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BACKGROUND: Objective monitoring of the severity of inflammation in patients with inflammatory bowel disease (IBD) is an essential part of disease management. However, repeat endoscopy to define extent and severity of inflammation is not practical. Fecal calprotectin (FC) is a biomarker that can be used as a surrogate test to distinguish inflammatory from noninflammatory gastrointestinal disease.

BACKGROUND: Adherence to maintenance medication regimens in inflammatory bowel disease patients has traditionally been poor. Although infliximab has demonstrated efficacy in inducing and maintaining disease remission, adherence to regularly scheduled infliximab infusions is required to maintain therapeutic trough drug levels and prevent the development of anti-infliximab antibodies.

BACKGROUND: Women with inflammatory bowel disease (IBD) may choose to remain childless due to a lack of IBD-specific reproductive knowledge.

BACKGROUND: Despite improvements in therapies for inflammatory bowel diseases (IBDs), patient quality of life continues to be significantly impacted.

Ileocolic resection (ICR) is the most common intestinal resection performed for Crohn's disease, with recurrences commonly occurring at the site of the anastomosis. This study used an animal model of ICR in wild-type mice to examine immunologic changes that developed around the surgical anastomosis and how these changes impacted gut responses to minor acute injury. ICR was performed in adult 129S1/SvlmJ mice and results compared with mice receiving sham or no surgery. Dextran sodium sulfate was given either on post-operative day 9 or day 24 to evaluate immune responses in the intestine both immediately following surgery and after a period of healing. Fecal occult blood measurements and animal weights were taken daily. Cytokine levels were measured in ileal and colonic tissue. Bacterial load in the neo-terminal ileum was measured using qPCR. Immune cell populations in the intestinal tissue, mesenteric lymph nodes, and spleen were assessed using flow cytometry. Cytokine secretion in response to microbial products was measured in isolated mesenteric lymph nodes and spleen cells. ICR resulted in an initial elevation of inflammatory markers in the terminal ileum and colon followed by enhanced levels of bacterial growth in the neo-terminal ileum. Intestinal surgical resection resulted in the recruitment of innate immune cells into the colon that exhibited a non-responsiveness to microbial stimuli. DSS colitis phenotype was more severe in the ileocolic resection groups and this was associated with local and systemic immunosuppression as evidenced by a reduced cytokine responses to microbial stimuli. This study reveals the development of an immune non-responsiveness to microbial products following ileocolic resection that is associated with enhanced levels of bacterial growth in the neo-terminal ileum. These surgical-induced altered immune-microbial interactions in the intestine may contribute to disease recurrence at the surgical anastomosis site following ileocolic resections in patients with Crohn's disease.

BACKGROUND: Constipation is an uncomfortable and common condition that affects many, irrespective of age. Since 1500 BC and before, health care practitioners have provided treatments and prevention strategies to patients for chronic constipation despite the significant variation in both medical and personal perceptions of the condition.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer in Canada. Screening guidelines recommend that first-time screening should occur at 50 years of age for average-risk individuals and at 40 years of age for those with a family history of CRC.

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning irritable bowel syndrome.

BACKGROUND: A population-based database of inflammatory bowel disease (IBD) patients is invaluable to explore and monitor the epidemiology and outcome of the disease. In this context, an accurate and validated population-based case definition for IBD becomes critical for researchers and health care providers.

The majority of patients diagnosed with Crohn’s disease eventually require surgical intervention. Unfortunately, postsurgical remission tends to be short lived; a significant number of patients experience clinical relapse and many require additional operations. The pathogenesis of this postoperative recurrence is poorly understood and, currently, there are no reliable tools to predict when and in whom the disease will recur. Furthermore, the postoperative prophylaxis profiles of available Crohn’s disease therapeutic agents such as 5-aminosalicylates, immunomodulators, steroids and probiotics have been disappointing. Recently, the combination of antibiotics and azathioprine in selected high-risk patients has demonstrated some potential for benefit. The goal of the present article is to provide a coherent summary of previous and new research to guide clinicians in managing the challenging and complex problem of postoperative Crohn’s disease recurrence.

BACKGROUND: The ideal bowel cleansing regimen for colonoscopy has yet to be determined.

BACKGROUND: The optimal topical anesthesia regimen for unsedated transnasal endoscopy is unknown. The addition of a nasal decongestant, such as xylometazoline (X), to a topical anesthestic may improve patient comfort.

