Clinical role of diosmectite in the management of diarrhea

Long-term diosmectite use does not alter the gut microbiota in adults with chronic diarrhea

Background

Diosmectite, a natural colloidal clay, has been used worldwide for a number of approved indications, including the treatment of chronic functional diarrhea. Here, we used high-resolution whole metagenome shotgun sequencing to assess the impact of a 5 weeks administration of diosmectite (3 g/sachet, 3 sachets/day) on the fecal microbiota of 35 adults with functional chronic diarrhea.

Results

Gut microbiota was not impacted by diosmectite administration. In particular, richness remained stable and no microbial species displayed a significant evolution. Segregating patients either by diosmectite response (non responder, early responder, late responder) or by nationality (Great-Britain or Netherlands) yielded the same results.

Conclusion

We concluded that no microbiota-related physiological alterations are expected upon long-term treatment with diosmectite.

Trial registration

Clinicaltrials.gov NCT03045926

Supplementary Information

The online version contains supplementary material available at 10.1186/s12866-022-02464-7.

The Cutting Edge of Gastroenteritis: Advances in Understanding of Enteric Infection

ABSTRACT

In recent years, multiple advances have been made in the care, diagnosis, and mechanistic understanding of acute gastroenteritis (AGE). In this review, we discuss the current state of the art of diagnosis and management, as well as how changes in practice can improve care and decrease costs. We will discuss present study demonstrating the effect of AGE on the microbiome and how that may be linked to secondary effects or long-term changes. We will explore the use of novel technologies to further our capacity to understand how gastrointestinal infections occur and promulgate. Finally, will discuss advances in our understanding of how gastrointestinal infections capacitate other changes such as post-viral motility or other post viral intestinal dysfunction.

Postoperative supplementation of propionate and silicon dioxide in patients after total gastrectomy - preliminary report

Introduction

Post-operative impairment of gastrointestinal tract function and metabolic consequences occur in patients after gastrectomy by Roux-en-Y method. Short-chain fatty acids and silicon dioxide may prove beneficial in the treatment of these conditions.

Aim

To evaluate a preparation containing propionic acid and silicon dioxide on the body weight, number of stools and their consistency (the Bristol scale), and pain and a feeling of gastric fullness after a meal, in patients after gastrectomy by Roux-en-Y method.

Material and methods

Measurements were performed at the beginning of the study, on day 7 and 14 of application (Colostop^®; Miralex, 2 × 15 g/day).

Results and conclusions

Initially the average daily number of movements was 10/day, after the therapy it was 3.8/day. At the beginning of the study, 3 patients described their faeces as type 6 and two as type 7 on the Bristol scale. After supplementation, 3 patients described stool consistency as type 5, and two as type 4. Initially, patients rated their pain at 3.4/10 on average, the stomach fullness as 4.6/10. At the end of the study, 3 patients did not feel any pain, while others reported pain at 1/10. Four patients described their feeling of gastric fullness as 1/10, and 1 no longer observed this feeling. Patients disclaimed any adverse effects, and satisfaction after therapy reached 9–10/10 points. Patients’ body weight did not change significantly. An improvement in standard diet tolerance was observed. Despite the limited study group, clinical benefits of the supplementation were observed.

Palygorskite Supplementation Improves Growth Performance, Oxidative Status, and Intestinal Barrier Function in Cherry Valley Ducks

