Some useful links

There is plenty of basic information on dietary therapy throughout the Internet. If you are interested in the latest medical findings you should consult the global database PUBMED of the medical publications. Below are examples of IBS-related studies:

Severe anaemia after gastric biopsy in an infant with eosinophilic gastritis.

Eosinophilic gastrointestinal disorders (EGID) are characterized by eosinophilic inflammation and are subclassified according to the affected site(s) as eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. Clinical presentation includes dyspeptic symptoms, vomiting, abdominal pain, diarrhoea and gastrointestinal bleeding. Peripheral eosinophilia is usually found but is not required for the diagnosis. The treatment is based on dietary elimination therapy, consisting of removal of common food triggers, most frequently cow's milk in infants. Corticosteroids are used as first line drug therapy in EG if dietary therapy fails to achieve an adequate clinical response or is impractical. A four month old infant was admitted for an episode of melena and hematemesis. An esophagogastroduodenoscopy showed haemorrhagic gastritis with ulcerative lesions and fibrin. A significant gastric bleeding was noted after the procedure. The gastric mucosa biopsies showed an eosinophilic infiltration. A clinically relevant anaemia is a quite rare complication in infants with eosinophilic gastritis and a biopsy may worsen bleeding, to a potentially severe level of low haemoglobin. In infants with low haemoglobin levels and suspect eosinophilic gastritis a watchful follow up after the biopsy should be considered, as well as the possibility of postponing the biopsy to reduce the bleeding risk.

KEYWORDS: Anaemia, Biopsy, Emergency, Endoscopy, Eosinophilic gastritis, Gastroenterology, Pediatric

Clinical management of eosinophilic esophagitis - a nationwide survey among gastroenterologists in Germany.

 Eosinophilic esophagitis (EoE) is an increasingly recognized immune-mediated esophageal disease and a common cause for dysphagia and food bolus obstruction. The aim of this study was to evaluate the current clinical management of EoE among adult gastroenterologists in Germany.  We performed a cross-sectional study of 1393 adult gastroenterologists using a questionnaire containing 22 questions to general, diagnostic, and therapeutic aspects of EoE. The self-administered online survey was conducted between November 2017 and February 2018. Data capture and analysis was performed using SurveyMonkey.  The overall responder rate was 29.6 %. More than half of the responders felt to observe a significant increase of EoE patients. The EREFS score was mostly either unknown or not routinely used. If EoE was suspected, most responders obtained multiple esophageal biopsies. The preferred primary treatment was proton pump inhibitors (PPI) in 37.2 % and topical steroids in 35.0 % of responders. PPI regimens were highly diverse, with only half of responders using high-dose PPI regimens. Allergy testing was often initiated. The most common dietary therapy was 6-food elimination diet, followed by allergy test-directed diets and 2-food elimination diet. The majority of responders indicated a need for long-term treatment.  Among gastroenterologists in Germany, substantial variation in the adherence to published EoE guidelines appears to exist. This indicates the need for intensified education and national guidelines in order to optimize and harmonize the clinical management of EoE patients.  Die eosinophile Ösophagitis (EoE) ist eine zunehmend häufig erkannte, immunvermittelte Erkrankung der Speiseröhre und eine der häufigsten Ursachen für Dysphagie und Bolusobstruktionen. Ziel dieser Umfrage war es, das gegenwärtige klinische Management der EoE unter Gastroenterologen in Deutschland zu untersuchen.  Wir führten eine Querschnittsstudie unter 1393 Gastroenterologen (bng, ALGK) mittels eines Fragebogens durch, der 22 Fragen zu allgemeinen, diagnostischen und therapeutischen Aspekten der EoE enthielt. Die online-Umfrage erfolgte zwischen November 2017 und Februar 2018. Die Daten wurden mittels SurveyMonkey erfasst und analysiert.  Die Responderrate betrug 29,6 %. Mehr als die Hälfte der Responder gaben an, eine signifikante Zunahme von EoE-Patienten zu beobachten. Der EREFS-Score war in der Mehrzahl entweder unbekannt oder wird in der Routine nicht verwendet. Bei Verdacht auf EoE entnahmen die Mehrzahl multiple Ösophagusbiopsien. Die bevorzugte Initialtherapie waren PPI oder topische Steroide. Die PPI-Regime waren sehr divers. Nur in der Hälfte der Fälle wurde eine hochdosierte PPI-Therapie durchgeführt. Eine Allergietestung wurde häufig veranlasst. Die häufigste dietätische Therapie war die 6-Food-Eliminationsdiät, gefolgt von der Allergietest-gesteuerten Diät und der 2-Food-Eliminationsdiät. Die Mehrzahl der Responder sahen die Notwendigkeit einer Langzeittherapie.  Unter Gastroenterologen in Deutschland gibt es eine substantielle Variation in der Adhärenz zu publizierten Leitlinien der EoE. Dieser Befund unterstreicht die Notwendigkeit einer intensiveren Fortbildung und einer nationalen Leitlinie, um eine Optimierung und Harmonisierung in der klinischen Versorgung von EoE-Patienten sicherzustellen.

