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Milk related disorders. A comparison between patients with IBS and healthy volunteers
TumorIn large Intestine,serum lipid| lad ~ Number Total choles. teml HDLcholesterol LDLcholesterol
Control 24
$1751
s
AdenomaM 13 245,5+/194,0+/-30.7 214.3+/-36.6 26.0** 65.7+/-29.6 108.3+/16,76
AdwmmaS 13
A m L 16 258.6+/29.1"*
65,8+/-20.3 58.4+/-19.6 65.5+/-14.5 120.6+1-22.0
Trlglycedde 108,0+1-47.2 135.2+/-71.9 PWV 945+/-38 996+/-47* Mean+/.Standarddeviation*<0.05 **<0,01
160.8+/12.5" 173.3+/76.7* 1177+/-53"
Milk Related Disorders. A Comparison between Patients with IBS and Healthy Volunteers Per G. Farup, Kristina W. Monsbakken, Per O. Vandvik
Copclnoma 14 255,2+/-21.5"
Patients with Irritable Bowel Syndrome (IBS)often relate symptoms to intake of milk. This study compares milk related disorders in patients with IBS and healthy volunteers. METHODS. Consecutive Nordic patients with 1BS (Rome II) and alarm symptoms (blood in stools, weight loss or a family history of gastrointestinal cancer) identified in a public screening were included in the trial. Patients with organic diseases were excluded. They were compared with an age and sex matched group of healthy volunteers. Abdominal symptoms related to intake of milk were recorded, a H2/CH4 breath test (BT) for lactose mafabsorption (LM) was performed, and symptoms 24 h after the BT were registered (the patient was blinded to the result of the BT). Symptoms after the BT were recorded as present/absent and a score based on intensity and duration was calculated. RESULTS. The table gives the main results. There was no difference in the prevalence of LM in the two groups. Milk related symptoms and symptoms after intake of lactose were significantly more common in patients with 1BS. In patients with and without LM, milk related abdominal symptoms were reported by 3/7 (43%) and 42/170 (25%) respectively (ns, p = 0.37), and symptoms after lactose BT by 6/ 7 (86%) and 43/170 (25%) respectively (p=0.002). The agreement between milk related symptoms and symptoms after lactose BT was 73%, kappa 0.29. CONCLUSION. The prevalence of LM is rare in the Nordic population, and the study shows no significant difference between patients with IBS and healthy volunteers. Milk related abdominal symptoms and symptoms after intake of lactose are nevertheless significantly more common in patients with IBS than in healthy volunteers. The agreement between symptoms related to intake of milk and symptoms after lactose BT was low. Altogether, the symptoms were unreliable for the diagnosis of LM.
57,6+t-14.6
161,9+/24,4~
178.5+/-17.5"*
138.4+/-40.5'
123.5+/.58.4
1248+/-82"*
1089.,-/-68"
$1749
Beneficial Effects of Prebiotics, Germinated Barley Foodstuff, in the Long Term Treatment of Ulcerative Colitis: a Multi-center Open Control Study Osamu Kanauchi, Keiichi Mitsuyama, Akira Andoh, Yoshihide Fujiyama, Michio Sata, Tadao Bamba, Yoshio Araki, Ken Takeuchi, Hiroyuki Hanai Background: Germinated barley foodstuff (GBF) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria. We previously showed that a one-month treatment of GBF reduced clinical and endoscopic activity of ulcerative colitis (UC) patients in a non-randonnaed open-label study (Aliment Pharmacul Ther 1998; 12: 1225-1230). The aim of this study was to investigate the efficacy of long term GBF treatment in a multi-center open control study. Methods: This research was approved by the ethical committee of the respective institutes, and informed consent was obtained from all patients. Study 1; Active UC patients (n= 15) were given 20 to 30 grams of GBF daily together with the baseline treatment for 6 months. The control group (n = 48) received only base line anti-inflammatory treatment. The treatment efficacy was evaluated by clinical activity index (Br MedJ 1989; 298: 82-86, active; CAI > 4). Study 2; Inactive disease patients (n = 22) were g~ven GBF for 6 months in the same way as in Study 1. The control group (n = 29) received only base line anti-inflammatory treatment. The treatment efficacy was evaluated by the CAI, the recurrence rate, and the steroid dose. Results: Study 1; After 6 months of treatment, GBF significantly reduced CAI in active disease patients compared to the control group (control 2.8 -+ 0.4, GBF 1.5 -+ 0.2 * *; p<0.05). Study 2; GBF slgnificandy reduced the CAI (control 2.8_+0.4, GBF; 1.5._+0.6') and the recurrence rate (control 21%, GBF 5.2%*) compared to those of the control group. After 6 months of GBF treatment, the steroid dose was significantly lower than that of the initial period (initial 12.1 _+ 1.4, 6-month 6.1 _+ 1.1 mg/d *). Conclusion: The long term GBF treatment can reduce the disease acuvity and also maintain remission in patients with UC. GBF has a clinical benefit in the treatment of UC.
