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Instant cascara (IC) is a sustainable beverage obtained from dried coffee cherry pulp, rich in nutrients and bioactive compounds. The present research aimed to determine the effects of IC on general health and brain-gut axis parameters of healthy female and male rats. Wistar rats were exposed to IC (10 mg/mL) in their drinking water for 3 weeks. Body weight and solid and liquid intakes were monitored as indicators of food safety. Gastrointestinal transit was radiographically evaluated one day (acute) and 3 weeks (chronic) after the start of IC exposure. Locomotor activity, anxiety, and anhedonia of the animals after 3 weeks of treatment was also studied. Overall, compared to water-exposed animals, IC significantly increased food intake in males (p < 0.0001) and liquid intake in females (p < 0.05) without changes in body weight in either case. IC did not significantly modify gastrointestinal motility parameters after its acute or repeated intake and did not cause any significant behavioral alterations in males or females (p > 0.05). In conclusion, repeated intake of IC at the studied concentration did not negatively affect brain-gut axis functions of healthy male and female rats. Anxiety behavior, diarrhea, constipation, abnormal weight modifications, or other typical effects of toxicity were not observed in animals treated with the new powdered beverage, suggesting its food safety under the studied conditions.

Objective We investigated associations between gastrointestinal symptoms - evaluated as a combined weighted symptom score (CWSS) – Diabetic autonomic neuropathy (DAN), and distal symmetrical polyneuropathy (DSPN) in type 1 and type 2 diabetes. Research design and methods Cross-sectional study in a tertiary outpatient clinic. CWSS was calculated based on questionnaires: gastroparesis composite symptom index (GCSI) and gastrointestinal symptom rating score (GSRS). DAN and DSPN were addressed using the composite autonomic symptom score 31 (COMPASS-31) questionnaire, cardiac autonomic reflex tests (CARTs), electrochemical skin conductance (ESC), vibration perception threshold (VPT), Michigan Neuropathy Screening Instrument (MNSI), pain- and thermal sensation. Analyses were adjusted for age, sex, diabetes duration, smoking, LDL-cholesterol, HbA1C and systolic blood pressure. Type 1 and type 2 diabetes were evaluated separately. Results We included 566 with type 1 diabetes and 377 with type 2 diabetes. Mean ± SD age was 58 ± 15 years and 565 (59.9 %) were women. A high CWSS was present in 143 (25 %) with type 1 and 142 (38 %) with type 2 diabetes. The odds of DAN by COMPASS-31 (p < 0.001) were higher in the high score group. For type 1 diabetes, odds of cardiac autonomic neuropathy were higher in the high CWSS group. The odds of DSPN by VPT and MNSI in type 1 diabetes, and by ESC, VPT and pain sensation in type 2 diabetes were higher in the high CWSS group. Conclusions A high symptom score was associated with neuropathy by COMPASS-31 and vibration perception. Gastrointestinal symptom burden associated inconsistently with other neuropathy tests between diabetes types., Objective: We investigated associations between gastrointestinal symptoms - evaluated as a combined weighted symptom score (CWSS) – Diabetic autonomic neuropathy (DAN), and distal symmetrical polyneuropathy (DSPN) in type 1 and type 2 diabetes. Research design and methods: Cross-sectional study in a tertiary outpatient clinic. CWSS was calculated based on questionnaires: gastroparesis composite symptom index (GCSI) and gastrointestinal symptom rating score (GSRS). DAN and DSPN were addressed using the composite autonomic symptom score 31 (COMPASS-31) questionnaire, cardiac autonomic reflex tests (CARTs), electrochemical skin conductance (ESC), vibration perception threshold (VPT), Michigan Neuropathy Screening Instrument (MNSI), pain- and thermal sensation. Analyses were adjusted for age, sex, diabetes duration, smoking, LDL-cholesterol, HbA1C and systolic blood pressure. Type 1 and type 2 diabetes were evaluated separately. Results: We included 566 with type 1 diabetes and 377 with type 2 diabetes. Mean ± SD age was 58 ± 15 years and 565 (59.9 %) were women. A high CWSS was present in 143 (25 %) with type 1 and 142 (38 %) with type 2 diabetes. The odds of DAN by COMPASS-31 (p < 0.001) were higher in the high score group. For type 1 diabetes, odds of cardiac autonomic neuropathy were higher in the high CWSS group. The odds of DSPN by VPT and MNSI in type 1 diabetes, and by ESC, VPT and pain sensation in type 2 diabetes were higher in the high CWSS group. Conclusions: A high symptom score was associated with neuropathy by COMPASS-31 and vibration perception. Gastrointestinal symptom burden associated inconsistently with other neuropathy tests between diabetes types.

BackgroundProkinetics are a class of pharmacological drugs designed to improve gastrointestinal (GI) motility, either regionally or across the whole gut. Each drug has its merits and drawbacks, and based on current evidence as high-quality studies are limited, we have no clear recommendation on one class or other. However, there remains a large unmet need for both regionally selective and/or globally acting prokinetic drugs that work primarily intraluminally and are safe and without systemic side effects.PurposeHere, we describe the strengths and weaknesses of six classes of prokinetic drugs, including their pharmacokinetic properties, efficacy, safety and tolerability and potential indications.

OBJECTIVE: Up to 50% of patients with systemic sclerosis (SSc) experience slow colonic transit, which may be associated with severe outcomes. Our objective, therefore, was to identify specific clinical features associated with slow colonic transit in SSc. METHODS: SSc patients with gastrointestinal symptoms were prospectively enrolled and completed a scintigraphy-based whole gut transit study. Clinical features were compared between patients with and without slow colonic transit in univariate and multivariable logistic regression analyses. RESULTS: Forty-eight of 100 patients (48%) in our cohort had slow colonic transit. In the univariate analyses, slow colonic transit was positively associated with female sex (odds ratio [OR] 12.61 [95% confidence interval (95% CI) 1.56-101.90]), telangiectasia (OR 4.00 [95% CI 1.32-12.10]), anticentromere antibodies (OR 3.25 [95% CI 1.25-8.44]), prior or current smoking (OR 2.56 [95% CI 1.06-6.21]), and a Medsger gastrointestinal severity score of ≥3 (OR 3.94 [95% CI 1.16-13.36]). Patients were less likely to have significant restriction on pulmonary function tests (OR 0.23 [95% CI 0.09-0.63]). In our multivariable model, the association between slow colonic transit and telangiectasia (OR 3.97 [95% CI 1.20-13.20]) and less restrictive lung disease on pulmonary function tests (OR 0.28 [95% CI 0.09-0.86]) remained statistically significant, though a trend with smoking remained (OR 2.16 [95% CI 0.82-5.75]). Interestingly, there were no significant associations between slow colonic transit and delayed transit in other regions of the gastrointestinal tract. CONCLUSION: Distinct clinical features are associated with slow colonic transit in SSc. Such features may provide insight in risk stratification and the study of disease mechanism in more homogeneous subgroups.

BACKGROUND: Enteric neuropathies, which result from abnormalities of the enteric nervous system, are associated with significant morbidity and high health-care costs, but current treatments are unsatisfactory. Cell-based therapy offers an innovative approach to replace the absent or abnormal enteric neurons and thereby restore gut function. METHODS: Enteric neuronal stem cells (ENSCs) were isolated from the gastrointestinal tract of Wnt1-Cre;R26tdTomato mice and generated neurospheres (NS). NS transplants were performed via injection into the mid-colon mesenchyme of nNOS-/- mouse, a model of colonic dysmotility, using either 1 (n = 12) or 3 (n = 12) injections (30 NS per injection) targeted longitudinally 1-2 mm apart. Functional outcomes were assessed up to 6 weeks later using electromyography (EMG), electrical field stimulation (EFS), optogenetics, and by measuring colorectal motility. RESULTS: Transplanted ENSCs formed nitrergic neurons in the nNOS-/- recipient colon. Multiple injections of ENSCs resulted in a significantly larger area of coverage compared to single injection alone and were associated with a marked improvement in colonic function, demonstrated by (1) increased colonic muscle activity by EMG recording, (2) faster rectal bead expulsion, and (3) increased fecal pellet output in vivo. Organ bath studies revealed direct neuromuscular communication by optogenetic stimulation of channelrhodopsin-expressing ENSCs and restoration of smooth muscle relaxation in response to EFS. CONCLUSIONS: These results demonstrate that transplanted ENSCs can form effective neuromuscular connections and improve colonic motor function in a model of colonic dysmotility, and additionally reveal that multiple sites of cell delivery led to an improved response, paving the way for optimized clinical trial design.

