Xiucai Fang

The Impact of Soluble Dietary Fibre on Gastric Emptying, Postprandial Blood Glucose and Insulin in Patients with Type 2 Diabetes

Dietary fibre plays an important role in controlling postprandial glycemic and insulin response in diabetic patients. The intake of dietary fibre has been shown to delay the gastric emptying in healthy subjects. The relationship between gastric emptying and postprandial blood glucose in diabetic patients with fibre-load liquids needs to be investigated. To investigate the impact of soluble dietary fibre (SDF) on gastric emptying, postprandial glycemic and insulin response in patients with type 2 diabetes. 30 patients with type 2 diabetes (DM) and 10 healthy subjects (HS) matched for gender and age were randomized to receive SDF-free liquid (500 mL, 500 Kcal) and isoenergetic SDF liquid (oat β-glucan 7.5 g, 500 mL, 500 Kcal) on two separate days based on a cross-over with 6-day wash-out period. Gastric emptying was monitored by ultrasonography at intervals of 30 min for 2 hours. Fasting and postprandial blood was collected at intervals of 30-60 min for 180 min to determine plasma glucose and insulin. Proximal gastric emptying was delayed by SDF-treatment both in DM (p=0.001) and HS (p=0.037). SDF resulted in less output volume in the distal stomach in DM (p<0.05). SDF decreased postprandial glucose (p=0.001) and insulin (p=0.001) in DM subjects. Postprandial glucose (r=-0.547, p=0.047) and insulin (r=-0.566, p=0.004) were negatively correlated with distal emptying of SDF in DM subjects. Distal gastric emptying was delayed significantly in DM subjects with HbA1c levels ≥6.5% (p=0.021) or with complications (p=0.011) by SDF, respectively. SDF improved postprandial glycaemia which was related to slowing of gastric emptying.

Changes in Enteric Neurons of Small Intestine in a Rat Model of Irritable Bowel Syndrome with Diarrhea

Background/Aims Physical and/or emotional stresses are important factors in the exacerbation of symptoms in irritable bowel syndrome (IBS). Several lines of evidence support that a major impact of stress on the gastrointestinal tract occurs via the enteric nervous system. We aimed to evaluate histological changes in the submucosal plexus (SMP) and myenteric plexus (MP) of the distal ileum in concert with the intestinal motor function in a rat model of IBS with diarrhea. Methods The rat model was induced by heterotypic chronic and acute stress (CAS). The intestinal transit was measured by administering powdered carbon by gastric gavage. Double immunohistochemical fluorescence staining with whole-mount preparations of SMP and MP of enteric nervous system was used to assess changes in expression of choline acetyltransferase, vasoactive intestinal peptide, or nitric oxide synthase in relation to the pan neuronal marker, anti-Hu. Results The intestinal transit ratio increased significantly from control values of 50.8% to 60.6% in the CAS group. The numbers of enteric ganglia and neurons in the SMP were increased in the CAS group. The proportions of choline acetyltransferase- and vasoactive intestinal peptide-immunoreactive neurons in the SMP were increased (82.1 ± 4.3% vs. 76.0 ± 5.0%, P = 0.021; 40.5 ± 5.9% vs 28.9 ± 3.7%, P = 0.001), while nitric oxide synthase-immunoreactive neurons in the MP were decreased compared with controls (23.3 ± 4.5% vs 32.4 ± 4.5%, P = 0.002). Conclusions These morphological changes in enteric neurons to CAS might contribute to the dysfunction in motility and secretion in IBS with diarrhea.

Response of Esophagus to High and Low Temperatures in Patients With Achalasia

Background/Aims Achalasia patients would feel exacerbated dysphagia, chest pain and regurgitation when they drink cold beverages or eat cold food. But these symptoms would relieve when they drink hot water. Reasons are unknown. Methods Twelve achalasia patients (mean age, 34 ± 10 years; F:M, 3:9) who never had any invasive therapies were chosen from Peking Union Medical College Hospital. They were asked to fill in the questionnaire on eating habits including food temperature and related symptoms and to receive high-resolution manometry examination. The exam was done in 2 separated days, at swallowing room temperature (25℃) then hot (50℃) water, and at room temperature (25℃) then cold (2℃) water, respectively. Parameters associated with esophageal motility were analyzed. Results Most patients (9/12) reported discomfort when they ate cold food. All patients reported no additional discomfort when they ate hot food. Drinking hot water was effective in 5/8 patients who ever tried to relieve chest pain attacks. On manometry, cold water increased lower esophageal sphincter (LES) resting pressure (P = 0.003), and prolonged the duration of esophageal body contraction (P = 0.002). Hot water decreased LES resting pressure and residue pressure during swallow (P = 0.008 and P = 0.002), increased LES relaxation rate (P = 0.029) and shortened the duration of esophageal body contraction (P = 0.003). Conclusions Cold water could increase LES resting pressure, prolong the contraction duration of esophageal body, and exacerbate achalasia symptoms. Hot water could reduce LES resting pressure, assist LES relaxation, shorten the contraction duration of esophageal body and relieve symptoms. Thus achalasia patients are recommended to eat hot and warm food and avoid cold food.

