Short-chain fructo-oligosaccharide administration dose-dependently increases fecal bifidobacteria in healthy humans

Short-chain fructo-oligosaccharides (SC-FOS) are a mixture of oligosaccharides consisting of glucose linked to fructose units (Gfn; n = </= 4), which are not digested in the human small intestine but are fermented in the colon where they specifically promote the growth of bifidobacteria. In healthy volunteers, we assessed the tolerance and the threshold dose of SC-FOS that significantly increased fecal bifidobacteria counts and the possibility of a dose-response relationship. Randomly divided into five groups and eating their usual diets, healthy volunteers (40: 18 males, 22 females) ingested in two oral doses for 7 d a powder mixture containing (g SC-FOS/d): 0, G0; 2.5, G2.5; 5, G5; 10, G10; 20, G20. Stools were collected before (d1) and at the end (d8) of sugar consumption, and tolerance was evaluated using a daily chart. Total anaerobe counts were not affected by SC-FOS ingestion. Bifidobacteria counts at d8 were greater in groups G10 and G20 than in G0 and G2.5 (P < 0.05). Fecal pH did not differ among groups. A significant correlation between the dose of SC-FOS ingested and the fecal bifidobacteria counts was observed at d8 (r = 0.53; P < 0.01). Excess flatus was significantly more frequent in subjects consuming G20 than in those consuming G0, G2.5 or G5 (P < 0.05), and more intense in G20 than in G0 and G5 groups (P < 0.05). In conclusion, the optimal and well-tolerated dose of SC-FOS that significantly increased fecal bifidobacteria in healthy volunteers consuming their usual diet is 10 g/d.

Foetal outcome in women with inflammatory bowel disease treated during pregnancy with oral mesalazine microgranules

BACKGROUND

Little information is available about the safety of high doses of mesalazine during pregnancy.

AIM

To study the fate of pregnancy and foetal outcome in women taking 1-4 g/day of mesalazine microgranules for inflammatory bowel disease.

PATIENTS AND METHODS

Case reports were collected from the Pharmacovigilance Department of Ferring SA, France, from a survey conducted in three gastroenterology units, and from a teratology information service. The evolution of pregnancy and foetal outcome were assessed by questionnaire.

RESULTS

The study covered a total of 123 pregnancies (126 foetuses). Ninety-six women took mesalazine during the first trimester, 85 during the second and 83 during the third. The mean daily dose was 2.1+/-0.8 g; 86 women received <3 g/day (low-dose group), 37 women received > or =3 g/day (high-dose group). The following abnormalities were observed in the low-dose and high-dose groups, respectively: ectopic pregnancy (1/0), spontaneous abortions (1/1), foetal death (0/1), premature deliveries (3/5, P < 0.05), congenital malformations (3/1) and one case of lethal oxalosis. Abnormalities were not considered to be related to mesalazine.

CONCLUSIONS

The use of oral mesalazine microgranules during pregnancy is safe at doses < or =2 g/day, and probably also at a dose of 3 g/day.

Demonstration of safety of probiotics -- a review

Probiotics are commonly defined as viable microorganisms (bacteria or yeasts) that exhibit a beneficial effect on the health of the host when they are ingested. They are used in foods, especially in fermented dairy products, but also in pharmaceutical preparations. The development of new probiotic strains aims at more active beneficial organisms. In the case of novel microorganisms and modified organisms the question of their safety and the risk to benefit ratio have to be assessed. Lactic acid bacteria (LAB) in foods have a long history of safe use. Members of the genera Lactococcus and Lactobacillus are most commonly given generally-recognised-as-safe (GRAS) status whilst members of the genera Streptococcus and Enterococcus and some other genera of LAB contain some opportunistic pathogens. Lactic acid bacteria are intrinsically resistant to many antibiotics. In many cases resistances are not, however, transmissible, and the species are also sensitive to many clinically used antibiotics even in the case of a lactic acid bacteria- associated opportunistic infection. Therefore no particular safety concern is associated with intrinsic type of resistance. Plasmid-associated antibiotic resistance, which occasionally occurs, is another matter because of the possibility of the resistance spreading to other, more harmful species and genera. The transmissible enterococcal resistance against glycopeptide antibiotics (vancomycin and teicoplanin) is particularly noteworthy, as vancomycin is one of the last effective antibiotics left in the treatment of certain multidrug-resistant pathogens. New species and more specific strains of probiotic bacteria are constantly identified. Prior to incorporating new strains into products their efficacy should be carefully assessed, and a case by case evaluation as to whether they share the safety status of traditional food-grade organisms should be made. The current documentation of adverse effects in the literature is reviewed. Future recommendations for the safety of already existing and new probiotics will be given.

Gluten-free diet induces regression of T-cell activation in the rectal mucosa of patients with celiac disease

OBJECTIVE

An increase in the number of intraepithelial lymphocytes (IEL) in the rectal epithelium of patients with active celiac disease has been described. No data are available about how they vary during a gluten-free diet. The aim of the study was to assess the effect of a gluten-free diet on T-cell activation in the rectal mucosa of adult patients with celiac disease.

METHODS

Frozen duodenal and rectal biopsies were available in four celiac patients (one male, three female, mean age 39 yr) both before and after 7 to 24 months on a gluten-free diet. Biopsy samples were stained using monoclonal antibodies directed against CD3, betaF1, TcRdelta1, CD25, and HLADR. Numbers of IEL were estimated by counting the peroxidase-stained cells per 100 epithelial cells. Four patients without histological abnormalities were used as control subjects.