Chatactedatlcl IB$ group Number of patients 82 Male I female (no) 26(32%) / 56(68%) Age In ywrs (mmn) 48.8 BMI (mean) 26.0 Milk related symptom=(no) 32/'/9 (40%) Lactose malablm'ptien (no) 3/74 (4,1%) Symptomoafter BT (no) 28/74(38%) Symptomocom after BT (mean) 3.5
Patients with IBD frequently report a history of food intolerance which might be related to IBD pathophysiology. It is unclear to which extent such intolerances are based on food allergy defined as a immune-mediated reaction, or caused by other mechanisms, since reliable diagnostic means to confirm food allergy are lacking. Therefore, the prevalence of food allergy and intolerance in 1BD patients is largely unknown. In cooperation with the German IBD patients organization DCCV we produced a questionnaire to identify IBD patients with food allergies or intolerances. This questionnaire was sent to 15.500 DCCV members of whom 10% responded enabling us to include 1430 patients with IBD (58% CD, 39% UC, median age 40 _+ 12 yrs) in our analysis. Furthermore, a control group consisting of 175 blood donors with no IBD (median age 38 -+ 11 yrs) was recruited. All individuals were asked in detail for allergic diseases, results of previous diagnostics, and reliable adverse reactions to foods. 74% of the IBD patients indicated adverse reactions to food, compared to 16% in the control group. In the IBD group a higher prevalence of bronchial asthma (8.4%, vs 2.3% in the control group), allergic rhinins (28% vs 18%), atopic dermatitis (26% vs 4.6%), positive family history of allergy (41% vs 25%) was reported (all p < 0.005). Elimination diet improved symptoms in 67% of the IBD patients, but only in 11% of the control group. We considered food allergy as a probable cause of symptoms warranting further examinations, if food intolerance was accompanied by a history of allergic skin or respiratory disease, a history of allergic disease among 1st grade relatives, and a clear improvement of symptoms after specific food elimination. 35% of IBD patients and 10% of controls (p < 0001) fulfilled two out of three of these criteria, and thus we invited these individuals for detailed diagnostics consisting of laboratory means and provocation tests. In conclusion, we found that adverse reactions to food is a serious phenomenon in patients with IBD, and that a relevant subgroup of patients is suffering most probably from immunemediated food allergy.
