1
|
Hashimoto Y, Kobayashi G, Kitagawa N, Okada H, Hamaguchi M, Fukui M. Protocol of efficacy of bifidobacteria intake on gastrointestinal symptoms in symptomatic type 2 diabetes mellitus patients in abdominis: An open-label, randomized controlled trial (Binary STAR study). PLoS One 2024; 19:e0295998. [PMID: 38206908 PMCID: PMC10783735 DOI: 10.1371/journal.pone.0295998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/16/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This randomized, parallel-group study aims to investigate the effects of the probiotic Bifidobacterium bifidum G9-1 (BBG9-1) on the symptoms of diarrhea or constipation in patients with type 2 diabetes mellitus (T2DM). METHODS This study will examine 100 patients with T2DM who suffering from symptoms of diarrhea or constipation. Eligible patients will be randomly assigned 1:1 to two groups (group A, BBG9-1 group; group B, control group), after the baseline examination. Patients assigned to group A will receive probiotic BBG9-1 oral administration along with their current treatment for 12 weeks, and patients assigned to group B will continue the current treatment for 12 weeks without probiotic BBG9-1 oral administration. Subsequently, examinations similar to the baseline examinations will be performed. The primary endpoint will be a change in the Gastrointestinal Symptom Rating Scale (GSRS) total score from baseline to week 12. Secondary endpoints will include the following: change and percent change in parameters such as GSRS subdomain scores, fecal properties/Bristol stool form scale, defecation frequency, biomarkers, gut microbiota, and macronutrients and factors that affect GSRS total score or constipation/diarrhea subdomain scores from baseline to week 12. DISCUSSION The results of this study will clarify the utility of probiotic BBG9-1 in the treatment of diarrhea or constipation in patients with T2DM. TRIAL REGISTRATION jRCTs051220127.
Collapse
Affiliation(s)
- Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Genki Kobayashi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noriyuki Kitagawa
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
2
|
Myke-Mbata BK, Basil B, Oloche JJ, Igbom A. Pharmacological Considerations in the Interpretation of Biochemical Results in Diabetic Patients with Cardiovascular Complications. EJIFCC 2023; 34:305-316. [PMID: 38303751 PMCID: PMC10828539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Diabetes mellitus with cardiovascular diseases is often a multi-systemic disease that requires a multi-therapeutic approach which mostly poses a challenge to laboratory result interpretation. The non-availability of information on many patients due to poor referral, documentation and record keeping has resulted in isolated interpretation of laboratory result of diabetic patients with multisystemic complications. This has led to both analytical and post-analytical errors which has a negative impact on total quality of results. Therefore, this review showed the possible therapeutic treatment of a diabetic patient with cardiovascular disease and how their pharmacological role could affect laboratory result.
Collapse
Affiliation(s)
| | - Bruno Basil
- Department of Chemical Pathology, Benue State University, Makurdi, Nigeria
| | - Jeremiah John Oloche
- Department of Pharmacology and Therapeutics, Benue State University, Makurdi, Nigeria
| | - Amarachukwu Igbom
- Department of Family Medicine, Lake District Hospital& Health Centre, Burns Lake, BC., Canada
| |
Collapse
|
3
|
Quan X, Chen W, Liang C, Jia Y, Wang Y, Luo H, Wang J. Downregulation of BDNF-TrkB signaling may contribute to the colonic motility disorders in mice with streptozocin-induced diabetes. Neurogastroenterol Motil 2023; 35:e14647. [PMID: 37417388 DOI: 10.1111/nmo.14647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 03/04/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) acts as a neuromodulator to regulate gut motility, but the role of BDNF in diabetes-related dysmotility is uncertain. The aim of this study was to investigate the possible involvement of BDNF and its receptor TrkB in the colonic hypomotility of mice with streptozotocin (STZ)-induced diabetes. METHODS A single intraperitoneal injection of STZ was used to establish a type 1 diabetes model. An organ bath system was applied to observe the contractile activities of colonic muscle strips. Immunofluorescence and western blotting were performed to evaluate the expression of BDNF and TrkB in the colon. ELISA was used to detect BDNF and SP levels in the serum and colon. The patch-clamp technique was applied to record the currents of L-type calcium channels and large conductance Ca2+ -activated K+ channels on smooth muscle cells. KEY RESULTS Compared with healthy controls, diabetic mice showed attenuated colonic muscle contraction (p < 0.001), which was partly reversed by BDNF supplementation. TrkB protein expression was significantly reduced in diabetic mice (p < 0.05). In addition, both BDNF and substance P (SP) levels were decreased, and exogenous administration of BDNF increased SP levels in diabetic mice (p < 0.05). Both the TrkB antagonist and the TrkB antibody inhibited the spontaneous contraction of colonic muscle strips (p < 0.01). Moreover, the BDNF-TrkB signaling system enhanced SP-induced muscle contraction. CONCLUSIONS Downregulation of BDNF/TrkB signaling and reduced SP release from the colon may contribute to the colonic hypomotility associated with type 1 diabetes. Brain-derived neurotrophic factor supplementation may have therapeutic potential for diabetes-related constipation.
Collapse
Affiliation(s)
- Xiaojing Quan
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chunni Liang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuan Jia
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yonghua Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hesheng Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinhai Wang
- Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
4
|
Abdu Seid M, Diress M, Mohammed A, Sinamaw D. Chronic constipation and its associated factors in patients with type-2 diabetes: A multicenter cross-sectional study. Diabetes Res Clin Pract 2023; 204:110905. [PMID: 37757985 DOI: 10.1016/j.diabres.2023.110905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Diabetes is one of the global public health concern and constipation is frequently seen among gastrointestinal symptoms in diabetes. Despite the fact that constipation is common, doctors and/or patients disregard it. This study aimed to determine the prevalence and contributing factors of constipation in patients with diabetes. METHODS Multi-center cross-sectional study was carried out and the data was analyzed using STATA 14. Binary and multilevel logistic regressions were also carried out to identify associated to factors. Factors having a p-value of less than 0.05 were deemed statistically significant in the final model. RESULTS 206 diabetics participated in the survey. The mean age of the participants was 52.7 years (SD ± 11.9). The prevalence of constipation was 16% (95% CI: 10.97-21.07). Age (AOR = 13.56; 95% CI: 1.71, 107.21), females (AOR = 4.58; 95% CI: 1.76, 11.87), the duration of the diabetes (AOR = 3.16; 95% CI: 1.21, 8.24), and psychological distress (AOR = 12.49, 95% CI: 1.53, 101.8) were significant factors. CONCLUSION The magnitude of constipation was considerable, and it was linked to psychological distress, longer-lasting diabetes, being a woman, and ageing. Patients with type-2 diabetes need to receive careful treatment in order to reduce the severity of the condition and its additional complications.
Collapse
Affiliation(s)
- Mohammed Abdu Seid
- Department of Biomedical Sciences, College of Health Sciences, Debre Tabor University, Ethiopia.
| | | | | | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Ethiopia.
| |
Collapse
|
5
|
Ajabnoor G, Eldakhakhny B, Hashim KT, Alzahrani MM, Eskandarani R, AlQusaibi B, Alqarni AK, Alsulaimani NM, Dahlan M, Enani S, Almoghrabi Y, Alamoudi AA, Alhozali A, Elsamanoudy A. The Effect of Chronic Laxative Use on Lipid Profile and HbA1c: A Hospital-Based Retrospective Study. Cureus 2023; 15:e45055. [PMID: 37829969 PMCID: PMC10567100 DOI: 10.7759/cureus.45055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Laxatives are over-the-counter medications used as a treatment for constipation. The lipid-lowering effect of the long-term use of laxatives has been proposed. AIM To investigate the possible impact of the chronic use of laxatives on serum lipid profile, body mass index (BMI), and hemoglobin A1c (HbA1c). METHODS An observational retrospective cohort study was conducted to analyze data related to patients who received laxatives for six or 12 months or more in the KAUH database system. BMI, weight, cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and HbA1c data were collected retrospectively from hospital records for three time points: baseline, six months, and 12 months of laxative treatment from the starting date for each patient. RESULTS A total of 106 patients' records fulfilled the inclusion criteria, 46 (43%) males with a mean age of 66 and 60 (57%) females with a mean age of 63. A significant decrease in plasma cholesterol and low-density lipoprotein-cholesterol (LDL-C) levels was observed in those who used laxatives for 12 months. Furthermore, an overall BMI and ALT reduction was seen in the combined. On the other hand, HbA1c levels appeared to improve in the combined group but not statistically significant. The change in the cholesterol level could be observed in patients receiving statin treatment and those without, with no statistical significance between the two groups. CONCLUSION Chronic laxative use for 12 months or more is associated with a decreased total and LDL-C level with no significant effect on high-density lipoprotein-cholesterol (HDL-C) levels. Additionally, there was a significant reduction in BMI and ALT. This effect is more prominent with combined therapy. Further multicentric studies on larger sample sizes are recommended to confirm our findings.
