Alpha-galactosidase versus active charcoal for improving sonographic visualization of abdominal organs in patients with excessive intestinal gas

Intra-Laboratory Validation of Alpha-Galactosidase Activity Measurement in Dietary Supplements

INTRODUCTION

Alpha-galactosidase (α-Gal) is an enzyme responsible for the hydrolyzation of glycolipids and glycoprotein commonly found in dietary sources. More than 20% of the general population suffers from abdominal pain or discomfort caused by intestinal gas and by indigested or partially digested food residuals. Therefore, α-Gal is used in dietary supplements to reduce intestinal gases and help complex food digestion. Marketed enzyme-containing dietary supplements must be produced in accordance with the Food and Drug Administration (FDA) regulations for Current Good Manufacturing Practice (cGMPs).

AIM

in this work we illustrated the process used to develop and validate a spectrophotometric enzymatic assay for α-Gal activity quantification in dietary supplements.

METHODS

The validation workflow included an initial statistical-phase optimization of materials, reagents, and conditions, and subsequently a comparative study with another fluorimetric assay. A final validation of method performance in terms of specificity, linearity, accuracy, intermediate-precision repeatability, and system precision was then executed.

RESULTS AND CONCLUSIONS

The proven method achieved good performance in the quantitative determination of α-Gal activity in commercial food supplements in accordance with the International Council for Harmonisation of Technical Requirements for Pharmaceuticals (ICH) guidelines and is suitable as a rapid in-house quality control test.

Effect of adding a capsule with activated charcoal to abdominal ultrasound preparation on image quality

Background

Patient preparation for routine abdominal ultrasound, such as fasting for 8 hours and having a light meal the night before the examination, is a common practice employed to avoid digestive motility and gases, which are considered the main causes of artifacts and image quality degradation.

Importance of this study

Patient preparation before abdominal ultrasound plays a major role to ensure better visualization of internal organs and pathologies by minimizing artifacts, but because abdominal gases are still present in many patients and in large amounts, causing artifacts, it is important to search for new, safe, efficient, reliable and cost-effective methods to improve patient preparation by eliminating excessive abdominal gases.

Material and method

This was a prospective study involving a randomly selected sample of 52 adult patients, both men and women, of different age groups. The participants met the inclusion criteria and had no history of previous or current abdominal surgery. Pediatric patients, pregnant women, patients with a history of abdominal surgery, bedridden patients, and patients with bowel obstruction were excluded. Routine abdominal ultrasound was performed after usual patient preparation involving fasting for 8 hours. Subsequently, the same patients were asked to come again after 48 hours for re-scanning and were instructed to follow the same routine preparation and to take one capsule of activated charcoal 8 hours before re-scanning. The results of both scans were compared by focusing on the pancreas as the reference.

Result

Significant improvement by 57.2% was noticed in overweight, obese and extremely obese patients. The improvement noted in underweight patients and in patients with normal weight was 39.05%. The improvement in males reached 66.9% while in females: 49.9%. The overall improvement in pancreas visualization was 63%.

Conclusion

Our preliminary study concluded that activated charcoal can be used to reduce gastrointestinal gases efficiently, providing an inexpensive, safe and easy-to-use method to improve visualization in routine abdominal ultrasound scans in adults.

Intestinal gas and liver steatosis: a casual association? A prospective multicentre assessment

BACKGROUND & AIMS

Excessive intestinal gas and liver steatosis are frequent sonographic findings. Both of these appear to be caused by variations of the gut microflora. We assessed the relationship between ultrasonographic detection of intestinal gas and liver steatosis.

METHODS

This study included 204 consecutive patients (99 male; mean age 53.0 ± 15.6 years), who underwent ultrasonography for abdominal complaints or follow-up of benign lesions. Body mass index, biochemical liver markers, sonographic presence of liver steatosis and/or degree of intestinal gas interfering with the examination were collected. Both sonographic findings were assessed based on standardized criteria. The association between liver steatosis and intestinal gas was evaluated by means of univariate and multivariate analyses.

RESULTS

Eighty (39.2%) of patients showed moderate to large amounts of gas preventing an accurate evaluation of the liver or pancreas and 90 (44.1%) had liver steatosis. A significant correlation between the degree of intestinal gas and liver steatosis both in obese (r=.603; P<.001) and in nonobese patients (r=.555; P<.001) was found. Univariate analysis showed that intestinal gas, body mass index, aspartate transaminase, alanine transaminase, gamma-GT, age and sex were predictors of liver steatosis; only intestinal gas (OR 7.4; 95% CI 3.4-16.1) and body mass index (OR; 1.4, 95% CI 1.2-1.5), however, were independent predictors at multivariate analysis. The presence of excessive gas was also significantly correlated with liver steatosis coupled with elevated ALT (P = .001).

CONCLUSION

This study shows a significant correlation between excessive intestinal gas and liver steatosis. The reasons of this finding and its clinical implications remain to be defined.