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Effect of multi-strain probiotic along with dietary and lifestyle modifications in the management of polycystic ovary syndrome (PCOS) has rarely been reported. We thus aimed to investigate the effect of multi-strain probiotic (Lactobacillus acidophilus UBLA-34, L. rhamnosus UBLR-58, L. reuteri UBLRu-87 (each of 2 billion colony forming units (CFU)); L. plantarum UBLP-40, L. casei UBLC-42, L. fermentum UBLF-31, Bifidobacterium bifidum UBBB-55 (each of 1 billion CFU) and fructo-oligosaccharides (100 mg)) and dietary and lifestyle modifications on restoration of menstrual regularity, weight reduction, metabolic and hormonal profile in women with PCOS.A 104 participants (age 18-40 years) were randomly allocated to receive probiotic or placebo capsules for 6 months. Baseline and end line assessment were performed for menstrual cycle regularity, ultrasonography scan for ovaries, total testosterone, dehydroepiandrosterone (DHEAS), insulin, luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio, fasting blood sugar (FBS), homeostatic model assessment-insulin resistance (HOMA-IR), weight reduction, waist-/hip circumference (WC, HC), waist to hip ratio (WHR), and body mass index (BMI). Plasma lipopolysaccharide and effect of intervention on quality of life was investigated. Diet and exercise were controlled during the trial.Probiotic supplement along with dietary and lifestyle modifications significantly regularised menstrual cycle (p 0.023), improved levels of total testosterone (p 0.043), WC (p 0.030), WHR (p 0.027) and menstrual domain of quality of life (p 0.034) as compared to placebo. No adverse events related to study were reported.Multi-strain probiotic along with dietary and lifestyle modifications were effective in the management of PCOS.CTRI: CTRI/2016/07/007086, dated 13 July 2016.

Irritable bowel syndrome (IBS) is a multifactorial disorder with altered intestinal motility, secretion, and sensation. Serotonin (5-HT) stimulates gut motility and alters serotonin signaling that may lead to both intestinal and extraintestinal symptoms in IBS.The aim of this study was to examine the association of serotonin transporter gene promoter polymorphism (5-HTTLPR) in IBS with orocecal transit time (OCTT) measured by lactulose hydrogen breath test.This prospective case-control study included 151 IBS patients (mean±SD 37.4±11.6 years, median 36, range 19-68). Ninety-two patients were diarrhea-predominant IBS (D-IBS), 44 constipation-predominant IBS (C-IBS), 15 alternating diarrhea and constipation IBS (M-IBS), and 100 healthy controls (mean±SD 37.2±11.4 years, median 36, range 20-64 years). 5-HTTLPR gene polymorphism was studied by polymerase chain reaction-based method. 5-HT levels were measured by enzyme-linked immunosorbent assay (ELISA). Orocecal transit time (OCTT) was measured by a non-invasive lactulose hydrogen breath test. OCTT was also compared with respect to 5-HTTLPR genotypes in different IBS phenotypes.Serum serotonin levels were significantly higher in overall IBS patients (152±77 ng/mL, p0.001), D-IBS (184±76 ng/mL, p0.001), compared to healthy controls (129±56 ng/mL). There was no difference in 5-HT levels between C-IBS (124±53 ng/mL) and controls. In the case of M-IBS, 5-HT levels were (88±49 ng/mL p0.05) significantly lower than that of controls. OCTT was significantly shorter in D-IBS patients (95±36 min) as compared to controls (112±41 min). In contrast, C-IBS showed significantly prolonged OCTT (136±54 min). There was a significant difference in OCTT between D-IBS and C-IBS patients (p0.001). There was no significant association found between OCTT and 5-HTTLPR.Serum serotonin concentrations were increased in D-IBS compared to controls and C-IBS. OCTT was shorter in D-IBS and delayed in C-IBS patients. There was no association of 5-HTLPR polymorphism with OCTT.