Isomalto-oligosaccharides ameliorate visceral hyperalgesia with repair damage of ileal epithelial ultrastructure in rats.

Background Treatment of irritable bowel syndrome (IBS) with probiotics has achieved effectiveness to a certain extent. Whether prebiotics will work is still unclear. This study aimed to investigate the therapeutic effects of the prebiotic isomalto-oligosaccharides (IMO) on visceral hypersensitivity (VHS) in rats and to explore potential mechanism. Methods Water avoidance stress (WAS) was used to induce VHS in rats. The score for the abdominal withdrawal reflex (AWR) was determined while colorectal distension and compared between VHS group and control group in order to validate VHS preparation. Rats with VHS were then divided into an IMO-treated group (intragastric 5% IMO, 2 mL/d, 14 days) and a water-control group (intragastric water). After treatment, AWR score and intestinal transit rate (ITR) were determined, stool culture was performed, the ultrastructure of the ileum epithelium was observed with scanning electron microscopy (SEM), and serum cytokines were measured. Results WAS significantly increased AWR score responding to colorectal distension, and lowered the pain threshold. IMO treatment improved VHS with a reduction in AWR score on graded colorectal distension and an increase in pain threshold. SEM showed damages on the ileal epithelial ultrastructure in VHS rats, which was attenuated by IMO treatment. ITR, fecal microbiota and serum cytokine levels were comparable among control group, water-control group, and IMO-treated rats. Conclusion In this randomized placebo-controlled study, the results showed that IMO ameliorated WAS-induced visceral hyperalgesia in rats, this effect may be attributed to the repair of damages on intestinal epithelial ultrastructure.

T1323 Do Different Types of Patients with Functional Dyspepsia in ROME III Criteria Vary in Related Pathophysiological Mechanisms

BACKGROUND: In Rome III criteria, patients with functional dyspepsia (FD) are divided into: epigastric pain syndrome (EPS), postprandial discomfort syndrome (PDS) and EPS+PDS. Now, it remains unknown whether differences in the FD related pathophysiological mechanisms exit among them. If the differences are detected, it will be very helpful to treat different types of FD patients according to their special pathophysiologies. AIMS: To investigate the differences in FD related pathophysiologies including gastric solid emptying (GE), gastric muscular electrical activity (GME), autonomic nerve system function (ANS), gastric accommodation/sensitivity and abnormal psychological factors among EPS, PDS and EPS+PDS types of FD patients. METHODS: 77 FD patients according to Rome III criteria (57F, mean age 44.8yrs, EPS 17, PDS 34, EPS+PDS 26) were enrolled in this study. GE, GME, ANS, gastric accommodation/sensitivity and abnormal psychological factors were measured by GE test (radionuclide and radiopaque maker methods), multi-channel electrogastrography, heart rate variability analyzer, liquid nutrient load test (LNLT) and Zung Anxiety/Depression Scale, respectively. The study was approved by the ethics committee of PUMC Hospital. RESULTS: 1. No significant differences exited in age, sex and course of FD among the three types (P>0.05). 2. Delayed GE%: EPS vs. PDS vs. EPS+PDS 33.3% vs. 36.7% vs. 40.0% (P= 0.912). 3. GME: Normal percentage of 2-4cpm gastric slow waves: fasting 78.9±10.6% vs. 75.2±15.0% vs. 69.9±19.0% (P=0.209) and postprandial 71.0±14.0% vs. 71.6±15.2% vs. 62.6±17.3% (P=0.097). Percentage of slow wave coupling%: fasting 67.5±17.0% vs. 64.9±21.2% vs. 61.5±23.3% (P=0.684) and postprandial 62.0±15.7% vs. 59.2±19.6% vs. 50.9±18.1% (P=0.138). 4. LNLT: Maximal Intake Volume: 511±140 vs. 451±129 vs. 480±148ml (P=0.431). 5. ANS: Sympathetic Activity: fasting 0.46±0.28 vs. 0.36±0.19 vs. 0.45±0.14 (P=0.174) and postprandial 0.51±0.17 vs. 0.51±0.19 vs. 0.54±0.13 (P=0.821). Vagal Activity: fasting 0.62±0.17 vs. 0.64±0.19 vs. 0.55±0.14 (P=0.156) and postprandial 0.49±0.17 vs. 0.49±0.19 vs. 0.46±0.13 (P=0.821). 6. Zung Anxiety Scale: 45.6±9.4 vs. 48.4±10.1 vs. 49.7±9.5 (P=0.430) and Zung Depression Scale: 49.5±10.4 vs. 55.1±10.4 vs. 55.8±8.6 (P=0.112). CONCLUSIONS: No differences in the FD related pathophysiologies including GE, GME, ANS, gastric accommodation/sensitivity and abnormal psychological factors were detected among EPS, PDS and EPS+PDS types of FD patients, which suggests that the sub-grouping method of EPS, PDS and EPS+PDS is helpless to the treatment strategy“to treat different types of FD patients according to their special pathophysiologies”.