The protective effect of nigeglanine on dextran sulfate sodium-induced experimental colitis in mice and Caco-2 cells.

Ulcerative colitis (UC) was a nonspecific inflammatory disease. The treatment of UC is imperative. The present study aimed to investigate the effect of nigeglanine on dextran sulfate sodium-induced UC in experimental mice and Caco-2 cells and define the underlying mechanism. The nigeglanine was shown a significant protective effect on the colon, significantly reduced the weight and colon length loss and inhibited intestinal epithelial cell damage. Nigeglanine also reduced proinflammatory factors and increased anti-inflammatory factor production. The results indicate that nigeglanine suppresses the nuclear factor kappa B and mitogen-activated protein kinases pathways in addition to NLRP3 inflammasome action, inhibiting colon epithelial cell pyroptosis. Surprisingly, ZO-1 and occludin protein levels increased with nigeglanine treatment, suggesting that nigeglanine plays a protective role in barrier integrity, reducing colitis progression. The present study suggests that dietary therapy with nigeglanine may be a useful treatment for prophylaxis and palliative UC.

KEYWORDS: NLRP3 inflammasome, dietary therapy, inflammatory factor, nigeglanine, ulcerative colitis

Dietary CCPS from bitter gourd attenuates sodium arsenite induced female reproductive ailments cum infertility in wistar rats: anti-inflammatory and anti-apoptotic role.

This investigation explored a dietary therapy of pectic polysaccharide (CCPS) against female repro-toxicity and infertility triggered by sodium arsenite in Wistar rats. The isolated CCPS consists of D-galactose and D-methyl galacturonate with a molar ratio of 1: 4. FTIR spectral analysis of CCPS and CCPS- sodium arsenite complex indicated a possible chelating property of CCPS in presence of binding sites (OH - /COOH) for As 3+ . Series of negatively charged galacturonate residues in CCPS provide better potential for cation chelation. CCPS significantly mitigated As 3+ induced ovarian, uterine lipid peroxidation, and reactive oxygen species (ROS) generation by the restoration of superoxide dismutase (SOD), catalase and glutathione peroxidase (GPx) activities. CCPS post-treatment enhanced ovarian steroidogenesis along with a restoration of normal tissue histoarchitecture in As 3+ fed rats by regulating the estradiol receptor alpha (ER-α). CCPS suppressed anti-inflammatory properties effectively found since a down-regulation of NF-kappa B (NF-қB), pro-inflammatory tumor necrosis-α (TNF-α) and interleukin-6 were observed in arsenicated rats with CCPS. This study confirmed the up-regulation of uterine pro-apoptotic/ apoptotic proteins caspase-3, poly ADP ribose polymerase (PARP), proliferating cell nuclear antigen (PCNA), phospho p53 and Bax, followed by down-regulation of Bcl-2 and protein Kinase B (AKT) signaling pathway along with uterine tissue regeneration in As 3+ exposed rats. Oral CCPS attenuated the above apoptotic expressional changes significantly and dietary CCPS ensured successful fertility with the birth of healthy pups in lieu of infertile condition in As 3+ fed rats. Moreover, this study also supports that CCPS treatment attenuated the As 3+ toxicity by modulating the S-adenosine methionine (SAM) pool components, B 12 , folate and homocysteine.

