Changes of High-Purity Insoluble Fiber from Soybean Dregs (Okara) after Being Fermented by Colonic Flora and Its Adsorption Capacity

In order to explore the changes and properties of high-purity insoluble dietary fiber from okara (HPIDF) after entering the colon and be fermented by colonic flora, fermented high-purity insoluble dietary fiber (F-HPIDF) was obtained by simulated fermentation in vitro by HPIDF and colonic flora from C57BL/6 mice. For exploring the differences of HPIDF and F-HPIDF, the changes of structure (SEM. FTIR, XRD, particle size, specific surface area, monosaccharide composition) and adsorption properties (water, oil, heavy metal irons, harmful substances) of HPIDF/F-HPIDF were explored. The results showed that F-HPIDF had a higher water-holding capacity (19.17 g/g), water-swelling capacity (24.83 mL/g), heavy metals-adsorption capacity (Cd2+: 1.82 μmol/g; Pb2+: 1.91 μmol/g; Zn2+: 1.30 μmol/g; Cu2+: 0.68 μmol/g), and harmful substances-adsorption capacity (GAC: 0.23 g/g; CAC: 14.80 mg/g; SCAC: 0.49 g/g) than HPIDF due to the changes of structure caused by fermentation. In addition, with the fermentation of HPIDF, some beneficial substances were produced, which might be potential intestinal prebiotics. The study of F-HPIDF strengthens the speculation that HPIDF may have potential bioactivities after entering the colon, which proved that okara-HPIDF may have potential functionality.

Diversion Colitis and Probiotic Stimulation: Effects of Bowel Stimulation Prior to Ileostomy Closure

Background: Diversion colitis is a non-specific inflammation of a defunctionalised segment of the colon after a temporary stoma has been performed. This inflammation is associated with a change in the colonic flora.Aim: To evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to closure of the protective ileostomy in patients operated on colorectal carcinoma and its effect on diversion colitis. A prospective, randomised, double-blind, controlled study is carried out.Methods: Patients who underwent surgery for colorectal carcinoma with protective ileostomy pending reconstructive surgery and with diversion colitis as diagnosis are included. Randomised and divided into two groups. Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery.Results: Patients in CG were distributed according to the endoscopic index of severity in pre-stimulation/post-stimulation as follows: severe n = 9/9 (25.7%), moderate n = 23/23 (65.7%), and mild n = 3/3 (8.6%); compared to the distribution in SG, severe n = 9/0 (26.5/0%), moderate n = 23/3 (67.6/8.8%), mild n = 2/19 (5.9/55.9%) and normal colonoscopy in 0/12 patients (0/35.3%).Conclusion: Probiotic stimulation of the efferent loop is a safe and effective method, managing to reduce both macroscopic and microscopic colitis, as well as a decrease in symptoms in the short term after reconstructive surgery.

Progestogens Are Metabolized by the Gut Microbiota: Implications for Colonic Drug Delivery

Following oral administration, the bioavailability of progestogens is very low and highly variable, in part due to metabolism by cytochrome P450 enzymes found in the mucosa of the small intestine. Conversely, the mucosa in the colon contains much lower levels of cytochrome P450 enzymes, thus, colonic delivery of progestogens may be beneficial. Microbiota in the colon are known to metabolize a great number of drugs, therefore, it is important to understand the stability of these hormones in the presence of colonic flora before developing formulations. The aim of this study was to investigate the stability of three progestogens: progesterone, and its two synthetic analogues, medroxyprogesterone acetate (MPA) and levonorgestrel (LNG), in the presence of human colonic microbiota. Progesterone, MPA, and LNG were incubated in mixed fecal inoculum (simulated human colonic fluid) under anerobic conditions. Progesterone was completely degraded after 2 h, whereas levels of MPA and LNG were still detectable after 24 h. The half-lives of progesterone, MPA, and LNG in fecal inoculum were 28, 644, and 240 min, respectively. This study describes the kinetics of colonic microbial metabolism of these hormones for the first time. MPA and LNG show promise for delivery to the colon, potentially improving pharmacokinetics over current oral delivery methods.

