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Актуальність. Однією з основних причин виникнення синдрому надлишкового бактеріального росту (СНБР) може бути ахлоргідрія будь-якого походження. Дані про цю проблему суперечливі, ряд дослідників заперечують зв’язок тривалого прийому інгібіторів протонної помпи (ІПП) з розвитком СНБР. Мета. Вивчення клінічних проявів та оцінювання стану мікробіоценозу верхніх відділів тонкої кишки у дітей, хворих на хронічний гастрит (ХГ) зі зниженою кислотоутворюючою функцією шлунка. Матеріали та методи. Обстежено 65 дітей, хворих на ХГ, віком 7–18 років. Методи дослідження включали: езофагогастродуоденоскопію, щиткову біопсію слизової оболонки шлунка на H. рylori, pH-метрію; ультразвукове дослідження органів черевної порожнини. Морфологічні зміни слизової оболонки оцінювали за візуально-аналоговою шкалою. Для верифікації СНБР усім пацієнтам проводився водневий дихальний тест (ВДТ) із використанням аналізатора Gastrolyzer та навантаженням лактулозою. Результати представлялися: кількістю спостережень, середніми значеннями показників, їх стандартними відхиленнями та помилками (М ± m для р < 0,05), відносними частотами (%). Результати. Серед 65 обстежених дітей, хворих на ХГ, виділено 27 осіб, у яких встановлено зниження кислотоутворюючої функції шлунка; середній показник pH становив 4,7 ± 0,4. У 17 дітей, хворих на ХГ, виявлено гастроезофагеальний рефлюкс (ГЕР). В обох групах хворих домінували симптоми діареї і метеоризму, проте в групі пацієнтів із ГЕР на тлі прийому ІПП частота і вираженість симптомів наростала зі збільшенням тривалості терапії. Встановлено, що інфекція H. рylori реєструвалася у 42 (64,6 %) серед усіх дітей, хворих на ХГ. За результатами ВДТ у більше ніж третини (44,4 %) пацієнтів виявлено СНРБ. У дітей, хворих на ХГ у поєднанні з ГЕР, позитивний ВДТ зареєстровано у 41,1 %. Відзначено, що частота виявлення СНБР у цих пацієнтів збільшується зі збільшенням тривалості прийому ІПП. Висновки. У дітей, хворих на ХГ із пониженою кислотопродукувальною функцією шлунка та у хворих дітей із ГЕР, які тривалий час отримували ІПП, відзначається висока частота скарг, пов’язаних із розвитком СНБР. Наявність СНБР у пацієнтів із ХГ і пацієнтів, які тривалий час отримували ІПП, підтверджується результатами ВДТ (44,4 і 41,1 % відповідно).

BACKGROUND In the early stage of acute pancreatitis (AP), a large number of cytokines induced by local pancreatic inflammation seriously damage the intestinal barrier function, and intestinal bacteria and endotoxins enter the blood, causing inflammatory storm, resulting in multiple organ failure, infectious complications, and other disorders, eventually leading to death. Intestinal failure occurs early in the course of AP, accelerating its development. As an alternative method to detect small intestinal bacterial overgrowth, the hydrogen breath test is safe, noninvasive, and convenient, reflecting the number of intestinal bacteria in AP indirectly. This study aimed to investigate the changes in intestinal bacteria measured using the hydrogen breath test in the early stage of AP to clarify the relationship between intestinal bacteria and acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Early clinical intervention and maintenance of intestinal barrier function would be highly beneficial in controlling the development of severe acute pancreatitis (SAP). AIM To analyze the relationship between intestinal bacteria change and ALI/ARDS in the early stage of SAP. METHODS A total of 149 patients with AP admitted to the intensive care unit of the Digestive Department, Xuanwu Hospital, Capital Medical University from 2016 to 2019 were finally enrolled, following compliance with the inclusion and exclusion criteria. The results of the hydrogen breath test within 1 wk of admission were collected, and the hydrogen production rates at admission, 72 h, and 96 h were calculated. The higher the hydrogen production rates the more bacteria in the small intestine. First, according to the improved Marshall scoring system in the 2012 Atlanta Consensus on New Standards for Classification of Acute Pancreatitis, 66 patients with a PaO2/FiO2 score ≤ 1 were included in the mild AP (MAP) group, 18 patients with a PaO2/FiO2 score ≥ 2 and duration < 48 h were included in the moderately SAP (MSAP) group, and 65 patients with a PaO2/FiO2 score ≥ 2 and duration > 48 h were included in the SAP group, to analyze the correlation between intestinal bacterial overgrowth and organ failure in AP. Second, ALI (PaO2/FiO2 = 2) and ARDS (PaO2/FiO2 > 2) were defined according to the simplified diagnostic criteria proposed by the 1994 European Union Conference. The MSAP group was divided into two groups according to the PaO2/FiO2 score: 15 patients with PaO2/FiO2 score = 2 were included in group A, and three patients with score > 2 were included in group B. Similarly, the SAP group was divided into two groups: 28 patients with score = 2 were included in group C, and 37 patients with score > 2 were included in group D, to analyze the correlation between intestinal bacterial overgrowth and ALI/ARDS in AP. RESULTS A total of 149 patients were included: 66 patients in the MAP group, of whom 53 patients were male (80.3%) and 13 patients were female (19.7%); 18 patients in the MSAP group, of whom 13 patients were male (72.2%) and 5 patients were female (27.8%); 65 patients in the SAP group, of whom 48 patients were male (73.8%) and 17 patients were female (26.2%). There was no significant difference in interleukin-6 and procalcitonin among the MAP, MSAP, and SAP groups (P = 0.445 and P = 0.399, respectively). There was no significant difference in the growth of intestinal bacteria among the MAP, MSAP, and SAP groups (P = 0.649). There was no significant difference in the growth of small intestinal bacteria between group A and group B (P = 0.353). There was a significant difference in the growth of small intestinal bacteria between group C and group D (P = 0.038). CONCLUSION Intestinal bacterial overgrowth in the early stage of SAP is correlated with ARDS.

