Einar Krag

Short-chain fatty acids and the irritable bowel syndrome: the effect of wheat bran.

Short-chain fatty acids (SCFA) in faeces were examined in 18 patients with the irritable bowel syndrome (IBS) during treatment with wheat bran or placebo. In the placebo period, the patients could be classified in accordance with the faecal concentrations of SCFA into one group with low concentrations (mean, 40 mmol/l; range, 19-77 mmol/l; 10 patients) and another with high concentrations (mean, 168 mmol/l; range, 145-187 mmol/l; 8 patients). The concentrations of SCFA differed (P less than 0.001) in both groups from concentrations found in faeces from a reference group of nine normal individuals (mean, 114 mmol/l; range, 93-155 mmol/l). Patients with low levels of SCFA had lower (P less than 0.001) mean stool mass and longer (P less than 0.05) transit times than those with high concentrations of SCFA in faeces. Ingestion of bran, although a precursor of SCFA, did not change faecal concentrations of SCFA. Abdominal pain, distension, and rumbling were not correlated to low or high concentrations of SCFA in faeces, nor did bran improve these symptoms when compared to placebo. The level of SCFA was rather constant intraindividually and independent of the variability of the daily faecal mass. It is concluded that patients with IBS apparently have continuously abnormal concentrations of SCFA in faeces, either high or low, which are unaffected by the treatment with bran and which hypothetically may be of pathophysiologic importance.

A Secretory Epithelium of the Small Intestine with Increased Sensitivity to Bile Acids in Irritable Bowel Syndrome Associated with Diarrhoea

Irritable bowel syndrome is occasionally associated with diarrhoea (IBSD). The loss of fluid cannot be explained by abnormal intestinal motility, but may be due to a secretory disorder of the intestine. Since the large bowel has proved to be absorptively normal in IBSD, perfusion studies of the ileum and jejunum were performed on 6 patients and 10 normal subjects. Perfusates were isosmotic saline solutions containing 0–2.5 mmol/l glycochenodeoxycholic acid (GCDC). Net movements of water and electrolytes, bidirectional fluxes of Na. K. and Cl. and the transmural electrical potential difference (PD) were recorded simultaneously. In the normal ileum 1 mmol/l GCDC significantly stimulated absorption, while 1.5–2.5 mmol/l decreased absorption and evoked secretion of water and electrolytes. In IBSD ileal secretion occurred spontaneously during control perfusions. Absorption was facilitated at 0.25 mmol/l GCDC, while larger concentrations evoked profuse secretion. Increased plasma to lumen fluxes appeared to be ...

The Effect of Coarse Wheat Bran in the Irritable Bowel Syndrome lA Double-Blind Cross-Over Study

Dietary supplementation with wheat bran has been widely advocated as a first-line treatment of patients with the irritable bowel syndrome (IBS). Few controlled trials have been reported, and the results are, furthermore, contradictory. The present study comprised 20 patients with IBS, of whom 18 (14 women, 4 men) completed the trial. The two treatment periods of 6 weeks each, with a daily intake of 30 g coarse wheat bran or 30 g placebo bran, respectively, were randomized in a double-blind cross-over design. Wheat bran significantly (P less than 0.05) increased the stool weight and shortened the intestinal transit time but was without significant effect on the colonic motility index was shown. We conclude that coarse wheat bran used as the only treatment in IBS does not provide a sufficient effect in a 6-week period. However, wheat bran seems to be justified in the treatment of constipation.

Antisecretory Therapy in 1017 Patients with Ulcerlike or Refluxlike Dyspepsia in General Practice

Objectives: The effect of omeprazole and H2-blockers in patients with ulcerlike and refluxlike dyspepsia is mainly studied in endoscoped patients. In general practice most patients are treated without endoscopy. We studied the effect of omeprazole versus H2-blockers and placebo in patients consulting the general practitioner because of dyspeptic complaints in which, based on symptom clusters, ulcerlike or refluxlike symptoms were predominant.Methods: Patients with ulcerlike or refluxlike dyspepsia according to a symptom-based classification were randomised to treatment with omeprazole 20 mg in the morning versus cimetidine 400 mg twice daily (n=469), if the patients had a verified medical history of peptic ulcer disease or reflux oesophagitis, or to a treatment with omeprazole 20 mg in the morning versus placebo (n=548), if no such history was present. The endpoint was a total relief of symptoms after two weeks of treatment.Results: In both groups treatment success was obtained in 50% of the patients trea...

