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Dietary supplements have increasingly gained popularity over the years not only to replete micronutrient deficiencies but for their use in treatment of disease. The popularity of dietary supplements for inflammatory bowel diseases (IBD) arises from their perceived ease of use, potential disease-modifying benefits, and perceived safety. Overall, randomized controlled trials have not consistently shown a benefit of fish oil for the maintenance of remission with Crohn's disease. The inconsistency of these findings highlights the need for more studies that are powered to clarify the context in which omega-3 fatty acids might have a role in the treatment algorithm of IBD.

Irritable bowel syndrome (IBS) is a common functional disorder with a prevalence of up to 15% in the USA. Patients with IBS are more inclined to seek complementary treatment options for management of their conditions due to a lack of sufficient relief from conventional treatments and preference towards a more natural approach. We reviewed the most up-to-date medical literature regarding complementary health modalities for the treatment of IBS. Proposed mechanisms for IBS range from alterations in gut motility, intestinal permeability, intestinal microbiome, visceral hypersensitivity, and brain-gut interactions. Addressing each mechanism has helped to broaden our treatment armamentarium by introducing specific targets to different aspects of the disease mechanisms. Today, treatment options for IBS range from conventional prescription drugs for symptomatic relief, including antibiotics for IBS predominant diarrhea to complementary modalities: specific diets, probiotics, botanical herbal regimens, acupuncture, and mind-body therapies. Numerous complementary health approaches are available to patients and gastroenterologists. There is sound evidence to support the use of such modalities to augment the care and overall quality of life of patients with IBS.

BACKGROUND Dietary supplements are frequently used by healthy individuals and those with chronic medical conditions but may cause damage to the liver. The aim of this study was to examine the prevalence and attitudes of dietary supplement use, and the frequency of disclosure to healthcare providers among parents/caregivers for children with chronic liver disease. METHODS We developed an anonymous survey for parents/caregivers of children (

Background Irritable bowel syndrome (IBS) is the most common functional digestive condition in the industrialized world. The gut microbiota plays a key role in disease pathogenesis. Objective A systematic review and meta-analysis on case–control studies was conducted to determine whether there is gut microbial dysbiosis in participants with IBS in comparison with healthy controls and, if so, whether the dysbiosis pattern differs among IBS subtypes and geographic regions. Methods This review was conducted and reported according to the MOOSE (Meta-Analysis of Observational Studies in Epidemiology) 2000 and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2009 guidelines. Research articles published up to May 9, 2018 were identified through MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (Cochrane Library), ClinicalTrials.gov, EMBASE, and Web of Science. Study quality was assessed using the Newcastle-Ottawa Scale. Case–control studies of participants with IBS who had undergone quantitative gut microbial stool analysis were included. The primary exposure measure of interest is log10 bacterial counts per gram of stool. Meta-analyses were performed to estimate the mean difference (MD) in gut microbiota between participants with IBS and healthy controls using the random-effects model with inverse variance in Revman 5.3 and R 3.5.1. Publication bias was assessed with funnel plots and Egger's test. Between-study heterogeneity was analyzed using Higgins I2 statistic with 95% CIs. Results There were 6,333 unique articles identified; 52 qualified for full-text screening. Of these, 23 studies were included for analysis (n=1,340 participants from North America, Europe, and Asia). Overall, the studies were moderate in quality. Comparing participants with IBS to healthy controls, lower fecal Lactobacillus (MD= –0.57 log10 colony-forming unit [CFU]/g; P 75%) in most comparisons, the direction of the effect estimates is relatively consistent across studies. Conclusions IBS is characterized by gut microbial dysbiosis. Prospective, large-scale studies are needed to delineate how gut microbial profiles can be used to guide targeted therapies in this challenging patient population.

Diet modifies the risk of colorectal cancer (CRC), and inconclusive evidence suggests that yogurt may protect against CRC. We analysed the data collected from two separate colonoscopy-based case–control studies. The Tennessee Colorectal Polyp Study (TCPS) and Johns Hopkins Biofilm Study included 5446 and 1061 participants, respectively, diagnosed with hyperplastic polyp (HP), sessile serrated polyp, adenomatous polyp (AP) or without any polyps. Multinomial logistic regression models were used to derive OR and 95 % CI to evaluate comparisons between cases and polyp-free controls and case–case comparisons between different polyp types. We evaluated the association between frequency of yogurt intake and probiotic use with the diagnosis of colorectal polyps. In the TCPS, daily yogurt intake v. no/rare intake was associated with decreased odds of HP (OR 0·54; 95 % CI 0·31, 0·95) and weekly yogurt intake was associated with decreased odds of AP among women (OR 0·73; 95 % CI 0·55, 0·98). In the Biofilm Study, both weekly yogurt intake and probiotic use were associated with a non-significant reduction in odds of overall AP (OR 0·75; 95 % CI 0·54, 1·04) and (OR 0·72; 95 % CI 0·49, 1·06) in comparison with no use, respectively. In summary, yogurt intake may be associated with decreased odds of HP and AP and probiotic use may be associated with decreased odds of AP. Further prospective studies are needed to verify these associations.

