ± 22%, respectively; p = 0.006). CONCLUSIONS & INFERENCES In patients with gas-related symptoms, a low-flatulogenic diet produces immediate beneficial effects with digestive, cognitive, and emotive dimensions. The number of gas evacuations is an objective biological marker of response to dietary treatment.
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Affiliation(s)
- F Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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Occult constipation: faecal retention as a cause of recurrent abdominal pain in children. Eur J Pediatr 2014; 173:781-5. [PMID: 24384798 DOI: 10.1007/s00431-013-2257-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/17/2013] [Indexed: 02/07/2023]
Abstract
UNLABELLED Recurrent abdominal pain (RAP) in children is generally believed to be functional. In practice, many children with RAP become pain-free with laxative therapy. The aims of the study were to establish the role of (occult) constipation in RAP and to investigate whether patients diagnosed with (occult) constipation could be identified by history and physical examination. During 2 years, all patients (age 4-16 years, secondary referral) fulfilling Apley criteria of RAP were included. After exclusion of gastrointestinal infections and food intolerance, laxatives were advised when pain persisted. (Occult) constipation was defined as 'abdominal pain disappearing with laxative treatment and not reappearing within a 6 month follow up period'; 'occult constipation' was diagnosed in patients who did not fulfil the Rome criteria of constipation. Two hundred children (87 M; median age 8.8 years) were evaluated. (Occult) constipation was found in 92 patients (46 %). Of these, 18 had considerable relief of pain when treated for a somatic cause but experienced complete relief only after laxative measures; they were considered to have two diagnoses. Using multivariate analysis, a simple model was developed with cystitis in past history, early satiety and flatulence as predictors for (occult) constipation. The risk of (occult) constipation ranged from 18/58 if no predictor was present to 4/4 if all three were present. CONCLUSION Laxatives played a pivotal role in the recovery of patients with RAP. We developed a simple model to identify patients at risk of having (occult) constipation.
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Theodorou V, Belgnaoui AA, Agostini S, Eutamene H. Effect of commensals and probiotics on visceral sensitivity and pain in irritable bowel syndrome. Gut Microbes 2014; 5:430-6. [PMID: 25184834 PMCID: PMC4153783 DOI: 10.4161/gmic.29796] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The last ten years' wide progress in the gut microbiota phylogenetic and functional characterization has been made evidencing dysbiosis in several gastrointestinal diseases including inflammatory bowel diseases and irritable bowel syndrome (IBS). IBS is a functional gut disease with high prevalence and negative impact on patient's quality of life characterized mainly by visceral pain and/or discomfort, representing a good paradigm of chronic gut hypersensitivity. The IBS features are strongly regulated by bidirectional gut-brain interactions and there is increasing evidence for the involvement of gut bacteria and/or their metabolites in these features, including visceral pain. Further, gut microbiota modulation by antibiotics or probiotics has been promising in IBS. Mechanistic data provided mainly by animal studies highlight that commensals or probiotics may exert a direct action through bacterial metabolites on sensitive nerve endings in the gut mucosa, or indirect pathways targeting the intestinal epithelial barrier, the mucosal and/or systemic immune activation, and subsequent neuronal sensitization and/or activation.
