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Abstract
Symptoms of abdominal pain, nausea, vomiting, bloating, abdominal distention, diarrhea, and constipation are common and may relate to abnormalities in gastrointestinal motility. There are a number of different options to study gastrointestinal motility. This article reviews novel and standard motility tests available in the stomach, small bowel, and colon. The indications for testing, technical details, advantages, and disadvantages of each test will be summarized.
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Ladopoulos T, Giannaki M, Alexopoulou C, Proklou A, Pediaditis E, Kondili E. Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol 2018; 31:273-281. [PMID: 29720852 PMCID: PMC5924849 DOI: 10.20524/aog.2018.0250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/30/2018] [Indexed: 12/17/2022] Open
Abstract
Gastrointestinal (GI) motility disorders are commonly present in critical illness. Up to 60% of critically ill patients have been reported to experience GI dysmotility of some form necessitating therapeutic intervention. It has been attributed to various factors, related to both the underlying disease and the therapeutic interventions undertaken. The assessment of motility disturbances can be challenging in critically ill patients, as the available tests used to detect abnormal motility have major limitations in the setting of an Intensive Care Unit. Critically ill patients with GI dysmotility require a multifaceted treatment approach that addresses multiple causes and utilizes multiple pharmacological pathways. In this review, we discuss the pathophysiology, assessment and management of GI dysmotility in critically ill patients.
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Affiliation(s)
- Theodoros Ladopoulos
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Maria Giannaki
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christina Alexopoulou
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Athanasia Proklou
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel Pediaditis
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eumorfia Kondili
- Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
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De Lorenzo A, Costacurta M, Merra G, Gualtieri P, Cioccoloni G, Marchetti M, Varvaras D, Docimo R, Di Renzo L. Can psychobiotics intake modulate psychological profile and body composition of women affected by normal weight obese syndrome and obesity? A double blind randomized clinical trial. J Transl Med 2017; 15:135. [PMID: 28601084 PMCID: PMC5466767 DOI: 10.1186/s12967-017-1236-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
Background Evidence of probiotics effects on gut function, brain activity and emotional behaviour were provided. Probiotics can have dramatic effects on behaviour through the microbiome–gut–brain axis, through vagus nerve. We investigated whether chronic probiotic intake could modulate psychological state, eating behaviour and body composition of normal weight obese (NWO) and preobese–obese (PreOB/OB) compared to normal weight lean women (NWL). Methods 60 women were enrolled. At baseline and after a 3-week probiotic oral suspension (POS) intake, all subjects underwent evaluation of body composition by anthropometry and dual X-ray absorptiometry, and psychological profile assessment by self-report questionnaires (i.e. EDI-2, SCL90R and BUT). Statistical analysis was carried out using paired t test or a non-parametric Wilcoxon test to evaluate differences between baseline and after POS intake, one-way ANOVA to compare all three groups and, where applicable, Chi square or t test were used to assess symptoms. Results Of the 48 women that concluded the study, 24% were NWO, 26% were NWL and 50% were PreOB/OB. Significant differences in body composition were highlighted among groups both at baseline and after a POS (p < 0.05). After POS intake, a significant reduction of BMI, resistance, FM (kg and %) (p < 0.05), and a significant increase of FFM (kg and %) (p < 0.05) were observed in all subjects in NOW and PreOB/OB. After POS intake, reduction of bacterial overgrowth syndrome (p < 0.05) and lower psychopathological scores (p < 0.05) were observed in NWO and PreOB/OB women. At baseline and after POS intake, all subjects tested were negative to SCL90R_GSI scale, but after treatment subjects positive to BUT_GSI scale were significantly reduced (8.33%) (p < 0.05) compared to the baseline (33.30%). In NWO and PreOB/OB groups significant differences (p < 0.05) in response to the subscales of the EDI-2 were observed. Significant improvement of the orocecal transit time was observed (p < 0.05) after POS intake. Furthermore, significant differences were observed for meteorism (p < 0.05) and defecation frequency (p < 0.05). Conclusions A 3-week intake of selected psychobiotics modulated body composition, bacterial contamination, psychopathological scores of NWO and PreOB/OB women. Further research is needed on a larger population and for a longer period of treatment before definitive conclusions can be made. Trial registration ClinicalTrials.gov Id: NCT01890070
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Affiliation(s)
- Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy. .,Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00136, Rome, Italy.
