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The Detection and Classification of Power Quality Disturbances (PQD) is important for quick diagnosis and mitigation disturbances. Poor power quality could have serious effects on sensitive electric devices. Consumers face difficulty to quantify the cost of failure equipment. There is a need to recognize and mitigate PQD to supply clean power to the consumer. In this Project PQDs simulated with MATLAB R2022b to be validated experimentally on a test bench using stepdown transformer

The behavior investigation of castellated beams with fiber-reinforced lightweight concrete deck slab as a modified choice for composite steel-concrete beams affected by harmonic load is presented in this study. The experimental program involved six fixed-supported castellated beams of 2140mm size. Three types of concrete were included: Normal Weight Concrete (NWC), Lightweight Aggregate Concrete (LWAC), and Lightweight Fiber-Reinforced Aggregate Concrete (LWACF). The specimens were divided into two groups: the first comprised three specimens tested under harmonic load effect of 30Hz operation frequency for 3 days, then the residual strength was determined through static load application. The second group included three specimens identical to those of group I, tested under static load only. The results show that LWAC was more influential than LWACF under harmonic load. The reduction in the residual strength of LWACF and NWC deck corresponding to the harmonic load was 0.94 and 0.7% respectively. The outcome proved that using LWACF as a deck for the castellated steel beams affected by harmonic load presents a significant choice with weight reduction of 16% compared to NWC. Steel fiber’s tensile strength 1700MPa enhanced the absorbed energy and the ductility factor by 0.4 and 0.5% respectively.

The study aimed at assessing the proximate composition, isolation, characterization of some Enterobacteriaceae from two (2) brands of poultry feeds marketed in Mando, Kaduna, Nigeria. A total of sixteen (16) samples of two (2) different poultry feeds (starter and finisher) from four (4) poultry farms in mando were collected and subjected to proximate and microbiological analysis. The proximate analysis was carried out using standard techniques and procedures. All the feed samples were cultured on separate media which include Eosin methylene blue (EMB), nutrient Agar (NA) and Salmonella-Shigella Agar (SSA) media using standard procedures. The antibiogram of the selected antibiotics was evaluated against the test isolates. The result of proximate analysis of the starter and finisher feeds indicated that the Dry matter of starter feed had the highest percentage composition of 95.02% and crude fiber of the finisher feed had the lowest composition of 3.78%. The highest number of bacterial load was recorded to be 10.0×104 CFU/g for the feed sample A (starter feed) and 12.0x104CFU/g was recorded for the feed sample B (finisher feed) which had the highest number of bacterial load recorded among the two (2) different poultry feeds analyzed. The bacteria isolates were identified as Salmonella species and Escherichia coli. Total viable count (TVC) of Salmonella species and E. coli in the feed samples (starter and finisher) ranges from 3.0×104CFU/g to 12.0×104CFU/g. Both organisms (Salmonella species, E. coli) were found as 37.5% and 25% of the analyzed feeds (Broiler starter and broiler finisher) samples, respectively. There was no level of significant (p>0.05) difference between the level of contamination of Salmonella species and E. coli in the two different feeds analyzed, as p=0.06 and p=0.13 for Salmonella species, and E. coli respectively. Sample A and B (Starter and Finisher) feeds had the highest number of Salmonella species occurrence with six ( 6) positive samples while E. coli was recorded in four (4) samples of A and B (Starter and Finisher) feeds. The result of the antibiogram indicated that ciprofloxacin (30 µg), Gentamycin (30µg), Perfloxacin (30µg) and Tarvid (30µg) was effective against Salmonella species and Escherichia coli. The significant of spread of the species of the Enterobacteriaceae in livestock feeds requires the need for effective quality assurance and control, good hygiene practices in production and proper handling of the poultry feeds.

Reduction of Heavy metals content from the polluted soil by tanneries in sokoto metropolitan using slurry of fungi A. aculeatus, A. niger and co-slurry of both was evaluated. Heavy metal Cu, Fe, Zn, Cd, Pb, Ni, and Cr content was determined in duplicate using atomic absorption spectrophotometer (AAS) up to 12 weeks. The reduction mean ranged was 6.51-9.09 mg/kg, 3.57-9.33 mg/kg and 2.12-10.12 mg/kg Cu for fungi carrying A. aculeatus, A. niger and co-slurry respectively while Cd, Ni and Pb were removed in all the setup. Chromium was decreased most especially in the co-slurry of both fungi 22.10-113.25 mg/kg. Meanwhile, Heavy metal contents in all the setups were different from the control. The study reveals local tanneries utilized many synthetic chemicals for use in their production which becomes detrimental to our soil environment.