[Background] Mild to moderate long-term weight loss is commonly observed among subjects who have undergone gastrectomy. Severe malnutrition, however, also occurs after gastrectomy, and is sometzmes refractory to conventional treatments. A better understanding of postprandial dynamics in postsurgical gastrointestinal (GI) tracts and its relation with nutritional status is necessary for efficient therapeutic stratification. [Aim] To determine the relationship between nutritional status and postprandial dynamics (gastric emptying of liquids [GE-L] and mixing of miheu with digestive fluids (MIX]) in the reconstructed GI tract in pauents after partial gastrectomy. [Methods[ We studied 19 patients who had had partial gastrectomy between 1991 and 2002 due to gastric neoplasm (postoperative month = 7-91 Mo). After over night fasting, patients were given a liquid meal (100 cc, 100 Cal) with 99mTc and received an iv infusion with 1111n for GE-L/hepatobiliary dual scintigraphy. GE-L was assessed by T50% of test meal. Patients were classified into rapid, normal, or delayed GE-L group. MIX was graphically assessed in the intestinal phase as an overlap of both radioacuve markers (99mTc and 11 lln). Patients were classified into two groups: poor or well MIX. Nutritional status was assessed by serum total cholesterol (TC, mg/dl) and albumin (Alb, g/dl) before and after surgery. We compared TC and Alb among the groups, and also before and after operation in each group. [Results[ TC and Alb in each group are shown in the table and tend to be lower in rapid GE-L with poor MIX group (mean + SEM). Compared with preoperative state, TC and Alb in postoperative state significantly dropped in the rapid GE-L group (particularly poor MIX group) (p<0.05). [Conclusion] Postprandial dynamics after gastrectomy was associated with long-term nutritional status. Particularly, the subjects with rapid gastric emptying and poor mixing of milieu with digestive fluids tend to have more severe malnutrition. This diagnosis must be considered in patients with long-term refractory malnutrition after gastrectomy. Evaluation of gastric emptying and mixing by dual scintigraphy may be useful in predicting development of long-term malnutrition.
$1753
Breast Milk Lactoferrin Regulates Intestinal Gene Expression by Binding Bacterial DNA but not Genomic DNA Peter Mulligan, Nicholas White, Ping Wang, James Wilson, lan Sanderson Background: We hypothesised that lactoferrin (LF) alters the expression of immune genes in the infant intestine by binding to DNA. We examined both the direct and indirect effects on immune gene regulation of its binding to DNA. Two biologically relevam compartments were studied: binding to pro-inflammatory, bacterial DNA sequences (CpG motifs) in the extracelfular environment, and binding to gene promoters in the cell nucleus. Methods: Reporter gene assays were used to detect NF-KB and LF transcription factor activity in transfected ceils. LF transcytosis across M-cell-fike monolayers was quantified using ELISA. Cytokine transcription was compared using RT-PCR, and IL-8 release by ELISA. Band-shifi assays were used to determine the DNA binding specificity of LF, and LF nuclear trafficking was studied by taggntg LF with green fluorescent protein. Results: LF inhibited CpG motifinduced NF-KB activation and IL-8 and IL-12 gene transcription in B-cells at LF concentrations greater than 0.5 p~M. Transcytosis of LF across M-cell-hke epithelial monolayers was
N a t ~ a l Status lind Postprandial Dynamicsin Patientswith ParlJalGastrectomy
AGA
Abstracts
Normal Welt 4.35+1-0.08 181.2+/-17.0
n.s. n.s. p = 0,014 p < 0,001 n.s, p=0.011 p=0.011
Adverse Reactions to Food in Patients with Inflammatory Bowel Disease (]BD) Michael Momma, Ulf Steder-Neukamm, Jochen Wedemeyer, Michael P. Manns, Stephan C. Bischoff
Rapid Gastric Emptying of Liquids and Poor Mixing of Milieu with Digestive Fluids Cause Long-term Malnutrition after Gastreetomy Ayako Muto, Ayako Suzuki, Toshthide Okada, Hiroshi Mabuchi
Rapid Poor Well 3.42+/-057 4.28+/-0.74 151.8+/-14.0 196.5+/-39.0
Stedliti.