Owing to the challenges to acquire detailed spatial information of gut bacteria in situ, three-dimensional (3D) microbiota distributions in the gut remain largely uncharted. Here, we propose a tissue clearing-based and D-amino acid labeling-facilitated (TiDaL) strategy that combines a novel microbiota in vivo labeling protocol, CUBIC-based tissue clearing and whole-mount tissue imaging, to achieve 3D imaging of indigenous gut microbiota. We demonstrate high-resolution 3D acquisition of their biogeography in different gut sections, and present quantitative spatial details in relation to the host epithelium. We unexpectedly observe microbiota in the small intestine crypts, which were thought to be bacteria-free. Significant bacterial overgrowth in the first two-thirds of the small intestine is detected in an enteritis model. We expect that this quantitative 3D imaging strategy for native gut microbiota will provide insightful information into the host-microbiota interactions.

Both cardiovascular and gastrointestinal disorders represent considerable health burden on community clinics and hospitals with overwhelming economic cost. An overlap in the occurrence of these disorders is encountered in daily practice. Both affect each other in bidirectional manner through several mechanisms including altered hemodynamics, systemic inflammation, bacterial overgrowth and interactions and adverse effects of medications. In addition, to the known overlap in the symptoms occurrence of upper gastrointestinal tract diseases and cardiovascular diseases (CVDs). Awareness of this interplay and its clinical manifestations optimizes patient management, and could prevent catastrophic consequences and even save lives. In this review, we highlighted the clinical aspects of this bidirectional association between gastrointestinal and CVDs aiming to shed light on this topic and improve patients' care.

Background The Serial Transverse Enteroplasty Procedure (STEP) Registry has reported a 47% success to achieve enteral autonomy in pediatric short bowel syndrome (SBS). We have performed the STEP with a technical modification (MSTEP) consisting in stapler application without mesenteric defects that can also be applied to the duodenum. Our experience with this technique is described. Materials and Methods In this study, 16 children with SBS underwent MSTEP (2005–2019). Indications were nutritional autonomy achievement (n = 11, with duodenal lengthening in 5/11) and bacterial overgrowth treatment (n = 5). Results With a median follow-up of 5.8 years (0.7–13.7 years), 5 of 11 (45%) patients achieved enteral autonomy, 4 of them with duodenal lengthening. Four of four who preserved > 50% colon, while only one of seven with Conclusion The effectiveness of MSTEP to achieve enteral autonomy seems similar to the classical STEP. It can be applied to the duodenum. The retained colon length may influence the post-STEP enteral autonomy achievement.

Background:Roux-en-Y gastric bypass is a frequently carried out bariatric procedure, proven to be effective in the management of obesity and its accompanying health issues. Following its popularity, admission to the emergency department for abdominal pain is often seen with known early and late onset causes. We present a case of a young woman with vague abdominal pain years after her gastric bypass, who eventually underwent a resection of a 'candy cane' like biliopancreatic blind loop. Methods:A healthy 23-year-old woman has been suffering of vague abdominal complaints after a gastric bypass procedure 4 years earlier. Postprandial pain, diarrhoea and abdominal distension were present at a daily to weekly basis. Several investigations and management options were administered by surgeons, gastroenterologists as well as endocrinologists. On a performed explorative laparoscopy, a large blind loop at the entero-enteric anastomosis was seen and resected. Results:At current follow-up of 15 months the resection of the candy cane like blind end of the biliopancreatic loop resulted in a complete withdrawal of our patient's symptoms. A tentative diagnosis of bacterial overgrowth in the blind loop was made. Conclusions:Abdominal pain after gastric bypass is a frequent cause of admission to the emergency department. Besides the more serious complications, internal hernia is often withheld as possible diagnosis in the differential diagnosis of late onset, postprandial epigastric pain. This case report highlights another possibility. At initial surgery, a candy cane shaped blind loop should be avoided both at the gastro-jejunal as well as the entero-enteric anastomosis.

Background Although serial transverse enteroplasty (STEP) improves function of dilated short bowel, a significant proportion of patients require repeat surgery. To address underlying reasons for unsuccessful STEP, we compared small intestinal mucosal characteristics between initial and repeat STEP procedures in children with short bowel syndrome (SBS). Methods Fifteen SBS children, who underwent 13 first and 7 repeat STEP procedures with full thickness small bowel samples at median age 1.5 years (IQR 0.7–3.7) were included. The specimens were analyzed histologically for mucosal morphology, inflammation and muscular thickness. Mucosal proliferation and apoptosis was analyzed with MIB1 and Tunel immunohistochemistry. Results Median small bowel length increased 42% by initial STEP and 13% by repeat STEP (p = 0.05), while enteral caloric intake increased from 6% to 36% (p = 0.07) during 14 (12-42) months between the procedures. Abnormal mucosal inflammation was frequently observed both at initial (69%) and additional STEP (86%, p = 0.52) surgery. Villus height, crypt depth, enterocyte proliferation and apoptosis as well as muscular thickness were comparable at first and repeat STEP (p > 0.05 for all). Patients, who required repeat STEP tended to be younger (p = 0.057) with less apoptotic crypt cells (p = 0.031) at first STEP. Absence of ileocecal valve associated with increased intraepithelial leukocyte count and reduced crypt cell proliferation index (p Conclusions No adaptive mucosal hyperplasia or muscular alterations occurred between first and repeat STEP. Persistent inflammation and lacking mucosal growth may contribute to continuing bowel dysfunction in SBS children, who require repeat STEP procedure, especially after removal of the ileocecal valve. Level of evidence Level IV, retrospective study.