| | - Micaela Costacurta
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Merra
- Emergency Department, "A. Gemelli" General Hospital Foundation, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Paola Gualtieri
- PhD School of Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Giorgia Cioccoloni
- PhD School of Applied Medical-Surgical Sciences, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Massimiliano Marchetti
- USL 1 UmbriaCastiglione del Lago, 06061, Perugia, Italy.,Department of Surgical Sciences, University Hospital "Umberto I", "Sapienza" University of Rome, 00161, Rome, Italy
| | - Dimitrios Varvaras
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133, Rome, Italy
| | - Raffaella Docimo
- Department of Experimental Medicine and Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy
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Nishimura N, Tanabe H, Yamamoto T. Sufficient intake of high amylose cornstarch maintains high colonic hydrogen production for 24 h in rats. Biosci Biotechnol Biochem 2017; 81:173-180. [DOI: 10.1080/09168451.2016.1234929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Abstract
Colonic hydrogen (H2) can suppress oxidative stress and damage in the body. We examined the minimum requirement of high amylose cornstarch (HAS) to maintain high colonic H2 production for 24 h. Ileorectostomized and sham-operated rats were fed a control diet supplemented with or without 20% HAS for 7 days. Colonic starch utilization was determined. Next, rats were fed the control diet with or without 10% or 20% HAS for 14 or 28 days, respectively. Breath and flatus H2 excretion for 24 h was measured. 1.04 g of resistant fraction in HAS was utilized for 24 h by colonic bacteria. High H2 excretion was not maintained for 24 h in rats fed the 10% HAS diet, from which only 0.89 g of resistant starch was estimated to be delivered. High colonic H2 production for 24 h would be maintained by delivering more HAS to the large intestine than is utilized.
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Affiliation(s)
- Naomichi Nishimura
- College of Agriculture, Academic Institute, Shizuoka University, Shizuoka, Japan
- Faculty of Health and Welfare Science, Department of Nutritional Sciences, Nayoro City University, Nayoro, Japan
| | - Hiroki Tanabe
- Faculty of Health and Welfare Science, Department of Nutritional Sciences, Nayoro City University, Nayoro, Japan
| | - Tatsuro Yamamoto
- Faculty of Health and Welfare Science, Department of Nutritional Sciences, Nayoro City University, Nayoro, Japan
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Park B, Lee HR, Lee YJ. Alcoholic liver disease: focus on prodromal gut health. J Dig Dis 2016; 17:493-500. [PMID: 27356233 DOI: 10.1111/1751-2980.12375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/02/2016] [Accepted: 06/19/2016] [Indexed: 12/11/2022]
Abstract
Alcoholic liver disease (ALD) is implicated in gut disturbances, both functionally and structurally. It has been noticed that the gut-liver interaction is an important feature in the prevention of systemic inflammation as well as liver health. The optimal functioning of the gut-liver axis depends on gut health. Therefore, gut problems may be important for estimating liver inflammation, while our knowledge of ALD could also provide an insight into gut health. Gut problems accompanied by ALD include gut motility and absorption problems, mucosal damage and the dysbiosis of gut microbiota and gastrointestinal carcinogenesis. Moreover, there is emerging evidence that besides direct inflammatory injury caused by alcohol, gut problems related to ALD play a crucial role in the pathogenesis of cardiovascular and immunological disorders. In this regard, we should consider ALD in relation to both gut health and chronic systemic low-grade inflammation. Accordingly, integrative therapeutic strategies are warranted for treating and preventing ALD and systemic inflammation as well as alcohol-related gut problems.
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Affiliation(s)
- Byoungjin Park
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye-Ree Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea.
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6
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Abstract
Accurately measuring the complex motor behaviors of the gastrointestinal tract has tremendous value for the understanding, diagnosis and treatment of digestive diseases. This review synthesizes the literature regarding current tests that are used in both humans and animals. There remains further opportunity to enhance such tests, especially when such tests are able to provide value in both the preclinical and the clinical settings.