$1752
S1750
Mklng AJb(g/dl) TC(mgldl)
Heldthy volunteers 105 23(22%)/ 82(78%) 463 24.6 13/105 (12%) 4/105 (3.8%) 21/104(20%) 1.7
Delayed Well 4.45+#0,25 1765+/-9.13
A-260
Control 24
$1751
s
AdenomaM 13 245,5+/194,0+/-30.7 214.3+/-36.6 26.0** 65.7+/-29.6 108.3+/16,76
AdwmmaS 13
A m L 16 258.6+/29.1"*
65,8+/-20.3 58.4+/-19.6 65.5+/-14.5 120.6+1-22.0
Trlglycedde 108,0+1-47.2 135.2+/-71.9 PWV 945+/-38 996+/-47* Mean+/.Standarddeviation*<0.05 **<0,01
160.8+/12.5" 173.3+/76.7* 1177+/-53"
Milk Related Disorders. A Comparison between Patients with IBS and Healthy Volunteers Per G. Farup, Kristina W. Monsbakken, Per O. Vandvik
Copclnoma 14 255,2+/-21.5"
Patients with Irritable Bowel Syndrome (IBS)often relate symptoms to intake of milk. This study compares milk related disorders in patients with IBS and healthy volunteers. METHODS. Consecutive Nordic patients with 1BS (Rome II) and alarm symptoms (blood in stools, weight loss or a family history of gastrointestinal cancer) identified in a public screening were included in the trial. Patients with organic diseases were excluded. They were compared with an age and sex matched group of healthy volunteers. Abdominal symptoms related to intake of milk were recorded, a H2/CH4 breath test (BT) for lactose mafabsorption (LM) was performed, and symptoms 24 h after the BT were registered (the patient was blinded to the result of the BT). Symptoms after the BT were recorded as present/absent and a score based on intensity and duration was calculated. RESULTS. The table gives the main results. There was no difference in the prevalence of LM in the two groups. Milk related symptoms and symptoms after intake of lactose were significantly more common in patients with 1BS. In patients with and without LM, milk related abdominal symptoms were reported by 3/7 (43%) and 42/170 (25%) respectively (ns, p = 0.37), and symptoms after lactose BT by 6/ 7 (86%) and 43/170 (25%) respectively (p=0.002). The agreement between milk related symptoms and symptoms after lactose BT was 73%, kappa 0.29. CONCLUSION. The prevalence of LM is rare in the Nordic population, and the study shows no significant difference between patients with IBS and healthy volunteers. Milk related abdominal symptoms and symptoms after intake of lactose are nevertheless significantly more common in patients with IBS than in healthy volunteers. The agreement between symptoms related to intake of milk and symptoms after lactose BT was low. Altogether, the symptoms were unreliable for the diagnosis of LM.
57,6+t-14.6
161,9+/24,4~
178.5+/-17.5"*
138.4+/-40.5'
123.5+/.58.4
1248+/-82"*
1089.,-/-68"
$1749
Beneficial Effects of Prebiotics, Germinated Barley Foodstuff, in the Long Term Treatment of Ulcerative Colitis: a Multi-center Open Control Study Osamu Kanauchi, Keiichi Mitsuyama, Akira Andoh, Yoshihide Fujiyama, Michio Sata, Tadao Bamba, Yoshio Araki, Ken Takeuchi, Hiroyuki Hanai Background: Germinated barley foodstuff (GBF) is a prebiotic foodstuff that effectively increases luminal butyrate production by stimulating the growth of protective bacteria. We previously showed that a one-month treatment of GBF reduced clinical and endoscopic activity of ulcerative colitis (UC) patients in a non-randonnaed open-label study (Aliment Pharmacul Ther 1998; 12: 1225-1230). The aim of this study was to investigate the efficacy of long term GBF treatment in a multi-center open control study. Methods: This research was approved by the ethical committee of the respective institutes, and informed consent was obtained from all patients. Study 1; Active UC patients (n= 15) were given 20 to 30 grams of GBF daily together with the baseline treatment for 6 months. The control group (n = 48) received only base line anti-inflammatory treatment. The treatment efficacy was evaluated by clinical activity index (Br MedJ 1989; 298: 82-86, active; CAI > 4). Study 2; Inactive disease patients (n = 22) were g~ven GBF for 6 months in the same way as in Study 1. The control group (n = 29) received only base line anti-inflammatory treatment. The treatment efficacy was evaluated by the CAI, the recurrence rate, and the steroid dose. Results: Study 1; After 6 months of treatment, GBF significantly reduced CAI in active disease patients compared to the control group (control 2.8 -+ 0.4, GBF 1.5 -+ 0.2 * *; p<0.05). Study 2; GBF slgnificandy reduced the CAI (control 2.8_+0.4, GBF; 1.5._+0.6') and the recurrence rate (control 21%, GBF 5.2%*) compared to those of the control group. After 6 months of GBF treatment, the steroid dose was significantly lower than that of the initial period (initial 12.1 _+ 1.4, 6-month 6.1 _+ 1.1 mg/d *). Conclusion: The long term GBF treatment can reduce the disease acuvity and also maintain remission in patients with UC. GBF has a clinical benefit in the treatment of UC.
