Effects of Bovine Colostrum with or without Egg on In Vitro Bacterial-Induced Intestinal Damage with Relevance for SIBO and Infectious Diarrhea

Small intestinal bacterial overgrowth (SIBO) occurs commonly, is difficult to treat, and frequently recurs. Bovine colostrum (BC) and chicken eggs contain immunoglobulins and other components that possess antimicrobial, immunoregulatory, and growth factor activities; however, it is not known if they have the ability to reduce injury caused by the presence of bacteria associated with SIBO (Streptococcus, Escherichia coli, Staphylococcus, Bacteroides, Klebsiella, Enterococcus, and Proteus) and infectious diarrhea (enteropathogenic Escherichia coli, Salmonella). We examined the effects of BC, egg, or the combination, on bacterial growth and bacteria-induced changes in transepithelial electrical resistance (TEER) and bacterial translocation across confluent Caco-2 monolayers. BC, egg, or the combination did not affect bacterial growth. Adding bacteria to monolayers reduced TEER and (with minor variations among species) increased bacterial translocation, increased monolayer apoptosis (increased caspase-3 and Baxα, reduced Bcl2), increased intercellular adhesion molecule 1 (ICAM-1), and reduced cell adhesion molecules zonulin1 (ZO1) and claudin-1. BC, egg, or the combination reduced these effects (all p < 0.01) and caused additional increases in vascular endothelial growth factor (VEGF) and Heat Shock Protein 70 (Hsp70) expression. We conclude that BC ± egg strengthens mucosal integrity against a battery of bacteria relevant for SIBO and for infectious diarrhea. Oral BC ± egg may have clinical value for these conditions, especially SIBO where eradication of precipitating organisms may be difficult to achieve.     

Probiotics in functional bowel disorders

Functional bowel disorders (FBDs) are the most common gastrointestinal (GI) disorders seen by gastroenterologists and primary care physicians. The disorders affect patients functioning and quality of life (QOL) and are associated with significant healthcare burden. The current theory regarding the development of FBDs suggests brain-gut axis dysfunctions associated abnormal GI motility and sensation. Recent data suggest that alterations in the intestinal microbiota may have a role in the pathogenesis of FBDs; or at least have the potential to affect intestinal functions that are thought to be relevant to the development of functional GI symptoms. This has led to growing interest of healthcare providers and patients in targeting the intestinal microbiota for the treatment of FBDs. In this article we discuss the potential role probiotic interventions in the treatment of FBDs. We review the evidence from pre-clinical and clinical studies and discuss the current recommendations for the use of probiotics for FBDs in clinical practice.     

Small Intestinal Bacterial Overgrowth in Patients with Interstitial Cystitis and Gastrointestinal Symptoms

Purpose Interstitial cystitis (IC) often coexists with irritable bowel syndrome (IBS). IBS may be explained by small-intestinal bacterial overgrowth (SIBO), which increases immune activation and visceral hypersensitivity. This prospective pilot study tested hypotheses that IC patients with gastrointestinal (GI) symptoms have SIBO, that nonabsorbable antibiotic use improves symptoms, and that improvement is sustained by prokinetic therapy. Methods Consecutive IC patients with GI symptoms had lactulose breath testing (LBT). Those with abnormal results received rifaximin 1,200–1,800 mg/day for 10 days then tegaserod 3 mg/nightly. Questionnaires addressed IC and GI global improvement. Results Of 21 patients, 17 (81%) had abnormal LBTs. Of 15 patients treated, GI global improvement was moderate to great in 11 (73%) and sustained in ten (67%). IC global improvement was moderate to great in six (40%) and sustained in seven (47%). Conclusions A majority of IC patients and GI symptoms had an abnormal LBT suggesting SIBO. Rifaximin improved symptoms, which was sustained by tegaserod.     

Resolution of late-onset heart and liver failures after reversion of jejuno-ileal bypass: a case report

Objectives: Jejuno-ileal bypass (JIB) was a kind of bariatric surgery performed from 1960s to 1980s, able to induce sustainable weight loss by creating a surgical short bowel syndrome.

Materials and methods: We report a case of an octogenarian woman who underwent in the early eighties this kind of surgery with consequent 40?kg weight loss. After 27 years, she first developed a reversible metabolic cardiomyopathy that began with signs and symptoms of heart failure. Thereafter, she was diagnosed with severe intractable liver insufficiency.

Results: Despite her old age, the patient underwent reversal of JIB with consequent early improvement of hepatic function.

Conclusions: This case demonstrate that in case of long-term and life-threatening complications, it is possible to successfully reverse JIB surgery after upto 30 years. The hypothesis on pathophysiology of heart and liver insufficiency are discussed.     

