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BACKGROUND AND AIMS Endoscopic mucosal resection (EMR) for removal of large polyps is well established in adults. EMR technique in the pediatric population is less utilized due to lower incidence of large intestinal polyps in pediatric patients and limited EMR training for pediatric gastroenterologists. The aim of this study is to retrospectively review safety and efficacy of pediatric EMR cases at two large, tertiary referral centers with adult and pediatric EMR expertise. METHODS A retrospective chart review was conducted at Cedars-Sinai Medical Center and Cincinnati Children's Hospital Medical Center from January 2012 to May 2021. Demographic, clinical, technical and follow up data were collected for patients

OBJECTIVE To evaluate short-term risk factors associated with dehiscence and death in cats undergoing full-thickness large intestinal incisions. ANIMALS 84 client-owned cats that had undergone full-thickness large intestinal incisions and for which information regarding outcome through postoperative day 7 was available. PROCEDURES Medical records from 4 veterinary teaching hospitals were reviewed. For cats that met the inclusion criteria, signalment, history, laboratory test results, surgical and medical procedures, perioperative complications, and outcome were analyzed. A Fisher exact or Wilcoxon rank sum test was used to identify individual variables associated with dehiscence of intestinal incisions or patient nonsurvival to hospital discharge or both. RESULTS 84 cats met the inclusion criteria. The overall dehiscence and survival to hospital discharge rates were 8.3% (7/84 cats) and 94% (79/84 cats), respectively. Factors associated with dehiscence and nonsurvival to hospital discharge included presence of band neutrophils, performance of partial colectomy with colonic resection and anastomosis, administration of blood products, postoperative cardiopulmonary arrest, and incisional inflammation or infection. Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence. Factors associated with dehiscence only included hypoalbuminemia, renal dysfunction, administration of blood products or > 2 classes of antimicrobials, and intra-abdominal fecal contamination. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that intestinal dehiscence and mortality rates associated with large intestinal incisions in cats may be higher than previously proposed, although the risk of either outcome was still low. Factors suggestive of systemic illness were associated with colonic dehiscence or death, and focused prospective studies of risk factors are warranted. (J Am Vet Med Assoc 2021;259:162–171)

Background Evidence is lacking concerning re‐introduction of feed and water following colic surgery. Objectives To describe current approaches of European and American specialists to re‐introduction of feed and water in adult horses following surgical treatment of common intestinal lesions, assuming an uncomplicated recovery. Study design Cross‐sectional survey. Methods Electronic invitations, with a link to the online survey, were sent to 1,430 large animal specialists, including Diplomates of the ECVS, ACVS, ECEIM and ACVIM colleges. Results The response rate was 12.6% including partial respondent data. Responses for each multiple‐choice question were between 123 and 178. Results are expressed as the percentage of the total number of responses and as a range where specific lesions are grouped together. Respondents reported that horses with large intestinal displacements were offered free choice water (63%‐65%) within 3 hours (55%‐63%), whereas horses with a small intestinal strangulating lesion were offered

Цель исследования - проведение сравнительного анализа влияния экстракта куркумы длинной и 5-аминосалициловой кислоты (5-АСК) в составе ректальных суппозиториев на клиническую картину и содержание продуктов перекисного окисления липидов (ПОЛ) в слизистой оболочке толстого кишечника при экспериментальной болезни Крона (БК). Методика. Эксперимент выполнен на 70 белых крысах-самцах Wistar. БК моделировали ректальным введением тринитробензосульфоновой кислоты. Ректальные суппозитории (массой 0,3 г каждая) начинали применять через 12 ч. Содержание 5-АСК в суппозиториях составляло 50 мг, 10% экстракта куркумы длинной оригинального состава 0,000075 г. На 3-и, 5-е и 7-е сут после моделирования БК оценивали клинический статус по модифицированной шкале Disease activity index и содержание продуктов ПОЛ в слизистой оболочке толстого кишечника. Результаты. В динамике БК в толстом кишечнике увеличивается содержание первичных, вторичных и конечных продуктов ПОЛ в гептановой и изопропанольной фазах; тяжесть клинических признаков (снижение массы тела, диарея, кровь в каловых массах) нарастает по мере увеличения содержания продуктов ПОЛ. Применение при БК ректальных суппозиториев с экстрактом куркумы снижает выраженность клинических симптомов, уменьшает содержание продуктов ПОЛ преимущественно в изопропанольной фазе липидного экстракта толстого кишечника; установлена корреляция индекса клинической активности БК с содержанием продуктов ПОЛ в толстом кишечнике. Заключение. Эффективность локального применения экстракта куркумы в составе ректальных суппозиториев сопоставима по эффективности с применением ректальных суппозиториев с 5-АСК по показателям индекса клинической активности и по содержанию продуктов ПОЛ в слизистой толстого кишечника. Aim. To compare effects of turmeric extract and 5-aminosalicylic acid (5-ASA) formulated into rectal suppositories on clinical symptoms and content of lipid peroxidation products (LPP) in the mucous membrane of the large intestine in experimental Crohn’s disease (CD). Methods: Experiments were performed on 70 Wistar male rats. CD was modeled by rectal administration of trinitrobenzenesulfonic acid; rectal suppositories (0.3 g each) were used every 12 h. The suppositories contained 5-ASA (50 mg) or 10% turmeric extract with an original composition (0.000075 g). On days 3, 5, and 7 of CD, the clinical status was evaluated with a modified Disease Activity Index scale, and LPP concentrations were measured in the large intestine mucosa. Results. In the course of CD in the colon, concentrations of primary, secondary, and final LPP in the heptane and isopropanol phases increased; severity of clinical signs (weight loss, diarrhea, blood in fecal masses) increased with increasing LPP concentrations. The use of rectal suppositories with turmeric extract alleviated severity of clinical symptoms and reduced LPP content primarily in the isopropanol phase of colon lipid extract. The index of CD clinical activity of CD was correlated with the large intestinal LPP content. Conclusion. Effectiveness of the local application of turmeric extract formulated into rectal suppositories was comparable with that of rectal suppositories with 5-ASA as determined by the Disease Activity Index and the LPP content in the large intestine.