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Affiliation(s)
- Vassilia Theodorou
- INRA; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France,El-Purpan; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France,Correspondence to: Vassilia Theodorou,
| | - Afifa Ait Belgnaoui
- INRA; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France,El-Purpan; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France,Lallemand Health Solutions Inc; Montreal, Canada
| | - Simona Agostini
- INRA; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France,El-Purpan; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France
| | - Helene Eutamene
- INRA; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France,El-Purpan; UMR 1331 TOXALIM; Neuro-Gastroenterology and Nutrition Group; Toulouse, France
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Burri E, Barba E, Huaman JW, Cisternas D, Accarino A, Soldevilla A, Malagelada JR, Azpiroz F. Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia. Gut 2014; 63:395-400. [PMID: 23645627 DOI: 10.1136/gutjnl-2013-304574] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Patients with irritable bowel syndrome and abdominal bloating exhibit abnormal responses of the abdominal wall to colonic gas loads. We hypothesised that in patients with postprandial bloating, ingestion of a meal triggers comparable abdominal wall dyssynergia. Our aim was to characterise abdominal accommodation to a meal in patients with postprandial bloating. DESIGN A test meal (0.8 kcal/ml nutrients plus 27 g/litre polyethylenglycol 4000) was administered at 50 ml/min as long as tolerated in 10 patients with postprandial bloating (fulfilling Rome III criteria for postprandial distress syndrome) and 12 healthy subjects, while electromyographic (EMG) responses of the anterior wall (upper and lower rectus, external and internal oblique via bipolar surface electrodes) and the diaphragm (via six ring electrodes over an oesophageal tube in the hiatus) were measured. Means +/- SD were calculated. RESULTS Healthy subjects tolerated a meal volume of 913±308 ml; normal abdominal wall accommodation to the meal consisted of diaphragmatic relaxation (EMG activity decreased by 15±6%) and a compensatory contraction (25±9% increase) of the upper abdominal wall muscles (upper rectus and external oblique), with no changes in the lower anterior muscles (lower rectus and internal oblique). Patients tolerated lower volume loads (604±310 ml; p=0.030 vs healthy subjects) and developed a paradoxical response, that is, diaphragmatic contraction (14±3% EMG increment; p<0.01 vs healthy subjects) and upper anterior wall relaxation (9±4% inhibition; p<0.01 vs healthy subjects). CONCLUSIONS In functional dyspepsia, postprandial abdominal distension is produced by an abnormal viscerosomatic response to meal ingestion that alters normal abdominal accommodation.
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Affiliation(s)
- Emanuel Burri
- Digestive System Research Unit, University Hospital Vall d'Hebron, , Barcelona, Catalunya, Spain
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35
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Manichanh C, Eck A, Varela E, Roca J, Clemente JC, González A, Knights D, Knight R, Estrella S, Hernandez C, Guyonnet D, Accarino A, Santos J, Malagelada JR, Guarner F, Azpiroz F. Anal gas evacuation and colonic microbiota in patients with flatulence: effect of diet. Gut 2014; 63:401-8. [PMID: 23766444 PMCID: PMC3933177 DOI: 10.1136/gutjnl-2012-303013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To characterise the influence of diet on abdominal symptoms, anal gas evacuation, intestinal gas distribution and colonic microbiota in patients complaining of flatulence. DESIGN Patients complaining of flatulence (n=30) and healthy subjects (n=20) were instructed to follow their usual diet for 3 days (basal phase) and to consume a high-flatulogenic diet for another 3 days (challenge phase). RESULTS During basal phase, patients recorded more abdominal symptoms than healthy subjects in daily questionnaires (5.8±0.3 vs 0.4±0.2 mean discomfort/pain score, respectively; p=<0.0001) and more gas evacuations by an event marker (21.9±2.8 vs 7.4±1.0 daytime evacuations, respectively; p=0.0001), without differences in the volume of gas evacuated after a standard meal (262±22 and 265±25 mL, respectively). On flatulogenic diet, both groups recorded more abdominal symptoms (7.9±0.3 and 2.8±0.4 discomfort/pain, respectively), number of gas evacuations (44.4±5.3 and 21.7±2.9 daytime evacuations, respectively) and had more gas production (656±52 and 673±78 mL, respectively; p<0.05 vs basal diet for all). When challenged with flatulogenic diet, patients' microbiota developed instability in composition, exhibiting variations in the main phyla and reduction of microbial diversity, whereas healthy subjects' microbiota were stable. Taxa from Bacteroides fragilis or Bilophila wadsworthia correlated with number of gas evacuations or volume of gas evacuated, respectively. CONCLUSIONS Patients complaining of flatulence have a poor tolerance of intestinal gas, which is associated with instability of the microbial ecosystem.
