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Oesophageal manometry during eating in the investigation of patients with chest pain or dysphagia.

Dysphagia is a frequent cause of referral for oesophageal manometry although the motor response to eating is not routinely studied. We examined symptoms and oesophageal motor patterns in response to eating bread in 30 patients with either gastro-oesophageal reflux (n = 20), or normal oesophageal function tests (n = 10). No patient experienced symptoms while swallowing water but one complained of heartburn and one developed symptomatic oesophageal 'spasm' during eating. In eight further patients, pain or dysphagia which occurred with swallowing bread was associated with aperistalsis. Comparing asymptomatic and symptomatic periods, there was a slight increase in mean swallow frequency from 7.5 (0.79) (SEM) to 9.0 (1.17) swallows per minute (NS; n = 10). The mean number of aperistalsis swallows increased from 4.5 (0.96) per minute to 6.2 (1.30) (p less than 0.01; n = 10). Aperistalsis during symptoms was mainly caused by non-conducted swallows rather than synchronous contractions (mean 5.8 (1.45) per minute compared with 1.2 (0.44]. Aperistalsis can be produced by rapid swallowing in the normal oesophagus through 'deglutitive inhibition'. These results suggest that some patients experience dysphagia associated with aperistalsis perhaps as a response to increased frequency of swallowing. Functional abnormalities of this nature will not be detected by conventional oesophageal manometry.

Adult↗

Wheat deficient in gliadins: promising tool for treatment of coeliac disease.

The toxicity of two varieties of bread wheat, one poor in alpha and beta gliadins and the other poor in alpha, beta, gamma, and omega gliadins, has been tested. The peptic-tryptic digest of these wheats was assessed using coeliac mucosa in an in vitro organ culture system. A significantly lower toxicity was found in respect of bread wheat containing all gliadin fractions. These results suggest new opportunities for the treatment of coeliac disease.

Adult↗

How should the chest wall be opened at necropsy?

AIMS: To compare several different instruments used to open the chest wall during necropsy and to assess whether any one type reduced the production of sharp rib ends and thus the potential for receiving an injury. METHODS: During the necropsy the pathologist opened the chest wall using two randomly assigned instruments from a selection of hand saw, electric saw, rib shears, and bread knife. The age, weight, sex, and height of the deceased were recorded, in addition to the textures of the resultant exposed rib ends. During the procedure, the speed, length, production of spray, and site of incision were also noted. The thoracic cavity was inspected and any details of tumours, adhesions, fluid, or organ damage were noted. RESULTS: Twenty four necropsies were carried out on an equal number of men and women. The total number of ribs that were incised was 422, with 206 through the bony aspect (49%). Sixty seven per cent of the bony rib ends were rough, and this was found to be instrument dependent. The rib shears produced the highest number of rough bony and cartilage rib ends. The electric saw produced the smoothest contoured rib ends. Spray occurred in 29% of cases, exclusively with the use of the electric saw. Organ damage was most frequently associated with the use of the bread knife. CONCLUSION: Rib shears, the instrument most frequently used to open the chest wall, appear to cause the highest frequency of rough, potentially dangerous rib ends. The electric saw produced the smoothest rib ends, both in cartilage and bone, and thus seems to offer the most efficacious method of reducing the potential hazard associated with ragged, spiky bone ends during the opening of the thoracic cavity. Although each of the procedures detailed in this study was shown to have its own advantages and disadvantages, personal preference and operator experience are perhaps the most important factors in ultimately determining the method used.

Accidents, Occupational↗

Social distribution of cardiovascular disease risk factors: change among men in England 1984-1993.

