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Stable reversal of primitive intestinal lymphangiectasia
EUROPEAN SOCIETY OF PARENTERAL AND ENTERAL NUTRlTION
emptying there is no relationship between volumes in the stomach measured by each method. There is, however, agreement between patterns of emptying and filling
222-P. PREBIOTIC TRIALS
APPLICATIONS
IN HUMAN VOLUNTEER
S. Kolida, K.M. Tuohy, G.R. Gibson School of Food Biosciences, University of Reading, Reading, United Kingdom Rationale: The human colonic microflora has a key role in health and disease, being unique in its complexity and range of functions. The colonic microbiota not only provides up to 10% of the host daily energy but also acts as a protective bzmier against infection. Method: The prebiotic approach aims to increase colonic bacteria that xe considered to be beneficial for human health, namely bifidobacteria and lactobacilli. Currently recognised prebiotics in Europe are FOS, lactulose and G O S and their efficacy has been proven in human trials. The next step will be to test their potential in preventing and/or alleviating the symptoms of gastrointestinal disease. The disease of interest here was ulcerative colitis, a chronic remitting and relapsing acute inflammation of the colorectal mucosa. The prebiotic potential of a biscuit, containing a mixture of FOS and patially hy&olysed gux gum was initially tested in a double blind placebo controlled double crossover study of 30 healthy humans. Results: There was a significant increase in Bifidobacterium spp. numbers upon the ingestion of the active biscuits. The same product was subsequently tested in a pilot trial of ulcerative colitis patients in remission. Bifidogenicity of the product was confilmed, with no major side effect. In search of an even better product that would not increase flatus production, a blend of FOS+GOS (1:l) was tested in vitro in a human gut model and its prebiotic potential assessed.FOS + G O S gave a higher bifidogenicity, and produced significant increases in butyrate. Conclusions: The cure for most chronic gastrointestinal diseases remains elusive. The constant reduction in the efficacy and potency of antibiotics, created by their indiscriminate use, has generated a need for alternative approaches of both treatment and prophylaxis. The prebiotic approach of colonic microflora management could provide that alternative.
223-P. STABLE REVERSAL LYMPHANGIECTASIA
OF PRIMITIVE
INTESTINAL
L. Santapia’, L. Alfonsi’, M. Genus’, F. D’Almiento’, F. Contaldo’, F. Pasanisi ’ ‘Medicina Clinica e Sperimentale, Nutrizione Clinica, ‘Scienze Biomorfologiche e Funzionali, Universit di Napoli Federico II, Naples, Italy Rationale: Primxy intestinal lymphangiectasia is a rare chronic disease chxacterized by protein loosing enteropathy with clinical symptoms of diayhea, vomiting, abdominal pain, steatholyea, edema and a typical hystological pattern of dilated lymphatics in the mucosa, submucosa and serosa of the small bowel. Long telm treatment includes corticosteroids, octreotide and antiplasmin associated with specific diet. Method: We report a case of a young woman affected by primary intestinal lymphangiectasia clinically developed at 24 years of age and immediately treated, without drugs, with an MCT enriched, low fat, hyperproteic diet only. Results: Apxt a short two months relapse after 3 years of follow up, the disease was clinically silent for more than five years and hystological enteral pattern significantly and permanently improved. Conclusions: This obselyation shows that a hypolipidic, MCT enriched, hyperproteic diet has been a successful treatment in a young woman affected by primitive intestinal lymphangiectasia.
224-P. DIFFERENCES IN THE FAECAL FLORA OF HEALTHY INDIVIDUALS AND PATIENTS WITH IRRITABLE BOWEL SYNDROME, AND IN VITRO EFFECTS OF A SYNBIOTIC UPON GUT FLORA COMPOSITION S. Pistoli, C. Smejkal, A. McCartney, G.R. Gibson FMSU-School of Food Biosciences, University of Reading, Reading, United Kingdom Rationale: Irritable bowel syndrome (IBS) is a condition where abdominal pain, diarrhoea, constipation, gas distension and/or vxiability in the bowel habit is experienced. It has been suggested that the gut microflora may be involved in this condition and that an ‘abnolmal’ colonic fermentation may provoke the symptoms of IBS. The aim of this study is to determine whether there is a difference between the faecal flora of IBS patients and healthy individuals. Moreover, the effect of the administration of a synbiotic, as a potential treatment of IBS symptoms was determined. Method: In this study, the faecal flora of 10 IBS patients was compared with that of 10 healthy individuals using (culture independent) Fluorescence in Situ Hybridisation and traditional plating techniques. Fmthelmore, the effect of supplementation of a synbiotic version of Lactobacillus plantanrm with different prebiotics was determined in gut model systems where the production of gas was also monitored. Results: As fx as the compz&on of the faecal flora of IBS patients with healthy individuals is concerned, it was found that IBS patients had lower total bacterial counts, and less bifidobacteria and lactobacilli than seen in healthy individuals. Experiments in the gut model systems showed that administration of L. plantanrm with a galactooligosaccharide (GOS) increased the numbers of bifidobacteria and lactobacilli whilst decreasing clostridia. Fmthelmore, the combination of L. plantanrm with G O S resulted in an increase in butyrate production. It was found that gas generated from the faecal microflora of an IBS patient was much greater than that gas produced from the faecal flora of a healthy individual used as a control. Conclusions: These observations can help to define improved dietary management strategies, based around gut flora activities, that may help improve IBS symptomology.