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning inflammatory bowel diseases – specifically, Crohn’s disease and ulcerative colitis.

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease – a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Montreal definition).

BACKGROUND: Guidelines regarding the use of infliximab in Crohn’s disease were previously published by the Canadian Association of Gastroenterology in 2004. However, recent clinical findings and drug developments warrant a review and update of these guidelines.

Crohn’s disease (CD) is an idiopathic inflammatory bowel disease and has no known cure. CD symptoms are treated using an array of medicines, including biological agents such as infliximab. However, infliximab therapy is expensive; therefore, identifying variables that can help predict response to infliximab is worthwhile. The present article reviews the impact of tobacco smoking on the efficacy of infliximab in CD. Earlier studies have speculated that smoking has a negative effect on the response to infliximab in CD, but the current literature is largely unable to identify a significant relationship between the two. Although smoking is known to have a negative effect on the course of CD, as well as other organ systems, presently, a CD patient’s smoking status should not influence treatment decisions regarding infliximab therapy.

BACKGROUND: Infliximab’s efficacy in the induction and maintenance of remission in luminal Crohn’s disease has been confirmed by randomized, controlled trials. Less clearly described are long-term outcomes in the clinical practice setting since the establishment of regularly scheduled, every eight-week maintenance infliximab infusions. Existing reports describing clinical practice outcomes are limited by short durations of follow-up or by the use of episodic dosing, or focus on safety data rather than clinical outcomes.

Intramural hematoma of the gastrointestinal tract is an uncommon occurrence, with the majority being localized to the esophagus or duodenum. Hematoma of the gastric wall is very rare, and has been described most commonly in association with coagulopathy, peptic ulcer disease, trauma, and amyloid-associated microaneurysms. A case of massive gastric intramural hematoma, secondary to anticoagulation therapy, and a gastric ulcer that was successfully managed with conservative therapy, is presented. A literature review of previously reported cases of gastric hematoma is also provided.

Rachid Mohamed, Robert Schultz, Richard N FedorakDivision of Gastroenterology, University of Alberta, Edmonton, AlbertaAbstract: Crohn’s disease is a chronic inflammatory disease that can affect any part of the gastrointestinal tract. Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea. This case report describes a 38-year-old woman with Crohn’s disease who presented with odynophagia. Direct visualization of the oropharynx revealed a large serpiginous Crohn’s disease ulcer. A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn’s disease. This manuscript describes the presentation of oropharyngeal Crohn’s and reviews previous reports and management options.Keywords: Crohn’s disease, odynophagia, immunomodulatory therapy, oropharyngeal Crohn’s disease, aphthous ulcer, gastroscopy

Infliximab is a chimeric, monoclonal anti-tumour necrosis factor-alpha antibody. It has been previously demonstrated to be an effective treatment for patients with Crohn’s disease who do not achieve the desired response with conventional treatments. Although the etiology of ulcerative colitis (UC) differs from that of Crohn’s disease, randomized controlled trials have demonstrated that infliximab is also beneficial for the treatment of moderate to severe UC in patients who are either intolerant of or refractory to immunosuppressant agents or steroids, or those who are steroid-dependent. A review of the literature is followed by practical recommendations regarding infliximab that address the needs of clinicians and UC patients. Where there is a lack of evidence-based information, the expert panel provides its combined opinion derived from the members’ clinical experiences.

Crohn’s disease and ulcerative colitis are both idiopathic inflammatory bowel diseases (IBDs) that affect 0.5% of Canadians. As yet, there is no known cure for either disease, and symptoms are treated with an array of medicines. The objective of the present review was to present the role of exercise and its impact on all facets of IBD. Exercise has been speculated to be protective against the onset of IBD, but the literature is inconsistent and weak. Preliminary studies reveal that exercise training may be beneficial to reduce stress and symptoms of IBD. Current research also recommends exercise to help counteract some IBD-specific complications by improving bone mineral density, immunological response, psychological health, weight loss and stress management ability. However, the literature advises that some patients with IBD may have limitations to the amount and intensity of exercise that they can perform. In summary, exercise may be beneficial to IBD patients, but further research is required to make a convincing conclusion regarding its role in the management of IBD and to help establish exercise regimens that can account for each IBD patient’s unique presentation.