OBJECTIVE To describe outcome and complications after large intestinal trocarization in equids with colic and identify factors associated with nonsurvival and clinically relevant peritonitis (CRP). ANIMALS 228 (198 horses, 24 ponies, and 6 donkeys and mules) equids with colic that underwent large intestinal trocarization. PROCEDURES Medical records from 2004 through 2015 were reviewed for equids with colic that underwent large intestinal trocarization. Factors associated with nonsurvival in all (ie, surgically and medically treated) equids and with CRP in medically only treated equids were identified. Medically only treated equids with a high peritoneal fluid cell count (ie, > 10,000 cells/μL) after large intestinal trocarization were classified as having CRP if they met ≥ 2 of the following clinical criteria: anorexia, fever, lethargy, abnormal oral mucous membrane color, abnormal WBC count, or high blood fibrinogen concentration (> 5 g/L). RESULTS Transabdominal large intestinal trocarization was performed in 190 (83%) equids, transrectal trocarization in 17 (7%), and both procedures in 21 (9%). Of 228 equids, 167 (73%) survived to hospital discharge. None died or were euthanized because of complications from large intestinal trocarization. Nonsurvival was associated with an increasing number of trocarization procedures and diagnosis of a large intestinal strangulating lesion. A diagnosis of nephrosplenic ligament entrapment of the large colon decreased the odds of nonsurvival. Twelve of 60 (20%) equids that received medical treatment only had CRP following large intestinal trocarization. CONCLUSIONS AND CLINICAL RELEVANCE Large intestinal trocarization could be considered for equids with colic and large intestinal gas distension. More than one trocarization procedure was associated with an increase in nonsurvival, which should be considered for equids for which consent for surgery has been obtained.

Background: Acute intestinal obstruction is one of the most common surgical emergencies. There are many causes of acute intestinal obstruction like bands and adhesions, neoplasms, strictures etc. Aims and Objectives: In this study we have tried to find out common clinical presentation, aetiology and treatment of acute intestinal obstruction. Materials and Methods: This is a prospective study conducted at department of General Surgery, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra in which we have studied 45 cases of acute intestinal obstruction to find out the clinical presentation, aetiology and treatment of acute intestinal obstruction. Conclusions: Acute intestinal obstruction is more common in females than in males. Small intestinal obstruction is more common than large intestinal obstruction. The commonest cause of intestinal obstruction is adhesions. The next most common cause is Tubercular stricture. Malignancy is most common cause of large intestinal obstruction. Most of the patients having large bowel obstruction required laparotomy.

Background Canine inflammatory bowel disease (IBD) is a group of chronic gastrointestinal (GI) disorders of still largely unknown etiology. Canine IBD diagnosis is time-consuming and costly as other diseases with similar signs should be initially excluded. In human IBD microRNA (miR) expression changes have been reported in GI mucosa and blood. Thus, there is a possibility that miRs may provide insight into disease pathogenesis, diagnosis and even treatment of canine IBD. The aim of this study was to determine the colonic mucosal and serum relative expression of a miRs panel in dogs with large intestinal IBD and healthy control dogs. Results Compared to healthy control dogs, dogs with large intestinal IBD showed significantly increased relative expression of miR-16, miR-21, miR-122 and miR-147 in the colonic mucosa and serum, while the relative expression of miR-185, miR-192 and miR-223 was significantly decreased. Relative expression of miR-146a was significantly increased only in the serum of dogs with large intestinal IBD. Furthermore, serum miR-192 and miR-223 relative expression correlated to disease activity and endoscopic score, respectively. Conclusion Our data suggest the existence of dysregulated miRs expression patterns in canine IBD and support the potential future use of serum miRs as useful noninvasive biomarkers.

This study was performed to evaluate compliance to an Enhanced Recovery Pathway (ERP) among patients ≥65 years and determine the effect of compliance on postoperative outcomes.ERPs improve postoperative outcomes in patients undergoing major surgery. Given the inherent decline of the older surgical patient, the benefit of an ERP in this population has been questioned.Patients undergoing major small and large intestinal surgery prior to and following ERP implementation at the Johns Hopkins Medical Institutions were entered into the ACS-NSQIP database. Outcomes included ERP compliance rates, complications, length of stay (LOS), and 30-day readmission rates were determined for older patients.Nine hundred seventy-four patients (69365 yrs and 281 ≥ 65 yrs) were included. Of those ≥ 65 years, 142 (51%) were entered prior to and 139 (49%) were entered following ERP implementation. More ERP than pre-ERP patients underwent laparoscopic procedures (45.3% vs. 32.4%, P = 0.02), had disseminated malignancies (9.4% vs. 2.8%, P = 0.03), and smoked (14.4% vs. 4.9%, P = 0.01). Overall compliance was 74.5%, and 47% of older ERP patients achieved high compliance (≥75% compliance with ERP variables). High compliance was associated with a 30% decrease LOS (IRR: 0.7 P = 0.001) and 60% decrease in major (CD ≥ II) complications (OR: 0.4 P = 0.05).LOS and complication rates following implementation of an ERP were significantly improved in highly compliant elderly patients. Interventions to further improve outcomes should target decreasing variability by increasing individual compliance with an effective clinical pathway.

It is suggested that the plant-derived polysaccharides have positive effect on improving the performance of livestock, but little information is available regarding their effects on piglets. This study aimed to assess the effects of alfalfa (Medicago sativa L.) polysaccharides (APS) on the growth performance and intestinal health of piglets. Two hundred 35-d-old piglets were randomly allotted to five groups fed basal diet supplemented with 0, 300, 500, 800, or 1200 mg APS /kg diet respectively for a 42-d experiment. Average daily gain (ADG), average daily feed intake (ADFI), feed efficiency (ADG/ADFI, G/F), small intestinal morphology, digestive enzymes activities, and selected large intestinal microbial populations were determined. Supplementation with APS to 35- to 77-d-old piglets quadratically (Q) (P

© 2018 Elsevier Ltd Background: Diets rich in dietary fibre are associated with multiple health benefits, but there is often only a restricted understanding of the mechanisms underlying these associations. This limits the ability to select or design foods for specific nutritional purposes. Traditionally, the diverse physical and chemical forms of dietary fibre have only been categorised as either soluble or insoluble. Scope and approach: In this review, the physicochemical properties that have been proposed to be responsible for the biological functionality of dietary fibres in the digestive tract are summarised and classified. The extent to which these properties follow naturally from categorisation into soluble vs insoluble forms are then assessed. Based on this analysis, a new approach to functional categorisation of dietary fibres is proposed. Key findings and conclusions: The physicochemical properties of dietary fibre components that are relevant to digestive tract functionality can be classified under the headings of binding, structuring, and transport barriers. Major nutritional outcomes such as control of macronutrient digestion or the nature of residual digesta that are available for fermentation by the large intestinal microbiota depend on combinations of these physicochemical properties in ways which are not readily reflected by a soluble vs insoluble fibre definition. An alternative approach is proposed based on 2D mapping of dietary fibre materials as a function of molecule/particle size and local density. This effectively separates diverse fibre materials and can be linked semi-quantitatively with functionally-important properties.