The effects of dietary palygorskite (Pal) supplementation on growth performance, oxidative status, and intestinal barrier function in ducks were investigated. In total, 720 one-day-old Cherry Valley ducks were categorized into 4 treatments comprising 6 replicates with 30 ducks each. Ducks were fed a basal diet supplemented with 0, 5, 10, or 20 g/kg Pal for 42 days. Twenty-four ducks (1 male/replicate) were slaughtered at 14 and 42 days and samples were collected for analysis. Pal supplementation quadratically increased weight gain and linearly and quadratically increased feed intake (P<0.05) during the starter period. Pal enhanced serum glutathione peroxidase activity (GSHPx) at 14 (linear and quadratic, P<0.05) and 42 days (linear, P<0.001), and lowered serum malondialdehyde (MDA) content at 14 and 42 days (quadratic, P<0.05). It enhanced 42-day liver superoxide dismutase activity (linear, P=0.003) and GSH-Px activity at 14 (quadratic, P=0.044) and 42 days (linear and quadratic, P<0.001), but decreased 14-day liver MDA content (quadratic, P=0.003). Pal reduced 42-day serum diamine oxidase activity (linear and quadratic, P<0.05) and serum endotoxin content at 14 (linear and quadratic, P<0.05) and 42 days (quadratic, P=0.017). It linearly and quadratically increased jejunal mucosal immunoglobulin (Ig) M at 42 days and IgG at 14 and 42 days, and 42-day ileal mucosal IgG and secretory IgA (P<0.05). Ileal mucosal IgM content was quadratically increased at 14 and 42 days (P<0.05) by Pal. Moreover, Pal enhanced the mRNA expression of 14-day occludin in the jejunal mucosa (quadratic, P=0.033) and that of 42-day zonula occludens-1 in the ileal mucosa (linear, P=0.027). Thus, dietary Pal supplementation exerts beneficial effects through improving growth performance, antioxidant capacity, and intestinal barrier function of ducks.

Characteristics of Pica Behavior among Mothers around Lake Victoria, Kenya: A Cross-Sectional Study

Background: Pica, the craving and purposeful consumption of nonfoods, is poorly understood. We described the prevalence of pica among women on Mfangano Island, Kenya, and examined sociodemographic and health correlates. Methods: Our cross-sectional study included 299 pregnant or postpartum women in 2012. We used a 24-h recall to assess pica, defined as consumption of earth (geophagy), charcoal/ash, or raw starches (amylophagy) and built multivariable logistic regression models to examine sociodemographic and health correlates of pica. Results: Eighty-one women (27.1%) engaged in pica in the previous 24 h, with 59.3% reporting amylophagy and 56.8% reporting geophagy, charcoal, and/or ash consumption. The most common substances consumed were raw cassava (n = 30, 36.6%), odowa, a chalky, soft rock-like earth (n = 21, 25.6%), and soil (n = 17, 20.7%). Geophagy, charcoal, and/or ash consumption was negatively associated with breastfeeding (OR = 0.38, 95% CI: 0.18-0.81), and amylophagy was associated with pregnancy (OR = 4.31, 95% CI: 1.24-14.96). Pica was more common within one of six study regions (OR = 3.64, 95% CI: 1.39-9.51). We found no evidence of an association between food insecurity and pica. Conclusion: Pica was a common behavior among women, and the prevalence underscores the need to uncover its dietary, environmental, and cultural etiologies.

Copper-modified palygorskite is effective in preventing and treating diarrhea caused by Salmonella typhimurium

The aim of this research was to develop effective alternative therapies to reduce antibiotic use in animal agriculture. In this study, the efficacy of copper-modified palygorskite (CM-Pal) in preventing diarrhea caused by Salmonella was specifically examined both in vitro and in vivo. The CM-Pal was prepared with palygorskite (Pal) and copper nitrate. The antibacterial activity of the CM-Pal was detected by comparing the differences in cell numbers on plate count agar before and after adding the CM-Pal to Salmonella typhimurium cultures. Seventy ICR mice were then allocated into seven groups. Five groups (the treatment groups) were infected with S. typhimurium by intraperitoneal (i.p.) injection and were given Pal, CM-Pal, montmorillonite powder, gentamicin, and physiological saline, respectively. One group (the prevention group) was given CM-Pal before infection with S. typhimurium. Another group (the uninfected group) was not infected with S. typhimurium. The effects of Pal, CM-Pal, montmorillonite powder, and gentamicin on the treatment or prevention of diarrhea in the mice were examined by stool studies, fecal scoring, and assessment of growth performance and villus height. The CM-Pal had satisfactory anti-bacterial properties in vitro: the antibacterial rate was 100% after 2 h incubation with S. typhimurium NJS1 cultures (1×10⁶ colony-forming units (CFU)/ml). In the in vivo experiment, the CM-Pal exerted superior effects in the treatment and prevention of diarrhea in mice compared with Pal, montmorillonite powder, and gentamicin. In the CM-Pal group, no mice showed signs of diarrhea at 24 h post infection (p.i.), and all mice fully recovered from infection. However, the Pal group, montmorillonite group, and gentamicin group only recovered after 48, 48, and 96 h, respectively. The villus height level in the CM-Pal treatment group recovered at 3 d p.i. However, the recovery time of the other groups was longer (at least 5 d). The CM-Pal prevention group had a better effect on weight gain than the other groups. This study suggested that CM-Pal may be an effective alternative to conventional antibiotics for the treatment and prevention of animal diarrhea caused by Salmonella.