The Influence of Ispaghula Husk and Lactulose on the In Viva and the In Vitro Production Capacity of Short-Chain Fatty Acids in Humans

To evaluate factors influencing the short-chain fatty acid (SCFA) concentrations in stools, three different experiments were performed: faecal concentrations of SCFA at defecation were determined by gas liquid chromatography in nine healthy volunteers on a free diet. SCFAs were 114 +/- 15.0 mmol/l (means +/- SD). The coefficient of variation (CV) of the assay was 4-15%, the intraindividual CV 12-33%, and the interindividual CV 11-29%. On incubation of faeces at 37 degrees C concentrations of SCFA doubled in 6 h and rose fourfold in 72 h. In three volunteers the experiments were extended by adding ispaghula husk or lactulose to the diet for two 14-day periods each; no change in faecal SCFA concentrations was seen, either at defecation or after incubation. When ispaghula husk or lactulose was added to faeces in an in vitro incubation system, the concentrations of SCFA were five times higher than those of controls. We conclude that instant handling of faeces is essential for determinations of SCFA concentrations to obtain interpretable and comparable results; that determination of total SCFA output is of limited value; that addition of fibre to the diet does not influence faecal SCFA concentrations; and that the capacity for SCFA production in faeces is large provided a sufficient amount of substrate is available.

Dyspepsia in general practice in Denmark. A 1-year analysis of consulters in general practice.

OBJECTIVE To estimate the incidence rate of patients with dyspepsia in general practice, related to age, gender and dwelling and to classify the patients into dyspepsia subgroups. DESIGN In a background population of 123,610 persons under the National Health Insurance System a systematic, prospective registration of dyspepsia patients consulting in general practice was done. Each patient was subject to a structured interview covering 18 dyspepsia symptoms and six alarm symptoms. A diagnostic chart was used to classify the patients into subgroups. SETTING General practice: 93 general practitioners in 63 centres in Denmark. PATIENTS Patients consulting the general practitioner with dyspepsia as their main complaint. RESULTS 4215 dyspepsia patients were registered within 1 year. The annual incidence rate of dyspepsia was 3.4%. Alarm symptoms were present in 11.7% of the patients. The highest incidence rates were related to middle age, female gender and rural dwelling. Of these 34% had dysmotility-like, 30% had reflux-like, 17% ulcer-like and 3% uncharacteristic dyspepsia, while 16% were classified into two or more groups. Dysmotility-like dyspepsia was predominant in women and reflux-like dyspepsia was predominant in men. CONCLUSIONS Within 1 year 34 patients out of 1000 will seek medical advise in general practice with a new episode of dyspepsia. Based on the registration of symptoms 28 of 34 can be classified into a single subgroup of dyspepsia; 4 of 34 patients will present with one or more alarm symptom.

Chronic ischemic gastritis reversed after revascularization operation

A patient with severe chronic gastritis and duodenitis that clinically and endoscopically disappeared after an intestinal revascularization procedure is reported. Chronic intestinal ischemia appears to be a cause of gastritis as seen in this patient.

Enzymatic Determination of Total 3α-Hydroxy Bile Acids in Faeces

A method for determining faecal bile acids, suitable for clinical purposes, is introduced. The analysis uses a 0.2-g stool specimen, a simple extraction procedure, and 3α-steroid dehydrogenase determination. The method, which is rapid, has been validated by gas-liquid chromatography and by recovery of internal standards. Stool examination was done in 16 healthy volunteers on free diet and in 25 patients with non-gastrointestinal diseases who were on a fat- and fibre-fixed diet. No difference was found between the two groups, so the data were pooled, and the normal reference interval (X ± 2S.D.) for faecal bile acid output was calculated to be 0-975 μmol/24h.

A New Method for Measurement of the Electrical Potential Difference across the Stomach Wall: Clinical Evaluation of the Gastric Mucosal Integrity

PD, the electrical potential difference across the gastric mucosa, is a variable used frequently in experimental studies. Existing methods for PD measurements are, however, unstable, and variations in the pH of the gastric juice causes liquid junction potentials between gastric juice and the PD measuring probe. A new PD measuring system has been developed with high stability, easy handling, and correction for the liquid junction potentials. PD was measured between a stomach microelectrode and an intravenous reference electrode connected to a millivoltmeter. pH was measured by an intragastric microelectrode. The liquid junction potential was calculated by using the pH measured in the gastric juice and the Henderson equation and was then subtracted from the measured PD to provide a better approximation of the PD across the mucosa. The liquid junction potential calculated as stated above correlated with the liquid junction potential calculated from precise ion determinations made in gastric juice samples (y = x; r = 0.92; p less than 0.05). The reliability of the PD measuring system was tested in vitro and in vivo and was satisfactory. In conclusion, a new, reliable, and easily applied method for gastric PD measurements corrected for the liquid junction potential between gastric juice and the PD measuring probe has been developed.

Lithogenic Index of Bile after Jejunoileal Bypass Operation for Obesity

Lithogenic index of cholecystokinin-stimulated, fasting, duodenal bile was determined in 12 obese patients before and 1-2 months after end-to-side jejunoileal bypass operation, either including 37.5 cm jejunum and 12.5 cm jejunum and 12.5 cm ileum or 12.5 cm jejunum and 37.5 ileum. The index did not change significantly after bypass with short ileum, whereas a four-fold, significant increase was found after bypass with long ileum. Surprisingly, the results may suggest that the lithogenicity of gallbladder bile increases when the length of the functioning ileal, relative to the functioning jejunal, segment in jejunoileal bypass is increased.