Assessing intestinal development and host-microbe interactions in healthy human infants requires noninvasive approaches. We have shown that the transcriptome of exfoliated epithelial cells in feces can differentiate breast-fed and formula-fed infants and term and preterm infants. However, it is not fully understood which regions of the intestine that the exfoliated cells represent. Herein, the transcriptional profiles of exfoliated cells with that of the ileal and colonic mucosa were compared. We hypothesized that exfoliated cells in the distal colon would reflect mucosal signatures of more proximal regions of the gut. Two-day-old piglets (n = 8) were fed formulas for 20 days. Luminal contents and mucosa were collected from ileum (IL), ascending colon (AC), and descending (DC) colon, and mRNA was extracted and sequenced. On average, ∼13,000 genes were mapped in mucosal tissues and ∼10,000 in luminal contents. The intersection of detected genes between three mucosa regions and DC exfoliome indicated an approximately 99% overlap. On average, 49% of the genes in IL, AC, and DC mucosa were present in the AC and DC exfoliome. Genes expressed predominantly in specific anatomic sites (stomach, pancreas, small intestine, colon) were detectable in exfoliated cells. In addition, gene markers for all intestinal epithelial cell types were expressed in the exfoliome representing a diverse array of cell types arising from both the small and large intestine. Genes were mapped to nutrient absorption and transport and immune function. Thus, the exfoliome represents a robust reservoir of information in which to assess intestinal development and responses to dietary interventions. NEW & NOTEWORTHY The transcriptome of exfoliated epithelial cells in stool contain gene signatures from both small and large intestinal mucosa affording a noninvasive approach to assess gut health and function.

Background/Purpose Distraction enterogenesis with intraluminal spring technology has been successfully used to lengthen segments of murine small intestine. We hypothesized that biocompatible springs could also be used to lengthen murine large intestine. Methods Age and weight matched C57BL/6 mice underwent surgical insertion of nitinol spring-loaded capsules into the cecum. Segment lengths were measured at initial spring placement and at euthanasia after 7 and 14 days. Histologic adaptations were evaluated at scarification. Results Cecal segments loaded with compressed springs lengthened an average of 150%, which was significantly longer than control segments loaded with either empty capsules or uncompressed springs. Muscularis layers tended to be thicker in the compressed spring groups compared to control groups. Conclusions Insertion of a compressed nitinol spring into the cecum results in significant colonic lengthening in a mouse model. The ability to increase cecum length serves as proof of concept that distraction enterogenesis technology may be feasibly applied to large intestinal models. The use of distraction enterogenesis technology shows promise for application to clinical models in the treatment of pediatric intestinal disease.

Along with the brief outline of the definition evolution of dietary fibers, this chapter focuses on how the physical and chemical structures of fibers are related to the health effects. The role of fiber in the human digestive tract including oral, gastric, small intestinal, and large intestinal phases is also discussed. Our further emphasis is on the colonic microbial fermentation performance and health implications of dietary fibers. Fibers with higher water holding capacity or viscosity are desirable for slowing down the metabolic response (e.g., post prandial blood glucose level), whereas the fibers with slow fermentation throughout the colon and higher level of butyrate/propionate production are considered ideal for colonic health. Thus foods that have the balance of viscous and slowly fermentable fibers are considered beneficial in terms of overall nutrition and health. Although role of fibers in small intestine is well studied and known, how the fiber specificity can modulate the gut microbial ecology for desired health benefits still needs further research investigation.

This article presents a clinical case of treatment of an anterior abdominal wall abscess,which arose due to the formation of an external fistula of the sigmoid colon duringperforation of the diverticulum of the latter.The patient underwent laparotomy, a combined left hemicolectomy with small bowelresection, excision of the large intestinal fistula of the anterior abdominal wall,rehabilitation, and drainage of the abdominal cavity. The postoperative period was withoutcomplications, the wound healed with primary tension. The patient was discharged fromthe hospital in a satisfactory condition on the 17th day.Сonclusion. The treatment of purulent-inflammatory diseases of the anterior abdominalwall it is necessary to pay attention to the cause of their occurrence, as well as to excludesurgical diseases of the abdominal cavity.

Impacts, traumas and strokes are spontaneously life-threatening, but chronic symptoms strangle patient every day. Colorectal tissue mechanics in such chronic situations not only regulates the physio-psychological well-being of the patient, but also confirms the level of comfort and post-operative clinical outcomes. Numerous uniaxial and multiaxial tensile experiments on healthy and affected samples have evidenced significant differences in tissue mechanical behavior and strong colorectal anisotropy across each layer in thickness direction and along the length. Furthermore, this study reviewed various forms of passive constitutive models for the highly fibrous colorectal tissue ranging from the simplest linearly elastic and the conventional isotropic hyperelastic to the most sophisticated second harmonic generation image based anisotropic mathematical formulation. Under large deformation, the isotropic description of tissue mechanics is unequivocally ineffective which demands a microstructural based tissue definition. Therefore, the information collected in this review paper would present the current state-of-the-art in colorectal biomechanics and profoundly serve as updated computational resources to develop a sophisticated characterization of colorectal tissues.