In this work, the presence of free-living amoebae (FLA) in dishcloths collected from human activity related places was evaluated. Once in the laboratory, 6 cm2 pieces of each dishcloth were cut and washed with Page’s Amoeba Solution (PAS) in sterile tubes. After washing, the dishcloth pieces were removed, and the tubes were centrifuged (1500 rpm for 10 min). The obtained pellets were seeded onto 2% non-nutrient agar (NNA) plates, incubated at room temperature and were monitored daily an inverted microscope. Once clonal cultures were obtained (only one type of FLA observed), molecular analyses were carried out in order to characterize the isolated FLA strains at the genus/genotype level. From the 31 dishcloths which were processed, FLA strains were isolated in NNA plates in 13 the samples (13/31, 42%). However, and due to bacterial overgrowth, only six strains were characterized at the molecular level (PCR and sequencing). Among the PCR positive strains, 83.33% (5/6) of the PCR positive samples belonged to Acanthamoeba genus (80% (4/5) to genotype T4 and 20% (1/5) to genotype T11). Furthermore, one strain was identified as a member of Allovahlkampfia genus using both morphological and molecular approaches. To the best of our knowledge, this is the first report on the isolation of Allovahlkampfia genus from dishcloths and in the Spanish territory. The presence of FLA in dishcloths should raise awareness to improve hygienic strategies in food- and domestic-related environments, in order to prevent contamination with these protozoa, which are able to be pathogenic and even to act as vehicles of other pathogenic agents.

Multidisciplinary intestinal rehabilitation (IR) teams have transformed care in pediatric intestinal failure (IF).1 Although most children with IF are identified in the neonatal intensive care unit (NICU), IR teams may not be involved at this stage. We describe our collaborative model, blending NICU and IR expertise to optimize care. Over 6 years, the NeoCHIRP (Neonatal Children's IR Program) team followed 164 babies for weekly visits (median, 8; range, 1-27). Bedside rounds included CHIRP team physician and surgeons, neonatologist champion, attending neonatologist and fellow, NICU dietitian, bedside nurse, and family. Medical and nutrition status, nutrition history, and laboratory data were discussed, and a nutrition plan to support IR, considering the child's other medical needs, was created to guide the next week's management. Typical issues addressed included parenteral nutrition (PN) composition, enteral nutrition plan, oral feeding, management of small-intestinal bacterial overgrowth and sodium status, and cholestasis. A total of 164 babies were followed by the NeoCHIRP team. Of 153 survivors, IF resolved by discharge in 89% (136 of 153). Seventeen of 153 babies (11%) went on to require home PN and were transferred from NICU directly to the CHIRP team. By discharge, 99% of babies were orally fed (69/136, 50% fully, 67/136, 49% partially), and cholestasis improved or resolved in 80/105 (76%). Eleven babies (7%) died; four deaths were unrelated to IF, but in seven babies, IF was at least a contributing factor. In this high-risk cohort, most babies achieved good outcomes, and those who required longer-term IR transitioned smoothly to the CHIRP team.

Food intolerances are increasingly common in populations of developed countries. One of the important factors in the etiopathogenesis of this phenomenon is disorders of the bacterial composition of the human gastrointestinal tract. The development of civilization as well as the increasing production of processed food contribute to the increased incidence of diseases of the digestive system, such as small intestinal bacterial overgrowth (SIBO) and food intolerances. These conditions may occur separately or coexist in one patient. The incidence of food intolerances and also allergies, continues to increase. It is estimated that factors such as stress, inadequate lifestyle, excessive consumption of processed, modified foods may contribute to this phenomenon. The article presents the relationship between bacterial overgrowth in the small intestine and the effect on various aspects of food intolerances, both in the context of diagnosis and the course of these diseases on the basis of recent research. The nature od low-FODMAP diet was presented, as well as its effect on the clinical course of SIBO and food intolerances.

The frequency with which necrotizing enterocolitis occurs in outbreaks makes it likely that the illness can have an infective origin. Immunological and non-immunological defences of the gastrointestinal are impaired in early life. Consequently the gut of the preterm infant is predisposed to bacterial overgrowth. A wide range of pathogenic bacteria and viruses have been isolated from infants with necrotizing enterocolitis or detected histologically. The presence of bacterial metabolites in the breath, intestinal bullae (hydrogen) and urine (D-lactate) during the course of the illness is further confirmatory evidence. The presence of bacteria or bacterial products (such as exo- and endotoxin) in the circulation will lead to ischaemia of the intestine and other organs either directly or via mediators such as cytokines or platelet activating factor. Future studies in necrotizing enterocolitis should be directed to understanding and modulating inflammatory mediators in necrotizing enterocolitis and preventing the disease with breast milk and nutritional supplements (glutamine, short chain fatty acids), chemoprophylaxis, and antibodies.

Small intestinal bacterial overgrowth can be defined as the presence of excessive bacteria in the small intestine which can interfere with digestion and absorption. Predisposing causes include sustained hypochlorhydria induced by proton pump inhibitors, small intestinal dysmotility and stasis due to anatomical or motor abnormalities, and reduced antibacterial activity as seen in immunological deficiency and chronic pancreatitis. Presentation is predominantly from consequences of malabsorption, including gastrointestinal symptoms (e.g. diarrhoea or steatorrhoea) and features of specific nutrient malabsorption (e.g. osteoporosis, anaemia, neuropathy, and night blindness). Definitive diagnosis is difficult, requiring a properly collected and appropriately cultured aspirate from the proximal small intestine revealing a total concentration of a mixed growth of bacteria generally greater than 105 organisms/ml. Alternative investigations frequently used include glucose/lactulose breath tests or either the 13C- or 14C-xylose breath test, with elevated levels of 13CO2 or 14CO2 found in the breath. There may be low levels of cobalamin (metabolized by Gram-negative anaerobes), increased serum folate (synthesized by overgrowth flora), and increased urinary indicans (intraluminal product of bacterial tryptophan metabolism). Aside from treatment of any nutritional deficiencies, specific treatment is with an antimicrobial that is effective against both aerobic and anaerobic enteric bacteria (e.g. doxycycline, amoxicillin–clavulanic acid, rifaximin, or ciprofloxacin), which can be administered in rotation to reduce antibiotic resistance. Where possible and appropriate, correction of any underlying cause should also be performed.