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Affiliation(s)
- Chaysavanh Manichanh
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anat Eck
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Encarna Varela
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquim Roca
- Molecular Biology Institute of Barcelona, Consejo Superior de Investigaciones Cientificas, Barcelona, Spain
| | - José C Clemente
- Department of Chemistry and Biochemistry, University of Colorado at Boulder, and Howard Hughes Medical Institute, Boulder, Colorado, USA
| | - Antonio González
- Department of Chemistry and Biochemistry, University of Colorado at Boulder, and Howard Hughes Medical Institute, Boulder, Colorado, USA
| | - Dan Knights
- Department of Chemistry and Biochemistry, University of Colorado at Boulder, and Howard Hughes Medical Institute, Boulder, Colorado, USA
| | - Rob Knight
- Department of Chemistry and Biochemistry, University of Colorado at Boulder, and Howard Hughes Medical Institute, Boulder, Colorado, USA
| | - Sandra Estrella
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Hernandez
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Denis Guyonnet
- Digestive Health Department, Danone Research, Palaiseau, France
| | - Anna Accarino
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Santos
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Juan-R Malagelada
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Guarner
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Azpiroz
- Digestive System Research Unit, Departament de Medicina, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Universitat Autònoma de Barcelona, Barcelona, Spain
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Kim JH, Sung IK. Current Issues on Irritable Bowel Syndrome: Diet and Irritable Bowel Syndrome. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 64:142-7. [DOI: 10.4166/kjg.2014.64.3.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Chang FY, Lu CL. Irritable bowel syndrome and migraine: bystanders or partners? J Neurogastroenterol Motil 2013; 19:301-11. [PMID: 23875096 PMCID: PMC3714407 DOI: 10.5056/jnm.2013.19.3.301] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 03/18/2013] [Accepted: 03/25/2013] [Indexed: 01/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) and migraine are distinct clinical disorders. Apart from the characteristics of chronic and recurrent pain in nature, these pain-related disorders apparently share many similarities. For example, IBS is female predominant with community prevalence about 5-10%, whereas that of migraine is 1-3% also showing female predominance. They are often associated with many somatic and psychiatric comorbidities in terms of fibromyaglia, chronic fatigue syndrome, interstitial cystitis, insomnia and depression etc., even the IBS subjects may have coexisted migraine with an estimated odds ratio of 2.66. They similarly reduce the quality of life of victims leading to the social, medical and economic burdens. Their pathogeneses have been somewhat addressed in relation to biopsychosocial dysfunction, heredity, genetic polymorphism, central/visceral hypersensitivity, somatic/cutaneous allodynia, neurolimbic pain network, gonadal hormones and abuses etc. Both disorders are diagnosed according to the symptomatically based criteria. Multidisciplinary managements such as receptor target new drugs, melantonin, antispasmodics, and psychological drugs and measures, complementary and alternatives etc. are recommended to treat them although the used agents may not be necessarily the same. Finally, the prognosis of IBS is pretty good, whereas that of migraine is less fair since suicide attempt and stroke are at risk. In conclusion, both distinct chronic pain disorders to share many similarities among various aspects probably suggest that they may locate within the same spectrum of a pain-centered disorder such as central sensitization syndromes. The true pathogenesis to involve these disorders remains to be clarified in the future.
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Affiliation(s)
- Full-Young Chang
- Environmental Heath and Safety Office, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Abstract
There is convincing evidence that patients with functional gastrointestinal disorders (FGIDs) exhibit dysfunctions of the gut involving hypersensitivity and abnormal reflexes, so that physiological, normally unperceived, stimuli induce symptoms. The type of symptoms depends on the specific sensory-reflex pathways and region(s) affected. Fat modulates the responses of the gut to various stimuli, and some of these modulatory mechanisms are abnormal in patients with FGIDs. Indeed, laboratory-based studies have shown that the symptoms experienced by these patients can be induced, or exacerbated, by administration of lipids in amounts that are well tolerated by healthy controls, and, thus, demonstrate a hypersensitivity to lipid. Very few studies have evaluated dietary patterns and eating behavior in these patients, with often-conflicting outcomes, and no studies have been performed to evaluate the role of targeted dietary interventions for the relief of symptoms. Given the evidence from laboratory studies, as well as patient experience, such studies, in large cohorts of patients, are needed with the view to develop personalized, cost-effective treatment approaches.
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Burri E, Cisternas D, Villoria A, Accarino A, Soldevilla A, Malagelada JR, Azpiroz F. Abdominal accommodation induced by meal ingestion: differential responses to gastric and colonic volume loads. Neurogastroenterol Motil 2013; 25:339-e253. [PMID: 23360536 DOI: 10.1111/nmo.12068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Using an experimental model of colonic gas infusion, we previously showed that the abdominal walls adapt to its content by an active phenomenon of abdominal accommodation. We now hypothesized that abdominal accommodation is a physiological phenomenon, and aimed to confirm that it can be induced by ingestion of a meal; a secondary aim was to determine whether the response to gut filling is region-specific. METHODS In healthy subjects (n = 24) a nutrient test meal was administered until tolerated at a rate of 50 mL min(-1). Electromyographic (EMG) activity of the anterior wall (upper and lower rectus, external and internal oblique) was measured via four pairs of surface electrodes, and EMG activity of the diaphragm via intraluminal electrodes on an esophageal tube. To address the secondary aim, the response to gastric filling was compared with that induced by colonic filling (1440 mL 30 min(-1) anal gas infusion; n = 8). KEY RESULTS Participants tolerated 927 ± 66 mL of meal (450-1500 mL). Meal ingestion induced progressive diaphragmatic relaxation (EMG reduction by 16 ± 2%; P < 0.01) and selective contraction of the upper abdominal wall (24 ± 2% increase in activity of the upper rectus and external oblique; P < 0.01 for both), with no significant changes in the lower rectus (4 ± 2%) or internal oblique (5 ± 3%). Colonic gas infusion induced a similar response, but with an overall contraction of the anterior wall. CONCLUSIONS & INFERENCES Meal ingestion induces a metered and region-specific response of the abdominal walls to accommodate the volume load. Abnormal abdominal accommodation could be involved in postprandial bloating.