BACKGROUND: Alkaline sphingomyelinase, an enzyme found exclusively in bile and the intestinal brush border, hydrolyzes sphingomyelin into ceramide, sphingosine and sphingosine-1-phosphate, thereby inducing epithelial apoptosis. Reduced levels of alkaline sphingomyelinase have been found in premalignant and malignant intestinal epithelia and in ulcerative colitis tissue. Probiotic bacteria can be a source of sphingomyelinase.

The Canadian North Helicobacter pylori (CANHelp) working group is a team composed of investigators, health officials and community leaders from Alberta and the Northwest Territories. The group’s initial goals are to investigate the impact of H pylori infection on Canada’s Arctic communities; subsequent goals include identifying treatment strategies that are effective in this region and developing recommendations for health policy aimed at management of H pylori infection. The team’s investigations have begun with the Aklavik H pylori Project in the Aboriginal community of Aklavik, Northwest Territories.

BACKGROUND: Unsedated transnasal gastroscopy is a technique with unverified clinical advantages.

BACKGROUND: The association between ulcerative colitis (UC) and colorectal cancer (CRC) is well established. Retrospective data show a 5.4% CRC incidence rate among patients with pancolitis and suggest that cancer surveillance should be provided to patients following eight to 10 years of extensive UC.

BACKGROUND: Azathioprine (AZA), used to treat inflammatory bowel disease (IBD), is metabolized by thiopurine methyltransferase (TPMT). The accumulation of individual metabolites varies because humans display genetic polymorphism for TPMT expression. Deficiencies in TPMT result in accumulation of toxic metabolites, followed by neutropenia and hepatic inflammation. Concern over acute toxicity frequently leads to under dosing and frequent monitoring tests and visits.

BACKGROUND: Patients with inflammatory bowel disease (IBD) suffer physical dysfunction and impaired quality of life (QOL), and need frequent health care. They often lack knowledge about their disease and desire more education. Educational interventions for other chronic diseases have demonstrated reduced health care use and increased knowledge, medication adherence and QOL.

BACKGROUND: Despite advances in training, operative techniques and endoscopic technology, upper and lower endoscopic procedures continue to have potential for intestinal perforation. Perforation rates provided to patients at the time of consent have frequently been derived from historical cohorts and survey datasets.

These guidelines are presented as a follow-up to the original Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of infliximab in Crohn's disease, published in the Canadian Journal of Gastroenterology (1). The original guidelines represented publications between 1998 and 2000. The current guidelines have been updated to reflect knowledge gained from two pivotal randomized clinical trails, with the use of infliximab in the maintenance of inflammatory Crohn's disease in remission (2) and in the maintenance of fistulous Crohn's disease in remission (3).

BACKGROUND: Vitamin D deficiency is a putative, pathogenic cofactor in the increase in osteopenia and osteoporosis seen in patients with Crohn’s disease.

The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada in 2009. The current article presents the updated findings from the study concerning celiac disease.

The incidence of antibiotic resistance to amoxicillin, clarithromycin, erythromycin, metronidazole and tetracycline inHelicobacter pylori strains isolated from gastric biopsy specimens obtained in Alberta was investigated. Results for all antibiotics were obtained using agar dilution, and in addition to metronidazole, the E test was used. Resistance to amoxicillin and tetracycline was not detected. Metronidazole resistance determined using agar dilution was approximately 12% (95% CI 4% to 26%) when minimal inhibitory concentrations (MICs) were at least 8 µg/mL, but fell to 2% (95% CI 0.1% to 13%) when MICs were set at 32 µg/mL or greater. The E test for metronidazole resistance (MIC 8 µg/mL or greater) yielded a slightly higher percentage of resistant strains compared with agar dilution tests (14%, 95% CI 5% to 29%). One of the 31 strains was resistant to clarithromycin (MIC 8 µg/mL) and erythromycin (MIC 16 µg/mL). Thus, the incidence of resistance to clarithromycin, part of the currently used triple therapy for eradication of H pylori, was 3% (95% CI 0.1% to 17%).