Cyathostomins are pervasive parasites of equids across the world. Larval stages encyst in the mucosa of the cecum, ventral and dorsal colon and can induce an inflammatory response leading to larval cyathostominosis, a life-threatening generalized typhlocolitis. Mucosal digestion is the only gold standard procedure for identifying and quantifying all larval stages. There is a lack of standardization of this technique and several aspects are ambiguous, such as precision of the method and the possibility of spatial variation of mucosal larval counts. The aim of this study was to estimate precision for enumeration of early third stage larvae (EL3) and late third stage/fourth stage (LL3/L4) larvae and investigate spatial variation of encysted counts within large intestinal organs. Six naturally infected and untreated horses aged 2-5 years were euthanized as part of an anthelmintic efficacy study, and the cecum (Cec), ventral colon (VC) and dorsal colon (DC) were collected. Each organ was rinsed, weighed, and visually separated into 3 equally sized sections. Two 5% tissue samples were collected from each section, a total of six replicates per organ. The mucosae were digested, and 2% examined under the microscope for presence of EL3 and LL3/L4 stage larvae. Overall, 59 % of the harvested larvae were EL3s, and 41 % were LL3/L4s. The ventral colons represented 45 % of the total organ weight, and contributed 37 and 41 % of the EL3s and LL3/L4s harvested, respectively. The Cec, representing only 27 % of the weight contributed 23 % of EL3s and 47 % of LL3/L4s. The DC represented 28 % of the total organ weight, and 28 % and 12 % of the total EL3s and LL3/L4s, respectively. Coefficients of variation varied from 33 to 183 % for EL3 counts and 38-245% for LL3/L4 counts. There were no statistically significant associations between EL3 counts and either organ or location. For LL3/L4 counts there were no statistically significant differences between the three locations within organs (p = 0.1166), but the DC had significantly lower counts than the other two organs (p0.0001). Increasing the number of mucosal replicates from each organ improved estimation, but required a considerably increased workload. In conclusion, mucosal larval cyathostomin counts are highly variable, complicating their use for treatment efficacy estimation.

Oral bioaccessibility of vanadium(IV) and vanadium(V) in soil, dust and concentrate fines from a vanadium titanomagnetite mining region was assessed by a whole digestive system in-vitro scheme. The scheme including the addition of sweat and the large intestinal digestion was used to estimate the oral bioaccessibility of vanadium(IV) and vanadium(V) in the whole digestive system for the first time. Higher oral bioaccessibility of vanadium(IV) and vanadium(V) was determined in gastric and small intestinal phases demonstrating that their major roles for vanadium digestion and absorption. The decreasing order of the oral bioaccessibility of vanadium(IV) and vanadium(V) in each digestive phase was stomach, small intestine, large intestine and mouth. Higher oral bioaccessibility of vanadium(V) in the whole digestion indicated its higher risk potential for human than vanadium(IV). Lower oral bioaccessibility of vanadium(IV) and vanadium(V) determined in bionic digestion illustrated detoxicity potential of human body for ingested vanadium. Compared with soil and dust, higher digestion rate of vanadium in vanadium titanomagnetite concentrate fines indicated its higher risk for human, especially for mining workers. Based on vanadium oral bioaccessibility, hazard quotients of the vanadium were much less than the critical level suggested for no non-carcinogenic risks to the populations surrounding the sampling sites. Indeed, compared with the estimations based on total vanadium content, the incorporation of oral vanadium bioaccessibility into risk assessments could give more realistic information.

The enteric nervous system (ENS) is an autonomic “brain-in-the-gut” that integrates gastrointestinal motility, secretion and blood flow into homeostatic patterns of gut behavior. Experimental models for the ENS are the same as for all independent integrative nervous systems, whether in the vertebrate brain and spinal cord or in invertebrate animals. The ENS coordinates and organizes the behavior of the musculature, secretory glands and vascular system, in each of the specialized organs of the gastrointestinal tract, into meaningful behavior of each organ. The ENS stores a library of programs for differing patterns of small and large intestinal adaptive behaviors. Programs in the library are akin to 21st century digital “apps” that run on smart phones, tablet computers and comparable devices.

INTRODUCTION Helicobacter pylori (Hp) infection produces drastic changes in the gastric microenvironment, which, in turn, influence the gastric microbiota composition and might be correlated with large intestinal microbiota changes. This excellent perturbing actor could trigger important modifications in the homeostatic functions exerted by gut commensals leading to a new gastrointestinal balance. At the same time, the therapeutic strategies used to eradicate Hp can modulate this physiological symbiosis, but can be also conversely affected by its properties. Area covered: The purpose of this review is to explore the reciprocal interplay between Hp infection and gut microbiota and analyze how microbial changes can influence the management of Hp eradication therapies. Expert commentary: While many studies have described Hp-dependent gut microbiota alterations, their clinical implications are only partially clear, as well as the mechanism of actions that sustain these processes. This represents a clear challenge for future research projects that will also need to understand which role is exerted by viruses, parasites, and yeasts.

PubMedID: 30057052 Purpose: This study was designed as an experimental controlled study, aiming to identify the effect of ice massage with short duration (40 min) and long duration (80 min) applied on Large Intestinal 4 (LI4) acupressure point on labor process and perception of labor pain. Methods: The participants, who met the research criteria according to the results of power analysis, were 72 healthy pregnant women divided into experiment and control group. Results: Results show that ice massage applied on the LI4 region was effective in the 80th minute. Moreover, in terms of the effect of ice massage on labor duration, the application was found to reduce the labor duration of the women in the experimental group approximately 1 h on average. Conclusion: It was found that the ice massage applied by midwives on the LI4 point during the active phase of delivery could reduce pain and shorten the delivery duration. © 2018 Elsevier Ltd Firat University Scientific Research Projects Management Unit This study is supported with ASYO2013YL1 numbered project by University Scientific Research Projects . Data acquired with the study was sent to the 20th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), December 4–7, 2014 in Paris as a poster presentation.

OBJECTIVE To describe clinical features and outcome of horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography. DESIGN: Retrospective case series. ANIMALS 25 horses. PROCEDURES Medical records of horses that underwent transabdominal ultrasonography between 2003 and 2010 were reviewed. Horses were included if the wall of the large intestine was ≥ 9 mm thick in any of 6 abdominal zones. RESULTS Median age was 13 years (range, 3 to 28 years). Horses were initially examined because of colic, diarrhea, inappetence, weight loss, lethargy, fever, or hematuria. Severe large intestinal thickening (range, 9 to 46.6 mm; mean ± SD, 18.8 ± 6.8 mm) was the primary ultrasonographic finding in all horses. Thickened large intestine was more likely to be detected in ventral versus upper (ie, combined paralumbar and intercostal) abdominal zones and in right versus left zones. Eleven horses survived and had resolution of clinical signs, including the l horse treated surgically for colon torsion. An additional horse survived but continued to have intermittent colic. Ten horses were euthanized or died, including 3 horses with neoplasia and 3 with colitis. Three horses were lost to follow-up, including 1 horse with a cecal mass and 1 with hepatosplenic lymphoma. Severity of thickening and number of zones affected were not significantly different between survivors and nonsurvivors. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in horses undergoing transabdominal ultrasonography, large intestinal wall thickness ≥ 9 mm may be detected in patients with a variety of conditions. Ultrasonographic examination of all abdominal zones was helpful to determine the extent of thickening and identify additional findings that helped prioritize differential diagnoses.