OBJECTIVE: To investigate change in the social distribution of some of the main risk factors for cardiovascular disease in men in England during a period when inequality in cardiovascular disease mortality widened DESIGN: Age standardised comparison of the social distribution of seven known risk factors for cardiovascular disease (body mass index, waist to hip ratio, systolic and diastolic blood pressure, consumption of fresh green vegetables, leisure time exercise, cigarette smoking and levels of social support) in two large cross sectional representative samples of the English population. SUBJECTS: Men aged 20-64 years in the 1984 Health and Lifestyle Survey (excluding Scotland and Wales) first sweep and the 1993 Health Survey for England. MAIN OUTCOME MEASURES: Mean values of continuous variables; age adjusted proportions of categorical variables; change in the relative index of inequality for each risk factor. RESULTS: The overall prevalence of cardiovascular disease risk factors improved during the period in which cardiovascular disease mortality was falling. The social distribution of cardiovascular disease risk factors, in contrast, did not become more extreme. Increases in the relative index of inequality for angina from 1.75 to 1.86, for eating vegetables less than once a day from 1.76 in 1984 to 1.96 in 1993, and an apparently larger increase in inequality of social support, from 1.92 to 2.53 were not statistically significant. In most cases the degree of inequality in risk factors tended to narrow non-significantly: for example the relative index of inequality fell from 5.02 in 1984 to 3.07 in 1993 for systolic blood pressure, from 5.60 to 4.29 for current smoking and from 6.24 to 4.19 for eating other than wholemeal bread as the main form of bread in the diet. The two statistically significant changes in inequality were in the direction of narrowing inequality: from a relative index of inequality of 2.12 to 0.90 for diastolic blood pressure (p<0.01) and from 19.3 to 0.87 (p<0.01) for psychological distress as indicated by the General Health Questionnaire. CONCLUSIONS: Healthier lifestyle options have not been adopted at a significantly faster rate by middle class than working class people over this time period. At the population level the change in risk factors is consistent with falling cardiovascular mortality. The change in the social distribution of risk factors within the population, however, shows little or no relation to the pattern of widening inequality in cardiovascular mortality. This may be because the effect is lagged, or because the adoption of healthier behaviour confers greater benefits on those in higher socioeconomic status groups.

Adult↗

Income and health behaviours. Evidence from monitoring surveys among Finnish adults.

STUDY OBJECTIVE: To examine the associations of individual and household income with various health behaviours, before and after adjusting for educational attainment and occupational social class. DESIGN AND SETTING: Data from 19 982 respondents to nationwide health behaviour surveys from 1993 to 1999 (response rate 70%) were linked with socioeconomic information from population registers. MEASUREMENTS: The income measures were total individual income liable to taxation and household's monthly disposable income. Health behaviours included smoking, alcohol use, leisure time physical activity, use of vegetables, use of saturated fat on bread, and being overweight. MAIN RESULTS: In men, smoking and infrequent vegetable use were more common among those with lower individual and household income. However, adjusting for education and occupational class removed most of the differences. Use of saturated fat on bread increased with decreasing individual income, before and after the adjustments. In women, smoking, infrequent vegetable use and being overweight were more common among those with lower income, but the differences by both income measures were largely removed by the adjustments. Women with higher income more often also were high alcohol users and had less physical activity, in particular when income was measured by the respondents' individual income. CONCLUSIONS: Adjusting for education and occupation largely removed income differences in health behaviours, but for some behaviours some independent effect remained. The results suggest that income does not only reflect the available material resources, but works as a general socioeconomic indicator that is associated with health behaviours in much the same way as other socioeconomic indicators.

Adolescent↗

Dust and flour aeroallergen exposure in flour mills and bakeries.

As part of an epidemiological study among workers exposed to flour total dust and flour aeroallergen concentrations were measured with personal samplers over a workshift in three large bakeries and four flour mills and packing stations. In the bakeries geometric means for total dust concentrations ranged from 0.4 mg/m3 in the bread wrapping area up to 6.4 mg/m3 at the dough brake. The flour aeroallergen concentrations ranged from 45.5 micrograms/m3 in the bread wrapping area up to 252.0 micrograms/m3 in the confectionary area. In the flour mills and packing stations the concentrations were higher with geometric means for total dust ranging from 0.5 mg/m3 in the office up to 16.9 mg/m3 for hygiene workers in an old mill. The flour aeroallergen concentrations ranged from 101.5 micrograms/m3 for transport workers up to 1728.2 micrograms/m3 for hygiene workers. The relation between total dust and flour aeroallergen concentrations varied for different areas and depended on the use of products other than flour.

Allergens↗

The efficacy of Cot-based gene enrichment in wheat (Triticum aestivum L.).

We report the results of a study on the effectiveness of Cot filtration (CF) in the characterization of the gene space of bread wheat (Triticum aestivum L.), a large genome species (1C = 16,700 Mb) of tremendous agronomic importance. Using published Cot data as a guide, 2 genomic libraries for hexaploid wheat were constructed from the single-stranded DNA collected at Cot values > 1188 and 1639 M x s. Compared with sequences from a whole genome shotgun library from Aegilops tauschii (the D genome donor of bread wheat), the CF libraries exhibited 13.7-fold enrichment in genes, 5.8-fold enrichment in unknown low-copy sequences, and a 3-fold reduction in repetitive DNA. CF is twice as efficient as methylation filtration at enriching wheat genes. This research suggests that, with improvements, CF will be a highly useful tool in sequencing the gene space of wheat.