Bacteriocin genes are biosynthetic genes which encodes proteins involved in bacteriocin regulation, self-immunity, transport and modification. This research was aimed at identifying the gene for the synthesis of bacteriocin. Four strains of lactic acid bacteria previously isolated from fermented foods (Nono (N2), Ogi (O3), Dawadawa (D1 and D3) and Wara (W3) were identified using molecular technique and used to produce bacteriocin. The bacteriocin activity was assayed against some test bacteria (Staphylococcus aureus, Escherichia coli, Klebsiella sp and methicillin resistant Staphylococcus aureus) using agar well diffusion method and the bacteriocin genes were identified using BAGEL3. The LAB identified were Lactobacillus fermentum O3, Leuconostoc mesenteroides N2, Weissella cibaria D1 and 2 strains of Lactobacillus plantarum D3 and W3. The entire identified LAB was able to produce bacteriocin. The antimicrobial activity showed varied inhibitory effects of the bacteriocins on the test bacteria. Bacteriocin from isolate O3 showed the highest inhibition zone 16mm on S. aureus. The identified gene for these bacteriocins were plnJK gene for Lactobacillus plantarum str WCFS1 and strain LZ95 (W3 and D3), entA gene for Lactobacillus fermentum str 3872 (O3) and ppnC7 gene for Leuconostoc mesenteroides str SRA3 (N2) with the interaction of other peptides were responsible for bacteriocin production.

Bio-preservation of Nigerian soft-white cheese (wara) in submerged consortium of bacteriocinogenic lactic acid bacteria (LAB) culture was investigated. Lactobacillus acidophilus PIT17 and Lactococcus lactis PIT30 were isolated from pito using the pour plate technique on MRS medium. The selection of L. acidophilus PIT17 and L. lactis PIT30 for the bio-preservation studies were based on their ability to produce acidophilin and nisin to inhibit the growth of the test isolates. The ‘wara’ were submerged in consortia of the L. acidophilus PIT17 and L. lactis PIT30 culture and were kept/stored at 2, 4, 6, 8, and 10°C and at room temperature. The shelf-life of the wara alongside control was determined. Physico-chemical and proximate analysis, microbial counts and organoleptic characteristics of the wara were also carried out before and after the bio-preservation. The shelf life of the wara were observed with a significant difference (p < 0.05) at storage temperatures of 2°C (5 days), 4°C (6 days), 6°C (4 days), 8°C (3 days), 10°C (6 days) and 24±1°C (3 days). The proximate analysis of wara showed significant difference (p < 0.05) at different storage temperatures employed. The total viable bacterial count (TVBC) of the cheese (wara) decreased significantly (p < 0.05) after 24 h of submerged bio-preservation of wara from 9.8 × 105 cfu/ml, 1.3 × 106 cfu/g to between 6.2 × 105 and 7.5 × 105 cfu/g. The organoleptic characteristics of wara revealed that there were significant difference (p < 0.05) in colour, texture, aroma, taste, and general acceptability. Key words: Organoleptic characteristics, proximate, physico-chemical, cheese, consortium.

Background: The wireless motility capsule concurrently measures temperature, pH and pressure as it traverses the gastrointestinal tract. Aims: To describe normative values for motility/contractility parameters across age, gender and testing centres. Methods: Healthy participants underwent a standardised wireless motility capsule assessment following an overnight fast and consumption of a meal of known nutritional content. Traces were divided into regions of interest and analysed using 2 software packages (MotiliGI and GIMS Data Viewer). Inter-observer agreement was independently assessed by 2 investigators. Results: Normative data for motility/contractility parameters (maximum amplitude, mean peak amplitude, contraction frequency and motility index) are presented for 107 individuals (62 male, median age 40 years, range 18-78). MotiliGI-Gastric, small bowel and colonic maximal contraction amplitude correlated with age (r =.24, P =.01; r =.22, P =.02; and r =.2, P =.04 respectively). Small bowel motility index was higher in females than males (150.4 ± 12 vs 122 ± 7.6, P =.04). Inter-observer agreement was excellent for transit times, pH and contractility/motility parameters. GIMS Data viewer-Gastric, small bowel and colonic log e motility index correlated with the respective area under the contraction curve, total contractions, sum of amplitudes and contraction frequency (all r>.35, P

Background The wireless motility capsule (WMC) offers the ability to investigate luminal gastrointestinal (GI) physiology in a minimally invasive manner. Aim To investigate the effect of testing protocol, gender, age and study country on regional GI transit times and associated pH values using the WMC. Methods Regional GI transit times and pH values were determined in 215 healthy volunteers from USA and Sweden studied using the WMC over a 6.5-year period. The effects of test protocol, gender, age and study country were examined. Results For GI transit times, testing protocol was associated with differences in gastric emptying time (GET; shorter with protocol 2 (motility capsule ingested immediately after meal) vs. protocol 1 (motility capsule immediately before): median difference: 52 min, P = 0.0063) and colonic transit time (CTT; longer with protocol 2: median 140 min, P = 0.0189), but had no overall effect on whole gut transit time. Females had longer GET (by median 17 min, P = 0.0307), and also longer CTT by (104 min, P = 0.0285) and whole gut transit time by (263 min, P = 0.0077). Increasing age was associated with shorter small bowel transit time (P = 0.002), and study country also influenced small bowel and CTTs. Whole gut and CTTs showed clustering of data at values separated by 24 h, suggesting that describing these measures as continuous variables is invalid. Testing protocol, gender and study country also significantly influenced pH values. Conclusions Regional GI transit times and pH values, delineated using the wireless motility capsule (WMC), vary based on testing protocol, gender, age and country. Standardisation of testing is crucial for cross-referencing in clinical practice and future research.