A Comorbidity Study of Functional Gastrointestinal Disorders in Patientswith Major Depressive Disorder

Background: To investigate the comorbidity of functional gastrointestinal disorders (FGIDs) in current major depressive disorder (MDD) patients. Method: The prevalence of gastrointestinal symptoms and the comorbidity of FGIDs were studied in a set of consecutively enrolled current MDD patients in a general hospital psychiatric outpatient clinic from Mar, 17th, 2011 to Dec, 31st, 2011. A total of consenting 62 patients were included. MDD diagnosis was made by experienced psychiatrists according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. FGIDs diagnosis was based on Rome III diagnostic questionnaire and approved by gastroenterologists. Result: In this group, 58 (93.5%) reported gastrointestinal symptom, the most prevalent symptom is abdominal pain or bloating or discomfort (87.1%), followed by diarrhea or constipation (85.5%), decreased or increased appetite (83.9%), reduced or increased food intake (83.9%), burp or belching (77.4%), nausea or vomiting (46.8%). Forty-six of the total 62 patients (74.2%) met the criteria of one or more FGIDs. In these 46 patients, 30 (65.2%) patients have overlap syndrome (two or more FGIDs). Functional dyspepsia (FD) is the most prevalent (54.8%), then belching disorder (29.0%), functional heartburn (16.1%), unspecified functional bowel disorder (16.1%) and irritable bowel syndrome (12.9%). Conclusion: In current MDD patients, gastrointestinal symptoms are common and a large percentage of them can already be diagnosed as FGIDs comorbidity, which demands clinical attention and future research.

Sera with anti-enteric neuronal antibodies from patients with irritable bowel syndrome promote apoptosis in myenteric neurons of guinea pigs and human SH-Sy5Y cells

Sera anti‐enteric neuronal antibodies (AENA), neuronal inflammation, and degeneration in myenteric plexus in patients with irritable bowel syndrome (IBS) were reported. Effects of sera AENA in patients with IBS are unclear.

Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study

Background/Aims Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized. Methods Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging. Results For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05). Conclusions Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.

Effects of high-fat, standard, and functional food meals on esophageal and gastric pH in patients with gastroesophageal reflux disease and healthy subjects: Effect of diet on esophageal, gastric pH

To investigate the effects of different test meals on esophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD) and healthy subjects and to demonstrate the relationship between esophageal acid exposure (EAE) and gastric pH.

Predictors of healthcare-seeking behavior among Chinese patients with irritable bowel syndrome

AIM To analyze predictors of healthcare-seeking behavior among Chinese patients with irritable bowel syndrome (IBS) and their satisfaction with medical care. METHODS Participating patients met IBS Rome III criteria (excluding those with organic diseases) and were enrolled in an IBS database in a tertiary university hospital. Participants completed IBS questionnaires in face-to-face interviews. The questionnaires covered intestinal and extra-intestinal symptoms, medical consultations, colonoscopy, medications, and self-reported response to medications during the whole disease course and in the past year. Univariate associations and multivariate logistic regression were used to identify predictors for frequent healthcare-seeking behavior (≥ 3 times/year), frequent colonoscopies (≥ 2 times/year), long-term medications, and poor satisfaction with medical care. RESULTS In total, 516 patients (293 males, 223 females) were included. Participants’ average age was 43.2 ± 11.8 years. Before study enrollment, 55.2% had received medical consultations for IBS symptoms. Ordinary abdominal pain/discomfort (non-defecation) was an independent predictor for healthcare-seeking behavior (OR = 2.07, 95%CI: 1.31-3.27). Frequent colonoscopies were reported by 14.7% of patients (3.1 ± 1.4 times per year). Sensation of incomplete evacuation was an independent predictor for frequent colonoscopies (OR = 2.76, 95%CI: 1.35-5.67). During the whole disease course, 89% of patients took medications for IBS symptoms, and 14.7% reported they were satisfied with medical care. Patients with anxiety were more likely to report dissatisfaction with medical care (OR = 2.08, 95%CI: 1.20-3.59). In the past year, patients with severe (OR = 1.74, 95%CI: 1.06-2.82) and persistent (OR = 1.66, 95%CI: 1.01-2.72) IBS symptoms sought medical care more frequently. CONCLUSION Chinese patients with IBS present high rates of frequent healthcare-seeking behavior, colonoscopies, and medications, and low satisfaction with medical care. Intestinal symptoms are major predictors for healthcare-seeking behavior.