Intestinal pseudo-obstruction is a complication that determines survival of patients with systemic sclerosis (SSc). Intestinal hypomotility and associated intestinal bacterial overgrowth are involv...

Background Small intestinal bacterial overgrowth treatment is usually based on antibiotics with no guidelines available. Objective This study aimed to investigate the efficacy of different antibiotics to treat small intestinal bacterial overgrowth. Methods Consecutive patients referred to our tertiary center and diagnosed with intestinal bacterial overgrowth were retrospectively included. Patients were diagnosed using a 75 g glucose breath test. Patients were treated either with a single antibiotic (quinolone or azole) or rotating antibiotics (quinolone and azole, one after the other) for 10 consecutive days per month for 3 months. A negative glucose breath test after antibiotic treatment was considered as remission. Quality of life (GIQLI) and gastrointestinal severity (IBS‐SSS) were assessed before and after antibiotic treatment. Symptomatic evaluation was realized in simple blind of glucose breath test result: patients were unaware of their results. Results Between August 2005 and February 2020, 223 patients were included in the analysis (female 79.8%, mean age 50.2 ± 15.7 years). Remission was observed in 119 patients (53.4%) after one course of antibiotics and was more frequent in patients receiving rotating antibiotics than in patients receiving a single antibiotic (70.0% vs. 50.8%, p = 0.050). Remission was associated with a significant improvement in quality of life (p = 0.035) and in bloating (p = 0.004). Conclusion In this study, the treatment of small intestinal bacterial overgrowth using rotating antibiotics was more effective than treatment using a single course of antibiotic. Remission was associated with improvement in both quality of life and bloating., Key Summary Summarize the established knowledge on this subject Small intestinal bacterial overgrowth is an increase in bacterial concentration in the small bowel whose common gastrointestinal symptoms are non‐specific: abdominal pain, bloating and diarrhea.Systemic antibiotics (e.g., azole and quinolone antibiotics) are commonly used in the treatment of small intestinal bacterial overgrowth.Recently, rifaximin, a non‐systemic antibiotic, has been proposed to improve the treatment of small intestinal bacterial overgrowth. However, this antibiotic is unavailable in this indication in some countries. What are the significant and/or new findings of this study? In this study, remission of small intestinal bacterial overgrowth was more frequent in patients receiving rotating antibiotics (azole and quinolone antibiotics) than in patients receiving a single antibiotic (azole antibiotic or quinolone antibiotic).SIBO remission was associated with an improvement in both quality of life and bloating.

Background. Liver disease occurs frequently in short bowel syndrome. Whether small bowel dilation in short bowel syndrome could influence the risk of liver injury through increased bacterial translocation remains unknown. Our aim was to analyze associations between small bowel dilation, mucosal damage, bloodstream infections, and liver injury in short bowel syndrome patients. Methods. Among short bowel syndrome children (n = 50), maximal small bowel diameter was measured in contrast series and expressed as the ratio to the height of the fifth lumbar vertebra (small bowel diameter ratio), and correlated retrospectively to fecal calprotectin and plasma citrulline respective markers of mucosal inflammation and mass bloodstream infections, liver biochemistry, and liver histology. Results. Patients with pathologic small bowel diameter ratio > 2.17 had increased fecal calprotectin and decreased citrulline (P 2.17 (P

BACKGROUNDNosocomial pneumonias are common in trauma patients and so interventions to prevent and treat nosocomial pneumonia may improve outcomes. Our prior work strongly suggests that tissue injury predisposes to infections like nosocomial pneumonia because mitochondrial debris originating from inj

The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Although the glucose hydrogen breath test is highly specific, its sensitivity is low; in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.

Since 1964 the author has seen and experienced the progress of nuclear medicine in Japan. The purpose of this review article is to trace the application of radiopharmaceuticals and instruments for the diagnosis of tumors and treatment of cancers in the past 55 years. The application of various radiopharmaceuticals for the detection of tumors and therapy of cancers are historically reviewed based on the author's personal clinical experience and research work. Nuclear medicine has been advanced by coordinated developments of instruments and radiopharmaceuticals like two wheels of a vehicle. The journey of nuclear medicine in the past was not necessarily a smooth one having met with periodic difficulties that changed its direction. The ways by which nuclear oncology has progressed by having overcome episodic problems are described. Future perspectives focusing on the recent trend of theranostics are described with the emphasis on efforts being made by the leadership of JSNM to contribute to the progress of nuclear medicine worldwide. The author believes that the multi-and trans-disciplinary collaboration of related specialists as well as other concerned parties will be necessary for the further progress of nuclear oncology in the future.

