Nutrition, bacteria and the gut.
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In an effort to reduce carcass contamination and consequent reprocessing, market-age broilers are often subjected to feed withdrawal (FW) before processing to reduce intestinal content and intestinal ruptures during processing. However, little is known regarding the effects of FW on mucus content and intestinal morphology. Therefore, 2 experiments were conducted to determine the effects of FW on intestinal characteristics. Male broilers were raised in floor pens on standard industry diets to 42 and 39 d of age for Experiments (Exp.) 1 and 2, respectively. In Exp. 1, feed was removed 24, 12, 8, and 0 h before sampling, respectively (n = 5 birds/time). Birds remained on litter with access to water for the first 4-h of the FW period and were then placed in crates. Body weights, left pectoralis major weights, and distal ileal and jejunal segments were collected for determination of morphological characteristics. For Exp. 2, birds (n = 8 birds/time) were subjected to 0, 12, and 24 h of FW. Birds were injected with 5-bromo-2'-deoxyuridine and thymidine at 24 and 21 h, respectively, before sampling to determine epithelial cell migration rates. One-centimeter distal ileal segments were collected for mucus quantification at 0, 12, and 24 h. In Exp. 1, ileal villi heights were unaffected by FW, but villus width and crypt depth decreased with increasing FW time (P < or = 0.05). Jejunal villus height increased as FW progressed. Jejunal crypt depths increased until 12 h of FW and then declined at 24 h. Mucus content decreased linearly and was reduced by 46% from 0 to 24 h FW (P < 0.05). The intestinal morphology alterations and the depletion of intestinal mucus that occur during a short-term FW may reduce the integrity of the intestine.
Giardiasis is the most prevalent intestinal parasitic disease in the United States. Most cases can be diagnosed by a single stool examination. However, in periodic cyst excretors, cysts may not be detected unless repeated stool examinations are performed. In clinically highly suspected cases, duodenal fluid should be studies after three negative stool examinations. Scanning electron microscopy is probably superior to light microscopy in screening duodenal fluid if the parasite is scanty or degenerated. A small intestinal biopsy is a last resort for the diagnosis; a mucosal impression smear should be routinely performed on such specimens. The latter is the most sensitive and reliable technique in making the diagnosis.
To regulate intestinal transit, increased fluid intake, along with fiber is recommended. Considering the usually large volumes of intestinal secretion, this advice is questionable. To demonstrate the effects of adding fluid to fiber, 11 volunteers ingested 15 g of wheat bran twice a day, randomly given without or with 600 mL of additional fluid. Stool weight and frequency were similarly increased in the two settings. Gastric emptying was delayed by bran only when bran was given without additional fluid. Orocecal transit showed no significant changes. Whole gut transit was slightly more accelerated with added fluid (20.6 vs. 13.5%). No test showed significant differences in direct comparison of bran and bran with additional fluid. We conclude that in healthy persons, such effects of wheat bran as acceleration of transit and increase in stool weight and frequency do not depend on an additional intake of fluid.
A rare case of primary enteropeptidase deficiency is reported. Details are given of the initial clinical presentation, treatment, and response of the patient from birth to the age of 18 months. Biochemical analysis of a small intestinal biopsy and duodenal juice samples confirmed the total absence of enteropeptidase activity. Proteolytic activity was very low in native duodenal juice, but normal levels could be induced by activation in vitro with a small amount of porcine enteropeptidase.
Seventeen children (mean age: 2.0 years, range: 36 days-8 years) hospitalized with acute gastroenteritis were investigated. Thirteen children had a rotavirus infection while four did not. Rotavirus serum IgA as well as ScIg, i.e., antirotavirus immunoglobulin containing secretory component, increased rapidly after rotavirus infection. While rotavirus IgA persisted in serum for at least 6 months, rotavirus ScIg disappeared from serum in less than 4 months. Rotavirus IgG could be detected in serum during the early stage of the infection and was still high after 6 months. The patients with nonrotavirus acute gastroenteritis did not show any of the above-mentioned serological hallmarks of those with rotavirus infection. The amounts of rotavirus ScIg found in serum about 1 week after the infection correlated to the amounts of rotavirus ScIg in duodenal fluid. Six months after the infection, rotavirus IgA was found in the feces of the majority of the patients while rotavirus ScIg could be detected only in one patient. The amounts of rotavirus IgA in sera and intestinal secretions showed identical patterns in the acute phase of the disease as well as after recovery. The same applied to rotavirus ScIg. These findings could be useful in future evaluations of vaccines and immunity against rotavirus infections.
The mechanisms of carbohydrate-induced diarrhea in suckling rats were investigated with respect to osmolality and type of sugar in the milk. Groups of 12-day-old rats were gavage fed either a basic low carbohydrate milk formula [10.8% fat; 8% protein; 1.4% carbohydrate (weight/volume)] or basic formula with added sucrose, fructose, lactose, or glucose polymers, all as 13% (weight/ volume). All formulas were isocaloric. Their corresponding osmolalities were 278, 645, 1,130, 617, and 349 mOsmol/kg, respectively. Gastric evacuation of water-soluble materials from formulas containing sucrose, fructose, or glucose polymers was significantly slower than the gastric evacuation of the basic formula and the formula that contained lactose. The net fluid absorption from the small intestine was significantly greater from the basic and lactose-containing formulas when compared with sucrose, fructose, or glucose polymer-containing formulas. When the synthetic milk formulas were placed directly into the isolated jejunoileum in vivo, the formulas of higher osmolality (fructose, sucrose, and lactose) caused water flux into the intestine at 60 min, while digestion of the lactose formula reversed the water flux within 120 min. We conclude that the type of added sugar is a decisive factor in gastric evacuation, and that water flux into and out of the intestine is significantly affected by the osmolality and rate of digestion and absorption of the carbohydrate in the formula; these differences among sugars may play a significant role in the etiology of diarrhea.