Collapse
Affiliation(s)
- Ghada Ajabnoor
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Food, Nutrition, and Lifestyle Research Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, SAU
- Department of Clinical Biochemistry, King Abdulaziz University Hospital, Jeddah, SAU
| | - Basmah Eldakhakhny
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Food, Nutrition, and Lifestyle Research Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah, SAU
| | - Kamal T Hashim
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | | | | | - Mansour Dahlan
- Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Sumia Enani
- Department of Food and Nutrition, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah, SAU
| | - Yousef Almoghrabi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Aliaa A Alamoudi
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Amani Alhozali
- Department of Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Ayman Elsamanoudy
- Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, EGY
| |
Collapse
|
6
|
Lucendo AJ. Editorial: type 1 diabetes, microscopic colitis and the need to explore the complex mechanisms of this association. Aliment Pharmacol Ther 2023; 57:1457-1458. [PMID: 37243458 DOI: 10.1111/apt.17501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain
- Instituto de Investigación Sanitaria Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo, Spain
| |
Collapse
|
7
|
Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29:1685-1707. [PMID: 37077514 PMCID: PMC10107216 DOI: 10.3748/wjg.v29.i11.1685] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection. Nevertheless, almost a quarter of procedures are still carried out with suboptimal preparation, resulting in longer procedure times, higher risk of complications, and higher likelihood of missing lesions. Current guidelines recommend high-volume or low-volume polyethylene glycol (PEG)/non-PEG-based split-dose regimens. In patients who have had insufficient bowel cleansing, the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option. A strategy that includes a prolonged low-fiber diet, a split preparation regimen, and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly. Furthermore, even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients, clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients. Patients with severe renal insufficiency (creatinine clearance < 30 mL/min) should be prepared with isotonic high volume PEG solutions. Few data on cirrhotic patients are currently available, and no trials have been conducted in this population. An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation, especially in patients undergoing resection of left colon lesions, where intestinal preparation has a poor outcome. The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients, as well as strategies to improve colonoscopy preparation in these patients.
Collapse
Affiliation(s)
- Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Bari 70013, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Cefalù 90015, Italy
| | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Rocco Ranaldo
- Department of Internal Medicine, “Mazzolani-Vandini” Hospital, Digestive Endoscopy, Ferrara 744011, Italy
| | - Antonella Contaldo
- Gastroenterology Unit, National Institute of Gastroenterology “S de Bellis” Research Hospital, Bari 70013, Italy
| | - Antonio Facciorusso
- Department of Medical Sciences, University of Foggia, Section of Gastroenterology, Foggia 71122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| |
Collapse
|
8
|
Das S, Gnanasambandan R. Intestinal microbiome diversity of diabetic and non-diabetic kidney disease: Current status and future perspective. Life Sci 2023; 316:121414. [PMID: 36682521 DOI: 10.1016/j.lfs.2023.121414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
A significant portion of the health burden of diabetic kidney disease (DKD) is caused by both type 1 and type 2 diabetes which leads to morbidity and mortality globally. It is one of the most common diabetic complications characterized by loss of renal function with high prevalence, often leading to acute kidney disease (AKD). Inflammation triggered by gut microbiota is commonly associated with the development of DKD. Interactions between the gut microbiota and the host are correlated in maintaining metabolic and inflammatory homeostasis. However, the fundamental processes through which the gut microbiota affects the onset and progression of DKD are mainly unknown. In this narrative review, we summarised the potential role of the gut microbiome, their pathogenicity between diabetic and non-diabetic kidney disease (NDKD), and their impact on host immunity. A well-established association has already been seen between gut microbiota, diabetes and kidney disease. The gut-kidney interrelationship is confirmed by mounting evidence linking gut dysbiosis to DKD, however, it is still unclear what is the real cause of gut dysbiosis, the development of DKD, and its progression. In addition, we also try to distinguish novel biomarkers for early detection of DKD and the possible therapies that can be used to regulate the gut microbiota and improve the host immune response. This early detection and new therapies will help clinicians for better management of the disease and help improve patient outcomes.
Collapse
Affiliation(s)
- Soumik Das
- School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu 632014, India
| | - Ramanathan Gnanasambandan
- School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu 632014, India.
| |
Collapse
|
9
|
Bell DSH. Detecting and treating the protean manifestations of diabetic autonomic neuropathy. Diabetes Obes Metab 2023; 25:1162-1173. [PMID: 36748121 DOI: 10.1111/dom.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
The manifestations of diabetic autonomic neuropathy (DAN) are protean and clinically involve multiple systems, including the cardiovascular system, the gastrointestinal system, the genitourinary system as well as the sweat glands (sudomotor dysfunction) and the gallbladder. In addition, cardiac autonomic neuropathy (CAN) is associated with a correctible inability to appreciate and correct hypoglycaemia. While not a clinical problem, pupillary involvement should be the clue and the catalyst to investigate for other manifestations of DAN. This review outlines a practical approach to detecting and investigating the manifestations of DAN. Of particular importance is early detection of cardiovascular involvement where prompt therapy through glycaemic control can decrease the severity of CAN and decelerate the frequency and severity of retinopathy and nephropathy in addition to decreasing cardiovascular events and mortality. CAN also plays a role in accelerating other diabetic complications such as acute ischaemic stroke, heart failure, medial artery calcinosis, foot ulcers, peripheral artery disease and Charcot joints. Many therapies of DAN are available, which should not only decrease morbidity and mortality from DAN, but also improve the patient's quality of life. However, the therapies available are largely symptomatic.
Collapse
|
10
|
Parsons RF, Tantisattamo E, Cheungpasitporn W, Basu A, Lu Y, Lentine KL, Woodside KJ, Singh N, Scalea J, Alhamad T, Dunn TB, Rivera FHC, Parajuli S, Pavlakis M, Cooper M. Comprehensive review: Frailty in pancreas transplant candidates and recipients. Clin Transplant 2023; 37:e14899. [PMID: 36591953 DOI: 10.1111/ctr.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Well-selected patients with kidney disease and diabetes mellitus who undergo simultaneous kidney-pancreas transplantation often experience dramatic improvements in quality of life and long-term survival compared to those who remain on medical therapy. Over the past several years the importance of frailty in the pancreas transplant candidate and recipient populations has grown. More patients with advanced age have entered the waitlist, and complications from prolonged diabetes, even in younger patients, have created increased evidence of risk for frailty. Given these concerns, and the broad challenges facing pancreas transplantation volumes overall, we generated this review to help establish the impact and implications. We summarize the interplay of immunological factors, aging, environmental factors, diabetes mellitus, and chronic kidney disease that put these patients at risk for frailty. We discuss its measurement and recommend a combination of two instruments (both well-validated and one entirely objective). We describe the outcomes for patients before and after pancreas transplantation who may have frailty, and what interventions can be taken to mitigate its effects. Broader investigation into frailty in the pancreas transplant population is needed to better understand how to select patients for pancreas transplantation and to how manage its consequences thereafter.
Collapse
Affiliation(s)
| | | | | | | | - Yee Lu
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Neeraj Singh
- John C. McDonald Regional Transplant Center, Shreveport, Los Angeles, USA
| | - Joseph Scalea
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tarek Alhamad
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ty B Dunn
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Martha Pavlakis
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington DC, USA
| |
Collapse
|
11
|
Muacevic A, Adler JR. Assessment of Pre-existing Type 2 Diabetes Mellitus Prevalence and Risk Factors Among Colorectal Cancer Patients in King Abdulaziz Medical City, Jeddah. Cureus 2022; 14:e32216. [PMID: 36479258 PMCID: PMC9721367 DOI: 10.7759/cureus.32216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and cancer are recognized as non-communicable chronic disorders which are among the top ten causes of death globally. In Saudi Arabia, the prevalence of type 2 DM (T2DM) and colorectal cancer (CRC) is alarmingly high. Both T2DM and CRC share common risk factors. In this study, we aim to assess the prevalence of pre-existing T2DM among CRC Saudi patients. METHODS In this cross-sectional study, data were collected from the medical records of 275 Saudi adult patients with CRC from 2009 to 2018 at King Abdulaziz Medical City, Jeddah (KAMC-J). RESULTS Participants had a mean age of 57.0 years, standard deviation (SD) of 13.0, and were mostly males (60.00%) and Saudi (100.0%). Participants had a mean BMI of 26.42 (7.35) kg/m2. The prevalence of pre-existing T2DM in this study was 40.80%. 15.8% of participants were overweight and obese (BMI>30), respectively. The average age of diabetics and non-diabetics was 63.6 (10.64) and 52.73 (12.43), respectively. Diabetic patients are significantly older than non-diabetic patients (p<0.001). The average BMI for diabetics was 26.96 (7.26) kg/m2, whereas the average BMI for non-diabetics was 25.93 (7.48) kg/m2. No significant differences were found between the two groups. CONCLUSION This study provides new insight into the high prevalence of pre-existing T2DM in CRC patients in Saudi Arabia. In particular, the age of diagnosis of CRC in diabetic patients was significantly higher than in non-diabetics.