Background Urine specimen collection is non-invasive and better accepted by patients for HPV and STI screening. The Copan UriSpongeTM, a Liquid Based Microbiology device, used for urine collection for culture and molecular assays. It consists of a leak-proof tube with a screw cap containing a plastic stick with sponges attached that absorb and retain the urine sample during transport preventing bacterial overgrowth. The objective of this study was to compare the UriSpongeTM (US) to the Colli-Pee (CP) (Novosanis) urine devices for self-collection of first void urine (FVU) for the detection of HPV with the Seegene AnyplexII™-HPV28-assay. Methods FVU, from 72 patients with a recent diagnosis of cervical dysplasia, attending the Gynecology clinic for colposcopy. 20 ml of first-void urine were collected using Colli-PeeTM and an additional aliquot of urine was collected in sterile containers to saturate UriSpongeTM. Nucleic acids were extracted by NucliSENS easyMAG (bioMrieux) from US and CP urine. HPV detection was performed using AnyplexIITM HPV28-Assay. Sample cellularity was evaluated with a quantitative real-time PCR detecting human CCR5 gene. Results Out of 72 urines tested 24 (33.3%) were positive for HR-HPV, 16 (22.2%) for HR+LR, 8 (11.1%) for LR and 24 (22.2%) were negative from both US and CP. Comparable cellularity was present in US and CP with a mean value of 2.09E+06. Optimal concordance for all HR- HPV genotypes compared to cervical sample was demonstrated for US and CP. HPV 16, 18, 51 and 31 were most frequently HR-HPV genotypes. Conclusion Data obtained in this study demonstrated that the Copan UriSpongeTM detected all HR-HPV positive samples and good cellularity compared to the cervical swab when compared to the Novosanis Colli-PeeTM using the Seegene AnyplexTM II HPV28 assay. The UriSpongeTM is easy to use for urine self-collection, its not bulky, can be conveniently shipped by mail at a relatively low cost. Disclosure No significant relationships.

Background Glucose hydrogen breath testing is a noninvasive test for small intestine bacterial overgrowth (SIBO). A positive glucose hydrogen breath test is common in children from low-income countries and has been found to be associated with malnutrition as measured by stunted growth. The microbiome associated with positive breath testing is relatively unstudied. Methods We performed 16 S V4 rDNA microbiome analysis on the stool of 90 Bangladeshi children aged 2 years from an impoverished neighborhood who were tested at the same time for SIBO by glucose hydrogen breath testing. Data were analyzed by linear discriminant analysis effect size with SIBO as the outcome. Any selected genera were tested individually by Wilcoxon’s rank-sum test to ensure that linear discriminant analysis effect size results were not outlier-skewed. Results Linear discriminant analysis effect size analysis identified Lactobacillus (linear discriminate analysis score, 4.59; P = .03) as over-represented in 15 out of the 90 children who were SIBO positive. Conclusions These results suggest that glucose hydrogen breath test positivity in children from low-income settings may be due to an upper intestinal Lactobacillus bloom, potentially explaining the association of SIBO with the gut damage and inflammation that leads to malnutrition.

ObjectivePharmacological treatment of non-alcoholic fatty liver disease (NAFLD) is still evolving. Probiotics could be a promising treatment option, but their effectiveness needs to be established. The present study aimed to evaluate the efficacy of a high potency multistrain probiotic in adult patients with NAFLD.MethodsThirty-nine liver biopsy-proven patients with NAFLD were randomised in a double-blind fashion to either lifestyle modifications plus an oral multistrain probiotic (675 billion bacteria daily, n=19) or identical placebo (n=20) for 1 year. Lifestyle modifications included regular exercise for all and control of overweight/obesity (with additional dietary restrictions), hypertension and hyperlipidaemia in those with these risk factors. Primary objective of the study was the histological improvement in NAFLD activity score (NAS) and its components and secondary objectives were improvement in alanine transaminase (ALT) and cytokine profile.ResultsThirty (76.9%) out of 39 patients with NAFLD completed the study with 1 year of follow-up. A repeat liver biopsy at 1 year could be done in 10 patients (52.6%) in probiotic group and five patients (25%) in placebo group. In comparison to baseline, hepatocyte ballooning (p=0.036), lobular inflammation (p=0.003) and NAS score (p=0.007) improved significantly at 1 year in the probiotic group. When compared with placebo, the NAS score improved significantly in the probiotic group (p=0.004), along with improvements in hepatocyte ballooning (p=0.05) and hepatic fibrosis (p=0.018). A significant improvement in levels of ALT (p=0.046), leptin (p=0.006), tumour necrosis factor-α (p=0.016) and endotoxins (p=0.017) was observed in probiotic group in comparison to placebo at 1 year. No significant adverse events were reported in the study.ConclusionPatients with NAFLD managed with lifestyle modifications and multistrain probiotic showed significant improvement in liver histology, ALT and cytokines.Trial registration numberThe clinical trial is registered with CLINICAL TRIAL REGISTRYINDIA (CTRI);http://ctri.nic.in, No. CTRI/2008/091/000074

Small intestinal bacterial overgrowth (SIBO) has been implicated in symptoms associated with functional gastrointestinal disorders (FGIDs), though mechanisms remain poorly defined and treatment involves non-specific antibiotics. Here we show that SIBO based on duodenal aspirate culture reflects an overgrowth of anaerobes, does not correspond with patient symptoms, and may be a result of dietary preferences. Small intestinal microbial composition, on the other hand, is significantly altered in symptomatic patients and does not correspond with aspirate culture results. In a pilot interventional study we found that switching from a high fiber diet to a low fiber, high simple sugar diet triggered FGID-related symptoms and decreased small intestinal microbial diversity while increasing small intestinal permeability. Our findings demonstrate that characterizing small intestinal microbiomes in patients with gastrointestinal symptoms may allow a more targeted antibacterial or a diet-based approach to treatment.

H 2 S is known to be a biomarker that is correlated to intestinal bacterial overgrowth in patients with Irritable Bowel Syndrome (IBS). CuO sensors are typically used to detect the presence and monitor the concentration of H 2 S. A CuO-sensor breathalyzer that may potentially be used to detect H 2 S in exhaled breath has been developed and it is described in this work. Using the uniquely tailored and continuous nanostructure of the CuO network and a robust design for a wireless device prototype for a resistive based breathalyzer, a noninvasive breath analysis tool that may be used in the diagnosis of SIBO and IBS is described here.

