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| 1 | Pathophysiological consequences of obstructive jaundice and perioperative management显示文摘Background: Obstructive jaundice is a common problem in daily clinical practice. Understanding completely the pathophysiological changes in obstructive jaundice remains a challenge for planning current and future management.Data sources: A Pub Med was searched for relevant articles published up to August 2016. The effect of obstructive jaundice on proinflammatory cytokines, coagulation status, hemodynamics and organ functions were evaluated.Results: The effects of obstructive jaundice included biliary tree, the hepatic cell and liver function as well as systemic complications. The lack of bile in the gut, the disruption of the intestinal mucosal barrier,the increased absorption of endotoxin and the subsequent endotoxemia cause proinflammatory cytokine production(TNF-α, IL-6). Bilirubin induces systemic inflammatory response syndrome which may lead to multiple organ dysfunction syndrome. The principal clinical manifestations include hemodynamic instability and acute renal failure, cardiovascular suppression, immune compromise, coagulation disorders,nutritional impairment, and wound healing defect. The proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma,albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.Conclusion: The perioperative management is an essential measure in improving the outcome after the appropriate surgical operation in jaundiced patients especially those with malignancy. | Efstathios T Pavlidis Theodoros E Pavlidis | 2018 | Hepatobiliary & Pancreatic Diseases International2018，17，1： | 63 |
| 2 | Irritable bowel syndrome and small intestinal bacterial overgrowth:Meaningful association or unnecessary hype显示文摘Irritable bowel syndrome(IBS)is a common condition characterized by abdominal pain or discomfort,bloating,and altered stool form and passage.Small intestinal bacterial overgrowth(SIBO)is a condition in which there is overgrowth of bacteria in small bowel in excess of 105colony forming units per milliliter on culture of the upper gut aspirate.Frequency of SIBO varied from 4%-78%among patients with IBS and from 1%-40%among controls.Higher frequency in some studies might be due to fallacious criteria[postlactulose breath-hydrogen rise 20 PPM above basal within 90 min(early-peak)].Glucose hydrogen breath test(GHBT)has a low sensitivity to diagnose SIBO.Hence,studies based on GHBT might have under-estimated frequency of SIBO.Therefore,it is important to analyze these studies carefully to evaluate whether the reported association between IBS and SIBO is over or under-projected.This review evaluates studies on association between SIBO and IBS,discordance between different studies,their strength and weakness including methodological issues and evidence on therapeutic manipulation of gut flora on symptoms of IBS. | Uday C Ghoshal Deepakshi Srivastava | 2014 | World Journal of Gastroenterology2014，20，10： | 29 |
| 3 | Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy: A meta-analysis显示文摘Background: Minimal hepatic encephalopathy(MHE) is an early and reversible form of hepatic encephalopathy. The documentations on the treatment with probiotics are inconsistent. The present meta-analysis was to verify the role of probiotics in the treatment of cirrhotic patients with MHE.Data sources: Seven electronic databases were searched for relevant randomized controlled trials(RCTs)published until July 2015. The effects of probiotics on serum ammonia, endotoxin, and MHE were evaluated.Results: A total of 14 RCTs(combined n = 1132) were included in the meta-analysis. When probiotics were compared to placebo or no treatment, probiotics were more likely to reduce values in the number connection test(NCT; week 4: MD =-30.25, 95% CI:-49.85 to-10.66), improve MHE(week 4: OR = 0.18,95% CI: 0.07 to 0.47; week 12: OR = 0.15, 95% CI: 0.07 to 0.32), and prevent overt HE progression(week4: OR = 0.22, 95% CI: 0.07 to 0.67) in patients with liver cirrhosis. When probiotics was compared to lactulose, probiotics tended to reduce serum ammonia levels(week 4: MD =-0.33 μmol/L, 95% CI:-5.39 to 4.74; week 8: MD = 6.22 μmol/L, 95% CI:-24.04 to 36.48), decrease NCT(week 8: MD = 3.93, 95% CI:-0.72 to 8.58), improve MHE(week 4: OR = 0.93, 95% CI: 0.45 to 1.91; week 12: OR = 0.73, 95% CI: 0.35 to 1.51) and prevent the development of overt HE(week 4: OR = 0.96, 95% CI: 0.17 to 5.44; week 12:OR = 2.7, 95% CI: 0.50 to 14.64) in patients with liver cirrhosis. However, lactulose appears to be more effective in reducing NCT values as compared to probiotics(week 4: MD = 6.7, 95% CI: 0.58 to 12.82).Conclusion: Probiotics can decrease serum ammonia and endotoxin levels, improve MHE, and prevent overt HE development in patients with liver cirrhosis. | Qing Cao Cheng-Bo Yu Shi-Gui Yang Hong-Cui Cao Ping Chen Min Deng Lan-Juan Li | 2018 | Hepatobiliary & Pancreatic Diseases International2018，17，1： | 25 |