Background and Aims We developed a through-the-scope twin clip (TTS-TC) for closing gastrointestinal wounds. The objective of this study was to evaluate the efficacy and safety of the TTS-TC in gastrointestinal wound closure. Methods Gastrointestinal nonperforating and perforating wounds (≥2.5 cm) were created in live pigs. TTS-TCs were used to convert the large wounds into small wounds. The remaining small wounds were closed using conventional through-the-scope clips (TTSC). The follow-up period was 1 month. Location and size of the wound, time of wound closure, intraoperative and postoperative adverse events and the conditions of wound healing were investigated. Results Thirteen wounds were created in 5 live pigs, including 2 gastric nonperforating and 3 perforating wounds, and 5 large intestinal nonperforating and 3 perforating wounds. The average long and short diameters of the wounds was 4.1 (0.9) cm, 3.4 (0.7) cm, respectively. All wounds were successfully closed using the TTS-TCs combined with TTSCs. The total average time for wound closure was 9.2 (5.3) minutes, and the average time for using the TTS-TCs was 3.9 (4.7) minutes. During the 1-month follow-up period, no bleeding, perforation, or death occurred, all the wounds healed with scar formation, and all the TTS-TCs detached spontaneously. Conclusions The TTS-TC was successfully used to close large-sized gastrointestinal wounds. The TTS-TC is a promising tool for large-size wound closure under flexible endoscopy.

Traditionally, the colon is considered a secondary intestinal segment in the drug absorption process. However, in many cases the role of colonic drug permeability cannot be overlooked. The purpose of this research was to compare colon permeability data obtained using two different rat perfusion methods the single-pass intestinal perfusion (SPIP) approach and the closed-loop (Doluisio) perfusion model. A list of 14 structurally diverse model drugs was constructed, and their rat colon permeability was studied using the two methods. The two sets of results were compared to each other, and were evaluated vs. in-vitro, ex-vivo, and in-vivo literature values. The SPIP and the Doluisio results exhibited good correlation between them (R2=0.81). The best correlation of both sets was obtained with transport studies across Caco-2 monolayers (R2∼0.9), as well as the sigmoidal fit vs. human fraction of dose absorbed (Fabs) data. On the other hand, Ussing chambers data, as well as lipophilicity (Log P) data, resulted in weak correlation to the in-situ results. In conclusion, the single-pass intestinal perfusion (SPIP) and the Doluisio (closed-loop) perfusion models were found to be equally convenient and useful for obtaining validated colon permeability values, although more human colonic Fabs data are needed for a better understanding of colonic drug permeability and absorption.

Intestinal intussusceptions and rectal prolapses deserve due attention and care because they have a high occurrence in the surgical clinic and require urgent intervention. Rectal prolapsed ileocecal intussusceptions are not so commonly seen on an outpatient basis and diagnosis is made to differentiate from simple rectal prolapses that does not compromise large intestinal segments and does not usually require celiotomy for its surgical reduction. Rectal examination is necessary in order to verify the difference here, since in simple rectal prolapse the thermometer or probe is not allowed to project between the prolapse and the anus. This report aims to present aspects related to rectal prolapsed ileo-cecal colic intussusception in canine species.

Background Horses that undergo surgery for treatment of primary large colon disease have been reported to be at increased risk of developing recurrent colic episodes postoperatively. The reasons for this are currently unknown. The aim of the current study was to characterise the faecal microbiota of horses with colic signs associated with primary large colon lesions treated surgically and to compare the composition of their faecal microbiota to that of a control group of horses undergoing emergency orthopaedic treatment. Faecal samples were collected from horses in both groups on admission to hospital, during hospitalisation and following discharge from hospital for a total duration of 12 weeks. Additionally, colonic content samples were collected from surgical colic patients if pelvic flexure enterotomy was performed during laparotomy. A total of 12 samples were collected per horse. DNA was extracted from samples using a commercial kit. Amplicon mixtures were created by PCR amplification of the V1 – V2 regions of the bacterial 16S rRNA genes and submitted for sequencing using the Ion Torrent PGM next-generation sequencing system. Multivariate data analysis was used to characterise the faecal microbiota and to investigate differences between groups. Results Reduced species richness was evident in the colonic samples of the colic group compared to concurrent sampling of the faeces. Alpha and beta diversity differed significantly between the faecal and colonic microbiota with 304 significantly differentially abundant OTUs identified. Only 46 OTUs varied significantly between the colic and control group. There were no significant differences in alpha and beta diversity of faecal microbiota between colic and control horses at admission. However, this lack of significant differences between groups should be interpreted with caution due to a small sample size. Conclusions The results of the current study suggest that faecal samples collected at hospital admission in colic cases may not accurately represent changes in upper gut microbiota in horses with colic due to large colon disease.

The present study evaluated the histopathological features, biological nature, anatomical location, sex, age and breeds of dogs affected by spontaneous gastrointestinal epithelial tumor. Biopsy samples of gastrointestinal tumors, from 95 dogs were examined and classified according to the WHO histological classification. A total of 131 samples, including 38 gastric, 13 small intestinal, and 80 large intestinal tumors were examined. The study observed that Jack Russell Terriers and Miniature Dachshunds were the breeds with the highest predisposition for gastrointestinal tumors. Gastric tumors included 5 adenomas, 30 adenocarcinomas (12 tubular, 2 papillary, 4 tubulopapillary and 12 signet-ring cell carcinomas) and 3 undifferentiated carcinomas. Intestinal tumors included 35 adenomas, 57 adenocarcinomas (43 acinar, 4 papillary, 7 mucinous and 3 signet-ring cell carcinomas), and 1 undifferentiated carcinoma. The study did not detect any difference among the incidence rates of invasion/metastasis in the tubular (44%), papillary (33%) and tubulopapillary (25%) adenocarcinomas. Additionally, the tubular (acinar), papillary and tubulopapillary adenocarcinomas were further divided into 48 polypoid and 17 non-polypoid types, based on their growth patterns. Invasion/metastasis was detected in 21% of the polypoid type and 100% of the non-polypoid type of adenocarcinomas. A correlation was detected between the occurrence of invasion/metastasis and the type of histopathological growth pattern in adenocarcinomas. The study demonstrated that Jack Russell terriers and Miniature Dachshunds are the most common breeds affected by gastrointestinal tumors and the entire group of the canine adenocarcinomas with non-polypoid growth pattern has greater malignant potentials, compared to the adenocarcinomas with polypoid growth patterns.

