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Lee JY, Bays DJ, Savage HP, Bäumler AJ. The human gut microbiome in health and disease: time for a new chapter? Infect Immun 2024:e0030224. [PMID: 39347570 DOI: 10.1128/iai.00302-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
The gut microbiome, composed of the colonic microbiota and their host environment, is important for many aspects of human health. A gut microbiome imbalance (gut dysbiosis) is associated with major causes of human morbidity and mortality. Despite the central part our gut microbiome plays in health and disease, mechanisms that maintain homeostasis and properties that demarcate dysbiosis remain largely undefined. Here we discuss that sorting taxa into meaningful ecological units reveals that the availability of respiratory electron acceptors, such as oxygen, in the host environment has a dominant influence on gut microbiome health. During homeostasis, host functions that limit the diffusion of oxygen into the colonic lumen shelter a microbial community dominated by primary fermenters from atmospheric oxygen. In turn, primary fermenters break down unabsorbed nutrients into fermentation products that support host nutrition. This symbiotic relationship is disrupted when host functions that limit the luminal availability of host-derived electron acceptors become weakened. The resulting changes in the host environment drive alterations in the microbiota composition, which feature an elevated abundance of facultatively anaerobic microbes. Thus, the part of the gut microbiome that becomes imbalanced during dysbiosis is the host environment, whereas changes in the microbiota composition are secondary to this underlying cause. This shift in our understanding of dysbiosis provides a novel starting point for therapeutic strategies to restore microbiome health. Such strategies can either target the microbes through metabolism-based editing or strengthen the host functions that control their environment.
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Affiliation(s)
- Jee-Yon Lee
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, California, USA
| | - Derek J Bays
- Department of Internal Medicine, Division of Infectious Diseases, School of Medicine, University of California Davis, Sacramento, California, USA
| | - Hannah P Savage
- Department of Pathology Microbiology and Immunology, School of Veterinary Medicine, University of California Davis, Davis, California, USA
| | - Andreas J Bäumler
- Department of Medical Microbiology and Immunology, School of Medicine, University of California Davis, Davis, California, USA
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2
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Hammer HF, Hammer J. "It's Not a Gas": The Future of Testing for Lactose Intolerance. Dig Dis Sci 2024; 69:1915-1917. [PMID: 38499734 DOI: 10.1007/s10620-024-08306-y] [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: 12/11/2023] [Accepted: 01/18/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Heinz F Hammer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Johann Hammer
- Department of Gastroenterology and Hepatology, Department of Internal Medicine 3, Medical University Vienna, Vienna, Austria
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Lee JY, Tiffany CR, Mahan SP, Kellom M, Rogers AWL, Nguyen H, Stevens ET, Masson HLP, Yamazaki K, Marco ML, Eloe-Fadrosh EA, Turnbaugh PJ, Bäumler AJ. High fat intake sustains sorbitol intolerance after antibiotic-mediated Clostridia depletion from the gut microbiota. Cell 2024; 187:1191-1205.e15. [PMID: 38366592 PMCID: PMC11023689 DOI: 10.1016/j.cell.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 09/27/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024]
Abstract
Carbohydrate intolerance, commonly linked to the consumption of lactose, fructose, or sorbitol, affects up to 30% of the population in high-income countries. Although sorbitol intolerance is attributed to malabsorption, the underlying mechanism remains unresolved. Here, we show that a history of antibiotic exposure combined with high fat intake triggered long-lasting sorbitol intolerance in mice by reducing Clostridia abundance, which impaired microbial sorbitol catabolism. The restoration of sorbitol catabolism by inoculation with probiotic Escherichia coli protected mice against sorbitol intolerance but did not restore Clostridia abundance. Inoculation with the butyrate producer Anaerostipes caccae restored a normal Clostridia abundance, which protected mice against sorbitol-induced diarrhea even when the probiotic was cleared. Butyrate restored Clostridia abundance by stimulating epithelial peroxisome proliferator-activated receptor-gamma (PPAR-γ) signaling to restore epithelial hypoxia in the colon. Collectively, these mechanistic insights identify microbial sorbitol catabolism as a potential target for approaches for the diagnosis, treatment, and prevention of sorbitol intolerance.