KEYWORDS: Arsenic, CCPS, Fertility and akt signaling

Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study.

To analyze the potential effect of social inequality on pancreatic cancer risk in Western Europe, by reassessing the association within the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, including a larger number of cases and an extended follow-up. Data on highest education attained were gathered for 459,170 participants from 10 European countries. A relative index of inequality (RII) based on adult education was calculated for comparability across countries and generations. Cox regression models were applied to estimate relative inequality in pancreatic cancer risk, stratifying by age, gender, and center, and adjusting for known pancreatic cancer risk factors. A total of 1,223 incident pancreatic cancer cases were included after a mean follow-up of 13.9 years. An inverse social trend was found in models adjusted for age, sex, and center for both sexes, which was also significant among women. Further adjusting by smoking intensity, alcohol consumption, body mass index, prevalent diabetes, and physical activity led to an attenuation of the RII risk and loss of statistical significance. The present reanalysis does not sustain the existence of an independent social inequality influence on pancreatic cancer risk in Western European women and men, using an index based on adult education, the most relevant social indicator linked to individual lifestyles, in a context of very low pancreatic cancer survival from (quasi) universal public health systems. The results do not support an association between education and risk of pancreatic cancer.

Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis.

To comprehensively evaluate the efficacy and safety of acupuncture combined with Chinese herbal medicine (CHM) in treating irritable bowel syndrome with diarrhea (IBS-D). Relevant randomized controlled trials (RCTs) were systemically retrieved from electronic databases from inception to March 2018, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical Database (CBM, SinoMed), China Science and Technology Journal Database (VIP), and Wan Fang Data. Meanwhile, pooled estimates, including the 95% confidence interval (CI), were calculated for primary and secondary outcomes of IBS-D patients. Besides, quality of relevant articles was evaluated using the Cochrane Collaboration's risk of bias tool, and the Review Manager 5.3 and Stata12.0 softwares were employed for analyses. A total of 21 RCTs related to IBS-D were included into this meta-analysis. Specifically, the pooled results indicated that acupuncture combined with CHM might result in more favorable improvements compared with the control group; the combined method could markedly enhance the clinical efficacy in the meantime of remarkably reducing the scores of abdominal pain, abdominal distention/discomfort, diarrhea, diet condition, physical strength, and sleep quality compared with those in the matched groups treated with western medicine, or western medicine combined with CHM. Additionally, a metaregression analysis was constructed according to the name of prescription, acupuncture type, treatment course and publication year, and subgroup analyses stratified based on the names of prescriptions and acupoints location were also carried out, so as to explore the potential heterogeneities; and IBS-D patients treated with the combined method only developed inconspicuous adverse events; more importantly, the combined treatment had displayed promising long-term efficacy. Findings in this study indicate that acupuncture combined with CHM is suggestive of an effective and safe treatment approach for IBS-D patients, which may serve as a promising method to treat IBS-D in practical application. However, more large-scale, multicenter, long-term, and high-quality RCTs are required in the future, given the small size, low quality, and high risk of the studies identified in this meta-analysis.

Impact of occupational stress on irritable bowel syndrome pathophysiology and potential management in active duty noncombat Greek military personnel: a multicenter prospective survey.

Irritable bowel syndrome (IBS) is one of the gut-brain axis interaction disorders. It has global distribution with varying prevalence and particular financial and psychological consequences. IBS has been associated with stress and anxiety, conditions that are usually prevalent in the army. There are scarce data investigating the impact of IBS on noncombat active duty military without reports of Greek military or stress in the occupational environment. The main exclusion criteria in our noncombat military multicenter prospective survey were gastrointestinal pathologies, malignancies, hematochezia, recent infections and antibiotics prescription, and pregnancy. Questionnaires included a synthesis of baseline information, lifestyle, and diet, psychological and stress-investigating scales and the IBS diagnosis checklist. Hospital Anxiety and Depression Scale and Rome IV criteria were utilized. Among 1605 participants included finally, the prevalence of IBS was 8% and 131 cases were identified. Women were more vulnerable to IBS, although male sex was prevalent at a ratio of 3.5 : 1 (male:female) in the entire sample. The mean age of all participants was 23.85 years; most of the IBS patients were older than thirty. Abnormal anxiety scores and high levels of occupational stress were related to an IBS diagnosis. This prospective multicenter survey showed, for the first time, the potential impact of occupational stress on IBS in active duty noncombat Greek Military personnel. The diagnosis of IBS by questionnaire is a quick, affordable way that can upgrade, by its management, the quality of life and relieve from the military burden. Our results are comparable with previous studies, although large-scale epidemiological studies are required for the confirmation of a possible causative relationship.