Colonoscopy is a common procedure that gastroenterologists perform on a daily basis. It is considered a low-risk outpatient procedure and patients can be discharged on the same day after the procedure. Colonoscopy has become more feasible with the increasing application of standard screening for colon cancer and diagnostic procedures for large intestinal disease. There are reported possible risk factors of splenic rupture during the procedure. However, splenic injury after colonoscopy is considered a rare complication and less than 100 cases have been reported in international literature. Interestingly, this is the first case report demonstrating systemic lupus erythematosus (SLE) as a possible risk factor leading to splenic rupture post-colonoscopy. Failure to recognise this possibility even in its rarity can lead to life-threatening complications. We present a case of an acute splenic rupture with massive intraperitoneal bleeding after colonoscopy in a patient with SLE.

Transplantation of microbiota from small intestine, not large intestine, of healthy mice exerts obvious effects on healthy recipients, bringing a new perspective on gut flora transplantation., Fecal microbiota transplantation is widely used. Large intestinal microbiota (LIM) is more similar to fecal microbiota than small intestinal microbiota (SIM). The SIM communities are very different from those of LIM. Therefore, SIM transplantation (SIMT) and LIM transplantation (LIMT) might exert different influences. Here, healthy adult male C57Bl/6 mice received intragastric SIMT, LIMT, or sterile PBS administration. Microbiota graft samples were collected from small/large intestine of healthy mice of the same age, sex, and strain background. Compared with PBS treatment, SIMT increased pellet number, stool wet weight, and stool water percentage; induced a fecal microbiota profile shift toward the microbial composition of the SIM graft; induced a systemic anti-inflammatory cytokines profile; and ameliorated depressive-like behaviors in recipients. LIMT, however, induced merely a slight alteration in fecal microbial composition and no significant influence on the other aspects. In sum, SIMT, rather than LIMT, affected defecation features, fecal microbial composition, cytokines profile, and depressive-like behaviors in healthy mice. This study reveals the different effects of SIMT and LIMT, providing an interesting clue for further researches involving gut microbial composition change.

To explore the effect of digestion on pea hull phenolics, an in vitro model consisting sequential oral, gastric, small and large intestinal digestions was applied to pea hulls. The phenolic content and antioxidant activity of the samples collected from these digestion steps were determined. The phenolics in these samples generally decreased in the order of sequential digestions in both red and yellow hull series, and no significant increase of total phenolic content (TPC), total flavonoid content (TFC) and individual phenolics were found in most digested groups compared with the corresponding control groups. The antioxidant activity of the samples generally changed according to their TPC and strong correlations (r 0.92, p 0.001) existed between them in red hull series. The present study implies that phenolics are released gradually from pea hulls during in vitro digestion and their release was mainly due to the pH of the digestion.

An adequate evaluation system for drug intestinal absorption is essential in the pharmaceutical industry. Previously, we established a novel prediction system of drug intestinal absorption in humans, using the mini-Ussing chamber equipped with human intestinal tissues. In this system, the TI value was defined as the sum of drug amounts transported to the basal-side component ( X corr ) and drug amounts accumulated in the tissue ( T corr ), which are normalized by AUC of a drug in the apical compartment, as an index for drug absorption. In order to apply this system to the screening assay, it is important to understand the differences between animal and human tissues in the intestinal absorption of drugs. In this study, the transport index (TI) values of three drugs, with different levels of membrane permeability, were determined to evaluate the rank order of drug absorbability in intestinal tissues from rats, dogs, and monkeys. The TI values in small intestinal tissues in rats and dogs showed a good correlation with those in humans. On the other hand, the correlation of TI values in monkeys was lower compared to rats and dogs. The rank order of the correlation coefficient between human and investigated animal tissues was as follows: dog ( r 2 = 0.978), rat ( r 2 = 0.955), and monkey ( r 2 = 0.620). TI values in large intestinal tissues from rats ( r 2 = 0.929) and dogs ( r 2 = 0.808) also showed a good correlation. The obtained TI values in small intestinal tissues in rats and dogs were well correlated with the fraction of drug absorbed ( F a ) in humans. From these results, the mini-Ussing chamber, equipped with intestinal tissues in rats and dogs, would be useful as a screening tool in the drug discovery stage. In addition, the obtained TI values can be used for the prediction of the F a in humans.

The diagnostic imaging evaluation of patients with suspected esophagogastrointestinal transit disorders is changing. Anatomical methods, e.g., barium studies, endoscopy, manometry, radiopaque markers, have long been the techniques available and used for diagnosis. The one exception has been gastric emptying, where radionuclide scintigraphy has been the standard for decades. Esophageal transit scintigraphy is an old and reliable methodology but probably underutilized. The diagnostic use of small and large intestinal transit scintigraphy is increasing, in part, because of the limitations of the other methods but, most importantly, because it is truly physiologic, i.e., the transit of radiolabeled food can be imaged and quantified from the mouth to rectum. Limitations to its wider use have been the lack of standardization, general availability, and reimbursement issues. Radionuclide methods are increasingly being used to evaluate esophagogastrointestinal transit in a single study, from top to bottom.

Animal experimental studies have found that resistant starch can significantly improve bowel function, but the outcomes are mixed while conducting human studies. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the relationship between resistant starch supplementation and large intestinal function. Three electronic databases (PubMed, Embase, Scopus) were searched to identify eligible studies. The standardized mean difference (SMD) or weighted mean difference (WMD) was calculated using a fixed-effects model or a random-effects model. The pooled findings revealed that resistant starch significantly increased fecal wet weight (WMD 35.51 g/d, 95% CI 1.21, 69.82) and butyrate concentration (SMD 0.61, 95% CI 0.32, 0.89). Also, it significantly reduced fecal PH (WMD -0.19, 95% CI -0.35, -0.03), but the increment of defecation frequency were not statistically significant (WMD 0.04stools/g, 95% CI -0.08, 0.16). To conclude, our study found that resistant starch elicited a beneficial effect on the function of large bowel in healthy adults.[Formula: see text].