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Affiliation(s)
- Jee-Yon Lee
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA
| | - Connor R Tiffany
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA
| | - Scott P Mahan
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA
| | - Matthew Kellom
- Environmental Genomics & Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Andrew W L Rogers
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA
| | - Henry Nguyen
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA
| | - Eric T Stevens
- Department of Food Science and Technology, University of California at Davis, Davis, CA 95616, USA
| | - Hugo L P Masson
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA
| | - Kohei Yamazaki
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA; Laboratory of Veterinary Public Health, School of Veterinary Medicine, Kitasato University, Towada, Japan
| | - Maria L Marco
- Department of Food Science and Technology, University of California at Davis, Davis, CA 95616, USA
| | - Emiley A Eloe-Fadrosh
- Environmental Genomics & Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Peter J Turnbaugh
- Department of Microbiology & Immunology, University of California, San Francisco, San Francisco, CA 94143, USA; Chan Zuckerberg Biohub-San Francisco, San Francisco, CA 94158, USA
| | - Andreas J Bäumler
- Department of Medical Microbiology and Immunology, School of Medicine, University of California at Davis, One Shields Ave, Davis, CA 95616, USA.
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Martinez IG, Mika AS, Biesiekierski JR, Costa RJS. The Effect of Gut-Training and Feeding-Challenge on Markers of Gastrointestinal Status in Response to Endurance Exercise: A Systematic Literature Review. Sports Med 2023; 53:1175-1200. [PMID: 37061651 DOI: 10.1007/s40279-023-01841-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND Nutrition during exercise is vital in sustaining prolonged activity and enhancing athletic performance; however, exercise-induced gastrointestinal syndrome (EIGS) and exercise-associated gastrointestinal symptoms (Ex-GIS) are common issues among endurance athletes. Despite this, there has been no systematic assessment of existing trials that examine the impact of repetitive exposure of the gastrointestinal tract to nutrients before and/or during exercise on gastrointestinal integrity, function, and/or symptoms. OBJECTIVE This systematic literature review aimed to identify and synthesize research that has investigated the impact of 'gut-training' or 'feeding-challenge' before and/or during exercise on markers of gastrointestinal integrity, function, and symptoms. METHODS Five databases (Ovid MEDLINE, EMBASE, CINAHL Plus, Web of Science Core Collection, and SPORTDiscus) were searched for literature that focused on gut-training or feeding-challenge before and/or during exercise that included EIGS and Ex-GIS variables. Quality assessment was conducted in duplicate and independently using the Cochrane Collaboration's risk-of-bias (RoB 2) tool. RESULTS Overall, 304 studies were identified, and eight studies were included after screening. Gut-training or feeding-challenge interventions included provision of carbohydrates only (n = 7) in various forms (e.g., gels or liquid solutions) during cycling or running, or carbohydrate with protein (n = 1) during intermittent exercise, over a varied duration (4-28 days). Gut discomfort decreased by an average of 47% and 26% with a 2-week repetitive carbohydrate feeding protocol (n = 2) and through repeated fluid ingestion over five trials (n = 1), respectively. Repetitive carbohydrate feeding during exercise for 2 weeks resulted in the reduction of carbohydrate malabsorption by 45-54% (n = 2), but also led to no significant change (n = 1). The effect of gut-training and feeding-challenges on the incidence and severity of Ex-GIS were assessed using different tools (n = 6). Significant improvements in total, upper, and lower gastrointestinal symptoms were observed (n = 2), as well as unclear results (n = 4). No significant changes in gastric emptying rate (n = 2), or markers of intestinal injury and permeability were found (n = 3). Inconclusive results were found in studies that investigated plasma inflammatory cytokine concentration in response to exercise with increased carbohydrate feeding (n = 2). CONCLUSIONS Overall, gut-training or feeding-challenge around exercise may provide advantages in reducing gut discomfort, and potentially improve carbohydrate malabsorption and Ex-GIS, which may have exercise performance implications.