| 4 | Critical flicker frequency for diagnosis and assessment of recovery from minimal hepatic encephalopathy in patients with cirrhosis显示文摘BACKGROUND:Minimal hepatic encephalopathy (MHE) impairs quality of life and predicts overt hepatic encephalopathy (HE) in cirrhotic patients.Diagnosis of MHE requires cumbersome tests.Lactulose is effective in the treatment of MHE.This study aimed to evaluate the use of critical flicker frequency (CFF) for the diagnosis of MHE in cirrhotic patients after treatment.METHODS:One hundred and ten patients were evaluated by psychometry (number connection tests A,B or figure connection tests A,B),P300 auditory event related potential (P300ERP),venous ammonia,and CFF for MHE.MHE was diagnosed by abnormal psychometry (>2SD age matched controls) and P300ERP.MHE patients were treated with lactulose for one month.Response was defined by normalization (<2SD of matched controls) of both psychometry and P300ERP.RESULTS:Of the 110 patients [Child Turcott Pugh score A:B:C 39:42:29,(age 41.6±11.6 years,M:F 82:28)],75 (68%) had abnormal results of psychometric tests,and 74 (67%) had prolonged P300ERP.Fifteen (20%) patients with abnormal results of psychometric tests had normal P300ERP.Thus sixty (54.5%) patients were diagnosed as having MHE.After treatment for one month,34 (57%) recovered while 26 (43%) continued to have abnormal resents of psychometric or P300ERP tests.CFF was <39 Hz in 72 (65.4%) patients before treatment and in 20 (33.3%) after treatment.CFF sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy for the assessment of recovery of MHE were 65%,91%,85%,77% and 80%,respectively.CONCLUSION:CFF is a simple,relatively reliable,and accurate test without any dependence on age or literacy in the diagnosis and assessment of recovery of patients with MHE. | Praveen Sharma Barjesh Chander Sharma Shiv Kumar Sarin | 2010 | Hepatobiliary & Pancreatic Diseases International2010，9，1： | 10 |
| 5 | Cisapride decreasing orocecal transit time in patients with nonalcoholic steatohepatitis显示文摘BACKGROUND : Altered small-intestine motility, lengthening of orocecal transit time (OCTT), and small-intestinal bacterial overgrowth (SIBO) have been detected in patients with nonalcoholic steatohepatitis (NASH). These changes might be related to the progressive course and poor prognosis of the disease. This study was undertaken to investigate the effect of 4-week treatment with cisapride on OCTT. METHODS: Ten NASH patients without diabetes were included. Ten healthy individuals served as controls. OCTT was measured by lactulose breath test (LBT). Anti- endotoxin core antibodies (EndoCAb) IgG were also examined. The effect of cisapride (10 mg TID during 4 weeks) on LBT and serum EndoCAb IgG levels in NASH patients was investigated. RESULTS: The NASH patients had more significantly prolonged OCTT (95±17 min) than the controls (59±18 min, P=0.00032). Cisapride administration decreased OCTT (from 95±17 min to 83±19 min, P=0.037), basal breathed H2 (from 9.87±1.60 ppm to 8.61±1.63 ppm, P=0.046) and EndoCAb IgG titers (from 5.24±0.68 GMU/ ml to 4.20±0.72 GMU/ml, P=0.013) in NASH patients. CONCLUSIONS: The present data suggest the existence of deranged intestinal motility and endotoxemia in NASH patients. Cisapride administration during 4 weeks possibly restore intestinal motility and ameliorate endotoxemia in NASH patients. | Xiang-Sheng Fu and Feng Jiang Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China | 2006 | Hepatobiliary & Pancreatic Diseases International2006，5，4： | 6 |
| 6 | Pediatricians lack knowledge for the diagnosis and management of functional constipation in children over 6 mo of age显示文摘AIM To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation.METHODS A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia.RESULTS Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements(according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools(83%), blood in the stools(36%), fecal incontinence(33%), and/or difficulty in defecating(47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly(according to 68%) The preferred nonpharmacologic treatment are high-fiber diet(96%), increased fluid intake(90%), toilet training(74%), and abdominal massage(49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used(87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment(85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians(69%) expect a positive response during the first week with a mean(± SD) of 4.1(± 2.56) d. Most participants(86%) treat during one month or even less. And the majority(67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints.CONCLUSION These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians. | Ariani Widodo Badriul Hegar Yvan Vandenplas | 2018 | World Journal of Clinical Pediatrics2018，7，1： | 6 |