Clostridium difficile

Clostridium difficile (recently renamed as Clostridioides difficile) is a Gram-positive spore-forming anaerobic bacillus that is ubiquitous in nature, and particularly common in healthcare environments. Its spores are part of the colonic flora in about 2–3% of healthy adults, with colonization rates increasing, typically up to 10–20%, during hospitalization. Disease occurs when the organism shifts from quiescent spores to replicating vegetative cells with toxin (A and B) production; this happens when there is inhibition of the resident colonic flora (gut microbiome) by prescribed antibiotics, although cases can occur when no such precipitant is identified. C. difficile infection is now recognized as the most important bacterial enteric pathogen in wealthier countries, epidemics, and outbreaks of which are common, most notoriously now due to the ribotype 027 (NAP-1) strain that is associated with more severe disease and poor outcomes.

Breath Hydrogen Test in Lactose Malabsorption

Lactose is the most important source in mammalian milk. In normal children, Lactose is hydrolyzed by lactase, and directly absorbed into bloodstream by an active transport mechanism. The term of lactose malabsorption is reserved to patients in whom impaired intestinal lactose hydrolysis and uptake has been proven by an appropriate test. The severity of lactose malabsorption and the extent of symptoms vary widely and are the results of several factors such as the amount of ingested lactose, gastric emptying time, intestinal transit time, and colonic flora. The diagnosis of lactose malabsorption is based on clinical findings and the results of appropriate tests. The breath hydrogen test has obvious advantages for pediatric population because it is painless, non-invasive, sensitive and specific. In the absence of bacterial colonization in the small intestine, the elevation of the concentration of hydrogen in the expired air implies the arrival of lactose in the colon. The increasing respiratory excretion of hydrogen is indicative of a deficit of lactase in enterocyte brush border. This test can also be used to show the existence of bacterial growth. Dietary fiber, some drugs, preparation for colonoscopy, colonic pH, and diarrhea can influence the result of breath hydrogen test.

Protective Effect of Inulin and the Integrity of the Microvasculature in Diabetes Mellitus

Type 2 diabetic microangiopathy affects every organ in the body and can lead to serious incapacitating complications. VLDL and apo C1 are two of the main biochemical abnormalities which start and propagate this condition. Inulin fructans prebiotic effect on the colonic flora enhance the bifidogenic strains. These predominate over the pathogenic strains which encourage lipidogenesis, thus reducing hyperlipidemia. Our aim is to find out the possible effect of inulin ingestion on the metabolism of VLDL and apo C1 and their role in the pathogenesis of diabetic angiopathy Twenty eight obese type 2 diabetic female patients were subjected to this study. Each patient ingested 4 grams of inulin daily for 3 weeks. Their fasting serum level of VLDL and apo C1 were estimated before and after the period of inulin ingestion. There was a significant decrease in fasting level of serum VLDL and apo C 1 after inulin ingestion period. In conclusion inulin can be given as a protective and as an add on therapy for type 2 diabetic patients. It reduces two of the main culprits which start and propagate the pathologic pathway of diabetic microangiopathy. This cuts short the other offenders (small HDL, small dense LDL and the small VLDL remnants).

