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Xu J, Wang L, Chen X, Le W. New Understanding on the Pathophysiology and Treatment of Constipation in Parkinson’s Disease. Front Aging Neurosci 2022; 14:917499. [PMID: 35813960 PMCID: PMC9257174 DOI: 10.3389/fnagi.2022.917499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022] Open
Abstract
Constipation, one of the most common prodromal non-motor symptoms of Parkinson’s disease (PD), usually occurs several years earlier than the onset of motor symptoms. Previous studies have shown that constipation occurrence increases as the disease progresses. However, the mechanism underlying this pathologic disorder is not clear yet. Moreover, chronic constipation causes slowness in gastric emptying and, therefore, may lead to a delay in the absorption of medications for PD, including levodopa and dopamine agonists. Accordingly, it is necessary to understand how the pathophysiological factors contribute to constipation during PD as well as pursue precise and effective treatment strategies. In this review, we encapsulate the molecular mechanism of constipation underlying PD and update the progress in the treatments of PD-associated constipation.
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Affiliation(s)
- Jianli Xu
- Institute of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Lei Wang
- Institute of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xi Chen
- Institute of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Xi Chen Weidong Le
| | - Weidong Le
- Institute of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
- Xi Chen Weidong Le
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Gourcerol G, Maltete D, Chastan N, Welter ML, Leroi AM, Derrey S. Does Bilateral Deep Brain Stimulation of the Subthalamic Nucleus Modify Ano-Rectal Motility in Parkinson's Disease? Results of a Randomized Cross-Over Study. Neuromodulation 2019; 22:478-483. [PMID: 30908813 DOI: 10.1111/ner.12947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 01/16/2019] [Accepted: 02/06/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ano-rectal motility impairment is often observed during Parkinson's disease (PD), generating symptoms as constipation and/or incontinence with impaired quality of life. Subthalamic nuclei (STN) deep brain stimulation (DBS) improves motor symptoms of PD, but its effects on anorectal motility are unknown. This study aimed to assess the effects of STN-DBS on the anorectal motility in PD patients, in a randomized cross-over study. METHODS Sixteen PD patients with bilateral STN-DBS for at least 6 months were included. The anal resting pressure, duration and maximal amplitude of squeeze effort, recto-anal inhibitory reflex, maximal tolerable rectal volume, and anal pressure during defecation effort were measured and compared after STN-DBS was switched OFF and then ON for 2 hours, or vice-versa, in a randomized order. KEY RESULTS STN-DBS increased maximal amplitude of anal squeezing pressure (OFF: 85.7 ± 14.5 vs ON: 108.4 ± 21.0 cmH2 O; P = 0.02), with no significant difference in the duration (P = 0.10). No other significant difference was found between stimulation conditions (OFF vs ON) for anal resting pressure (OFF: 72.5 ± 8.6 cmH2 O vs ON: 71.7 ± 9.0 cmH2 O; P = 0.24), recto-anal inhibitory reflex, maximal tolerable rectal volume (OFF: 231 ± 24 mL vs ON: 241 ± 26 mL; P = 0.68), or anal pressure during defecation effort with a similar rate of ano-rectal dyssynergia (7/16 and 8/16 with and without STN-DBS, respectively). No order effect (ON-OFF vs OFF-ON) was observed. CONCLUSION AND INFERENCES STN-DBS increased anal squeezing pressure, but did not modify anorectal dyssynergia in PD patients, This study demonstrated the involvement of STN in the voluntary control of anorectal motility in PD patients.