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Affiliation(s)
- E Burri
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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40
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Marteau P, Guyonnet D, Lafaye de Micheaux P, Gelu S. A randomized, double-blind, controlled study and pooled analysis of two identical trials of fermented milk containing probiotic Bifidobacterium lactis CNCM I-2494 in healthy women reporting minor digestive symptoms. Neurogastroenterol Motil 2013; 25:331-e252. [PMID: 23480238 DOI: 10.1111/nmo.12078] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The probiotic fermented milk (PFM) containing Bifidobacterium lactis CNCM I-2494 improved gastrointestinal (GI) well-being and digestive symptoms in a previous trial involving women reporting minor digestive symptoms. Our objective is to confirm these findings in a second study and in a pooled analysis of both studies. METHODS In this double-blind, controlled, parallel design study, subjects without diagnosed GI disorders consumed PFM or control dairy product daily for 4 weeks. Endpoints comprised weekly assessment of GI well-being (primary endpoint), rate of responders and digestive symptoms. Data were analyzed on full analysis set population (n = 324) and on the pooled data of randomized subjects of this study with those of the first study (n = 538). KEY RESULTS In this second study, no significant difference was observed in the percentage of women reporting an improvement in GI well-being [OR = 1.20 (95% CI 0.87, 1.66)] and rate of responders [OR = 1.38 (95% CI 0.89, 2.14)]. Composite score of digestive symptoms was significantly (P < 0.05) reduced in PFM when compared to the control group [LSmean = -0.42 (95% CI -0.81, -0.03)]. In the pooled analysis, significant differences were observed in favor of PFM group for all endpoints: percentage of women with improved GI well-being [OR = 1.36 (95% CI 1.07, 1.73)], rate of responders [OR = 1.53 (95% CI 1.09, 2.16)] and composite score of digestive symptoms [LSmean = -0.48 (95% CI -0.80, -0.16)]. CONCLUSIONS & INFERENCES This second study did not confirm improvement on the primary endpoint. However, a pooled analysis of the two trials showed improvement in GI well-being and digestive symptoms in women reporting minor digestive symptoms.
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Affiliation(s)
- P Marteau
- Department of digestive diseases, AP-HP, Lariboisière Hospital, University Denis Diderot, Paris, France.
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41
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Abstract
BACKGROUND Short sleep and weight gain are inversely related. Sleep deprivation acutely increases food intake but little is known about eating behavior in chronically sleep-deprived, obese individuals. OBJECTIVE To characterize the relationship between sleep, food intake and alcohol consumption under free-living conditions in obese, chronically sleep-deprived individuals. DESIGN Cross-sectional study of a cohort of obese men and premenopausal women. SUBJECTS A total of 118 obese subjects (age: 40.3±6.7 years; 91 females/27 males; body mass index 38.7±6.4 kg m(-2)). MEASUREMENTS Energy, macronutrient, alcohol and caffeine intake assessed by 3-day food records. Sleep duration estimated by actigraphy. Respiratory disturbance index assessed by a portable device. RESULTS SUBJECTS slept 360.7±50.2 min per night and had a total energy intake of 2279.1±689 kcal per day. Sleep duration and energy intake were inversely related (r=-0.230, P=0.015). By extrapolation, each 30-min deficit per day in sleep duration would translate to an ∼83 kcal per day increase in energy intake. In addition, sleep apnea was associated with a shift from carbohydrate to fat intake. Alcohol intake in subjects consuming >3.5 g of alcohol per day (N=41) was inversely related to sleep duration (r=-0.472, P=0.002). CONCLUSIONS Shorter sleep duration and obstructive sleep apnea are associated with higher energy, fat and alcohol intakes in obese individuals. The importance of this study relies on the population studied, obese subjects with chronic sleep deprivation. These novel findings apply to the large segment of the US population who are obese and sleep-deprived.
