An increase in intestinal gas production due to small intestinal bowel overgrowth (SIBO) is a contributing factor for flatus incontinence. The aims of our study were to assess the efficacy of ...metronidazole in a select population of patients with flatus incontinence associated with SIBO and to compare its efficacy with that of a combination of simethicone and activated charcoal (SC; Carbosylane) in randomized experimental arms.
Adult patients suffering from flatus incontinence associated with SIBO diagnosed by a glucose breath test were enrolled in the study. They were given metronidazole or Carbosylane (SC) for 10 days. The reduction in the mean daily number of gas leakages reported in a 3-day diary before and at the end of the treatment was used as the primary endpoint.
Of 52 consecutive subjects with flatus incontinence, 23 (44%) had SIBO, 16 (33%) of whom were included in and completed the study. The relative reduction in flatus incontinence episodes was significantly higher in the metronidazole than in the SC group (66.8±34.8% vs. 25±50%, P = 0.03), decreasing by more than 50% in 7 (87.5%) of the subjects in the metronidazole group compared with only 1 (12.5%) in the SC group (odds ratio 1.9, 95% confidence interval 0.9-56.9, P = 0.06).
Our results show a promising trend indicating that metronidazole might significantly improve flatus incontinence associated with SIBO and might be more successful in treating flatus incontinence than gas absorbents.
Abstract Objective Intestinal glucose absorption is orchestrated by specialized glucose transporters such as SGLT1 and GLUT2. However, the role of GLUT2 in the regulation of glucose absorption ...remains to be fully elucidated. Methods We wanted to evaluate the role of GLUT2 on glucose absorption and glucose homeostasis after intestinal-specific deletion of GLUT2 in mice (GLUT2ΔIEC mice). Results As anticipated, intestinal GLUT2 deletion provoked glucose malabsorption as visualized by the delay in the distribution of oral sugar in tissues. Consequences of intestinal GLUT2 deletion in GLUT2ΔIEC mice were limiting body weight gain despite normal food intake, improving glucose tolerance, and increasing ketone body production. These features were reminiscent of calorie restriction. Other adaptations to intestinal GLUT2 deletion were reduced microvillus length and altered gut microbiota composition, which was associated with improved inflammatory status. Moreover, a reduced density of glucagon-like peptide-1 (GLP-1) positive cells was compensated by increased GLP-1 content per L-cell, suggesting a preserved enteroendocrine function in GLUT2ΔIEC mice. Conclusions Intestinal GLUT2 modulates glucose absorption and constitutes a control step for the distribution of dietary sugar to tissues. Consequently, metabolic and gut homeostasis are improved in the absence of functional GLUT2 in the intestine, thus mimicking calorie restriction.
The aim of our study is to evaluate the association between meals and perceived gastrointestinal symptoms in real life in a French cohort of irritable bowel syndrome (IBS) patients.
This prospective ...cross-sectional observational study included patients from the French association (association des patients souffrant du syndrome de l'intestin irritable APSSII) of IBS. Data were collected on demographics, IBS subtype, dietary food, and meal-induced gastrointestinal symptoms from patient filled self-questionnaires or questionnaires.
Eighty-four patients with IBS were included; 82.3% female with a mean age of 46.9 ± 15.7 years. Each transit pattern subtype represented one-third of the population. Forty-five percent of patients had severe IBS according to IBS-Severity Scoring System; mean IBS Quality of Life score was 53.9 ± 18.3. Patients believed that food could trigger or exacerbate gastrointestinal symptoms in 73.3% and 93.4%, respectively. Eighty-nine percent had already tried diets, mostly lactose free diet and low fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols diet in 61.3% and 53.6% of cases. Thirty-nine percent of meals induced gastrointestinal symptoms. Meal-induced gastrointestinal symptoms were associated with severity and subtype but not with quality of life.
This study has confirmed the important link between gastrointestinal symptoms and food. Gastrointestinal symptoms induced by meals are frequent and associated with severity and IBS-diarrhea subtype. Our study also underlines patients' interest in food and diet. More knowledge is needed on food that triggers IBS symptoms but also on diet conditions in order to improve this condition.