Copper/zinc-loaded montmorillonite influences intestinal integrity, the expression of genes associated with inflammation, TLR4-MyD88 and TGF-β1 signaling pathways in weaned pigs after LPS challenge

This study was aimed at investigating whether dietary copper/zinc-loaded montmorillonite (Cu/Zn-Mt) could alleviate Escherichia coli LPS-induced intestinal injury through pro- and anti-inflammatory signaling pathways (TLRs, NLRs and TGF-β1) in weaned piglets. Eighteen 21-d-old pigs were randomly divided into three groups (control, LPS and LPS + Cu/Zn-Mt). After 21 d of feeding, pigs in the LPS group and LPS + Cu/Zn-Mt group received i.p. administration of LPS, whereas pigs in the control group received saline. At 4 h post-injection, jejunum samples were collected for analysis. The results indicated that, compared with the LPS group, supplemental Cu/Zn-Mt increased transepithelial electrical resistance, the expressions of anti-inflammatory cytokines (TGF-β1) in mRNA and protein levels, and decreased FD4 and the mRNA expression of pro-inflammatory cytokines (TNF-α, IL-6, IL-8 and IL-1β). The pro-inflammatory signaling pathways results demonstrated that Cu/Zn-Mt supplementation decreased the mRNA levels of TLR4 and its downstream signals (MyD88, IRAK1, TRAF6) but had no effect on NOD1 and NOD2 signals. Cu/Zn-Mt supplementation did not affect NF-κB p65 mRNA abundance, but down-regulated its protein expression. The anti-inflammatory signaling pathways results showed supplemental Cu/Zn-Mt also increased TβRII, Smad4 and Smad7 mRNA expressions. These findings suggested dietary Cu/Zn-Mt attenuated LPS-induced intestinal injury by alleviating intestinal inflammation, influencing TLR4-MyD88 and TGF-β1 signaling pathways in weaned pig.

The capacity and effectiveness of diosmectite and charcoal in trapping the compounds causing the most frequent intoxications in acute medicine: A comparative study

The aim of the study was to compare the adsorption ability of two adsorbent materials, namely diosmectite and activated charcoal towards selected model compounds that are most commonly involved in acute intoxication. Eleven model compounds were selected: acetylsalicylic acid, α-amanitin, amlodipine, digoxin, phenobarbital, ibuprofen, imipramine, carbamazepine, oxazepam, promethazine, and theophylline. Of the tested compounds, promethazine and imipramine were the most effectively adsorbed to diosmectite. Their adsorption to diosmectite (0.356±0.029mg promethazine/mg diosmectite and 0.354±0.019mg imipramine/mg diosmectite, respectively) was significantly higher than their adsorption to activated charcoal. The effect of temperature and pH on the adsorption efficiencies was also evaluated. In the case of experiments with mixture of both adsorbents, they mostly behaved in a solution independently or in a slightly antagonistic way. Using various methods such as N₂ adsorption and thermogravimetric analysis, the structure and texture of diosmectite and activated charcoal were attained.