225-P. CHARACTERISATION OF THE GUT MICROFLORA IN PATIENTS WITH IRRITABLE BOWEL SYNDROME AND THE DEVELOPMENT OF A DIETARY SYNBIOTIC TREATMENT STRATEGY C.W. Smeikal, S. Pistoli, G.R. Gibson School of Food Biosciences, University of Reading, Reading, United Kingdom Rationale: Irritable bowel syndrome is a common disorder of the intestines that effects S-22% of the general population with a significant proportion being women. Some IBS sufferers have constipation, others have diaxhcea and some experience both. There xe many puported causes of IBS, however there is increasing evidence that a depletion in beneficial gut bacteria such as lactobacilli and bifidobacteria contributes to this disorder. Additionally, attention has been drawn to the relationship between the carriage of yeasts such as Candida spp, food borne pathogens and colonisation by Helicobacter pylori. Method: Results using fluorescent in situ hybridisation (FISH) for key bacterial groups in the gut showed that in the faeces of IBS patients there is one log fewer “beneficial” lactobacilli and bifidiobacteria, compared to non IBS sufferers. Moreover, groups such as bacterioides, clostridia and colifolms were higher in IBS patients. Results: PCR analysis has confilmed the presence of both pathogenic yeasts and Candida albicans in the faeces of a significant number of patients. A synbiotic (mix of both pre and probiotic) has been developed incorporating a spray-dried probiotic Lactobacillus plantxum strain and a prebiotic galactooligosaccharide. The prebiotic optimally supports the growth of L. plantxum and significantly enhances the growth of beneficial bacteria as tested by an in vitro gut model system. The use of PCR-DGGE also enabled us to elucidate a characteristic fingerprint for this strain and will be useful for identifying it in a mixed community. Additionally, bacteriocin typing of L. plantarum showed that it had an inhibitory effect on Candida albicans.
emptying there is no relationship between volumes in the stomach measured by each method. There is, however, agreement between patterns of emptying and filling
222-P. PREBIOTIC TRIALS
APPLICATIONS
IN HUMAN VOLUNTEER
S. Kolida, K.M. Tuohy, G.R. Gibson School of Food Biosciences, University of Reading, Reading, United Kingdom Rationale: The human colonic microflora has a key role in health and disease, being unique in its complexity and range of functions. The colonic microbiota not only provides up to 10% of the host daily energy but also acts as a protective bzmier against infection. Method: The prebiotic approach aims to increase colonic bacteria that xe considered to be beneficial for human health, namely bifidobacteria and lactobacilli. Currently recognised prebiotics in Europe are FOS, lactulose and G O S and their efficacy has been proven in human trials. The next step will be to test their potential in preventing and/or alleviating the symptoms of gastrointestinal disease. The disease of interest here was ulcerative colitis, a chronic remitting and relapsing acute inflammation of the colorectal mucosa. The prebiotic potential of a biscuit, containing a mixture of FOS and patially hy&olysed gux gum was initially tested in a double blind placebo controlled double crossover study of 30 healthy humans. Results: There was a significant increase in Bifidobacterium spp. numbers upon the ingestion of the active biscuits. The same product was subsequently tested in a pilot trial of ulcerative colitis patients in remission. Bifidogenicity of the product was confilmed, with no major side effect. In search of an even better product that would not increase flatus production, a blend of FOS+GOS (1:l) was tested in vitro in a human gut model and its prebiotic potential assessed.FOS + G O S gave a higher bifidogenicity, and produced significant increases in butyrate. Conclusions: The cure for most chronic gastrointestinal diseases remains elusive. The constant reduction in the efficacy and potency of antibiotics, created by their indiscriminate use, has generated a need for alternative approaches of both treatment and prophylaxis. The prebiotic approach of colonic microflora management could provide that alternative.