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Affiliation(s)
- Isabel G Martinez
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Alice S Mika
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Jessica R Biesiekierski
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia
| | - Ricardo J S Costa
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
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Nahrungsmittelunverträglichkeiten - eine diagnostische Herausforderung. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-021-4932-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Surve A, Cottam D, Belnap L, Richards C, Medlin W. Long-Term (> 6 Years) Outcomes of Duodenal Switch (DS) Versus Single-Anastomosis Duodeno-Ileostomy with Sleeve Gastrectomy (SADI-S): a Matched Cohort Study. Obes Surg 2021; 31:5117-5126. [PMID: 34523085 DOI: 10.1007/s11695-021-05709-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no comparative studies on the long-term outcomes after the primary traditional duodenal switch (DS) and single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S). PURPOSE This study aims to compare the long-term outcomes in a matched cohort. SETTING This study took place in a single private institute, in the USA. MATERIALS AND METHODS Data from 266 patients who underwent a primary laparoscopic traditional DS or primary laparoscopic SADI-S from September 2011 to December 2015 by four surgeons were used for a retrospective matched cohort. Data were obtained by matching every DS patient to a SADI-S patient of the same age, sex, and body mass index (BMI). In addition, only patients that were out at least 5 years and had a minimum 5-year follow-up were included in the study. RESULTS The matched cohort included 30 DS and 30 SADI-S patients. There were no statistically significant differences in the preoperative characteristics and baseline comorbidities between both groups. The SADI-S patients had significantly shorter operative time and length of stay. The overall long-term complications, especially the long-term Clavien-Dindo grade IIIb complications, were significantly fewer with SADI-S. At 6 years, the DS patients had statistically higher %EWL; however, the ending BMIs were statistically similar between both groups. There were no significant differences in the long-term comorbidity and nutritional outcomes of both groups. The long-term failure rates were comparable. CONCLUSIONS Most long-term outcomes of SADI-S were either similar or significantly better than DS. Part of the reasons could be the surgeon's learning curve and the small sample sizes of both groups.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
| | - Legrand Belnap
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Christina Richards
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
| | - Walter Medlin
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA
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Abstract
PURPOSE OF REVIEW Disaccharidase testing, as applied to the evaluation of gastrointestinal disturbances is available but it is not routinely considered in the diagnostic work-up. The purpose of this review was to determine if disaccharidase testing is clinically useful and to consider how the results could alter patient management. RECENT FINDINGS Indicate that carbohydrate maldigestion could contribute functional bowel disorders and negatively impact the fecal microbiome. Diagnostic techniques include enzyme activity assays performed on random endoscopically obtained small intestinal biopsies, immunohistochemistry, stable isotope tracer and nonenriched substrate load breath testing, and genetic testing for mutations. More than 40 sucrase--isomaltase gene variants coding for defective or reduced enzymatic activity have been reported and deficiency conditions are more common than previously thought. SUMMARY The rationale for disaccharidase activity testing relates to a need to fully assess unexplained recurrent abdominal discomfort and associated symptoms. All disaccharidases share the same basic mechanism of mucosal expression and deficiency has far reaching consequences. Testing for disaccharidase expression appears to have an important role in symptom evaluation, but there are accuracy and logistical issues that should be considered. It is likely that specific recommendations for patient management, dietary modification, and enzyme supplementation would come from better testing methods.
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Affiliation(s)
- Antone R. Opekun
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
- Section of Gastroenterology, Hepatology and Nutrition, Texas Children’s Hospital, Houston, TX, USA
| | - Bruno P. Chumpitazi
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
- Section of Gastroenterology, Hepatology and Nutrition, Texas Children’s Hospital, Houston, TX, USA
| | - Mustafa M. Abdulsada
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX, USA
| | - Buford L Nichols
- Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
- Director Emeritus, USDA/ARS Children’s Nutrition Research Center, Houston, TX, USA
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Enko D, Wagner H, Kriegshäuser G, Brandmayr W, Halwachs-Baumann G, Schnedl WJ, Zelzer S, Mangge H, Meinitzer A. Assessment of tryptophan metabolism and signs of depression in individuals with carbohydrate malabsorption. Psychiatry Res 2018; 262:595-599. [PMID: 28965810 DOI: 10.1016/j.psychres.2017.09.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/17/2017] [Accepted: 09/21/2017] [Indexed: 01/16/2023]
Abstract
This prospective cross-sectional study aimed to investigate the potential association between primary-adult lactose malabsorption, fructose malabsorption, tryptophan (TRP) metabolism and the presence of depressive signs. Overall 251 patients, who were referred for lactase gene C/T-13910 polymorphism genotyping and fructose hydrogen/methane breath testing, were included. All participants filled out the Beck Depression Inventory (BDI II). Serum concentrations of tryptophan (TRP), kynurenine (KYN), kynuric acid (KYNA), and TRP competing amino acids (leucine, isoleucine, valine, phenylalanine, tyrosine) were measured by high-pressure liquid-chromatography. Logistic regression analysis was performed with lactose malabsorption, fructose malabsorption and all potential biomarkers of TRP metabolism to assess the effect on signs of depression, defined as a BDI II score > 13. Primary-adult lactose malabsorption and fructose malabsorption was detected in 65 (25.90%) and 65 (25.90%) patients, respectively. Fructose malabsorption was significantly associated with BDI II score, whereas no such relationship was found for lactose malabsorption. Serum levels of TRP and TRP metabolites were no predictors of depression. The authors suggest to conduct further prospective longitudinal studies in order to get further insight of associations between carbohydrate malabsorption, biomarkers and mood disorders.