Endoscopic sleeve gastroplasty (ESG) is a procedure in which endoscopically placed sutures involute the stomach and promote weight loss. There is limited data on the durability of these sutures. This was a single center series of 5 patients who underwent ESG performed by a single endoscopist. Patients underwent repeat endoscopy for different clinical indications. ESGs were successfully reversed at 3 weeks and 1 month following index ESG without significant fibrosis or scaring. At 8 and 14 months, a few sutures had dehisced though there were extensive areas of fibrosis. By 2 years, most of the sutures had dehisced; however, the gastric volume remained reduced. This case series offers an intriguing evaluation of the anatomical changes induced by ESG.

Coronavirus disease 2019 (COVID-19) is a highly contagious infectious disease that can rapidly escalate to respiratory failure and death. It has infected millions of people worldwide. The trajectory of this disease continues to progress in some areas of the United States and worldwide. The Institute for Health Metrics now predicts a resurgence of infections in the fall of 2020. The pathogenesis of COVID-19 includes an inflammatory phase with either resolution or the potential to accelerate to a cytokine storm, characterized by high interleukin (IL)-6 and other inflammatory markers. COVID-19 is a condition without a gold-standard treatment. The US Federal Drug Administration (FDA) issued an emergency use authorization for remdesivir in severe cases of COVID-19, which shortened the recovery time in hospitalized patients with lower respiratory tract infection in one study. Although several vaccine trials are underway, no vaccines are available for primary prevention of COVID-19 at this time. Dietary supplement sales have dramatically risen during the COVID-19 pandemic despite depressed economic conditions. Commonly used immune-modulating dietary supplements, including vitamin D, ascorbic acid, zinc, and melatonin, are reviewed in this manuscript highlighting biological plausibility for salutary benefit against COVID-19. Ongoing clinical trials recruiting subjects at the time of this writing are provided for each dietary supplement.

Studies have found a positive association between metabolic risk factors, such as obesity and diabetes, and adenomatous polyps (AP). However, fewer studies have assessed the association between sessile serrated polyps (SSP) or synchronous diagnosis of APs and SSPs (synch polyps). Study participants (N = 1,370; ages 40–85) undergoing screening colonoscopy were enrolled between August 2016 and February 2020. Self-reported metabolic risk factors, including diabetes, hypertension, hyperlipidemia, and overweight/obesity, were evaluated for associations with new diagnoses of APs, SSPs, and synch polyps at the present colonoscopy. Average participant age was 60.73 ± 8.63 (SD) years; 56.7% were female and 90.9% white. In an assessment of individual metabolic risk factors, adjusted for age, sex, race, and smoking status, increased body mass index (BMI; overweight or obese vs. normal BMI of Prevention Relevance: Self-reported medical history provides valuable insight into polyp risk, potentially enabling the use of larger retrospective studies of colonoscopy populations to assess knowledge gaps. More aggressive colonoscopy screening, critical to colorectal cancer prevention, may be considered in populations of individuals with metabolic risk factors and modifiable lifestyle risk factors.

Irritable bowel syndrome (IBS) is a multifaceted illness involving maladaptive shifts in the gut microbiota that affect the enteric nervous and immune systems, mucosal barrier function, the balance of neurotransmitters and hormones, and emotional well-being. There is abundant evidence indicating that certain foods elicit symptoms in IBS. Numerous elimination-type diets have been shown to alleviate symptoms. However, among these, the most controversial is a group of foods called fructo, oligo-, di-, and monosaccharides and polyols (FODMAPs). This paper reviews the role of diet and systematically analyze the literature for the role of FODMAPs in IBS.