ObjectivesSpine surgery is associated with early impairment of gastrointestinal motility, with postoperative ileus rates of 5-12%. A standardized postoperative medication regimen aimed at early restoration of bowel function can reduce morbidity and cost, and its study should be prioritized.MethodsA standardized postoperative bowel medication protocol was implemented for all elective spine surgeries performed by a single neurosurgeon from March 1, 2022 to June 30, 2022 at a metropolitan Veterans Affairs medical center. Daily bowel function was tracked and medications were advanced using the protocol. Clinical, surgical, and length of stay data are reported.ResultsAcross 20 consecutive surgeries in 19 patients, mean age was 68.9 years [standard deviation (SD) = 10; range 40-84]. Seventy-four percent reported preoperative constipation. Surgeries consisted of 45% fusion and 55% decompression; lumbar retroperitoneal approaches constituted 30% (10% anterior, 20% lateral). Two patients were discharged in good condition prior to bowel movement after meeting institutional discharge criteria; the other 18 cases all had return of bowel function by postoperative day (POD) 3 (mean = 1.8-days, SD = 0.7). There were no inpatient or 30-day complications. Mean discharge occurred 3.3-days post-surgery (SD = 1.5; range 1-6; home 95%, skilled nursing facility 5%). Estimated cumulative cost of the bowel regimen was $17 on POD 3.ConclusionsCareful monitoring of return of bowel function after elective spine surgery is important for preventing ileus, reducing healthcare cost, and ensuring quality. Our standardized postoperative bowel regimen was associated with return of bowel function within 3 days and low costs. These findings can be utilized in quality-of-care pathways.

Background: Diabetes-induced gastrointestinal (GI) symptoms are common but difficult to correctly diagnose and manage. We used multi-segmental magnetic resonance imaging (MRI) to evaluate structural and functional GI parameters in diabetic patients and to study the association with their symptomatic presentation. Methods: Eighty-six participants (46 with diabetes and GI symptoms, 40 healthy controls) underwent baseline and post-meal MRI scans at multiple timepoints. Questionnaires were collected at inclusion and following the scans. Data were collected from the stomach, small bowel, and colon. Associations between symptoms and collected data were explored. Utilizing machine learning, we determined which features differentiated the two groups the most. Key Results: The patient group reported more symptoms at inclusion and during MRI scans. They showed 34% higher stomach volume at baseline, 40% larger small bowel volume, 30% smaller colon volume, and less small bowel motility postprandially. They also showed positive associations between gastric volume and satiety scores, gastric emptying time and reflux scores, and small bowel motility and constipation scores. No differences in gastric emptying were observed. Small bowel volume and motility were used as inputs to a classification tool that separated patients and controls with 76% accuracy. Conclusions: In this work, we studied structural and functional differences between patients with diabetes and GI symptoms and healthy controls and observed differences in stomach, small bowel, and colon volumes, as well as an adynamic small bowel in patients with diabetes and GI symptoms. Associations between recorded parameters and perceived symptoms were also explored and discussed.

Ileus is a common life-threatening problem in horses, and currently available treatments may be ineffective. The purpose of this study was to determine whether bit chewing, a form of sham feeding, decreases the gastric emptying time (GET), small intestinal transit time (SITT), and total orocecal transit time (OCTT) in clinically normal horses in a prospective crossover study. Nine healthy horses were acclimated and fed a standardized diet. Following 24 h of fasting, self-contained video endoscopy capsules and acetaminophen were administered into the stomach via a nasogastric tube. Each horse underwent experimental (bit chewing for 20 min every 6 h) or control (no bit chewing) conditions, with a 3-week minimum washout period between conditions. The horses were enrolled in either part of the study until all video capsules were retrieved and/or 30 days lapsed. The video capsules were recovered from manure, and GET, SITT, and OCTT were determined from a video analysis. Bit chewing significantly decreased OCTT (p = 0.015) compared to the control conditions. Bit chewing decreased GET and SITT, but the differences were not significant. The mean (median) times determined via the video capsule analysis for the bit-chewing conditions were as follows: GET, 2.34 h (2.86 h); SITT, 3.22 h (3.65 h); and OCTT, 5.13 h (6.15 h), and for the control conditions, they were as follows: GET, 3.93 h (5 h); SITT, 3.79 h (4.4 h); and OCTT, 8.02 h (9.92 h). Bit chewing decreased OCTT in healthy horses. Because this segment of the gastrointestinal tract is frequently affected by ileus, bit chewing may be a safe and inexpensive intervention for that condition in horses. Further investigation in clinical patients with ileus is warranted.

Background: Sepsis is a highly incident condition in which a cascade of proinflammatory cytokines is involved. One of its most frequent consequences is ileus, which can increase mortality. Animal models such as that induced by systemic administration of lipopolysaccharide (LPS) are useful to deeply evaluate this condition. The effects of sepsis on the gastrointestinal (GI) tract have been explored but, to our knowledge, in vivo studies showing the motor and histopathological consequences of endotoxemia in an integrated way are lacking. Our aim was to study in rats the effects of sepsis on GI motility, using radiographic methods, and to assess histological damage in several organs. Methods: Male rats were intraperitoneally injected with saline or E. coli LPS at 0.1, 1, or 5 mg kg. Barium sulfate was intragastrically administered, and X-rays were performed 0–24 h afterwards. Several organs were collected for organography, histopathology, and immunohistochemistry studies. Key Results: All LPS doses caused gastroparesia, whereas changes in intestinal motility were dose-and time-dependent, with an initial phase of hypermotility followed by paralytic ileus. Lung, liver, stomach, ileum, and colon (but not spleen or kidneys) were damaged, and density of neutrophils and activated M2 macrophages and expression of cyclooxygenase 2 were increased in the colon 24 h after LPS 5 mg kg. Conclusions and Inferences: Using radiographic, noninvasive methods for the first time, we show that systemic LPS causes dose-, time-, and organ-dependent GI motor effects. Sepsis-induced GI dysmotility is a complex condition whose management needs to take its time-dependent changes into account.

Background: Diabetes-induced gastrointestinal (GI) symptoms are common but difficult to correctly diagnose and manage. We used multi-segmental magnetic resonance imaging (MRI) to evaluate structural and functional GI parameters in diabetic patients and to study the association with their symptomatic presentation. Methods: Eighty-six participants (46 with diabetes and GI symptoms, 40 healthy controls) underwent baseline and post-meal MRI scans at multiple timepoints. Questionnaires were collected at inclusion and following the scans. Data were collected from the stomach, small bowel, and colon. Associations between symptoms and collected data were explored. Utilizing machine learning, we determined which features differentiated the two groups the most. Key Results: The patient group reported more symptoms at inclusion and during MRI scans. They showed 34% higher stomach volume at baseline, 40% larger small bowel volume, 30% smaller colon volume, and less small bowel motility postprandially. They also showed positive associations between gastric volume and satiety scores, gastric emptying time and reflux scores, and small bowel motility and constipation scores. No differences in gastric emptying were observed. Small bowel volume and motility were used as inputs to a classification tool that separated patients and controls with 76% accuracy. Conclusions: In this work, we studied structural and functional differences between patients with diabetes and GI symptoms and healthy controls and observed differences in stomach, small bowel, and colon volumes, as well as an adynamic small bowel in patients with diabetes and GI symptoms. Associations between recorded parameters and perceived symptoms were also explored and discussed.

Background: Gastrointestinal symptoms originating from different segments overlap and complicate diagnosis and treatment. In this study, we aimed to develop and test a pan-alimentary framework for the evaluation of gastrointestinal (GI) motility and different static endpoints based on magnetic resonance imaging (MRI) without contrast agents or bowel preparation. Methods: Twenty healthy volunteers (55.6 ± 10.9 years, BMI 30.8 ± 9.2 kg/m2) underwent baseline and post-meal MRI scans at multiple time points. From the scans, the following were obtained: Gastric segmental volumes and motility, emptying half time (T50), small bowel volume and motility, colonic segmental volumes, and fecal water content. Questionnaires to assess GI symptoms were collected between and after MRI scans. Key results: We observed an increase in stomach and small bowel volume immediately after meal intake from baseline values (p<.001 for the stomach and p=.05 for the small bowel). The volume increase of the stomach primarily involved the fundus (p<.001) in the earliest phase of digestion with a T50 of 92.1 ± 35.3 min. The intake of the meal immediately elicited a motility increase in the small bowel (p<.001). No differences in colonic fecal water content between baseline and 105 min were observed. Conclusion & Inferences: We developed a framework for a pan-alimentary assessment of GI endpoints and observed how different dynamic and static physiological endpoints responded to meal intake. All endpoints aligned with the current literature for individual gut segments, showing that a comprehensive model may unravel complex and incoherent gastrointestinal symptoms in patients.

Electrical stimulation has been demonstrated as an alternative approach to alleviate intractable colonic motor disorders, whose effectiveness can be evaluated through colonic motility assessment. Various methods have been proposed to monitor the colonic motility and while each has contributed towards better understanding of colon motility, a significant limitation has been the spatial and temporal low-resolution colon motility data acquisition and analysis. This paper presents the study of employing bio-impedance characterization to monitor colonic motor activity. Direct distal colon stimulation was undertaken in anesthetized pigs to validate the bio-impedance scheme simultaneous with luminal manometry monitoring. The results indicated that the significant decreases of bio-impedance corresponded to strong colonic contraction in response to the electrical stimulation in the distal colon. The magnitude/power of the dominant frequencies of phasic colonic contractions identified at baseline (in the range 2-3 cycles per minute (cpm)) were increased after the stimulation. In addition, positive correlations have been found between bio-impedance and manometry. The proposed bio-impedance-based method can be a viable candidate for monitoring colonic motor pattern with high spatial and temporal resolution. The presented technique can be integrated into a closed-loop therapeutic device in order to optimize its stimulation protocol in real-time.