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Affiliation(s)
- Dietmar Enko
- Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Helga Wagner
- Department of Applied Statistics, Johannes Kepler University Linz, Linz, Austria.
| | - Gernot Kriegshäuser
- Institute of Clinical Chemistry and Laboratory Medicine, General Hospital Steyr, Steyr, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Wolfgang Brandmayr
- Department of Psychiatry and Psychotherapeutic Medicine, General Hospital Steyr, Steyr, Austria.
| | | | | | - Sieglinde Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Harald Mangge
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
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Hackl E, Darkwah J, Smith G, Ermolina I. Effect of Arginine on the Aggregation of Protein in Freeze-Dried Formulations Containing Sugars and Polyol: 1-Formulation Development. AAPS PharmSciTech 2018; 19:896-911. [PMID: 29047017 DOI: 10.1208/s12249-017-0884-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/18/2017] [Indexed: 01/03/2023] Open
Abstract
L-arginine was introduced into protein-based freeze-dried formulations to study the ability of arginine to reduce/prevent from protein aggregation during manufacturing, storage and reconstitution of lyophilized protein-based pharmaceuticals. As L-arginine is known to be very hygroscopic, additional excipients which could provide a moisture buffering capacity need to be introduced into the formulation. In the first part of our study-excipient formulation development-the screening of a number of sugars/polyols has been done in order to select the best combination of excipients that, in a complex with L-arginine, can (i) produce freeze-dried cakes with elegant appearance, adequate mechanical properties and reconstitution times, and (ii) resist/minimise the moisture sorption. Various freeze-dried cakes containing L-arginine in combination with mannitol, trehalose, lactose and sucrose were produced and analysed by TGA, DSC, texture analysis, moisture sorption, cake shrinkage, TVIM and SEM. The non-linear dependencies of the physicochemical properties of the freeze-dried cakes on the sugar-to-mannitol ratios were found. The best combinations of excipients (L-arginine, mannitol and trehalose) were selected to be used in the second part of this work, in which the impact of each selected formulation will be studied in relation to the aggregation of a protein.
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Ludlow H, Green J, Turner J. Late gastrointestinal effects of pelvic radiation: a nurse-led service. ACTA ACUST UNITED AC 2017; 26:S15-S22. [DOI: 10.12968/bjon.2017.26.4.s15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Helen Ludlow
- Macmillan Senior Nurse for Late GI Effects of Treatment, Inflammatory Bowel Disease Clinical Nurse Specialist and Nurse Endoscopist, Cardiff and Vale University Health Board
| | - John Green
- Consultant Gastroenterologist, Cardiff and Vale University Health Board
| | - Jeff Turner
- Consultant Gastroenterologist, Cardiff and Vale University Health Board
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Yuce O, Kalayci AG, Comba A, Eren E, Caltepe G. Lactose and Fructose Intolerance in Turkish Children with Chronic Abdominal Pain. Indian Pediatr 2017; 53:394-7. [PMID: 27254047 DOI: 10.1007/s13312-016-0860-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the prevalence of lactose and fructose intolerance in children with chronic abdominal pain. METHODS Hydrogen breath tests were done to detect lactose and fructose malabsorption in 86 children with chronic abdominal pain (44 irritable bowel syndrome, 24 functional abdominal pain and 17 functional abdominal pain syndrome as per Rome III criteria) presenting to a Pediatric Gastroentreology department. RESULTS 14 (16.3%) of patients were diagnosed with lactose intolerance and 11 (12.8%) with fructose intolerance. CONCLUSION Lactose and fructose intolerance in children can lead to chronic abdominal pain and symptoms improve with dietary modifications.
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Affiliation(s)
- Ozlem Yuce
- Department of Pediatric Gastroenterology, Ondokuz Mayis University, Samsun, Turkey. Correspondence to: Dr Ozlem Yuce, Ondokuz Mayis University, Faculty of Medicine, Department of Pediatric Gastroenterology, Samsun, Turkey.