Histological evidence of fibrosis affecting the outer layer of the large intestinal tunica muscularis was identified in five of 32 horses affected by colic. In three cases, foci of pale eosinophilia and vacuolation of myocytes were observed. These findings are suggestive of a degenerative and fibrotic abnormality in the outer layer of the tunica muscularis of the large intestinal smooth muscle of some horses with colic.

Torsion of an intraabdominal testis is a well-known complication and is usually associated with a testicular malignancy. Torsed intraabdominal testis compressing the large bowel leading to a mechanical gut obstruction is still an unreported entity. A 27 years old young patient presenting with nonspecific abdominal pain after 48 hours of delay. Due to features of gut obstruction, an emergency laparotomy was done. A large torsed intraabdominal testis was found with an empty right scrotum which was compressing the sigmoid colon leading to a complete gut obstruction. Interestingly, two of his siblings also were also suffering from undescended testicles.

797 Background: SBA is rare and often grouped with, and treated like, large intestinal adenocarcinomas. However, SBA has a very different microenvironment and could respond differently to the same therapies, potentially lowering efficacy. Also no standard treatments exist due to the lack of prospective randomized trials. We presented data at GI ASCO 2016 that suggested SBAs might benefit from targeting the PD-1/PD-L1 axis based on strong PD-L1 staining in ~50% of SBAs tested. Thus, we designed a pilot phase 2 trial to study safety and efficacy of avelumab in SBA. Methods: Patients (pts) with advanced (not amenable to surgery) or metastatic disease were eligible; ampullary tumors were considered part of the duodenum and allowed. Pts with prior PD-1/PD-L1 were excluded. Avelumab (10 mg/kg) was given every 2 weeks in 14-day cycles, and imaging was performed every 8 weeks. Primary endpoint was response rate (RR). Enrollment of 25 pts were planned, and avelumab would be considered active if ≥4 responses (RR≥16%) were observed (80% power, a = 5%). Secondary endpoints included disease-control rate (DCR) and progression-free survival (PFS). Results: Eight SBA pts (5 small intestine; 3 ampullary) were enrolled, with a majority (88%) being male and a median age of 61 years. Median time on treatment was 3.4 months; 1 patient is still on study with an ongoing partial response (PR). Of 7 efficacy-evaluable patients, 2 had a PR for a RR of 29%; DCR was 71% (5/7). Median PFS was 8.0 months. Most frequent, related adverse events were fatigue (38%), elevated alkaline phosphatase (25%), and infusion related reaction (25%), all ≤G2; a G3 (not serious) hypokalemia and a G4 (serious) diabetic ketoacidosis occurred in 1 pt each. Conclusions: Avelumab was considered safe, and antitumor activity was observed as evidenced by a 29% RR and 71% DCR. Despite this benefit, accrual was slower than expected and the study was closed early due to feasibility. A general clinical observation is that more pts are receiving immunotherapy off-label as the availability of these agents increases. This was a likely contributor to slow accrual, in addition to disease rarity. Analysis of PD-L1 expression, MSI status, and other immune cell markers is planned and will be compared to response. Clinical trial information: NCT03000179 .

Yoshiharu Uno Office Uno Column, Yota, Onoe-Cho, Kakogawa, Japan Purpose: Variations in the caliber of human large intestinal tract causes changes in pressure and the velocity of its contents, depending on flow volume, gravity, and density, which are all variables of Bernoulli’s principle. Therefore, it was hypothesized that constipation and diarrhea can occur due to changes in the colonic transit time (CTT), according to Bernoulli’s principle. In addition, it was hypothesized that high amplitude peristaltic contractions (HAPC), which are considered to be involved in defecation in healthy subjects, occur because of cecum pressure based on Bernoulli’s principle.Methods: A virtual healthy model (VHM), a virtual constipation model and a virtual diarrhea model were set up. For each model, the CTT was decided according to the length of each part of the colon, and then calculating the velocity due to the cecum inflow volume. In the VHM, the pressure change was calculated, then its consistency with HAPC was verified.Results: The CTT changed according to the difference between the cecum inflow volume and the caliber of the intestinal tract, and was inversely proportional to the cecum inflow volume. Compared with VHM, the CTT was prolonged in the virtual constipation model, and shortened in the virtual diarrhea model. The calculated pressure of the VHM and the gradient of the interlocked graph were similar to that of HAPC.Conclusion: The CTT and HAPC can be explained by Bernoulli’s principle, and constipation and diarrhea may be fundamentally influenced by flow dynamics. Keywords: colonic transit time, Bernoulli’s principle, constipation, diarrhea, high amplitude peristaltic contractions&nbsp

The objective of this study was to investigate the effects of fulvic acid (FA) and humic acid (HA), the two main compounds of humic substances (HSs), on copper (Cu) and zinc (Zn) homeostasis. Seventy-two male Wistar rats were randomly divided into nine experimental groups. The control diet (AIN-93G formula) and the diets supplemented with 0.1%, 0.2%, 0.4% and 0.8% FA or HA were fed for 26 days. Cu and Zn concentrations of the large intestinal content (LIC), liver, kidney, femur and hair were determined. FA and HA did not influence significantly the Cu or Zn contents of the experimental diets, the rats’ feed intake, weight gain and the feed to gain ratio. Both FA and HA decreased the Cu concentrations of the LIC significantly and in a dose-related manner; however the absorption-stimulating effect of HA was more pronounced. FA increased the Cu content of the liver, but neither FA nor HA had a dose-dependent effect on it. FA or HA supplementations had no significant effect on the Cu concentration of the kidney. At the concentrations used, dietary FA or HA supplementations are not promising growth promoters. FA influences the Cu homeostasis unlike HA, because FA not only stimulates Cu absorption, but the extra quantity of absorbed Cu is retained in the organism. The stimulatory effect of HA on Zn absorption may not be manifested in Cu and Zn homeostasis, because of the tight connection of these microelements to FA and HA, which prevents the transmission of Zn from the ZnHA complex to the organs. As regards the effect of FA and HA on Cu and Zn homeostasis, both FA and HA stimulated the absorption of these microelements, but only FA increased the retention of Cu (in the liver) and Zn (in the kidney).