RESULTS

In the four patients with active celiac disease but in none of the controls, CD25 was expressed by both duodenal and rectal lamina propria cells and HLADR was expressed by duodenal (4/4) and rectal (2/4) epithelial cells. In addition, two patients with active celiac disease had features of lymphocytic colitis, i.e., >20 IEL per 100 epithelial cells. After a gluten-free diet, the mean number of rectal CD3+ betaF1+ IEL decreased (9% vs 21%) and the expression of CD25 and HLADR was no longer present. These changes mirrored those found in the small intestinal biopsies.

CONCLUSION

These results suggest that in celiac disease, gluten-driven T-cell activation is not restricted to the proximal part of the intestine but is present on the whole intestinal length. Assessment of the effectiveness of a gluten-free diet through rectal biopsies warrants investigation, as it could lessen discomfort for patients and prove more cost-effective.

Casein peptide release and passage to the blood in humans during digestion of milk or yogurt

In adult humans, after milk or yogurt ingestion, many peptides derived from alpha s1-, beta- or kappa-caseins were detected in stomach, including the kappa-caseinoglycopeptide, an inhibitor of platelet aggregation. Smaller peptides derived from casein and lactoferrin were recovered from duodenum. Two long peptides, the kappa-caseinoglycopeptide and the N-terminal peptide of alpha s1-casein, were absorbed and detected in plasma. These results support the concept that food-born peptides could have physiological activities in man.

Use of mesalazine slow release suppositories 1 g three times per week to maintain remission of ulcerative proctitis: a randomised double blind placebo controlled multicentre study

BACKGROUND

Daily administration of rectal formulations of mesalazine is effective in preventing relapse of ulcerative proctitis. Maintenance of remission with lower doses would be an advantage.

AIM

The efficacy of mesalazine suppositories (Pentasa) 1 g three times a week v placebo to maintain remission in patients with cryptogenetic proctitis was studied.

METHODS

Ninety five patients with cryptogenetic proctitis were randomised within two weeks of remission to receive for one year or until relapse three suppositories per week of either Pentasa (n = 48) or placebo (n = 47). In the case of a relapse, the patients received one suppository/day.

RESULTS

It was found that 25 of 48 subjects v 18 of 47 remained in remission in the mesalazine and placebo groups respectively. The relapse rate was lower in the mesalazine group for the following time intervals: 0-90 days (19% v 38%, p = 0.035), 0-180 days (29% v 54%, p = 0.017), 0-270 days (38% v 60%, p = 0.031), and 0-365 days (48% v 62%, p = 0.18). Treatment of relapse with one suppository/day induced remission in 11 of 18 and 2 of 26 patients in the mesalazine and placebo groups respectively (p = 0.001). Overall, 61% v 28% patients remained in the protocol and were in remission at one year (p = 0.001). Tolerance was good.

CONCLUSION

Mesalazine suppositories 1 g three times a week are effective for preventing relapses of cryptogenetic proctitis. Increasing the dose to 1 g/day is effective in a high proportion of subjects who relapsed.

Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?

BACKGROUND

Uncontrolled studies of lactose intolerant subjects have shown that symptom severity decreases after chronic lactose consumption. Adaptation of the colonic flora might explain this improvement.

AIMS

To compare the effects of regular administration of either lactose or sucrose on clinical tolerance and bacterial adaptation to lactose.

METHODS

Forty six lactose intolerant subjects underwent two 50 g lactose challenges on days 1 and 15. Between these days they were given 34 g of lactose or sucrose per day, in a double blind protocol. Stool samples were obtained on days 0 and 14, to measure faecal beta-galactosidase and pH. Symptoms, breath H2 excretion, faecal weight and electrolytes, and orofaecal transit time were assessed.

RESULTS

Except for faecal weight, symptoms were significantly milder during the second challenge in both groups, and covariance analysis showed no statistical difference between them. In the lactose group, but not in the sucrose group, faecal beta-galactosidase activity increased, pH dropped, and breath H2 excretion decreased.

CONCLUSION

Bacterial adaptation occurred when lactose intolerant subjects ingested lactose for 13 days, and all symptoms except diarrhoea regressed. Clinical improvement was also observed in the control group which displayed no signs of metabolic adaptation. This suggests that improved clinical tolerance may be just a placebo effect.

Mesalazine-induced lupus

We report a case of lupus induced by mesalazine therapy taken for over a year for Crohn's disease. The patient had polyarthritis, alopecia, lymphoneutropenia, antinuclear factors, anti-histone antibodies, anti-Sm and anti-RNP. Discontinuation of mesalazine was followed by rapid resolution of the joint manifestations, alopecia and lymphoneutropenia; the anti-histone antibodies fell to undetectable levels and the titers of the other auto-antibodies decreased gradually.

Primary ileal villous atrophy is often associated with microscopic colitis

Three cases of apparent primary villous atrophy of the terminal ileum in women with chronic diarrhoea are reported. Eight cases have previously been reported in the literature. Clinical characteristics are the presence of severe chronic secretory diarrhoea with episodes of hypokalaemia combined with signs of ileal malabsorption and/or efficacy of cholestyramine. Diagnosis is based on ileoscopy and histology. An association with microscopic colitis was present in the three patients and in four cases in the literature. The pathogenesis of primary ileal villous atrophy remains unknown and may involve dysimmunity. Its association with microscopic colitis may indicate a common pathogenesis or support the hypothesis that the faecal stream or bile salts play a role in the pathogenesis of microscopic colitis.