AIM To investigate the relationship between 25-hydroxyvitamin D [25(OH)D] levels and fibrosis stage in patients with non-alcoholic fatty liver disease (NAFLD). METHODS Two individual reviewers identified relevant studies using the PubMed, EMBASE, Cochrane, and Scopus databases. Inclusion criteria were as follows: (1) Studies that evaluated adults with NAFLD and serum or plasma 25(OH)D levels; and (2) assessed fibrosis stage using liver biopsy. A rigorous analysis yielded six articles as having sufficient data to employ in evaluating the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. To meta-analyze vitamin D levels in F0-F2 vs F3-F4 fibrosis, a random-effects meta-analysis fit using restricted maximum likelihood was applied. To examine trends across each stage of fibrosis with respect to vitamin D levels, a meta-regression was performed. P < 0.05 was considered statistically significant. RESULTS A total of 937 subjects from six studies were included in the final analysis to evaluate the association of serum vitamin D levels in patients with NAFLD based on their liver fibrosis stage by histopathological analysis. The lead investigators of each of the six studies were contacted and the data were collected. First, the investigators performed a meta-analysis to compare serum vitamin D levels in patients with NAFLD with stage F0-F2 compared to F3-F4, which did not show significance [meta-estimate of the pooled mean difference = -0.86, P = 0.08 (-4.17, 2.46)]. A meta-regression evaluation of serum vitamin 25 (OH)D levels across the individual stages (F0-F4) of fibrosis did not show an association for the six included studies. CONCLUSION Low vitamin D status is not associated with higher stages of liver fibrosis in patients with NAFLD.

Purpose of review Medical foods in the United States, and foods for special medical purposes in other countries, are food formulations used to manage specific chronic diseases or conditions under medical or physician supervision. The process of reviewing and approving food claims for health benefits varies widely from country to country. Recent findings CODEX Alimentarius, a 187-country and one-member (European Union) organization, has standardized not only nutrition labeling and food safety worldwide but has also recently taken on a prominent role in analyzing therapeutic and health claims for food in member countries by providing a framework to study these issues. Two recent activities at CODEX - analyzing foods for special dietary uses and foods for special medical purposes therapeutic food claims - have focused on both how these food categories are formulated for patients with specific conditions and diseases. Summary Food and specially formulated foods can play a role in preventing or mitigating disease and other health-related conditions. This article will examine the means by which regulatory authorities across the globe address health claims for foods and food-derived products to alter human physiology and disease outcome.

The irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by chronic nonspecific abdominal pain with altered bowel movements in the absence of known organic disease. IBS is diagnosed by the Rome IV criteria for functional GI disorders. Although research has shown several factors that might be contributing to IBS pathophysiology, there is no specific cause for this disorder identified yet. There are four disease subtypes found in equal proportions: diarrhea, constipation, mixed, and undefined (IBS-U). IBS is a prevalent disorder that primary care physicians evaluate in the clinic. In this chapter, the authors review the epidemiology and updated research regarding its pathophysiology, diagnostics, and integrative therapeutic strategies.

Digestive diseases encompass numerous acute and chronic conditions of the gastrointestinal tract, ranging from common digestive disorders to serious, life-threatening diseases. Over 60 million Americans are afflicted with known digestive diseases with the association of many other adverse health conditions and disability. The annual economic impact on the US economy is more than $141 billion. The Western diet and lifestyle contribute to this high prevalence of digestive disease in America and worldwide. The most common digestive conditions in the United States, Canada, and Europe were uncommon in Asia and Africa until recently, with the expansion of fast food franchises and heightened availability of processed foods worldwide. Digestive diseases have a complex underlying pathogenesis that involves a number of influences, including environmental factors, genetics, inflammation, and the gut microbiome. The risk of developing a digestive disease is modifiable by making key dietary and lifestyle modifications. Adopting a personalized approach to digestive illness can achieve improved patient satisfaction and quality of life for patients.