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Key Words
- acute pancreatitis
- biliary pancreatitis
- necroptosis
- apoptosis
- pancreatic cell death
- ac, ascending colon
- cf6, filling the colon at 6 hours
- ct, computed tomography
- gebt, gastric emptying breath test
- hdam, high-definition anorectal pressure manometry/topography
- hram, high-resolution anorectal manometry
- ht, hydroxytryptophan
- iqr, interquartile range
- mmc, migrating motor complex
- mri, magnetic resonance imaging
- 99mtc, technetium-99m
- spect, single-photon emission computed tomography
- 13c, carbon-13
- 3-d, 3-dimensional
- wmc, wireless motility capsule
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Guidoccio F, Paglianiti I, Boni G, Mariani G. Will Comprehensive Assessment from Esophagus to Large Bowel Revive the Momentum for Radionuclide Gastrointestinal Transit Studies? J Nucl Med 2015; 56:657-8. [DOI: 10.2967/jnumed.115.154963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 02/25/2015] [Indexed: 11/16/2022] Open
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Breath tests in the diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome in comparison with quantitative upper gut aspirate culture. Eur J Gastroenterol Hepatol 2014; 26:753-60. [PMID: 24849768 DOI: 10.1097/meg.0000000000000122] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) is reported in 4-78% patients with irritable bowel syndrome (IBS). This wide range of percentages might be because of the different techniques and criteria used to define the condition. We studied the utility of early (breath hydrogen increase 20 ppm above basal within 90 min) and double peaks on lactulose and glucose hydrogen breath tests (LHBT and GHBT, respectively) to diagnose SIBO (gold standard: upper gut aspirate culture). We also studied the clinical parameters that are associated with SIBO among them. METHODS Overall, 80 patients with IBS (Rome 3) were evaluated for SIBO using aspirate culture, GHBT, and LHBT (with methane). RESULTS A total of 15/80 (19%) patients had SIBO (≥ 10 CFU/ml) on culture compared with 0/10 historical controls; 4/15 (27%) with and none of 65 without SIBO had positive GHBT (sensitivity 27%, specificity 100%). None of 15 with and one of 65 without SIBO had double peaks on LHBT (sensitivity 0%, specificity 98%); 5/15 (33%) with and 23/65 (35%) without SIBO had an early peak on LHBT (sensitivity 33%, specificity 65%); and 2/15 (13.3%) with and 26/63 (41.3%) without SIBO had high methane on LHBT (sensitivity 13.3%, specificity 58.7%). Patients with SIBO on culture more often had diarrhea [6/15 (40%) vs. 8/65 (12.3%), P=0.011], higher weekly stool frequency [21 (3-28) vs. 14 (4-49), P=0.003], and looser forms [Bristol 5-6, 11/15 (73.3%) vs. 33/65 (50.8%), P=0.116]. CONCLUSION On the basis of culture, 19% patients with IBS had SIBO. The specificity of GHBT was 100%, but the sensitivity of this test and the diagnostic performances of LHBT and breath methane were all very poor. SIBO was more common in IBS patients with diarrhea than in patients with other bowel habits.
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Zhao J, Zheng X, Chu H, Zhao J, Cong Y, Fried M, Fox M, Dai N. A study of the methodological and clinical validity of the combined lactulose hydrogen breath test with scintigraphic oro-cecal transit test for diagnosing small intestinal bacterial overgrowth in IBS patients. Neurogastroenterol Motil 2014; 26:794-802. [PMID: 24641100 DOI: 10.1111/nmo.12331] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 02/21/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Small intestinal bacterial overgrowth (SIBO) may be a cause of irritable bowel syndrome (IBS); however, current investigations have important limitations. We aimed to identify clinically relevant diagnostic criteria for SIBO based on lactulose hydrogen breath test (LHBT) alone and combined with scintigraphic measurement of oro-cecal transit (SOCT). METHODS Results of LHBT/SOCT investigation from 89 IBS patients and 13 healthy volunteers were included in a systematic analysis of six published criteria for SIBO diagnosis. Clinical relevance of competing criteria was determined by assessing (i) prevalence of SIBO in IBS patients and healthy volunteers (ii) if SIBO diagnosis predicted improvement in IBS symptoms in a prospective, pilot therapeutic trial of a non-absorbable antibiotic (rifaximin 600 mg b.d.) in IBS patients. KEY RESULTS Reproducibility of SIBO diagnosis by combined LHBT/SOCT was near perfect. A ≥5 ppm H2 increase prior to appearance of cecal contrast was detected in more IBS patients than healthy volunteers (35/89 vs 1/13; p = 0.026), but not for other diagnostic criteria. IBS patients with SIBO, compared to those without SIBO, reported significantly greater improvement in abdominal symptoms following rifaximin therapy (p < 0.002 overall IBS symptom severity). This improvement was most marked in D-IBS patients in whom all symptoms improved, including stool frequency and consistency (all p < 0.004). CONCLUSIONS & INFERENCES Combined LHBT/SOCT testing using a H2 5 ppm cutoff may identify a subgroup of IBS patients with SIBO. Pilot data examining the clinical response to rifaximin suggest that this subset of IBS patients may benefit more than those with a normal test.