A randomized double blind placebo controlled multicenter study of mesalazine for the prevention of acute radiation enteritis

BACKGROUND AND PURPOSE

Symptoms of acute radiation enteritis (ARE), dominated by diarrhea, occur in more than 70% of patients receiving pelvic irradiation. Eicosanoids and free radicals release have been implicated in the pathogenesis. Mesalazine (5-ASA) is a potent inhibitor of their synthesis in the mucosa and could therefore be of some interest in preventing ARE.

PATIENTS AND METHODS

The study was performed in six radiotherapy units in France who agreed on standardized irradiation procedures. One hundred and fifty-three patients planned for external beam radiotherapy to the pelvis > or = 45 Gy for prostate (n = 97) or uterus (n = 54) cancer were randomized on a double blind basis to receive prophylactic 5-ASA (4 g/day Pentasa) or placebo. Patients with concomitant chemotherapy were excluded. Prostate and uterus cancers were chosen since these centropelvic tumors require a similar radiotherapy protocol during the first step of treatment and involve a comparable volume of small intestine. The symptoms of ARE and their severity were assessed every week during irradiation, and 1 and 3 months after its end. All patients followed a low fiber and low lactose diet. End points were diarrhea, use of antidiarrheal agents, abdominal pain, and body weight. Effficacy was evaluated using intention to treat.

RESULTS

(means +/- SD) Groups did not differ for age (mean 64 +/- 9 years), sex, tumor site, or irradiation procedure. During irradiation, diarrhea occurred in 69% and 66% of the 5-ASA and placebo groups, respectively (chi2, P = 0.22). Curves of survival without diarrhea did not differ between groups (logrank P = 0.09). Severity of diarrhea did not differ between groups except at d15 where it was significantly more severe in the 5-ASA group (ANOVA P = 0.006). Duration of diarrhea did not differ (22 +/- 15 days in both groups, P = 0.88). Abdominal pain was less frequently reported in the 5-ASA group at d28 (34% vs. 51%, P = 0.048). Use of antidiarrheal agents and body weight did not differ between groups.

CONCLUSION

Mesalazine 4 g/day did not decrease the symptoms of ARE.

Survival of lactic acid bacteria in a dynamic model of the stomach and small intestine: validation and the effects of bile

This study was conducted to validate a dynamic model of the stomach and small intestine to quantify the survival of lactic acid bacteria and to assess the influence of gastrointestinal secretions. The survival of a single strain of each of the following species, Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus bulgaricus, and Streptococcus thermophilus, was measured under physiological conditions (e.g., peristalsis, changes in pH, and changes in concentrations of enzymes and bile) and were compared with data obtained from humans. No significant differences were found between the in vitro and in vivo data, indicating that the model has a predictive value for the survival of these bacteria in humans. The survival of these strains of lactic acid bacteria in the gastrointestinal model was investigated under two different conditions in the small intestine: simulation of physiological secretion of bile and low bile secretion. Reductions in viability were significantly different between the bacterial species. The dose-response effect of bile on the survival of the tested bacteria was significant, demonstrating the bactericidal effect of bile salts. This study demonstrates the differences among bacterial species in their sensitivity to gastric and intestinal secretions.

Efficacy and tolerance of mesalazine suppositories vs. hydrocortisone foam in proctitis

BACKGROUND

Topical treatments with steroids or mesalazine are the most effective treatments for idiopathic proctitis.

AIM

To compare the efficacy and tolerance of mesalazine suppositories vs. hydrocortisone acetate foam in the treatment of acute proctitis.

PATIENTS AND METHODS

242 patients with active idiopathic proctitis were randomized to receive once daily either one Pentasa suppository (mesalazine 1 g) or 100 mg hydrocortisone (Colofoam) for 14-21 days (until remission). Disease activity and tolerance of the treatments were assessed using a daily questionnaire, by physician assessment, and endoscopy score.

RESULTS

Both treatments induced a significant reduction in disease activity. Mesalazine suppositories were significantly more effective than hydrocortisone on rectal blood loss (P = 0.002) and mucus (P = 0.02) parameters, and on the degree of the decrease in endoscopy score (P = 0.02). No significant difference was observed between treatments concerning histology or tolerance.

CONCLUSION

Mesalazine suppositories were as well-tolerated as hydrocortisone foam, but were more effective for some parameters of disease activity.

Effects of intrajejunal perfusion and chronic ingestion of Lactobacillus johnsonii strain La1 on serum concentrations and jejunal secretions of immunoglobulins and serum proteins in healthy humans

OBJECTIVES

Link-Amster reported an increase in serum IgA when healthy subjects ingested a fermented dairy product containing Lactobacillus johnsonii La1. We aimed to assess the effects of La1 on the jejunal secretions and serum concentrations of total and specific immunoglobulins and proteins.

METHODS

Twelve healthy volunteers ingested a fermented milk containing La1 or a control from day 1 till day 28, following a randomised double blind protocol. At days 0 and 28, the jejunum was successively perfused with a control solution and with a La1 suspension. The serum concentrations and jejunal secretions of albumin, orosomucoid, transferrin, alpha 2-macroglobulin, m-IgA, p-IgA, IgG, IgM, secretory component, and specific antibodies against La1 were assessed.