Mechanisms of antidiarrhoeal effects by diosmectite in human intestinal cells

Background

Rotavirus (RV) induces diarrhoea through a sequence of enterotoxic and cytotoxic effects. The former are NSP4-dependent, induce calcium-dependent chloride secretion and involve oxidative stress. Diosmectite (DS) is a natural clay that has been recommended as an active therapy for diarrhoea, but the mechanism of its effect is not clear. Electrical parameters may be used to measure the direct enterotoxic and cytotoxic effects in polar epithelial intestinal cells. To investigate the effects of DS on RV-induced enterotoxic and cytotoxic damage. Caco-2 cells were used as a model of RV infection to evaluate chloride secretion, epithelial integrity, oxidative stress and viral infectivity in Ussing chambers.

Results

Diosmectite reduced the expression of NSP4 and oxidative stress, resulting in a strong inhibition of chloride secretion. Preincubating RV with DS reduced the cytotoxic effect. Finally, the viral load was reduced by DS but not by control clay. This result suggests that DS specifically affects the early events of RV infection protecting the enterocyte, whereas it does not restore already-established cell damage.

Conclusion

These findings indicate that DS exerts an anti-diarrhoeal effect by inhibiting viral replication and the expression of NSP4. Both ion secretion and cell damage induced by RV are strongly inhibited consequent to the antiviral effect, which explains its clinical efficacy.

Preventive obesity agent montmorillonite adsorbs dietary lipids and enhances lipid excretion from the digestive tract

Western diets are typically high in fat and are associated with long-term complications such as obesity and hepatic steatosis. Because of the enjoyable taste of high-fat diets (HFDs), we are interested in determining how to decrease lipid absorption and enhance lipid excretion from the digestive tract after the consumption of eating fatty foods. Montmorillonite was initially characterized as a gastrointestinal mucosal barrier protective agent for the treatment of diarrhoea. Dietary lipid adsorbent- montmorillonite (DLA-M) was isolated and purified from Xinjiang montmorillonite clay via the water extraction method. Here, we show that DLA-M has an unexpected role in preventing obesity, hyperlipidaemia and hepatic steatosis in HFD-fed rats. Interestingly, combined application of polarized light microscopy and lipid staining analyses, showed that DLA-M crystals have dietary lipid-adsorbing ability in vitro and in vivo, which enhances lipid excretion via bowel movements. In summary, our results indicate that DLA-M prevent HFD-induced obesity. This novel dietary lipid-adsorbing agent can help prevent obesity and its comorbidities.

Combined diosmectite and mesalazine treatment for mild-to-moderate ulcerative colitis: a randomized, placebo-controlled study

BACKGROUND

The relapse rate of ulcerative colitis (UC) is high. The efficacy of combined diosmectite and mesalazine treatment for active mild-to-moderate UC was investigated.

MATERIAL/METHODS

A total of 120 patients with UC were enrolled in this randomized, single-blind, placebo-controlled study. Sixty patients were assigned to the Diosmectite group (diosmectite and mesalazine) and 60 were assigned to Placebo group (placebo and mesalazine). In the induction phase, the primary end point was the clinical remission rate at 8 weeks; secondary end points were clinical response, endothelial mucosal healing, Mayo score, erythrocyte sedimentation rate, C-reactive protein levels, and defecation frequency. In the maintenance phase, the primary end point was clinical remission at 52 weeks; secondary end points were clinical response, endothelial mucosal healing, Mayo score, erythrocyte sedimentation rate, and defecation frequency.

RESULTS

At 8 weeks, the Diosmectite group had a significantly higher clinical remission rate (68.3% vs. 50%) and mucosal healing rate (66.7% vs. 48.3%) compared with the Placebo group. There were no significant differences in clinical response rates, Mayo score, erythrocyte sedimentation rate, C-reactive protein, or defecation frequency. At 52 weeks, the Diosmectite group had a significantly higher clinical remission rate (61.7% vs. 40%) and mucosal healing rate (60% vs. 38.3%) compared with the Placebo group. Defecation frequency was lower, but this was not significant.

CONCLUSIONS

Combined diosmectite and mesalazine treatment successfully induced and maintained the treatment of active mild-to-moderate UC as indicated by higher rates of clinical remission and mucosal healing.