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Affiliation(s)
- J Zhao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Division of Gastroenterology & Hepatology, Tongde Hospital of Zhejiang Province, Hangzhou, China
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10
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Ghoshal UC, Srivastava D. Irritable bowel syndrome and small intestinal bacterial overgrowth: Meaningful association or unnecessary hype. World J Gastroenterol 2014; 20:2482-2491. [PMID: 24627585 PMCID: PMC3949258 DOI: 10.3748/wjg.v20.i10.2482] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 01/07/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common condition characterized by abdominal pain or discomfort, bloating, and altered stool form and passage. Small intestinal bacterial overgrowth (SIBO) is a condition in which there is overgrowth of bacteria in small bowel in excess of 105 colony forming units per milliliter on culture of the upper gut aspirate. Frequency of SIBO varied from 4%-78% among patients with IBS and from 1%-40% among controls. Higher frequency in some studies might be due to fallacious criteria [post-lactulose breath-hydrogen rise 20 PPM above basal within 90 min (early-peak)]. Glucose hydrogen breath test (GHBT) has a low sensitivity to diagnose SIBO. Hence, studies based on GHBT might have under-estimated frequency of SIBO. Therefore, it is important to analyze these studies carefully to evaluate whether the reported association between IBS and SIBO is over or under-projected. This review evaluates studies on association between SIBO and IBS, discordance between different studies, their strength and weakness including methodological issues and evidence on therapeutic manipulation of gut flora on symptoms of IBS.
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11
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Yamada T, Kan H, Matsumoto S, Koizumi M, Matsuda A, Shinji S, Sasaki J, Uchida E. Dysmotility by mechanical bowel preparation using polyethylene glycol. J Surg Res 2014; 191:84-90. [PMID: 24857541 DOI: 10.1016/j.jss.2014.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 01/29/2014] [Accepted: 03/03/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of mechanical bowel preparation (MBP) on morbidity (e.g., anastomotic leakage and surgical site infection) have been evaluated. Its effect on early recovery after surgery has drawn renewed attention, and its use is discouraged in the postsurgical management of enhanced recovery. However, most surgeons in Japan prefer polyethylene glycol (PEG) for MBP. We investigated the effect of MBP with PEG on postoperative intestinal motility. MATERIALS AND METHODS We prospectively evaluated a consecutive series of 258 colon cancer patients who underwent colonic resection and primary anastomosis. We orally administered 2000 mL of PEG in the PEG group and did not administer PEG to patients in the no-PEG group. Postoperative gastrointestinal motility was assessed with radiopaque markers. All patients ingested radiopaque markers 2 h before surgery. Postoperative intestinal motility was radiologically assessed by counting the number of residual markers. Abdominal radiography was conducted on postoperative days 1, 3, and 5 to count residual markers in the large and small intestines. RESULTS The total number of residual markers in the no-PEG group was less than that in the PEG group on day 5 (P < 0.01) but not on days 1 and 3. On all 3 d, the numbers of residual markers in the small intestine were significantly less in the no-PEG group than in the PEG group (P < 0.001). There were no differences in postoperative complications between the no-PEG and PEG groups. CONCLUSIONS PEG can negatively affect postoperative intestinal motility, and MBP using PEG is unnecessary in elective colon cancer surgery.
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Affiliation(s)
- Takeshi Yamada
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
| | - Hayato Kan
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Satoshi Matsumoto
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Michihiro Koizumi
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Junpei Sasaki
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Eiji Uchida
- Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
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12
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Joint SNMMI and EANM guideline for small-bowel and colon transit: an important step towards long-awaited standardization. Eur J Nucl Med Mol Imaging 2014; 41:405-7. [DOI: 10.1007/s00259-013-2650-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Abstract
Transit assessment of the small intestine and colon is relevant in the study of physiology, pathophysiology, and pharmacodynamics, and there is increasing use of small-bowel and colonic transit measurements in clinical practice as well. The main methods that are applied in clinical practice are substrate-hydrogen breath tests for small-bowel transit and radiopaque markers for colonic transit. Over the past 2-3 decades, scintigraphy has become the preferred standard in research studies, particularly for studies of pathophysiology and pharmacodynamics. New approaches include experimental stable isotope measurement of orocecal transit and the recently approved method using a wireless motility capsule that is validated as an accurate measurement of small-bowel and colonic transit.