The gut microbiome and irritable bowel syndrome: State of art review

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, the physiology of which is not very well understood. There are multiple factors and pathways involved in pathogenesis of this entity. Among all, dysmotility, dysregulation of the brain-gut axis, altered intestinal microbiota and visceral hypersensitivity play a major role. Over the last years, research has shown that the type of gut microbiome present in an individual plays a significant role in the pathophysiology of IBS. Multiple studies have consistently shown that subjects diagnosed with IBS have disruption in gut microbiota balance. It has been established that host immune system and its interaction with metabolic products of gut microbiota play an important role in the gastrointestinal tract. Therefore, probiotics, prebiotics and antibiotics have shown some promising results in managing IBS symptoms via modulating the interaction between the above. This paper discusses the various factors involved in pathophysiology of IBS, especially gut microbiota.     

枯草杆菌二联活菌对结肠癌患者小肠细菌过度生长的影响

目的探讨结肠癌患者小肠细菌过度生长(SIBO)的检测及枯草杆菌二联活菌对其的影响。方法选取2015年1月~2016年5月于我院接受结肠癌手术治疗的患者86例为观察组,同时选取同期来院体检的健康者62例为对照组。所有研究对象均进行葡萄糖氢呼气试验,检测SIBO情况。将表现为SIBO阳性的结肠癌患者随机分为A、B两组。A组患者仅进行利福昔明治疗,B组在A组基础上服用枯草杆菌二联活菌颗粒。观察两组研究对象SIBO阳性率、治疗前后A、B两组胃肠道症状积分及治疗后A、B两组SIBO转阴率情况。结果观察组SIBO阳性率为60.47%(52例),明显高于健康体检者组成的对照组的SIBO阳性率9.68%(6例)(P0.05)。治疗前,A、B两组的胃肠道症状积分得分相比,差异无统计学意义(P0.05)。A、B两组治疗后的胃肠道症状积分均低于治疗前(P0.05)。治疗后,A组的胃肠道症状积分为(9.11±0.83)分,明显高于B组的(8.75±0.57)分(P0.05)。治疗后,A组的SIBO转阴率为34.62%,明显低于B组的88.46%(P0.05)。结论结肠癌术后患者相对于健康人发生SIBO可能性更高。枯草杆菌二联活菌联合利福昔明治疗结肠癌术后SIBO效果较好,能够明显改善患者的胃肠道状况,提高SIBO的转阴率。     

小肠细菌过度生长对非酒精性肝病肝纤维化指标的影响

目的：探讨非酒精性脂肪性肝病(NAFLD)与小肠细菌过度生长(SIBO)的关系,进一步了解NAFLD患者SIBO的发生率及肠源性内毒素血症(IETM)对肿瘤坏死因子-α(TNF-α)、肝纤维化水平的影响,评价其在NAFLD发生发展过程中的作用。方法选择2013年2~8月本院经B超及病史诊断为NAFLD患者32例,行乳果糖氢呼气试验(LHBT)检测,根据LHBT结果将32例NAFLD患者分为SIBO阳性组和SIBO阴性组。对两组IETM、TNF-α、肝纤维化指标进行检测。结果 IETM、TNF-α在SIBO阳性组和SIBO阴性组比较差异均有统计学意义;SIBO阳性组TNF-α、肝纤维化指标有逐渐增高的趋势,两者均与IETM呈正相关。结论 SIBO和内毒素血症等机制促进NAFLD的发生和发展。     

Proton Pump Inhibitors: Review of Emerging Concerns

First introduced in 1989, proton pump inhibitors (PPIs) are among the most widely utilized medications worldwide, both in the ambulatory and inpatient clinical settings. The PPIs are currently approved by the US Food and Drug Administration for the management of a variety of gastrointestinal disorders including symptomatic peptic ulcer disease, gastroesophageal reflux disease, and nonulcer dyspepsia as well as for prevention of gastrointestinal bleeding in patients receiving antiplatelet therapy. PPIs inhibit gastric acid secretion, and the most commonly associated adverse effects include abdominal pain, diarrhea, and headache. Although PPIs have had an encouraging safety profile, recent studies regarding the long-term use of PPI medications have noted potential adverse effects, including risk of fractures, pneumonia, Clostridium difficile diarrhea, hypomagnesemia, vitamin B₁₂ deficiency, chronic kidney disease, and dementia. These emerging data have led to subsequent investigations to assess these potential risks in patients receiving long-term PPI therapy. However, most of the published evidence is inadequate to establish a definite association between PPI use and the risk for development of serious adverse effects. Hence, when clinically indicated, PPIs can be prescribed at the lowest effective dose for symptom control.