Consumption of nuts and seeds and pancreatic ductal adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition.

Four epidemiologic studies have assessed the association between nut intake and pancreatic cancer risk with contradictory results. The present study aims to investigate the relation between nut intake (including seeds) and pancreatic ductal adenocarcinoma (PDAC) risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards models were used to estimate hazards ratio (HR) and 95% confidence intervals for nut intake and PDAC risk. Information on intake of nuts was obtained from the EPIC country-specific dietary questionnaires. After a mean follow-up of 14 years, 476,160 participants were eligible for the present study and included 1,283 PDAC cases. No association was observed between consumption of nuts and PDAC risk. Furthermore, no evidence for effect-measure modification was observed when different subgroups were analyzed. Overall, in EPIC, the highest intake of nuts was not statistically significantly associated with PDAC risk.

KEYWORDS: EPIC, diet, intake, nuts, pancreatic cancer, prospective cohort study, seeds

Adaptation of the Human Gut Microbiota Metabolic Network During the First Year After Birth.

Predicting the metabolic behavior of the human gut microbiota in different contexts is one of the most promising areas of constraint-based modeling. Recently, we presented a supra-organismal approach to build context-specific metabolic networks of bacterial communities using functional and taxonomic assignments of meta-omics data. In this work, this algorithm is applied to elucidate the metabolic changes induced over the first year after birth in the gut microbiota of a cohort of Spanish infants. We used metagenomics data of fecal samples and nutritional data of 13 infants at five time points. The resulting networks for each time point were analyzed, finding significant alterations once solid food is introduced in the diet. Our work shows that solid food leads to a different pattern of output metabolites that can be potentially released from the gut microbiota to the host. Experimental validation is presented for ferulate, a neuroprotective metabolite involved in the gut-brain axis.

KEYWORDS: human gut microbiome, metabolic networks, metabolomics, metagenomics, personalized nutrition

Contribution of sociodemographic, occupational, lifestyle and dietary characteristics to the oxidative stress microenvironment in adipose tissue.

The present study was conceived on the basis of the few previous reports suggesting a potential relevance of the oxidative stress microenvironment in the adipose tissue, a biological matrix which is closely related to the development of several chronic pathologies. Thus, our aim was to describe the levels of enzymatic and non-enzymatic antioxidants and markers of oxidative damage in adipose tissue samples from a Spanish cohort, as well as their main sociodemographic, lifestyle, and dietary predictors. The study was conducted in a subsample of GraMo cohort, recruited in Granada (Southern Spain). A face-to-face questionnaire was used to gather data regarding sociodemographic characteristics, lifestyle, dietary habits, health status, and perceived exposure to chemicals. We analyzed adipose tissue levels of lipid peroxidation (TBARS), total superoxide dismutase (SOD) activity, heme oxygenase-1 activity, and glutathione cycle biomarkers. Potential predictors of oxidative stress markers were assessed using stepwise multivariable linear regression analyses. SOD and TBARS levels were mainly related to sociodemographic and occupational characteristics, while the components of the glutathione cycle and HO-1 were predominantly associated with dietary habits. Men showed significantly lower levels of oxidative stress levels than women. In the regression models including only women, the use of oral contraceptive and hormonal therapy was associated with lower levels of oxidative stress, while the number of children was positively associated with increased oxidative biomarkers. Our results suggest that adipose tissue is potentially important matrix for the assessment of oxidative stress, which can be affected by specific environmental factors. These findings might be relevant for public health.