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Joo YE. Increased Expression of Brain-derived Neurotrophic Factor in Irritable Bowel Syndrome and Its Correlation With Abdominal Pain (Gut 2012;61:685-694). J Neurogastroenterol Motil 2013; 19:109-11. [PMID: 23350058 PMCID: PMC3548116 DOI: 10.5056/jnm.2013.19.1.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 12/11/2012] [Accepted: 12/13/2012] [Indexed: 12/15/2022] Open
Affiliation(s)
- Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Khashan AS, Quigley EMM, McNamee R, McCarthy FP, Shanahan F, Kenny LC. Increased risk of miscarriage and ectopic pregnancy among women with irritable bowel syndrome. Clin Gastroenterol Hepatol 2012; 10:902-9. [PMID: 22373726 DOI: 10.1016/j.cgh.2012.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 01/23/2012] [Accepted: 02/14/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is the most commonly diagnosed gastrointestinal condition and is most prevalent in women of reproductive age. We investigated the effects of IBS on risk for adverse outcomes from pregnancy. METHODS We conducted a cohort study by using the United Kingdom General Practice Research Database. The study cohort consisted of 100,000 women selected by stratified random sampling from all women with a diagnosis of pregnancy from January 1, 1990, to December 31, 2008. Those with a recorded diagnosis of IBS before pregnancy were identified (n = 26,543). Outcome measures were spontaneous miscarriage, ectopic pregnancy, preeclampsia, and stillbirth. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between IBS and pregnancy outcomes were estimated by using logistic regression adjusted for several potential confounders. RESULTS Of women diagnosed with IBS before pregnancy, 6578 (7%) had a spontaneous miscarriage, 741 (0.74%) had an ectopic pregnancy, 425 (0.43%) developed preeclampsia, and 217 (0.22%) had a stillbirth. Maternal IBS was associated with a moderately increased risk of miscarriage (OR, 1.21; 95% CI, 1.13-1.30) and ectopic pregnancy (OR, 1.28%; 95% CI, 1.06-1.55). There did not appear to be an association between IBS and preeclampsia (OR, 1.09; 95% CI, 0.85-1.39) or stillbirth (OR, 1.00; 95% CI, 0.69-1.44). CONCLUSIONS IBS, a common disorder in women of reproductive age, appears to increase the risk of miscarriage and ectopic pregnancy. These findings indicate the importance of prenatal care for women with IBS.
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Affiliation(s)
- Ali S Khashan
- Anu Research Centre, Department of Obstetrics and Gynecology, University College Cork, National University of Ireland, Cork, Ireland
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Martínez-Vázquez MA, Vázquez-Elizondo G, González-González JA, Gutiérrez-Udave R, Maldonado-Garza HJ, Bosques-Padilla FJ. Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: systematic review and meta-analysis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2012; 77:82-90. [PMID: 22672854 DOI: 10.1016/j.rgmx.2012.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 04/28/2012] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit. AIMS To determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS. METHODS We carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI. RESULTS Twenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics. CONCLUSIONS Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations.
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Affiliation(s)
- M A Martínez-Vázquez
- Gastroenterology Unit, Internal Medicine Department, Dr José E González University Hospital, Monterrey, NL, Mexico
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The gut microbiota and irritable bowel syndrome: friend or foe? Int J Inflam 2012; 2012:151085. [PMID: 22577594 PMCID: PMC3346986 DOI: 10.1155/2012/151085] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 01/07/2012] [Indexed: 12/20/2022] Open
Abstract
Progress in the understanding of the pathophysiology of irritable bowel syndrome (IBS), once thought to be a purely psychosomatic disease, has advanced considerably and low-grade inflammation and changes in the gut microbiota now feature as potentially important. The human gut harbours a huge microbial ecosystem, which is equipped to perform a variety of functions such as digestion of food, metabolism of drugs, detoxification of toxic compounds, production of essential vitamins, prevention of attachment of pathogenic bacteria to the gut wall, and maintenance of homeostasis in the gastrointestinal tract. A subset of patients with IBS may have a quantitative increase in bacteria in the small bowel (small intestinal bacterial overgrowth). Qualitative changes in gut microbiota have also been associated with IBS. Targeting the gut microbiota using probiotics and antibiotics has emerged as a potentially effective approach to the treatment of this, hitherto enigmatic, functional bowel disorder. The gut microbiota in health, quantitative and qualitative microbiota changes, and therapeutic manipulations targeting the microbiota in patients with IBS are reviewed in this paper.