AIMS/HYPOTHESIS: We hypothesised that type 1 diabetic patients with established diabetic sensorimotor polyneuropathy (DSPN) would have segmental and/or pan-enteric dysmotility in comparison to healthy age-matched controls. We aimed to investigate the co-relationships between gastrointestinal function, degree of DSPN and clinical symptoms.METHODS: An observational comparison was made between 48 patients with DSPN (39 men, mean age 50 years, range 29-71 years), representing the baseline data of an ongoing clinical trial (representing a secondary analysis of baseline data collected from an ongoing double-blind randomised controlled trial investigating the neuroprotective effects of liraglutide) and 41 healthy participants (16 men, mean age 49 years, range 30-78) who underwent a standardised wireless motility capsule test to assess gastrointestinal transit. In patients, vibration thresholds, the Michigan Neuropathy Screening Instrument and Patient Assessment of Upper Gastrointestinal Symptom questionnaires were recorded.RESULTS: Compared with healthy controls, patients showed prolonged gastric emptying (299 ± 289 vs 179 ± 49 min; p = 0.01), small bowel transit (289 ± 107 vs 224 ± 63 min; p = 0.001), colonic transit (2140, interquartile range [IQR] 1149-2799 min vs 1087, IQR 882-1650 min; p = 0.0001) and whole-gut transit time (2721, IQR 1196-3541 min vs 1475 (IQR 1278-2214) min; p CONCLUSIONS/INTERPRETATION: Pan-enteric prolongation of gastrointestinal transit times and a more acidic caecal pH, which may represent heightened caecal fermentation, are present in patients with type 1 diabetes. The potential implication of delayed gastrointestinal transit on the bioavailability of nutrition and on pharmacotherapeutic and glycaemic control warrants further investigation.TRIAL REGISTRATION: EUDRA CT: 2013-004375-12.

Background Manual analysis of data acquired from manometric studies of colonic motility is laborious, subject to laboratory bias and not specific enough to differentiate all patients from control subjects. Utilizing a cross-correlation technique, we have developed an automated analysis technique that can reliably differentiate the motor patterns of patients with slow transit constipation (STC) from those recorded in healthy controls. Methods Pancolonic manometric data were recorded from 17 patients with STC and 14 healthy controls. The automated analysis involved calculation of an indicator value derived from cross-correlations calculated between adjacent recording sites in a manometric trace. The automated technique was conducted on blinded real data sets (observed) and then to determine the likelihood of positive indicator values occurring by chance, the channel number within each individual data set were randomized (expected) and reanalyzed. Key Results In controls, the observed indicator value (3.2 ± 1.4) was significantly greater than that predicted by chance (0.8 ± 1.5; P

Stereotypical changes in pH occur along the gastrointestinal (GI) tract. Classically, there is an abrupt increase in pH on exit from the stomach, followed later by a sharp fall in pH, attributed to passage through the ileocecal region. However, the precise location of this latter pH change has never been conclusively substantiated. We aimed to determine the site of fall in pH using a dual-scintigraphic technique. On day 1, 13 healthy subjects underwent nasal intubation with a 3-m-long catheter, which was allowed to progress to the distal ileum. On day 2, subjects ingested a pH-sensitive wireless motility capsule labeled with 4 MBq 51Chromium [EDTA]. The course of this, as it travelled through the GI tract, was assessed with a single-headed γ-camera using static and dynamic scans. Capsule progression was plotted relative to a background of 4 MBq 111Indium [diethylenetriamine penta-acetic acid] administered through the catheter. Intraluminal pH, as recorded by the capsule, was monitored continuously, and position of the capsule relative to pH was established. A sharp fall in pH was recorded in all subjects; position of the capsule relative to this was accurately determined anatomically in 9/13 subjects. In these nine subjects, a pH drop of 1.5 ± 0.2 U, from 7.6 ± 0.05 to 6.1 ± 0.1 occurred a median of 7.5 min (1–16) after passage through the ileocecal valve; location was either in the cecum ( n = 5), ascending colon ( n = 2), or coincident with a move from the cecum to ascending colon ( n = 2). This study provides conclusive evidence that the fall in pH seen within the ileocolonic region actually occurs in the proximal colon. This phenomenon can be used as a biomarker of transition between the small and large bowel and validates assessment of regional GI motility using capsule technology that incorporates pH measurement.