Collapse
|
12
|
Portincasa P, Bonfrate L, Wang DQH, Frühbeck G, Garruti G, Di Ciaula A. Novel insights into the pathogenic impact of diabetes on the gastrointestinal tract. Eur J Clin Invest 2022; 52:e13846. [PMID: 35904418 DOI: 10.1111/eci.13846] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
Type 2 and type 1 diabetes are common endocrine disorders with a progressively increasing incidence worldwide. These chronic, systemic diseases have multiorgan implications, and the whole gastrointestinal (GI) tract represents a frequent target in terms of symptom appearance and interdependent pathophysiological mechanisms. Metabolic alterations linked with diabetic complications, neuropathy and disrupted hormone homeostasis can lead to upper and/or lower GI symptoms in up to 75% of diabetic patients, with multifactorial involvement of the oesophagus, stomach, upper and lower intestine, and of the gallbladder. On the other hand, altered gastrointestinal motility and/or secretions are able to affect glucose and lipid homeostasis in the short and long term. Finally, diabetes has been linked with increased cancer risk at different levels of the GI tract. The presence of GI symptoms and a comprehensive assessment of GI function should be carefully considered in the management of diabetic patients to avoid further complications and to ameliorate the quality of life. Additionally, the presence of gastrointestinal dysfunction should be adequately managed to improve metabolic homeostasis, the efficacy of antidiabetic treatments and secondary prevention strategies.
Collapse
Affiliation(s)
- Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - David Q-H Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Gema Frühbeck
- Department of Endocrinology & Nutrition, Clínica Universidad de Navarra, Pamplona, Spain Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), ISCIII, Pamplona, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Gabriella Garruti
- Department of Emergency and Organ Transplants, Unit of Endocrinology, University of Bari Medical School, Bari, Italy
| | - Agostino Di Ciaula
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| |
Collapse
|
13
|
Lin CH, Lin HY, Lin TC, Chan HY, Chen JJ. The relation between second-generation antipsychotics and laxative use in elderly patients with schizophrenia. Psychogeriatrics 2022; 22:718-727. [PMID: 35810468 DOI: 10.1111/psyg.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/06/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to investigate factors associated with concomitant laxative use among elderly patients with schizophrenia, discharged on second-generation antipsychotics (SGAs), from two large public psychiatric hospitals in Taiwan. METHODS Elderly patients with schizophrenia who were discharged between 2006 and 2019 and received SGA monotherapy at discharge were included in the analysis. Multivariate logistic regression was used to identify factors associated with regular laxative use at discharge. The Cochrane-Armitage trend test was used to evaluate whether significant time trends existed for rates of laxative use at discharge. RESULTS A total of 2591 elderly patients with schizophrenia were discharged during the study period, and 1727 of 2591 patients who met the inclusion criteria were included for analysis. Of these 1727 patients, 732 (42.4%) also received concomitant laxatives. Female gender, mood stabiliser use and concomitant diabetes mellitus were found to be associated with increased laxative use. Among SGAs, clozapine was associated with the highest rate of laxative use, followed by zotepine, quetiapine, olanzapine and risperidone. Additionally, risperidone, amisulpride, aripiprazole, paliperidone and sulpiride were associated with comparable rates of laxative use. Laxative use rates grew over time from 30.8% in 2006 to 46.6% in 2019 (z = 4.83, P < 0.001). CONCLUSIONS Laxative use is common in elderly schizophrenia patients treated with SGAs. In cases of clinically significant constipation, switching to an SGA with a lower risk for constipation, or discontinuing the use of mood stabilisers should be considered, if clinically feasible.
Collapse
Affiliation(s)
- Ching-Hua Lin
- Department of Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yi Lin
- Department of Medical Education, Cathay General Hospital, Taipei, Taiwan
| | - Ta-Chun Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan.,Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiahn-Jyh Chen
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan, Taiwan
| |
Collapse
|
14
|
Adamek HE, Bergmann L, Müssig K. [Bowel preparation in patients with Diabetes mellitus: Development of a procedure model]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:784-789. [PMID: 35545113 DOI: 10.1055/a-1791-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.
Collapse
Affiliation(s)
| | - Laura Bergmann
- Med. Klinik 2, Klinikum Leverkusen gGmbH, Leverkusen, Germany
| | - Karsten Müssig
- Klinik für Innere Medizin und Gastroenterologie, Niels-Stensen-Kliniken GmbH, Franziskus-Hospital Harderberg, Georgsmarienhütte, Germany
| |
Collapse
|
15
|
Müssig K, Adamek HE. Adjustment of Anti-Hyperglycaemic Agents During Bowel Preparation for Colonoscopy in Patients with Diabetes. Exp Clin Endocrinol Diabetes 2022; 130:627-632. [PMID: 35359009 DOI: 10.1055/a-1782-9389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Due to the growing diabetes pandemic, the number of colonoscopies performed in patients with diabetes is steadily rising. However, recommendations on adjustments of anti-hyperglycaemic agents (AHG) during bowel preparation for colonoscopy are limited. METHODS A total of nine articles were revealed on a PubMed search using the search terms "diabetes" and "colonoscopy", "sigmoidoscopy", "endoscopy", "endoscopic intervention", "endoscopic invasive diagnostics", "endoscopic surgery", or "diabetes care in the hospital" and manual screening of the references of the articles reporting on AHG adjustment during bowel preparation. RESULTS Regular glucose measurements and the opportunity to contact the diabetes team were commonly advised. Recommendations also agreed that all oral AHG and short-acting insulin should be omitted when patients are on clear fluids. Recent studies suggest discontinuation of sodium-glucose cotransporter-2 (SGLT2) inhibitors even three days before the colonoscopy. In contrast, recommendations differed regarding adjustment of basal insulin depending on diabetes type and time point in relation to the intervention. CONCLUSIONS While discontinuation of oral AHG and short-acting insulin during bowel preparation for colonoscopy is generally accepted, recommendations on the adaptation of basal insulin follow different approaches.
Collapse
Affiliation(s)
- Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | - Henning E Adamek
- Second Department of Internal Medicine (Gastroenterology, Hepatology, Diabetology), Klinikum Leverkusen, Leverkusen, Germany
| |
Collapse
|
16
|
Abhyankar M, Gupta S, Kamat T, Chawla R, Revankar S, Walia S. Probiotic supplementation (Vibact DS) in patients with type 2 diabetes mellitus: Real-world experience from India. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_106_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
17
|
Ito H, Ito K, Tanaka M, Hokamura M, Tanaka M, Kusano E, Kondo J, Izutsu T, Matsumoto S, Inoue H, Antoku S, Yamasaki T, Mori T, Togane M. Constipation Is a Frequent Problem Associated with Vascular Complications in Patients with Type 2 Diabetes: A Cross-sectional Study. Intern Med 2022; 61:1309-1317. [PMID: 35491175 PMCID: PMC9152859 DOI: 10.2169/internalmedicine.7676-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective Diabetes is recognized as an underlying disease of constipation. However, the prevalence of constipation varies according to the diagnostic criteria applied. We investigated the prevalence of constipation based on the new guideline for constipation in Japanese patients with type 2 diabetes and examined the relationship with the clinical background, including diabetic vascular complications. Methods Questionnaire surveys including items concerning the diagnosis and treatment status of constipation were administered to 410 patients with type 2 diabetes. Results Although 29% of the patients considered that they had experienced constipation (self-judged), only 14% had consulted a physician about constipation. The prevalence of chronic constipation based on the guideline was 26%. After including laxative users, constipation was finally found in 36%. Despite the use of laxatives (n=81), 51% of the patients were still diagnosed with chronic constipation. Patients with constipation (chronic constipation or laxative use) were significantly older and had a longer duration of diabetes than those without constipation. The body mass index (BMI) of patients with constipation (24.9±3.8 kg/m2) was significantly lower than that of those without constipation (26.3±4.6 kg/m2). Diabetic neuropathy (49% vs. 32%) and coronary heart disease (CHD) (27% vs. 13%) were significantly more frequent in the patients with constipation than in those without constipation. A multivariate logistic regression analysis revealed that gender, BMI, diabetic neuropathy, insulin use, and CHD were significantly associated with constipation. Conclusion An accurate diagnosis of constipation is desirable in patients with type 2 diabetes because constipation is independently associated with CHD.
Collapse
Affiliation(s)
- Hiroyuki Ito
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Kiyoko Ito
- Department of Nursing, Edogawa Hospital, Japan
| | | | | | | | - Eiji Kusano
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Jiro Kondo
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Takuma Izutsu
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Suzuko Matsumoto
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Hideyuki Inoue
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Shinichi Antoku
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Tomoko Yamasaki
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Toshiko Mori
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| | - Michiko Togane
- Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Japan
| |
Collapse
|
18
|
Exploring the Inflammatory Pathogenesis of Colorectal Cancer. Diseases 2021; 9:diseases9040079. [PMID: 34842660 PMCID: PMC8628792 DOI: 10.3390/diseases9040079] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer is one of the most commonly diagnosed cancers worldwide. Traditionally, mechanisms of colorectal cancer formation have focused on genetic alterations including chromosomal damage and microsatellite instability. In recent years, there has been a growing body of evidence supporting the role of inflammation in colorectal cancer formation. Multiple cytokines, immune cells such T cells and macrophages, and other immune mediators have been identified in pathways leading to the initiation, growth, and metastasis of colorectal cancer. Outside the previously explored mechanisms and pathways leading to colorectal cancer, initiatives have been shifted to further study the role of inflammation in pathogenesis. Inflammatory pathways have also been linked to some traditional risk factors of colorectal cancer such as obesity, smoking and diabetes, as well as more novel associations such as the gut microbiome, the gut mycobiome and exosomes. In this review, we will explore the roles of obesity and diet, smoking, diabetes, the microbiome, the mycobiome and exosomes in colorectal cancer, with a specific focus on the underlying inflammatory and metabolic pathways involved. We will also investigate how the study of colon cancer from an inflammatory background not only creates a more holistic and inclusive understanding of this disease, but also creates unique opportunities for prevention, early diagnosis and therapy.