Severe systemic inflammation is associated with nausea, loss of appetite, and delayed gastric emptying, which increases hospitalization admission length and mortality rate. There is a lack of human controlled studies exploring gastric emptying rates and underlying mechanisms during inflammatory conditions. We aimed to investigate if systemic inflammation in young men delays gastro-intestinal transit times, lowers motility, and affects gastrointestinal hormone secretion. This substudy of a randomized crossover trial investigated eight healthy young men on two separate occasions; (I) following an overnight fast (healthy conditions/HC) and (II) fasting and bedrest combined with two lipopolysaccharide (LPS) injections of 1 ng kg-1 following an overnight fast and 0.5 ng kg-1 following another 24 h (systemic inflammation/SI). A standardized protein beverage and a SmartPill capsule (a wireless gastrointestinal monitoring system) were swallowed during each occasion. Whole gut transit time was comparable between HC and SI. SI decreased gastric mean pressure peak amplitude (p = 0.04) and increased pH rise across the pylorus and small bowel pH (p = 0.02) compared with HC. Glucagon-like peptide-1 was elevated during SI compared with HC (p = 0.04). Peptide YY was lower during SI compared with HC (p = 0.007). Prolonged LPS exposure combined with fasting and bedrest elevated glucagon-like peptide 1 concentrations, which may play a role for the nausea and loss of appetite typically associated with SI.

Severe systemic inflammation is associated with nausea, loss of appetite, and delayed gastric emptying, which increases hospitalization admission length and mortality rate. There is a lack of human controlled studies exploring gastric emptying rates and underlying mechanisms during inflammatory conditions. We aimed to investigate if systemic inflammation in young men delays gastro-intestinal transit times, lowers motility, and affects gastrointestinal hormone secretion. This substudy of a randomized crossover trial investigated eight healthy young men on two separate occasions; (I) following an overnight fast (healthy conditions/HC) and (II) fasting and bedrest combined with two lipopolysaccharide (LPS) injections of 1 ng kg-1 following an overnight fast and 0.5 ng kg-1 following another 24 h (systemic inflammation/SI). A standardized protein beverage and a SmartPill capsule (a wireless gastrointestinal monitoring system) were swallowed during each occasion. Whole gut transit time was comparable between HC and SI. SI decreased gastric mean pressure peak amplitude (p = 0.04) and increased pH rise across the pylorus and small bowel pH (p = 0.02) compared with HC. Glucagon-like peptide-1 was elevated during SI compared with HC (p = 0.04). Peptide YY was lower during SI compared with HC (p = 0.007). Prolonged LPS exposure combined with fasting and bedrest elevated glucagon-like peptide 1 concentrations, which may play a role for the nausea and loss of appetite typically associated with SI.

Background: The wireless motility capsule (WMC) technique is a noninvasive and radiation-free method for measuring regional and whole gut transit in response to ingestion of a granola bar (SmartBar) or an eggbeater meal. The WMC has the potential to measure gastrointestinal transit in metabolic research as part of a standardized mixed meal tolerance test. Objectives: To evaluate gastrointestinal transit with the WMC and postprandial plasma/serum concentrations of metabolites and gastrointestinal hormones as well as subjective appetite following ingestion of a SmartBar compared with a standardized mixed meal. Methods: Fourteen healthy participants [3 men, median (IQR) age 53.8 (45.8; 64.50) y, body weight 63.9 (59.9; 69.7) kg, BMI 23.1 (21.8; 23.9) kg/m2] completed a 2-d crossover study. Following ingestion of either a SmartBar (260 kcal, 7 energy percent (E%) fat, 74E% carbohydrate, and 19E% protein) or a standardized mixed meal (498 kcal, 34E% fat, 49E% carbohydrate, and 17E% protein), participants swallowed the WMC. Blood samples were drawn in the fasted state and postprandially for analyses of gastrointestinal hormones and metabolites. The primary outcome was difference in gastric emptying time between the 2 test days. Wilcoxon signed rank tests were used to test differences between test days. Results: Median (IQR) gastric emptying time was 98.0 (70.0; 113.0) min longer (P = 0.001) and incremental area under the curve of triglyceride, glucose-dependent insulinotropic polypeptide, and peptide YY were 40 mmol/L × min, 45.7%, and 63.7% greater after the standardized mixed meal compared with the SmartBar (all P < 0.001). Conclusions: The WMC can be used in combination with a standardized mixed meal for evaluation of gastrointestinal transit in healthy men and women. Gastric emptying time was prolonged in response to the standardized mixed meal whereas transit times of the small bowel, colon, and whole gut did not differ between the test meals.

In previous study, it is difficult to estimate the biological states such as postural ones and aetas in accordance with the previous analysis of electrogastrograms (EGGs), basically the frequency resolution of healthy individuals. In addition, few studies have compared gastric myoelectrical activity in supine and sitting posture. The aim of this study is to evaluate the severity of 3D sickness in daily life. The authors herein conduct nonlinear analysis of EGGs of the healthy young and give the feasibility to discriminate the postural differences. It is suggested that the EGGs acquired in the seated position have increased wavelength irregularity and attractor complexity than those acquired in the supine position.

Intestinal constipation is characterized by a delay in bowel emptying that is difficult to define because to define it, it is necessary to take into account the frequency of bowel movements, the consistency of stools and the feeling of complete bowel emptying. The present study aimed to analyze the prevalence of intestinal constipation in students of the nutrition course at a private higher education institution in Blumenau, Santa Catarina. This is a cross-sectional, systematic quantitative research. Data collection was carried out from 11/03/20 to 11/10/20 through the application of a virtual questionnaire, prepared in accordance with the Rome III criteria and assessment of water consumption. The study sample comprised 50 academics, whose age ranged between 20 and 39 years. The results suggested that 54% of the participants had two or more symptoms suggestive of constipation. The most prevalent symptoms reported by the participants were: sensation of incomplete evacuation, 54% (n = 27) and hardened / fragmented stools 54% (n = 27). Regarding the total reported pure water intake, 14 participants stated that they consumed the amount recommended by the Food Guide for the Brazilian Population (two liters), which corresponds to 28% of the sample. Thus, it is concluded that this study represents a contribution to the recognition of the importance of constipation, since the presence of such symptoms influences the quality of life of individuals., La stitichezza intestinale è caratterizzata da un ritardo nello svuotamento intestinale della definizione difficile perché definirlo, è necessario tenere conto della frequenza di evacuazioni, della coerenza delle feci e della sensazione di uno svuotamento intestinale completo. Il presente studio mirava ad analizzare la prevalenza della stitichezza intestinale negli accademici del corso nutrizionale in un'istituzione privata di istruzione superiore di Blumenau, Santa Catarina. È un sondaggio di natura quantitativo sistematico del tipo trasversale. La raccolta dei dati è stata eseguita dal 03/11/20 al 10/11/20 applicando un questionario virtuale, preparato in conformità con i criteri di Roma III e la valutazione del consumo di acqua. Hanno composto il campione dello studio 50 accademici, la cui fascia di età variava tra 20 e 39 anni. I risultati hanno suggerito che il 54% dei partecipanti ha presentato due o più suggestivi sintomi della stitichezza intestinale. I sintomi più prevalenti riportati dai partecipanti sono stati: sensazione di evacuazione incompleta, 54% (n = 27) e feci indurite / frammentate del 54% (n = 27). Per quanto riguarda l'assunzione totale di acqua pura riportata, 14 partecipanti hanno riportato consumare la quantità raccomandata dalla Guida alimentare per la popolazione brasiliana (due litri), che corrisponde al 28% del campione. In questo modo, si conclude che questo studio rappresenta un contributo al riconoscimento dell'importanza della stitichezza intestinale, poiché la presenza di tali sintomi influenza la qualità della vita degli individui., A constipação intestinal é caracterizada por um retardo no esvaziamento intestinal de difícil definição pois para defini-la, é preciso levar em conta a frequência de evacuações, a consistência das fezes e a sensação de esvaziamento intestinal completo. O presente estudo teve como objetivo analisar a prevalência de constipação intestinal em acadêmicas do curso de nutrição em uma instituição privada de ensino superior de Blumenau, Santa Catarina. Trata-se de uma pesquisa de natureza quantitativa sistemática do tipo transversal. A coleta de dados foi realizada no período de 03/11/20 a 10/11/20 através da aplicação de um questionário virtual, elaborado de acordo com os Critérios de Roma III e avaliação do consumo hídrico. Compuseram a amostra do estudo 50 acadêmicas, cuja faixa etária variou entre 20 e 39 anos. Os resultados sugeriram que 54% das participantes apresentaram dois ou mais sintomas sugestivos de constipação intestinal. Os sintomas mais prevalentes relatado pelas participantes foram: sensação de evacuação incompleta, 54% (n=27) e fezes endurecidas/ fragmentadas 54% (n=27). No que se refere à ingestão total de água pura relatada, 14 participantes afirmaram consumir a quantidade recomendada pelo Guia Alimentar para a População Brasileira (dois litros), o que corresponde a 28 % da amostra. Desta maneira, conclui-se que este estudo representa uma contribuição para o reconhecimento da importância da constipação intestinal, uma vez que a presença de tais sintomas influencia na qualidade de vida dos indivíduos., El estreñimiento intestinal se caracteriza por un retraso en el vaciado intestinal de la definición difícil porque para definirla, es necesario tener en cuenta la frecuencia de las evacuaciones, la consistencia de las heces y la sensación de vaciado intestinal completo. El presente estudio destinado a analizar la prevalencia del estreñimiento intestinal en académicos del curso de nutrición en una institución privada de educación superior de Blumenau, Santa Catarina. Es una encuesta de naturaleza cuantitativa sistemática del tipo transversal. La recopilación de datos se realizó de 03/11/20 a 10/11/20 mediante la aplicación de un cuestionario virtual, preparado de acuerdo con los criterios y evaluación de Roma III del consumo de agua. Componen la muestra del estudio 50 académicos, cuyo rango de edad varió entre 20 y 39 años. Los resultados sugirieron que el 54% de los participantes presentaron dos o más síntomas sugestivos de estreñimiento intestinal. Los síntomas más prevalentes informados por los participantes fueron: sensación de evacuación incompleta, 54% (n = 27) y heces endurecidas / fragmentadas 54% (n = 27). En lo que respecta a la ingesta total de agua pura, 14 participantes informaron que consumían la cantidad recomendada por la guía de alimentos para la población brasileña (dos litros), que corresponde al 28% de la muestra. De esta manera, se concluye que este estudio representa una contribución al reconocimiento de la importancia del estreñimiento intestinal, ya que la presencia de tales síntomas influye en la calidad de vida de los individuos.