Uncontrolled diabetes mellitus may affect any part of the gastrointestinal tract (GIT) and impact negatively the quality of life. Angiotensin-converting enzyme (ACE) gene polymorphism can have direct effect on circulating level of ACE which further modifies the degradation of substance P and thus may influence the gut motility. Hence, it could be hypothesised that ACE gene polymorphism would influence the gut motility. An observational analytical study was conducted at PGIMER, Chandigarh. 300 Type2 diabetes mellitus (T2DM) and 200 age and sex matched healthy individuals were enrolled. After taking written consent, 5 ml blood sample was collected for measurement of substance P by ELISA method and for ACE gene polymorphism (insertion[I]/deletion[D]) by polymerase chain reaction. Orocecal transit time (OCTT) was measured using non-invasive lactulose breath test. Out of 300 diabetic patients, 32.7%, 44% and 23.3% belonged to II, ID and DD genotypes, respectively. The frequency of D allele (OR = 1.39) and DD genotype (OR = 2.17) was significantly higher in patients than in controls and was associated with increased risk. Moreover, more number of diabetes patients with constipation (90%) belonged to DD genotype and their OCTT was significantly delayed (166.7 ± 7.3 min) as compared to ID (143.5 ± 4.2 min) or II (121.8 ± 4.9 min) genotype. From this study, it could be concluded that ACE gene polymorphism could be an important contributing factor to influence the gut motility and thus giving rise to the GI symptoms for T2DM patients.

Serotonin (5-HT) release and serotonin reuptake transporter (5-HTT) expression have been reported to be decreased in experimental colitis, in interleukin-10 knockout-associated colitis, and in patients with ulcerative colitis. Serotonin is known to play an important role in the pathogenesis of colitis, but individual genetic variants of 5-HTT gene in microscopic colitis and ulcerative colitis are not known. This study aimed to evaluate the association between the serotonin transporter gene promoter polymorphism (5-HTTLPR) and 5-HT concentration in microscopic colitis (MC) and ulcerative colitis (UC) patients. This prospective case–control study included 41 patients with microscopic colitis (age 19–82 years, mean 35 ± 13.6), 75 patients with ulcerative colitis (age 16–65 years, mean 38.5 ± 11.6), and 100 controls (age 20–64 years, mean 38 ± 11). 5-HTTLPR gene polymorphism was studied by polymerase chain reaction-based assay. 5-HT levels were measured by ELISA. The frequency of the 5-HTTLPR (SS) genotype was significantly lower in MC (12 %) patients compared to controls (30 %) (p

Background: Studies of serotonin reuptake transporter (SERT-P) polymorphism and irritable bowel syndrome (IBS) have shown diverse results among different populations, which might be due to racial and ethnic difference. Aim: This study was to investigate the potential association between the SERT-P polymorphism and clinical subtypes of IBS patients in the Indian population. Method: This prospective case-control study included 151 IBS patients. Ninety-two patients were diarrhea-predominant IBS, 44 were constipation-predominant IBS (C-IBS), 15 were alternating diarrhea and constipation IBS, and 100 were healthy controls. SERT gene polymorphism was studied by polymerase chain reaction. Result: A genotypic association was observed between SS genotype of SERT-P polymorphism and C-IBS (P < 0.05). When the L/S and L/L genotypes were combined into one group, the frequency of the S/S genotype was significantly higher than that of the non-S/S genotype between C-IBS and the control group (P < 0.05). There was no significant difference in the SERT-P genotype and allele frequency between c-ibs, alternating diarrhea and constipation IBS, all types of IBS cases, and controls. Conclusions: A significant association was observed between the SS genotype of SERT-P polymorphism and C-IBS in the Indian population.