| 7 | Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care显示文摘BACKGROUND Hepatic encephalopathy(HE)is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50%of cirrhotic patients.Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.AIM To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care.METHODS All patients hospitalised with HE requiring Rifaximin to 3 tertiary centres over46-mo(2012–2016)were identified via pharmacy dispensing records.Patients with hepatocellular carcinoma and those prescribed Rifaximin prior to admission were excluded.Medical records were reviewed to determine baseline characteristics and survival.The Kaplan-Meier method was used to calculate survival probability.Univariate survival analysis was performed with variables reaching statistical significance included in a multivariate analysis.The primary outcome was 12-mo mortality following commencement of Rifaximin.RESULTS188 patients were included.Median age was 57 years(IQR 50-65),71%were male and median model for end stage liver disease and Child Pugh scores were 25(IQR 18-31)and 11(IQR 9-12)respectively.The most common causes of cirrhosis were alcohol(62%),hepatitis C(31%)and non-alcoholic fatty liver disease(20%).A precipitating cause for HE was found in 92%patients with infection(43%),GI bleeding(16%),medication non-compliance(15%)and electrolyte imbalance(14%)the most common.During a mean follow up period of 12±13 mo 107(57%)patients died and 32(17%)received orthotopic liver transplantation.Themost common causes of death were decompensated chronic liver disease(57%)and sepsis(19%).The probability of survival was 44%and 35%at 12-and 24-mo respectively.At multivariate analysis a model for end stage liver disease>15 and international normalised ratio reached statistical significance in predicting mortality.CONCLUSION Despite advances made in the management of HE patients continue to have poor survival.Thus,in all patients presenting with HE the appropriateness of orthotopic liver transplantation should be considered. | Anuj Bohra Thomas Worland Samuel Hui Ryma Terbah Ann Farrell Marcus Robertson | 2020 | World Journal of Gastroenterology2020，26，18： | 4 |
| 8 | Blood glucose response after oral intake of lactulose in healthy volunteers:A randomized,controlled,cross-over study显示文摘AIM To investigate possible changes of blood glucose levels after oral intake of lactulose in healthy subjects.METHODS The study was performed as prospective, randomized, two-part study with 4-way cross-over design with n = 12 in each study arm. Capillary blood glucose levels were determined over a time period of 180 min after intake of a single dose of 10 g or 20 g lactulose provided as crystal or liquid formulation. During the manufacturing process of lactulose, impurities with sugars(e.g., lactose, fructose, galactose) occur. Water and 20 g glucose were used as control and reference. Because lactulose is used as a functional food ingredient, it may also be consumed by people with impaired glucose tolerance, including diabetics. Therefore, it is of interest to determine whether the described carbohydrate impurities may increase blood glucose levels after ingestion. RESULTS The blood glucose concentration-time curves after intake of 10 g lactulose, 20 g lactulose, and water were almost identical. None of the three applications showed any changes in blood glucose levels. After intake of 20 g glucose, blood glucose concentration increased by approximately 3 mmol/L(mean Cmax = 8.3 mmol/L), reaching maximum levels after approximately 30 min and returning to baseline within approximately 90 min, which was significantly different to the corresponding 20 g lactulose formulations(P < 0.0001). Comparing the two lactulose formulations, crystals and liquid, in the dosage of 10 g and 20 g, there was no difference in the blood glucose profile and calculated pharmacokinetic parameters despite the different amounts of carbohydrate impurities(1.5% for crystals and 26.45% for liquid). Anyhow, the absolute amount of single sugars was low with 0.3 g in crystals and 5.29 g in liquid formulation in the 20 g dosages. Lactulose was well tolerated by most volunteers, and only some reported mild to moderate mainly gastrointestinal side effects. CONCLUSION The unchanged blood glucose levels after lactulose intake in healthy subjects suggest its safe use in subjects with impaired glucose tolerance. | Jasmin Steudle Christiane Schon Manfred Wargenau Lioba Pauly Susann Schwejda-Güttes Barbara Gaigg Angelika Kuchinka-Koch John F Stover | 2018 | World Journal of Gastrointestinal Pharmacology and Therapeutics2018，9，3： | 4 |