Background The morphology, motor responses and spatiotemporal organization among colonic propagating sequences (PS) have never been defined throughout the entire colon of patients with slow transit constipation (STC). Utilizing the technique of spatiotemporal mapping, we aimed to demonstrate ‘manometric signatures’ that may serve as biomarkers of the disorder. Methods In 14 female patients with scintigraphically confirmed STC, and eight healthy female controls, a silicone catheter with 16 recording sites spanning the colon at 7.5 cm intervals was positioned colonoscopically with the tip clipped to the cecum. Intraluminal pressures were recorded for 24 h. Key Results Pan-colonic, 24 h, spatiotemporal mapping identified for the first time in STC patients: a marked paucity of propagating pressure waves in the mid-colon (P = 0.01), as a consequence of a significant (P

This study aimed at evaluating the fermentative performance of Saccharomyces cerevisiae isolated from palm wine on honey slurry and dates palm fruit juice blend for wine production. The yeast was isolated from palm wine on saboraud dextrose agar (SDA) using pour plate technique and was identified using microscopic and standard biochemical techniques. Physicochemical parameters were determined during 21 days fermentation using standard procedures. The proximate composition of the blend before fermentation and the produced wine was evaluated. The microbiological and sensory evaluations of the produced wine was investigated. The yeast strain was identified as Saccharomyces cerevisiae. The fermentation recorded total viable yeast count from 2.5x106 to 13.0 x 106 CFU/mL. The physicochemical parameters revealed that during the fermentation, the pH values ranged from 4.3 to 5.4, percentage titratable acidity (TTA) ranged from 5.2 to 9.4. The temperature of the fermentation ranged from 24 to 29°C and the specific gravity values decreased steadily from 1.100 to1.010. Proximate composition of the date fruit revealed low protein content between 1.00 and 1.05, but high moisture content (82.43%). The produced wine contained reasonable amount of total carbohydrate A (19.59%), B (25.28%), C (22.7%) and D (21.88%). There were variations on other proximate compositions observed. The produced wine was not contaminated with bacteria and fungi. Sensory evaluation of the wine revealed acceptable aroma/flavor and taste. This study indicates that Saccharomyces cerevisiae strain from the palm wine have good fermentative performance which suggested that it could be used for fruit wine production and other industrial applications preceded by further experiments.

The influence of aqueous extracts of Basella alba on the growth of Desulfovibrio indonesiensis NCIMB 13468 and D. vulgaris NCIMB 8303 was examined. The active components of B. alba extract was determined by GC-MS. The result obtained revealed 46 components in the extract of B. alba. The 5 - 100% extract of B. alba was tested against serial dilution of D. indonesiensis and D. vulgaris. The results obtained revealed a ten times growth induction in 50-100% extracts after 1 day of growth when compared with untreated D. vulgaris and D. indonensiensis. After 2 days of growth, there was 100 times growth induction in 70 - 100 % extracts, 100 times growth induction in 5-100 % extract after 3 days and 10, 000 times growth induction after 4 days in 5-100% extracts. The biofilms of D. indonesiensis and D. vulgaris was examined using scanning electron microscopy and confocal laser scanning microscopy. The results obtained revealed an enhanced growth of the test organisms treated with extracts of B. alba when compared with untreated organisms. The results of this study suggest that aqueous extracts of B. alba can be used as a rapid detection tool for D. indonesiensis and D. vulgaris.Key words: Basella alba, extracts, induction, D. indonesiensis NCIMB 13468 and D. vulgaris NCIMB 8303.

Manual analysis of data acquired from manometric studies of colonic motility is laborious, subject to laboratory bias and not specific enough to differentiate all patients from control subjects. Utilizing a cross-correlation technique, we have developed an automated analysis technique that can reliably differentiate the motor patterns of patients with slow transit constipation (STC) from those recorded in healthy controls.Pancolonic manometric data were recorded from 17 patients with STC and 14 healthy controls. The automated analysis involved calculation of an indicator value derived from cross-correlations calculated between adjacent recording sites in a manometric trace. The automated technique was conducted on blinded real data sets (observed) and then to determine the likelihood of positive indicator values occurring by chance, the channel number within each individual data set were randomized (expected) and reanalyzed.In controls, the observed indicator value (3.2 ± 1.4) was significantly greater than that predicted by chance (0.8 ± 1.5; P0.0001). In patients, the observed indicator value (-2.7 ± 1.8) did not differ from that predicted by chance (-3.5 ± 1.6; P = 0.1). The indicator value for controls differed significantly from that of patients (P0.0001), with all individual patients falling outside of the range of indicator values for controls.Automated analysis of colonic manometry data using cross-correlation separated all patients from controls. This automated technique indicates that the contractile motor patterns in STC patients differ from those recorded in healthy controls. The analytical technique may represent a means for defining subtypes of constipation.