We report the efficacy of a long-acting somatostatin analogue, associated with conventional therapy, in controlling profuse ileostomy losses in a child with short bowel syndrome following a volvulus. The first therapeutic effects of the treatment [50 to 100 micrograms/day of SMS 201-995 (Sandoz Ltd.) subcutaneously] appeared 48 h after institution. Ileal output was reduced on an average from 1,800 to 600 ml. The transit time to the ileostomy was prolonged from 20 to 360 min. The loss of chloride and sodium was reduced. Clinical tolerance was good. This treatment allowed rapid weaning of parenteral nutrition and implementation of a constant rate enteral infusion with rapid nutritional restitution. Hospitalization was shortened and this treatment raises future opportunities in the short bowel syndrome.
Defective jejunal sodium/proton exchange causes severe, congenital secretory diarrhea. We report a boy who presented typically in utero, but in whom diarrhea resolved during the first year of life. Pregnancy was complicated by polyhydramnios, and an ultrasound at 31 weeks showed a distended fetal small intestine. The abdomen was grossly distended at birth, and profuse secretory diarrhea began immediately. He subsequently thrived on breast milk and electrolyte supplements. Studies of jejunal brush border sodium/proton exchange at 6 months showed a partial defect. Nonequilibrium rectal dialysis showed rectal sodium and potassium transport to be intact. Diarrhea lessened after 9 months, and the patient subsequently required occasional laxatives. These observations suggest that there is a spectrum of congenital abnormality in this exchanger, and that in children with incomplete defects normal colonic sodium salvage can subsequently mask net small intestinal secretion.
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BACKGROUND: The serotonin type 4 (5-HT4) receptor has been associated with functions of the gastrointestinal tract such as modulation of the peristaltic reflex, smooth muscle tone, intestinal secretion and visceral sensitivity. The activation of peripheral 5-HT4 receptors with agonists such as tegaserod has been shown to accelerate gastric emptying and improve symptoms of constipation in animals and humans. However, detailed data on the expression profile and on the localization of this receptor subtype are lacking so far. OBJECTIVE: To study the pattern and expression levels of 5-HT4 receptor messenger RNA expression in the gut. METHOD: Normal tissue samples were collected from the whole gastrointestinal tract of patients undergoing abdominal surgery and, in addition, of monkeys. We performed a comprehensive analysis of 5-HT4 receptor expression by quantitative reverse transcription-polymerase chain reaction, using human and non-human primate tissues from the oesophagus to the rectum. In addition, the brain and heart of non-human primates were analysed. RESULTS: Significantly higher levels of 5-HT4 receptor mRNA were measured in the human stomach, duodenum, jejunum, ileum and caecum and also in the corresponding non-human primate gut segments, ranging from 2- to 12-fold compared with the liver. No differences were found between females and males of both human and non-human primates. CONCLUSIONS: These results show 5-HT4 receptor mRNA expression throughout the gastrointestinal tract in humans and primates, and also support the preclinical and clinical findings of 5-HT4 receptors ligands exhibiting multiple effects throughout the gastrointestinal tract.
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PTH and calcitonin are the two major hormones controlling calcium metabolism. Recently two new substances related to these hormones have been isolated: calcitonin gene related peptide (CGRP) and PTH-related protein (PTHrP). CGRP is a potent vasodilator and stimulant of intestinal secretion while PTHrP is probably the agent responsible for humoral hypercalcaemia of malignancy. We report here a patient with a prostatic tumour presenting with vasodilation, diarrhoea and hypercalcaemia. Our investigations revealed that the primary prostatic and liver secondary tumour contained CGRP, calcitonin and PTHrP. Most of the immunoreactive CGRP in the tumour and plasma co-eluted with the biologically active form of CGRP. The circulating levels of CGRP correlated with the presence of the diarrhoea. PTHrP concentration in the tumours was one of the highest reported for any tumour although previous studies may have utilized less than optimal extraction procedures. The somatostatin analogue, octreotide (SMS 201-995), did not reduce the plasma CGRP or the diarrhoea, a finding similar to that seen in patients with medullary thyroid carcinoma and high plasma CGRP. The hypercalcaemia was also unaffected by octreotide administration. This is the first report of a prostatic tumour associated with over-production of calcitonin, PTHrP and CGRP. The major life-threatening effects of this unusual case of prostatic carcinoma were diarrhoea and hypercalcaemia. Both these effects could be tentatively ascribed to newly discovered substances, CGRP and PTHrP. With the greater availability of assays to measure CGRP and PTHrP in plasma, a detailed examination of the incidence of over-production of these substances in various cancers will be possible.
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The human infant in the first six months of life is particularly vulnerable to diarrhoeal disease. Vulnerability to diarrhoeal processes is associated with the state of development of the infant gastrointestinal tract, not only of its digestive and absorptive processes but also of its unique and elaborate local defence system, consisting of both immune and non-immune elements. Protection from enteric infection, and sensitisation to food antigens is a function of the integration of gastric acid and biliary secretion, intestinal motor activity and local immune mechanisms. Development of these functions is controlled by a species specific programme in which the potential for accelerated development appears limited. Human milk provides passive protection during the initial vulnerable period. However, premature weaning may at best result in overloading of digestive and absorptive mechanisms and has the potential for the development of sensitisation to food antigens and serious diarrhoeal disease.