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Burri E, Cisternas D, Villoria A, Accarino A, Soldevilla A, Malagelada JR, Azpiroz F. Accommodation of the abdomen to its content: integrated abdomino-thoracic response. Neurogastroenterol Motil 2012; 24:312-e162. [PMID: 22188369 DOI: 10.1111/j.1365-2982.2011.01846.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We previously showed that changes in intra-abdominal content induce a volume-dependent muscular response of the anterior abdominal wall and the diaphragm. We aimed to determine the contribution of the thorax to abdominal accommodation and the influence of the intra-abdominal expansion rate. METHODS Gas (1440 mL total load) was infused into the colon of nine healthy subjects, while abdomino-thoracic perimeters (by tape measure), electromyography (EMG) activity of the diaphragm (via six ring electrodes over an esophageal tube in the hiatus), intercostals and anterior abdominal wall (via five pairs of surface electrodes) and the position of the diaphragm by ultrasonography were measured. Infusion rates of 24, 48, and 96 mL min(-1) were tested on separate days. KEY RESULTS Gas infusion induced anterior abdominal wall contraction (18 ± 1% EMG increment; P < 0.001) with relatively modest girth increment (4.9 ± 0.9 mm; P = 0.001), diaphragmatic relaxation (by 15 ± 1%; P < 0.001) with cephalad displacement (by 23 ± 6 mm; P = 0.005), and intercostal contraction (by 19 ± 2%; P < 0.001) with increased thoracic perimeter (by 2.0 ± 0.5 mm; P = 0.009). Responses were similar with the three infusion rates. CONCLUSIONS & INFERENCES Accommodation of intra-abdominal loads involves a volume-related integrated abdomino-thoracic response regardless of the expansion rate.
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Affiliation(s)
- E Burri
- Digestive System Research Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), University Hospital Vall d'Hebron, Barcelona, Spain
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Neonatal maternal separation in male rats increases intestinal permeability and affects behavior after chronic social stress. Physiol Behav 2011; 105:1058-66. [PMID: 22155491 DOI: 10.1016/j.physbeh.2011.11.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 12/19/2022]
Abstract
Prolonged maternal separation in rats has several effects on health and behavior. Here we investigated how maternal separation might interact with social stress in adulthood on behavior and gastrointenstinal permeability. The effects of either daily 180 min long term pup-dam separation (LMS) during the stress hyporesponsive period or daily 10 min brief maternal separation (BMS) on behavior, corticosterone and intestinal permeability were investigated, compared to a non-handling (NH) condition in male offspring. The animals from each separation condition were then randomly assigned to adult stress and control conditions, where the stress condition was exposure to 14 days of social instability (CSI). Sucrose preference, elevated plus maze behavior and corticosterone were measured. Colitis was experimentally induced by dextran sulfate sodium for 7 days, followed by measurement of intestinal permeability using the (51)CrEDTA method. Granulocyte marker protein was measured in feces and colons were examined histologically for inflammation. Prior to the social stress, the LMS offspring showed elevated corticosterone levels, lower elevated plus maze activity and less fluid consumption. After social stress, corticosterone levels were suppressed in LMS animals and again they showed less fluid consumption. LMS animals had significantly higher intestinal permeability, but only when also exposed to the social stress in adulthood. The current results support a two-hit model, whereby early life events interact with adult life events in altering animals' vulnerability.