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Affiliation(s)
- Guillaume Gourcerol
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.,Nutrition, Gut and Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Clinical Investigation Centre INSERM 0204, Rouen University Hospital, University of Rouen, Rouen, France
| | - David Maltete
- Nutrition, Gut and Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Clinical Investigation Centre INSERM 0204, Rouen University Hospital, University of Rouen, Rouen, France.,Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - Nathalie Chastan
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - Marie Laure Welter
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM (INSERM UMR 1127), Paris, France
| | - Anne Marie Leroi
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.,Nutrition, Gut and Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Clinical Investigation Centre INSERM 0204, Rouen University Hospital, University of Rouen, Rouen, France
| | - Stéphane Derrey
- Nutrition, Gut and Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
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Langlois LD, Le Long E, Meleine M, Antor M, Atmani K, Dechelotte P, Leroi AM, Gourcerol G. Acute sacral nerve stimulation reduces visceral mechanosensitivity in a cross-organ sensitization model. Neurogastroenterol Motil 2017; 29. [PMID: 27997083 DOI: 10.1111/nmo.12987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/06/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sacral nerve stimulation (SNS) is a surgical treatment of fecal and urinary incontinence that consists of inserting a stimulating electrode into one of the s3 or s4 sacral holes. In addition to the benefit of SNS in the treatment of incontinence, recent studies showed that SNS is effective in the treatment of irritable bowel syndrome as well as bladder pain syndrome. The aim of this study was to evaluate the effect of SNS on visceral mechanosensitivity in a cross-organ sensitization rat model. METHODS Hypersensitive model was obtained by instillation of acetic acid into the bladder of rats during 5 minutes, 30 minutes before the start of the experiments. Visceral sensitivity was assessed by monitoring the change in mean arterial pressure in response to graded isobaric colorectal distension series. To decipher the mechanisms underlying SNS effect, rats were administered intravenously either a nonselective opioid receptor antagonist (naloxone) or a nitric oxide synthesis antagonist (L-NAME). Neuronal activation in the dorsal horn of the sacral spinal cord was measured by counting c-fos immunoreactive cells in response to colorectal distension and NMS. KEY RESULTS Intravesical acetic acid instillation increased mean arterial pressure variation in response to colorectal distension when compared to saline group. SNS reduced the variation in arterial pressure. Colorectal distension induced a rise in c-fos immunoreactive cells in the dorsal horn of the spinal cord. This effect was reduced by SNS. CONCLUSIONS & INFERENCES SNS reduces visceral mechanosensitivity in a cross-organ sensitization model.
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Affiliation(s)
- L D Langlois
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - E Le Long
- Department of Urology, Rouen University Hospital, Rouen, France
| | - M Meleine
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - M Antor
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - K Atmani
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - P Dechelotte
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - A M Leroi
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
| | - G Gourcerol
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
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Derrey S, Chastan N, Maltete D, Verin E, Dechelotte P, Lefaucheur R, Proust F, Freger P, Leroi AM, Weber J, Gourcerol G. Impact of deep brain stimulation on pharyngo-esophageal motility: a randomized cross-over study. Neurogastroenterol Motil 2015; 27:1214-22. [PMID: 26053217 DOI: 10.1111/nmo.12607] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 05/04/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bilateral subthalamic nucleus (STN) stimulation is used to alleviate Parkinson's disease (PD) motor symptoms. Recently, it has been shown that this therapeutic also increased gut cholinergic contractions. We therefore investigated the effect of STN stimulation on esophageal motility in an interventional randomized study. METHODS Sixteen humans PD patients (4 women, 12 men; age: 62.4 ± 9.3-years old) who underwent STN stimulation for at least 6 months were randomly evaluated with either stimulator turned OFF then ON, or inversely. Esophageal high resolution manometry was performed at the end of each ON and OFF period, with a 5 min resting period followed by ten swallows of 5 mL. KEY RESULTS During the ON, an increase in the distal contractility index was found (OFF: 1750 ± 629 vs ON: 2171 ± 755 mmHg/cm/s; p = 0.03), with no difference in the distal front velocity. A decrease in the integrative relaxation pressure of the lower esophageal sphincter (LES) was noted (OFF: 11.1 ± 1.8 mmHg vs ON: 7.2 ± 1.8 mmHg; p < 0.05) in ON. The LES resting pressure remained unchanged during the two periods. This resulted in a decrease in the intrabolus pressure (p = 0.03). No difference was observed for the upper esophageal sphincter, nor the pharyngeal contraction amplitude and velocity. CONCLUSIONS & INFERENCES In conclusion, STN stimulation in PD patients increased esophageal body contractions and enhanced the LES opening. This suggests that the nigrostriatal-striatonigral loop is involved in the control of esophageal motility.