KEYWORDS: Adipose tissue, Diet, Lifestyle, Occupation, Oxidative stress, Sociodemographic characteristics

Diet quality and nutrient density in subjects with metabolic syndrome: Influence of socioeconomic status and lifestyle factors. A cross-sectional assessment in the PREDIMED-Plus study.

Socioeconomic disparities and lifestyle factors are likely to determine the overall quality of the diet. In addition, overeating is compatible with inadequate micronutrient intake and it can lead to adverse health outcomes. To assess adequacy of dietary nutrient intake and to investigate the influence of socioeconomic and lifestyle factors on nutrient density in a large primary cardiovascular prevention trial conducted in healthy participants with metabolic syndrome (MetS) to assess the cardiovascular effects of an energy-restricted Mediterranean diet (PREDIMED-Plus). Baseline cross-sectional analysis of the PREDIMED-Plus trial with 6646 Spanish participants with overweight/obesity and MetS. Energy and nutrient intake were calculated using a validated 143-item Food Frequency Questionnaire (FFQ) and nutrient density was estimated dividing the absolute nutrient intake by total energy intake. The prevalence of inadequate intake was estimated according to dietary reference intakes. Multivariable linear regression models were fitted to examine associations between socioeconomic status or lifestyle factors and nutrient density. A considerable proportion of the screened participants showed a deficient intake of vitamins A, D, E, B 9 , calcium, magnesium and dietary fibre. Inadequate intake of four or more of the ten nutrients considered was present in 17% of participants. A higher nutrient density was directly and significantly associated with female sex, higher educational level and a better adherence to the Mediterranean diet. Lifestyle factors such as non-smoking and avoidance of sedentary lifestyles were also independently associated with better nutrient density. Patients with MetS, despite being overweight, exhibited suboptimal nutrient intake, especially among men. Low nutrient density diet can be largely explained by differences in socioeconomic and lifestyle factors. These results highlight the importance of focussing on nutritional education in vulnerable populations, taking into account nutrient requirements.

KEYWORDS: Diet quality, Lifestyle factors, Mediterranean diet, Metabolic syndrome, Nutrient density, Socioeconomic factors

Many Patients With Irritable Bowel Syndrome Have Atypical Food Allergies Not Associated With Immunoglobulin E.

Confocal laser endomicroscopy (CLE) is a technique that permits real-time detection and quantification of changes in intestinal tissues and cells, including increases in intraepithelial lymphocytes and fluid extravasation through epithelial leaks. Using CLE analysis of patients with irritable bowel syndrome (IBS), we found that more than half have responses to specific food components. Exclusion of the defined food led to long-term symptom relief. We used the results of CLE to detect reactions to food in a larger patient population and analyzed duodenal biopsy samples and fluid from patients to investigate mechanisms of these reactions. In a prospective study, 155 patients with IBS received 4 challenges with each of 4 common food components via the endoscope, followed by CLE, at a tertiary medical center. Classical food allergies were excluded by negative results from immunoglobulin E serology analysis and skin tests for common food antigens. Duodenal biopsy samples and fluid were collected 2 weeks before and immediately after CLE and were analyzed by histology, immunohistochemistry, reverse transcription polymerase chain reaction, and immunoblots. Results from patients who had a response to food during CLE (CLE + ) were compared with results from patients who did not have a reaction during CLE (CLE - ) or healthy individuals (controls). Of the 108 patients who completed the study, 76 were CLE + , and 46 of these reacted to wheat. CLE + patients had a 4-fold increase in prevalence of atopic disorders compared with controls. Numbers of intraepithelial lymphocytes were significantly higher in duodenal biopsy samples from CLE + vs CLE - patients or controls. Expression of claudin-2 increased from crypt to villus tip and was up-regulated in CLE + patients compared with CLE - patients or controls. Levels of occludin were lower in duodenal biopsy samples from CLE + patients vs controls and were lowest in villus tips. Levels of messenger RNAs encoding inflammatory cytokines were unchanged in duodenal tissues after CLE challenge, but eosinophil degranulation increased, and levels of eosinophilic cationic protein were higher in duodenal fluid from CLE + patients than controls. In a CLE analysis of patients with IBS, we found that more than 50% of patients could have nonclassical food allergy, with immediate disruption of the intestinal barrier upon exposure to food antigens. Duodenal tissues from patients with responses to food components during CLE had immediate increases in expression of claudin-2 and decreases in occludin. CLE + patients also had increased eosinophil degranulation, indicating an atypical food allergy characterized by eosinophil activation.