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Affiliation(s)
- Lawrence A Szarka
- Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Sutton DGM, Preston T, Love S. In vitro validation of the lactose 13C-ureide breath test for equine orocaecal transit time measurement. Equine Vet J 2011:42-8. [PMID: 21790753 DOI: 10.1111/j.2042-3306.2011.00406.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Validation of a reliable, noninvasive clinical test for quantification of equine orocaecal transit time (OCTT) is required. This would facilitate an evidence-based approach to investigation and treatment of equine small intestinal disorders. OBJECTIVES 1) Comparison of the lactose (13) C-ureide breath test (LUBT) with the hydrogen breath test (H(2) BT) for OCTT measurement. 2) Identification of the characteristics of gastrointestinal microbial glycosylureide hydrolase activity in vitro. 3) Production of an optimised protocol for the LUBT for in vivo measurement of equine OCTT. HYPOTHESIS Significant lactose (13) C-ureide ((13) C-LU) hydrolase activity is restricted to the large bowel. The rate of expiratory (13) CO(2) production after ingestion of the isotope will provide an indirect quantifiable measure of orocaecal transit rate. Requisite bacterial activity may be enhanced by a primer dose of unlabelled substrate as shown in Man. METHODS Combined LUBT and H(2) BT were performed in 8 healthy individuals. Analysis of sequential end expiratory breath samples was used to calculate OCTT and results compared. Digestion of (13) C-LU was investigated in vitro using fresh faecal material or intestinal aliquots collected post mortem. Isotopic fermentation rate was measured by rate of appearance of (13) CO(2) . RESULTS Peaks in expiratory (13) CO(2) occurred in all individuals after ingestion of the labelled test meal, whereas H(2) expiration was variable. Both faecal and intestinal microbial digestion of (13) C-LU were maximised by prior exposure to (12) C-LU. Induced bacterial glucoseureide hydrolase activity was significantly greater in the caecum than in the small intestine (n = 10, P<0.05). CONCLUSIONS Significant (13) C-LU digestion is restricted to the equine large intestine under normal conditions, and is enhanced by prior exposure to (12) C-LU, making (13) C-LU a suitable noninvasive marker of equine OCTT. The LUBT is more reliable than the H(2) BT for measurement of equine OCTT.
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Affiliation(s)
- D G M Sutton
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
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15
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Abstract
Breath tests provide a valuable non-invasive diagnostic strategy to in vivo assess a variety of enzyme activities, organ functions or transport processes. Both the hydrogen breath tests and the (13)C-breath tests using the stable isotope (13)C as tracer are non-radioactive and safe, also in children and pregnancy. Hydrogen breath tests are widely used in clinical practice to explore gastrointestinal disorders. They are applied for diagnosing carbohydrate malassimilation, small intestinal bacterial overgrowth and for measuring the orocecal transit time. (13)C-breath tests non-invasively monitor the metabolisation of a (13)C-labelled substrate. Depending on the choice of the substrate they enable the assessment of gastric bacterial Helicobacter pylori infection, gastric emptying, liver and pancreatic function as well as measurements of many other enzyme activities. The knowledge of potential pitfalls and influencing factors are important for correct interpretation of breath test results before drawing clinical conclusions.
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Affiliation(s)
- Barbara Braden
- John Radcliffe Hospital, Headley Way, OX3 9DU Oxford, UK.
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16
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Bratten JR, Spanier J, Jones MP. Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls. Am J Gastroenterol 2008; 103:958-63. [PMID: 18371134 DOI: 10.1111/j.1572-0241.2008.01785.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Recent reports suggest that abnormalities of lactulose breath testing (LBT) are common in patients with irritable bowel syndrome (IBS), although the criteria for abnormal studies are poorly validated, and controlled comparisons are limited. The goal of this study was to determine the prevalence of abnormal LBT using the previously published criteria in both IBS patients and healthy controls, as well as to determine the prevalence and symptom association with methane (CH(4)) and hydrogen (H(2)) productions during LBT. METHODS Consecutive LBT from patients meeting Rome II criteria for IBS and healthy control subjects were examined. Patients listed their most bothersome digestive symptom at the start of the test. LBT was performed using 10 g of lactulose mixed in 240 mL of water, and breath samples collected every 20 min for a 180-min period. Both breath H(2) and CH(4) were measured. LBT was considered positive if it met any of the previously published criteria: (a) breath H(2) of > 20 parts per million (ppm), (b) increase in breath H(2) in < 90 min, (c) dual H(2) peaks (12-ppm increase over baseline with a decrease of > or = 5 ppm before 2nd peak), and (d) breath CH(4) of > 1 ppm. RESULTS In total, 224 patients with IBS and 40 controls were studied. Twenty percent of IBS patients were CH(4)(+) compared with 15% of controls. CH(4)(+) IBS patients were significantly more likely than CH(4)(-) IBS patients to have constipation, and significantly less likely to have diarrhea; however, the association did not hold for symptoms of bloating or pain. Patients and controls did not differ significantly with respect to the frequency of a positive study defined by increase in breath H(2) in < 90 min (121 per 180 vs 26 per 40, P = 0.79), increase in breath H(2) of > 20 ppm (92 per 180 vs 24 per 40, P= 0.31), or dual peaks (25 per 180 vs 9 per 40, P = 0.17). CONCLUSIONS The majority of patients with IBS and healthy subjects meet criteria for an "abnormal" LBT using previously published test criteria, and groups are not discriminated using this diagnostic method. Similarly, while CH(4) production was associated with constipation among IBS patients, the prevalence of CH(4)-positive subjects did not significantly differ between IBS patients and controls. The utility of LBT, in its current form as a diagnostic tool in IBS requires critical reappraisal.