Cloning, Molecular↗

Quantitative food intake in the EPIC-Germany cohorts. European Investigation into Cancer and Nutrition.

The EPIC-Heidelberg and the EPIC-Potsdam studies with about 53,000 study participants represent the German contribution to the EPIC (European Investigation into Cancer and Nutrition) cohort study. Within the EPIC study, standardized 24-hour dietary recalls were applied as a quantitative calibration method in order to estimate the amount of scaling bias introduced by the varying center-specific dietary assessment methods. This article presents intake of food items and food groups in the two German cohorts estimated by 24-hour quantitative dietary recalls. Recalls from 1,013 men and 1,078 women in Heidelberg and 1,032 men and 898 women in Potsdam were included in the analysis. The intake of recorded food items or recipe ingredients as well as fat used for cooking was summarized into 16 main food groups and a variety of different subgroups stratified by sex and weighted for the day of the week and age. In more than 90% of the recalls, consumption of dairy products, cereals and cereal products, bread, fat, and non-alcoholic beverages, particularly coffee/tea, was reported. Inter-cohort evaluations revealed that bread, potatoes, fruit and fat were consumed in higher amounts in the Potsdam cohort while the opposite was found for pasta/rice, non-alcoholic, and alcoholic beverages. It was concluded that the exposure variation was increased by having two instead of one EPIC study centers in Germany.

Adult↗

Australian food sources and intakes of omega-6 and omega-3 polyunsaturated fatty acids.

BACKGROUND/AIMS: Both omega-6 and omega-3 polyunsaturated fatty acids (PUFAs) are recognised as essential nutrients in the human diet, yet we have little information on the extent to which different food sources contribute to their intake. The aim of the present study was to ascertain the daily intakes and food sources of omega-6 and omega-3 PUFAs in our local community. METHODS: Three-day food records were obtained from 83 healthy adults living in the Illawarra region of New South Wales. The PUFA composition of the foods which they consumed was derived from food composition tables and recently published food analysis data. RESULTS: Polyunsaturated margarine, nuts/seeds, bread, snacks/desserts and takeaway foods were important sources of omega-6 PUFAs, while canola oil and margarine, takeaway foods, snacks/desserts and bread were sources of alpha-linolenic acid (LNA), an omega-3 PUFA. As expected, fish was the main source of the very long chain (VLC) omega-3 PUFAs, i.e. eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA), to which significant health benefits are attributed. An unexpected finding, however, was that, due to the large amount eaten, meat was also a major contributor (29%) to the dietary intake of VLC omega-3 PUFAs. Median intakes of omega-6 and omega-3 PUFAs were 9.9 and 1.2 g/day, respectively, resulting in a dietary omega-6:omega-3 ratio of 8:1. The median intake of VLC omega-3 PUFA was 0.18 g/day. CONCLUSION: We have identified food sources and intakes of PUFAs for an Australian subpopulation differentiating between omega-6 and omega-3 PUFAs. Whilst canola and fish were the primary sources of LNA and VLC omega-3 PUFAs respectively, we found that meat made a significant contribution to VLC omega-3 PUFA intake.

Adult↗

Within-subject comparisons of implant-supported mandibular prostheses: evaluation of masticatory function.

In the past, fixed prostheses were believed to be more efficient implant-supported devices than removable types for edentulous patients. However, this hypothesis was never properly tested. Therefore, a within-subject crossover clinical trial was designed in which 145 completely edentulous subjects were tested wearing implant-supported mandibular fixed prostheses and long-bar overdentures. Eight subjects received the fixed appliance first and seven the removable type. The patients' perceptions of various characteristics of the implant-supported prostheses were measured after a minimum of two months' adaptation. Mandibular movements and jaw muscle electromyographic activity were recorded while the patients chewed five standard-sized test foods: bread, apple, hard cheese, sausage, and raw carrot. The prostheses were then changed, worn for the same period of adaptation, and the procedures repeated. There were three test sessions per prosthesis, and each included five trials per food. The measurements were repeated three times at one-week intervals. Mastication time was found to be shorter for three foods (bread, cheese, and sausage) when subjects wore the long-bar overdenture. The vertical amplitude of the masticatory strokes was significantly less with the overdenture for all foods except carrot. Cycle duration was significantly longer with the overdenture for sausage and carrot. Contrary to what might be expected, the long-bar overdenture appears to be no less efficient than the fixed prosthesis. Furthermore, these data suggest that patients are capable of adapting their masticatory movements to the characteristics of the two prostheses.