Flatulence is a common symptom in patients with irritable bowel syndrome (IBS). This may be due to production of hydrogen by intestinal flora. With the presence of methanogenic flora, 4 mol of hydrogen (H(2)) are used with 1 mol of carbon dioxide (CO(2)) to produce 1 mol of methane (CH(4)), a process greatly reducing the volume of gas in the colon. However, the prevalence of methanogenic flora has not yet been reported in healthy and IBS patients from North India. Therefore, this study was planned.This study was conducted prospectively and included 345 patients with irritable bowel syndrome (fulfilling Rome II criteria) and 254 age- and gender-matched apparently healthy controls. Each subject underwent a hydrogen breath test using 10 g lactulose after an overnight fast. An SC Microlyser from Quintron, USA, was used to measure methane and hydrogen at baseline and at every 30 min for 4 h. Subjects with fasting methane concentration10 p.p.m. were labeled as low methane producers (LMPs) and10 p.p.m. as predominant methane producers (PMPs).The IBS and control groups included 66.78% and 67.53% men, respectively. Mean age in the two groups was 48.52 +/- 30.54 years (range 15-68 years) and 45.67 +/- 30.54 years (range 15-78 years), respectively. Prevalence of predominant methanogenic flora in IBS and control groups was 14.5% (50/345) and 34.6% (88/254), respectively (P0.001). Fifty-two out of 254 (20.6 %) were PMPs and 36 out of 254 (14.0%) were LMPs in controls. In contrast to this, IBS patients had 17 out of 354 (4.9%) that were PMPs and 33 out of 345 (9.6%) that were LMPs.Methanogenic flora was significantly lower in IBS patients from North India than in apparently healthy subjects. This may be one of the causes of flatulence in IBS patients.

Reactive oxygen species have been implicated in the etiology of multiple organ dyspepsia syndrome and infection's complications in patients with trauma. But the oxidative stress and antioxidants levels in abdominal trauma have not yet been studied. Therefore, this study was planned to measure lipid peroxidation for oxidative stress and reduced glutathione, catalase and superoxide dismutase (SOD) for antioxidant levels in plasma & heamolysate of 30 patients with abdominal trauma and 30 controls. From this study we can summarize that there was an increase in oxidative stress and decrease in antioxidant levels (causing oxidative stress) on day zero in patients with abdominal trauma. This oxidative stress on day zero was not related to the development of complications. There was no significant difference in oxidative stress between patients with solitary and multiple abdominal organ injury and also between patients with hollow viscus injury and solid organ injury on day zero. From this study, we conclude that in patients with abdominal trauma there was increase in oxidative stress and decrease in antioxidant levels on day zero.

Gallstones (GS) are associated with slow intestinal transit but the effect of altered transit time on physiological changes in gastrointestinal tract among GS patients is poorly understood.To investigate the association of gallstone disease with change in intestinal motility and how motility alters serum bile acid (SBA) levels.A total of 333 subjects were enrolled, of which 183 were GS patients and 150 age-matched and sex-matched controls. Intestinal transit time was assessed by measuring orocecal transit time (OCTT). Breath tests were used to evaluate OCTT and small intestinal bacterial overgrowth (SIBO). Total SBA levels were measured by enzymatic colorimetric assay. A linear regression analysis was performed to look for interrelationship between OCTT and SBA levels.Orocecal transit time was significantly delayed (P0.001) in GS patients (134.8±30.64 min) compared with controls (85.35±19.81 min). SIBO was observed to be significantly higher (P0.01) in patients (15%) compared with controls (0.7%). OCTT was further delayed significantly (P0.01) in GS patients with SIBO (165.6±33.9 min) compared with patients lacking SIBO. Total SBA levels were found to be significantly higher (P0.05) in GS patients (5.3±2.7 μmol/L) compared with controls (3.7±1.8 μmol/L). SBA levels were also significantly higher (P0.05) in SIBO-positive GS patients (6.4±2.8 μmol/L) compared with SIBO-negative patients (4.8±2.4 μmol/L). There was positive correlation between OCTT and SBA levels in SIBO-positive patients.The findings indicate that delayed OCTT leads to SIBO and thus enhance SBA levels in etiology underlying GSs.

Serotonin (5-HT) is an important signaling molecule in the gut targeting enterocytes, smooth muscles and enteric neurons. Most of the body serotonin is present in enterochromaffin cells. Serotonin activates both intrinsic and extrinsic primary afferent neurons to, respectively initiate peristaltic and secretory reflexes and to transmit information to the central nervous system. Serotonin is inactivated by the serotonin reuptake transporter (SERT) in the enterocytes or neurons. Exogenous serotonin application evokes so many responses that it is difficult to determine which is physiologically relevant. This effect is largely due to the presence of multiple receptor subtypes, which appear to be present on several classes of myenteric neurons, on smooth muscle cells, and on epithelial cells. Irritable bowel syndrome (IBS) is a complex disorder that is associated with altered gastrointestinal motility, secretion and sensation. Altered serotonin signaling may lead to both intestinal and extra intestinal systems in IBS. In this review, the literature related to role of serotonin signaling in pathophysiology of IBS has been searched and summarized. Therapeutic agents targeting altered serotonin signaling may provide new effective treatment for patients with IBS. Tegaserod, 5-HT(4) partial agonist is used in constipation predominant IBS while alosetron, a 5-HT(3) antagonist used in IBS with diarrhea. Other compounds such as tricyclic antidepressants and serotonin selective reuptake inhibitors have been used in some patients with IBS.