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Affiliation(s)
- S Derrey
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
| | - N Chastan
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - D Maltete
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - E Verin
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - P Dechelotte
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France
| | - R Lefaucheur
- Department of Neurology, Rouen University Hospital, University of Rouen, Rouen, France
| | - F Proust
- Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
| | - P Freger
- Department of Neurosurgery, Rouen University Hospital, University of Rouen, Rouen, France
| | - A M Leroi
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
| | - J Weber
- Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France.,Clinical Investigation Centre INSERM 0204, Rouen University Hospital, University of Rouen, Rouen, France
| | - G Gourcerol
- Nutrition, Gut & Brain Unit (INSERM UMR 1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, University of Rouen, Rouen, France
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Pallarés V, Moya J, Samper-Belda FJ, Canals S, Moratal D. Neurosurgery planning in rodents using a magnetic resonance imaging assisted framework to target experimentally defined networks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 121:66-76. [PMID: 26094858 DOI: 10.1016/j.cmpb.2015.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/04/2015] [Accepted: 05/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Meaningful targeting of brain structures is required in a number of experimental designs in neuroscience. Current technological developments as high density electrode arrays for parallel electrophysiological recordings and optogenetic tools that allow fine control of activity in specific cell populations provide powerful tools to investigate brain physio-pathology. However, to extract the maximum yield from these fine developments, increased precision, reproducibility and cost-efficiency in experimental procedures is also required. METHODS We introduce here a framework based on magnetic resonance imaging (MRI) and digitized brain atlases to produce customizable 3D-environments for brain navigation. It allows the use of individualized anatomical and/or functional information from multiple MRI modalities to assist experimental neurosurgery planning and in vivo tissue processing. RESULTS As a proof of concept we show three examples of experimental designs facilitated by the presented framework, with extraordinary applicability in neuroscience. CONCLUSIONS The obtained results illustrate its feasibility for identifying and selecting functionally and/or anatomically connected neuronal population in vivo and directing electrode implantations to targeted nodes in the intricate system of brain networks.
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Affiliation(s)
- Vicente Pallarés
- Instituto de Neurociencias, Consejo Superior de Investigaciones Científicas - Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
| | - Javier Moya
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Francisco J Samper-Belda
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Santiago Canals
- Instituto de Neurociencias, Consejo Superior de Investigaciones Científicas - Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain.
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain.
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Langlois L, Meleine M, Ouelaa W, Caremel R, Bridoux V, Benard M, Dechelotte P, Ducrotte P, Grise P, Leroi AM, Gourcerol G. Acute sacral nerve stimulation reduces visceral mechanosensitivity in Rat through spinal opioid pathway. Neurogastroenterol Motil 2015; 27:816-23. [PMID: 25808214 DOI: 10.1111/nmo.12555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sacral nerve stimulation (SNS) is an alternative surgical treatment of refractory urge incontinence and/or fecal incontinence. Despite its clinical efficacy, the mechanisms of action of SNS remain poorly understood. The aim of this experimental study was to evaluate the effect of SNS on visceral mechanosensitivity in rats. METHODS Anesthetized Sprague-Dawley rats were treated with SNS or sham stimulation. SNS was performed by implanting an electrode close to the sacral nerve root S1. Rats were administered either a non-selective opioid receptor antagonist (naloxone) or a nitric oxide synthase inhibitor (L-NAME). Colonic mechanosensitivity was evaluated using the variation of arterial blood pressure as a spino-bulbar reflex in response to graded isobaric colorectal distension (CRD). C-fos immunoreactive neurons were quantified in spinal and supraspinal sites. μ-opioid receptor (MOR) internalization was counted in the sacral spinal cord with sham or effective SNS in response to CRD. KEY RESULTS SNS reduced visceral mechanosensitivity in response to CRD. This effect was reversed by intrathecal and intraveinous naloxone administration. In both models, CRD induced increased c-fos immunoreactivity in the dorsal horn neurons of the sacral spinal cord and supraspinal areas. This increase was prevented by SNS. MOR internalization was significantly higher in stimulated group. CONCLUSIONS & INFERENCES SNS impacts on visceral mechanosensitivity by decreasing the spino-bulbar reflex in response to CRD. Spinal opioid receptors are likely involved in this effect.