Antecedentes: se ha propuesto que el sobrecrecimiento bacteriano del intestino delgado (SBID) y la traslocacion bacteriana a traves de la pared intestinal se relacionan con el higado graso no alcoholico (HGNA). El objetivo del presente estudio ha sido estudiar dicha relacion en obesos morbidos. Pacientes y metodos: se incluyeron consecutivamente pacientes con obesidad morbida previo a su intervencion de cirugia bariatrica. Los criterios de exclusion fueron: biopsia hepatica normal, otras causas de enfermedad hepatica o atrofia de la mucosa duodenal. Se realizo una gastroscopia para cultivo del aspirado duodenal, biopsias duodenales y extraccion de sangre venosa periferica para estudio de lipopolisacarido (LPS) y proteina de union del LPS (LBP). La biopsia hepatica se realizo durante la intervencion quirurgica. Resultados: se incluyeron 71 pacientes; 26 fueron excluidos por biopsia hepatica normal. Cuarenta y cinco tenian HGNA. Dieciocho eran varones, con edad media de 45,8 anos (22-69) e indice de masa corporal (IMC) de 47,8 kg/m2 (37-58); el 25% tuvo SBID en el cultivo del aspirado duodenal. Existio significacion estadistica entre niveles de LBP y SBID con el grado de esteatosis (p < 0,05 y p = 0,077, respectivamente). No existio relacion estadistica con el indice de esteatohepatitis no alcoholica (EHNA), aunque si hubo una tendencia a su asociacion. Los niveles de LPS no guardaron relacion con el grado de esteatosis o el indice de EHNA. Conclusiones: en pacientes con obesidad morbida e HGNA se observan mayores niveles circulantes de LBP y mayor frecuencia de SBID cuanto mayor es el grado de esteatosis hepatica

The review summarizes recent findings on the syndrome of small intestine bacterial overgrowth (SIBO) which is not a separate disease. The triggers of SIBO and the impact on gastrointestinal physiology are considered. Treatment approaches are described taking into account the mechanism of occurrence of digestive disorders. The article highlights the therapeutic effect of probiotic medicines and refers to the research profile of L. rhamnosus strain GG.

CONTEXT AND OBJECTIVE: Occurrences of liver failure following jejunoileal bypass were extensively reported in the past and were one of the main factors that led to abandonment of this procedure. The newer predominantly malabsorptive procedures called biliopancreatic diversions (BPDs) have also been implicated in several cases of acute and subacute liver failure. The aim here was to review the current available evidence on occurrences of liver failure following BPDs. DESIGN AND SETTING: Narrative review; bariatric surgery service of a public university hospital. METHODS: A review of the literature was conducted through an online search of medical databases. RESULTS: Associations between BPDs and liver failure have only infrequently been reported in the literature. However, they appear to be more than merely anecdotal. The pathophysiological mechanisms remain obscure, but they seem to be related to rapid weight loss, protein malnutrition, deficits of hepatotrophic factors, high circulating levels of free fatty acids and bacterial overgrowth in the bypassed bowel segments. Reversal of the BPD may ameliorate the liver impairment. CONCLUSIONS: Although infrequent, liver failure remains a concern following BPDs. Careful follow-up is required in individuals who undergo any BPD. RESUMO CONTEXTO E OBJETIVO: A ocorrência de falência hepática após a derivação jejunoileal foi extensivamente descrita no passado e foi um dos principais fatores que levaram ao abandono do procedimento. Os procedimentos predominantemente malabsortivos mais modernos, chamados de derivações biliopancreáticas, também já foram implicados em diversos casos de falência hepática aguda e subaguda. O objetivo foi revisar a atual evidência disponível sobre a ocorrência de insuficiência hepática após derivações biliopancreáticas. TIPO DE ESTUDO E LOCAL: Revisão narrativa; Serviço de Cirurgia Bariátrica de hospital universitário. MÉTODOS: Revisão da literatura conduzida por meio de pesquisa online de bancos de dados médicos. RESULTADOS: A associação entre derivações biliopancreáticas e falência hepática na literatura é infrequente. Entretanto, ela aparenta ser mais do que meramente anedótica. Os mecanismos fisiopatológicos continuam pouco compreendidos, mas parecem estar relacionados à rápida perda de peso, desnutrição proteica e déficit de fatores hepatotróficos, altos níveis circulantes de ácidos graxos livres e supercrescimento bacteriano em segmentos intestinais excluídos do trânsito. A reversão da cirurgia pode melhorar o comprometimento hepático. CONCLUSÕES: Embora infrequente, a falência hepática continua sendo preocupante após as derivações biliopancreáticas. Seguimento cuidadoso é mandatório em indivíduos submetidos a essas cirurgias.

Backgroung & Aims The objective of this review is to identify common areas in gastroenterology practice where studies performed provide an opportunity for enhancing value or lowering costs. Methods We provide examples of topics in gastroenterology where clinicians could enhance value by either using less invasive testing, choosing a single best test, or by using patient symptoms to guide additional testing. Results The topics selected for review are selected in esophageal, pancreatic, and colorectal cancer; functional gastrointestinal diseases (irritable bowel syndrome, bacterial overgrowth, constipation); immune-mediated gastrointestinal diseases; and pancreaticobiliary pathology. We propose guidance to alter practice based on current evidence. Conclusions These studies support the need to review current practice and to continue performing research to further validate the proposed guidance to enhance value of care in gastroenterology and hepatology.