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Affiliation(s)
- Jason R Bratten
- Division of Gastroenterology, Northwestern University, Chicago, Illinois, USA
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Maheshwari A, Thuluvath PJ. Autonomic neuropathy may be associated with delayed orocaecal transit time in patients with cirrhosis. Auton Neurosci 2005; 118:135-9. [PMID: 15795187 DOI: 10.1016/j.autneu.2005.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Revised: 02/02/2005] [Accepted: 02/08/2005] [Indexed: 12/13/2022]
Abstract
UNLABELLED Orocaecal transit (OCT) time is delayed in patients with cirrhosis, but the reasons for this remain unclear. We hypothesized that autonomic neuropathy (AN) may explain the delay in OCT. METHODS We determined OCT and autonomic function tests (AFT) in 48 patients (Child A-15, B-27, C-6) with cirrhosis of various aetiologies. AFT were categorized as normal, borderline, or abnormal. OCT was measured using the lactulose hydrogen (H2) breath test. OCT was defined as the time from baseline when there was a rise in H2 levels of >20 ppm over baseline or >10 ppm over baseline sustained over 2 consecutive time points. RESULTS Based on OCT, patients were separated into those with delayed OCT (>90 min, group I) and normal OCT (< or = 90 min, group II). Mean OCT time of patients in group I was 169.7+/-49.7 min vs. 84.4+/-12.1 min in group II. Baseline clinical characteristics of patients with and without AN, and those with normal and delayed OCT were similar. Presence of mild encephalopathy did not have an effect on OCT. AN was seen more frequently in group I than group II [16/32 (50%) vs. 3/16 (19%), p=0.03]. Logistic regression analysis showed that the presence of AN was the only independent variable associated with delayed OCT (OR 7.3, CI 1.3-39.4, p=0.02). CONCLUSION Our study showed that the presence of AN was associated with delayed OCT in patients with cirrhosis.
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Affiliation(s)
- Anurag Maheshwari
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, 1830 E. Monument Street, suite 430, Baltimore, MD 21205, USA
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Vonk RJ, Priebe MG, Koetse HA, Stellaard F, Lenoir-Wijnkoop I, Antoine JM, Zhong Y, Huang CY. Lactose intolerance: analysis of underlying factors. Eur J Clin Invest 2003; 33:70-5. [PMID: 12492455 DOI: 10.1046/j.1365-2362.2003.01099.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We studied the degree of lactose digestion and orocecal transit time (OCTT) as possible causes for the variability of symptoms of lactose intolerance (LI) in a sample of a population with genetically determined low lactase activity. METHODS Lactose digestion index (LDI) was measured by the recently developed 13C-lactose/2H-glucose test. The OCTT was determined using the breath hydrogen test. Based on a 6-h symptom score (SSC) after a challenge dose of 25 g of lactose the subjects were divided into a tolerant group (T: n= 15; SSC = 0) and an intolerant group (IT: n= 28; SSC 1-40). The intolerant group was subdivided according to the severity of symptoms: group ITa (n = 17; mild symptoms without diarrhoea) and group ITb (n = 11; with diarrhoea). RESULTS The LDI was lower in the intolerant group (0.34 +/- 0.14) (mean +/- SD) than in the tolerant group (0.47 +/- 0.14) (P = 0.008). The OCTT of group IT (60, 30-90 min) (median, quartiles) was significantly shorter than that of group T (105, 60-120 min) (P = 0.003) and was positively correlated with the LDI (P = 0.050). In groups ITa and ITb the OCTT (60, 30-90 min; 60, 26-83 min) and LDI (0.30 +/- 0.14; 0.39 +/- 0.14) were similar. CONCLUSIONS Lactose digestion capacity, which is determined by small intestinal lactase activity as well as by OCTT, affects the occurrence of lactose intolerance. However, the major difference in intolerance symptoms is caused by differences in the colonic processing of maldigested lactose.