Collapse
|
19
|
Hata S, Nakajima H, Hashimoto Y, Miyoshi T, Hosomi Y, Okamura T, Majima S, Nakanishi N, Senmaru T, Osaka T, Okada H, Ushigome E, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Effects of probiotic Bifidobacterium bifidum G9-1 on the gastrointestinal symptoms of patients with type 2 diabetes mellitus treated with metformin: An open-label, single-arm, exploratory research trial. J Diabetes Investig 2021; 13:489-500. [PMID: 34665938 PMCID: PMC8902400 DOI: 10.1111/jdi.13698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Aims/Introduction Metformin is associated with the risk of gastrointestinal complications, and probiotic Bifidobacterium bifidum G9‐1 (BBG9‐1) can improve the symptoms of diarrhea. This study aimed to clarify the effects of probiotic BBG9‐1 on the gastrointestinal symptoms of type 2 diabetes mellitus patients using metformin. Materials and methods In this open‐label single‐arm exploratory study, 40 patients (mean age 64.0 ± 9.4 years) were given probiotic BBG9‐1 for 10 weeks. Changes in the gastrointestinal symptom rating scale total score, which was the primary end‐point, gastrointestinal symptom rating scale subscale scores, glycated hemoglobin levels and gut microbiota after the administration of probiotic BBG9‐1 were evaluated by the Student's t‐test. Results The gastrointestinal symptom rating scale total score significantly improved (from 2.02 ± 0.51 to 1.59 ± 0.43, change, −0.43 ± 0.49, P < 0.001). Furthermore, all gastrointestinal symptom rating scale subscale scores, including diarrhea (from 2.32 ± 1.14 to 1.89 ± 0.99, change, −0.42 ± 0.95, P = 0.007) and constipation (from 3.00 ± 1.16 to 2.20 ± 1.07, change, −0.80 ± 1.19, P < 0.001), scores also significantly improved. However, the glycated hemoglobin levels did not change (from 7.0 ± 0.7 to 7.0 ± 0.6%, change, 0.0 ± 0.4, P = 0.91). The relative abundance of the genus Sutterella decreased by the use of probiotic BBG9‐1 (from 0.011 ± 0.009 to 0.008 ± 0.006, change, −0.003 ± 0.006, P = 0.002). Conclusions Type 2 diabetes mellitus patients treated with metformin showed significant improvement in all gastrointestinal symptom rating scores after using probiotic BBG9‐1 without changing the glucose control. This study showed the potential usefulness of probiotic BBG9‐1 for improving gastrointestinal symptoms, including constipation and diarrhea, in type 2 diabetes mellitus patients treated with metformin.
Collapse
Affiliation(s)
- Shinnosuke Hata
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hanako Nakajima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoki Miyoshi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukako Hosomi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuro Okamura
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takafumi Osaka
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
20
|
Role of Postbiotics in Diabetes Mellitus: Current Knowledge and Future Perspectives. Foods 2021; 10:foods10071590. [PMID: 34359462 PMCID: PMC8306164 DOI: 10.3390/foods10071590] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
In the last decade, the gastrointestinal microbiota has been recognised as being essential for health. Indeed, several publications have documented the suitability of probiotics, prebiotics, and symbiotics in the management of different diseases such as diabetes mellitus (DM). Advances in laboratory techniques have allowed the identification and characterisation of new biologically active molecules, referred to as “postbiotics”. Postbiotics are defined as functional bioactive compounds obtained from food-grade microorganisms that confer health benefits when administered in adequate amounts. They include cell structures, secreted molecules or metabolic by-products, and inanimate microorganisms. This heterogeneous group of molecules presents a broad range of mechanisms and may exhibit some advantages over traditional “biotics” such as probiotics and prebiotics. Owing to the growing incidence of DM worldwide and the implications of the microbiota in the disease progression, postbiotics appear to be good candidates as novel therapeutic targets. In the present review, we summarise the current knowledge about postbiotic compounds and their potential application in diabetes management. Additionally, we envision future perspectives on this topic. In summary, the results indicate that postbiotics hold promise as a potential novel therapeutic strategy for DM.
Collapse
|
21
|
Pieber TR, Svehlikova E, Mursic I, Esterl T, Wargenau M, Sartorius T, Pauly L, Schwejda-Guettes S, Neumann A, Faerber V, Stover JF, Gaigg B, Kuchinka-Koch A. Blood glucose response after oral lactulose intake in type 2 diabetic individuals. World J Diabetes 2021; 12:893-907. [PMID: 34168736 PMCID: PMC8192256 DOI: 10.4239/wjd.v12.i6.893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lactulose is approved for the symptomatic treatment of constipation, a gastrointestinal (GI) complication common in individuals with diabetes. Lactulose products contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose for the treatment of mild constipation. A previous study in healthy subjects revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in individuals with diabetes.
AIM To evaluate the blood glucose profile after oral lactulose intake in mildly constipated, non-insulin-dependent subjects with T2DM in an outpatient setting.
METHODS This prospective, double-blind, randomized, controlled, single-center trial was conducted at the Clinical Research Center at the Medical University of Graz, Austria, in 24 adult Caucasian mildly constipated, non-insulin-dependent subjects with T2DM. Eligible subjects were randomized and assigned to one of six treatment sequences, each consisting of four treatments stratified by sex using an incomplete block design. Subjects received a single dose of 20 g or 30 g lactulose (crystal and liquid formulation), water as negative control or 30 g glucose as positive control. Capillary blood glucose concentrations were measured over a period of 180 min post dose. The primary endpoint was the baseline-corrected area under the curve of blood glucose concentrations over the complete assessment period [AUCbaseline_c (0-180 min)]. Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs glucose, as well as for liquid lactulose vs crystal lactulose. Safety parameters included GI tolerability, which was assessed at 180 min and 24 h post dose, and adverse events occurring up to 24 h post dose.
RESULTS In 24 randomized and analyzed subjects blood glucose concentration-time curves after intake of 20 g and 30 g lactulose were almost identical to those after water intake for both lactulose formulations despite the different amounts of carbohydrate impurities (≤ 3.0% for crystals and approx. 30% for liquid). The primary endpoint [AUCbaseline_c (0-180 min)] was not significantly different between lactulose and water regardless of lactulose dose and formulation. Also with regard to all secondary endpoints lactulose formulations showed comparable results to water with one exception concerning maximum glucose level. A minor increase in maximum blood glucose was observed after the 30 g dose, liquid lactulose, in comparison to water with a mean treatment difference of 0.63 mmol/L (95% confidence intervals: 0.19, 1.07). Intake of 30 g glucose significantly increased all blood glucose endpoints vs 30 g liquid and crystal lactulose, respectively (all P < 0.0001). No differences in blood glucose response were observed between the different lactulose formulations. As expected, lactulose increased the number of bowel movements and was generally well tolerated. Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose.
CONCLUSION Blood glucose AUCbaseline_c (0-180 min) levels in mildly constipated, non-insulin dependent subjects with T2DM are not affected by the carbohydrate impurities contained in 20 g and 30 g crystal or liquid lactulose formulations.