BACKGROUND:The quality of colonoscopies performed by primary care physicians (PCPs) is unknown. OBJECTIVE:To determine whether PCP colonoscopists achieve colonoscopy quality benchmarks, and patient satisfaction with having their colonoscopy performed by a primary care physician. DESIGN:Prospective multi-center, multi-physician observational study. Colonoscopic quality data collection occurred via completion of case report forms and pathological confirmation of lesions. Patient satisfaction was captured by a telephone survey. SETTING:Thirteen rural and suburban hospitals in Alberta, Canada. MEASUREMENTS:Proportion of successful cecal intubations, average number of adenomas detected per colonoscopy, proportion of patients with at least one adenoma, and serious adverse event rates; patient satisfaction with their wait time and procedure, as well as willingness to have a repeat colonoscopy performed by their primary care endoscopist. RESULTS:In the two-month study period, 10 study physicians performed 577 colonoscopies. The overall adjusted proportion of successful cecal intubations was 96.5% (95% CI 94.6-97.8), and all physicians achieved the adjusted cecal intubation target of ≥90%. The average number of ademonas detected per colonoscopy was 0.62 (95% CI 0.5-0.74). 46.4% (95% CI 38.5-54.3) of males and 30.2% (95% CI 22.3-38.2) of females ≥50 years of age having their first colonoscopy, had at least one adenoma. Four serious adverse events occurred (three post polypectomy bleeds and one perforation) and 99.3% of patients were willing to have a repeat colonoscopy performed by their primary care colonoscopist. LIMITATIONS:Two-month study length and non-universal participation by Alberta primary care endoscopists. CONCLUSIONS:Primary care physician colonoscopists can achieve quality benchmarks in colonoscopy. Training additional primary care physicians in endoscopy may improve patient access and decrease endoscopic wait times, especially in rural settings.

Metabolomic profiling can be used to study disease-induced changes in inflammatory bowel diseases (IBD). The aim of this study was to investigate the difference in the metabolomic profile of males and females as they developed IBD. Using the IL-10 gene-deficient mouse model of IBD and wild-type mice, urine at age 4, 6, 8, 12, 16, and 20 weeks was collected and analyzed by nuclear magnetic resonance (NMR) spectroscopy. Multivariate data analysis was employed to assess differences in metabolomic profiles that occurred as a consequence of IBD development and severity (at week 20). These changes were contrasted to those that occurred as a consequence of gender. Our results demonstrate that both IL-10 gene-deficient and wild-type mice exhibit gender-related changes in urinary metabolomic profile over time. Some male-female separating metabolites are common to both IL-10 gene-deficient and control wild-type mice and, therefore, appear to be related predominantly to gender maturation. In addition, we were able to identify gender-separating metabolites that are unique for IL-10 gene-deficient and wild-type mice and, therefore, may be indicative of a gender-specific involvement in the development and severity of the intestinal inflammation. The comparison of the gender-separating metabolomic profile from IL-10 gene-deficient mice and wild-type mice during the development of IBD allowed us to identify changes in profile patterns that appear to be imperative in the development of intestinal inflammation, but yet central to gender-related differences in IBD development. The knowledge of metabolomic profile differences by gender and by disease severity has potential clinical implications in the design of both biomarkers of disease as well as the development of optimal therapies.

Inflammatory bowel diseases (IBD), which consists of Crohn disease and ulcerative colitis, are chronic inflammatory conditions of the gas-trointestinal tract. In genetically susceptible individuals, the interaction between environmental factors and normal intestinal commensal flora is believed to lead to an inappropriate immune response that results in chronic inflammation. The incidence of IBD have increased in the past century in developed and developing countries. The purpose of the present review is to summarize the current knowledge of the association between environmental risk factors and IBD. A number of environmental risk factors were investigated including smoking, hygiene, microorganisms, oral contraceptives, antibiotics, diet, breast-feeding, geographical factors, pollution and stress. Inconsistent findings among the studies highlight the complex pathogenesis of IBD. Additional studies are necessary to identify and elucidate the role of environmental factors in IBD etiology.