This study examined the effects of anthocyanin-rich blackcurrant extract and dietary fibers individually and their combinations on biomarkers of large intestinal health in rats. After six weeks of feeding, rats fed diets with blackcurrant gained significantly less body weight and reduced their food intake resulting in a lower food efficiency compared with those rats fed control diets. Combining dietary fiber (apple or broccoli) with blackcurrant in the diet was more effective in reducing the body weight gain and food intake. Cecal bacterial populations and short-chain fatty acids differed between the experimental diets. Blackcurrants significantly altered the bacterial populations by increasing the abundance of Bacteroides-Prevotella-Porphyromonas group and Lactobacillus spp., while decreasing the abundance of Bifidobacterium spp. and Clostridium perfringens. Propionic acid concentrations were increased by the diets with blackcurrant. Butyric acid concentrations were increased by dietary fiber supplementation. Dietary fiber increased the number of goblet cells in the colon. Diets with blackcurrant were more effective in altering the biomarkers of large intestinal health than those without blackcurrant.

Tibial dyschondroplasia (TD) is a common skeletal problem of avian species. The cause and etiology of this disorder is still not clear. The intestinal bacterial community is a complex ecosystem and plays very important role in healthy life of human and animals. Many researchers have made the connection between diseases and alteration of gut microbiota. However, little is know about the role of gut microbiota in TD. The objective of this study was to explore the diversity and composition of small and large intestinal bacterial communities of TD chickens. The intestinal contests were collected from healthy and TD chickens at day 18 of the trail. The V3-V4 region of 16S rDNA was amplified and sequenced by high-throughput sequencing. Our results indicated that healthy chickens had higher abundance and diversity of gut microbiota than TD chickens but there was no significant difference (P 0.05) among the gut microbiota of small and large intestine. However, the composition of bacterial communities were significantly different (P 0.05) between healthy and TD chickens. The occurrence of gut pathogens associated with immunity and inflammation were much higher in the intestinal contests of TD chickens as compared to healthy ones. In summary, our results showed an interesting difference of gut microbiota between healthy and TD chickens, which provided a new thought about the pathogenesis of TD.

Evaluation of palm kernel shell ash (PKSA) as organic mineral supplement on broiler chicks performance was conducted. Ninety six Arbor Acre day old chicks were randomly assigned in 3 replicates of eight birds per replicate to four experimental diets containing graded levels of PKSA at 0, 5,10 and 15kg/ton of feed labeled T1, T2, T3 and T4 respectively. At 1st week of life, the chicks were assessed for growth performance, digestive tract development, histology and digesta pH. The growth performance of the chicks were affected (P less than 0.05) by the supplementation on treatment groups in all parameters except the FCR. The digestive tract development shown by percentage crop weight, proventriculus weight, liver weight and large intestinal weights were significantly affected. The histological analysis of the villi shows that birds consuming T1 and T3 diets were more developed (p less than 0.05) than those consuming T2 and T4 diets. The pH of the digesta contents in the GIT of the various segments showed that PKSA supplementation affected (P less than 0.05) them except those in the proventriculus and large intestine.The quadratic function showed that only pH of digesta in crop and small intestine were positively influenced (P less than 0.05) among the significant parameters by optimum inclusion levels of 25% and 17.5% PKSA respectively. Therefore, PKSA could be used favorably in broiler chicks production at levels of up to 10%.

Polyphenols, which occur in many vegetable and herbal medicines, are considered as the most active constituents to ameliorate metabolic syndrome in vitro and in vivo. To date, a great number of research works and reviews have addressed the bioefficient effect of phenolic compounds, however, the considerable diversity of their structures and in vivo bioavailability make them effect on different signaling pathways. First, polyphenols will be hydrolyzed by enzymes in intestinal before absorption. The large portion of polyphenolic compounds consist of several hydroxyl groups, which are enzymatic catalyzed by methylation, glucuronidation, or sulfatation. However, only 5%–10% of total polyphenolic compounds may be absorbed in the small intestine. The rest of polyphenols may be accumulated in the large intestinal and excreted in the faeces. During the process of absorption, polyphenols are often conjugated in the small intestine and later in the liver. The current chapter describes the absorption, bioavailability, and metabolomics of polyphenols.

BACKGROUND: Gastrointestinal symptoms are common in the general population and may originate from disturbances in gut motility. However, fundamental mechanistic understanding of motility remains inadequate, especially of the less accessible regions of the small bowel and colon. Hence, refinement and validation of objective methods to evaluate motility of the whole gut is important. Such techniques may be applied in clinical settings as diagnostic tools, in research to elucidate underlying mechanisms of diseases, and to evaluate how the gut responds to various drugs. A wide array of such methods exists; however, a limited number are used universally due to drawbacks like radiation exposure, lack of standardization, and difficulties interpreting data. In recent years, several new methods such as the 3D-Transit system and magnetic resonance imaging assessments on small bowel and colonic motility have emerged, with the advantages that they are less invasive, use no radiation, and provide much more detailed information.PURPOSE: This review outlines well-established and emerging methods to evaluate small bowel and colonic motility in clinical settings and in research. The latter include the 3D-Transit system, magnetic resonance imaging assessments, and high-resolution manometry. Procedures, indications, and the relative strengths and weaknesses of each method are summarized.

Achieving endoscopic remission has become one of the treatment goals in Crohn’s disease (CD) because recent studies have indicated that mucosal healing is associated with better CD outcomes after the initiation of medical treatment. Scoring the endoscopic disease severity is important, because endoscopy can objectively assess the severity of the disease. Crohn’s disease index of severity (CDEIS), the simple endoscopic score for Crohn’s disease (SES-CD), and the Rutgeerts postoperative endoscopic index are frequently used to assess endoscopic disease activity in CD. Changes in endoscopic scores are associated with clinical responses to medical treatments. CDEIS and SES-CD are clinically difficult to score. Although novel technologies to enable the diagnosis of small intestinal lesions have been developed, there have been few scoring systems to assess the severity of small intestinal lesions. The development of a simple score for both small and large intestinal lesions of CD is warranted.