Chatactedatlcl IB$ group Number of patients 82 Male I female (no) 26(32%) / 56(68%) Age In ywrs (mmn) 48.8 BMI (mean) 26.0 Milk related symptom=(no) 32/'/9 (40%) Lactose malablm'ptien (no) 3/74 (4,1%) Symptomoafter BT (no) 28/74(38%) Symptomocom after BT (mean) 3.5
Patients with IBD frequently report a history of food intolerance which might be related to IBD pathophysiology. It is unclear to which extent such intolerances are based on food allergy defined as a immune-mediated reaction, or caused by other mechanisms, since reliable diagnostic means to confirm food allergy are lacking. Therefore, the prevalence of food allergy and intolerance in 1BD patients is largely unknown. In cooperation with the German IBD patients organization DCCV we produced a questionnaire to identify IBD patients with food allergies or intolerances. This questionnaire was sent to 15.500 DCCV members of whom 10% responded enabling us to include 1430 patients with IBD (58% CD, 39% UC, median age 40 _+ 12 yrs) in our analysis. Furthermore, a control group consisting of 175 blood donors with no IBD (median age 38 -+ 11 yrs) was recruited. All individuals were asked in detail for allergic diseases, results of previous diagnostics, and reliable adverse reactions to foods. 74% of the IBD patients indicated adverse reactions to food, compared to 16% in the control group. In the IBD group a higher prevalence of bronchial asthma (8.4%, vs 2.3% in the control group), allergic rhinins (28% vs 18%), atopic dermatitis (26% vs 4.6%), positive family history of allergy (41% vs 25%) was reported (all p < 0.005). Elimination diet improved symptoms in 67% of the IBD patients, but only in 11% of the control group. We considered food allergy as a probable cause of symptoms warranting further examinations, if food intolerance was accompanied by a history of allergic skin or respiratory disease, a history of allergic disease among 1st grade relatives, and a clear improvement of symptoms after specific food elimination. 35% of IBD patients and 10% of controls (p < 0001) fulfilled two out of three of these criteria, and thus we invited these individuals for detailed diagnostics consisting of laboratory means and provocation tests. In conclusion, we found that adverse reactions to food is a serious phenomenon in patients with IBD, and that a relevant subgroup of patients is suffering most probably from immunemediated food allergy.