BACKGROUND: Inflammatory bowel disease (IBD), comprised of Crohn's disease (CD) and ulcerative colitis (UC), is characterized by chronic mucosal inflammation, frequent hospitalizations, adverse health economics, and compromised quality of life. Diet has been hypothesised to influence IBD activity. OBJECTIVES: To evaluate the efficacy and safety of dietary interventions on IBD outcomes. SEARCH METHODS: We searched the Cochrane IBD Group Specialized Register, CENTRAL, MEDLINE, Embase, Web of Science, Clinicaltrials.gov and the WHO ICTRP from inception to 31 January 2019. We also scanned reference lists of included studies, relevant reviews and guidelines. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared the effects of dietary manipulations to other diets in participants with IBD. Studies that exclusively focused on enteral nutrition, oral nutrient supplementation, medical foods, probiotics, and parenteral nutrition were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, extracted data and assessed bias using the risk of bias tool. We conducted meta‐analyses where possible using a random‐effects model and calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. We assessed the certainty of evidence using GRADE. MAIN RESULTS: The review included 18 RCTs with 1878 participants. The studies assessed different dietary interventions for active CD (six studies), inactive CD (seven studies), active UC (one study) and inactive UC (four studies). Dietary interventions involved either the consumption of low amounts or complete exclusion of one or more food groups known to trigger IBD symptoms. There was limited scope for data pooling as the interventions and control diets were diverse. The studies were mostly inadequately powered. Fourteen studies were rated as high risk of bias. The other studies were rated as unclear risk of bias. The effect of high fiber, low refined carbohydrates, low microparticle diet, low calcium diet, symptoms‐guided diet and highly restricted organic diet on clinical remission in active CD is uncertain. At 4 weeks, remission was induced in: 100% (4/4) of participants in the low refined carbohydrates diet group compared to 0% (0/3) of participants in the control group (RR 7.20, 95% CI 0.53 to 97.83; 7 participants; 1 study; very low certainty evidence). At 16 weeks, 44% (23/52) of participants in the low microparticle diet achieved clinical remission compared to 25% (13/51) of control‐group participants (RR 3.13, 95% CI 0.22 to 43.84; 103 participants; 2 studies; I² = 73%; very low certainty evidence). Fifty per cent (16/32) of participants in the symptoms‐guided diet group achieved clinical remission compared to 0% (0/19) of control group participants (RR 20.00, 95% CI 1.27 to 315.40; 51 participants ; 1 study; very low certainty evidence) (follow‐up unclear). At 24 weeks, 50% (4/8) of participants in the highly restricted organic diet achieved clinical remission compared to 50% (5/10) of participants in the control group (RR 1.00, 95% CI 0.39 to 2.53; 18 participants; 1 study; very low certainty evidence). At 16 weeks, 37% (16/43) participants following a low calcium diet achieved clinical remission compared to 30% (12/40) in the control group (RR 1.24, 95% CI 0.67 to 2.29; 83 participants; 1 study; very low certainty evidence). The effect of low refined carbohydrate diets, symptoms‐guided diets and low red processed meat diets on relapse in inactive CD is uncertain. At 12 to 24 months, 67% (176/264) of participants in low refined carbohydrate diet relapsed compared to 64% (193/303) in the control group (RR 1.04, 95% CI 0.87 to 1.25; 567 participants; 3 studies; I² = 35%; low certainty evidence). At 6 to 24 months, 48% (24/50) of participants in the symptoms‐guided diet group relapsed compared to 83% (40/48) participants in the control diet (RR 0.53, 95% CI 0.28 to 1.01; 98 participants ; 2 studies; I² = 54%; low certainty evidence). At 48 weeks, 66% (63/96) of participants in the low red and processed meat diet group relapsed compared to 63% (75/118) of the control group (RR 1.03, 95% CI 0.85 to 1.26; 214 participants; 1 study; low certainty evidence). At 12 months, 0% (0/16) of participants on an exclusion diet comprised of low disaccharides / grains / saturated fats / red and processed meat experienced clinical relapse compared to 26% (10/38) of participants on a control group (RR 0.11, 95% CI 0.01 to 1.76; 54 participants; 1 study; very low certainty evidence). The effect of a symptoms‐guided diet on clinical remission in active UC is uncertain. At six weeks, 36% (4/11) of symptoms‐guided diet participants achieved remission compared to 0% (0/10) of usual diet participants (RR 8.25, 95% CI 0.50 to 136.33; 21 participants; 1 study; very low certainty evidence). The effect of the Alberta‐based anti‐inflammatory diet, the Carrageenan‐free diet or milk‐free diet on relapse rates in inactive UC is uncertain. At 6 months, 36% (5/14) of participants in the Alberta‐based anti‐inflammatory diet group relapsed compared to 29% (4/14) of participants in the control group (RR 1.25, 95% CI 0.42 to 3.70; 28 participants; 1 study; very low certainty evidence). Thirty per cent (3/10) of participants following the carrageenan‐free diet for 12 months relapsed compared to 60% (3/5) of the participants in the control group (RR 0.50, 95% CI 0.15 to 1.64; 15 participants; 1 study; very low certainty evidence). At 12 months, 59% (23/39) of milk free diet participants relapsed compared to 68% (26/38) of control diet participants (RR 0.83, 95% CI 0.60 to 1.15; 77 participants; 2 studies; I² = 0%; low certainty evidence). None of the included studies reported on diet‐related adverse events. AUTHORS' CONCLUSIONS: The effects of dietary interventions on CD and UC are uncertain. Thus no firm conclusions regarding the benefits and harms of dietary interventions in CD and UC can be drawn. There is need for consensus on the composition of dietary interventions in IBD and more RCTs are required to evaluate these interventions. Currently, there are at least five ongoing studies (estimated enrollment of 498 participants). This review will be updated when the results of these studies are available.