Low concordance between studies that examine the role of microbiota in human diseases is a pervasive challenge that limits the capacity to identify causal relationships between host-associated microorganisms and pathology. The risk of obtaining false positives is exacerbated by wide interindividual heterogeneity in microbiota composition1, probably due to population-wide differences in human lifestyle and physiological variables2 that exert differential effects on the microbiota. Here we infer the greatest, generalized sources of heterogeneity in human gut microbiota profiles and also identify human lifestyle and physiological characteristics that, if not evenly matched between cases and controls, confound microbiota analyses to produce spurious microbial associations with human diseases. We identify alcohol consumption frequency and bowel movement quality as unexpectedly strong sources of gut microbiota variance that differ in distribution between healthy participants and participants with a disease and that can confound study designs. We demonstrate that for numerous prevalent, high-burden human diseases, matching cases and controls for confounding variables reduces observed differences in the microbiota and the incidence of spurious associations. On this basis, we present a list of host variables that we recommend should be captured in human microbiota studies for the purpose of matching comparison groups, which we anticipate will increase robustness and reproducibility in resolving the members of the gut microbiota that are truly associated with human disease.

Low concordance between studies that examine the role of microbiota in human diseases is a pervasive challenge that limits the capacity to identify causal relationships between host-associated microorganisms and pathology. The risk of obtaining false positives is exacerbated by wide interindividual heterogeneity in microbiota composition1, probably due to population-wide differences in human lifestyle and physiological variables2 that exert differential effects on the microbiota. Here we infer the greatest, generalized sources of heterogeneity in human gut microbiota profiles and also identify human lifestyle and physiological characteristics that, if not evenly matched between cases and controls, confound microbiota analyses to produce spurious microbial associations with human diseases. We identify alcohol consumption frequency and bowel movement quality as unexpectedly strong sources of gut microbiota variance that differ in distribution between healthy participants and participants with a disease and that can confound study designs. We demonstrate that for numerous prevalent, high-burden human diseases, matching cases and controls for confounding variables reduces observed differences in the microbiota and the incidence of spurious associations. On this basis, we present a list of host variables that we recommend should be captured in human microbiota studies for the purpose of matching comparison groups, which we anticipate will increase robustness and reproducibility in resolving the members of the gut microbiota that are truly associated with human disease.

type:Article, The energy balance of vertebrates is regulated by the difference in energy input and energy expenditure. Generally, most vertebrates obtain their energy from nutrients of foods through the gastrointestinal (GI) tract. Therefore, food intake and following food digestion, including motility of the GI tract, secretion and absorption, are crucial physiological events for energy homeostasis. GI motility changes depending on feeding, and GI motility is divided into fasting (interdigestive) and postprandial (digestive) contraction patterns. GI motility is controlled by contractility of smooth muscles of the GI tract, extrinsic and intrinsic neurons (motor and sensory) and some hormones. In mammals, ghrelin (GHRL) and motilin (MLN) stimulate appetite and GI motility and contribute to the regulation of energy homeostasis. GHRL and MLN are produced in the mucosal layer of the stomach and upper small intestine, respectively. GHRL is a multifunctional peptide and is involved in glucose metabolism, endocrine/exocrine functions and cardiovascular and reproductive functions, in addition to feeding and GI motility in mammals. On the other hand, the action of MLN is restricted and species such as rodentia, including mice and rats, lack MLN peptide and its receptor. From a phylogenetic point of view, GHRL and its receptor GHS-R1a have been identified in various vertebrates, and their structural features and various physiological functions have been revealed. On the other hand, MLN or MLN-like peptide (MLN-LP) and its receptors have been found only in some fish, birds and mammals. Here, we review the actions of GHRL and MLN with a focus on contractility of the GI tract of species from fish to mammals.

BackgroundKnowledge on optimal electrical stimulation (ES) modalities and region-specific functional effects of colonic neuromodulation is lacking. We aimed to map the regional colonic motility in response to ES of (a) the colonic tissue and (b) celiac branch of the abdominal vagus nerve (CBVN) in an anesthetized porcine model.MethodsIn male Yucatan pigs, direct ES (10 Hz, 2 ms, 15 mA) of proximal (pC), transverse (tC), or distal (dC) colon was done using planar flexible multi-electrode array panels and CBVN ES (2 Hz, 0.3-4 ms, 5 mA) using pulse train (PT), continuous (10 min), or square-wave (SW) modalities, with or without afferent nerve block (200 Hz, 0.1 ms, 2 mA). The regional luminal manometric changes were quantified as area under the curve of contractions (AUC) and luminal pressure maps generated. Contractions frequency power spectral analysis was performed. Contraction propagation was assessed using video animation of motility changes.Key resultsDirect colon ES caused visible local circular (pC, tC) or longitudinal (dC) muscle contractions and increased luminal pressure AUC in pC, tC, and dC (143.0 ± 40.7%, 135.8 ± 59.7%, and 142.0 ± 62%, respectively). The colon displayed prominent phasic pressure frequencies ranging from 1 to 12 cpm. Direct pC and tC ES increased the dominant contraction frequency band (1-6 cpm) power locally. Pulse train CBVN ES (2 Hz, 4 ms, 5 mA) triggered pancolonic contractions, reduced by concurrent afferent block. Colon contractions propagated both orally and aborally in short distances.Conclusion and inferencesIn anesthetized pigs, the dominant contraction frequency band is 1-6 cpm. Direct colonic ES causes primarily local contractions. The CBVN ES-induced pancolonic contractions involve central neural network.

Based on the bilateral relationship between the gut microbiota and formation/function of the enteric nervous system (ENS), we sought to determine whether antibiotics-induced dysbiosis might impact the expressivity of genetically-induced ENS abnormalities. To address this, we took advantage of the TashT mouse model of Hirschsprung disease, in which colonic aganglionosis and hypoganglionosis are both much more severe in males. These defects result into two male-biased colon motility phenotypes: either megacolon that is lethal around weaning age or chronic constipation in adults, the latter being also associated with an increased proportion of nitrergic neurons in the distal ENS. Induction of dysbiosis using a cocktail of broad-spectrum antibiotics specifically impacted the colonic ENS of TashTTg/Tg mice in a stage-dependent manner. It further decreased the neuronal density at postweaning age and differentially modulated the otherwise increased proportion of nitrergic neurons, which appeared normalized around weaning age and further increased at post-weaning age. These changes delayed the development of megacolon around weaning age but led to premature onset of severe constipation later on. Finally, local inhibition of nitric oxide signaling improved motility and prevented death by megacolon. We thus conclude that exposure to antibiotics can negatively influence the expressivity of a geneticallyinduced enteric neuropathy.

Alteration in the gastrointestinal (GI) motility and transit comprises an important component of the functional gastrointestinal disorders (FGID). Available animal GI motility and transit models are to study symptoms (delayed gastric emptying, constipation, diarrhea) rather than biological markers to develop an effective treatment that targets the underlying mechanism of altered GI motility in patients. Animal data generated from commonly used methods in human like scintigraphy, breath test and wireless motility capsule may directly translate to the clinic. However, species differences in the control mechanism or pharmacological responses of GI motility may compromise the predictive and translational value of the preclinical data to human. In this review we aim to provide a summary on animal models used to mimic GI motility alteration in FGID, and the impact of the species differences in the physiological and pharmacological responses on the translation of animal GI motility and transit data to human.

