Factors influencing frequency of flatus emission by healthy subjects

The purpose of the present study was to measure the frequency of flatus emission by 25 healthy subjects and to determine if factors commonly thought to influence flatulence actually correlate with the frequency of gas passage. Over a one-week period on their usual diet, subjects passed gas 10±1 times/day [upper limit of normal (mean+2sd): 20 times/day]. The addition of the nonabsorbable disaccharide lactulose (10 g/day) to the diet significantly (P<0.01) increased flatus frequency to 19±2.4 times per day. Gender, age, and the ability of an individual's colonic flora to produce methane had no significant influence on flatus frequency either on the basal or lactulose-supplemented diets. Some subjects consistently passed gas more often than did others. These individual differences appeared to result, in part, from differences in the ability of the flora to produce gas from a given quantity of fermentable material.Supported in part by the Department of Veterans Affairs, and the National Institute of Diabetes and Digestive and Kidney Diseases DK-13093.     

IBS Subjects with Methane on Lactulose Breath Test Have Lower Postprandial Serotonin Levels Than Subjects with Hydrogen

We have previously shown that methane on lactulose breath test (LBT) is highly associated with constipation in IBS and that methane gas itself slows small bowel transit in dogs. Previous studies suggest that serotonin may have a role in the control of transit in IBS. In this study, we aim to evaluate the role of serotonin in methane producing IBS subjects. Rome I-positive IBS subjects were recruited into the study after exclusion criteria were met. A fasting LBT was performed after subjects filled out a questionnaire rating the degree of constipation and diarrhea. Within 7 days of this test, subjects returned fasting for determination of serotonin before and after a 75-g oral glucose meal. The serotonin response was compared between hydrogen and methane producing IBS subjects. After 2 subjects were excluded for inadequate blood samples, 18 subjects completed the study. Four of 18 subjects produced methane. The postprandial serotonin level in methane producing IBS subjects was lower than in hydrogen producers (P < 0.05). Methane producers had a reduction in serotonin after glucose. Methane producing IBS subjects have reduced postprandial serotonin. Whether methane is a surrogate marker of constipation or contributing to the reduced serotonin remains to be determined.     

慢性重型肝炎营血证的鲜生地汁治疗

目的：观察口服鲜生地汁对慢性重型肝炎（重肝）早／中期（中医营血证）患者的疗效。方法：患者分为两组，在给予重肝综合治疗的同时，治疗组患者口服鲜生地汁，100ml／d（分服）；对照组患者口服乳果糖10ml／次，3次／d，分别于治疗前及第2周末记录患者症状，检测肝功能、凝血酶原活动度及血浆内毒素、细胞因子。结果：两组患者腹胀及大便干结症状、肝功能均好转；血浆内毒素下降；肿瘤坏死因子-α降低；凝血酶原活动度增加：治疗组效果优于对照组。治疗组患者口干、烦热症状亦有明显改善。结论：口服鲜生地汁可有效减轻重肝患者内毒素血症、降低细胞因子水平，并在改善口干、烦热等营血证表现及凝血机制方面与乳果糖比较具有明显优势。     

Effect of acute copper exposure on gastrointestinal permeability in healthy volunteers

In vitro studies indicate that treating cells with copper results in alteration of tight junction permeability. In humans, ingestion of a single bolus of up to 10 mg Cu/L (as copper sulfate) causes nausea and vomiting in approximately 20 and 5% of the volunteers, respectively. To understand better the gastric and intestinal effects of copper, in this study we evaluated in asymptomatic volunteers (1) the effects of acute copper ingestion on gastric and intestinal permeability and (2) whether the appearance of gastrointestinal symptoms is associated with changes in mucosal permeability. Thirty-one asymptomatic subjects were assessed in a randomized, double-blind, crossover study that included two permeability tests, one after ingesting 200 ml distilled water and the other after ingesting 200 ml water containing 10 mg Cu/L (as copper sulfate). Fifteen minutes after ingestion subjects drank a second solution containing 40 g sucrose, 7.5 g lactulose, and 2 g mannitol, and urine was collected for 5 hr. Sugar concentrations were determined by gas chromatography. Symptoms during the trials were recorded in self-administered questionnaires. Ingestion of the 10 mg/L copper solution significantly increased gastric permeability to sucrose [20.8 (11.8–73.4) vs 28.4 (16.6–113.9) mg, respectively; P = 0.0064] but did not change intestinal permeability to lactulose/mannitol [0.87 (0.53–2.06) vs 1.17 (0.58–2.39)%, respectively; P = 0.18]. Gastrointestinal symptoms were reported during both the basal and the experimental conditions, but after copper ingestion they increased to 22.6% of the subjects and were significantly more intense than under basal conditions (P = 0.047). However, changes in permeability were not related to the appearance of symptoms. These results indicate that acute oral exposure to 10 mg Cu/L exerts an effect on gastric but not intestinal mucosa, reducing the gastric mucosal barrier capacity, independently of the appearance of gastrointestinal symptoms.     