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Affiliation(s)
- R J Vonk
- Laboratory Nutrition and Metabolism, Laboratory Centre CMC V, Y2147, University Hospital Groningen, PO Box 30 001, 9700 Groningen, the Netherlands.
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Abstract
BACKGROUND The importance of intestinal dysmotility in functional dyspepsia is a controversial issue. GOALS To investigate the orocecal transit time in patients with functional dyspepsia, as well as a possible association between intestinal transit and the presence of anxiety or Helicobacter pylori infection in these patients. STUDY The participants in this study were 23 patients with dysmotility-like functional dyspepsia and 24 control subjects. Orocecal transit time was measured by the lactulose hydrogen breath test. The presence of anxiety was assessed by the Hospital Anxiety and Depression (HAD) scale. RESULTS No significant difference in orocecal transit times was found between patients (median, 55 minutes; 95% confidence interval [CI], 40-60 minutes) and control subjects (median, 50 minutes; 95% CI, 40-60 minutes; p = 1). In the assessment, 15 patients (73%) scored for anxiety on the HAD scale, and 15 patients (65%) had positive test results for H. pylori. There was no significant difference in orocecal transit times between the patients with (median, 55 minutes; 95% CI, 40-63 minutes) and those without H. pylori infection (50 minutes; 95% CI, 40-68 minutes; p = 0.85), or between the patients with (median, 45 minutes; 95% CI, 40-68 minutes) and those without (60 minutes; 95% CI, 40-63 minutes; p = 0.77) anxiety. CONCLUSIONS Orocecal transit time is within the normal range in patients with functional dyspepsia. Anxiety and H. pylori infection do not seem to influence orocecal transit time in these patients.
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Affiliation(s)
- Sônia Letícia Silva Lorena
- Disciplina de Gastroenterologia, Departamento de Clínica Médica, Universidade Estadual de Campinas, Brazil
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Boekema PJ, Lo B, Samsom M, Akkermans LM, Smout AJ. The effect of coffee on gastric emptying and oro-caecal transit time. Eur J Clin Invest 2000; 30:129-34. [PMID: 10651837 DOI: 10.1046/j.1365-2362.2000.00601.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The consumption of coffee allegedly induces or aggravates gastrointestinal symptoms. In order to investigate the effect of coffee on gastrointestinal motility we studied the effect of coffee on gastric emptying and oro-caecal transit time. METHODS In a randomised, controlled, cross-over study gastric emptying and oro-caecal transit time were studied in 12 healthy volunteers, using applied potential tomography and lactulose hydrogen breath test, respectively. After 1 day of coffee abstinence and an overnight fast, coffee or the control drink (water) was drunk and 10 min thereafter a liquid nutrient meal was ingested together with lactulose. During 150 min, recordings were made with applied potential tomography and breath samples were taken every 5 min. Lag-phase duration and gastric half-emptying time were determined by two blinded observers. RESULTS The lag-phase duration after coffee (median 19.8 min, range 6-47 min) was not significantly different from that after water (median 19.3 min, range 11-37.5), nor was the gastric half-emptying time (median 75.7 min, range 56-157.6 vs. median 83.4 min, range 64. 6-148.4). Likewise, coffee had no significant effect on oro-caecal transit time (median 135 min, range 60-270 vs. median 140 min, range 55-270). No significant correlation between any of these parameters and mean daily coffee intake was found. CONCLUSIONS Coffee does not affect gastric emptying of a liquid meal or small bowel transit.
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Affiliation(s)
- P J Boekema
- University Medical Center Utrecht, Utrecht, The Netherlands.