KEYWORDS: Diet, Eosinophil, Food Allergy, Tight Junction

Milk-whey diet substantially suppresses seizure-like phenotypes of para Shu , a Drosophila voltage-gated sodium channel mutant.

The Drosophila mutant para Shu harbors a dominant, gain-of-function allele of the voltage-gated sodium channel gene, paralytic (para). The mutant flies display severe seizure-like phenotypes, including neuronal hyperexcitability, spontaneous spasms, ether-induced leg shaking, and heat-induced convulsions. We unexpectedly found that two distinct food recipes used routinely in the Drosophila research community result in a striking difference in severity of the para Shu phenotypes. Namely, when para Shu mutants were raised on the diet originally formulated by Edward Lewis in 1960, they showed severe neurological defects as previously reported. In contrast, when they were raised on the diet developed by Frankel and Brousseau in 1968, these phenotypes were substantially suppressed. Comparison of the effects of these two well-established food recipes revealed that the diet-dependent phenotypic suppression is accounted for by milk whey, which is present only in the latter. Inclusion of milk whey in the diet during larval stages was critical for suppression of the adult para Shu phenotypes, suggesting that this dietary modification affects development of the nervous system. We also found that milk whey has selective effects on other neurological mutants. Among the behavioral phenotypes of different para mutant alleles, those of para GEFS+ and para bss were suppressed by milk whey, while those of para DS and para ts1 were not significantly affected. Overall, our study demonstrates that different diets routinely used in Drosophila labs could have considerably different effects on neurological phenotypes of Drosophila mutants. This finding provides a solid foundation for further investigation into how dietary modifications affect development and function of the nervous system and, ultimately, how they influence behavior.

KEYWORDS: Voltage-gated sodium channel, dietary therapy, epilepsy, fruit fly

Specific foods can reduce symptoms of irritable bowel syndrome and functional constipation: a review.

Functional gastrointestinal disorders (FGIDs) are groups of disorders involving digestive symptoms that chronically persist despite the absence of organic abnormalities in the gastrointestinal tract. Representative FGIDs include functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC). In particular, IBS is a disease representative of FGIDs in which abdominal pain and discomfort associated with abnormal bowel movements chronically persist and recur. These symptoms are known to be related to lifestyle habits, such as meals and stress. In recent years, according to advances in dietary therapy for IBS and FC, specific foods have been shown to alter these symptoms. In IBS, bowel movement abnormalities and abdominal discomfort have been reported to be reduced when patients eat these specific foods. Several studies suggest that individuals with certain attitudes toward eating or with preferences for fatty food, fast food, junk snack food, fried food, and hot/spicy food showed a higher prevalence of gastrointestinal (GI) symptoms. Those who are cognizant of nutritional balance or healthy food intake have a lower prevalence of GI symptoms. Thus, eating specific foods with higher dietary fiber and low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharaides, and polyols) is effective for relief from some GI symptoms.First, two kinds of dietary fibers are found in foods: water-soluble dietary fiber and insoluble dietary fiber. Enduring misconceptions about the physical effects of fiber in the gut have led to misunderstandings about the health benefits attributable to insoluble and soluble fiber. Previous reviews suggest that health benefits have been shown in regard to fiber, and reproducible evidence of clinical efficacy has been published.Second, the ingestion of certain carbohydrates causes gastrointestinal symptoms. Foods rich in fermentable oligosaccharides, disaccharides, monosaccharaides, and polyols (collectively known as FODMAP) have been shown to cause abdominal pain and abdominal discomfort in westerners with IBS. Dietary therapy for FGIDs should include specific foods that have been scientifically proven to be effective for managing symptoms of irritable bowel syndrome and functional constipation.