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Concomitant Prevalence of Low Serum Diamine Oxidase Activity and Carbohydrate Malabsorption. Can J Gastroenterol Hepatol 2016; 2016:4893501. [PMID: 28042564 PMCID: PMC5155086 DOI: 10.1155/2016/4893501] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/13/2016] [Accepted: 11/21/2016] [Indexed: 01/06/2023] Open
Abstract
The aim of this retrospective study was to analyze the concomitant prevalence rates for lactose malabsorption (LM), fructose malabsorption (FM), and histamine intolerance (HI) in patients with so far unexplained gastrointestinal (GI) symptoms. A total of 439 outpatients, who presented unclear abdominal discomfort, underwent lactose (50 g) and fructose (25 g) hydrogen (H2) breath tests. Additionally, serum diamine oxidase (DAO) measurements were performed. Individuals with low serum DAO activity (<10 U/mL), GI symptoms, and response to histamine-free diet were diagnosed with HI. Of all 439 patients, 341 (77.7%) were found with 7 various GI conditions. In total, 94 (21.4%), 31 (7.1%), and 100 (22.8%) individuals presented LM, FM, or HI only, whereas 116 (26.4%) patients showed an overlap of GI entities investigated here. Interestingly, 89 out of 241 (36.9%) individuals with carbohydrate malabsorption were also diagnosed with HI (LM + HI: 52 [11.8%], FM + HI: 23 [5.2%], and LM + FM + HI 14 [3.2%] individuals). In conclusion different combinations of LM, FM, and HI are present in individuals with unclear abdominal discomfort/pain. In clinical practice we suggest testing for LM, FM, and additional HI in the diagnostic work-up of these patients. Depending on these various diagnoses possible, patients should get an individualized dietary advice.
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Heckl S, Reiners C, Buck AK, Schäfer A, Dick A, Scheurlen M. Evidence of impaired carbohydrate assimilation in euthyroid patients with Hashimoto's thyroiditis. Eur J Clin Nutr 2015; 70:222-8. [PMID: 26443039 DOI: 10.1038/ejcn.2015.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES Hashimoto's thyroiditis (HT) represents a wide-spread autoimmune disease. In euthyroid patients with HT, an impaired assimilation of common carbohydrates has been observed. Our objectives were to compare the frequency of (1) fructose (FM), lactose (LM) and sorbitol malassimilation (SM), (2) gastrointestinal symptoms (GS) following carbohydrate ingestion and (3) recurrent GS relevant to the participants' daily lives. SUBJECTS/METHODS We conducted a prospective case-control study of 45 ambulatory patients with HT and 38 healthy volunteers, matched with regard to age, gender and area of origin. Hydrogen breath tests with fructose, lactose, sorbitol and glucose were performed, the lactose testing additionally comprising measurements of capillary blood glucose (cBG). GS during the tests and recurrent GS concerning the participants' daily lives were assessed. A food-frequency questionnaire was administered. RESULTS FM was diagnosed in 48.9% of patients compared with 26.3% of the control group (P=0.035). In all, 42.2% of patients with HT and 21.1% of healthy controls showed LM (P=0.04). FM and/or LM was present in 73.3% of the patients and in 42.1% of healthy controls (P=0.004). GS after the ingestion of fructose (P=0.003) or lactose (P=0.025) and recurrent GS were significantly more prevalent in the case group. The consumption of free fructose, lactose or sorbitol did not differ. CONCLUSIONS Carbohydrate malassimilation and gastrointestinal complaints are frequent in euthyroid patients with HT, leading to novel clinical and pathophysiological considerations and concepts.
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Affiliation(s)
- S Heckl
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - C Reiners
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - A K Buck
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - A Schäfer
- Department of Internal Medicine II, University of Würzburg, Würzburg, Germany
| | - A Dick
- Children's Hospital, University of Würzburg, Würzburg, Germany
| | - M Scheurlen
- Department of Internal Medicine II, University of Würzburg, Würzburg, Germany
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Schnedl WJ, Kalmar P, Mangge H, Krause R, Wallner-Liebmann SJ. Co-occurrence of carbohydrate malabsorption and primary epiploic appendagitis. World J Gastroenterol 2015; 21:10242-10245. [PMID: 26401090 PMCID: PMC4572806 DOI: 10.3748/wjg.v21.i35.10242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/05/2015] [Accepted: 04/03/2015] [Indexed: 02/06/2023] Open
Abstract
Unspecific abdominal complaints including bloating and irregular bowel movements may be caused by carbohydrate malabsorption syndromes, e.g., lactose and fructose malabsorption. These symptoms were investigated with hydrogen (H2) breath tests and correlated to carbohydrate malabsorption. During performing these H2-breath tests the patient presented with an acute, localized, non-migratory pain in the left lower abdominal quadrant. Primary epiploic appendagitis is a rare cause of abdominal acute or subacute complaints and diagnosis of primary epiploic appendagitis (PEA) is made when computed tomography reveals a characteristic lesion. We report on a patient with co-occurrence of lactose and fructose malabsorption, which was treated successfully with a diet free of culprit carbohydrates, with PEA recovering without medication or surgical treatment within few days. Since the abdominal unspecific symptoms had been present for months, they appeared not to be correlated to the acute localized abdominal pain, therefore we speculate on a random co-occurrence of combined carbohydrate malabsorption and PEA.