Synchronized motility, permeability and secretory (hormones and enzymes) events are integral to normal physiology. Smooth muscle syncytium operates with enteric nervous system (ENS) and endocrine signalling to accommodate, mix and control passage of ingested materials. The intestinal epithelial cells (IECs) drive digestion and absorption while repelling harmful compounds. This thesis investigated GI barrier function (permeability, mucosal integrity), motility and hormonal patterns in inflammatory bowel disease (IBD) by: 1) assessing GI motility using a wireless motility capsule (WMC, SmartPill®) and video capsule endoscopy (VCE, Pillcam®), 2) investigation of intestinal fatty acid binding protein (I-FABP) as a biomarker of Crohn’s disease (CD) disease activity, 3) evaluation of small intestinal permeability in IBD, 4) investigating meal-related WMC motility and simultaneous hormonal (e.g., Ghrelin, GLP-1, GIP, PYY) patterns in IBD. Reference WMC motility values for transit times for gastric emptying, small bowel, orocecal, small+large bowel, colon and whole gut were established. Software-generated estimates and visually determined values were nearly identical. Compared with VCE estimates (represents fasting conditions), the WMC records longer GET and SBTT. Variations in intra-subject reproducibility must be considered in clinical investigations. This data was then used to investigate IBD patients. I-FABP was primarily expressed in the epithelium of the small bowel and to lesser extent also in the colon and stomach. Circulating I-FABP was elevated in active CD with a magnitude comparable to TNFα. I-FABP lowers and rises again in parallel with TNFα and HBI during infliximab treatment. I-FABP can be used as a jejunum and ileum selective prognostic biomarker for monitoring disease activity. Increased small intestine mucosal barrier permeability to lactulose in both CD and UC was found. Sucralose can serve a dual purpose in quantifying small and large intestinal permeabil, Mag-tarmkanalens glatta muskulatur är funktionellt integrerad med enteriska nervsystemet och endokrin signalering för ackommodation, blandning och passage genom mag-tarmkanalen. De intestinala epitelcellerna upprätthåller digestion och absorption, samtidigt med barriärfunktion mot skadliga agens. Avhandlingen utvärderar patofysiologiska barriärmekanismer vid inflammatorisk tarmsjukdom (IBD) beträffande permeabilitet, förändrad motilitet och hormonella mönster vid Crohns sjukdom (CD) och ulcerös colit (UC) genom att, 1) utvärdera mag-tarmkanalens motilitet med trådlös motilitetskapsel (WMC) och videokapsel endoskopi (VCE), 2) studera I-FABP som biomarkör vid CD avseende distribution i mag-tarmkanalen, samband med sjukdomsktivitet, parallellitet med TNFα och Harvey-Bradshaw index (HBI) under anti-TNFα-behandling, 3) utvärdera intestinal permeabilitet vid IBD, 4) studera användning av WMC för att registrera motilitet vid måltidssvar och hormonella mönster. WMC registrerade pH, tryck och temperatur längs hela mag-tarmkanalen. Referensvärden för ventrikeltömningstid och transittider för tunntarm, colon och totala mag-tarmkanalen etablerades. Dessa värden har använts för utvärdering av IBD. Mjukvaruberäknade värden var lika visuellt avlästa värden. Mätvärden för VCE under fasta visade snabb transit, medan WMC hade längre ventrikeltömningstid och transittid för tunntarm. Intra-individuell variation måste bedömas särskilt vid kliniska undersökningar. I-FABP lokaliserades till epitelet i tunntarmen, i mindre omfattning i ventrikel och colon. Cirkulerande I-FABP var förhöjt vid aktiv CD, som TNFα. Plasmanivåer av I-FABP följde parallellt TNFα och HBI under behandling och uppföljning. I-FABP kan användas som selektiv prognostisk markör för CD i jejunum och ileum vid monitorering av CD patienter. Ökad tunntarmspermeabilitet sågs både vid CD och UC med hyperpermeabilitet för laktulos, medan sukralos, som ersättning för laktulos, kunde mäta permeabilitet i både tunntarm och col

Synchronized motility, permeability and secretory (hormones and enzymes) events are integral to normal physiology. Smooth muscle syncytium operates with enteric nervous system (ENS) and endocrine signalling to accommodate, mix and control passage of ingested materials. The intestinal epithelial cells (IECs) drive digestion and absorption while repelling harmful compounds. This thesis investigated GI barrier function (permeability, mucosal integrity), motility and hormonal patterns in inflammatory bowel disease (IBD) by: 1) assessing GI motility using a wireless motility capsule (WMC, SmartPill®) and video capsule endoscopy (VCE, Pillcam®), 2) investigation of intestinal fatty acid binding protein (I-FABP) as a biomarker of Crohn’s disease (CD) disease activity, 3) evaluation of small intestinal permeability in IBD, 4) investigating meal-related WMC motility and simultaneous hormonal (e.g., Ghrelin, GLP-1, GIP, PYY) patterns in IBD. Reference WMC motility values for transit times for gastric emptying, small bowel, orocecal, small+large bowel, colon and whole gut were established. Software-generated estimates and visually determined values were nearly identical. Compared with VCE estimates (represents fasting conditions), the WMC records longer GET and SBTT. Variations in intra-subject reproducibility must be considered in clinical investigations. This data was then used to investigate IBD patients. I-FABP was primarily expressed in the epithelium of the small bowel and to lesser extent also in the colon and stomach. Circulating I-FABP was elevated in active CD with a magnitude comparable to TNFα. I-FABP lowers and rises again in parallel with TNFα and HBI during infliximab treatment. I-FABP can be used as a jejunum and ileum selective prognostic biomarker for monitoring disease activity. Increased small intestine mucosal barrier permeability to lactulose in both CD and UC was found. Sucralose can serve a dual purpose in quantifying small and large intestinal permeabil, Mag-tarmkanalens glatta muskulatur är funktionellt integrerad med enteriska nervsystemet och endokrin signalering för ackommodation, blandning och passage genom mag-tarmkanalen. De intestinala epitelcellerna upprätthåller digestion och absorption, samtidigt med barriärfunktion mot skadliga agens. Avhandlingen utvärderar patofysiologiska barriärmekanismer vid inflammatorisk tarmsjukdom (IBD) beträffande permeabilitet, förändrad motilitet och hormonella mönster vid Crohns sjukdom (CD) och ulcerös colit (UC) genom att, 1) utvärdera mag-tarmkanalens motilitet med trådlös motilitetskapsel (WMC) och videokapsel endoskopi (VCE), 2) studera I-FABP som biomarkör vid CD avseende distribution i mag-tarmkanalen, samband med sjukdomsktivitet, parallellitet med TNFα och Harvey-Bradshaw index (HBI) under anti-TNFα-behandling, 3) utvärdera intestinal permeabilitet vid IBD, 4) studera användning av WMC för att registrera motilitet vid måltidssvar och hormonella mönster. WMC registrerade pH, tryck och temperatur längs hela mag-tarmkanalen. Referensvärden för ventrikeltömningstid och transittider för tunntarm, colon och totala mag-tarmkanalen etablerades. Dessa värden har använts för utvärdering av IBD. Mjukvaruberäknade värden var lika visuellt avlästa värden. Mätvärden för VCE under fasta visade snabb transit, medan WMC hade längre ventrikeltömningstid och transittid för tunntarm. Intra-individuell variation måste bedömas särskilt vid kliniska undersökningar. I-FABP lokaliserades till epitelet i tunntarmen, i mindre omfattning i ventrikel och colon. Cirkulerande I-FABP var förhöjt vid aktiv CD, som TNFα. Plasmanivåer av I-FABP följde parallellt TNFα och HBI under behandling och uppföljning. I-FABP kan användas som selektiv prognostisk markör för CD i jejunum och ileum vid monitorering av CD patienter. Ökad tunntarmspermeabilitet sågs både vid CD och UC med hyperpermeabilitet för laktulos, medan sukralos, som ersättning för laktulos, kunde mäta permeabilitet i både tunntarm och col

Vasoactive intestinal peptide (VIP), a gut peptide hormone originally reported as a vasodilator in 1970, has multiple physiological and pathological effects on development, growth, and the control of neuronal, epithelial, and endocrine cell functions that in turn regulate ion secretion, nutrient absorption, gut motility, glycemic control, carcinogenesis, immune responses, and circadian rhythms. Genetic ablation of this peptide and its receptors in mice also provides new insights into the contribution of VIP towards physiological signaling and the pathogenesis of related diseases. Here, we discuss the impact of VIP on gastrointestinal function and diseases based on recent findings, also providing insight into its possible therapeutic application to diabetes, autoimmune diseases and cancer.

Vasoactive intestinal peptide (VIP), a gut peptide hormone originally reported as a vasodilator in 1970, has multiple physiological and pathological effects on development, growth, and the control of neuronal, epithelial, and endocrine cell functions that in turn regulate ion secretion, nutrient absorption, gut motility, glycemic control, carcinogenesis, immune responses, and circadian rhythms. Genetic ablation of this peptide and its receptors in mice also provides new insights into the contribution of VIP towards physiological signaling and the pathogenesis of related diseases. Here, we discuss the impact of VIP on gastrointestinal function and diseases based on recent findings, also providing insight into its possible therapeutic application to diabetes, autoimmune diseases and cancer.