[Background] Mild to moderate long-term weight loss is commonly observed among subjects who have undergone gastrectomy. Severe malnutrition, however, also occurs after gastrectomy, and is sometzmes refractory to conventional treatments. A better understanding of postprandial dynamics in postsurgical gastrointestinal (GI) tracts and its relation with nutritional status is necessary for efficient therapeutic stratification. [Aim] To determine the relationship between nutritional status and postprandial dynamics (gastric emptying of liquids [GE-L] and mixing of miheu with digestive fluids (MIX]) in the reconstructed GI tract in pauents after partial gastrectomy. [Methods[ We studied 19 patients who had had partial gastrectomy between 1991 and 2002 due to gastric neoplasm (postoperative month = 7-91 Mo). After over night fasting, patients were given a liquid meal (100 cc, 100 Cal) with 99mTc and received an iv infusion with 1111n for GE-L/hepatobiliary dual scintigraphy. GE-L was assessed by T50% of test meal. Patients were classified into rapid, normal, or delayed GE-L group. MIX was graphically assessed in the intestinal phase as an overlap of both radioacuve markers (99mTc and 11 lln). Patients were classified into two groups: poor or well MIX. Nutritional status was assessed by serum total cholesterol (TC, mg/dl) and albumin (Alb, g/dl) before and after surgery. We compared TC and Alb among the groups, and also before and after operation in each group. [Results[ TC and Alb in each group are shown in the table and tend to be lower in rapid GE-L with poor MIX group (mean + SEM). Compared with preoperative state, TC and Alb in postoperative state significantly dropped in the rapid GE-L group (particularly poor MIX group) (p<0.05). [Conclusion] Postprandial dynamics after gastrectomy was associated with long-term nutritional status. Particularly, the subjects with rapid gastric emptying and poor mixing of milieu with digestive fluids tend to have more severe malnutrition. This diagnosis must be considered in patients with long-term refractory malnutrition after gastrectomy. Evaluation of gastric emptying and mixing by dual scintigraphy may be useful in predicting development of long-term malnutrition.
$1753
Breast Milk Lactoferrin Regulates Intestinal Gene Expression by Binding Bacterial DNA but not Genomic DNA Peter Mulligan, Nicholas White, Ping Wang, James Wilson, lan Sanderson Background: We hypothesised that lactoferrin (LF) alters the expression of immune genes in the infant intestine by binding to DNA. We examined both the direct and indirect effects on immune gene regulation of its binding to DNA. Two biologically relevam compartments were studied: binding to pro-inflammatory, bacterial DNA sequences (CpG motifs) in the extracelfular environment, and binding to gene promoters in the cell nucleus. Methods: Reporter gene assays were used to detect NF-KB and LF transcription factor activity in transfected ceils. LF transcytosis across M-cell-fike monolayers was quantified using ELISA. Cytokine transcription was compared using RT-PCR, and IL-8 release by ELISA. Band-shifi assays were used to determine the DNA binding specificity of LF, and LF nuclear trafficking was studied by taggntg LF with green fluorescent protein. Results: LF inhibited CpG motifinduced NF-KB activation and IL-8 and IL-12 gene transcription in B-cells at LF concentrations greater than 0.5 p~M. Transcytosis of LF across M-cell-hke epithelial monolayers was
N a t ~ a l Status lind Postprandial Dynamicsin Patientswith ParlJalGastrectomy
AGA
Abstracts
Normal Welt 4.35+1-0.08 181.2+/-17.0
n.s. n.s. p = 0,014 p < 0,001 n.s, p=0.011 p=0.011
Adverse Reactions to Food in Patients with Inflammatory Bowel Disease (]BD) Michael Momma, Ulf Steder-Neukamm, Jochen Wedemeyer, Michael P. Manns, Stephan C. Bischoff
Rapid Gastric Emptying of Liquids and Poor Mixing of Milieu with Digestive Fluids Cause Long-term Malnutrition after Gastreetomy Ayako Muto, Ayako Suzuki, Toshthide Okada, Hiroshi Mabuchi
Rapid Poor Well 3.42+/-057 4.28+/-0.74 151.8+/-14.0 196.5+/-39.0
Stedliti.
$1752
S1750
Mklng AJb(g/dl) TC(mgldl)
Heldthy volunteers 105 23(22%)/ 82(78%) 463 24.6 13/105 (12%) 4/105 (3.8%) 21/104(20%) 1.7
Delayed Well 4.45+#0,25 1765+/-9.13
A-260