Magnetic resonance colonography (MRC) has been developed to assess inflammatory bowel diseases. We aimed to assess the feasibility of MRC in rats with TNBS-induced chronic colitis and to confront ...imaging results with fibrosis and stenosing features of the model.
Chronic colitis was induced in 12 rats by weekly intra-rectal injection of increasing doses of TNBS for 6 weeks, while 8 control rats received the vehicle. At week 7, MRC was performed. Fibrosis scores were assessed and fibrosis mediators measured.
Chronic colitis was associated with significant body weight loss (p<0.0001) and higher colon weight/length compared to controls (p = 0.0004). Fibrosis mediators and histological scores were significantly higher in rats with TNBS than in controls: α-SMA expression (0.9 versus 0.61, p = 0.0311) and fibrosis score (p = 0.0308). Colon wall thickness was higher in rats with TNBS than in controls: maximal thickness (2.38 versus 0.74 mm, p<0.0001) and minimal thickness (1.33 versus 0.48 mm, p<0.0001). Wall signal intensity on T2w images was higher in rats with TNBS than in controls (9040 versus 6192, p = 0.0101) and correlated with fibrosis score (r = 0.5214; p = 0.04). Luminal narrowing was higher in rats with TNBS (50.08 versus 10.33%, p<0.0001) and correlated with α-SMA expression (r = 0.5618; p = 0.01). Stenosis was observed in 7/9 rats with TNBS and in no controls (p = 0.0053).
MRC is feasible and easily distinguishes rats with colitis from controls. MRC signs correlated with fibrosis parameters. MRC evaluation may be part of a new anti-fibrosis drug assessment in experimental models of chronic colitis.
Background/Aims
Association between symptoms, quality of life and gastric emptying in dyspepsia is inconsistent in the literature. The aim of our study is to investigate if gastric emptying is ...associated with specific symptoms and quality of life in dyspeptic patients.
Methods
We reviewed retrospectively gastric emptying measured by 13C-labelled octanoate breath testing for more than 6 hours in 198 consecutive patients with dyspepsia complaints. Gastrointestinal symptoms were assessed using a 5-points Likert scale and by a symptomatic composite score, whereas quality of life was measured by the GIQLI.
Results
In our cohort, 90 patients (45%) had a delayed gastric emptying (half emptying time above 166 minutes when assessed over 6-8 hours). There was no difference in symptoms or quality of life between patients with or without delayed gastric emptying. However, patients with severely delayed gastric emptying (half emptying time above 200 minutes) had increased postprandial fullness (P = 0.012), abdominal pain (P = 0.026), bloating (P = 0.044), early satiety (P = 0.018), symptomatic composite score (P = 0.005), and a lower quality of life (P = 0.018). This association was no longer observed if the calculation of gastric emptying was limited to the first 4-hour samples.
Conclusions
There is no association between symptoms, quality of life and gastric emptying in an overall dyspeptic population. However, there is an association between symptoms, quality of life of delayed gastric emptying in the subgroup of patients with severely delayed gastric emptying. An 8-hour measurement of gastric emptying should be recommended.
(J Neurogastroenterol Motil 2019;25:534-543)
Neither food intake nor the clinical characteristics of irritable bowel syndrome (IBS) patients with severe food avoidance and restriction have been investigated. The aim of our study was to identify ...those patients and to characterize their symptoms, quality of life, and nutrient intake.
IBS patients who completed the IBS Quality of Life Instrument (IBS-QOL) at our secondar and tertiary center were included. The 3 questions constituting the food domain were used to identify patients with reported severe food avoidance and restriction. The patients also completed validated questionnaires to assess stool form (Bristol Stool Form), gastrointestinal (GI) symptom severity (z score of IBS Severity Scoring System and Gastrointestinal Symptom Rating Scale-IBS), psychological distress (Hospital Anxiety and Depression Scale), GI-specific anxiety (Visceral Sensitivity Index), and somatic symptom severity (z score of Symptom Checklist-90-Revised and Patient Health Questionnaire-15). A 4-day food diary was used to analyze food intake in 246 patients.