223-P. STABLE REVERSAL LYMPHANGIECTASIA
OF PRIMITIVE
INTESTINAL
L. Santapia’, L. Alfonsi’, M. Genus’, F. D’Almiento’, F. Contaldo’, F. Pasanisi ’ ‘Medicina Clinica e Sperimentale, Nutrizione Clinica, ‘Scienze Biomorfologiche e Funzionali, Universit di Napoli Federico II, Naples, Italy Rationale: Primxy intestinal lymphangiectasia is a rare chronic disease chxacterized by protein loosing enteropathy with clinical symptoms of diayhea, vomiting, abdominal pain, steatholyea, edema and a typical hystological pattern of dilated lymphatics in the mucosa, submucosa and serosa of the small bowel. Long telm treatment includes corticosteroids, octreotide and antiplasmin associated with specific diet. Method: We report a case of a young woman affected by primary intestinal lymphangiectasia clinically developed at 24 years of age and immediately treated, without drugs, with an MCT enriched, low fat, hyperproteic diet only. Results: Apxt a short two months relapse after 3 years of follow up, the disease was clinically silent for more than five years and hystological enteral pattern significantly and permanently improved. Conclusions: This obselyation shows that a hypolipidic, MCT enriched, hyperproteic diet has been a successful treatment in a young woman affected by primitive intestinal lymphangiectasia.
224-P. DIFFERENCES IN THE FAECAL FLORA OF HEALTHY INDIVIDUALS AND PATIENTS WITH IRRITABLE BOWEL SYNDROME, AND IN VITRO EFFECTS OF A SYNBIOTIC UPON GUT FLORA COMPOSITION S. Pistoli, C. Smejkal, A. McCartney, G.R. Gibson FMSU-School of Food Biosciences, University of Reading, Reading, United Kingdom Rationale: Irritable bowel syndrome (IBS) is a condition where abdominal pain, diarrhoea, constipation, gas distension and/or vxiability in the bowel habit is experienced. It has been suggested that the gut microflora may be involved in this condition and that an ‘abnolmal’ colonic fermentation may provoke the symptoms of IBS. The aim of this study is to determine whether there is a difference between the faecal flora of IBS patients and healthy individuals. Moreover, the effect of the administration of a synbiotic, as a potential treatment of IBS symptoms was determined. Method: In this study, the faecal flora of 10 IBS patients was compared with that of 10 healthy individuals using (culture independent) Fluorescence in Situ Hybridisation and traditional plating techniques. Fmthelmore, the effect of supplementation of a synbiotic version of Lactobacillus plantanrm with different prebiotics was determined in gut model systems where the production of gas was also monitored. Results: As fx as the compz&on of the faecal flora of IBS patients with healthy individuals is concerned, it was found that IBS patients had lower total bacterial counts, and less bifidobacteria and lactobacilli than seen in healthy individuals. Experiments in the gut model systems showed that administration of L. plantanrm with a galactooligosaccharide (GOS) increased the numbers of bifidobacteria and lactobacilli whilst decreasing clostridia. Fmthelmore, the combination of L. plantanrm with G O S resulted in an increase in butyrate production. It was found that gas generated from the faecal microflora of an IBS patient was much greater than that gas produced from the faecal flora of a healthy individual used as a control. Conclusions: These observations can help to define improved dietary management strategies, based around gut flora activities, that may help improve IBS symptomology.
225-P. CHARACTERISATION OF THE GUT MICROFLORA IN PATIENTS WITH IRRITABLE BOWEL SYNDROME AND THE DEVELOPMENT OF A DIETARY SYNBIOTIC TREATMENT STRATEGY C.W. Smeikal, S. Pistoli, G.R. Gibson School of Food Biosciences, University of Reading, Reading, United Kingdom Rationale: Irritable bowel syndrome is a common disorder of the intestines that effects S-22% of the general population with a significant proportion being women. Some IBS sufferers have constipation, others have diaxhcea and some experience both. There xe many puported causes of IBS, however there is increasing evidence that a depletion in beneficial gut bacteria such as lactobacilli and bifidobacteria contributes to this disorder. Additionally, attention has been drawn to the relationship between the carriage of yeasts such as Candida spp, food borne pathogens and colonisation by Helicobacter pylori. Method: Results using fluorescent in situ hybridisation (FISH) for key bacterial groups in the gut showed that in the faeces of IBS patients there is one log fewer “beneficial” lactobacilli and bifidiobacteria, compared to non IBS sufferers. Moreover, groups such as bacterioides, clostridia and colifolms were higher in IBS patients. Results: PCR analysis has confilmed the presence of both pathogenic yeasts and Candida albicans in the faeces of a significant number of patients. A synbiotic (mix of both pre and probiotic) has been developed incorporating a spray-dried probiotic Lactobacillus plantxum strain and a prebiotic galactooligosaccharide. The prebiotic optimally supports the growth of L. plantxum and significantly enhances the growth of beneficial bacteria as tested by an in vitro gut model system. The use of PCR-DGGE also enabled us to elucidate a characteristic fingerprint for this strain and will be useful for identifying it in a mixed community. Additionally, bacteriocin typing of L. plantarum showed that it had an inhibitory effect on Candida albicans.