Because the limiting and vulnerable zinc pool has not been identified, it becomes a challenge to determine which of the many zinc pools is most susceptible to deficiency. As a consequence, defining and assessing zinc status in the individual patient is a somewhat uncertain process. Laboratory analysis of zinc status is difficult because no single biochemical criterion can reliably reflect zinc body stores. Many indexes have been examined in the hopes of discovering a method for the assessment of zinc nutriture. None of the methods currently used can be wholeheartedly recommended because they are fraught with problems that affect their use and interpretation. However, these methods remain in use for clinical and research purposes, though their benefits and drawbacks must always be acknowledged. Until an acceptable method of analysis is discovered, clinicians must rely for confirmation of zinc deficiency on a process of supplementing with zinc and observing the patient’s response. The main indexes (plasma/serum, erythrocyte, leukocyte, neutrophil, urine, hair and salivary zinc levels, taste acuity and oral zinc tolerance tests, and measurement of metallothionein levels) are reviewed. Measurement of plasma or erythrocyte metallothionein levels shows promise as a future tool for the accurate determination of zinc status.

Osteoporosis has long been a recognized complication of Crohn’s disease (CD), with a documented incidence ranging from 31% to 65%. The cause of osteoporosis in Crohn’s patients is likely multifactorial; corticosteroids, inflammatory cytokines, small bowel resection and the resultant calcium and vitamin D deficiencies, hypogonadism, malnutrition and the cachexia of inflammation all play a role. However, the mechanism responsible for osteoporosis associated with CD remains unclear. Treatment of decreased bone density in CD patients has been limited to calcium and vitamin D replacement. The present understanding of the pathophysiology, mechanism and treatment of osteoporosis in CD is reviewed, with the focus on the role of steroid-induced osteoporosis and the use of bisphosphonates.

Available evidence suggests that trace elements, such as zinc, once thought to have no nutritional relevance, are possibly deficient in large sections of the human population. Conditioned deficiencies have been reported to result from malabsorption syndromes, acrodermatitis enteropathica, alcoholism, gastrointestinal disease, thermal injury, chronic diseases (eg, diabetes, sickle cell anemia), and in total parenteral nutrition therapy. Awareness that patients with these problems are at risk has led health professionals to focus increasingly on the importance of zinc therapy in the prevention and treatment of deficiency. More recently zinc toxicity and its role in human nutrition and well-being have come under investigation. Reports have focused on the role of zinc toxicity in causes of copper deficiency, changes in the immune system and alterations in blood lipids. As the numerous challenges presented by the study of zinc in human nutrition are met, more appropriate recommendations for dietary and therapeutic zinc intake are being made.

BACKGROUND: In a recent clinical trial gastrointestinal tract perforations in patients on nonsteroidal anti-inflammatory drugs (NSAIDs) were found to occur with a frequency of 0.15%, and possibly to be reduced in patients concomitantly using the cytoprotective agent misoprostol.

The body requires certain levels of essential nutrients, such as zinc, to maintain life. Intake less than the required levels can cause impaired function, disease and death. Every essential nutrient has a unique range of tissue concentration and intake necessary for proper physiological and biochemical functioning. Many criteria have been used to set dietary intake levels for nutrients. For trace elements, however, a limited number of investigative approaches are currently employed by researchers due to inadequate information on individual requirements and intake levels. Further, a clear lack of satisfactory biochemical methods to measure zinc nutritional status continues to hinder formulation of dietary guidelines. Thus, many assumptions have to be made, and large safety margins have to be added to assumed daily requirements in order to compensate for this absence of information. Numerous barriers to a full understanding of what constitutes an adequate dietary recommendation for zinc still exist. Zinc is incompletely absorbed, and this absorption can be greatly influenced by the chemical form in which zinc is bound; interactions with other nutrients also affect absorption. Part three of this five-part review presents the current Canadian recommended nutrient intakes for zinc for various sex and age categories and provides a rationale for the suggested values. The important nutrient interactions that affect the bioavailability of zinc, including those with phytates, copper, cadmium, tin and iron, are discussed.

Although zinc has been the most intensely studied trace element, much remains to be learned about its metabolism. Little is known about the normal mechanisms of absorption and transport across the intestinal tract. In addition, numerous unknowns surround the intricacies of bodily zinc homeostasis. Part two of this five-part review presents current views on the normal intestinal absorption, intracellular and extracellular metabolism, transport, excretion and homeostasis of zinc in the human body. The alterations in zinc metabolism that occur with age and changing physiological conditions are also discussed.