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Liu L, Li Q, Sapolsky R, Liao M, Mehta K, Bhargava A, Pasricha PJ. Transient gastric irritation in the neonatal rats leads to changes in hypothalamic CRF expression, depression- and anxiety-like behavior as adults. PLoS One 2011; 6:e19498. [PMID: 21589865 PMCID: PMC3093391 DOI: 10.1371/journal.pone.0019498] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 04/05/2011] [Indexed: 12/27/2022] Open
Abstract
AIMS A disturbance of the brain-gut axis is a prominent feature in functional bowel disorders (such as irritable bowel syndrome and functional dyspepsia) and psychological abnormalities are often implicated in their pathogenesis. We hypothesized that psychological morbidity in these conditions may result from gastrointestinal problems, rather than causing them. METHODS Functional dyspepsia was induced by neonatal gastric irritation in male rats. 10-day old male Sprague-Dawley rats received 0.1% iodoacetamide (IA) or vehicle by oral gavage for 6 days. At 8-10 weeks of age, rats were tested with sucrose preference and forced-swimming tests to examine depression-like behavior. Elevated plus maze, open field and light-dark box tests were used to test anxiety-like behaviors. ACTH and corticosterone responses to a minor stressor, saline injection, and hypothalamic CRF expression were also measured. RESULTS Behavioral tests revealed changes of anxiety- and depression-like behaviors in IA-treated, but not control rats. As compared with controls, hypothalamic and amygdaloid CRF immunoreactivity, basal levels of plasma corticosterone and stress-induced ACTH were significantly higher in IA-treated rats. Gastric sensory ablation with resiniferatoxin had no effect on behaviors but treatment with CRF type 1 receptor antagonist, antalarmin, reversed the depression-like behavior in IA-treated rats CONCLUSIONS The present results suggest that transient gastric irritation in the neonatal period can induce a long lasting increase in depression- and anxiety-like behaviors, increased expression of CRF in the hypothalamus, and an increased sensitivity of HPA axis to stress. The depression-like behavior may be mediated by the CRF1 receptor. These findings have significant implications for the pathogenesis of psychological co-morbidity in patients with functional bowel disorders.
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Affiliation(s)
- Liansheng Liu
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America
| | - Qian Li
- Department of Pharmacology and Toxicology, University of Kansas, Kansas City, Kansas, United States of America
| | - Robert Sapolsky
- Department of Biology, School of Humanities and Sciences, Stanford University, Stanford, California, United States of America
| | - Min Liao
- Department of Surgery, University of California San Francisco, San Francisco, United States of America
| | - Kshama Mehta
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America
| | - Aditi Bhargava
- Department of Surgery, University of California San Francisco, San Francisco, United States of America
| | - Pankaj J. Pasricha
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, California, United States of America
- * E-mail:
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Abstract
OBJECTIVES The abdomen normally accommodates intra-abdominal volume increments. Patients complaining of abdominal distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in abdominal distension. METHODS In 20 patients complaining of abdominal bloating and 15 healthy subjects, we increased the volume of the abdominal cavity with a colonic gas load, while measuring abdominal girth and electromyographic activity of the anterior abdominal muscles and of the diaphragm. RESULTS In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more abdominal distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. CONCLUSIONS In this experimental provocation model, abnormal accommodation of the diaphragm is involved in abdominal distension.
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Shen B, Sanmiguel C, Bennett AE, Lian L, Larive B, Remzi FH, Fazio VW, Soffer EE. Irritable pouch syndrome is characterized by visceral hypersensitivity. Inflamm Bowel Dis 2011; 17:994-1002. [PMID: 20684016 DOI: 10.1002/ibd.21412] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Irritable pouch syndrome (IPS) is a functional disorder in patients with ileal pouch-anal anastomosis (IPAA), which presents with symptoms in the absence of structural abnormalities of the pouch. Thus, it resembles other functional disorders, such as irritable bowel syndrome characterized by visceral hypersensitivity in the presence of normal rectal biomechanics. The aim was to assess pouch biomechanics and perception of balloon distension in different groups of subjects with IPAA and to correlate the findings with clinical features. METHODS Pouch tone, compliance, and sensation to balloon distension were measured in 18 patients with IPS, 11 patients with active pouch inflammation (pouchitis or Crohn's disease of the pouch), and 12 asymptomatic subjects with normal pouches. All patients were recruited from a subspecialty Pouchitis Clinic. RESULTS Scores of sensation of gas, urge to defecate, and pain measured by visual analog scales at various distension pressures were significantly higher in IPS than pouchitis and normal pouch patients. Pouch tone was comparable among the groups and compliance was reduced in the pouchitis group. The visual analog scale showed a trend of correlation with the Pouchitis Disease Activity Index symptom scores in IPS. CONCLUSIONS IPS, like other gut functional disorders, is characterized by visceral hypersensitivity, with normal pouch biomechanics.
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Affiliation(s)
- Bo Shen
- Department of Gastroenterology, Digestive Disease Institute, the Cleveland Clinic Foundation, Cleveland, Ohio, USA
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