The value of nutrition therapy for the adult hospitalized patient is derived from the outcome benefits achieved by the delivery of early enteral feeding. Nutritional assessment should identify those patients at high nutritional risk, determined by both disease severity and nutritional status. For such patients if they are unable to maintain volitional intake, enteral access should be attained and enteral nutrition (EN) initiated within 24-48 h of admission. Orogastric or nasogastric feeding is most appropriate when starting EN, switching to post-pyloric or deep jejunal feeding only in those patients who are intolerant of gastric feeds or at high risk for aspiration. Percutaneous access should be used for those patients anticipated to require EN for >4 weeks. Patients receiving EN should be monitored for risk of aspiration, tolerance, and adequacy of feeding (determined by percent of goal calories and protein delivered). Intentional permissive underfeeding (and even trophic feeding) is appropriate temporarily for certain subsets of hospitalized patients. Although a standard polymeric formula should be used routinely in most patients, an immune-modulating formula (with arginine and fish oil) should be reserved for patients who have had major surgery in a surgical ICU setting. Adequacy of nutrition therapy is enhanced by establishing nurse-driven enteral feeding protocols, increasing delivery by volume-based or top-down feeding strategies, minimizing interruptions, and eliminating the practice of gastric residual volumes. Parenteral nutrition should be used in patients at high nutritional risk when EN is not feasible or after the first week of hospitalization if EN is not sufficient. Because of their knowledge base and skill set, the gastroenterologist endoscopist is an asset to the Nutrition Support Team and should participate in providing optimal nutrition therapy to the hospitalized adult patient.

Malnutrition affects up to 50% of hospitalized patients and contributes to adverse health and economic outcomes, but often remains unrecognized or undertreated.This study assessed the utilization of oral nutritional supplements (ONS) and its association with the number of 30-day unplanned hospital readmissions of adult malnourished patients in comparison with the readmissions rates of their malnourished counterparts who did not receive ONS.This was a retrospective cohort study.Of 153,161 inpatient encounters analyzed, a total of 8,713 (5.7%) malnourished adults admitted to an academic medical center hospital in the United States between October 1, 2016, and September 30, 2017 were included in the analyses. The study utilized records of patients at risk of malnutrition on admission and subsequently diagnosed as malnourished by a registered dietitian following established criteria.ONS utilization rate, hospital length of stay (LOS), and 30-day unplanned hospital readmissions data were obtained from electronic medical records.The associations between the number of 30-day unplanned hospital readmissions and ONS use were analyzed using mixed-effects negative binomial regression models, with coefficients and 95% CIs reported. Important covariates such as age, sex, and the severity of illness index were included in the regression models.Only 3.1% of malnourished patients received ONS. ONS users had 38.8% fewer readmissions compared with non-ONS counterparts (P=0.017). The reduction in hospital readmissions by ONS was even greater for oncology patients (46.1%, P0.001). A 50% reduction in time from hospital admission to ONS provision was associated with a 10.2% (P0.01), 10.2% (P=0.014), and 16.6% (P0.01) decrease in LOS for overall, oncology, and intensive care unit encounters, respectively.In a large cohort of malnourished adult inpatient encounters, ONS provision rate was low, but when used, ONS intervention was associated with 38.8% fewer 30-day readmissions. This association was more pronounced for oncology encounters. Shorter LOS was observed when the interval between admission and ONS initiation was shorter. Reduced LOS and readmissions rates could result in financial benefits for health care systems prioritizing hospital nutrition care, in addition to informing significant medical benefits for their patients.

Dietary alteration of the gut microbiome is an important target in the treatment of obesity. Animal and human studies have shown bidirectional weight modulation based on the probiotic formulation used. In this study, we systematically reviewed the literature and performed a meta-analysis to assess the impact of prebiotics, probiotics and synbiotics on body weight, body mass index (BMI) and fat mass in adult human subjects. We searched Medline (PubMed), Embase, the Cochrane Library and the Web of Science to identify 4721 articles, of which 41 were subjected to full-text screening, yielding 21 included studies with 33 study arms. Probiotic use was associated with significant decreases in BMI, weight and fat mass. Studies of subjects consuming prebiotics demonstrated a significant reduction in body weight, whereas synbiotics did not show an effect. Overall, when the utilization of gut microbiome-modulating dietary agents (prebiotic/probiotic/synbiotic) was compared to placebo, there were significant decreases in BMI, weight and fat mass. In summary, dietary agents for the modulation of the gut microbiome are essential tools in the treatment of obesity and can lead to significant decreases in BMI, weight and fat mass. Further studies are needed to identify the ideal dose and duration of supplementation and to assess the durability of this effect.

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, the physiology of which is not very well understood. There are multiple factors and pathways involved in pathogenesis of this entity. Among all, dysmotility, dysregulation of the brain-gut axis, altered intestinal microbiota and visceral hypersensitivity play a major role. Over the last years, research has shown that the type of gut microbiome present in an individual plays a significant role in the pathophysiology of IBS. Multiple studies have consistently shown that subjects diagnosed with IBS have disruption in gut microbiota balance. It has been established that host immune system and its interaction with metabolic products of gut microbiota play an important role in the gastrointestinal tract. Therefore, probiotics, prebiotics and antibiotics have shown some promising results in managing IBS symptoms via modulating the interaction between the above. This paper discusses the various factors involved in pathophysiology of IBS, especially gut microbiota.