Collapse
Affiliation(s)
- Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Eva Svehlikova
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Ines Mursic
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Tamara Esterl
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz 8036, Austria
| | - Manfred Wargenau
- Department of Statistic, M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Düsseldorf 40211, Germany
| | - Tina Sartorius
- Department of Nutritional CRO, BioTeSys GmbH, Esslingen 73728, Germany
| | - Lioba Pauly
- Department of Medical & Clinical Affairs, Market Access & Education Business Unit Enteral Nutrition, Bad Homburg 61352, Germany
| | - Susann Schwejda-Guettes
- Department of Medical & Clinical Affairs, Market Access & Education Business Unit Enteral Nutrition, Bad Homburg 61352, Germany
| | - Annalena Neumann
- Department of Medical, Clinical & Regulatory Affairs, Business Unit Parenteral Nutrition, Keto-Analogues and Standard I.V. Fluids, Fresenius Kabi Deutschland GmbH, Bad Homburg 61352, Germany
| | - Valentin Faerber
- Department of Medical, Clinical & Regulatory Affairs, Business Unit Parenteral Nutrition, Keto-Analogues and Standard I.V. Fluids, Fresenius Kabi Deutschland GmbH, Bad Homburg 61352, Germany
| | | | - Barbara Gaigg
- Market Unit Lactulose, Fresenius Kabi Austria GmbH, Linz 4020, Austria
| | | |
Collapse
|
22
|
Cameron SJS, Perdones-Montero A, Van Meulebroek L, Burke A, Alexander-Hardiman K, Simon D, Schaffer R, Balog J, Karancsi T, Rickards T, Rebec M, Stead S, Vanhaecke L, Takáts Z. Sample Preparation Free Mass Spectrometry Using Laser-Assisted Rapid Evaporative Ionization Mass Spectrometry: Applications to Microbiology, Metabolic Biofluid Phenotyping, and Food Authenticity. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2021; 32:1393-1401. [PMID: 33980015 DOI: 10.1021/jasms.0c00452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mass spectrometry has established itself as a powerful tool in the chemical, biological, medical, environmental, and agricultural fields. However, experimental approaches and potential application areas have been limited by a traditional reliance on sample preparation, extraction, and chromatographic separation. Ambient ionization mass spectrometry methods have addressed this challenge but are still somewhat restricted in requirements for sample manipulation to make it suitable for analysis. These limitations are particularly restrictive in view of the move toward high-throughput and automated analytical workflows. To address this, we present what we consider to be the first automated sample-preparation-free mass spectrometry platform utilizing a carbon dioxide (CO2) laser for sample thermal desorption linked to the rapid evaporative ionization mass spectrometry (LA-REIMS) methodology. We show that the pulsatile operation of the CO2 laser is the primary factor in achieving high signal-to-noise ratios. We further show that the LA-REIMS automated platform is suited to the analysis of three diverse biological materials within different application areas. First, clinical microbiology isolates were classified to species level with an accuracy of 97.2%, the highest accuracy reported in current literature. Second, fecal samples from a type 2 diabetes mellitus cohort were analyzed with LA-REIMS, which allowed tentative identification of biomarkers which are potentially associated with disease pathogenesis and a disease classification accuracy of 94%. Finally, we showed the ability of the LA-REIMS system to detect instances of adulteration of cooking oil and determine the geographical area of production of three protected olive oil products with 100% classification accuracy.
Collapse
Affiliation(s)
- Simon J S Cameron
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, U.K
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast BT9 5DL, U.K
| | - Alvaro Perdones-Montero
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, U.K
| | - Lieven Van Meulebroek
- Laboratory of Chemical Analysis, Department of Veterinary Public Health and Food Safety, Ghent University, Ghent B-9820, Belgium
| | - Adam Burke
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, U.K
| | - Kate Alexander-Hardiman
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, U.K
| | - Daniel Simon
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, U.K
- Waters Research Center, Budapest 1031, Hungary
| | | | - Julia Balog
- Waters Research Center, Budapest 1031, Hungary
| | | | - Tony Rickards
- Department of Microbiology, Imperial College Healthcare NHS Trust, London W6 8RD, U.K
| | - Monica Rebec
- Department of Microbiology, Imperial College Healthcare NHS Trust, London W6 8RD, U.K
| | - Sara Stead
- Waters Corporation, Wilmslow SK9 4AX, U.K
| | - Lynn Vanhaecke
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast BT9 5DL, U.K
- Laboratory of Chemical Analysis, Department of Veterinary Public Health and Food Safety, Ghent University, Ghent B-9820, Belgium
| | - Zoltán Takáts
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London SW7 2AZ, U.K
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast BT9 5DL, U.K
| |
Collapse
|
23
|
Agha OQ, Alsayid M, Brown MD. Bowel preparation in diabetic patients undergoing colonoscopy. Ann Gastroenterol 2021; 34:310-315. [PMID: 33948054 PMCID: PMC8079869 DOI: 10.20524/aog.2021.0599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a risk factor for poor bowel preparation in patients who undergo colonoscopy, because of their decreased intestinal transit and slow gastric emptying. This might lead to neoplastic or preneoplastic lesions being missed, longer procedural time, a higher risk of procedure-related adverse events, significant cost burden, patient dissatisfaction, and the need for a repeat colonoscopy. Multiple strategies have been suggested to improve bowel preparation in these patients. Proposed pharmacologic strategies include adding magnesium citrate, bisacodyl, lubiprostone or pyridostigmine. Non-pharmacologic strategies include preferential procedure scheduling or using a diabetes-specific preparation protocol. In this article, we present a comprehensive review of the literature and provide specific recommendations to general practitioners and gastroenterologists for improving bowel preparation in patients with diabetes.
Collapse
Affiliation(s)
- Osama Qasim Agha
- Division of Internal Medicine, Creighton University School of Medicine, Phoenix, Arizona (Osama Qasim Agha).,Division of Internal Medicine, St Joseph's Hospital and Medical Center, Phoenix, Arizona (Osama Qasim Agha)
| | - Muhammad Alsayid
- Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois (Muhammad Alsayid, Michael D. Brown), USA
| | - Michael D Brown
- Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois (Muhammad Alsayid, Michael D. Brown), USA
| |
Collapse
|
24
|
Risk factors of Clostridium difficile-associated diarrhea in hospitalized adults: Vary by hospitalized duration. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 54:276-283. [DOI: 10.1016/j.jmii.2019.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
|
25
|
Subramaniam K, Joseph MP, Babu LA. A Common Drug Causing a Common Side Effect at an Uncommon Time: Metformin-Induced Chronic Diarrhea and Weight Loss After Years of Treatment. Clin Diabetes 2021; 39:237-240. [PMID: 33986581 PMCID: PMC8061542 DOI: 10.2337/cd20-0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Manoj P. Joseph
- Department of Medicine, Silverline Hospital, Kochi, Kerala, India
| | - Lakshmi A. Babu
- Department of Medicine, Silverline Hospital, Kochi, Kerala, India
| |
Collapse
|
26
|
Storey S, Zhang Z, Luo X, Von Ah D, Metzger M, Zhang J, Jakka A, Huang K. Association of Comorbid Diabetes With Clinical Outcomes and Healthcare Utilization in Colorectal Cancer Survivors. Oncol Nurs Forum 2021; 48:195-206. [PMID: 33600395 DOI: 10.1188/21.onf.195-206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare clinical outcomes and healthcare utilization in colorectal cancer (CRC) survivors with and without diabetes. SAMPLE & SETTING CRC survivors (N = 3,287) were identified from a statewide electronic health record database using International Classification of Diseases (ICD) codes. Data were extracted on adults aged 21 years or older with an initial diagnosis of stage II or III CRC with diabetes present before CRC diagnosis or no diagnosis of diabetes (control). METHODS & VARIABLES ICD codes were used to extract diabetes diagnosis and clinical outcome variables. Healthcare utilization was determined by encounter type. Data were analyzed using descriptive statistics, multivariable logistic, and Cox regression. RESULTS CRC survivors with diabetes were more likely to develop anemia and infection than CRC survivors without diabetes. In addition, CRC survivors with diabetes were more likely to utilize emergency resources sooner than CRC survivors without diabetes. IMPLICATIONS FOR NURSING Oncology nurses can facilitate the early identification of high-risk survivor groups, reducing negative clinical outcomes and unnecessarily high healthcare resource utilization in CRC survivors with diabetes.
Collapse
Affiliation(s)
| | | | - Xiao Luo
- Indiana University-Purdue University Indianapolis
| | | | | | | | | | | |
Collapse
|
27
|
Conway RBN, Peltier A, Figaro MK. Constipation and glycemic control. J Diabetes Complications 2021; 35:107799. [PMID: 33303296 DOI: 10.1016/j.jdiacomp.2020.107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Rebecca B N Conway
- Department of Community Health, University of Texas Health Science Center at Tyler, Tyler, TX, United States of America.
| | - Amanda Peltier
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | | |
Collapse
|
28
|
Hashimoto Y, Nakajima H, Hata S, Miyoshi T, Hosomi Y, Majima S, Nakanishi N, Senmaru T, Osaka T, Okada H, Ushigome E, Hamaguchi M, Asano M, Yamazaki M, Fukui M. Effect of probiotics, Bifidobacterium bifidum G9-1, on gastrointestinal symptoms in patients with type 2 diabetes mellitus: study protocol for open-label, single-arm, exploratory research trial (Big STAR study). J Clin Biochem Nutr 2020; 67:223-227. [PMID: 33293761 PMCID: PMC7705076 DOI: 10.3164/jcbn.20-100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
Metformin is associated with risks of gastrointestinal complications in patients with type 2 diabetes. In contrast, probiotic Bifidobacterium bifidum G9-1 (BBG9-1) could improve the symptoms of diarrhea caused by metformin in animal models. Thus, the primary outcome of this study will be the effect of the probiotic BBG9-1 on gastrointestinal symptoms, including diarrhea, in patients with type 2 diabetes who use metformin. This open-label, single-arm, and exploratory study will examine 40 patients with type 2 diabetes who use metformin and have symptoms of constipation or diarrhea. After the baseline examination (objective 1), patients will be administered probiotic BBG9-1 for 10 ± 2 weeks. Then, examinations will be performed (objective 2). The primary outcome will be changes in the symptoms of constipation or diarrhea from objective 1 to objective 2. Secondary outcomes will include changes in gut microbiota, and correlations between changes in fecal properties and biomarkers, including HbA1c level and body mass index. This is the first study to investigate the effect of probiotic BBG9-1 on the change in the symptom of constipation or diarrhea in patients with type 2 diabetes who use metformin.