Introduction The wireless motility capsule (WMC) is a minimally invasive ambulatory technology that concurrently measures pressure, pH and temperature as it traverses the gastrointestinal (GI) tract. Knowledge gaps remain concerning GI motility in type 1 diabetes (T1DM) with established diabetic sensorimotor polyneuropathy (DSPN). It has been recently suggested that the change in pH across the ileocaecal valve (ICV) is a surrogate marker of bacterial fermentation in’the caecum. 1 The aim was to explore whether T1DM patients with DSPN have demonstrable GI dysmotility with in comparison to matched healthy controls. Furthermore, we aimed to investigate the co-relationships between motility, self-reported GI symptoms, quality of life and objective markers of DSPN. Methods 41 patients with T1DM with DSPN (33 male, mean age 51 years, range 35–71) and 41 healthy controls (28 male, mean age 51 years, range 28–78) underwent a WMC study using a standardised protocol following consumption of a meal of known nutritional composition (SmartBar). 2 Segmental transit was derived from measures around known anatomical landmarks as identified by compartmental pH changes. In patients, vibration thresholds and the Michigan Neuropathy Screening Instrument (MNSI) were collected in conjunction with self-reported GI symptoms (Patient Assessment of Upper Gastrointestinal Disorder Severity Symptom Index (PAGI-SYM)). Results Differences in regional and whole gut transit times are shown in Table 1. ICJ pH drop was associated with prolonged colonic transit (r = 0.34, p = 0.01). Multivariate linear regression, controlling for age, gender, duration of T1DM and glycaemic control, did not demonstrate an association between PAGI-SYM, regional or total transit times but higher vibration thresholds and MSNI were associated with prolonged gastric emptying time ( p = 0.03, p = 0.002 respectively). Conclusion T1DM is associated with prolongation of regional and whole gut transit prior to the development symptoms independent of disease duration and glycaemic control. Moreover, such prolongation is associated with clinical markers of DPSN. Further work is warranted to examine the longitudinal nature of these findings and whether pharmacotherapeutic interventions can lead to the restoration of normal motility. References 1 Farmer, et al . WJG 2014. 2 Wang YT, et al. APT 2015. Disclosure of Interest None Declared

The morphology, motor responses and spatiotemporal organization among colonic propagating sequences (PS) have never been defined throughout the entire colon of patients with slow transit constipation (STC). Utilizing the technique of spatiotemporal mapping, we aimed to demonstrate 'manometric signatures' that may serve as biomarkers of the disorder.In 14 female patients with scintigraphically confirmed STC, and eight healthy female controls, a silicone catheter with 16 recording sites spanning the colon at 7.5 cm intervals was positioned colonoscopically with the tip clipped to the cecum. Intraluminal pressures were recorded for 24 h.Pan-colonic, 24 h, spatiotemporal mapping identified for the first time in STC patients: a marked paucity of propagating pressure waves in the midcolon (P = 0.01), as a consequence of a significant (P0.0001) decrease in extent of propagation of PS originating in the proximal colon; an increase in frequency of retrograde PS in the proximal colon; a significant reduction in the spatiotemporal organization among PS (P0.001); absence of the normal nocturnal suppression of PS.Pancolonic, 24 h, spatiotemporal pressure mapping readily identifies characteristic disorganization among consecutive PS, regions of diminished activity and absent or deficient fundamental motor patterns and responses to physiological stimuli. These features are all likely to be important in the pathophysiology of slow transit constipation.

Previous studies report an association between joint hypermobility (JHM), as a clinical feature of underlying connective tissue (CT) disorder, and pelvic organ prolapse. However, its association with rectal evacuatory dysfunction (RED) has not been evaluated. To investigate the prevalence of JHM in the general population and in patients with symptoms of RED referred for anorectal physiological investigation.Bowel symptom and Rome III questionnaires to detect irritable bowel syndrome were sent to 273 patients with RED. Patients then underwent full investigation, including evacuation proctography. A validated 5-point self-reported questionnaire was used to assess JHM in both the patient group and 100 age- and sex-matched controls [87 female, median age 55 (range 28-87)].Seventy-three patients were excluded from analysis (incomplete questionnaire or investigation). Of 200, 65 patients [32%: 63 female, median age 52 (range 15-80)] and 14% of controls (P = 0.0005 vs patients) had features satisfying criteria for JHM. Overall constipation score (P 0.0001), abdominal pain (P = 0.003), need for manual assistance (P = 0.009), and use of laxatives (P = 0.03) were greater in the JHM group than the non-JHM group. On proctography, 56 of JHM patients (86%) were found to have significant morphological abnormalities (e.g. functional rectocoele), compared with 64% of the non-JHM group (P = 0.001).The greater prevalence of JHM in patients with symptoms of RED, and the demonstration of significantly higher frequencies of morphological abnormalities than those without JHM, raises the possibility of an important pathoaetiology residing in either an enteric or supporting pelvic floor abnormality of CT.

