Graziamaria Veneto

Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms

Simethicone, activated charcoal and antimicrobial drugs have been used to treat gas‐related symptoms with conflicting results.

Lactose Malabsorption and Intolerance in the Elderly

BACKGROUND Lactase activity declines with age in rats, but it is not clear whether this model is also shared by humans. Few studies have evaluated lactose intolerance and malabsorption in the elderly and no definite conclusions can be drawn. The aim of our study was therefore to verify the impact of age on lactose intolerance and malabsorption. METHODS Eighty-four healthy subjects took part in the study. Thirty-three were <65 years, 17 were between 65 and 74 years and 34 were >74 years. All the subjects underwent a preliminary evaluation of intestinal gas production capacity and oro-cecal transit time by H2/CH4 breath test after lactulose. After a 3-day period, an H2/CH4 breath test after lactose was performed. The occurrence of intolerance symptoms during the test and in the 24 h after the test was recorded. RESULTS Breath H2 and CH4 excretion parameters at fasting and after lactulose did not differ between the three groups. Cumulative breath H2 excretion after lactose was higher in subjects >74 years than in subjects <65 years and in subjects aged 65-74 years, while no difference was found between the latter two groups. In subjects >74 years, the prevalence of lactose malabsorption was higher than in the other two groups, while no significant difference was observed between subjects <65 years and subjects aged 65-74 years. Within the malabsorber subjects, the prevalence of lactose intolerance was higher in subjects <65 years than in those aged 65-74 years and in those aged >74 years. No significant difference was found between the latter two groups. No difference was found between the three groups in terms of daily calcium intake and a significant negative correlation between symptom score and daily calcium intake was only found in the group of subjects aged <65 years. CONCLUSIONS As age increases, the prevalence of lactose malabsorption shows an increase while the prevalence of intolerance symptoms among malabsorbers shows a decrease. Accordingly, daily calcium intake was similar among the adults and elderly studied.Background: Lactase activity declines with age in rats, but it is not clear whether this model is also shared by humans. Few studies have evaluated lactose intolerance and malabsorption in the elderly and no definite conclusions can be drawn. The aim of our study was therefore to verify the impact of age on lactose intolerance and malabsorption. Methods: Eighty-four healthy subjects took part in the study. Thirty-three were < 65 years, 17 were between 65 and 74 years and 34 were > 74 years. All the subjects underwent a preliminary evaluation of intestinal gas production capacity and oro-cecal transit time by H 2 /CH 4 breath test after lactulose. After a 3-day period, an H 2 /CH 4 breath test after lactose was performed. The occurrence of intolerance symptoms during the test and in the 24 h after the test was recorded. Results: Breath H 2 and CH 4 excretion parameters at fasting and after lactulose did not differ between the three groups. Cumulative breath H 2 excretion after lactose was higher in subjects > 74 years than in subjects < 65 years and in subjects aged 65-74 years, while no difference was found between the latter two groups. In subjects > 74 years, the prevalence of lactose malabsorption was higher than in the other two groups, while no significant difference was observed between subjects < 65 years and subjects aged 65-74 years. Within the malabsorber subjects, the prevalence of lactose intolerance was higher in subjects < 65 years than in those aged 65-74 years and in those aged > 74 years. No significant difference was found between the latter two groups. No difference was found between the three groups in terms of daily calcium intake and a significant negative correlation between symptom score and daily calcium intake was only found in the group of subjects aged < 65 years. Conclusions: As age increases, the prevalence of lactose malabsorption shows an increase while the prevalence of intolerance symptoms among malabsorbers shows a decrease. Accordingly, daily calcium intake was similar among the adults and elderly studied.

Early Increase of Bone Resorption in Patients with Liver Cirrhosis Secondary to Viral Hepatitis

Bone loss is an established complication of cholestatic liver cirrhosis, while little is known about bone mass and metabolism in noncholestatic liver cirrhosis. The aim of the present study is, therefore, to evaluate bone mass and mineral metabolism in patients with liver cirrhosis secondary to viral hepatitis. Bone mineral density measurement at lumbar and femoral levels and the evaluation of bone and mineral metabolism and gonadal function were performed in 31 patients with liver cirrhosis and 37 healthy volunteers. Lumbar and femoral bone mineral density values were significantly lower in patients than in healthy volunteers. Prevalence and severity of bone loss increased according to the severity of liver disease. All serum indices of bone and mineral metabolism and of gonadal function showed a similar behavior, but a significant increase of bone resorption was present in all Child-Pugh classes. In particular, class A patients showed normal mean bone mineral density values but increased serum levels of the telopeptide of type I collagen. Liver cirrhosis predisposes to bone loss regardless of the presence of cholestasis. The severity of metabolic osteopathy worsens as liver function does. The underlying mechanism is represented by an increased bone resorption.