RESULTS

Serum concentrations of IgA slightly increased between d0 and d28 in the group receiving La1 (1.85 +/- 0.64 g/L vs 1.76 +/- 0.76; P = 0.02). The other parameters were not altered.

CONCLUSION

This study shows that the immunomodulating effects of La1 ingestion in man are not due to modification of jejunal protein permeability.

Do patients with short-bowel syndrome need a lactose-free diet?

We compared the tolerance of a diet providing 20 g/d lactose and a lactose-free diet in 14 patients with short-bowel syndrome with either the colon in continuity (group A, n = 8) or a terminal jejunostomy (group B, n = 6). Lactose tolerance was studied after a single 20-g lactose load in the fasting state, and during two 3-d periods during which the subjects consumed their usual diet plus either 20 g/d lactose, with no more than 4 g/d as milk, or no lactose. Records and measurements included symptoms, fecal weight, and during the 8 h after the lactose load, breath-hydrogen excretion (group A) or lactose and hexoses flow rates in stomal effluents (group B). Results are expressed as medians with ranges in parentheses. Lactose absorption was 61% (0-90) in group A and 53% (18-84) in group B, and no symptoms of intolerance were noticed. During the lactose-rich diet as compared to the lactose-free diet, no symptoms were noticed nor was there any worsening of diarrhea: 1534 g/d (240-4760) versus 1466 (1590-7030) in group A, and 4122 g/d (1730-6830) versus 3496 (1590-7030) in group B. We conclude that a diet providing 20 g/d lactose with no more than 4 g/d as milk is well tolerated in the majority of patients with short-bowel syndrome, and that a lactose-free diet has usually no benefit in these subjects.

Ileal absorption of bile acids in patients with chronic cholestasis: SeHCAT test results and effect of ursodeoxycholic acid (UDCA)

The effect of cholestasis on ileal bile acid absorption is controversial in animal models (up- or down-regulation) and unknown in humans. We therefore studied values of the selena homotaurocholic acid (SeHCAT) test before and after long-term administration (>3 months, 13-15 mg/kg/day) of ursodeoxycholic acid (UDCA) in 27 patients with chronic cholestatic liver diseases (24 women, 3 men; mean age, 50 years; 24 primary biliary cirrhosis, 2 secondary biliary cirrhosis, 2 others). The control group consisted of 14 healthy volunteers. Seven-day SeHCAT percentage retention was identical in the 12 untreated cholestatic patients (serum bilirubin, 75+/-42 micromol/L, alkaline phosphatase, 4.2+/-1.0 N; mean+/-SEM) and in the control group (43.6+/-2.9 and 43.8+/-4.2%, respectively). In the 22 patients treated by UDCA for 38+/-8 months, SeHCAT percentage retention was 20.3+/-3.0%. In the seven patients with the SeHCAT test done before and after UDCA treatment (16+/-5 months), SeHCAT percentage retention decreased significantly under UDCA therapy (42.0+/-4.4 vs 19.4+/-4.1%; P < 0.02). We conclude that, in patients with chronic cholestasis (1) SeHCAT percentage retention is not altered-taken together with the known defect of biliary excretion, this lack of increase in SeHCAT percentage retention argues against up-regulation of bile acid ileal transport; and (2) UDCA treatment induces a decrease in the SeHCAT percentage retention-this effect may be related primarily to a decreased bile acid ileal absorption.

Adverse events in patients treated with 5-aminosalicyclic acid: 1993-1994 pharmacovigilance report for Pentasa in France

BACKGROUND

The incidence of the side-effects of 5-aminosalicylic acid (5-ASA) in clinical practice is not known.

AIM

To present the safety reports on the use of Pentasa in France.

METHODS

Pentasa-related adverse events were recorded from 1 January 1993 to 31 December 1994. Spontaneous reports to Ferring S.A. came from physicians or pharmacovigilance regional centres.

RESULTS

In 1993 and 1994, 51 and 79 adverse events were reported; the estimated gross incidence was 6.6 and 9.0 per million days of therapy. Detailed information was obtained 64% of cases in 1993 and 53% in 1994. Adverse events with a high likelihood of causalty included five cases of diarrhoea, 14 cases of pancreatitis, seven cases of liver abnormalities, seven of blood dyscrasias, two cases of renal insufficiency (one of which was in a fetus), and eight of cardiac disorders including three myocarditis.

CONCLUSIONS

Pentasa seldom has adverse effects. The majority of the adverse events do not seem to be dose-related. Clinicians should be aware of exceptional but severe adverse events including pancreatitis, cardiac disorders, blood dyscrasias and renal insufficiency.

Digestion and tolerance of lactose from yoghurt and different semi-solid fermented dairy products containing Lactobacillus acidophilus and bifidobacteria in lactose maldigesters--is bacterial lactase important?

OBJECTIVE

To compare the digestibility and tolerance of lactose from three semi-solid fermented dairy products with the same amount of lactose but different lactase contents and bacterial cultures in lactase deficient adults.

DESIGN

Measurement of breath hydrogen (H2) concentration and of clinical symptoms after consumption of the test meals.

SETTING

Metabolic ward for healthy volunteers, INSERM U290, Hôpital St. Lazare, Paris.

SUBJECTS

Fifteen lactase-deficient healthy adult volunteers (20-45 y) started the study. One subject became a non-H2-producer during the study; therefore the results of 14 subjects are presented.