Risk factors for infection development after transrectal prostate biopsy and the role of resistant bacteria in colonic flora

Introduction: In this study, we aimed to identify risk factors for the development of infectious complications after prostate biopsy and to investigate the role of intestinal colonization of bacteria that are resistant to prophylactic antibiotics. Methodology: A total of 168 patients who had undergone transrectal prostate biopsy (TRPB) under ciprofloxacin and gentamycin prophylaxis were included in the study. Stool cultures and subsequent antibiotic susceptibility testing were performed in all patients before the start of antibiotic prophylaxis. Results: Of the 168 patients, 17 (10.1%) developed urinary tract infection (UTI), while 6 (3.57%) developed sepsis within seven days after biopsy. Ciprofloxacin-resistant bacterial colonization was detected in 81 (48.2%) of the patients. None of the patients with ciprofloxacin-sensitive bacteria in intestinal flora developed a UTI. The colonization of intestinal ciprofloxacin-resistant bacteria increased UTI risk significantly after TRPB (p < 0.0001). Urolithiasis history, presence of permanent urinary catheterization, hospitalization history for more than 48 hours in the last year, and recent antibiotic usage significantly increased UTI risk after TRPB. Conclusions: Development of an infection was more frequent in patients with resistant bacterial colonization. We hope to guide more comprehensive studies designed to find a standard prophylactic regimen for TRPB that can be used all over the world.

Qualitative Parameters of the Colonic Flora in Patients with HNF1A-MODY Are Different from Those Observed in Type 2 Diabetes Mellitus

Background. Type 2 diabetes mellitus (T2DM) is determined by genetic and environmental factors. There have been many studies on the relationship between the composition of the gastrointestinal bacterial flora, T2DM, and obesity. There are no data, however, on the gut microbiome structure in monogenic forms of the disease including Maturity Onset Diabetes of the Young (MODY).Methods. The aim of the investigation was to compare the qualitative parameters of the colonic flora in patients with HNF1A-MODY and T2DM and healthy individuals. 16S sequencing of bacterial DNA isolated from the collected fecal samples using the MiSeq platform was performed.Results. There were significant between-group differences in the bacterial profile. At the phylum level, the amount of Proteobacteria was higher (p=0.0006) and the amount of Bacteroidetes was lower (p=0.0005) in T2DM group in comparison to the control group. In HNF1A-MODY group, the frequency of Bacteroidetes was lower than in the control group (p=0.0143). At the order level, Turicibacterales was more abundant in HNF1A-MODY group than in T2DM group.Conclusions. It appears that there are differences in the gut microbiome composition between patients with HNF1A-MODY and type 2 diabetes. Further investigation on this matter should be conducted.

Place and role of nonabsorbable antibiotics in the treatment of acute infectious diarrhea

Objectives. In the present study we wanted to evaluate the efficiency of Rifaximin-α on acute infectious diarrhea. Materials and methods. We revised the literature, as well as the studies which have been published within recent years. Discussions and conclusions. Rifaximin-α is an nonabsorbable antibiotic, bactericid, with a wide spectrum of action. It is recommended in acute diarrheic syndromes without invasive mechanism. Its properties (lack of intestinal absorbtion, minimal effect on colonic flora and no medication interactions) confer Rifaximin-α an excellent safety profile. Taking into account its wide spectrum of action and its high intestinal concentrations, it is considered an efficient and safe option in the treatment of acute infectious noninvasive diarrhea, as well as in the treatment and the prophilaxy of traveller´s diarrhea. Further more ample studies are needed to evaluate its efficiency in the treatment of recurrent infections with Clostridium difficile.

D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome

D-lactic acidosis or D-lactate encephalopathy is a rare condition that occurs primarily in individuals who have a history of short bowel syndrome. The unabsorbed carbohydrates act as a substrate for colonic bacteria to form D-lactic acid among other organic acids. The acidic pH generated as a result of D-lactate production further propagates production of D-lactic acid, hence giving rise to a vicious cycle. D-lactic acid accumulation in the blood can cause neurologic symptoms such as delirium, ataxia, and slurred speech. Diagnosis is made by a combination of clinical and laboratory data including special assays for D-lactate. Treatment includes correcting the acidosis and decreasing substrate for D-lactate such as carbohydrates in meals. In addition, antibiotics can be used to clear colonic flora. Although newer techniques for diagnosis and treatment are being developed, clinical diagnosis still holds paramount importance, as there can be many confounders in the diagnosis as will be discussed subsequently.