Adult↗

A within-subject comparison of mandibular long-bar and hybrid implant-supported prostheses: evaluation of masticatory function.

Sixteen edentulous subjects participated in a within-subject crossover clinical trial to test the hypotheses that a long-bar overdenture attached to 4 implants gives greater patient satisfaction and masticatory efficiency than a two-implant hybrid overdenture. All subjects were given a new maxillary conventional denture. Ten received mandibular long-bar overdentures first and six the hybrid overdentures. Two months later, psychometric assessments and functional tests were repeated 3 times at one-week intervals. The mandibular prosthesis was then changed, and recordings were repeated after another 2 months. Mandibular movements and electromyographic activity of jaw muscles were recorded while subjects chewed standard-sized pieces of 5 foods: bread, cheese, apple, sausage, and carrot. Measurements included masticatory time, cleaning time (the time between the end of mastication and the last swallow), and duration and amplitude of masticatory cycles and phases. Multilevel analyses were performed. No significant differences in masticatory time were found between prostheses for any test food. However, cleaning time for carrot [estimated mean of difference (delta) +/- SE: 1.6 sec +/- 0.7] and bread (delta = 1.0 sec +/- 0.4) was slightly but significantly longer for subjects wearing long-bar overdentures. Cycle duration was longer with the long-bar overdenture only for subjects chewing carrot. The opening phase was shorter and the closing phase longer with the long-bar overdenture for almost all test foods. Vertical amplitude was significantly less with the long-bar overdenture for cheese (delta = -2.6 mm +/- 1.1), apple (delta = -2.6 mm +/- 1.0), and sausage (delta = -2.9 mm +/- 1.3). These results suggest that mastication with the 2 prostheses is equally efficient, although clearance of some foods from the mouth is longer with the long-bar overdentures. They also indicate that patients adapt their masticatory movements to the characteristics of different prostheses.

Adult↗

Effect of dietary fat content in meals on pharmacokinetics of quazepam.

Dietary fat content in meals has been reported to increase the absorption of several drugs proportionately. However, there is no information about the effects of dietary fat in meals on the sedative hypnotic agent quazepam, although limited data suggest that food intake alters quazepam absorption. Therefore, the authors measured and compared pharmacokinetic parameters of quazepam taken in a fasted state and taken 30 minutes after consuming meals containing different amounts of dietary fat. A three-arm randomized crossover study was conducted. Nine healthy male volunteers took a single oral 20-mg dose of quazepam under the following conditions: (1) after fasting overnight for at least 12 hours, (2) 30 minutes after consuming a low-fat meal (two slices of bread and 200 ml of apple juice), or (3) 30 minutes after consuming high-fat meal (two slices of bread with 30 gm of butter and 200 ml of apple juice). Plasma concentrations of quazepam and its metabolite, 2-oxoquazepam, were monitored up to 48 hours after the dosing. In comparison with corresponding plasma values for quazepam taken in a fasting state, the peak concentrations (Cmax) of quazepam taken 30 minutes after consuming a low-fat meal and high-fat meal were 243% (90% confidence interval [CI] = 161%-325%) and 272% (90% CI = 190%-355%), respectively. Area under the plasma concentration-time curve from 0 to 8 hours (AUC(0-8)) and 0 to 48 hours (AUC(0-48)) of quazepam was increased with the low-fat meal by 2-fold (90% CI = 1.5- to 2.7-fold) and 1.4-fold (90% CI = 1.0- to 1.7-fold), respectively, and with the high-fat meal by 2.2-fold (90% CI = 1.3- to 3-fold) and 1.5-fold (90% CI = 0.7- to 2.4-fold), respectively. The pharmacokinetic change in 2-oxoquazepam to the parent compound was similar. Quazepam was well tolerated, with no significant difference in the Stanford Sleepiness Scale between fasted and fed conditions. These findings show that food intake has an evident effect on quazepam absorption, but further studies are needed to clarify a determinant factor of this alteration (2.5-fold for Cmax and 2.1-fold for AUC(0-8), on average). It might not be necessary to do dose adjustment with meal content because quazepam is well tolerated.