INTERVENTION

Each subject consumed, on four different days and in random order, after a 12 h fast, three semisolid test meals containing 18 g of lactose, and a 10 g dose of lactulose which allowed calculation of lactose malabsorption. The three meals were: traditional yoghurt, fermented milk (Ofilus) that contained Lactobacillus acidophilus and Bifidobacterium sp., and a similar product 'Bulgofilus' enriched with Lactobacillus bulgaricus to increase the lactase content.

RESULTS

Compared with lactulose, the sum of symptoms was significantly lower for Bulgofilus (P = 0.05), and bloating was less severe for Ofilus (P = 0.06). Between the fermented milks, there were no differences. The area under the breath H2 curve was significantly lower for each fermented milk when compared to lactulose (P < 0.0001). The degree of maldigestion of lactose did not differ significantly between the products; it was 21 +/- 3% (range 6-52) for Ofilus, 21 +/- 3% (range 6-44) for Bulgofilus, and 18 +/- 3% (range 3-43) for yoghurt.

CONCLUSION

Despite the differences in the lactase and bacterial content, lactose was as well digested and tolerated from the three different semi-sold fermented dairy products. This could be due to a slow gastric emptying of the semi-solid milk.

Calcium, phosphorus, vitamin D, dairy products and colorectal carcinogenesis: a French case--control study

A protective effect of calcium against colorectal cancer has been described in Anglo-Saxon but not in Latin communities, and no such effect has been observed regarding adenomas. We investigated the relationship between calcium, dairy products and the adenoma-carcinoma sequence in a French region by comparing small adenoma ( < 10 mm, n = 154), large adenoma (n = 208) and polyp-free (n = 426) subjects, and cancer cases (n = 171) with population controls (n = 309). There was no protective effect of calcium against colorectal tumours except for low fat calcium and large adenomas in men (OR for highest quintile = 0.3, P for trend = 0.06). There was even a trend towards an increased risk of cancer with dairy calcium in men and non-dairy calcium in women. Vitamin D was inversely related to the risk of small adenomas in women (OR for highest quintile = 0.4, P for trend = 0.04). Regarding dairy products, only consumption of yoghurt displayed an inverse relationship with risk of large adenomas, in both men and women. These data failed to demonstrate a protective effect of calcium against colorectal carcinogenesis. They suggest that the type of dairy product might be the important factor with regard to prevention of colorectal tumours.

[Isolated and spontaneously regressive colonic neurofibromatosis]

This case report concerns a man presenting protein losing enteropathy. Multiple polypoid colonic lesions were discovered corresponding to intra and submucosal neurofibromas. No extradigestive sign was noticed, and the diagnosis of isolated colonic neurofibromatosis was upheld. Eight years later, it was observed that both protein losing enteropathy and the colonic neurofibromas had apparently spontaneously disappeared. Isolated digestive neurofibromatosis and spontaneous tumoural regressions are discussed.

Inability of Lactobacillus casei strain GG, L. acidophilus, and Bifidobacterium bifidum to degrade intestinal mucus glycoproteins

BACKGROUND

Lactic acid bacteria have been suggested for use in the prevention of relapse of ulcerative colitis and of recurrent pouchitis. These strains may not damage the protective intestinal mucus glycoproteins.

METHODS

Lactobacillus casei strain GG and strains isolated from a commercial fermented product (Lactobacillus acidophilus, Bifidobacterium bifidum, and a mesophylic lactic culture) were cultured in vitro on hog gastric mucin and human intestinal glycoproteins. Furthermore, germ-free rats were mono-associated with Lactobacillus GG and poly-associated with the other strains. Glycoproteins were isolated from rat distal ileum, cecum, and colon. Mucus degradation was established by assaying carbohydrates (hexosamines, hexoses, pentoses), proteins, and blood group antigenicity.

RESULTS

All strains colonized the intestinal mucus but were not found in the deep crypts. Degradation of mucus glycoproteins was observed neither in vitro nor in vivo.

CONCLUSION

The tested strains do not break down intestinal mucus glycoproteins and thus far are safe to use for therapy.

[Comparative randomized open study of the efficacy and tolerance of enemas with 2 gr of 4-amino-salicylic acid (4-ASA) and 1 gr of 5-amino-salicylic acid (5-ASA) in distal forms of hemorrhagic rectocolitis]

OBJECTIVES AND METHODS

The aim of this multicentre, randomized open trial was to compare the efficacy and tolerance of 4-ASA vs 5-ASA enemas in the treatment of distal moderately active ulcerative colitis. Fifty patients were randomized to receive enemas in 100 mL suspension of 4-ASA (2 g, n = 26), or 5-ASA (1 g, n = 24). The subjects filled a daily questionnaire on enema retention duration, and tolerance. Clinical and endoscopic evaluations were performed at baseline and after 2 and 4 weeks.

RESULTS

Significant clinical and endoscopic improvements occurred in both groups. Efficacy and enema retention time did not differ between groups. Tolerance was significantly better for 4-ASA: score 0.46 +/- 0.77 vs 1.00 +/- 0.73, P = 0.03.

CONCLUSIONS

Efficacy of both treatments was equivalent, but 4-ASA enemas were better tolerated than 5-ASA in this open trial.