Collapse
Affiliation(s)
- Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hanako Nakajima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shinnosuke Hata
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tomoki Miyoshi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yukako Hosomi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Saori Majima
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takafumi Osaka
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hiroshi Okada
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Mai Asano
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| |
Collapse
|
29
|
Klinge MW, Haase AM, Mark EB, Sutter N, Fynne LV, Drewes AM, Schlageter V, Lund S, Borghammer P, Krogh K. Colonic motility in patients with type 1 diabetes and gastrointestinal symptoms. Neurogastroenterol Motil 2020; 32:e13948. [PMID: 32688448 DOI: 10.1111/nmo.13948] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM). The electromagnetic 3D-Transit system allows assessment of regional transit times and motility patterns throughout the GI tract. We aimed to compare GI transit times and detailed motility patterns of the colon in patients with DM and GI symptoms to those of healthy controls (HC). We further aimed to determine whether any abnormalities in motility were reversible by cholinergic stimulation. METHODS We compared 18 patients with DM with 20 HC by means of the 3D-Transit system. Patients were studied before and during oral administration of 60 mg pyridostigmine. KEY RESULTS Compared to HC, patients had prolonged gastric emptying (DM: 3.3 hours (interquartile range (IQR) 2.6-4.6); HC: 2.3 hours (IQR 1.7-2.7) (P < .01)), colonic transit time (DM: 52.6 hours (IQR 23.3-83.0); HC: 22.4 hours (IQR 18.9-43.6) (P = .02)), and whole gut transit time (DM: 69.4 hours (IQR 32.9-103.6); HC: 30.3 hours (IQR 25.2-49.9) (P < .01)). In addition, compared to HC, patients had prolonged transit time in the ascending colon (DM: 20.5 hours (IQR 11.0-44.0); HC: 8.0 hours (IQR 3.8-21.0) (P < .05)) and more slow retrograde movements in the colon (DM: 2 movements (IQR 1-4); HC: 1 movement (IQR 0-1) (P = .01)). In patients, pyridostigmine increased the number of bowel movements (P < .01) and reduced small intestine transit times (P < .05). CONCLUSIONS Patients with DM and GI symptoms have longer than normal GI transit times. This is only partly reversible by pyridostigmine. The increased number of retrograde colonic movements in patients could potentially explain the abnormally long transit time in proximal colon.
Collapse
Affiliation(s)
- Mette Winther Klinge
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Haase
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology and Steno Diabetes Center North, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna Sutter
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology and Steno Diabetes Center North, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sten Lund
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - Per Borghammer
- Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus, Denmark
| |
Collapse
|
30
|
Shaffer SR, Nugent Z, Walkty A, Yu BN, Lix LM, Targownik LE, Bernstein CN, Singh H. Time trends and predictors of laboratory-confirmed recurrent and severe Clostridioides difficile infections in Manitoba: a population-based study. CMAJ Open 2020; 8:E737-E746. [PMID: 33199507 PMCID: PMC7676992 DOI: 10.9778/cmajo.20190191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many previous studies of Clostridioides difficile infection (CDI) epidemiology have used hospital discharge data codes, which can have limited accuracy. We used a data set of laboratory-confirmed cases of CDI in the province of Manitoba, Canada, to describe the epidemiology of CDI over a decade. METHODS We conducted a population-based historical cohort study using Manitoba Health's population-wide laboratory-based CDI data set linked to administrative health databases. All individuals living in Manitoba and experiencing a CDI episode between 2005 and 2015 were included (n = 8471) and followed up from CDI diagnosis. We assessed time trends of CDI, incidence and predictors of recurrence and severe outcomes, and health care encounters after CDI diagnosis. CDI episodes were stratified by community versus hospital site of acquiring CDI. RESULTS Between 2005 and 2009, overall CDI diagnoses decreased by an average of 12.6% per year (95% confidence interval [CI] -4.4 to -20.0), with no statistically significant change from 2010 to 2015. In stratified analysis, incident and recurrent CDI had a similar decrease in the initial study time period and then stabilized. The proportion of community-associated CDI cases increased by an average of 4.8% per year (95% CI 2.8 to 6.8) during the study period. CDI acquired in a health care facility had a higher recurrence rate and more severe outcomes. Recurrence of CDI increased the likelihood of admission to hospital. INTERPRETATION Between 2005 and 2015, the rates of overall laboratory-confirmed CDI, incident CDI, recurrent CDI and severe outcomes following CDI initially decreased before stabilizing, and an increasing proportion of CDI cases were community-associated. There is an increasing need to test for CDI among outpatients with diarrhea and to increase efforts to prevent recurrent CDI.
Collapse
Affiliation(s)
- Seth R Shaffer
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Zoann Nugent
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Andrew Walkty
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - B Nancy Yu
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Lisa M Lix
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Laura E Targownik
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Charles N Bernstein
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont
| | - Harminder Singh
- Internal Medicine (Shaffer, Nugent, Walkty, Bernstein, Singh), University of Manitoba, Winnipeg, Man.; Inflammatory Bowel Disease Centre (Shaffer), University of Chicago Medicine, Chicago, Ill.; CancerCare Manitoba, Research Institute (Nugent, Singh); Community Health Sciences (Yu, Lix, Singh), University of Manitoba, Winnipeg, Man.; Division of Epidemiology and Population Health (Yu), BC Centre for Excellence in HIV/AIDS, Vancouver, BC; Division of Gastroenterology (Targownik), Mount Sinai Hospital, University of Toronto, Toronto, Ont.
| |
Collapse
|
31
|
Elias-Oliveira J, Leite JA, Pereira ÍS, Guimarães JB, Manso GMDC, Silva JS, Tostes RC, Carlos D. NLR and Intestinal Dysbiosis-Associated Inflammatory Illness: Drivers or Dampers? Front Immunol 2020; 11:1810. [PMID: 32903730 PMCID: PMC7438795 DOI: 10.3389/fimmu.2020.01810] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
The intestinal microbiome maintains a close relationship with the host immunity. This connection fosters a health state by direct and indirect mechanisms. Direct influences occur mainly through the production of short-chain fatty acids (SCFAs), gastrointestinal hormones and precursors of bioactive molecules. Indirect mechanisms comprise the crosstalk between bacterial products and the host's innate immune system. Conversely, intestinal dysbiosis is a condition found in a large number of chronic intestinal inflammatory diseases, such as ulcerative colitis and Crohn's disease, as well as in diseases associated with low-grade inflammation, such as obesity, type 1 and 2 diabetes mellitus and cardiovascular diseases. NOD-Like receptors (NLRs) are cytoplasmic receptors expressed by adaptive and innate immune cells that form a multiprotein complex, termed the inflammasome, responsible for the release of mature interleukin (IL)-1β and IL-18. NLRs are also involved in the recognition of bacterial components and production of antimicrobial molecules that shape the gut microbiota and maintain the intestinal homeostasis. Recent novel findings show that NLRs may act as positive or negative regulators of inflammation by modulating NF-κB activation. This mini-review presents current and updated evidence on the interplay between NLRs and gut microbiota and their dual role, contributing to progression or conferring protection, in diabetes and other inflammatory diseases.
Collapse
Affiliation(s)
- Jefferson Elias-Oliveira
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jefferson Antônio Leite
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Ítalo Sousa Pereira
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jhefferson Barbosa Guimarães
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gabriel Martins da Costa Manso
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - João Santana Silva
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rita Cássia Tostes
- Department of Pharmacology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniela Carlos
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| |
Collapse
|
32
|
Zad M, Do CN, Heffernan A, Johnston L, Al-Ansari M. Factors affecting bowel preparation adequacy and procedural time. JGH OPEN 2020; 4:206-214. [PMID: 32280766 PMCID: PMC7144787 DOI: 10.1002/jgh3.12241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/09/2019] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Abstract
Background and Aim Poor bowel preparation results in difficult colonoscopies, missed lesions, and repeat procedures. Identifying patient risk factors for poor bowel preparation, such as prolonged runway time and prolonged cecal intubation, will aid in interventions prior to a procedure. Methods This was a retrospective, single‐center analysis of 3 295 colonoscopies performed between May 2012 and November 2014. Indications for colonoscopy included gastrointestinal bleed and anemia, change in bowel habits, for screening, and others (including planning re‐anastomoses, abdominal distension, family history and angioectasias). Data were collected from medical charts and endoscopy reports. Comparisons between patient factors and runway time were made with adequacy of bowel preparation as the primary outcomes. Results Male and diabetic patients had statistically higher rates of inadequate bowel preparation and prolonged cecal intubation times. A previous history of abdominal surgery also demonstrated prolonged cecal intubation. A runway time of ≤7.63 h was associated with higher rates of adequate bowel preparation by multivariate analysis. The optimal time frame is 3–6 h for the highest success rates. Conclusion Patient risk factors for inadequate bowel preparation or prolonged cecal intubation should signal clinicians to intervene prior to colonoscopy. A runway time between 3 and 6 h is optimal for adequate bowel preparation. This may involve further patient education, along with work flow optimization, to facilitate ideal runway times. Future studies should explore how to avoid repeat endoscopies using protocols enforcing this timeframe.