乳果糖治疗亚临床肝性脑病不同疗程的疗效观察

目的　观察乳果糖对亚临床肝性脑病 (SHE)不同疗程的疗效。方法　经数字连接试验 (NCT)和脑干听觉诱发电位 (BAEPs)诊断的SHE患者 86例 ,随机分为对照A组 2 2例 ,治疗B组 2 1例、C组 2 2例、D组 2 1例 ;对照组予常规护肝治疗 ,治疗组在对照组治疗的基础上予以乳果糖口服治疗 ,疗程分别为 4周、8周、12周 ,治疗前后每 2周予血氨、NCT和BAEPs检测。结果　疗程结束治疗组与对照组比较 ,血氨水平改善明显 (P <0 .0 1) ,BAEPs异常率降低 (P <0 .0 1) ,各组转为肝性脑病 (HE)的例数分别为A组 5例、B组 4例、C组 3例和D组 1例 ,C、D组转为HE的病例数明显少于A组 (P <0 .0 1) ;B组、C组停用乳果糖后出现了血氨上升 ,BAEPs异常率增加 ,转为HE的病例数明显多于D组。结论　乳果糖是治疗SHE的有效药物 ,长期治疗能够降低血氨 ,改善NCT ,降低HE的患病率     

复方聚乙二醇电解质散联合乳果糖在结肠镜肠道准备中的应用观察

目的:比较复方聚乙二醇电解质散联合乳果糖、单纯复方聚乙二醇电解质散及硫酸镁在结肠镜肠道准备中的应用效果。方法:选取在我院脾胃科接受结肠镜检查的患者126例,随机分成3组,对照组、观察A组、观察B组,每组42例,对照组口服硫酸镁清肠,观察A组口服复方聚乙二醇电解质散清肠,观察B组口服复方聚乙二醇电解质联合乳果糖清肠,根据Boston肠道准备量表对肠道进行分段评分,计算肠道清洁率,并记录患者在肠道准备过程中不良反应的发生情况,比较3组的上述指标。结果:观察A组和观察B组肠道清洁有效率分别为92.85%、95.24%,明显优于对照组(80.95%),差异具有统计学意义(P<0.05)。但是观察B组在肠道清洁非常满意率明显优于观察A组,差异具有统计学意义(P<0.05)。观察A组和观察B组肠道不良反应发生率分别为9.52%、7.14%,明显低于对照组(16.66%),差异具有统计学意义(P<0.05)。观察B组比观察A组不良反应率有所下降,但比较无统计学差异(P>0.05)。结论:复方聚乙二醇电解质散联合乳果糖应用于结肠镜检查前的肠道准备,不仅能增加肠道清洁的有效率,还可以明显提高肠道清洁的质量,而且把不良反应少,安全性高,值得临床进一步推广。     

Clostridioides difficile colonization among very young children in resource-limited settings

ObjectivesTo describe the epidemiology and risk factors for Clostridioides difficile (C. difficile) colonization among young children in eight low-resource settings.MethodsWe tested 41 354 monthly non-diarrhoeal and diarrhoeal stools for C. difficile toxin genes (TcdA and TcdB) using quantitative PCR (qPCR) in 1715 children from birth to age two years in a multisite birth cohort study. We estimated the prevalence, cumulative incidence, and seasonality of C. difficile colonization and investigated the associations of C. difficile detection with risk factors of infection, markers of enteropathy, and growth.ResultsThe prevalence of C. difficile detection was lower in diarrhoeal (2.2%; n = 151/6731) compared to non-diarrhoeal stools (6.1%; n = 2106/34 623). By 24 months of age, the cumulative incidence of C. difficile varied widely by site, with 17.9% (n = 44; Pakistan) to 76.3% (n = 148; Peru) of children having at least one positive stool. Only Bangladesh and Pakistan had seasonal differences in C. difficile detection. Female sex (adjusted risk ratio (aRR): 1.18; 95% CI: 1.02–1.35), cephalosporin use in the past 15 days (aRR: 1.73; 95% CI: 1.39–2.16), and treated water (aRR: 1.24; 95% CI: 1.02–1.50) were risk factors for C. difficile positivity. The presence of C. difficile was significantly associated with elevated faecal myeloperoxidase, neopterin, and α-1-antitrypsin, but no associations were found between C. difficile and child growth at 24 months of age.DiscussionC. difficile colonization among children ages 0–2 years was variable across low-resource settings. Significant elevation of intestinal inflammation and barrier disruption markers associated with C. difficile detection suggests a subclinical impact of colonization.     

贝飞达联合乳果糖治疗肝硬化后血清内毒素TNFα、IL-6的变化及预防自发性腹膜炎的临床意义

[目的]观察肝硬化患者应用贝飞达联合乳果糖治疗前后血清内毒素、TNFα、IL-6水平的变化以及自发性细菌性腹膜炎(SBP)的发生率,寻找一种能够更有效降低SBP发生的方法.[方法]100例肝硬化患者随机分成对照组(A组) 和治疗组(B组),对照组50例,给予常规护肝利尿补充白蛋白治疗;治疗组50例,在常规治疗的基础上加服贝飞达 乳果糖联用,疗程3个月.[结果]对照组治疗前后血清内毒素及TNFα、IL-6水平无明显变化,治疗组治疗后血清内毒素及TNFα、IL-6明显下降,SBP发生率明显降低,与对照组比较差异有显著性.[结论]贝飞达联合乳果糖治疗肝硬化患者可有效的降低血浆中内毒素及TNFα、IL-6水平,明显降低SBP发生率.     

加味大承气汤灌肠治疗多器官功能障碍综合征患者肠道黏膜屏障功能障碍临床研究

目的观察加味大承气汤灌肠对多器官功能障碍综合征患者肠道黏膜屏障功能障碍的治疗作用。方法将患者40例随机分为A组与B组,均予常规西医治疗,在此基础上A组予以大承气汤液灌肠,B组予安慰剂灌肠。两组治疗7d。比较两组治疗前、治疗第3日及第7日的尿乳果糖/甘露醇比值（L/M）和循环D-乳酸质量浓度。结果治疗组尿（L/M）和循环D-乳酸的下降大于对照组。结论加味大承气汤灌肠治疗可改善多器官功能障碍综合征患者肠道黏膜通透性,保护肠黏膜屏障功能。