| 9 | Morphological and molecular response of small intestine to lactulose and hydrogen-rich water in female piglets fed Fusarium mycotoxins contaminated diet显示文摘Background: Following the intake of Fusarium mycotoxin-contaminated feed,small intestines may be exposed to high levels of toxic substances that can potentially damage intestinal functions in livestock.It is well known that Fusarium mycotoxins will lead a breakdown of the normally impeccable epithelial barrier,resulting in the development of a 'leaky' gut.H2 administration with different methods has been proved definitely potentials to prevent serious intestinal diseases.The goal of this study is to investigate the roles of lactulose(LAC) and hydrogenrich water(HRW) in preventing intestinal dysfunction in piglets fed Fusarium mycotoxin-contaminated feed.Methods: A total of 24 female piglets were evenly assigned to 4 groups: negative control(NC) group,mycotoxincontaminated(MC) feed group,MC feed with LAC treatment(MC + LAC),and MC feed with HRW treatment(MC +HRW),respectively.Piglets in the NC group were fed uncontaminated control diet,while remaining piglets were fed Fusarium mycotoxin-contaminated diet.For the NC and MC groups,10 mL/kg body weight(BW) of hydrogen-free water(HFW) was orally administrated to piglets twice daily;while in the MC + LAC and MC + HRW groups,piglets were treated with the same dose of LAC solution(500 mg/kg BW) and HRW twice daily,respectively.On d 25,serum was collected and used for biochemical analysis.Intestinal tissues were sampled for morphological examination as well as relative genes and protein expression analysis.Results: Our data showed that Fusarium mycotoxins induced higher serum diamine oxidase(DAO) activities(P < 0.05),D-lactic acid levels(P < 0.01),and endotoxin status(P < 0.01),lower villus height(P < 0.01) and ratio of villus height to crypt depth(P < 0.05) in small intestine,greater apoptosis index and higher mRNA expression related to tight junctions(P < 0.05).In addition,the distribution and down-regulation of claudin-3(CLDN3) protein in the small intestinal was also observed.As expected,oral administrations of HRW and LAC were found to remarkably provide beneficial effects against Fusarium mycotoxin-induced apoptosis and intestinal leaking.Moreover,either HRW or LAC treatments were also revealed to prevent abnormal intestinal morphological changes,disintegrate tight junctions,and restore the expression and distribution of CLDN3 protein in the small intestinal mucosal layer in female piglets that were fed Fusarium mycotoxins contaminated diet.Conclusions: Our data suggest that orally administrations of HRW and LAC result in less Fusarium mycotoxininduced apoptosis and leak in the small intestine.Either HRW or LAC treatments could prevent the abnormal changes of intestinal morphology and molecular response of tight junctions as well as restore the distribution and expression of CLDN3 protein of small intestinal mucosa layer in female piglets that were fed Fusarium mycotoxins contaminated diet. | Xu Ji Qing Zhang Weijiang Zheng Wen Yao | 2019 | Journal of Animal Science and Biotechnology2019，10，3： | 4 |
| 10 | Advances in cirrhosis: Optimizing the management of hepatic encephalopathy显示文摘Hepatic encephalopathy(HE) is a major complication of cirrhosis resulting in significant socioeconomic burden, morbidity, and mortality. HE can be further subdivided into covert HE(CHE) and overt HE(OHE). CHE is a subclinical, less severe manifestation of HE and requires psychometric testing for diagnosis. Due to the time consuming screening process and lack of standardized diagnostic criteria, CHE is frequently underdiagnosed despite its recognized role as a precursor to OHE. Screening for CHE with the availability of the Stroop test has provided a pragmatic method to promptly diagnose CHE. Management of acute OHE involves institution of lactulose, the preferred first-line therapy. In addition, prompt recognition and treatment of precipitating factors is critical as it may result in complete resolution of acute episodes of OHE. Treatment goals include improvement of daily functioning, evaluation for liver transplantation, and prevention of OHE recurrence. For secondary prophylaxis, intolerance to indefinite lactulose therapy may lead to non-adherence and has been identified as a precipitating factor for recurrent OHE. Rifaximin is an effective add-on therapy to lactulose for treatment and prevention of recurrent OHE. Recent studies have demonstrated comparable efficacy of probiotic therapy to lactulose use in both primary prophylaxis and secondary prophylaxis. | Andy Liu Ryan B Perumpail Radhika Kumari Zobair M Younossi Robert J Wong Aijaz Ahmed | 2015 | World Journal of Hepatology2015，7，29： | 3 |