Hepatotoxicity is one of the most serious adverse effects of antituberculosis drugs. The aim of this study was to produce a rat model of isoniazid-rifampicin (INH-RIF) induced hepatotoxicity. Materials and Methods: Wistar rats (100–150 g) were treated with different doses of INH i.e. 25, 50 and 75 mg/kg/day with a fixed dose of RIF i.e. 50 mg/kg/day intragastrically for a period of 28 days. Serum glutamate oxaloacetate aminotransferase (SGOT), glutamate pyruvate aminotransferase (SGPT), bilirubin (Bil) and alkaline phosphatase (ALP) were estimated at 0,14, 21 and 28 days in rats. Histological analysis was carried out to assess the liver. Results: Treatment of rats with INH–RIF (50 mg/kg/day each) induced hepatotoxicity as judged by elevated serum SGPT, SGOT, Bil and ALP as compared with their base line. Histological evaluation of INH–RIF induced hepatotoxicity also showed liver damage. Conclusion: The present study suggests that 50 mg/kg/day each of INH–RIF was selected as hepatotoxic dose (i.e. minimum dose with maximum hepatotoxicity) in wistar rats.

Background Clinical symptom based criteria for IBS is not sufficient enough to rule out microscopic colitis (MC). We sought to study whether biopsy is necessary in IBS. Methods This prospective study included colonic mucosa of 197 patients with IBS (129 IBS-D, 50IBS-C and 18 IBS-M) to rule out MC. Results Overall prevalence of MC in patients with IBS was 23.4% (46/197). The prevalence of MC in patients with IBS-D was 28.7% (37/129), higher than in patients with IBS-C 12% (6/50) and IBS-M 16.7% (3/18). Conclusions Microscopic colitis is present in a relevant proportion of symptomatic patients meeting diagnostic criteria for IBS. Despite the fact that IBS is a functional disorder, in many patients morphological changes occur in colon mucosa. The diagnostic criteria of IBS are not specific enough to exclude the presence of MC. Therefore, in patients of IBS, it may be reasonable to perform a biopsy to screen for MC.

To evaluate the hepatoprotective effect of garlic on liver injury induced by isoniazid (ZNH) and rifampicin (RIF).Wistar rats weighing 150-200 g were treated orally with 50 mg/kg of INH and RIF daily each for 28 d. For hepatoprotective studies, 0.25 g/kg per day of freshly prepared garlic homogenate was administered orally half an hour before the INH+RIF doses. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and bilirubin were estimated on d 0, 14, 21, and 28 in all the rats. Histological analysis was carried out to assess the injury to the liver. Lipid peroxidation (LPO) as a marker of oxidative stress and non-protein thiols (glutathione) for antioxidant levels were measured in liver homogenate.The treatment of rats with INH+RIF (50 mg/kg per day each) induced hepatotoxicity in all the treated animals as judged by elevated serum ALT, AST, and bilirubin levels, presence of focal hepatocytic necrosis (6/8) and portal triaditis (8/8). Garlic simultaneously administered at a dose of 0.25 g/kg per day prevented the induction of histopathological injuries in INH+RIF co-treated animals, except in 4 animals, which showed only moderate portal triaditis. The histological changes correlated with oxidative stress in INH+RIF treated animals. The group which received 0.25 g/kg per day garlic homogenate along with INH+RIF showed higher levels of glutathione (P0.05) and low levels of LPO (P0.05) as compared to INH+RIF treated group.Freshly prepared garlic homogenate protects against INH+RIF-induced liver injury in experimental animal model.