We included 955 IBS patients (75 % women; mean age 38.3 ± 13.3 years). In total, 13.2 % of the patients reported severe food avoidance and restriction, and in these patients all aspects of quality of life were lower (P < .01) and psychological, GI, and somatic symptoms were more severe (P < .05). Reported severe food avoidance and restriction was associated with lower total energy intake (P = .002) and lower intake of protein (P = .001) and carbohydrates (P = .005). In a logistic regression analysis, loose stools were found to be independently associated with reported severe food avoidance and restriction (R
= 0.062).
IBS patients with severe food avoidance and restriction constitute a subgroup with more severe symptoms overall, reduced quality of life, and reduced intake of nutrients. This needs to be acknowledged in the clinical management of these patients.
AIM:To investigate whether targeting proteasome might reverse intestinal fibrosis in rats.METHODS:Chronic colitis was induced in rats by repeated administration of increasing dose ...of2,4,6-trinitrobenzene sulfonic acid(TNBS,15,30,45,60,60,60 mg)by rectal injection for 6 wk(from day0 to day 35),while control rats received the vehicle.TNBS+bortezomib(BTZ)rats received intraperitoneal injections of BTZ twice weekly(from day 37 to day44)at a dose of 25 mg/kg,whereas the control and TNBS groups received the same amount of the vehicle.Histologic scoring of inflammation and fibrosis was performed.Colonic production of transforming growth factor(TGF)-βwas measured by ELISA.Colon fibrosisrelated proteins such as phospho-p38,phosphoSMAD2/3,Akt and peroxisome proliferator activated receptorγ(PPARγ)were studied by western blot.Expression of the tight junction proteins,occludin and claudin-1,were assessed by Western blot.Colon proteasome activities(chymotrypsin-like and trypsinlike activities)were assessed.RESULTS:TNBS-treated rats had a higher colon weight/length ratio compared to control rats(P<0.01).Furthermore,fibrosis and inflammation scores were higher in TNBS-treated rats compared to control rats(P<0.01 for both).Colonic production of TGF-βproduction tended to be higher in TNBS-treated rats(P<0.06).Fibrosis-related proteins such as phospho-p38,phospho-SMAD2/3,and PPARγwere significantly higher in TNBS-treated rats compared to control rats(all P<0.05).TNBS rats had a higher expression of Akt compared to control rats(P<0.01).Tight junction proteins were modified by repeated TNBS challenge:colon occludin expression rose significantly(P<0.01),whereas claudin-1 expression fell(P<0.01).Bortezomib inhibition significantly decreased chymotrypsin-like activity(P<0.05),but had no significant effect on trypsin-like activity(P>0.05).In contrast,bortezomib had no effect on other studied parameters such as fibrosis score,TGF-βsignaling,or tight junction expression(P>0.05 for all).CONCLUSION:Rats with TNBS-induced chronic colitis exhibited colon fibrosis associated with higher TGF-βsignaling.Proteasome inhibition by bortezomib had no effect on fibrosis in our experimental conditions.
Introduction
Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS) patients. The aim of this study was to determine the prevalence of symptomatic fructose malabsorption in IBS ...patients and to test whether the patient's characteristics can help to detect a fructose malabsorption.
Materials and methods
Ninety Rome III IBS patients (predominant diarrhoea (IBS-D): 31%, predominant constipation (IBS-C): 18%, mixed type (IBS-M): 51%) were included prospectively. After exclusion of a small intestinal bacterial overgrowth by a glucose breath test, fructose malabsorption was assessed by a five-hour breath test, with symptom monitoring, after a 25 g load of fructose. An increase of more than 20 ppm of hydrogen (H2) or methane (CH4) levels in the exhaled air led to the diagnosis of malabsorption.
Results
Fructose test was abnormal in 20/90 patients among whom only 35% were intolerant, with a simultaneous rise of H2/CH4 levels and the onset of abdominal discomfort or diarrhoea. IBS characteristics were not predictive even if young (p = 0.031) and male IBS patients (p = 0.029) were at higher risk of malabsorption. At variance, 18 additional patients experienced intestinal symptoms during the test despite normal fructose absorption.
Discussion
After a 25 g fructose load, symptomatic fructose malabsorption and intolerance without malabsorption were detected in 22% and 28% of IBS patients respectively.
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