| 11 | Influence of lactulose on interventional therapy for HCC patients with hepatocirrhosis and hypersplenism显示文摘Objective: To investigate the influence of lactulose on immunity of hepatocellular carcinoma(HCC) patients with hepatocirrhosis and hypersplenism after double-interventional therapies. Methods: A total of 40 HCC patients with hepatocirrhosis and hypersplenism, hospitalized during January 2013 to June 2014, were enrolled and randomized into control group and observation group. Both groups received partial splenic embolization combined with transcatheter arterial chemoembolization. Besides, observation group orally took lactulose 30 m L/d. Four days before interventional therapies and at day 1, 3, 7 and 14 after therapies, fasting venous blood was collected to detect white blood cell count, red blood cell count(RBC), and platelet count(PLT). Four days before therapies and at day 7 and 14 after therapies, the levels of alanine aminotransferase, aspartate transaminase, total bilirubin, malondialdehyde, super-oxide dismutase(SOD), IFN-α, and IL-4 as well as the distribution of T cell subsets in peripheral blood were tested. Complications were observed after interventional therapies. Results: Before interventional therapies the levels of white blood cell count, PLT and RBC in both groups showed no difference, while after interventional therapies the levels of PLT and RBC in both groups showed an increasing tendency(P<0.05). At day 14 after interventional therapies, the level of blood cell as well as that of SOD, IFN-α and IL-4 in serum were significantly higher than that before therapies; meanwhile, the levels of alanine aminotransferase and total bilirubin of observation group after therapies were significantly lower than before and control group(P<0.05), the levels of CD4+/CD8+, SOD and IFN-α were all higher than before and control group(P<0.05). Conclusions: Oral administration of lactulose could adjust the imbalance of oxidation system/antioxidant system in HCC patients with hepatocirrhosis and hypersplenism after interventional therapies, and improve the antitumor immunity and prognosis. | Deng-Wei Zong Chen-Yang Guo Hong-Tao Cheng Hong-Tao Hu Jin-Cheng Xiao Hai-Liang Li | 2016 | Asian Pacific Journal of Tropical Medicine2016，9，2： | 3 |
| 12 | Intestinal microbiome analysis demonstrates azithromycin post-treatment effects improve when combined with lactulose显示文摘Background Next-generation sequencing has revolutionized our perspective on the gut microbiome composition,revealing the true extent of the adverse effects of antibiotics.The impact of antibiotic treatment on gut microbiota must be considered and researched to provide grounds for establishing new treatment strategies that are less devastating on commensal bacteria.This study investigates the impact on gut microbiome when a commonly used antibiotic,azithromycin is administered,as well as uncovers the benefits induced when it is used in combination with lactulose,a prebiotic known to enhance the proliferation of commensal microbes.Methods 16S rRNA gene sequencing analysis of stool samples obtained from 87 children treated with azithromycin in combination with or without lactulose have been determined.Children's gut microbial profile was established at the pre-and post-treatment stage.Results Azithromycin caused an increase in the relative abundance of opportunistic pathogens such as Streptococcus that was evident 60 days after treatment.While few days after treatment,children who also received lactulose started to show a higher relative abundance of saccharolytic bacteria such as Lactobacillus,Enterococcus,Anaerostipes,Blautia and Roseburia,providing a protective role against opportunistic pathogens.In addition,azithromycin-prebiotic combination was able to provide a phylogenetic profile more similar to the pre-treatment stage.Conclusion It is suggested that during azithromycin treatment,lactulose is able to reinstate the microbiome equilibrium much faster as it promotes saccharolytic microbes and provides a homeostatic effect that minimizes the opportunistic pathogen colonization. | Elpiniki Nikolaou Elena Kamilari Dragana Savkov Artemy Sergeev Irina Zakharova Paris Vogazianos Marios Tomazou Athos Antoniades Christos Shammas | 2020 | World Journal of Pediatrics2020，16，2： | 1 |