During the fasting state the upper gastrointestinal tract exhibits a specific periodic migrating contraction pattern that is known as the migrating motor complex (MMC). Three different phases can be distinguished during the MMC. Phase III of the MMC is the most active of the three and can start either in the stomach or small intestine. Historically this pattern was designated to be the housekeeper of the gut since disturbances in the pattern were associated with small intestinal bacterial overgrowth; however, its role in the involvement of hunger sensations was already hinted in the beginning of the 20th century by both Cannon (Cannon W, Washburn A. Am J Physiol 29: 441–454, 1912) and Carlson (Carlson A. The Control of Hunger in Health and Disease. Chicago, IL: Univ. of Chicago Press, 1916). The discovery of motilin in 1973 shed more light on the control mechanisms of the MMC. Motilin plasma levels fluctuate together with the phases of the MMC and induce phase III contractions with a gastric onset. Recent research suggests that these motilin-induced phase III contractions signal hunger in healthy subjects and that this system is disturbed in morbidly obese patients. This minireview describes the functions of the MMC in the gut and its regulatory role in controlling hunger sensations.

Emerging evidence suggests that many gastrointestinal diseases are associated-if not caused-by alterations in the gut microbiome. Specific microbiome signatures have been reported for irritable bowel syndrome and inflammatory bowel disease, and these have been associated with pro and antiinflammatory effects contributing to disruption or maintenance of gut homeostasis. Small intestinal bacterial overgrowth (SIBO) is a well-established example of small intestinal dysbiosis. SIBO is defined as a heterogeneous syndrome with excessive and/or abnormal type of bacteria in the proximal small bowel. In addition to increased microbial density, loss of microbial diversity of microbes colonizing the gut mucosa-also labeled as the mucosa associated microbiome (MAM)-is the key finding. However, thus far the translation of this new knowledge into clinical practice and the ability to specifically target alterations of the bacterial colonization of the gut are hampered by the lack of valid and readily available clinical tests to diagnose gut microbial dysbiosis. In the past, culture of jejunal fluid aspirate is considered the “gold standard” for diagnosing dysbiosis, including SIBO, but is rarely used in the clinical setting. Breath tests measuring hydrogen and methane in the exhaled breath-preferentially after a glucose test meal-are simple and widely utilized in the routine clinical setting, but their sensitivity and specificity is far from optimal. In the future utilization of molecular technologies, high throughput will enable us to identify “biomarkers” for various GI and non-GI diseases that will guide therapy.

Probiotics and prebiotics have gained attention due to accumulating evidence supporting the beneficial effects of probiotics/prebiotics on various diseases. Intestinal microbiota composition in adult patients with short bowel syndrome (SBS) has shown lower concentrations of many bacterial strands found in higher concentrations in healthy adults. Regarding the role of probiotics and prebiotics in the gut microflora maintenance, their effects to decrease bacterial overgrowth and prevent bacterial translocation in SBS are of interest. Certain probiotic strains have been extensively investigated to ascertain the impact on lactose intolerance, diarrhea and constipation, and maintenance of gut microbial balance to name a few. Prebiotics, most of which are carbohydrate compounds, have been explored with abundant interest due to their beneficial functions to host. Indeed, this field is under immense growth and the potential benefit with the use of pre- and probiotics is not fully understood in those with SBS.

The surgical management of intestinal failure secondary to short bowel syndrome has undergone tremendous evolution in the last several decades. From the landmark description of an intestinal lengthening procedure by Bianchi in 1980 to the multidisciplinary modern care paradigm known as intestinal rehabilitation, innovative new treatments in this field have vastly improved patient outcomes. Initial attempts to treat short bowel syndrome surgically saw the birth of reversed intestinal segments, artificial valves and colonic transposition, all aimed at decreasing transit time and thus increasing absorption. In the long term, a common pitfall of these approaches, and intestinal adaptation itself, is bowel dilation and the associated poor motility, dysfunction and propensity for bacterial overgrowth. The development of techniques to mitigate these unfavorable conditions was a prelude to the birth of modern day operations aimed at increasing bowel length and improving function. This review examines the relevant historical approaches to short bowel syndrome and how they provided the foundation for the development of current intestinal lengthening surgery, followed by an in-depth discussion of surgical techniques and their outcomes.

Keratoconjunctivitis sicca (KCS) is a relatively common condition affecting dogs worldwide.1-3 KCS is characterised by a deficiency in the production of the aqueous portion of the tear film, leading to conjunctival hyperaemia, bacterial overgrowth, ocular discharge, corneal vascularisation, corneal pigmentation, ocular pain and loss of vision.4-6 The primary cause of KCS is immune-mediated, but many other causes have also been reported, including congenital, metabolic, infectious, drug-induced, neurogenic, radiation, iatrogenic and idiopathic.7 The diagnosis of KCS is based on the presence of consistent clinical signs and measurement of decreased aqueous tear production using the Schirmer tear test (STT).8 It is largely accepted that an STT value greater than 15 mm/minute is considered normal for dogs, 11 to 14 mm/minute indicates subclinical KCS, 6 to 10 mm/minute indicates mild KCS and 5 mm/minute or less indicates severe KCS. However, several authors have criticised the STT’s variable sensitivity and reproducibility for diagnosing mild KCS.9,10 Due to the variability of STT measurements, a definitive diagnosis for mild cases of KCS may be difficult with the STT alone. As such, there is currently much interest in alternative measures for the diagnosis of KCS. A small number of previous studies …

Gastroparesis likely involves various pathophysiological disorders and is increasingly prevalent as complications of surgeries, medications, and chronic diabetes. Key to diagnosis is evidence of delayed gastric emptying, generally based on standardized scintigraphy, and ruling out distal obstruction or other dysmotilities. Initial medical management includes reviewing potentially exacerbating medications and ruling out other reversible causes, achieving tighter glucose control in diabetics, and implementing dietary and lifestyle changes. While current available medications are limited, symptomatic control is aimed at improving gastric emptying, alleviating nausea and vomiting, and treating associated abdominal pain. Other potential therapies are aimed at reducing acid production, improving gastric accommodation or pyloric dysfunction, and treating bacterial overgrowth. Future studies should be aimed toward identification of subpopulations of gastroparetics who are better responders to the various medications based on differences in underlying pathophysiology and adopting standardized study end point measures that may allow for comparisons across trials. This chapter will review current treatment options, upcoming promising medications, and some of the hurdles in advancing the field forward.