Collapse
Affiliation(s)
- Mohammadali Zad
- Gastroenterology, Logan Hospital Brisbane Queensland Australia
| | - Cuong N Do
- General Medicine, Princess Alexandra Hospital Brisbane Queensland Australia
| | - Aaron Heffernan
- School of Medicine Griffith University Gold Coast Queensland Australia
| | - Lucy Johnston
- Paediatrics, Monash Hospital Melbourne Victoria Australia
| | | |
Collapse
|
33
|
Selbuz S, Buluş AD. Gastrointestinal symptoms in pediatric patients with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2020; 33:185-190. [PMID: 31846427 DOI: 10.1515/jpem-2019-0350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Abstract
Background Various gastrointestinal (GI) symptoms are associated with diabetes. Common GI complaints associated with the manifestation of the disease include abdominal pain, diarrhea, nausea, bloating and vomiting. There have been very few studies examining GI problems of pediatric patients with type 1 diabetes mellitus (T1DM). The aims of this study were to find out the prevalence of GI symptoms in pediatric patients with T1DM and to determine the correlation among such symptoms, duration of diabetes and glycemic control. Methods One hundred and thirty-seven (median age 13.2 years, female 45.3%) patients with T1DM were examined. Demographic features, GI symptoms, signs and physical examination findings of the patients were recorded by pediatric gastroenterology specialists for the differential diagnosis and exclusion of other etiologies. Complete blood count, blood glucose, lipid profile, electrolytes, amylase, lipase, celiac antibodies and glycated hemoglobin (HbA1c) levels were evaluated and stool examination was performed. Endoscopy was performed on the patients who had refractory GI complaints. Gastric emptying (GE) time was evaluated using GE scintigraphy. Results Overall, 74 (54%) patients had ≥1 GI complaints. Patients often reported gastroesophageal reflux (32.8%) and abdominal pain (18%). The most significant findings in terms of GI symptoms were determined when patients were classified according to the glycemic control status. Reflux and dyspeptic symptoms were significantly more common in poorly or very poorly controlled diabetic patients (p=0.003 and p=0.004, respectively). Conclusions Diabetes can affect the entire GI tract, and GI symptoms are common in pediatric patients. We recommend that T1DM patients be evaluated for GI symptoms.
Collapse
Affiliation(s)
- Suna Selbuz
- Keçiören Research and Training Hospital, Pediatric Endocrinology, Ankara, Turkey
| | - Ayşe Derya Buluş
- Keçiören Research and Training Hospital, Pediatric Endocrinology, Ankara, Turkey
| |
Collapse
|
34
|
|
35
|
Singh H, Nugent Z, Walkty A, Yu BN, Lix LM, Targownik LE, Bernstein CN, Witt J. Direct cost of health care for individuals with community associated Clostridium difficile infections: A population-based cohort study. PLoS One 2019; 14:e0224609. [PMID: 31703080 PMCID: PMC6839863 DOI: 10.1371/journal.pone.0224609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
Background Even though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of community-acquired CDI. We estimated cost of care for individuals with community-associated CDI and compared with that for matched controls without CDI in the time period of six months before to one year after CDI. Methods All individuals in the province of Manitoba, diagnosed with CDI between July 2005 and March 2015 were matched up to 4 individuals without CDI. Health care utilization and direct costs resulting from hospitalizations, physician reimbursement claims and prescriptions were determined from the population based provincial databases. Quantile regressions were performed to determine predictors of cost of individuals with community associated CDI. Results Of all CDIs, 30–40% in each period of the study had community-associated CDI; of which 12% were recurrent CDIs. The incremental median and 90th percentile cost of care for individuals with community-associated CDI was $800 and $16,000 respectively in the six months after CDI diagnosis. After adjustment for age, co-morbidities, sex, socioeconomic status and magnitude of health care utilization prior to CDI, the median incremental cost for recurrent CDI was $1,812 and that for a subsequent episode of CDI was $3,139 compared to those with a single community-associated CDI episode. The median cost for a prescription of Vancomycin was $316 (IQR 209–489). Conclusions Health care costs of an episode of community-associated CDI have been much more than the cost of antibiotic treatment. Our study provides population-based data for formal cost effectiveness analysis for use of newer treatments for community-associated CDI.
Collapse
Affiliation(s)
- Harminder Singh
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Research Institute, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Zoann Nugent
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- CancerCare Manitoba, Research Institute, Winnipeg, Manitoba, Canada
| | - A Walkty
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - B Nancy Yu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Public Health Branch, Manitoba Health, Seniors and Active Living, Winnipeg, Manitoba, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E. Targownik
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Charles N. Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Julia Witt
- Department of Economics, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
36
|
Kalkan S, Karatay E, Akbal E. Increased gastrointestinal symptom frequency in diabetes mellitus even with good glycemic control. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2019. [DOI: 10.32322/jhsm.635710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
37
|
Crooks B, Limdi JK, McLaughlin J. How to manage chronic diarrhoea in the elderly? Frontline Gastroenterol 2019; 10:427-433. [PMID: 31656570 PMCID: PMC6788271 DOI: 10.1136/flgastro-2018-101097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/08/2019] [Accepted: 03/20/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Benjamin Crooks
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Jimmy K Limdi
- Section of IBD, Division of Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - John McLaughlin
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford, UK
- Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
38
|
An J, Li Y, Song S, Liu S. Electroacupuncture promotes the gastrointestinal motility of diabetic mice by CNP/NPR-B-cGMP and PDE3A-cGMP signaling. Neurogastroenterol Motil 2019; 31:e13539. [PMID: 30672071 DOI: 10.1111/nmo.13539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Electroacupuncture (EA) can promote gastrointestinal (GI) motility of diabetic mice, but the mechanism is not clearly elucidated. Natriuretic peptides (NPs) were related to the diabetes-induced gut dysfunction of mice, which may be associated with ICC (interstitial cells of cajal). Besides, EA could increase the ICC of diabetic mice. Our aim was to explore whether EA can promote the gut motility by CNP/NPR-B-cGMP and PDE3A-cGMP signaling in diabetic mice, and the relationship between NPs and ICC. METHODS Wild C57BL/6 male mice were divided into five groups: control group, diabetic mellitus (DM group), diabetic mellitus plus sham EA group (SEA), diabetic mellitus plus low-frequency EA group (LEA), and diabetic mellitus plus high-frequency group (HEA). Gastrointestinal motility was assessed by gastric emptying and GI transit test. Immunofluorescence staining was applied to assess the expression level of CNP, NPR-B, and c-Kit. Western blot, PCR, and ELISA were used to detect the level of CNP, NPR-B, PDE2A, PDE3A, c-Kit, mSCF, and cGMP content. The correlativity between NPR-B and mSCF was evaluated by Pearson's correlation and linear regression analyses. KEY RESULTS (a) EA could improve the GI dysfunction of diabetic mice. (b) CNP, NPR-B, and cGMP contents were decreased, but the level of PDE3A, c-Kit, and mSCF was increased in the EA groups. (c) There was a negative correlation between NPR-B and mSCF among the groups. CONCLUSIONS AND INFERENCES Electroacupuncture promotes the GI function by CNP/NPR-B-cGMP and PDE3A-cGMP signaling in diabetic mice; up-regulated mSCF/c-Kit signaling by EA may be mediated partially via down-regulation of CNP/NPR-B signaling.
Collapse
Affiliation(s)
- Jing An
- Division of Gastroenterology, Union Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, China
| | - YingLi Li
- Division of Gastroenterology, Union Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, China
| | - ShuangNing Song
- Division of Gastroenterology, Union Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, China
| | - Shi Liu
- Division of Gastroenterology, Union Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
39
|
Carvour ML, Wilder SL, Ryan KL, Walraven C, Qeadan F, Brett M, Page K. Predictors of Clostridium difficile infection and predictive impact of probiotic use in a diverse hospital-wide cohort. Am J Infect Control 2019; 47:2-8. [PMID: 30205907 PMCID: PMC6321775 DOI: 10.1016/j.ajic.2018.07.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hospital-based predictive models for Clostridium difficile infection (CDI) may aid with surveillance efforts. METHODS A retrospective cohort of adult hospitalized patients who were tested for CDI between May 1, 2011, and August 31, 2016, was formed. Proposed clinical and sociodemographic predictors of CDI were evaluated using multivariable predictive logistic regression modeling. RESULTS In a cohort of 5,209 patients, including 1,092 CDI cases, emergency department location (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.51, 2.41; compared with an intensive care unit reference category, which had the lowest observed odds in the study) and prior exposure to a statin (aOR, 1.26, 95% CI, 1.06, 1.51), probiotic (aOR, 1.39; 95% CI, 1.08, 1.80), or high-risk antibiotic (aOR, 1.54; 95% CI, 1.29, 1.84), such as a cephalosporin, a quinolone, or clindamycin, were independent predictors of CDI. Probiotic use did not appear to attenuate the odds of CDI in patients exposed to high-risk antibiotics, but moderate-risk antibiotics appeared to significantly attenuate the odds of CDI in patients who received probiotics. CONCLUSIONS Emergency department location, high-risk antibiotics, probiotics, and statins were independently predictive of CDI. Further exploration of the relationship between probiotics and CDI, especially in diverse patient populations, is warranted.