| 13 | Effect of a specific Escherichia coli Nissle 1917 strain on minimal/mild hepatic encephalopathy treatment显示文摘BACKGROUND Hepatic encephalopathy(HE)can be considered a result of dysregulated gutliver-brain axis function,where cognitive impairment can be reversed or prevented by the beneficial effects induced by'gut-centric'therapies,such as the administration of nonabsorbable disaccharides,nonabsorbable antibiotics,probiotics and prebiotics.AIM To assess the short-term efficacy and safety of the probiotic Escherichia coli Nissle(EcN)1917 strain compared to lactulose and rifaximin in patients with minimal/mild HE.METHODS From January 2017 to March 2020,a total of 45 patients with HE were enrolled in this prospective,single-centre,open-label,randomized study.Participants were randomly assigned at a ratio of 1:1:1 to one of the treatment groups:The EcN group(n=15),lactulose group(n=15)or rifaximin group(n=15)for a 1 mo intervention period.The main primary outcomes of the study were changes in serum ammonia and Stroop test score.The secondary outcomes were markers of a chronic systemic inflammatory response(ІL-6,ІL-8,and IFN-γ)and bacteriology of the stool flora evaluated by specialized nonculture techniques after a 1 mo intervention period.RESULTS Patients who were given rifaximin or EcN showed a more significant reduction in serum ammonia and normalization of Bifidobacteria and Lactobacilli abundance compared to the lactulose group.However,the most pronounced restoration of the symbiotic microflora was associated with EcN administration and characterized by the absence of E.coli with altered properties and pathogenic enterobacteria in patient faeces.In the primary outcome analysis,improvements in the Stroop test parameters in all intervention groups were observed.Moreover,EcN-treated patients performed 15%faster on the Stroop test than the lactulose group patients(P=0.017).Both EcN and rifaximin produced similar significant reductions in the proinflammatory cytokines INF-γ,IL-6 and IL-8.EcN was more efficient than lactulose in reducing proinflammatory cytokine levels.CONCLUSION The use of the probiotic EcN strain was safe and quite efficient for HE treatment.The probiotic reduced the ammonia content and the level of serum proinflammatory cytokines,normalized the gut microbiota composition and improved the cognitive function of patients with HE.The application of the EcN strain was more effective than lactulose treatment. | Elina Manzhalii Valentyna Moyseyenko Vitalii Kondratiuk Nataliia Molochek Tetyana Falalyeyeva Nazarii Kobyliak | 2022 | World Journal of Hepatology2022，14，3： | 1 |
| 14 | Blood glucose response after oral lactulose intake in type 2 diabetic individuals显示文摘BACKGROUND Lactulose is approved for the symptomatic treatment of constipation,a gastrointestinal(GI)complication common in individuals with diabetes.Lactulose products contain carbohydrate impurities(e.g.,lactose,fructose,galactose),which occur during the lactulose manufacturing process.These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus(T2DM)using lactulose for the treatment of mild constipation.A previous study in healthy subjects revealed no increase in blood glucose levels after oral lactulose intake.However,it is still unclear whether the intake of lactulose increases blood glucose levels in individuals with diabetes.AIM To evaluate the blood glucose profile after oral lactulose intake in mildly constipated,non-insulin-dependent subjects with T2DM in an outpatient setting.METHODS This prospective,double-blind,randomized,controlled,single-center trial was conducted at the Clinical Research Center at the Medical University of Graz,Austria,in 24 adult Caucasian mildly constipated,non-insulin-dependent subjects with T2DM.Eligible subjects were randomized and assigned to one of six treatment sequences,each consisting of four treatments stratified by sex using an incomplete block design.Subjects received a single dose of 20 g or 30 g lactulose(crystal and liquid formulation),water as negative control or 30 g glucose as positive control.Capillary blood glucose concentrations were measured over a period of 180 min post dose.The primary endpoint was the baseline-corrected area under the curve of blood glucose concentrations over the complete assessment period[AUC_(baseline_c(0-180 min))].Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs glucose,as well as for liquid lactulose vs crystal lactulose.Safety parameters included GI tolerability,which was assessed at 180 min and 24 h post dose,and adverse events occurring up to 24 h post dose.In 24 randomized and analyzed subjects blood glucose concentration-time curves after intake of 20 g and 30 g lactulose were almost identical to those after water intake for both lactulose formulations despite the different amounts of carbohydrate impurities(≤3.0%for crystals and approx.30%for liquid).The primary endpoint[AUC_(baseline_c(0-180 min))]was not significantly different between lactulose and water regardless of lactulose dose and formulation.Also with regard to all secondary endpoints lactulose formulations showed comparable results to water with one exception concerning maximum glucose level.A minor increase in maximum blood glucose was observed after the 30 g dose,liquid lactulose,in comparison to water with a mean treatment difference of 0.63 mmol/L(95%confidence intervals:0.19,1.07).Intake of 30 g glucose significantly increased all blood glucose endpoints vs 30 g liquid and crystal lactulose,respectively(all P<0.0001).No differences in blood glucose response were observed between the different lactulose formulations.As expected,lactulose increased the number of bowel movements and was generally well tolerated.Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose.CONCLUSION Blood glucose AUC_(baseline_c(0-180 min))levels in mildly constipated,non-insulin dependent subjects with T2DM are not affected by the carbohydrate impurities contained in 20 g and 30 g crystal or liquid lactulose formulations. | Thomas R Pieber Eva Svehlikova Ines Mursic Tamara Esterl Manfred Wargenau Tina Sartorius Lioba Pauly Susann Schwejda-Guettes Annalena Neumann Valentin Faerber John Friedrich Stover Barbara Gaigg Angelika Kuchinka-Koch | 2021 | World Journal of Diabetes2021，12，6： | 1 |
