Digestive Health

Saturday, 26 November
2011

Prebiotics Won’t Relieve Crohn’s – Kristina Fiore

Prebiotics aren’t effective in active Crohn’s disease, researchers said here.

Different from probiotics, which are actual bacteria, these prebiotic carbohydrates enhance the presence of indigenous bacteria in the gut.

But in a randomized controlled trial, there was no difference in the number of patients who had a clinical response between those on prebiotics or those on placebo, James O. Lindsay, MD, of Barts and the London in the U.K., and colleagues presented during a poster session at Digestive Disease Week here.

“We didn’t see any differences, and there were more side effects with prebiotics,” Lindsay told MedPage Today. “[Prebiotics] are less effective in active disease.”

Research has shown that intestinal microbiota drive the inflammation associated with Crohn’s. So previous studies have looked at probiotics to see if these would alleviate the disease. But Lindsay said these studies were “generally all negative.”

Probiotics simply add bacteria into the gut that may not be native to a patient. So Lindsay and colleagues hypothesized that if Crohn’s patients were given prebiotics — which are essentially carbohydrates that induce changes in gut bacteria — their natural microflora would be enhanced.

They chose fructo-oligosaccharide, since preliminary data have shown that this carbohydrate can increase two types of colon bacteria — bifidobacteria and Faecalibacterium prausnitzii — and ultimately induce immunoregulatory dendritic cell responses.

Lindsay and his team had done earlier studies on the effects of this prebiotic, and found that it does increase the presence of certain bacteria.

So to assess the impact of a diet supplemented with prebiotics in patients with active Crohn’s, the researchers conducted a randomized, double-blind, placebo-controlled trial in 103 patients.

For four weeks, they received either 15g/day of fructo-oligosaccharide or an identical non-prebiotic maltodextrin placebo.

The primary endpoint was clinical response at week four, and secondary endpoints included disease remission and reduction in CRP and fecal calprotectin.

The researchers found no benefit of prebiotics over placebo. Lindsay said there was no difference between groups in the number of patients who had a clinical response to the treatment.

In fact, significantly more patients taking prebiotics withdrew from the study (26% versus 8%, P=0.018).

There were no differences in CRP or fecal calprotectin levels.

Yet there were some differences in immunological results. There was a significant increase in IL-10 production in patients on prebiotics, as well as a significant reduction in IL-6+, compared with those on placebo (P<0.05).

There was no effect on IL-12, but the other two findings may have something to do with the release of short-chain fatty acids induced by the prebiotic, Lindsay said.

Still, patients taking prebiotics had more flatulence and borborygmus compared with those on placebo (10.8% versus 7.3%, P=0.004 and 8.3% versus 6.1%, P=0.029, respectively). Lindsay said that’s because of increased fermentation in the gut among prebiotic users.

But overall, there were no differences in changes in gut bacteria at the end of the study.

Lindsay said that could possibly be due to a short follow-up, although that’s unlikely because four weeks should be sufficient time to see any changes in bacterial colonization.

So the researchers concluded that patients with active Crohn’s disease won’t clinically benefit from a diet supplemented with prebiotics, even though it does appear to impact immunology.

Primary source: Digestive Disease Week
Source reference:
Benjamin JL, et al “No clinical benefit of prebiotics in the treatment of active Crohn’s Disease: A double-blind, randomised, placebo-controlled trial” DDW 2010; Abstract T2020.

Saturday, 26 November
2011

Resolve GERD by Losing Weight – Kristina Fiore

Dropping some pounds will relieve reflux symptoms, researchers said here.

Among obese patients in a weight loss program, about two-thirds of those with gastroesophageal reflux disease (GERD) reported complete symptom resolution by the end of the intervention, Mandeep Singh, MD, of Kansas University Medical Center in Kansas City, and colleagues reported during an oral session at Digestive Disease Week here.

“Weight loss leads to a resolution of GERD symptoms, and there appears to be a dose-response relationship,” Singh said.

It’s well known that obesity is a risk factor for reflux disease, but the impact of structured weight loss on GERD isn’t clear.

So to investigate the effects, the researchers assessed 179 patients in a weight loss intervention. The program included dietary modification via a reduced caloric intake of 1,200 to 1,500 kcal per day.

Patients ate prepackaged meals in combination with fruits and vegetables. They were also required to expend 2,000 kcal per week, via walking 15 to 60 minutes per day, five days a week.

All of the participants completed a GERD questionnaire at baseline and after six months on the program.

At baseline, their mean weight was 101 kg, and their mean body mass index (BMI) was 35.

The prevalence of GERD was 38% in the entire cohort.

After six months, 98% of patients lost weight, with a mean loss of 13 kg.

The prevalence of GERD decreased significantly to 17% (P<0.001).

Singh also said that mean GERD symptom scores were lower at six months (P<0.01).

The most resounding statistic was that 66% of patients had a complete resolution of GERD, Singh said.

Another 16% had partial resolution, 12% had no change, and 6% had worsening symptoms.

Singh noted that 4% of patients in the intervention developed GERD in spite of losing weight, but the researchers did not have an explanation for this.

There also appeared to be a threshold. In women, for instance, there was a significant improvement in GERD after losing more than 5% of body weight, and after loss of more than 10% of body weight in males.

“Clearly the threshold is much lower in females,” Singh said, though the reasons are unclear. It could be, however, related to the fact that the study was predominantly female — a limitation in terms of being able to generalize the results to the obese male population.

When Singh was asked by an audience member whether resolution of GERD could be related instead to a switch to foods with a lower glycemic index, Singh replied that the researchers hadn’t investigated it but it could be the subject of future research.