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Burge MR, Tuttle MS, Violett JL, Stephenson CL, Schade DS. Potato-lactulose breath hydrogen testing as a function of gastric motility in diabetes mellitus. Diabetes Technol Ther 2000; 2:241-8. [PMID: 11469266 DOI: 10.1089/15209150050025212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Scintigraphic determination of gastric emptying is the current standard for the assessment of gastric motility and the diagnosis of diabetic gastroparesis. However, such studies are expensive, inconvenient, and involve exposure to radiation. Because the time course of breath hydrogen (H2) excretion after ingestion of lactulose correlates with upper gastrointestinal transit time, we hypothesized that patients with diabetic gastroparesis would exhibit prolonged breath H2 excretion after ingestion of a test meal containing complex carbohydrate and lactulose compared to subjects without diabetes and subjects with diabetes but without gastroparesis. RESEARCH DESIGN AND METHODS Ten healthy subjects without diabetes, 10 subjects with diabetes but without gastroparesis (gastric emptying T1/2,T1/2 < 90 minutes), and 10 subjects with diabetes and previously diagnosed gastroparesis (T1/2 > 90 minutes) were admitted for a single 24-hour study. Gastric motility agents were withheld 24 hours prior to the study. Euglycemia was established and maintained overnight in subjects with diabetes with continuous intravenous insulin infusion. At 6:00 AM, all subjects ingested a breakfast containing 100 g of cooked potato starch and 20 g lactulose. Breath H2 excretion was monitored at baseline and every 30 minutes for 12 hours after ingestion of the test meal. RESULTS Twelve hours after ingestion of the test meal, raw and baseline adjusted breath H2 excretion was significantly elevated in the gastroparesis group compared to the unaffected group with diabetes and the group without diabetes (p < 0.001). The baseline and 12-hour data points were adequate to discriminate between normal and delayed gastric emptying. CONCLUSIONS We conclude that patients with previously diagnosed gastroparesis exhibit prolonged breath H2 excretion after ingestion of a test meal. This test may prove to be a safe, reliable, and affordable outpatient screening test for diabetic gastroparesis.
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Affiliation(s)
- M R Burge
- University of New Mexico School of Medicine, Department of Medicine and Endocrinology, Albuquerque 87131, USA.
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Smith JT. Methods for assessing the effects of drugs on gastrointestinal function in patients and healthy volunteers. J Clin Pharmacol 1997; 37:29S-33S. [PMID: 9048282 DOI: 10.1177/009127009703700119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The gastrointestinal tract is a complex organ with many functions. Many diseases affect the way in which the gastrointestinal tract performs these functions. The pharmaceutical industry and academia are putting great effort into the development of treatments for these diseases. As a consequence, there is increasing pressure on the clinical pharmacologist and gastroenterologist to develop methods to measure the effects of drugs on the gastrointestinal tract. This article reviews the methods currently available to assess gastrointestinal function; in particular it focuses on motility and sensitivity.
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Affiliation(s)
- J T Smith
- Department of Clinical Pharmacology, Hoechst Marion Roussel Ltd., Walton, Milton Keynes, United Kingdom
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Muth ER, Stern RM, Koch KL. Effects of vection-induced motion sickness on gastric myoelectric activity and oral-cecal transit time. Dig Dis Sci 1996; 41:330-4. [PMID: 8601378 DOI: 10.1007/bf02093824] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to investigate the effects of vection-induced motion sickness on three cycle per minute gastric myoelectric activity and oral-cecal transit time. Forty-five subjects were exposed to a rotating optokinetic drum while electrogastrograms and subjective reports of symptoms were monitored. Prior to exposure, baseline breath hydrogen levels were established and subjects ingested vanilla pudding containing 10 g of lactulose. Breath hydrogen measurements were obtained before drum rotation and every 10 minutes after rotation, for 3 hr. Based on the severity of motion sickness symptoms reported, subjects were divided into two groups: a group susceptible to, and a group not susceptible to, vection-induced motion sickness. Averaged across subjects, the percentage of three cycle per minute activity decreased from baseline to rotation (3.6%) and from rotation to recovery (3.0%) [F(2/70)=2.43,P<0.1], with the susceptible group showing a greater overall decrease from baseline to recovery (8.9%), than the nonsusceptible group (4.2%) [F(1/35)=11.16,P<0.01]. The susceptible group had longer average oral-cecal transit times (144 min) than the nonsusceptible group (107 min) [t(36)=3.27,P<0.01]. Furthermore, symptom reports were positively correlated with oral-cecal transit times (r = 0.43, P < 0.05). In conclusion, vection-induced motion sickness is accompanied by decreased gastric three cycle per minute activity and prolonged oral-cecal transit times.
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Affiliation(s)
- E R Muth
- Department of Psychology, Pennsylvania State University, University Park, USA
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