Adult↗

Dietary effect on mixed function P450 1A2 activity assayed by estimation of caffeine metabolism in man.

Two studies were performed in order to evaluate cytochrome P450 1A2 mediated caffeine metabolism during different nutritional conditions. 1. In the first study, 23 healthy male non-smokers, mean age 25, changed from a customary mixed diet to a standard diet in 6 days. The 6 day's standard diet was based on bread, potatoes, rice and boiled meat. Thus, broccoli, cabbage and other cruciferous vegetables, spinach, leeks, onion, parsley, grapefruit, toasted bread, fried and charcoal grilled food, smoked fish and meat, ham and sausages were avoided. 2. In the second study, 33 healthy non-smoking subjects, 24 men and nine women mean age 25 years, volunteered. The study was designed to compare a customary home dietary period with the 6 day period of low dietary P450 induction and with a 5 day supplementary dietary period, i.e. ingestion of known dietary inducers. None of the women were using oral contraceptives or were pregnant during the experimental period. In the period of diet supplementation, the volunteers received charcoal grilled hamburger as a supplement to the standard low induction diet for lunch for 5 days. The hamburgers were made with 150 g beef (18-20% fat) and were grilled on charcoal for 10 min on each side until they were 'well done'. In the present study P450 1A2 activity was estimated from the caffeine metabolic ratio, the so-called CYP 1A2 index:(AFMU + 1-MX + 1-MU/ 17 -DMU) of the caffeine metabolites formed after oral ingestion of 200 mg caffeine. Urine was collected 4-8 h after caffeine ingestion in study 1 and 5 h after caffeine ingestion in study 2. In study 1 the CYP 1A2 index decreased from 4.28 +/- 0.98 in the customary home dietary period to 3.87 +/- 0.69 in the standard dietary period corresponding to 10.6% (P < 0.06) decrease in the CYP 1A2 index. In study 2 the CYP 1A2 index decreased from 4.47 +/- 1.76 in the customary home dietary period to 3.90 +/- 1.12 in the standard dietary period corresponding to a 14.6% decrease (P < 0.2) in P450 1A2 activity. The female subjects had a mean index value of 3.89 +/- 1.14 which was 16.8% (P = 0.09) lower than the mean male index value of 4.68 +/- 1.76 during the home dietary period. After the 5 day period with charcoal grilled hamburgers as a dietary supplement, the CYP 1A2 index increased to almost the same level as in the customary home dietary period. The index increased to 4.45 +/- 1.57 in the whole group of volunteers, corresponding to a 14.1% (P < 0.05) increase. The mean increase in the CYP 1A2 index covered a large inter-individual variation in response to ingestion of charcoal grilled meat ranging from a 29% decrease to a 147% increase.

Adult↗

The influence of Sir Andrew Clark (1826-93) on William Osler (1849-1919).

Three lines of evidence suggest that Sir Andrew Clark had a significant influence on William Osler's postgraduate training: (1) numerous references to Clark in Osler's textbook of medicine; (2) the similarity of Clark's and Osler's aphoristic messages for students; and (3) personal encounters, including Clark's reminiscence that he 'had striven ten years for bread, ten years for bread and butter, and twenty years for cakes and ale'. Clark's meticulous approach to clinical problems, his work ethic and his enthusiasm for bedside teaching may have fostered or reinforced these same attributes in Osler. Osler honoured Clark's memory by helping Sir John MacAlister and others realize Clark's ambition to unite various London medical societies into a single organization, which, in 1907, became the Royal Society of Medicine.

Clinical Medicine↗

Dietary glycemic load and macronutrient intake in healthy Italian children.

The objective is of this study is to examine the relationship of dietary glycemic load (GL) and overall glycemic index (OGI) with macronutrients intake, body mass index (BMI) and insulin sensitivity in healthy children. The subjects comprised of 105 healthy non-obese eight-years old children, 60 boys and 45 girls. A Food Frequency Questionnaire (FFQ) evaluating dietary habits, GL and OGI. Insulin sensitivity was evaluated by the homeostatic model assessment (HOMA). GL was positively associated with dietary total (correlation coefficient, r=0.57) and starch (r=0.67) carbohydrates, daily consumption of pasta and white bread, cooked potatoes, bakery products and cookies, and negatively with dietary fats (r=-0.52). OGI was positively associated with daily consumption of white bread and cookies, and negatively associated with soluble carbohydrates (r=-0.35), and consumption of fibres, proteins, fruit, legumes and carrots. No significant association was found of GL or OGI with BMI or insulin sensitivity. In healthy children, GL and OGI may represent a useful indicator of quality of diet.