| 15 | The synbiotic mixture of lactulose and Bacillus coagulans protects intestinal barrier dysfunction and apoptosis in weaned piglets challenged with lipopolysaccharide显示文摘Background Lactulose as an effective prebiotic protects intestinal mucosal injury.Bacillus coagulans is widely used in feed additives because of its ability to promote intestinal health.Our previous study suggests that the combination of lactulose and Bacillus coagulans may be a good candidate as alternative for antibiotic growth promoters.However,the in vivo effects of lactulose and Bacillus coagulans on growth and intestinal health under immune challenge in piglets remains unclear.The objective of this study is to explore the protective effects of synbiotic containing lactu-lose and Bacillus coagulans on the intestinal mucosal injury and barrier dysfunction under immune challenge in weaned piglets.Methods Twenty four weaned piglets were assigned to 4 groups.Piglets in the CON-_(saline)and LPS-_(LPS)group were fed the basal diet,while others were fed either with chlortetracycline(CTC)or synbiotic mixture of lactulose and Bacillus coagulans for 32 d before injection of saline or lipopolysaccharide(LPS).Piglets were sacrificed 4 h after LPS injection to collect samples to determine intestinal morphology,integrity and barrier functions as well as relative genes and proteins.Results Our data showed that no differences were observed in the growth performance of the four test groups.LPS injection induced higher serum diamine oxidase activities,D-lactic acid levels,and endotoxin status,lower villus height and ratio of villus height to crypt depth,greater mRNA and lower protein expression related tight junction in both jejunum and ileum.In addition,a higher apoptosis index,and protein expression of Bax and caspase-3 were also observed in the LPS challenge group.Interestingly,dietary synbiotic mixture with lactulose and Bacillus coagulans protected against LPS-induced intestinal damage,barrier dysfunction and higher apoptosis as well as CTC.Conclusions Our data suggest that dietary supplementation of synbiotic mixture with lactulose and Bacillus coagu-lans showed resilience to LPS-induced intestinal morphological damage,barrier dysfunction and aggressive apoptosis in piglets as well as the protective effects of CTC.These results indicate that synbiotic mixture of lactulose and Bacillus coagulans showed beneficial effects on performance and resilience to acute immune stress in weaned piglets. | Weijiang Zheng Zuyan Zhao Yunnan Yang Liren Ding Wen Yao | 2023 | Journal of Animal Science and Biotechnology2023，14，5： | 1 |
| 16 | Epidemiology of small intestinal bacterial overgrowth显示文摘Small intestinal bacterial overgrowth(SIBO)is defined as an increase in the bacterial content of the small intestine above normal values.The presence of SIBO is detected in 33.8%of patients with gastroenterological complaints who underwent a breath test,and is significantly associated with smoking,bloating,abdominal pain,and anemia.Proton pump inhibitor therapy is a significant risk factor for SIBO.The risk of SIBO increases with age and does not depend on gender or race.SIBO complicates the course of a number of diseases and may be of pathogenetic significance in the development of their symptoms.SIBO is significantly associated with functional dyspepsia,irritable bowel syndrome,functional abdominal bloating,functional constipation,functional diarrhea,short bowel syndrome,chronic intestinal pseudo-obstruction,lactase deficiency,diverticular and celiac diseases,ulcerative colitis,Crohn’s disease,cirrhosis,metabolic-associated fatty liver disease(MAFLD),primary biliary cholangitis,gastroparesis,pancreatitis,cystic fibrosis,gallstone disease,diabetes,hypothyroidism,hyperlipidemia,acromegaly,multiple sclerosis,autism,Parkinson’s disease,systemic sclerosis,spondylarthropathy,fibromyalgia,asthma,heart failure,and other diseases.The development of SIBO is often associated with a slowdown in orocecal transit time that decreases the normal clearance of bacteria from the small intestine.The slowdown of this transit may be due to motor dysfunction of the intestine in diseases of the gut,autonomic diabetic polyneuropathy,and portal hypertension,or a decrease in the motor-stimulating influence of thyroid hormones.In a number of diseases,including cirrhosis,MAFLD,diabetes,and pancreatitis,an association was found between disease severity and the presence of SIBO.Further work on the effect of SIBO eradication on the condition and prognosis of patients with various diseases is required. | Irina Efremova Roman Maslennikov Elena Poluektova Ekaterina Vasilieva Yury Zharikov Andrey Suslov Yana Letyagina Evgenii Kozlov Anna Levshina Vladimir Ivashkin | 2023 | World Journal of Gastroenterology2023，29，22： | 1 |