KEYWORDS: Fermentable oligosaccharides Disaccharides Monosaccharaides And polyols FODMAP, Functional constipation FC, Functional dyspepsia FD, Functional gastrointestinal disorders FGIDs, Irritable bowel syndrome IBS

Eosinophilic esophagitis, gastroenteritis, and colitis in a patient with prior parasite exposure.

Eosinophilic gastrointestinal disorders (EGID) comprise a spectrum of inflammatory diseases that can affect any segment of the gastrointestinal tract. The pathogenesis of these conditions is complex; differentiating between primary and secondary forms of these disorders can be clinically challenging. We report a case of primary EGID in a patient with remote parasite exposure, whose symptoms were initially attributed to irritable bowel syndrome. Endoscopy revealed the rare finding of EGID involving the entire gastrointestinal tract; symptoms improved with an elimination diet. This case raises the possibility of a link between prior parasite exposure and development of EGID, and underscores the necessity of exploring alternative diagnoses in patients with presumed IBS who present with severe symptoms.

KEYWORDS: Colitis, Eosinophilic, Esophagitis, Gastroenteritis

Adherence to Dietary Recommendations Measured by Smartphone-based Recipe Nutrition Calculator in Kidney Transplant Patients.

Dietary restriction of protein, salt, and energy is recommended to prevent lifestyle related diseases, proteinuria, and graft dysfunction in kidney transplant patients. It is useful if the patients can evaluate meal components by themselves for each meal. A total of 26 maintenance-phase kidney transplant patients were included in the study. The mean age, sex, body mass index, number of years post-transplantation, creatinine clearance, and 24-hour urinary excretion of protein were recorded on a medical chart. Estimated daily protein and salt oral intake were calculated from 24 UE of nitrogen and sodium, respectively. We compared these laboratory results and patients' self-reported dietary intake using a smartphone-based recipe nutrition calculator (SRNC). Estimated daily protein and salt oral intake calculated from 24 UE of nitrogen and sodium were 55.4 ± 12.9 g/d and 8.5 ± 3.1 g/d, respectively. Estimated daily protein and salt oral intake measured by SRNC were 52.4 ± 13.8 g/day and 6.5 ± .9 g/day, respectively. The results of estimated daily protein and salt oral intake measured by SRNC were correlated to those calculated from 24 UE. The results of estimated daily protein and salt oral intake measured by SRNC were correlated to those calculated from 24 UE in maintenance-phase kidney transplant patients. SRNC was useful as a measurement modality to evaluate the adherence to dietary guidance. Dietary therapy for these patients may have the potential to improve kidney graft function and survival.

Low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols diet and irritable bowel syndrome in Asia.

Functional bowel disorders, including irritable bowel syndrome (IBS), are a chronic condition that can significantly reduce patients' quality of life. Therefore, this paper will review the roles of a low fermentable oligosaccharides, disaccharides, monosaccharides, and polypols (FODMAP) diet in treating IBS, particularly in an Asian setting. About 20% of the general population is diagnosed with IBS. However, there are limited effective medical therapies available for treating IBS. Therefore, IBS presents a major challenge to the health-care providers. Recently, there is an increasing interest in the use of a diet low in FODMAP for the treatment of IBS. A low FODMAP diet can decrease the delivery of readily fermentable substrates to the small intestine and colon, thereby improving functional gastrointestinal symptoms.

KEYWORDS: Asian, fermentable oligosaccharides, disaccharides, monosaccharides, and polypols, gastrointestinal, irritable bowel syndrome

Dietary and symptom assessment in adults with self-reported non-coeliac gluten sensitivity.