After concluding that weight loss significantly improves GERD symptoms among obese patients — and appears to be dose dependent — Singh said future randomized controlled trials are needed to confirm the findings.

Primary source: Digestive Disease Week
Source reference:
Singh M, et al “Weight loss can lead to complete resolution of GERD symptoms: A prospective study” DDW 2010; Abstract 937.

Wednesday, 5 October
2011

The Life of the Liver

The liver is the heaviest organ in the body and is one of the largest. It’s located in the upper right part of your belly under the ribs and is responsible for functions vital to life. The main functions of the liver is to process nutrients from food, make bile, remove toxins from the body and build proteins. It’s easy to see how inflammation of the liver, or hepatitis, interferes with these important functions and can lead to poor health. Fortunately, the liver is extremely resilient and most cases of liver inflammation don’t even come to medical attention, but in cases of severe liver disease, there can be serious interruption of these essential liver functions. Let’s look a each of these functions a little closer.

Processing Nutrients from Food
The digestive system immediately begins to break down the food that we eat into smaller and smaller pieces. Eventually these nutrients will enter the blood and travel to the liver through the hepatic portal system, the major pathway that blood takes from the digestive system to the liver. The liver will then process these nutrients in different ways, depending on the body’s needs. It usually stores some of the nutrients in a form that the body can use for quick energy. The rest will be used to make other important chemicals the body needs. When the liver is severely damaged, such as in liver failure, it can’t continue to process nutrients from the blood that the body must have. Without aggressive medical care, the absence of these essential liver functions can result in signs of serious illness like brain damage and coma.

Making Bile
Bile is a thick, green-yellow fluid that the liver produces to help digest food, especially fat, as it passes from the stomach to the intestines. This fluid is made in the liver, but is stored in a nearby sac called the gallbladder. When a person eats a meal heavy in fat, like a juicy steak, the body will use its store of bile to help break down the fats in the steak for digestion.

Removing Toxins from the Blood
All of the blood in the body will eventually pass through the liver. This is important because the liver needs to pull out any bad things in the blood, such as toxins, and remove them from the body. Some of these toxins are drugs, like penicillin and Tylenol, and other toxins are things that the body needs but is done with, like damaged cells, proteins and old hormones. The liver prepares all of these types of toxins to be removed from the body. However, when the liver is damaged, these toxins can’t be removed and they start to accumulate creating problems.

Building Proteins
A protein is a complex chemical that is essential to living things, like plants, animals and people. Proteins are everywhere in the body, and need to be constantly produced. The liver is in charge of building many kinds of proteins that the body uses every day. For instance, there are many proteins produced by the liver that are responsible for blood clotting. When the liver is damaged, sometimes the body isn’t able to clot blood effectively. In mild cases, it just takes a longer time for bleeding to stop. However, in severe cases the blood wouldn’t be able to clot. A simple cut on the skin would lead to continued bleeding (though not necessarily a dangerous amount), and possibly bruises.

Watch Tutorial on The Importance of The Liver

Wednesday, 5 October
2011

The Life of the Liver

The liver is the heaviest organ in the body and is one of the largest. It’s located in the upper right part of your belly under the ribs and is responsible for functions vital to life. The main functions of the liver is to process nutrients from food, make bile, remove toxins from the body and build proteins. It’s easy to see how inflammation of the liver, or hepatitis, interferes with these important functions and can lead to poor health. Fortunately, the liver is extremely resilient and most cases of liver inflammation don’t even come to medical attention, but in cases of severe liver disease, there can be serious interruption of these essential liver functions. Let’s look a each of these functions a little closer.

Processing Nutrients from Food
The digestive system immediately begins to break down the food that we eat into smaller and smaller pieces. Eventually these nutrients will enter the blood and travel to the liver through the hepatic portal system, the major pathway that blood takes from the digestive system to the liver. The liver will then process these nutrients in different ways, depending on the body’s needs. It usually stores some of the nutrients in a form that the body can use for quick energy. The rest will be used to make other important chemicals the body needs. When the liver is severely damaged, such as in liver failure, it can’t continue to process nutrients from the blood that the body must have. Without aggressive medical care, the absence of these essential liver functions can result in signs of serious illness like brain damage and coma.

Making Bile
Bile is a thick, green-yellow fluid that the liver produces to help digest food, especially fat, as it passes from the stomach to the intestines. This fluid is made in the liver, but is stored in a nearby sac called the gallbladder. When a person eats a meal heavy in fat, like a juicy steak, the body will use its store of bile to help break down the fats in the steak for digestion.

Removing Toxins from the Blood
All of the blood in the body will eventually pass through the liver. This is important because the liver needs to pull out any bad things in the blood, such as toxins, and remove them from the body. Some of these toxins are drugs, like penicillin and Tylenol, and other toxins are things that the body needs but is done with, like damaged cells, proteins and old hormones. The liver prepares all of these types of toxins to be removed from the body. However, when the liver is damaged, these toxins can’t be removed and they start to accumulate creating problems.

Building Proteins
A protein is a complex chemical that is essential to living things, like plants, animals and people. Proteins are everywhere in the body, and need to be constantly produced. The liver is in charge of building many kinds of proteins that the body uses every day. For instance, there are many proteins produced by the liver that are responsible for blood clotting. When the liver is damaged, sometimes the body isn’t able to clot blood effectively. In mild cases, it just takes a longer time for bleeding to stop. However, in severe cases the blood wouldn’t be able to clot. A simple cut on the skin would lead to continued bleeding (though not necessarily a dangerous amount), and possibly bruises.

Watch Tutorial on The Importance of The Liver