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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2006.02.001 Byline: Kamal Nagpal (a), Vivek Ratna Minocha (b), Vivek Agrawal (b), Suman Kapur (c) Keywords: Gut permeability; Acute pancreatitis Abstract: This study aims to evaluate the intestinal mucosal permeability in patients with acute pancreatitis. The lactulose:mannitol (L:M) ratio was used to assess permeability. It is an inexpensive and quite reliable method. The intestinal permeability was increased in patients with acute pancreatitis compared with the controls. In addition, patients with severe pancreatitis had higher intestinal barrier dysfunction compared with patients with mild pancreatitis, the L:M ratio being .2 and .029, respectively. It was also concluded that the permeability increased gradually over the course of pancreatitis and was maximum at day 7 (P < .01). This provides a window of opportunity for therapeutic intervention to prevent the late observed increase in intestinal permeability. Author Affiliation: (a) 37 Arklow Road, Doncaster DN2 5LB, United Kingdom (b) Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India (c) Department of Neurochemistry, Institute of Human Behaviour and Allied Sciences, Delhi, India Article History: Received 30 May 2005; Revised 5 February 2006

PURPOSE: The purpose of this study was to evaluate the use of sorbitol as an inexpensive alternative to lactulose for treating constipation in the elderly. PATIENTS AND METHODS: Thirty men aged 65 to 86 with chronic constipation were studied in a randomized, double-blind, cross-over trial in which lactulose and 70% sorbitol O to 60 mL daily) were each given for 4 weeks preceded by a 2-week washout period. RESULTS: The average number of bowel movements per week was 6.71 with sorbitol and 7.02 with lactulose (95% confidence interval of the difference: -0.43 to 1.06), and the average number of days per week with bowel movements was 5.23 with sorbitol and 5.31 with lactulose (95% confidence interval of the difference: -0.32 to 0.48). Eleven patients stated a preference for sorbitol, 12 for lactulose, and seven had no preference. On a visual analogue scale measuring severity of constipation (0 to 100 mm), the average score for sorbitol was 35.6 mm versus 37.1 mm for lactulose (95% confidence interval of the difference: -6.4 to 9.3). The sorbitol and lactulose treatment periods were also similar in percent of bowel movements recorded as 'normal,' frequency and severity of symptoms such as bloating, cramping, and excessive flatulence, and overall health status as assessed by a previously validated five-category questionnaire. There were no significant differences between sorbitol and lactulose in any outcome measured except nausea, which was increased with lactulose (p CONCLUSION: These results support the hypothesis that sorbitol and lactulose have no clinically significant differences in laxative effect. Sorbitol can be recommended as a cost-effective alternative to lactulose for the treatment of constipation in the elderly., Constipation is a common problem that increases after the age of 65 years. It is treated by increasing dietary fiber and fluids, adding a bulk-forming agents to the diet such as psyllium, or laxative therapy. However, long-term therapy with laxatives may not be appropriate for elderly patients because of potential adverse side effects. Although lactulose, a glucose compound, is an effective laxative with few adverse side effects, it is very expensive. Sorbitol is another glucose compound with laxative effects that less expensive. The use of sorbitol as an alternative to lactulose for treating constipation in the elderly was assessed. Lactulose treatment and 70 percent sorbitol treatment were each given for four-week periods to 30 men aged 65 to 86 years with chronic constipation. Sorbitol caused 6.71 bowel movements per week, with an average of 5.23 days per week with bowel movements. Lactulose caused 7.02 bowel movements per week, with an average of 5.31 days per week with bowel movements. Eleven patients preferred sorbitol, 12 patients preferred lactulose, and seven patients had no preference. The severity of constipation, the amount of normal bowel movements, frequency and severity of symptoms such as bloating, cramping, excessive flatulence, and overall health status were similar for sorbitol and lactulose treatments. Nausea occurred more often during treatment with lactulose compared with sorbitol. These findings show that there are no clinical differences in the laxative effects between sorbitol and lactulose. Thus, sorbitol can serve as a cost-effective alternative to lactulose in treating chronic constipation in the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)

EDITOR--The study by Kontiokari et al did not show a significant reduction in the prevalence of urinary tract infection in women using a lactobacillus drink, but it did show a [...]

Background: Many lactose maldigesters tolerate more lactose in experimental studies than in everyday life, in which their symptoms may result from other carbohydrates as well. Objective: The question of whether the symptoms caused by large quantities of carbohydrates are more severe in lactose maldigesters than in control lactose digesters or in lactose digesters who report milk to be the cause of their gastrointestinal symptoms (pseudohypolactasic subjects) was studied in a randomized, double-blind, crossover study. Comparisons between commonly used diagnostic methods for lactose maldigestion were also made. Design: The subjects were 40 women aged 20-63 y from 3 groups: lactose maldigesters (n = 12), pseudohypolactasic subjects (n = 15), and control lactose digesters (n = 13). The subjects were given either 50 g lactose, 50 g sucrose, 25 g lactulose, or 25 g fructooligosaccharides. After carbohydrate ingestion, urine was collected and the breath-hydrogen concentration was measured every 30 min for 3 h. Blood glucose was measured every 20 min for 1 h and subjective gastrointestinal symptoms were monitored for 8 h with a questionnaire. Results: When lactulose and fructooligosaccharides were ingested, the lactose maldigesters (P = 0.04 and 0.09, respectively) and the pseudohypolactasic subjects (P = 0.006 and 0.01, respectively) reported more symptoms than did the control lactose digesters. Sucrose caused more symptoms in the lactose maldigesters than in the control lactose digesters (P = 0.05). Conclusions: Lactose maldigesters and lactose digesters with pseudohypolactasia experience more symptoms than control lactose digesters after a single intake of large amounts of indigestible carbohydrates. Lactose maldigesters also experience more symptoms after ingesting sucrose. Am J Clin Nutr 1999;69:973-9.