Colonic manometry is performed using either colonoscopically assisted catheter placement, after bowel preparation, or nasocolonic intubation of the unprepared bowel. There has been little systematic evaluation of the effects of bowel cleansing upon colonic propagating pressure wave sequences.Eight healthy volunteers underwent nasocolonic placement of a water-perfused silicone catheter which recorded pressures at 16 recording sites each spaced 7.5 cm apart in the unprepared colon for 24 h. These measures were compared with those obtained in another eight healthy volunteers in whom the catheter was placed to the caecum at colonoscopy in the prepared colon.The colonic motor responses to meals and morning waking, and the normal nocturnal suppression did not differ between the two groups, nor were the overall frequency, regional dependence nor extent of propagating sequences (PS) influenced by bowel preparation. Bowel preparation did result in a significant increase in the frequency of high amplitude PS (22 +/- 7 vs 8 +/- 4 HAPS/24 h; P = 0.003). Additionally, a number of the measures of spatiotemporal organization among consecutive PS (linkage among sequences and predefecatory stereotypical patterning) were significantly altered by bowel preparation.The overall frequency of PSs, the colonic responses to physiological stimuli such a meal and morning waking and nocturnal suppression, are not influenced by prior bowel preparation. However, investigators wishing to study HAPS frequency, or the more complex spatiotemporal relationships among consecutive PSs, should control for bowel preparation when making comparisons among study groups.

BACKGROUND Unexplained gastrointestinal (GI) symptoms and joint hypermobility (JHM) are common in the general population, the latter described as benign joint hypermobility syndrome (BJHS) when associated with musculo-skeletal symptoms. Despite overlapping clinical features, the prevalence of JHM or BJHS in patients with functional gastrointestinal disorders has not been examined. METHODS The incidence of JHM was evaluated in 129 new unselected tertiary referrals (97 female, age range 16-78 years) to a neurogastroenterology clinic using a validated 5-point questionnaire. A rheumatologist further evaluated 25 patients with JHM to determine the presence of BJHS. Groups with or without JHM were compared for presentation, symptoms and outcomes of relevant functional GI tests. KEY RESULTS Sixty-three (49%) patients had evidence of generalized JHM. An unknown aetiology for GI symptoms was significantly more frequent in patients with JHM than in those without (P < 0.0001). The rheumatologist confirmed the clinical impression of JHM in 23 of 25 patients, 17 (68%) of whom were diagnosed with BJHS. Patients with co-existent BJHS and GI symptoms experienced abdominal pain (81%), bloating (57%), nausea (57%), reflux symptoms (48%), vomiting (43%), constipation (38%) and diarrhoea (14%). Twelve of 17 patients presenting with upper GI symptoms had delayed gastric emptying. One case is described in detail. CONCLUSIONS & INFERENCES In a preliminary retrospective study, we have found a high incidence of JHM in patients referred to tertiary neurogastroenterology care with unexplained GI symptoms and in a proportion of these a diagnosis of BJHS is made. Symptoms and functional tests suggest GI dysmotility in a number of these patients. The possibility that a proportion of patients with unexplained GI symptoms and JHM may share a common pathophysiological disorder of connective tissue warrants further investigation.

Introduction The wireless motility capsule (WMC) allows investigation of regional gut transit times, intraluminal pH and pressure changes as it traverses the gastrointestinal tract. It is a useful diagnostic tool to confirm slow transit constipation (STC), which recent studies suggest is allied to dysregulated rather than impaired colonic motility (Dinning et al . NGM 2010). Whether luminal pH differs in STC is unknown. AIM: to compare colonic pressure and pH profiles between healthy volunteers (HV) and STC. Method data from 18 WMC studies in STC (15 female, median age 37; colon transit time (CTT) >72h) were compared to those of 112 HV (48 female; median age 43). Pressure and pH profiles were analysed for: (1) the whole colon; (2) within the caecum and proximal colon (first 60 min following passage of WMC through the ICJ); and (3) within the distal colon (last 60 min prior to WMC expulsion). Results overall frequency of colonic contractions was similar between STC and HV (STC: 3.0 ± 1.3/min vs. HV: 2.8 ± 1.2/min; P =NS). However, the colonic motility index (CMI) was significantly higher in STC than HV (STC: 330 ± 166 vs. HV: 184 ± 104; P .0001). CMI and CTT were positively correlated ( r = 0 .38; P = 0 .003). The proximal and distal colonic pressure profiles were similar between groups. For colonic pH profile, STC had a significantly more alkaline pH, both overall (STC: 7.7 ± 1.0 vs. HV: 6.8 ± 0.7; P .0001), and in the distal colon (STC: 8.1 ± 1 vs. HV: 7.2 ± 0.9; P = 0 .0004). Using linear regression modelling, alkaline pH was associated with an increase in the CMI when controlling for age and gender between groups (beta=62.1; P = 0 .023). Conversely, proximal colonic pH was more acidic in STC, manifest as a greater difference in pH across the ICJ than in HV (STC delta ICJ: 1.8 ± 0.6 vs. HV: 1.3 ± 0.8; P Conclusion the CMI was found to be higher in STC than HV, supporting a more contemporary acceptance of underlying dysregulation of colonic contractility rather than “inertia”. Differences in colonic pH in STC may reflect alterations in regional gut microbiota (i.e. dysbiosis), resulting in excessive production of acidic metabolites in the proximal colon (e.g. short-chain fatty acids) of STC patients, and more alkaline metabolites in the distal colon (perhaps related to methanogenic activity). The observed associations between colonic pH, CMI and CCT warrants further investigation; conceivably, this may represent a biomarker to sub-classify constipated patients, and identify those who may benefit from antibiotic and/or dietary interventions Disclosure of interest None Declared.