Child↗

Dietary factors associated with wheezing and allergic rhinitis in children.

The effect of dietary factors on asthma is controversial. This study examined food consumption and the use of fats in relation to wheezing and allergic rhinitis in children. Baseline questionnaire data on individual and family characteristics were recorded by parents of 5,257 children aged 6-7 yrs living in central Italy participating in the International Study on Asthma and Allergies in Childhood study. A total of 4,104 children (78.1%) were reinvestigated after 1 yr using a second parental questionnaire to record occurrence of respiratory symptoms over the intervening 12 months. Consumption of foods rich in antioxidants, such as vitamins C and E, animal fats, and food containing omega-3 fatty acids were investigated using a food-frequency questionnaire. Frequency of use of fats was also evaluated. Wheezing, shortness of breath with wheeze, and symptoms of allergic rhinitis in the past 12 months were considered. Intake of cooked vegetables, tomatoes, and fruit were protective factors for any wheeze in the last 12 months and shortness of breath with wheeze. Consumption of citrus fruit had a protective role for shortness of breath with wheeze. Consumption of bread and margarine was associated with an increased risk of wheeze, while bread and butter was associated with shortness of breath with wheeze. Dietary antioxidants in vegetables may reduce wheezing symptoms in childhood, whereas both butter and margarine may increase the occurrence of such symptoms.

Antioxidants↗

Use of plant stanol ester margarine among persons with and without cardiovascular disease: early phases of the adoption of a functional food in Finland.

BACKGROUND: The plant stanol ester margarine Benecol is a functional food that has been shown to lower effectively serum total and LDL-cholesterol. The purpose of this post-marketing study is to characterize users of plant stanol ester margarine with and without cardiovascular disease. METHODS: A cohort of plant stanol ester margarine users was established based on a compilation of 15 surveys conducted by the National Public Health Institute in Finland between 1996-2000. There were 29,772 subjects aged 35-84 years in the cohort. The users of plant stanol ester margarine were identified by the type of bread spread used. RESULTS: The plant stanol ester margarine was used as bread spread by 1332 (4.5%) subjects. Almost half (46%) of the users reported a history of cardiovascular disease. Persons with cardiovascular disease were more likely to use plant stanol ester margarine (8%) than persons without cardiovascular disease (3%). Users with and without cardiovascular disease seemed to share similar characteristics. In particular, they were elderly people with otherwise healthy life-styles and diet. They were less likely smokers, more likely physically active and less likely obese than nonusers. The users reported being in good or average health in general and having used cholesterol-lowering drugs. CONCLUSION: Plant stanol ester margarine seems to be used by persons for whom it was designed and in a way it was meant: as part of efforts for cardiovascular disease risk reduction.

Adult↗

Prevention by mannan and other sugars of in vitro damage of rat fetal small intestine induced by cereal prolamin peptides toxic for human celiac intestine.

Peptic-tryptic-cotazym and peptic-tryptic digests were obtained, simulating in vivo protein digestion, from pure "bread" wheat gliadins and from rye, barley, and oats prolamine and tested on small intestine cultures from fetal rats. When tested at a concentration of 0.1 mg of peptides/ml of culture medium the peptic-tryptic-cotazym and peptic-tryptic digests of gliadin and prolamines were very active in slowing in vitro development of fetal rat intestine and in increasing the occurrence and severity of degenerative changes. The ability of some sugars to interfere with inhibition of fetal intestinal morphogenesis induced by these peptides was also tested. Mannan at a concentration of 0.1 mM was effective in allowing intestinal morphogenesis to take place in the presence of prolamine peptic-tryptic-cotazym and prolamine peptic-tryptic digests of the four toxic cereals. Some oligomers of N-acetyl-glucosamine were also effective in blocking the inhibitory effect of "bread" wheat gliadin peptides. These data are compatible with the hypothesis that some sugars may exert a protective effect on the toxic activity of cereal prolamin peptides on the human celiac intestine.

Animals↗