Altered small intestinal motility is thought to contribute to the development of small intestinal bacterial overgrowth (SIBO). The clinical manifestations of SIBO and consequent malabsorption are wide ranging and include abdominal pain, bloating, diarrhea, weight loss, and nutritional deficiencies. However, due to the nonspecific nature of symptoms, the diagnosis may often be overlooked. To date, few studies have illustrated a direct relationship between impaired small intestinal motility and SIBO. In addition, further study has been limited by the technical challenges and lack of widespread availability of antroduodenal manometry. The development of a wireless motility capsule (WMC) (SmartPill) that evaluates pressure, pH, and temperature throughout the GI tract offers the potential to identify patients with small bowel transit delays who may be at risk for bacterial overgrowth.The primary aims of this study were to: (1) characterize the relationship of prolonged small bowel transit time (SBTT) in patients undergoing WMC with SIBO as based on a positive lactulose breath testing (LBT); and (2) to assess the relationship of prolonged gastric, colonic, and whole gut transit times (WGTT) and additional motility parameters with SIBO (positive LBT). We also sought to evaluate the relationship of small bowel motility parameters (SB motility index, contractions per minute, and SB peak amplitudes) with LBT results.We performed a retrospective study of consecutive patients who were referred for wireless motility testing at a single, tertiary care institution from April 2009 to December 2012. Of the 72 total patients identified, 34 underwent both WMC and LBT. Gastric, small bowel, colonic, WGTT, and SB motility parameters were measured and correlated with LBT results. Statistical methods utilized for data analysis include ANOVA, 2-sample t tests, nonparametric Kruskal Wallis test, Wilcoxon rank-sum test, and the Fisher exact test.Of the 37 patients who underwent both WMC and LBT, 24 (65%) were LBT positive. The mean SBTT among those who were LBT positive was 6.6 hours as compared with 4.2 hours in those who were LBT negative (P=0.04). Among patients who were LBT positive, 47.6% had prolonged SBTT (≥6 h), whereas only 7.7% of those who were LBT negative had a delay in their SBTT (P=0.01). In addition, patients who were LBT positive were more likely to have prolongation of both colonic and WGTT versus those who were LBT negative (CTT: positive LBT=64.4 h vs. negative LBT=35.5 h, P=0.02; WGTT: positive LBT=70.5 h vs. negative LBT=44.1 h, P=0.02). However, there were no statistical differences observed between the groups for gastric emptying times or other small intestinal motility parameters (SB motility index, contractions per minute, and peak amplitudes) between the 2 groups.Patients with underlying SIBO have significant delays in SBTT as compared with those without. The association between prolonged SBTT and positive LBT may be useful in identifying those patients with SIBO diagnosed by LBT and potentially target therapeutic options for those refractory to standard therapy. Interestingly, patients with positive LBT did not necessarily have a generalized gastrointestinal motility (similar GETs among groups), suggesting that small bowel transit specifically predisposes to the development of SIBO. Future, prospective studies are needed to further characterize intestinal dysmotility and other contributing pathophysiological mechanisms in SIBO and to investigate the potential benefits of prokinetics in this challenging patient population.

Inflammatory bowel disease (IBD), which primarily includes Crohn's disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. The mechanisms of IBD pathogenesis are not well understood at this time, but likely involve an interaction between genetic, gut microbial, immune, and environmental factors. Emerging epidemiologic studies have suggested a relationship between specific dietary nutrients as an environmental factor and IBD risk. Clinical trials have also shown oral diets to have variable efficacy in affecting clinical outcomes for IBD. This review discusses the key studies that evaluated the use of various oral diets as well as nutrition support in the management of IBD.

We present a general framework for analysis of wireless capsule endoscopy (CE) studies. The current available workstations provide a time-consuming and labor-intense work-flow for clinicians which requires the inspection of the full-length video. The development of a computer-aided diagnosis (CAD) CE workstation will have a great potential to reduce the diagnostic time and improve the accuracy of assessment. We propose a general framework based on hidden Markov models (HMMs) for study synopsis that forms the computational engine of our CAD workstation. Color, edge and texture features are first extracted and analyzed by a Support Vector Machine classifier, and then encoded as the observations for the HMM, uniquely combining the temporal information during the assessment. Experiments were performed on 13 full-length CE studies, instead of selected images previously reported. The results (e.g. 0.933 accuracy with 0.933 recall for detection of polyps) show that our framework achieved promising performance for multiple classification. We also report the patient-level CAD assessment of complete CE studies for multiple abnormalities, and the patient-level validation demonstrates the effectiveness and robustness of our methods.