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Ohrem HL, Schornick E, Kalivoda A, Ognibene R. Why is mannitol becoming more and more popular as a pharmaceutical excipient in solid dosage forms? Pharm Dev Technol 2013; 19:257-62. [DOI: 10.3109/10837450.2013.775154] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gates M, Hanning RM, Gates A, Martin ID, Tsuji LJS. Intakes of milk and alternatives among on-reserve First Nations youth in northern and southern Ontario, Canada. Public Health Nutr 2013; 16:515-23. [PMID: 23102257 PMCID: PMC10271611 DOI: 10.1017/s1368980012003035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 05/01/2012] [Accepted: 05/04/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the adequacy of milk and alternatives, Ca and vitamin D intakes in First Nations (FN) youth in Ontario, Canada. Intakes were compared with the general population and dietary standards. Variation in intakes by community (proxy for remoteness) and BMI was examined. DESIGN Data were collected by 24 h recall between November 2003 and June 2010. Intakes were analysed descriptively. Variation in intakes, by community and BMI category, was assessed using ANOVA. SETTING Five remote FN communities of the Mushkegowuk Territory (northern Ontario, Canada) and two less-remote southern Ontario FN communities. SUBJECTS Schoolchildren (n 457) in grades 6 to 12. RESULTS Compared with Canada's Food Guide recommendations, 72.6 to 84.7% had an inadequate intake of milk and alternatives depending on age and sex group; 86.2% of individuals fell below the RDA for Ca; 96.4% fell below the RDA for vitamin D. Community variation in intakes was detected, although in all cases Fort Albany had higher intakes, even when it was the more northern (remote) community. A BMI × sex interaction was found for intake of milk and alternatives (P = 0.041): an inverse relationship between intake and BMI was seen in females; in males, those who were overweight had the highest intake, followed by normal-weight and obese youth. CONCLUSIONS The nutritional inadequacies parallel the results of other Canadian studies of Aboriginal populations. Population health interventions to improve intakes are warranted. Moreover, community variation in intakes exists among FN youth in the present study (Fort Albany pairs only), but results were not as expected.
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Affiliation(s)
- Michelle Gates
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
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Gates M, Hanning RM, Gates A, McCarthy DD, Tsuji LJS. Assessing the impact of pilot school snack programs on milk and alternatives intake in 2 remote First Nation communities in northern Ontario, Canada. THE JOURNAL OF SCHOOL HEALTH 2013; 83:69-76. [PMID: 23331265 DOI: 10.1111/josh.12000] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/13/2011] [Accepted: 05/16/2011] [Indexed: 06/01/2023]
Abstract
BACKGROUND Canadian Aboriginal youth have poorer diet quality and higher rates of overweight and obesity than the general population. This research aimed to assess the impact of simple food provision programs on the intakes of milk and alternatives among youth in Kashechewan and Attawapiskat First Nations (FNs), Ontario, Canada. METHODS A pilot school snack program was initiated in Kashechewan in May 2009 including coordinator training and grant writing support. A supplementary milk and alternatives program was initiated in Attawapiskat in February 2010. Changes in dietary intake were assessed using Web-based 24-hour dietary recalls in grade 6 to 8 students, pre- and 1-week post-program, with a 1-year follow-up in Kashechewan. Student impressions were collected after 1 week using open-ended questions in the Web survey. Teacher and administrator impressions were collected via focus groups after 1 year in Kashechewan. RESULTS After 1 week, calcium intake increased in Kashechewan (805.9 ± 552.0 to 1027.6 ± 603.7 mg, p = .044); however, improvements were not sustained at 1 year; milk and alternatives (1.7 ± 1.7 servings to 2.1 ± 1.4 servings, p = .034) and vitamin D (2.5 ± 2.6 to 3.5 ± 3.4 µg, p = .022) intakes increased in Attawapiskat. Impressions of the programs were positive, though limited resources, staff, facilities, and funding were barriers to sustaining the consistent snack provision of the 1-week pilot phase. CONCLUSION These illustrations show the potential of snack programs to address the low intakes of milk and alternatives among youth in remote FNs. Community-level constraints must be addressed for sustained program benefits.