The tremendous technological advances in trace element analysis seen in recent years have stimulated and facilitated research in a number of disciplines including microbiology, nutrition, agriculture, clinical medicine and, most recently, psychology. The importance of trace elements to human health is receiving greater attention as clinical cases of deficiency and toxicity are described. Zinc has been recognized as an essential trace element for humans since the early 1960s. It has been found to play a critical role in the physiological and biochemical well-being of humans. This review discusses the tissue distribution, concentration and intracellular binding of zinc in healthy humans. (Other reviews in this five-part series will appear in following issues.) The biochemical roles of zinc, including its involvement in the actions of metalloenzymes, cell synthesis, wound healing, growth, reproduction, hormone metabolism, cellular structural stability and immunological processes, are highlighted in order to provide an understanding of the unique and extensive role zinc plays in the biochemistry of the human body.

A critical role for the gut epithelium lies in its ability to discriminate between pathogens and commensals and respond appropriately. Dysfunctional interactions between microbes and epithelia are believed to have a role in inflammatory bowel disease (IBD). In this study, we analyzed microbiota and gene expression in IBD patients and examined responses of mucosal biopsies to bacterial DNA.Biopsies were taken from non-inflamed areas of the colon in healthy controls (HC) and Crohn's disease (CD) and ulcerative colitis (UC) patients in remission. Biopsies were snap-frozen or cultured with DNA from Lactobacillus plantarum (LP) or Salmonella dublin (SD). Gene expression was analyzed under basal conditions and in response to DNA. Gene networks were analyzed using Ingenuity Pathways software. Mucosal-associated microbiota was analyzed using terminal restriction fragment length polymorphism. Frequency of single nucleotide polymorphisms in NOD2 and TLR9 was assessed.Patients with IBD had altered microbiota, enhanced expression of inflammatory genes, and increased correlations between specific gene expression and microbes. Principle component analysis showed CD and UC patients to cluster independently from healthy controls in both gene expression and microbial analysis. DNA from LP stimulated anti-inflammatory pathways in controls and UC patients, but induced an upregulation of IL17A in CD patients. There were no differences in SNP frequencies of TLR9 or NOD2 in the groups.Patients with Crohn's disease exhibit altered responses to bacterial DNA. These findings suggest that the gut response to bacterial DNA may depend not only on the specific type of bacterial DNA, but also on the host.

Glutamine is the primary metabolic fuel of the small intestine. The ability of enteral glutamine to support jejunal architecture and metabolism is well established, but its effect on intestinal absorptive function, especially in the terminal ileum, remains undetermined. The purpose of this study was to develop a functional ileal fluid absorption surgical injury model and to determine if oral glutamine supplementation would be beneficial in accelerating healing and restoring function. The effects of either 1 cm resection and ileal end-to-end anastomosis or sham laparotomy on rat in vivo fluid absorption at study start (day 0), one and two days was investigated. In sham-operated rats, fluid absorption was not altered. In contrast, ileal fluid absorption was significantly reduced at days 0 (17.2±4.8 μL/cm/h) and 1 (31.4±13.6 μL/cm/h), but returned to normal by day 2 (71.0±6.2 μL/cm/h) in anastomosed rats. To examine the effects of glutamine in this model, rats were fed either glutamine (2.4 g/kg/day) or an isonitrogenous glycine-supplemented elemental oral diet for five days before their randomization to sham or anastomotic groups. This dose of glutamine reached the ileum and was completely absorbed along the small intestine. Glutamine-fed rats demonstrated no difference in recovery of in vivo ileal fluid absorption, ileal villus morphometric measurements, mg DNA:mg protein ratio, degree of inflammation or glutaminase activity. In contrast, jejunal, but not ileal, villus morphometry, mg DNA:mg protein ratio and glutaminase activity were increased in glutamine-fed ‘not operated’ rats (P

Psychological stress may alter gastrointestinal absorptive function by increasing the quantity of intestinal free radicals or by lowering endogenous intestinal free radical scavenging capacity. Vitamin E has been shown to be a potent endogenous antioxidant and free radical scavenger under both physiological and pathological conditions. The purpose of this study was to determine whether cold wrap restraint stress altered in vivo intestinal fluid absorption in rats, and whether vitamin E administration prior to the induction of cold wrap restraint stress could prevent such changes in intestinal secretion. Jejunal, ileal and colonic fluid and electrolyte transport rates were measured in vivo using an isolated loop technique. Cold wrap restraint stress reduced in vivo fluid absorption in the ileum and colon, but not in the jejunum. Administration of vitamin E prior to the cold wrap restraint stress procedure completely prevented this alteration of ileal and colonic fluid absorption.