Digestibility and bulking effect of ispaghula husks in healthy humans

The digestibility of ispaghula, a mucilage from Plantago ovata composed mainly of arabinoxylans, and its faecal bulking effect were studied in seven healthy volunteers who ingested a low fibre controlled diet plus either placebo or 18 g/day of ispaghula for two 15 day periods. Whole gut transit time and gas excretion in breath and flatus were not different during the periods of ispaghula and placebo ingestion. Faecal wet and dry weights rose significantly, however, during ispaghula ingestion. Faecal short chain fatty acid concentrations and the molar proportions of propionic and acetic acids also increased. Most of the ispaghula had reached the caecum four hours after ingestion in an intact highly polymerised form. During ispaghula ingestion, the increase in the faecal output of neutral sugars was accounted for by the faecal excretion of arabinose and xylose in an intact highly polymerised form; the apparent digestibilities of these sugars were 24 (11) and 53% (6) respectively (mean (SEM)). In conclusion, ispaghula is more resistant to fermentation than previously reported in humans, and its bulking effect largely results from intact material.

Tolerance and absorption of lactose from milk and yogurt during short-bowel syndrome in humans

This study aimed to compare the absorption and tolerance of 20-g lactose loads as milk and yogurt in 17 patients with short-bowel syndrome with either a terminal jejunostomy (group A, n = 6) or a jejunocolic anastomosis (group B, n = 11). Records and measurements during the 8 h after the meals included fecal weight, symptoms, lactose and hexose flow rates in stomal effluents (group A), and breath-hydrogen excretion (group B). In group A lactose was better absorbed in the form of yogurt than in the form of milk (mean +/- SE: 76 +/- 6% vs 50 +/- 9%, P < 0.05), whereas no significant difference could be detected by using the breath-hydrogen test in group B. The excellent tolerance to 20 g lactose from milk and yogurt suggests that lactose should not be excluded from the diet of these subjects.

Gastro-jejunal digestion of soya-bean-milk protein in humans

In order to determine how soya-bean proteins are digested and metabolized in the human intestine before colonic bacterial fermentation and to estimate their true digestibility, the gastro-jejunal behaviour of soya-bean proteins in water and in two other forms (a concentrated soya-bean-protein solution (isolate) and a drink composed of crude soya-bean proteins (soymilk)) was studied in humans. Experiments were carried out in eight healthy volunteers using a double-lumen steady-state intestinal perfusion method with polyethyleneglycol (PEG) as a non-absorbable volume marker. Gastric emptying and N and electrolyte contents of the jejunal digesta were analysed. Gastric half-emptying time (min) of the liquid phase after water ingestion (12.59 (SE 0.12)) was shorter (P < 0.05) than those for soymilk (37.74 (SE 11.57)) and isolate (36.52 (SE 11.23)). Electrolytic balances showed that for all meals, Na+, Cl- and K+ were secreted when Ca2+ was efficiently absorbed from the jejunal lumen. Gastro-jejunal N absorption for isolate and soymilk were 63 and 49% respectively, and were not significantly different from one another; after water ingestion, endogenous N was estimated to be 21 mmol. An estimate of the exogenous:endogenous values for the effluents was obtained from the amino acid compositions of soymilk and effluents after water or soymilk ingestion, indicating that 70% of the total N was exogenous and 30% endogenous. Under these conditions the endogenous fraction represented 31 mmol after soymilk ingestion and the gastro-jejunal N balance indicated that 54% of the soymilk was absorbed. This finding indicates that the true gastrojejunal digestibility of soya-bean proteins is similar to that of milk proteins.

Gastrointestinal effects and energy value of polydextrose in healthy nonobese men

We studied seven healthy volunteers before and during acute (PD1) and chronic (PD2) ingestion of 30 g polydextrose (PD)/d. The energy value of PD was assessed after [U-14C]PD was added to the 10-g morning dose of PD during PD1 and at the end of PD2. Thirty-one +/- five percent (mean +/- SD) (PD1) and 29 +/- 4% (PD2) of the dose appeared in breath within 48 h. A small fraction of the ingested radioactivity was recovered in urine (4 +/- 1%) and excreted in flatus (< or = 1%) and in feces as volatile fatty acids (VFAs) (< 1%) and bacteria (3-4%); the remaining radioactivity in stools, 33 +/- 3% (PD1) and 32 +/- 4% (PD2), was assumed to be intact PD. Breath excretion of the label was 49 +/- 5% after intracolonic infusion of [U-14C] acetate. The energy value of PD, calculated by means of Miller and Wolin's stoichiometric equation of colonic fermentation, was similar during PD1 and PD2: 4.0 and 6.1 kJ/g, respectively, when breath 14CO2 and VFA production from PD were used for calculation.

Association of hepatic vein obstruction and coeliac disease in North African subjects

This study describes three adults with coeliac disease and hepatic vein obstruction, an association which has not been reported so far. Similarities were found with the cases of five children with Budd-Chiari syndrome and intestinal villous atrophy recently reported in the literature. All subjects had North African origin. Coeliac disease and Budd-Chiari syndrome are uncommon conditions, and it is postulated that this is probably not a chance association, although no link between these diseases and the ethnic origin of the subjects could be elucidated.