Collapse
Affiliation(s)
- Martha L. Carvour
- Division of Epidemiology, Biostatistics, and Preventive Medicine; Department of Internal Medicine; University of New Mexico; 1 University of New Mexico; MSC 10-5550; Albuquerque, New Mexico 87131; USA; ; ;
- Division of Infectious Diseases; Department of Internal Medicine; University of New Mexico; 1 University of New Mexico; MSC 10-5550; Albuquerque, New Mexico 87131; USA; ;
| | - Shane L. Wilder
- University of New Mexico School of Medicine, 2425 Camino de Salud; Albuquerque, New Mexico 87106; USA;
| | - Keenan L. Ryan
- Department of Pharmacy; University of New Mexico Hospital; 2211 Lomas Blvd. NE; Albuquerque, New Mexico 87106; USA; ,
| | - Carla Walraven
- Department of Pharmacy; University of New Mexico Hospital; 2211 Lomas Blvd. NE; Albuquerque, New Mexico 87106; USA; ,
| | - Fares Qeadan
- Division of Epidemiology, Biostatistics, and Preventive Medicine; Department of Internal Medicine; University of New Mexico; 1 University of New Mexico; MSC 10-5550; Albuquerque, New Mexico 87131; USA; ; ;
| | - Meghan Brett
- Division of Infectious Diseases; Department of Internal Medicine; University of New Mexico; 1 University of New Mexico; MSC 10-5550; Albuquerque, New Mexico 87131; USA; ;
| | - Kimberly Page
- Division of Epidemiology, Biostatistics, and Preventive Medicine; Department of Internal Medicine; University of New Mexico; 1 University of New Mexico; MSC 10-5550; Albuquerque, New Mexico 87131; USA; ; ;
| |
Collapse
|
40
|
Sanders KM, Ward SM. Nitric oxide and its role as a non-adrenergic, non-cholinergic inhibitory neurotransmitter in the gastrointestinal tract. Br J Pharmacol 2019; 176:212-227. [PMID: 30063800 PMCID: PMC6295421 DOI: 10.1111/bph.14459] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 12/19/2022] Open
Abstract
NO is a neurotransmitter released from enteric inhibitory neurons and responsible for modulating gastrointestinal (GI) motor behaviour. Enteric neurons express nNOS (NOS1) that associates with membranes of nerve varicosities. NO released from neurons binds to soluble guanylate cyclase in post-junctional cells to generate cGMP. cGMP-dependent protein kinase type 1 (PKG1) is a major mediator but perhaps not the only pathway involved in cGMP-mediated effects in GI muscles based on gene deletion studies. NOS1+ neurons form close contacts with smooth muscle cells (SMCs), interstitial cells of Cajal (ICC) and PDGFRα+ cells, and these cells are electrically coupled (SIP syncytium). Cell-specific gene deletion studies have shown that nitrergic responses are due to mechanisms in SMCs and ICC. Controversy exists about the ion channels and other post-junctional mechanisms that mediate nitrergic responses in GI muscles. Reduced nNOS expression in enteric inhibitory motor neurons and/or reduced connectivity between nNOS+ neurons and the SIP syncytium appear to be responsible for motor defects that develop in diabetes. An overproduction of NO in some inflammatory conditions also impairs normal GI motor activity. This review summarizes recent findings regarding the role of NO as an enteric inhibitory neurotransmitter. LINKED ARTICLES: This article is part of a themed section on Nitric Oxide 20 Years from the 1998 Nobel Prize. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.2/issuetoc.
Collapse
Affiliation(s)
- Kenton M Sanders
- Department of Physiology and Cell BiologyUniversity of Nevada, Reno, School of MedicineRenoNVUSA
| | - Sean M Ward
- Department of Physiology and Cell BiologyUniversity of Nevada, Reno, School of MedicineRenoNVUSA
| |
Collapse
|
41
|
Chen Y, Liu G, He F, Zhang L, Yang K, Yu H, Zhou J, Gan H. MicroRNA 375 modulates hyperglycemia-induced enteric glial cell apoptosis and Diabetes-induced gastrointestinal dysfunction by targeting Pdk1 and repressing PI3K/Akt pathway. Sci Rep 2018; 8:12681. [PMID: 30140011 PMCID: PMC6107553 DOI: 10.1038/s41598-018-30714-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
Diabetic neuropathy can damage systemic nervous system, including alteration of enteric nervous system and subsequent gastrointestinal dysfunction. The effect of diabetes on enteric glia cell (EGC) is not clear. We investigated the effect of diabetes and hyperglycemia on EGC, and the role of microRNA375 in modulating EGC survival in vivo and in vitro. Streptozotocin-induced diabetic mice were intraperitoneally injected with microRNA375 inhibitor or its negative control. EGC was transfected with microRNA375 inhibitor or its mimic. Diabetes mice with gastrointestinal dysfunction showed increased apoptosis of EGC (no difference in cell numbers) and gene expression of micorRNA375 in the myenteric plexus. Hyperglycemia triggered apoptosis of EGC in vitro with decreased expression of Pdk1 and p-Akt, but increased expression of micorRNA375. MicorRNA375 mimic induced apoptosis of EGC in vitro with repressed Pdk1and p-Akt. MicorRNA375 inhibitor could both prevent hyperglycemia-induced apoptosis of EGC in vitro and diabetes-induced gastrointestinal dysfunction in vivo. Our results suggest that diabetes-induced gastrointestinal dysfunction is related to increased apoptosis of EGC in the myenteric plexus. Hyperglycemia can increase the expression of microRNA375 and damage EGC survival through PI3K/Akt pathway. MicroRNA375 specific inhibition can prevent hyperglycemia induced EGC damage and diabetes-induced gastrointestinal dysfunction.
Collapse
Affiliation(s)
- Yan Chen
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Gongxiang Liu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Fuqian He
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Zhang
- Department of elderly digestive, Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Kun Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Huan Yu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jinqiu Zhou
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Huatian Gan
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
42
|
Shan TD, Lv SY, Tian ZB, Liu XS, Liu FG, Sun XG. Knockdown of lncRNA H19 inhibits abnormal differentiation of small intestinal epithelial cells in diabetic mice. J Cell Physiol 2018; 234:837-848. [PMID: 30078183 DOI: 10.1002/jcp.26902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM) comprises a group of metabolic diseases characterized by insulin deficiency or resistance and hyperglycemia. We previously reported the presence of abnormal differentiation of small intestinal epithelial cells (IECs) in diabetic mice, but the exact mechanism of this phenomenon has not been thoroughly elucidated to date. In this study, we found that H19 was markedly upregulated in IECs of DM mice. H19 knockdown significantly inhibited abnormal differentiation of IECs in DM mice. Bioinformatics analysis identified miR-141-3p as a candidate for H19. Based on luciferase reporter assays, we found that miR-141-3p directly targeted H19. Luciferase reporter assays also showed that miR-141-3p could directly target β-catenin. Furthermore, H19 might act as an endogenous "sponge" by competing for miR-141-3p binding to regulate miRNA targets in vitro and in vivo. In summary, our findings provide the first evidence supporting the role of H19 in IECs of DM mice, and miR-141-3p targets not only protein-coding genes but also the lncRNA H19.
Collapse
Affiliation(s)
- Ti-Dong Shan
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Shao-Yan Lv
- Department of Emergency Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Zi-Bin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Xi-Shuang Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Fu-Guo Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Xu-Guo Sun
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| |
Collapse
|
43
|
Sha H, Tong X, Zhao J. Abnormal expressions of AGEs, TGF-β1, BDNF and their receptors in diabetic rat colon-Associations with colonic morphometric and biomechanical remodeling. Sci Rep 2018; 8:9437. [PMID: 29930382 PMCID: PMC6013484 DOI: 10.1038/s41598-018-27787-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/08/2018] [Indexed: 02/06/2023] Open
Abstract
Present study aims to investigate the role of AGEs, TGF-β1, BDNF and their receptors on diabetes-induced colon remodeling. Diabetes was induced by a single tail vein injection 40 mg/kg of STZ. The parameters of morphometric and biomechanical properties of colonic segments were obtained from diabetic and normal rats. The expressions of AGE, RAGE, TGF- β1, TGF- β1 receptor, BDNF and TrkB were immunohistochemically detected in different layers of the colon. The expressions of AGE, RAGE, TGF-β1 and TGF- β1 receptor were increased whereas BDNF and TrkB were decreased in the diabetic colon (P < 0.05, P < 0.01). AGE, RAGE and TGF-β1 receptor expressions were positively correlated whereas the BDNF expression was negatively correlated with most of the morphometry and biomechanical parameters (P < 0.05, P < 0.01, P < 0.001). AGE, TGF- β1 and BDNF in different layers correlated with their receptors RAGE, TGF- β1 receptor and TrkB respectively. STZ-induced diabetes up-regulated the expression of AGE, RAGE, TGF- β1 and TGF- β1 receptors and down-regulated BDNF and TrkB in different layers of diabetic colon mainly due to hyperglycemia. Such changes maybe important for diabetes-induced colon remodeling, however it is needed to further perform mechanistic experiments in order to study causality or approaches that explain the relevance of the molecular pathways.
Collapse
Affiliation(s)
- Hong Sha
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiaolin Tong
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Jingbo Zhao
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark.
| |
Collapse
|