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Affiliation(s)
- Michelle Gates
- University of Waterloo, School of Public Health and Health Systems, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
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La JH, Feng B, Schwartz ES, Brumovsky PR, Gebhart GF. Luminal hypertonicity and acidity modulate colorectal afferents and induce persistent visceral hypersensitivity. Am J Physiol Gastrointest Liver Physiol 2012; 303:G802-9. [PMID: 22859365 PMCID: PMC3469591 DOI: 10.1152/ajpgi.00259.2012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Carbohydrate malabsorption such as in lactose intolerance or enteric infection causes symptoms that include abdominal pain. Because this digestive disorder increases intracolonic osmolarity and acidity by accumulation of undigested carbohydrates and fermented products, we tested whether these two factors (hypertonicity and acidity) would modulate colorectal afferents in association with colorectal nociception and hypersensitivity. In mouse colorectum-pelvic nerve preparations in vitro, afferent activities were monitored after application of acidic hypertonic saline (AHS; pH 6.0, 800 mosM). In other experiments, AHS was instilled intracolonically to mice and behavioral responses to colorectal distension (CRD) measured. Application of AHS in vitro excited 80% of serosal and 42% of mechanically-insensitive colorectal afferents (MIAs), sensitizing a proportion of MIAs to become mechanically sensitive and reversibly inhibiting stretch-sensitive afferents. Acute intracolonic AHS significantly increased expression of the neuronal activation marker pERK in colon sensory neurons and augmented noxious CRD-induced behavioral responses. After three consecutive daily intracolonic AHS treatments, mice were hypersensitive to CRD 4-15 days after the first treatment. In complementary single fiber recordings in vitro, the proportion of serosal class afferents increased at day 4; the proportion of MIAs decreased, and muscular class stretch-sensitive afferents were sensitized at days 11-15 in mice receiving AHS. These results indicate that luminal hypertonicity and acidity, two outcomes of carbohydrate malabsorption, can induce colorectal hypersensitivity to distension by altering the excitability and relative proportions of colorectal afferents, suggesting the potential involvement of these factors in the development of abdominal pain.
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Affiliation(s)
- Jun-Ho La
- Center for Pain Research, Department of Anesthesiology, School of Medicine, University of Pittsburgh, W1402 Biomedical Science Tower, 200 Lothrop St. Pittsburgh, PA 15213, USA.
| | - Bin Feng
- 1Center for Pain Research, Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Erica S. Schwartz
- 1Center for Pain Research, Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Pablo R. Brumovsky
- 1Center for Pain Research, Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; ,2School of Biomedical Sciences, Austral University, CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas), Pilar, Argentina
| | - G. F. Gebhart
- 1Center for Pain Research, Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
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Guarino A, Lo Vecchio A, Berni Canani R. Chronic diarrhoea in children. Best Pract Res Clin Gastroenterol 2012; 26:649-61. [PMID: 23384809 DOI: 10.1016/j.bpg.2012.11.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 10/16/2012] [Accepted: 11/02/2012] [Indexed: 01/31/2023]
Abstract
Chronic diarrhoea in children shows an age related spectrum. In infants and young children a major role is related to persistent intestinal infections, intolerance to specific nutrients such as cow's milk protein, and toddler's diarrhoea. In older children and adolescents, inflammatory bowel diseases are strongly increasing and nonspecific diarrhoea is also frequent. Coeliac disease is a major cause of diarrhoea throughout childhood. In neonates, congenital diarrhoea is a rare but severe syndrome that includes several highly complex diseases. In children, diagnosis should be based on noninvasive techniques. Endoscopy should be decided based on clinical criteria, but also driven by noninvasive tests to assess the digestive absorptive functions and intestinal inflammation. A stepwise approach may reduce the need of endoscopy, also in the light of its relatively limited diagnostic yield compared to adult patients. Treatment of chronic diarrhoea in children is also substantially different from what is generally done in adults and includes a major role for nutritional interventions. Therefore chronic diarrhoea in children is a complex age-specific disorder that requires an age-specific management that is in many aspects distinct from that in adults.
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Affiliation(s)
- Alfredo Guarino
- Department of Pediatrics, University of Naples Federico II, Via S. Pansini 5, Naples, Italy.