| 17 | Production of Ryazhenka,a traditional Ukrainian fermented baked milk,by using electro-activated whey as supplementing ingredient and source of lactulose显示文摘In this work,electro-activated whey(EAW)was used as ingredient in the preparation of Ryazhenka,a fermented baked milk,at a supplementation level of 3 and 9%.Fermentation kinetics,viscosity,color,antioxidant capacity,and protein profiles of the final product were studied.Moreover,effect of electro-activation onβ-lactoglobulin allergenicity was evaluated by a specific ELISA test.The results showed that addition of electro-activated whey as supplementing ingredient is technologically feasible in the process of Ryazhenka production.The fermentation kinetics showed that this process was in the technologically accepted interval even if the addition of EAW delayed the fermentation phase.The viscosity study showed that addition of EAW permitted to obtain a final product with good followability corresponding to good consistency of drinkable dairy beverages.Moreover,addition of EAW prevented syneresis during the refrigerated storage at 4℃ and enriched the product with lactulose which is a recognized prebiotic.The chromatic evaluation of the final product showed a compatibility of EAW with Ryazhenka which is known for its specific yellowish-brownish color.Addition or EAW significantly improved the antioxidant capacity of the Ryazhenka with values of IC_(50)DPPH=2.54±0.02 and IC_(50)PFRAP=244.03±28.83 for the Ryazhenka produced by adding 9%EAW to the milk after the baking process and prior to fermentation.Moreover,by using aβ-lactoglobulin specific ELISA test,this study showed a significant decrease of whey and pureβ-lactoglobulin allergenicity by 95%.This decrease was also observed in Ryazhenka supplemented with 9%EAW but at lower level.Thus,it can be concluded that electro-activated whey can be considered as a promising functional ingredient containing a prebiotic lactulose as functional ingredient in the dairy industry. | Sabina Aidarbekova Mohammed Aider | 2022 | Food Bioscience2022，46，2： | 0 |
| 18 | Evidence-based approach to management of hepatic encephalopathy in adults显示文摘Hepatic encephalopathy(HE)is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease.Although ammonia is clearly implicated in the pathogenesis of HE,the pathogenesis of HE is multifactorial with numerous mechanisms that results in functional impairment of neuronal cells.The initial management of HE focuses on supportive care and stabilization which includes providing appropriate nutritional support.Thereafter,focus should be on identifying and treating the precipitating factors.There are many therapeutic agents available for the management of HE,most of which are directed towards lowering the gut nitrogen load and thus the serum ammonia level.This review aims to provide an update on the conventional and emerging treatment options for HE. | Gilles Jadd Hoilat Fathima Keshia Suhail Talal Adhami Savio John | 2022 | World Journal of Hepatology2022，14，4： | 0 |
| 19 | Glucose substrate in the hydrogen breath test for gut microbiota determination:A recommended noninvasive test显示文摘Intestinal dysbiosis and small intestinal bacterial overgrowth(SIBO)are common in patients with liver cirrhosis.Existing studies have not explored the association between gut dysbiosis and SIBO.We propose some suggestions for the authors’experimental methods and concepts,and we hope these suggestions can be adopted.The hydrogen breath test is worthy of recommendation due to its high accuracy and convenient operation.We suggest changing the substrate of the hydrogen breath test from lactulose to glucose to improve the accuracy of each parameter.SIBO is a small subset of gut dysbiosis,and we propose clarifying the concept of both.SIBO may be caused by liver cirrhosis or one of the pathogeneses of gastrointestinal diseases.Therefore,interference from other gastrointestinal diseases should be excluded from this study. | Qi-Qi Xie Jia-Feng Wang Yang-Fen Zhang Dong-Hui Xu Bo Zhou Ting-Hui Li Zhi-Peng Li | 2022 | World Journal of Clinical Cases2022，10，26： | 0 |
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