To ascertain whether caecal pH is different in patients with irritable bowel syndrome (IBS), whose primary symptoms are bloating and distension, to healthy controls.Motility and pH data were reviewed from 16 patients with Rome III defined IBS and 16 healthy controls, who had undergone a wireless motility capsule (WMC) study using a standardized protocol. Motility measures were anchored around known anatomical landmarks as identified by compartmental pH changes. Sixty-minute epochs were used to quantify antral, duodenal, ileal, caecal and distal colonic contractility. The maximum and minimum pH was measured either side of the ileo-caecal junction.No differences were seen in motility parameters, compartmental transit times or maximal ileal pH between the two groups. Caecal pH was significantly lower in patients compared to controls (5.12 ± 0.05 vs 6.16 ± 0.15, P0.0001). The ileal:caecal Δchange was greater in patients than controls (-2.63 ± 0.08 vs -1.42 ± 0.11, P0.0001). There was a significant correlation between caecal pH and right colonic contractility (r = 0.54, P = 0.002).Patients with bloating and distension have a lower caecal pH compared to controls. The measurement of caecal pH using the WMC provides a quantifiable biomarker of fermentation potentially identifying those patients that may preferentially benefit from antibiotic or dietary interventions.

Introduction The joint hypermobility syndrome (JHS) is a common non-inflammatory connective tissue disorder characterised by joint hyperflexibility and skin hyperelasticity. A validated 5 point hypermobility questionnaire screens for the presence or absence of JHS; formal diagnosis requires fulfilment of the Brighton criteria. Previous small cohorts demonstrate an association between the JHS and lower gastrointestinal symptoms (1), particularly alternating bowel habit with predominant constipation. The underlying mechanism for these symptoms is unknown. Methods Retrospective observational study of patients attending a specialist colorectal physiology unit for investigation of chronic constipation. Patients completed validated lower GI symptom and 5 point hypermobility questionnaires, then underwent lower GI physiology testing. 43 patients with an established rheumatological diagnosis of JHS were compared to 146 consecutive patients who screened negative (score = 0) for JHS (Non-JHS). Demographic features, prevalence of presenting symptoms, and physiological abnormalities were compared in JHS and Non-JHS. In view of the multiple comparisons, the significance level was set at p:0.01. Results In patients with constipation, those with JHS were younger, and females were more likely to be nulliparous. JHS patients had significantly more alternating bowel habit, infrequent bowel motions, abdominal pain, and childhood bowel problems. They were significantly more likely to require manual manoeuvres to help with rectal evacuation, but did not have an increased prevalence of other evacuatory symptoms. On physiology testing JHS patients had more rectal hyposensitivity, but were less likely to have internal (IAS) and external anal sphincter (EAS) abnormalities on ultrasound (see Table 1). There was no difference in the prevalence of pelvic dyssynergia, slow colonic transit or rectal morphological abnormalities. Conclusion JHS patients have more severe constipation which is likely to date back to childhood, and which requires digitation. These patients are more likely to have rectal hyposensitivity but less likely to have structural or transit abnormalities to account for their symptoms. The diagnosis of JHS should be considered in young nulliparous females with a longstanding history of very infrequent bowel motions. Disclosure of Interest None Declared Reference Castori, M., et al. , Am J Med Genet A, 2010. 152A (3): p. 556–64.

Introduction Fermentation of undigested carbohydrates by the colonic microbiota is an important part of maintaining a healthy colonic environment. However, excessive fermentation is thought to play a role in exacerbating symptoms of bloating, distension, pain and alternating bowel habit. By-products of the fermentation process include short chain fatty acids (SCFA’s) which reduce caecal pH. Measurement of caecal pH therefore provides an opportunity to objectively quantify aspects of fermentation but has been technically challenging to achieve. In this retrospective study, we compared intestinal pH and pressure profiles using an ingestible wireless motility capsule (WMC) (SmartPill, Buffalo, US) in healthy controls and patients with symptoms of bloating, distension, pain and alternating bowel habit. Methods Motility and pH data were reviewed from 16 healthy controls (Cx) and 16 age and sex matched patients (Px) that had undergone the WMC study using a standardised protocol. Motility measures (area under curve (AUC)) were anchored around known anatomical landmarks as identified by compartmental pH changes. 60-minute epochs were used to quantify antral, duodenal, ileal, caecal and distal colonic contractility. The maximum and minimum pH was measured either side of the ileo-caecal junction. All data are presented as means (±95% CI). Results No differences were seen in any of the motility parameters, compartmental transit times or maximal ileal pH between the two groups. Minimum caecal pH was significantly lower in patients compared to control (Px = 5.14 ± 0.14 v Cx = 6.12 ± 0.16, p Conclusion In this study, we have shown that patients with lower abdominal symptoms typically associated with, but not limited to, conditions such as irritable bowel syndrome (IBS) have a significantly lower caecal pH compared to controls. This low pH environment is maintained by fermentation and subsequent SCFA production. SCFA have been shown to inhibit colonic motility in-vitro and contractility as measured by the WMC was correlated with caecal pH. With the recent success of anti-biotic therapy and low fermentable diets in the treatment of lower bowel symptoms in IBS, measurement of caecal pH using the WMC provides an objective and quantifiable biomarker of fermentation. This may be used to sub-classify patients with a broad spectrum of GI disorders and identify those that may benefit most from antibiotic, probiotic and dietary interventions providing novel insights into the pathophysiological mechanisms of lower GI symptoms. Disclosure of Interest A. Hobson Paid Instructor for: Given Imaging, S. Mohammed: None Declared, G. Dukes Employee of: GSK, M. Scott: None Declared