Article is attempt of the critical analysis of modern approaches to treatment of a small intestine bacterial overgrowth syndrome (SIBO). SIBO now is one of the major problems in gastroenterology. At the same time, the bacterial overgrowth is cause and consequence of many diseases of digestive system and extradigestive manifestations. Many researches testify to prevalence of SIBO in patients with digestive diseases. However, pathogenesis of a disease is studied insufficiently today. Nevertheless, the available data of scientific researches allow to belong to the offered ways of diagnostics and treatment critically.Data on physiology of microbiota of the digestive tract of the healthy person are provided in a review. Mechanisms of antimicrobic resistance of a microbiota of intestines are considered. Interrelations between an antibiotikassociated degeneration of normal flora and bacterial overgrowth are presented. The analysis of an antibiotiktherapi of SIBO indicates low efficiency and also possible ways became chronicle diseaseand frequent recurrence of an illness. The multiple-factors and complexity of pathogenesis of SIBO are leaded authors to a conclusion to use ethiopathogenesis approaches for solution of SIBO.

Antibiotics have been proposed as supplements in re-feeding programmes for malnourished children. A review of paediatric literature showed that growth promotion by antibiotics, when it was observed, was mostly mediated by its anti-infective properties. Despite the widespread use of antibiotics as growth promoters in animal rearing, the available evidence again points to the suppression of infections as the underlying mechanism. Under controlled hygienic conditions, growth promotion was frequently not observed. Models for 'sub-inhibitory' antibiotic effects on gut bacteria have been proposed, and direct antibiotic effects on host physiology are accumulating. Human gut microbiota analyses in malnourished children (restricted to stool as convenience samples) displayed developmental immaturity of the gut microbiota and growth deficits that were only transiently ameliorated by nutritional interventions. These studies need to be complemented by microbiota analysis in the upper small intestine where bacterial overgrowth, frequently reported in people of the developing world, may directly compete with nutrient absorption by the human host. So far, however, the available medical and veterinary literature suggests that the growth promoting effect of antibiotics mostly works through prevention of infection and a concomitant decrease of the caloric burden of an inflammatory response.

Irritable bowel syndrome, one of the most common functional gastro intestinal disorders all over the world is considered to have a multi factorial pathogenesis. Recently more and more studies are focusing on the changes that take place in the micro biota of patients with irritable bowel syndrome, underlining the bacterial role in this pathogenesis. As a consequence, bacterial overgrowth, along with intestinal dysmotility, altered brain-gut axis and genetic factors are considered part of this pathophysiology. This report intends to summarize the actual knowledge on irritable bowel syndrome and small intestinal bacterial overgrowth syndrome, from details on the epidemiology, clinical manifestation, pathophysiology, diagnosis, treatment to details on the relationship between these two syndromes.

Non-responsive celiac disease is defined as the persistency of symptoms, signs or laboratory abnormalities typical of CD despite 6-12 months of dietary gluten avoidance. Small intestine bacterial overgrowth has been classically considered a potential cause for non-responsive celiac disease. Nevertheless, the evidence regarding its prevalence among non-responsive celiac patients is conflicting, as well as the evidence showing a benefit in small intestine bacterial overgrowth treatment in this clinical setting. We report the case of a 34 year-old woman diagnosed with non-responsive celiac disease in spite of adequate gluten-free diet, that had complete resolution of symptoms after treatment with antibiotics for small intestine bacterial overgrowth.

In the field of gastroenterology hydrogen breath test are used for the diagnosis of carbohydrate malabsorption and small intestine bacterial overgrowth. This paper provides information on performing a hydrogen breath test and shows potential sources of error.

Urine is the excretory product of the body produced by the process of filtration, reabsorption, and tubular secretion. Urine can be collected and examined easily, and presence of certain substances in the urine may indicate the metabolic state of the body. The routine and microscopic examinations of urine are helpful in the diagnosis of several pathological conditions. A random sample is usually taken for routine clinical examination; however, first-morning urine is preferred for urinalysis and microscopic analysis, since it is generally more conc. Fresh or preserved urine samples are used for chemical and culture-based microbiological testing. The specimens that are unpreserved for more than 2 h or refrigerated for a long time may not be suitable for analysis due to potential bacterial overgrowth and invalidation of bacterial colony counts or errors in chemical urinalysis.

Hydrogen breath test is a non-invasive and inexpensive method for estimation of small bowel transit time, detection of excess bacteria in the small intestine and demonstration of maldigestion or malabsorption. Until now, little has been known about breath hydrogen excretion in lambs. The aim of our study was to assess the patterns of breath hydrogen excretion in lambs before and after feeding ewe’s milk, and to evaluate pathological and/or physiological alterations in the lambs’ gastrointestinal function. We assumed that intestinal disorders may influence the breath hydrogen concentrations, which could be detected early in the subclinical stage. A total of 52 healthy black-headed Dorper lambs were included in the study. Breath hydrogen was measured after overnight fasting and at 30, 60 and 90 min after the start of feeding. There was a 2-week follow-up period after the measurements to assess the gastrointestinal health of lambs. During the follow-up period, clinical signs of diarrhoea developed in 6 lambs. Based on our results in healthy lambs, the median concentration of baseline breath hydrogen was 1.00 parts per million (minimum: 0.00, maximum: 2.00). We observed a significant elevation in breath hydrogen concentrations 60 min after feeding (P= 0.004), whereas the values detected 30 min after feeding were similar to the baseline values. Regarding the lambs in which clinical signs of diarrhoea developed, we revealed significantly higher baseline breath hydrogen concentrations compared to those which remained healthy (P< 0.001). Our observations underline that hydrogen breath test may be a useful tool for indicating potential bacterial overgrowth before any clinical signs of diarrhoea.