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Affiliation(s)
- L Langlois
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France
| | - M Meleine
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France
| | - W Ouelaa
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France
| | - R Caremel
- Department of Urology, Rouen University Hospital, Rouen, France
| | - V Bridoux
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - M Benard
- Cell Imaging Platform of Normandy (PRIMACEN), Mont-Saint-Aignan, France
| | - P Dechelotte
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France
| | - P Ducrotte
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - P Grise
- Department of Urology, Rouen University Hospital, Rouen, France
| | - A M Leroi
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
| | - G Gourcerol
- Nutrition, Gut & Brain Unit (INSERM U1073), Institute for Biomedical Research and Innovation, Rouen University, Rouen, France.,Department of Physiology, Rouen University Hospital, Rouen, France
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Ouelaa W, Ghouzali I, Langlois L, Fetissov S, Déchelotte P, Ducrotté P, Leroi AM, Gourcerol G. Gastric electrical stimulation decreases gastric distension-induced central nociception response through direct action on primary afferents. PLoS One 2012; 7:e47849. [PMID: 23284611 PMCID: PMC3527470 DOI: 10.1371/journal.pone.0047849] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/21/2012] [Indexed: 12/26/2022] Open
Abstract
Background & Aims Gastric electrical stimulation (GES) is an effective therapy to treat patients with chronic dyspepsia refractory to medical management. However, its mechanisms of action remain poorly understood. Methods Gastric pain was induced by performing gastric distension (GD) in anesthetized rats. Pain response was monitored by measuring the pseudo-affective reflex (e.g., blood pressure variation), while neuronal activation was determined using c-fos immunochemistry in the central nervous system. Involvement of primary afferents was assessed by measuring phosphorylation of ERK1/2 in dorsal root ganglia. Results GES decreased blood pressure variation induced by GD, and prevented GD-induced neuronal activation in the dorsal horn of the spinal cord (T9–T10), the nucleus of the solitary tract and in CRF neurons of the hypothalamic paraventricular nucleus. This effect remained unaltered within the spinal cord when sectioning the medulla at the T5 level. Furthermore, GES prevented GD-induced phosphorylation of ERK1/2 in dorsal root ganglia. Conclusions GES decreases GD-induced pain and/or discomfort likely through a direct modulation of gastric spinal afferents reducing central processing of visceral nociception.
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Affiliation(s)
- Wassila Ouelaa
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Ibtissem Ghouzali
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Ludovic Langlois
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Serguei Fetissov
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
| | - Pierre Déchelotte
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
- Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Philippe Ducrotté
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
- Department of Nutrition, Rouen University Hospital, Rouen, France
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anne Marie Leroi
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
- Department of Nutrition, Rouen University Hospital, Rouen, France
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
- Department of Physiology, Rouen University Hospital, Rouen, Rouen, France
| | - Guillaume Gourcerol
- Nutrition, Gut & Brain Unit (ADEN – INSERM U1073), Institute for Biomedical Research and innovation, Rouen University, Rouen, France
- Department of Nutrition, Rouen University Hospital, Rouen, France
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
- Department of Physiology, Rouen University Hospital, Rouen, Rouen, France
- * E-mail:
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