Introduction: Perception of the urge to defaecate is essential to normal evacuation. Anecdotal reports suggest an alteration in the ‘call to stool' in some constipated patients, particularly those with impaired rectal sensation (hyposensitivity) on diagnostic testing, but this has not been robustly tested. This study aimed to objectively assess pre-defaecatory sensations in patients with chronic constipation (CC) in comparison to asymptomatic volunteers (HV), and further to evaluate the role of rectal sensory status. Method: 100 patients with CC and 23 HV (all F) completed a standardized diary / questionnaire over a 5 day period, assessing presence (yes/no), quality (verbal descriptors), intensity (VAS) and location (area of anatomical diagram) of the urge to defaecate prior to attempted evacuation, as well as a sense of how effective evacuation was (VAS). Patients were stratified by rectal sensory status (to latex balloon distension) into those with hyposensitivity (RH: n=21), normal rectal sensation (NS: n=66), or hypersensitivity (n=13). All HV had normal rectal sensation. Results: Over the study period, mean defaecatory attempts /per subject were 4.3 in CC and 4.5 in HV (P= NS). On 13% of occasions, patients with CC visited the toilet in the absence of any urge to defaecate, compared to only 4% of visits by HV (P=0.0003). In both groups, urge to defaecate was described most commonly as "pressure/fullness" (CC=66% vs. HV=60%; P= NS), but patients used multiple other descriptive terms also: "aching" (23 vs. 10%); "cramping" (15 vs. 5%); "colic" (11 vs. 1%); "burning" (5 vs. 0%); "butterflies" (10 vs. 3%); "bloating" (35 vs. 10%); "nausea" (10 vs. 0%) [CC vs. HV, respectively: P ,0.05 for all). Generally, HV described a posterior sensation located in the anorectum (CC=31% vs. HV= 62%; P,0.0001), whereas CC were more like to describe a poorly localised sensation both anteriorly and posteriorly (CC = 41% vs. HV = 19%; P=0.0001). The area of viscerosomatic referral was greater in CC than HV (CC = 3% of diagram area [range 0-35%] vs. HV = 2% [0-8]; P,0.0001). Compared to constipated patients with NS, those with RH: (1) were less likely to describe the urge to defaecate as "pressure" or "fullness" (P=0.03 & P=0.001, respectively); (2) were more likely to report the urge as a sense of "nausea/sickness" (P= 0.01); (3) described a more diffuse area of sensation (P=0.001), predominately anteriorly (median RH = 2.6% vs. NS = 0.8%; P=0.003); (4) considered evacuation to be more effective (VAS in RH = 5.0 vs. NS = 2.8; P=0.004). Conclusions: This study confirms that patients with constipation have altered perception (location, quality and strength) of the urge to defaecate, with the greatest alteration seen in those with rectal hyposensitivity. Whether sensory dysfunction should be regarded a therapeutic target in constipated patients warrants consideration.

Background Previous studies report an association between joint hypermobility (JHM), as a clinical feature of underlying connective tissue (CT) disorder, and pelvic organ prolapse. However, its association with rectal evacuatory dysfunction (RED) has not been evaluated. To investigate the prevalence of JHM in the general population and in patients with symptoms of RED referred for anorectal physiological investigation. Methods Bowel symptom and Rome III questionnaires to detect irritable bowel syndrome were sent to 273 patients with RED. Patients then underwent full investigation, including evacuation proctography. A validated 5-point self-reported questionnaire was used to assess JHM in both the patient group and 100 age- and sex-matched controls [87 female, median age 55 (range 28–87)]. Key Results Seventy-three patients were excluded from analysis (incomplete questionnaire or investigation). Of 200, 65 patients [32%: 63 female, median age 52 (range 15–80)] and 14% of controls (P = 0.0005 vs patients) had features satisfying criteria for JHM. Overall constipation score (P