Intestinal nitrogen and electrolyte movements following fermented milk ingestion in man

The present study focuses on the digestion and absorption of milk and fermented milk (FM) reflected by gastro-ileal N and electrolyte movements in six healthy volunteers. The N and electrolyte content of the intestinal effluents were analysed both at the beginning of the jejunum and in the distal ileum. The gastric half-emptying time of the liquid phase was significantly (P < 0.05) shorter for milk (35 (SE 2) min) than for FM (60 (SE 2) min). The N balance showed that 58 and 50% of ingested proteins, milk and FM respectively were absorbed between the stomach and the proximal jejunum and that 91 and 90% respectively were absorbed between the stomach and the terminal ileum in 240 min. Evaluation of mineral absorption indicated that 44 and 67% of Ca was absorbed in the duodenum after milk and FM ingestion respectively, and 41 and 11% of Ca disappeared between the jejunum and the ileum respectively. With regards to N and Ca intestinal availability, the present study confirms that FM products represent an interesting source of N as well as minerals for man. This confers on FM a beneficial effect compared with milk especially for lactase (EC 3.2.1.108)-deficient subjects and children with persistent diarrhoea.

Enterocolitis cystica profunda lesions in a patient with unclassified ulcerative enterocolitis

Enteritis cystica profunda and diffuse colitis cystica profunda are exceedingly rare conditions. We report here the first case in which these two entities are associated in one patient. This 48-year-old woman presented initially with a solitary ulcer of the rectum and developed later deep ileal and colonic ulcerations with intervening normal mucosa, polypoid masses, and a dense fibrosis of the bowel wall. Colon and ileum specimens demonstrated submucosal mucous cysts and occasionally herniation of mucosal epithelium into the submucosa, which led to the diagnosis of enteritis and colitis cystica profunda. The exact nature of the underlying ileocolonic disease, which necessitated colectomy and extensive ileal resection, remained undetermined although an aggravating role of iterative surgical procedures is possible. Enteritis cystica profunda and diffuse colitis cystica profunda therefore seem to share a common pathogeny and have to be considered as lesions complicating an underlying disease rather than specific and autonomic diseases.

Potential of using lactic acid bacteria for therapy and immunomodulation in man

There is in 1993 no proven medical indication of lactic acid bacteria (LAB) for therapy or immunomodulation in man. However, within the bulk of publications, rigorous trials have now opened rational fields of research on beneficial effects of LAB. These include lactose digestion, cholesterol metabolism, diarrheal disorders, prophylaxis of intestinal or urogenital infections, immunomodulation or even oral vaccination. We try here to analyse these studies, considering LAB as pharmacological agents, and conclude that pursuit of research could be promising for ecological therapy of mucosal diseases, and for development of original and flexible vectors for targeting in the gastrointestinal tract.

Alpha-chain disease: analysis of alpha-chain protein and secretory component in jejunal fluid

BACKGROUND

It is unclear why different forms of alpha-chain disease protein appear in intestinal fluid. This was studied in a 23-year-old Mauritanian man in whom alpha-chain disease was diagnosed localized to the duodenum and jejunum, nasopharynx, and bone marrow.

METHODS

The duodenal infiltrate was studied by immunohistochemistry. Forms of alpha chain-containing proteins in serum and jejunal fluid were analyzed by ultracentrifugation and radioimmunoassays.

RESULTS

The infiltrating cells contained alpha-1 chain but no light chains, and approximately 66% showed variable expression of J chain. Serum contained a large fraction of monomeric alpha-chain disease protein, whereas both monomeric and heavier forms appeared in jejunal fluid. Some of the latter were bound to secretory component, and the fluid contained virtually no free component.

CONCLUSIONS

Linkage of polymeric alpha-chain disease protein to secretory component depends on balanced synthesis of alpha chains and J chain in the proliferating B cells, giving rise to polymers with binding site for secretory component expressed as an epithelial receptor. Insufficient receptor-mediated transport capacity (either relative and/or because of intestinal crypt reduction) results in passive external transfer of polymers without bound secretory component along with leakage of serum-derived or locally produced monomeric alpha-chain disease protein, the latter presumably originating from immunocytes with little or no J-chain synthesis.

Peritoneal sarcoidosis. An unrecognized cause of sclerosing peritonitis

In a Caucasian woman with a history of ocular and pulmonary sarcoidosis, the occurrence of sclerosing peritonitis with exudative ascites but without any of the well-known causes of this syndrome prompts us to consider that sclerosing peritonitis is a manifestation of sarcoidosis. The dramatic improvement that occurred on corticosteroid therapy adds credibility to this previously unreported association.

Gastroileal nitrogen and electrolyte movements after bovine milk ingestion in humans

Gastric emptying and flow rates of nitrogen and electrolytes (Na+, K+, Cl-, Mg2+, Ca2+) were studied in humans after bovine milk ingestion. With water as the control, intestinal effluents were collected after meal ingestion at the beginning of the jejunum or in the distal ileum. The flow rate of the effluent peaked in the first 40-min period after meal ingestion and returned to the initial amount within 100 min. After water ingestion the quantity of nitrogen recovered in the digesta remained unchanged both in the jejunum and in the ileum during the test period. After milk ingestion the nitrogen concentration in the jejunal digesta peaked in the first 20 min. Forty-two percent of milk nitrogen was absorbed before the jejunum and 93% was absorbed before the end of the ileum. These results showed that for the completion of the absorption of dietary proteins such as milk proteins, the lower part of the intestine is necessary.

Association of chronic interstitial cystitis, protein-losing enteropathy and paralytic ileus with seronegative systemic lupus erythematosus: case report and review of the literature

We report the case of a female patient with seronegative lupus and predominant bladder and intestinal involvement in the form of interstitial cystitis and protein-losing enteropathy. This association is exceptional in the literature but may be underestimated because of frequent latency of interstitial cystitis. It may define a peculiar subgroup of lupus patients usually responsive to steroid therapy. In this case, only cyclophosphamide markedly improved the protein-losing enteropathy but did not influence the bladder disease.