Objective: This study screens the aqueous and ethanolic extracts of Averrhoa carambola Linn for antidiarrhoeal activity in Castor oil induced diarrhea model and Prostaglandin induced diarrhea model, Gastro-intestinal motility test model in mice. Materials and methods:  The plant material of Averrhoa carambola Linn was extracted by using various solvents like petroleum ether, chloroform, ethanol, and water by using soxhlet apparatus. The extracts were screened for antidiarrhoeal activity by different in vivo assay methods. The acute toxicity of Averrhoa carambola Linn was determined in albino mice of either sex weighing from 20 - 25g according to the Organization for Economic Co-operation and Development (OECD) guidelines for Testing of Chemicals number 420 (OECD, 2001). The study was initiated with a sighting study aimed to determine the dose for the acute toxicity study. Results: Acute oral toxicity study indicated that ethanolic extract of Averrhoa carambola (EEAC) and aqueous extract of Averrhoa carambola (AEAC) was safe up to a dose of 2000 mg/kg body weight of mice. Results of antidiarrhoeal activity study revealed that the extracts of Averrhoa carambola Linn leaves showed significant anti-diarrhoeal activity in a dose-dependent manner when compared to control. Conclusion: Results indicated a possible role of the EEAC& AEAC in the prevention & treatment of diarrhea. The phenolic/flavonoid contents of EEAC& AEAC having antioxidant potential might be responsible for the antidiarrhoeal property of Averrhoa carambola leaves.

Objective: This study screens the aqueous and ethanolic extracts of Averrhoa carambola Linn for antidiarrhoeal activity in Castor oil induced diarrhea model and Prostaglandin induced diarrhea model, Gastro-intestinal motility test model in mice. Materials and methods:  The plant material of Averrhoa carambola Linn was extracted by using various solvents like petroleum ether, chloroform, ethanol, and water by using soxhlet apparatus. The extracts were screened for antidiarrhoeal activity by different in vivo assay methods. The acute toxicity of Averrhoa carambola Linn was determined in albino mice of either sex weighing from 20 - 25g according to the Organization for Economic Co-operation and Development (OECD) guidelines for Testing of Chemicals number 420 (OECD, 2001). The study was initiated with a sighting study aimed to determine the dose for the acute toxicity study. Results: Acute oral toxicity study indicated that ethanolic extract of Averrhoa carambola (EEAC) and aqueous extract of Averrhoa carambola (AEAC) was safe up to a dose of 2000 mg/kg body weight of mice. Results of antidiarrhoeal activity study revealed that the extracts of Averrhoa carambola Linn leaves showed significant anti-diarrhoeal activity in a dose-dependent manner when compared to control. Conclusion: Results indicated a possible role of the EEAC& AEAC in the prevention & treatment of diarrhea. The phenolic/flavonoid contents of EEAC& AEAC having antioxidant potential might be responsible for the antidiarrhoeal property of Averrhoa carambola leaves.

Gastrointestinal (GI) problems give rise to 10 percent of initial patient visits to their physician. Although blockages and infections are easy to diagnose, more than half of GI disorders involve abnormal functioning of the GI tract, where diagnosis entails subjective symptom-based questionnaires or objective but invasive, intermittent procedures in specialized centers. Although common procedures capture motor aspects of gastric function, which do not correlate with symptoms or treatment response, recent findings with invasive electrical recordings show that spatiotemporal patterns of the gastric slow wave are associated with diagnosis, symptoms, and treatment response. We here consider developing non-invasive approaches to extract this information. Using CT scans from human subjects, we simulate normative and disordered gastric surface electrical activity along with associated abdominal activity. We employ Bayesian inference to solve the ill-posed inverse problem of estimating gastric surface activity from cutaneous recordings. We utilize a prior distribution on the spatiotemporal activity pertaining to sparsity in the number of wavefronts on the stomach surface, and smooth evolution of these wavefronts across time. We implement an efficient procedure to construct the Bayes optimal estimate and demonstrate its superiority compared to other commonly used inverse methods, for both normal and disordered gastric activity. Region-specific wave direction information is calculated and consistent with the simulated normative and disordered cases. We apply these methods to cutaneous multi-electrode recordings of two human subjects with the same clinical description of motor function, but different diagnosis of underlying cause. Our method finds statistically significant wave propagation in all stomach regions for both subjects, anterograde activity throughout for the subject with diabetic gastroparesis, and retrograde activity in some regions for the subject with idiopathic

Vasoactive intestinal peptide (VIP), a gut peptide hormone originally reported as a vasodilator in 1970, has multiple physiological and pathological effects on development, growth, and the control of neuronal, epithelial, and endocrine cell functions that in turn regulate ion secretion, nutrient absorption, gut motility, glycemic control, carcinogenesis, immune responses, and circadian rhythms. Genetic ablation of this peptide and its receptors in mice also provides new insights into the contribution of VIP towards physiological signaling and the pathogenesis of related diseases. Here, we discuss the impact of VIP on gastrointestinal function and diseases based on recent findings, also providing insight into its possible therapeutic application to diabetes, autoimmune diseases and cancer.

Background: Previous studies indicated delayed gastric emptying in patients with end-stage renal disease (ESRD) using indirect methods. The objective of the current study was to examine gastrointestinal motility using a direct method as well as the role of the incretin hormones and glucagon. Methods: Patients on chronic hemodialysis and with either normal glucose tolerance, impaired glucose tolerance or type 2 diabetes, and healthy control subjects (N = 8, respectively) were studied. Gastric emptying time was measured by repeated gamma camera imaging for 6 hours after intake of a radioactive labeled standardized mixed solid and liquid meal. Glucagon, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) levels were measured. Key Results: Patients were age, gender and BMI matched with controls. We found significantly higher gastric retention at 15 minutes, prolonged gastric mean emptying time, and gastric half-emptying time of the solid marker in all three groups of ESRD patients compared to controls. Significant differences in mean total area under the concentration curve (AUC) values across the four groups for GIP (P = 0.001), but not for GLP-1 and glucagon. The ESRD group had significant higher total AUC of GIP and glucagon compared to controls (P < 0.001 and P < 0.04) but not for GLP-1 (P = 0.4). No difference in incremental AUC was found. Conclusions and Inferences: We found altered gastrointestinal motility in dialysis patients, with higher gastric retention and prolonged gastric emptying, and higher total AUC of GIP and glucagon independent of the presence of diabetes or prediabetes.

Polyneuropathy is a common complication to diabetes. Neuropathies within the enteric nervous system are associated with gastroenteropathy and marked symptoms that severely reduce quality of life. Symptoms are pleomorphic but include nausea, vomiting, dysphagia, dyspepsia, pain, bloating, diarrhoea, constipation and faecal incontinence. The aims of this review are fourfold. First, to provide a summary of the pathophysiology underlying diabetic gastroenteropathy. Secondly to give an overview of the diagnostic methods. Thirdly, to provide clinicians with a focussed overview of current and future methods for pharmacological and nonpharmacological treatment modalities. Pharmacological management is categorised according to symptoms arising from the upper or lower gut as well as sensory dysfunctions. Dietary management is central to improvement of symptoms and is discussed in detail, and neuromodulatory treatment modalities and other emerging management strategies for diabetic gastroenteropathy are discussed. Finally, we propose a diagnostic/investigation algorithm that can be used to support multidisciplinary management.

Background: Food and diet are central issues for proper functioning of the cardiovascular (CV) system and gastrointestinal (GI) tract. We hypothesize that different types of dietary FAs affect CV parameters as well as GI motor function and visceral sensitivity. Methods: Male Wistar rats were fed with control diet (CTRL), diet supplemented with 7% soybean oil (SOY), SOY + 3.5% virgin coconut oil (COCO), and SOY + 3.5% evening primrose oil (EP) for 4 weeks. The content of insoluble fiber in CTRL was higher than in SOY, COCO, or EP. Body weight gain and food/water intake were measured. At day 28, biometric, biochemical, CV parameters, GI motor function (X-ray and colon bead expulsion test), and visceral sensitivity were evaluated. Changes in propulsive colonic activity were determined in vitro. The colon and adipose tissue were histologically studied; the number of mast cells (MCs) in the colon was calculated. Results: SOY, COCO, and EP had increased body weight gain but decreased food intake vs CTRL. Water consumption, biometric, biochemical, and CV parameters were comparable between groups. SOY increased the sensitivity to colonic distention. All groups maintained regular propulsive neurogenic contractions; EP delayed colonic motility (P < 0.01). SOY, COCO, and EP displayed decreased size of the cecum, lower number and size of fecal pellets, and higher infiltration of MCs to the colon (P < 0.001). Conclusions and Inferences: Dietary FAs supplementation and lower intake of insoluble fiber can induce changes in the motility of the lower GI tract, in vivo and in vitro, but CV function and visceral sensitivity are not generally affected.

Loperamide is a potent mu opioid receptor agonist available over the counter to treat diarrhea. Although at therapeutic doses loperamide is devoid of central effects, it may exert them if used at high doses or combined with drugs that increase its systemic and/or central bioavailability. Recently, public health and scientific interest on loperamide has increased due to a growing trend of misuse and abuse, and consequent reports on its toxicity. Our aim was to evaluate in the rat the effects of increasing loperamide doses, with increasing likelihood to induce central effects, on gastrointestinal motor function (including gastric dysmotility and nausea-like behavior). Methods: Male Wistar rats received an intraperitoneal injection of vehicle or loperamide (0.1, 1, or 10 mg kg). Three sets of experiments were performed to evaluate: (a) central effects (somatic nociceptive thresholds, immobility time, core temperature, spontaneous locomotor activity); (b) general gastrointestinal motility (serial X-rays were taken 0-8 hours after intragastric barium administration and analyzed semiquantitatively, morphometrically, and densitometrically); and (c) bedding intake (a rodent indirect marker of nausea). Animals from sets 1 and 3 were used to evaluate gastric dysmotility ex vivo at 2 and 4 hours after administration, respectively. Key Results: Loperamide significantly induced antinociception, hypothermia, and hypolocomotion (but not catalepsy) at high doses and dose-dependently reduced gastrointestinal motor function, with the intestine exhibiting higher sensitivity than the stomach. Whereas bedding intake occurred early and transiently, gastric dysmotility was much more persistent. Conclusions and inferences: Our results suggest that loperamide-induced nausea and gastric dysmotility might be temporally dissociated.