Addressing the global obesity epidemic requires innovative approaches that are also acceptable to affected individuals. There is growing evidence suggesting that food addiction, one contributor to obesity, bears many similarities to drug and alcohol addiction, presenting a potential role for addiction-focused acupuncture as a novel treatment modality. In this perspective article, we begin by briefly reviewing the evidence linking food and drug/alcohol addiction. We then describe the development of an acupuncture-based protocol for treating opioid addiction in Hong Kong in the 1970s and discuss the evidence base for acupuncture's efficacy in treating a range of substance use disorders. Next, we describe acupuncture's proposed mechanism of action in attenuating withdrawal and promoting abstinence. Finally, we note the dearth of studies specifically examining the effectiveness of acupuncture in treating food addiction and suggest that more research should focus in this area as part of the effort to combat rising rates of obesity worldwide.

Vitamin D is a secosteroid hormone that possesses immunomodulatory properties and has been demonstrated to potentially influence inflammatory bowel disease (IBD) pathogenesis and activity. Epidemiologic data have associated vitamin D deficiency with an increased risk of IBD, hospitalizations, surgery, and loss of response to biologic therapy. Conversely, IBD itself can lead to vitamin D deficiency. This bidirectional relationship between vitamin D and IBD suggests the need for monitoring and repletion of vitamin D, as needed, in the IBD patient. This review discusses the role of vitamin D in IBD and provides practical guidance on vitamin D repletion.

Small intestinal bacterial overgrowth (SIBO) is an increasingly recognized clinical syndrome; however, its etiophathogenesis is poorly understood. We hypothesized that loss of gastric acid, a delayed intestinal transit, and ileocecal valve dysfunction may contribute to the genesis of this syndrome. Our primary aim was to assess these parameters using wireless motility capsule (WMC) testing and to correlate them with the presence or absence of SIBO. We prospectively evaluated 30 consecutive patients at a tertiary care center with suspected SIBO, diagnosed by lactulose hydrogen breath testing (LBT), and small bowel aspirate microbiology. Patients underwent WMC testing to assess ileocecal junction pressure (ICJP), small bowel transit time (SBTT), and regional gastrointestinal pH. Thirty patients completed testing; 15 had a positive LBT, and 11 had a positive aspirate culture. As compared with LBT-negative patients, ICJP was lower (27.8 vs. 72.7 mmHg, p = 0.027), SBTT was longer (10.0 vs. 1.1 h, p = 0.004), gastric pH was higher (3.63 vs. 2.42, p