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Le MT, Frye RF, Rivard CJ, Cheng J, McFann KK, Segal MS, Johnson RJ, Johnson JA. Effects of high-fructose corn syrup and sucrose on the pharmacokinetics of fructose and acute metabolic and hemodynamic responses in healthy subjects. Metabolism 2012; 61:641-51. [PMID: 22152650 PMCID: PMC3306467 DOI: 10.1016/j.metabol.2011.09.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/06/2011] [Accepted: 09/27/2011] [Indexed: 02/07/2023]
Abstract
It is unclear whether high-fructose corn syrup (HFCS), which contains a higher amount of fructose and provides an immediate source of free fructose, induces greater systemic concentrations of fructose as compared with sucrose. It is also unclear whether exposure to higher levels of fructose leads to increased fructose-induced adverse effects. The objective was to prospectively compare the effects of HFCS- vs sucrose-sweetened soft drinks on acute metabolic and hemodynamic effects. Forty men and women consumed 24 oz of HFCS- or sucrose-sweetened beverages in a randomized crossover design study. Blood and urine samples were collected over 6 hours. Blood pressure, heart rate, fructose, and a variety of other metabolic biomarkers were measured. Fructose area under the curve and maximum concentration, dose-normalized glucose area under the curve and maximum concentration, relative bioavailability of glucose, changes in postprandial concentrations of serum uric acid, and systolic blood pressure maximum levels were higher when HFCS-sweetened beverages were consumed as compared with sucrose-sweetened beverages. Compared with sucrose, HFCS leads to greater fructose systemic exposure and significantly different acute metabolic effects.
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Affiliation(s)
- MyPhuong T. Le
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL 32610
| | - Reginald F. Frye
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL 32610
| | - Christopher J. Rivard
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver, Aurora, CO 80045
| | - Jing Cheng
- Department of Epidemiology and Health Policy Research, University of FL, Gainesville, FL 32610
| | - Kim K. McFann
- Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, CO 80045
| | - Mark S. Segal
- Division of Nephrology, Hypertension, and Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL 32610
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver, Aurora, CO 80045
| | - Julie A. Johnson
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL 32610
- Address correspondence to Julie A. Johnson, Department of Pharmacotherapy and Translation Research, College of Pharmacy, University of Florida, PO BOX 100486, Gainesville, FL 32610. Phone (352) 273-6007, Fax (352) 273-6121, and
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Born P. The clinical impact of carbohydrate malabsorption. Arab J Gastroenterol 2011; 12:1-4. [DOI: 10.1016/j.ajg.2011.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/30/2010] [Indexed: 01/28/2023]
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Scientific Opinion on the evaluation of substances as acceptable previous cargoes for edible fats and oils. EFSA J 2009. [DOI: 10.2903/j.efsa.2009.1391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Valeur J, Øines E, Morken MH, Holst JJ, Berstad A. Plasma glucagon-like peptide 1 and peptide YY levels are not altered in symptomatic fructose-sorbitol malabsorption. Scand J Gastroenterol 2009; 43:1212-8. [PMID: 18609141 DOI: 10.1080/00365520802116448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Carbohydrate malabsorption causes more symptoms in patients with functional gastrointestinal disorders than in healthy individuals. The purpose of this study was to investigate whether this could be explained by differences in ileal brake hormone secretion. MATERIAL AND METHODS Eighteen consecutive patients with functional abdominal complaints, referred to our clinic for investigation of self-reported food hypersensitivity, were included in the study and compared with 15 healthy volunteers. All subjects ingested a mixture of 25 g fructose and 5 g sorbitol. Pulmonary hydrogen and methane excretion and plasma glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) levels were measured during the next 3 h. Both habitual and post-test symptoms were assessed. RESULTS Malabsorption of fructose and sorbitol was present in 61% of the patients and 73% of the controls. Nevertheless, the patients experienced significantly more symptoms following carbohydrate challenge, and 78% of the patients claimed that the challenge replicated their habitual gastrointestinal complaints. No significant differences in gas excretion or GLP-1 and PYY levels were found between patients and controls or between symptomatic and asymptomatic carbohydrate malabsorbers. A weak correlation between hydrogen excretion and PYY levels was demonstrated in non-producers of methane. CONCLUSIONS Neither intestinal gas production nor ileal brake hormone secretion seems to play a role in the symptomatology of carbohydrate intolerance in patients with self-reported food hypersensitivity. Other mechanisms related to bacterial fermentation may be involved and should be investigated further.
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Affiliation(s)
- Jørgen Valeur
- Institute of Medicine, Section for Gastroenterology, University of Bergen, Norway.
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