Melanoidins present in coffee silverskin, the only by-product of the roasting process, are formed via the Maillard reaction. The exact structure, biological properties, and mechanism of action of coffee silverskin melanoidins, remain unknown. This research work aimed to contribute to this novel knowledge. To achieve this goal, melanoidins were obtained from an aqueous extract of Arabica coffee silverskin (WO2013004873A1) and was isolated through ultrafiltration (>10 kDa). The isolation protocol was optimized and the chemical composition of the high molecular weight fraction (>10 kDa) was evaluated, by analyzing the content of protein, caffeine, chlorogenic acid, and the total dietary fiber. In addition, the structural analysis was performed by infrared spectroscopy. Antioxidant properties were studied in vitro and the fiber effect was studied in vivo, in healthy male Wistar rats. Melanoidins were administered to animals in the drinking water at a dose of 1 g/kg. At the fourth week of treatment, gastrointestinal motility was evaluated through non-invasive radiographic means. In conclusion, the isolation process was effective in obtaining a high molecular weight fraction, composed mainly of dietary fiber, including melanoidins, with in vitro antioxidant capacity and in vivo dietary fiber effects.

Polyneuropathy is a common complication to diabetes. Neuropathies within the enteric nervous system are associated with gastroenteropathy and marked symptoms that severely reduce quality of life. Symptoms are pleomorphic but include nausea, vomiting, dysphagia, dyspepsia, pain, bloating, diarrhoea, constipation and faecal incontinence. The aims of this review are fourfold. First, to provide a summary of the pathophysiology underlying diabetic gastroenteropathy. Secondly to give an overview of the diagnostic methods. Thirdly, to provide clinicians with a focussed overview of current and future methods for pharmacological and nonpharmacological treatment modalities. Pharmacological management is categorised according to symptoms arising from the upper or lower gut as well as sensory dysfunctions. Dietary management is central to improvement of symptoms and is discussed in detail, and neuromodulatory treatment modalities and other emerging management strategies for diabetic gastroenteropathy are discussed. Finally, we propose a diagnostic/investigation algorithm that can be used to support multidisciplinary management.

The increasing prevalence of functional and motility gastrointestinal (GI) disorders is at odds with bottlenecks in their diagnosis, treatment, and follow-up. Lack of noninvasive approaches means that only specialized centers can perform objective assessment procedures. Abnormal GI muscular activity, which is coordinated by electrical slow-waves, may play a key role in symptoms. As such, the electrogastrogram (EGG), a noninvasive means to continuously monitor gastric electrical activity, can be used to inform diagnoses over broader populations. However, it is seldom used due to technical issues: inconsistent results from single-channel measurements and signal artifacts that make interpretation difficult and limit prolonged monitoring. Here, we overcome these limitations with a wearable multi-channel system and artifact removal signal processing methods. Our approach yields an increase of 0.56 in the mean correlation coefficient between EGG and the clinical "gold standard", gastric manometry, across 11 subjects (p < 0.001). We also demonstrate this system's usage for ambulatory monitoring, which reveals myoelectric dynamics in response to meals akin to gastric emptying patterns and circadian-related oscillations. Our approach is noninvasive, easy to administer, and has promise to widen the scope of populations with GI disorders for which clinicians can screen patients, diagnose disorders, and refine treatments objectively.

Oriented smooth muscle layers in the intestine contract rhythmically due to the action of interstitial cells of Cajal (ICC) that serve as pacemakers of the intestine. Disruption of ICC networks has been reported in various intestinal motility disorders, which limit the quality and expectancy of life. A significant challenge in intestinal smooth muscle engineering is the rapid loss of function in cultured ICC and smooth muscle cells (SMC). Here we demonstrate a novel approach to maintain the function of both ICC and SMC in vitro. Primary intestinal SMC mixtures cultured on feeder cells seeded electrospun poly(3-caprolactone) scaffolds exhibited rhythmic contractions with directionality for over 10 weeks in vitro. The simplicity of this system should allow for wide usage in research on intestinal motility disorders and tissue engineering, and may prove to be a versatile platform for generating other types of functional SMC in vitro.

Dysfunktion av den gastrointestinala motiliteten under det postoperativa skedet är en komplikation som kan orsakas till följd av kirurgiska ingrepp. Detta kan orsaka bukspänning, illamående samt smärta som komplicerar en ofullständig och snabb återhämtning efter kirurgiska ingrepp. Dysfunktion av den gastrointestinala motiliteten ökar risken för ytterligare postoperativa komplikationer som uttorkning, elektrolytrubbning och sepsis. Samt ökar riskerna för reoperation och återintagning på sjukhus efter utskrivning. Dysfunktion av den gastrointestinala motiliteten kan ge ökat lidande för patienter, skapa längre vårdtider, medföra högre sjukhuskostnader samt öka arbetsbelastningen för hälso- och sjukvårdspersonal. Syfte: Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder vid dysfunktion av den gastrointestinala motiliteten hos patienter under det postoperativa skedet. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Resultat: Resultatet baserades på nio vetenskapliga artiklar med kvantitativa ansats. Utifrån kodning av meningsenheter från de vetenskapliga artiklarna framkom fyra huvudkategorier: Patientnära samtal, Mobilisering, Kost- och vätskeintag och Stimulering av den gastrointestinala motiliteten. Slutsats: Omvårdnadsåtgärder var en viktig del i förebyggandet för främjandet av den gastrointestinala motiliteten under det postoperativa skedet samt förbättrade möjligheten till ett tidigare tillfrisknande för patienter. Ett tidigt ingripande med omvårdnadsåtgärder till patienter som genomgått kirurgi bidrog det till minskat lidande, kortare vårdtider för patienterna samt minskad arbetsbelastning för hälso- och sjukvårdspersonal., Dysfunction of the gastrointestinal motility in the post-operative stage is a complication that can be caused by surgical procedures. This can cause abdominal tension, nausea and pain that complicate an incomplete and rapid recovery after surgery. Dysfunction of gastrointestinal motility increases the risk of additional postoperative complications such as dehydration, electrolyte disruption and sepsis. As well as increasing the risk of reoperation and readmission in hospitals after discharge. Dysfunction of the gastrointestinal motility can lead to increased suffering for patients, create longer care times, bring higher hospital costs and increase the workload of healthcare professionals. Purpose: The purpose was to describe nursing care measures in dysfunction of the gastrointestinal motility to patients in the postoperative stage. Method: The study was conducted as a literature review with inductive approach. Result: The result was based on nine scientific articles with quantitative approaches. Based on the coding of opinion units from the scientific articles, four main categories emerged: Patient-related conversation, Mobilization, Diet and fluid intake and Stimulation of gastrointestinal motility. Conclusion: Nursing care measures were an important part of the prevention of the promotion of gastrointestinal motility in the postoperative stage, and improved the possibility of an earlier recovery for patients. Early intervention with nursing care measures for patients who have undergone surgery, it contributed to reduced suffering, shorter patient care times and reduced workload for healthcare professionals.

The increasing prevalence of functional and motility gastrointestinal (GI) disorders is at odds with bottlenecks in their diagnosis, treatment, and follow-up. Lack of noninvasive approaches means that only specialized centers can perform objective assessment procedures. Abnormal GI muscular activity, which is coordinated by electrical slow-waves, may play a key role in symptoms. As such, the electrogastrogram (EGG), a noninvasive means to continuously monitor gastric electrical activity, can be used to inform diagnoses over broader populations. However, it is seldom used due to technical issues: inconsistent results from single-channel measurements and signal artifacts that make interpretation difficult and limit prolonged monitoring. Here, we overcome these limitations with a wearable multi-channel system and artifact removal signal processing methods. Our approach yields an increase of 0.56 in the mean correlation coefficient between EGG and the clinical "gold standard", gastric manometry, across 11 subjects (p < 0.001). We also demonstrate this system's usage for ambulatory monitoring, which reveals myoelectric dynamics in response to meals akin to gastric emptying patterns and circadian-related oscillations. Our approach is noninvasive, easy to administer, and has promise to widen the scope of populations with GI disorders for which clinicians can screen patients, diagnose disorders, and refine treatments objectively.

Oriented smooth muscle layers in the intestine contract rhythmically due to the action of interstitial cells of Cajal (ICC) that serve as pacemakers of the intestine. Disruption of ICC networks has been reported in various intestinal motility disorders, which limit the quality and expectancy of life. A significant challenge in intestinal smooth muscle engineering is the rapid loss of function in cultured ICC and smooth muscle cells (SMC). Here we demonstrate a novel approach to maintain the function of both ICC and SMC in vitro. Primary intestinal SMC mixtures cultured on feeder cells seeded electrospun poly(3-caprolactone) scaffolds exhibited rhythmic contractions with directionality for over 10 weeks in vitro. The simplicity of this system should allow for wide usage in research on intestinal motility disorders and tissue engineering, and may prove to be a versatile platform for generating other types of functional SMC in vitro.