Fragility fractures associated with osteoporosis extract a large financial and personal toll on society. Pharmaceutical or dietary calcium intake is needed to increase bone mineral density to prevent fragility fractures. Although dairy products are a good source of calcium, patients who are unable to digest lactose tend to avoid them and are put at a greater risk for fracture than the general population. Anecdotal reports suggest that lactose maldigesters, when consuming raw milk, have a dramatic reduction in symptoms relative to pasteurized milk. The mechanism of the reported reduction in symptoms, if true, is unknown. The purpose of the current study was to survey raw milk drinkers to ascertain their health-related motivations for consuming raw milk, especially as they relate to lactose maldigestion.An online survey regarding raw milk was completed by 153 of 1527 members of a raw milk-buying community.The primary reason the respondents cited for drinking raw milk was that they believed it was more healthful; 30% reported some gastrointestinal discomfort when drinking pasteurized milk, yet almost all (99%) reported consuming raw milk without discomfort. Despite the reports of gastrointestinal discomfort, only 5% of respondents had been diagnosed as lactose intolerant by a medical professional, and only 1% had been diagnosed as lactose intolerant via the gold-standard hydrogen breath test.The primary motivation for drinking raw milk is its perceived health value, not its digestibility. Although raw milk appears to be more easily digested than pasteurized milk in our survey sample, the mechanism of digestibility remains unknown.背景：与骨质疏松症相关的脆性骨 折给社会造成了极大的财务和人力 压力。需要服用药物或摄入饮食钙 来增高骨密度，以预防脆性骨折。 虽然奶制品是钙的良好来源，但不 能消化乳糖的患者常常无法吸收奶 制品，且这些患者的骨折风险大于 一般人群。零星的报告表明，饮用 未消毒牛奶时，乳糖消化不良——饮用巴氏消毒奶的相关症状明显减 少。如果报告的情况属实，尚不明 确所报告的症状减少的机理。本研 究旨在调查未消毒牛奶饮用者，确 定他们饮用未消毒牛奶的健康相关 动机，特别是与乳糖消化不良相关 的动机。方法：未消毒牛奶相关的在线调查 由 1527 个购买未消毒牛奶社区中的 153 个完成。结果：受访者饮用未消毒牛奶的主 要原因是他们认为这样更有益于健 康；30% 的人报告饮用巴氏消毒奶 时有一些胃肠不适，但几乎所有 (99%) 饮用未消毒牛奶的人都没有 不适的报告。尽管有胃肠道不适的 报告，但仅 5% 的受访者被医疗专 业人员确诊为乳糖不耐症，并且通 过氢呼吸测试，仅 1% 的受访者被 确诊为乳糖不耐症。结论：饮用未消毒牛奶的主要动机 是获得感知到的健康价值，而非其 可消化性优势。虽然我们调查的样 本中未消毒牛奶似乎比巴氏消毒奶 更容易消化，但尚不明确其可消化 性的机理。Las fracturas por fragilidad asociadas a la osteoporosis suponen un gran coste económico y personal para la sociedad. La ingesta de calcio farmacéutico o dietético es necesaria para aumentar la densidad mineral y prevenir fracturas por fragilidad. Aunque los productos lácteos son una buena fuente de calcio, los pacientes que no pueden digerir la lactosa tienden a evitarlos y tienen un mayor riesgo de fractura que la población general. Informes anecdóticos indican que las personas que no digieren bien la lactosa, al consumir leche cruda, tienen una gran reducción de síntomas en comparación con la leche pasteurizada. El mecanismo de la reducción notificada en los síntomas, de ser verdad, se desconoce. El propósito del estudio actual era hacer una encuesta a las personas que beben leche cruda para determinar sus motivaciones relacionadas con la salud para consumir leche cruda, sobre todo en relación con la mala digestión de la lactosa.153 de 1527 miembros de una comunidad que compra leche cruda completó una encuesta online en relación a la leche cruda.El motivo principal que los encuestados citaron para beber leche cruda fue que creían que era más sano; el 30 % notificó ciertas molestias gastrointestinales al beber leche pasteurizada, aunque casi todos (99 %) notificaron consumir leche cruda sin molestias. A pesar de los informes de molestias gastrointestinales, un profesional médico había diagnosticado intolerancia a la lactosa en solo el 5 % de los encuestados, y solamente al 1 % se le había diagnosticado intolerancia a la lactosa mediante el método de referencia de prueba de hidrógeno en el aliento.El motivo principal para beber leche cruda es su valor saludable percibido, no su digestibilidad. Aunque la leche cruda parece ser digerida más fácilmente que la pasteurizada en la muestra de nuestra encuesta, se desconoce el mecanismo de digestibilidad.

Irritable bowel syndrome is a complex disorder whose pathophysiology involves alterations in the enteric microbiota, visceral hypersensitivity, gut immune/barrier function, hypothalamic-pituitary-adrenal axis regulation, neurotransmitters, stress response, psychological factors, and more. The importance of diet in the management of irritable bowel syndrome has taken center stage in recent times as the literature validates the relationship of certain foods with the provocation of symptoms. Likewise, a number of elimination dietary programs have been successful in alleviating irritable bowel syndrome symptoms. Knowledge of the dietary management strategies for irritable bowel syndrome will help guide nutritionists and healthcare practitioners to deliver optimal outcomes. This tutorial reviews the nutrition management strategies for irritable bowel syndrome.

Objective: Patients with small intestine bacterial overgrowth (SIBO) have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. A growing number of patients are interested in using complementary and alternative therapies for their gastrointestinal health. The objective was to determine the remission rate of SIBO using either the antibiotic rifaximin or herbals in a tertiary care referral gastroenterology practice. Design: One hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing (LBT) were offered either rifaximin 1200 mg daily vs herbal therapy for 4 weeks with repeat LBT post-treatment. Results: Three hundred ninety-six patients underwent LBT for suspected SIBO, of which 251 (63.4%) were positive 165 underwent treatment and 104 had a follow-up LBT. Of the 37 patients who received herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). The odds ratio of having a negative LBT after taking herbal therapy as compared to rifaximin was 1.85 (CI=0.77-4.41, P=.17) once adjusted for age, gender, SIBO risk factors and IBS status. Fourteen of the 44 (31.8%) rifaximin non-responders were offered herbal rescue therapy, with 8 of the 14 (57.1%) having a negative LBT after completing the rescue herbal therapy, while 10 non-responders were offered triple antibiotics with 6 responding (60%, P=.89). Adverse effects were reported among the rifaximin treated arm including 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile. Only one case of diarrhea was reported in the herbal therapy arm, which did not reach statistical significance (P=.22). Conclusion: SIBO is widely prevalent in a tertiary referral gastroenterology practice. Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders. Further, prospective studies are needed to validate these findings and explore additional alternative therapies in patients with refractory SIBO.