Management of traveller's diarrhoea with a combination of sodium butyrate, organic acids, and A-300 silicon dioxide

Introduction

Traveller's diarrhoea (TD), defined by UNICEF/WHO as three or more unformed stools with or without other symptoms, imposes a considerable burden on travellers from developed countries. Various efforts have focused on decreasing the prevalence and severity of this condition.

Aim

To assess the efficacy of a combination of sodium butyrate, organic acids, and A-300 silicon dioxide in treatment providing symptomatic relief of TD.

Material and methods

The study was conducted in accordance with a protocol presented to the Bioethical committee of Poznan University of Medical Sciences. A total of 278 patients travelling to countries with higher risk of diarrhoea for at least 10 days were divided into a study arm being administered, in case of TD, a combination of sodium butyrate, organic acids, and A-300 silicon dioxide (n = 139) and a placebo arm (n = 139) with placebo administration.

Results

Forty-seven patients completed the study (22 in the study arm and 25 in the placebo arm). The diarrhoea occurrence after initiation of treatment at first symptoms was significantly lower in the study arm as compared to the placebo arm (9% vs. 36%, p = 0.041). Also, subjects from the study arm more frequently reported that the regimen administered had been efficient for their symptoms in comparison to the placebo arm (72.7% vs. 32%, p = 0.008). No adverse effects of the administered medication were noted during the study.

Conclusions

Sodium butyrate, organic acids, and A-300 silicon dioxide can be successful in decreasing symptoms of TD. Because of its efficacy and lack of observed side effects it has a strong potential in the treatment of patients with TD.

The clinical significances of irritable bowel syndrome in Taiwan

BACKGROUND AND AIM

According to the Rome III definition, irritable bowel syndrome (IBS) has been a biopsychosocial dysfunction. We tried to know whether the IBS clinical manifestations were comparable to other countries.

METHOD

We have reviewed the IBS publications in Taiwan, thus its clinical significances are summarized and compared to others.

RESULTS

Among a selected population of paid physical checkup, the Rome I & II criteria defined prevalences were 17.5% and 22.1%, respectively without an observed female predominance. However, female was a factor leading to constipation predominant IBS (C-IBS). Taiwan IBS patients did excessively consume society resource in terms of physician visits and absenteeism. They also had more chance of cholecystectomy, whereas normal appendix was often found in case of appendectomy. Overlapping extra-colonic manifestations, e.g. dyspepsia and lower urinary tract symptoms were common. Helicobacter pylori infection and female gender were closely related to the coexisted dyspepsia. Various psychiatric disturbances were also confirmed here. Intestinal transit correlated well with bowel symptoms, e.g. slow in constipation but fast in diarrhea. Diminished cholinergic activity was observed among the C-IBS patients. Various agents including mebeverine, pinaverium, peppermint oil, smectitie and tegarserod did somewhat improve IBS symptoms. Unfortunately, the IBS knowledge was not well understood among the medical professionals.

CONCLUSIONS

IBS is common in Taiwan, its impacts on the society are similarly observed while female gender often results in severe impacts. Disordered motility and cholinergic nervous system are likely some of its pathogeneses. Current recommended treatments are effectively demonstrated.

Pica in pregnancy: new ideas about an old condition

Pica, the purposive consumption of nonfood substances, is a millennia-old nutritional enigma. Its worldwide ubiquity, prevalence among pregnant women and children, and association with both positive and negative health outcomes, especially micronutrient deficiencies, underscore the importance of understanding this behavior. Multiple proposed etiologies of pica are reviewed, including cultural expectations, psychological stress, hunger, dyspepsia, micronutrient deficiencies (Fe, Zn, and Ca), and protection against toxins and pathogens. Currently available data, although limited, best support the protection hypothesis as a cause of most types of pica, although some evidence suggests that pagophagy (ice consumption) may occur during iron deficiency. It is possible that the binding capacity of pica substances explains the association with micronutrient deficiencies; earth, starch, etc. may render micronutrients in ingesta unavailable for absorption. Increased research efforts are warranted and must be hypothesis driven, interdisciplinary, and permit the testing of multiple causal inferences.