Fecal recovery in humans of viable Bifidobacterium sp ingested in fermented milk

Bifidobacterium sp is a natural component of the dominant colonic microflora that was recently introduced into several fermented dairy products. The aim of the present study was to study the fate of this microorganism in the human gut. On the basis of antibiotic resistance characters, a variant of Bifidobacterium sp that could be distinguished from indigenous bifidobacteria in the fecal flora was selected, and its survival and colonization in the colon was examined. This strain was used to ferment milk, and 125 g of the fermented product obtained was ingested by eight healthy volunteers three times daily for 8 days. Stools were recovered and weighed throughout the study. The results showed that the exogenous Bifidobacterium sp appeared in the stools and reached a mean level of 8.8 +/- 0.1 log colony-forming units per gram. This level was maintained as long as the fermented dairy product was consumed. When its ingestion stopped, the exogenous Bifidobacterium sp gradually decreased and was no longer detectable 8 days after cessation. The mean recovered quantity during the 8-day period of administration of the ingested bifidobacteria excreted in stools was 12.1 +/- 0.1 log colony-forming units per gram, i.e., 29.7% +/- 6% of the ingested bacteria, which was similar to the percentage that reached the colon in previous studies. It is concluded that under physiological conditions, exogenously administered Bifidobacterium sp do not colonize the human colon. However, the high fecal concentrations of exogenous bifidobacteria reached are compatible with metabolic "probiotic" activities.

Survival of bifidobacteria ingested via fermented milk during their passage through the human small intestine: an in vivo study using intestinal perfusion

The ability of a strain of Bifidobacterium sp to survive passage through the upper gastrointestinal tract when ingested in fermented milk was investigated in six fasting healthy adults by using in vivo ileal perfusion. After ingestion of 10.0 +/- 0.5 log10 bifidobacteria in 400 g fermented milk, ileal flow of bifidobacteria increased significantly and reached a maximum of 8.8 +/- 0.2 log10 bifidobacteria/h 1.7 +/- 0.4 h after ingestion of fermented milk. The average number of bifidobacteria recovered from the terminal ileum during the 8 h after fermented-milk ingestion was 9.0 +/- 0.1 log10 and constituted 23.5 +/- 10.4% of the number ingested. These results indicate that in healthy adults Bifidobacterium sp survive transit through the gastrointestinal tract when ingested in fermented milk. Further studies are needed to investigate the behavior of these exogenous bacteria in the colonic lumen and to explore their effects on the physiology of the human gastrointestinal tract.

Site and substrates for methane production in human colon

On two occasions separated by seven days, 22 g mucin (hog gastric mucin) was infused into right and left colon of 12 healthy volunteers (6 CH4 producers and 6 non-producers) maintained on a controlled diet. In the six CH4 producers, excess volumes of H2 excreted in breath were 73.4 +/- 11.9 and 35.1 +/- 14.1 (SE) ml/8 h (P less than 0.05) in response to right and left colonic infusion of mucin, respectively; excess volumes of CH4 were, respectively, 6.7 +/- 1.7 and 38.9 +/- 11.1 ml/8 h (P less than 0.05). In the six CH4 nonproducers, excess volumes of H2 excreted in breath were 76.6 +/- 17.6 and 30.8 +/- 6.3 ml/8 h (P less than 0.02) in response to right and left colonic infusion of mucin, respectively; excess volumes of CH4 were, respectively, 0.0 +/- 0.0 and 0.1 +/- 0.1 ml/8 h (not significant). In a further experiment, 17 healthy volunteers (10 CH4 producers and 7 nonproducers) were given on 2 consecutive days an oral load and an enema of 10 g lactulose. In the 10 CH4 producers, excess volumes of H2 excreted in breath were 74.6 +/- 15.1 and 32.3 +/- 11.5 ml/6 h (P less than 0.001) in response to oral ingestion and lactulose enema, respectively; excess volumes of CH4 were, respectively, 7.7 +/- 3.0 and 38.2 +/- 7.2 ml/6 h (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of chronic administration of ursodeoxycholic acid on the ileal absorption of endogenous bile acids in man

The effect of long-term administration of ursodeoxycholic acid on the ileal absorption of endogenous bile acids was determined using the tauro 23 (75Se) selena-25 homotaurocholic acid test in a controlled double-blind study involving healthy subjects (n = 15). Subjects received placebo or 13 to 15 mg/kg/day ursodeoxycholic acid for 5 wk. In the placebo group (n = 7) there was no change in the composition of serum bile acids or in the mean percentage of retention of tauro 23(75Se) selena-25 homotaurocholic acid (36.1% +/- 6.0% vs. 38.7% +/- 6.7%). In contrast, in the ursodeoxycholic acid group, serum ursodeoxycholic acid conjugates increased and the percentage of retention of tauro 23 (75Se) selena-25 homotaurocholic acid fell from 45.8% +/- 6.8% to 20.5% +/- 5.7% (p less than 0.01). We conclude that ursodeoxycholic acid administration reduces ileal absorption of endogenous bile acids. These findings provide a rational explanation for the changes in the composition of the bile acid pool during ursodeoxycholic acid therapy and could have important therapeutic implications.