The mechanisms behind non-coeliac gluten sensitivity (NCGS) are not fully understood although clinical symptoms have shown to subside after wheat withdrawal. Self-prescription of a gluten-free diet (GFD) without medical supervision is common in NCGS subjects, resulting in dietary restrictions that can cause macro- and micronutrient deficiencies. The primary aim was to describe dietary intake, including FODMAP, in subjects with self-reported gluten sensitivity on GFD in whom coeliac disease (CD) and wheat allergy were excluded. Secondary, clinical symptoms and health-related quality of life (HR-QoL) were examined. Baseline characteristics were obtained from 65 adults with self-reported NCGS on GFD recruited to a randomised placebo-controlled challenge trial at Oslo University Hospital. Dietary intake was obtained by a seven-day food record and symptoms recorded by questionnaires. Mean proportions of energy were 43 E% from fat, 40 E% from carbohydrate and 17 E% from protein. Intakes of vitamin D, folic acid, calcium, iodine and iron were lower than recommended, mean (SD) 7.3 μg, 235 μg, 695 mg, 81 μg and 9.6 mg, respectively. Mean (SD) intake of FODMAP was 11.6 g. Gastrointestinal symptoms as scored by 100 mm visual analogue scale (VAS) were all below 15 mm of which wind and bloating were the most expressed. Tiredness, concentration difficulties, fatigue and muscle/joint pain were scored highest among extra-intestinal symptoms. Gastrointestinal symptoms as scored by gastrointestinal symptom rating scale - irritable bowel syndrome version (GSRS-IBS) were correlated with mild depression and inversely correlated with five sub-domains of HR-QoL. Subjects with self-reported NCGS on GFD had high proportion of energy from fat and sub-optimal intakes of vitamin D, folic acid, calcium, iodine and iron. Despite GFD and moderate intake of FODMAP, the subjects reported various gastro- and extra-intestinal symptoms and reduced HR-QoL. The findings highlight the importance of dietary education and nutritional follow-up of subjects on GFD.

KEYWORDS: FODMAP, Gluten-free diet, Non-coeliac gluten sensitivity

Pre-Pregnancy Adherence to the Mediterranean Diet and Gestational Diabetes Mellitus: A Case-Control Study.

Gestational diabetes mellitus (GDM), an important public health problem that affects mothers and offspring, is a common metabolic disorder. We evaluated the effect of the pre-pregnancy Mediterranean diet (MD) level of exposure on the odds of GDM development. A case-control study was conducted in pregnant women. Pre-pregnancy dietary intake was assessed using a validated food frequency questionnaire to calculate an MD adherence index. Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were estimated using multivariable logistic regression models including age, BMI, family history of diabetes mellitus, previous GDM, miscarriages, and gravidity. Overall, middle-high MD adherence was 216/291 and very high adherence was 17/291 in cases. In controls the corresponding figures were 900/1175 and 73/1175, respectively. Compared to low adherence, high MD adherence was associated with GDM reduction, and very high MD adherence was even more strongly associated. The protective effect of adherence to the MD prior to pregnancy should be considered as a preventive tool against the development of GDM.

KEYWORDS: Mediterranean diet (MD), gestational diabetes mellitus (GDM), pregnancy, lifestyles, maternal nutrition

Glycolytic inhibitor 2-deoxyglucose prevents cortical hyperexcitability after traumatic brain injury.

Traumatic brain injury (TBI) causes cortical dysfunction and can lead to post-traumatic epilepsy. Multiple studies demonstrate that GABAergic inhibitory network function is compromised following TBI, which may contribute to hyperexcitability and motor, behavioral, and cognitive deficits. Preserving the function of GABAergic interneurons, therefore, is a rational therapeutic strategy to preserve cortical function after TBI and prevent long-term clinical complications. Here, we explored an approach based on the ketogenic diet, a neuroprotective and anticonvulsant dietary therapy which results in reduced glycolysis and increased ketosis. Utilizing a pharmacologic inhibitor of glycolysis, we found that acute in vitro application of 2-DG decreased the excitability of excitatory neurons, but not inhibitory interneurons, in cortical slices from naïve mice. Employing the controlled cortical impact (CCI) model of TBI in mice, we found that in vitro 2-DG treatment rapidly attenuated epileptiform activity seen in acute cortical slices 3 to 5 weeks after TBI. One week of in vivo 2-DG treatment immediately after TBI prevented the development of epileptiform activity, restored excitatory and inhibitory synaptic activity, and attenuated the loss of parvalbumin-expressing inhibitory interneurons. In summary, 2-DG may have therapeutic potential to restore network function following TBI.

KEYWORDS: Epilepsy, Neurological disorders, Neuroscience