Small intestine bacterial overgrowth and metabolic bone disease

Small intestine bacterial overgrowth is a malabsorption syndrome and, therefore, it may contribute to the occurrence of metabolic bone disease. However, studies that evaluate the magnitude of this problem and the potential underlying mechanisms are still needed. Fourteen patients with bacterial overgrowth and 22 comparable healthy volunteers took part in this study. All patients were affected by conditions known to predispose to bacterial overgrowth. Diagnosis was based on the following criteria: increased breath hydrogen levels in the fasting state and/or increased breath hydrogen excretion after the ingestion of 50 g of glucose solution, improvement after a 10-day course of antibiotic therapy of severity of symptoms and of H2 excretion parameters. Measurement of bone mineral density by dual-energy x-ray absorptiometry at lumbar spine and femoral level and evaluation of nutritional status were performed. Physical activity, sunlight exposure, and cigarette smoking were also evaluated. Patients showed lumbar and femoral bone mineral density values significantly lower than control group; also the prevalence of bone loss at both lumbar and femoral levels was higher in patient group than in healthy volunteers. Body mass index was significantly lower in patients than in healthy volunteers. Lumbar and femoral bone mineral density were significantly correlated and both correlated with body mass index and with duration of symptoms. No correlation between BMD values and physical activity, sunlight exposure, and cigarette smoking was evident. Our results show that small intestine bacterial overgrowth is an important cofactor in the development of metabolic bone disease. The severity of bone loss is related to poor nutritional status and duration of malabsorption symptoms.

Role of lifestyle factors in the pathogenesis of osteopenia in adult coeliac disease: a multivariate analysis.

Objectives Coeliac disease is frequently complicated by alterations of bone mass and mineral metabolism. In this condition the degree of malabsorption is a major determinant of bone loss. However, the role of lifestyle factors such as exposure to sunlight, physical activity and cigarette smoking, which have been demonstrated to influence bone mass and mineral metabolism in other conditions, has never been investigated in coeliac disease. Design We evaluated the impact of potential co‐factors on bone homeostasis in coeliac disease by means of a multivariate analysis model. Methods Thirty‐nine adult patients with untreated coeliac disease (18 symptomatic, 21 subclinical/silent) were studied. Bone mineral density was measured by dualenergy X‐ray absorptiometry at lumbar spine and femoral neck levels. Age at diagnosis, gender, duration of symptoms and severity of symptoms were recorded. Nutritional status, cigarette smoking habit, exposure to sunlight, and physical activity were evaluated. The impact of each independent variable on lumbar and femoral bone mineral density was evaluated by means of a multivariate analysis model. Results The severity of symptoms and nutritional status were significant sources of variability of both lumbar and femoral bone mineral density. Physical activity was a significant source of variability at femoral level, while gender was at lumbar level. Cigarette smoking habit and exposure to sunlight showed no significant effect on bone mineral density. Conclusions Gender, malnutrition, global severity of the disease and physical activity are important co‐factors in the pathogenesis of bone loss in coeliac disease.

Bone Mass and Metabolism in Dermatitis Herpetiformis

Dermatitis herpetiformis is a gluten-sensitiveskin disease with intestinal lesions and malabsorptionsymptoms less severe than those found in celiac disease.While several studies have shown the occurrence of osteopenia in celiac disease, bone mass andmetabolism have never before been evaluated indermatitis herpetiformis. Therefore, in 16 untreatedpatients, 16 sex- and age-matched untreated celiacpatients, and 16 sex- and age-matched healthy volunteers,lumbar and femoral bone mineral density were measuredand bone and mineral metabolism and nutritional statuswere evaluated. All these parameters were significantly altered in the two groups of patients andalthough the degree of these alterations was milder inpatients with dermatitis herpetiformis than in celiacpatients, the presence of subtotal villous atrophy in patients with dermatitis herpetiformis wasassociated with the presence of more severe alterations.Bone mineral density was significantly correlated withnutritional status, and patients showing bone loss were characterized by a body mass indexlower than 20. Alterations of bone mass and mineralmetabolism complicate dermatitis herpetiformis whensevere intestinal lesions coexist. A low nutritional status may be predictive of the presence ofbone loss.

Screening for celiac disease in idiopathic osteoporosis

the study is that we have a culture at Cedars-Sinai Medical Center to order breath tests on those with suspected IBS after a negative investigation because of earlier findings presented internally. We then use a database to drive the IBS hypothesis further. This was therefore a prospective database designed to study the IBS and small intestinal bacterial overgrowth (SIBO) phenomenon, and not just a database of SIBO from which to “ troll” for ideas. Our article is the culmination of that database. If nothing else, the reader should be surprised that 78% of these patients, whose diagnoses were not determinable by their primary physicians, had abnormal breath tests and if the breath test findings are corrected with antibiotics, the patients get better. Interestingly, the majority of the previous studies of SIBO have been conducted in subjects with altered anatomy such as gastrectomy, blind loops, etc. In and of itself the findings of such a high rate of positive breath tests in subjects without SIBO risk factors is unique. With regard to the lactulose breath curves presented in the article, the lack of two observable peaks was an averaging phenomenon of the breath test curves of all subjects. Although we agree that in some cases a single early peak may still represent bacterial overgrowth, to be fair these were excluded because rapid transit could not be eliminated as a confounding variable.