The enteric nervous system (ENS) is central to intestinal motility and a candidate target for the heterogeneous spectrum of dysmotility diseases. White et al. reveal that relapsing intestinal dysmotility occurs when partial ENS depletion by enteric neurotropic viruses is followed by functional impairment due to intermittent nonspecific intestinal inflammation.

Dysfunktion av den gastrointestinala motiliteten under det postoperativa skedet är en komplikation som kan orsakas till följd av kirurgiska ingrepp. Detta kan orsaka bukspänning, illamående samt smärta som komplicerar en ofullständig och snabb återhämtning efter kirurgiska ingrepp. Dysfunktion av den gastrointestinala motiliteten ökar risken för ytterligare postoperativa komplikationer som uttorkning, elektrolytrubbning och sepsis. Samt ökar riskerna för reoperation och återintagning på sjukhus efter utskrivning. Dysfunktion av den gastrointestinala motiliteten kan ge ökat lidande för patienter, skapa längre vårdtider, medföra högre sjukhuskostnader samt öka arbetsbelastningen för hälso- och sjukvårdspersonal. Syfte: Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder vid dysfunktion av den gastrointestinala motiliteten hos patienter under det postoperativa skedet. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Resultat: Resultatet baserades på nio vetenskapliga artiklar med kvantitativa ansats. Utifrån kodning av meningsenheter från de vetenskapliga artiklarna framkom fyra huvudkategorier: Patientnära samtal, Mobilisering, Kost- och vätskeintag och Stimulering av den gastrointestinala motiliteten. Slutsats: Omvårdnadsåtgärder var en viktig del i förebyggandet för främjandet av den gastrointestinala motiliteten under det postoperativa skedet samt förbättrade möjligheten till ett tidigare tillfrisknande för patienter. Ett tidigt ingripande med omvårdnadsåtgärder till patienter som genomgått kirurgi bidrog det till minskat lidande, kortare vårdtider för patienterna samt minskad arbetsbelastning för hälso- och sjukvårdspersonal., Dysfunction of the gastrointestinal motility in the post-operative stage is a complication that can be caused by surgical procedures. This can cause abdominal tension, nausea and pain that complicate an incomplete and rapid recovery after surgery. Dysfunction of gastrointestinal motility increases the risk of additional postoperative complications such as dehydration, electrolyte disruption and sepsis. As well as increasing the risk of reoperation and readmission in hospitals after discharge. Dysfunction of the gastrointestinal motility can lead to increased suffering for patients, create longer care times, bring higher hospital costs and increase the workload of healthcare professionals. Purpose: The purpose was to describe nursing care measures in dysfunction of the gastrointestinal motility to patients in the postoperative stage. Method: The study was conducted as a literature review with inductive approach. Result: The result was based on nine scientific articles with quantitative approaches. Based on the coding of opinion units from the scientific articles, four main categories emerged: Patient-related conversation, Mobilization, Diet and fluid intake and Stimulation of gastrointestinal motility. Conclusion: Nursing care measures were an important part of the prevention of the promotion of gastrointestinal motility in the postoperative stage, and improved the possibility of an earlier recovery for patients. Early intervention with nursing care measures for patients who have undergone surgery, it contributed to reduced suffering, shorter patient care times and reduced workload for healthcare professionals.

[Background] Vincristine is a commonly used chemotherapeutic agent. It is associated with undesirable digestive side effects. However, the impact of vincristine on gastrointestinal structure and motility or its long-term effects have not been deeply studied in animal models. This could be useful in order to develop therapeutic or preventive strategies for cancer patients. The aim of this study was to analyze such effects., [Methods] Rats received saline or vincristine (0.1 mg kg-1 , ip) daily for 10 days. Evaluations were performed during treatment and 2-6 weeks after. Somatic mechano-sensitivity was assessed using von Frey hairs. Gastrointestinal motor function was studied by means of radiographic still images and colonic propulsion of fecal pellets using fluoroscopy videos. Histological assessment of the gut morphology and immunohistochemistry for HuC/D and nNOS were performed in whole-mount myenteric plexus preparations., [Key Results] Peripheral sensitivity was increased in animals treated with vincristine and did not subside 2 weeks after treatment finalization. Vincristine treatment inhibited gastrointestinal motility although this was recovered to normal values with time. Damage in the digestive wall after vincristine treatment was greater in the ileum than in the colon. Villi shortening (in ileum) and large inflammatory nodules still remained 2 weeks after treatment finalization. Finally, the proportion of nNOS-immunoreactive neurons was increased with vincristine and continued to be increased 2 weeks after treatment finalization., [Conclusions and Inferences] Vincristine alters gastrointestinal motility, peripheral sensitivity and mucosal architecture. Vincristine-induced neuropathy (somatic and enteric), intestinal mucosa damage and inflammatory infiltrations are relatively long-lasting.

Chronic watery diarrhea poses a diagnostic and therapeutic challenge and is often a disabling condition for patients. Although acute diarrhea is likely to be caused by infection, the causes of chronic diarrhea (>4 weeks in duration) are more elusive. We review the pathophysiology, diagnosis, and treatment of chronic diarrhea. Drawing on recent insights into the molecular mechanisms of intestinal epithelial transport and barrier function, we discuss how diarrhea can result from a decrease in luminal solute absorption, an increase in secretion, or both, as well as derangements in barrier properties. We also describe the various extraepithelial factors that activate diarrheal mechanisms. Finally, clinical evaluation and tests used in the assessment of patients presenting with chronic diarrhea are reviewed, and an algorithm guiding therapeutic decisions and pharmacotherapy is presented.

Introduction: An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. It is the most important cause of maternal mortality and morbidity in the first trimester. Our aimed is to study the different modes of clinical presentation, predisposing and etiological factors in case of ectopic pregnancy. Materials and Methods: Department of Obstetrics and Gynaecology, Sri Aurobindo Medical College and Post Graduate Institution, Indore, MP from April 2014 to July 2015. All patients included in the study were diagnosed with ectopic pregnancy, in reproductive age group of 15-49 years. Total 50 patients participated in the study. A pre structured and pre tested questionnaire was used to know age, parity, risk factors and modes of presentation of ectopic pregnancy. Result: out of 50 cases, the maximum no. of cases that is 22(44%) were in age group of 21 to 25 years. In present study 48% of patients were nulliparous which was highest. In present study, Infertility, History of previous abortion and pelvic inflammatory diseases were found to be the major predisposing factor for ectopic gestation. In present study, Abdominal Pain was the most common symptom seen in 47 (94%) cases followed by amenorrhea and abdominal tenderness. Conclusion: A better understanding of risk factors and presentations related to ectopic pregnancy can help to manage and prevent its occurrence.

Introduction: An ectopic pregnancy occurs when a fertilized ovum implants outside the normal uterine cavity. It is the most important cause of maternal mortality and morbidity in the first trimester. Our aimed is to study the different modes of clinical presentation, predisposing and etiological factors in case of ectopic pregnancy. Materials and Methods: Department of Obstetrics and Gynaecology, Sri Aurobindo Medical College and Post Graduate Institution, Indore, MP from April 2014 to July 2015. All patients included in the study were diagnosed with ectopic pregnancy, in reproductive age group of 15-49 years. Total 50 patients participated in the study. A pre structured and pre tested questionnaire was used to know age, parity, risk factors and modes of presentation of ectopic pregnancy. Result: out of 50 cases, the maximum no. of cases that is 22(44%) were in age group of 21 to 25 years. In present study 48% of patients were nulliparous which was highest. In present study, Infertility, History of previous abortion and pelvic inflammatory diseases were found to be the major predisposing factor for ectopic gestation. In present study, Abdominal Pain was the most common symptom seen in 47 (94%) cases followed by amenorrhea and abdominal tenderness. Conclusion: A better understanding of risk factors and presentations related to ectopic pregnancy can help to manage and prevent its occurrence.

The enteric nervous system (ENS) of the gastrointestinal tract controls many diverse functions, including motility and epithelial permeability. Perturbations in ENS development or function are common, yet there is no human model for studying ENS-intestinal biology and disease. We used a tissue-engineering approach with embryonic and induced pluripotent stem cells (PSCs) to generate human intestinal tissue containing a functional ENS. We recapitulated normal intestinal ENS development by combining human-PSC-derived neural crest cells (NCCs) and developing human intestinal organoids (HIOs). NCCs recombined with HIOs in vitro migrated into the mesenchyme, differentiated into neurons and glial cells and showed neuronal activity, as measured by rhythmic waves of calcium transients. ENS-containing HIOs grown in vivo formed neuroglial structures similar to a myenteric and submucosal plexus, had functional interstitial cells of Cajal and had an electromechanical coupling that regulated waves of propagating contraction. Finally, we used this system to investigate the cellular and molecular basis for Hirschsprung's disease caused by a mutation in the gene PHOX2B. This is, to the best of our knowledge, the first demonstration of human-PSC-derived intestinal tissue with a functional ENS and how this system can be used to study motility disorders of the human gastrointestinal tract.