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Objective:To investigate the effect of the lactitol powder combined with piperacillin sodium and tazobactam sodium in patients with spontaneous bacterial peritonitis (SBP), and the influence on the body microenvironment.Methods:The clinical data of 135 patients with SBP from January 2017 to December 2019 in Huxi Hospital Affiliated Jining Medical College were retrospectively analyzed. Among them, 68 patients were treated with lactitol powder combined with piperacillin sodium and tazobactam sodium (observation group), 67 patients were treated with piperacillin sodium and tazobactam sodium (control group). The curative effect was compared between 2 groups. The recovery time of clinical symptoms and signs (disappearance time of abdominal pain, disappearance time of abdominal distension, disappearance time of abdominal tenderness, recovery time of body temperature and recovery time of ascites white blood cell), liver function indexes (alanine aminotransferase, ALT; total bilirubin; albumin; aspartate aminotransferase, AST), microcirculation indexes (haptoglobin; procalcitonin; interleukin-6, IL-6; neutrophil gelatinase-associated lipocalin, NGAL), intestinal mucosal permeability indexes (endotoxin, blood ammonia, diamine oxidase) and adverse reactions (diarrhea, nausea and skin itching) were recorded.Results:The total effective rate in observation group was significantly higher than that in control group: 95.59% (65/68) vs. 82.09% (55/67), and there was statistical difference ( P<0.05). The disappearance time of abdominal pain, disappearance time of abdominal distension, disappearance time of abdominal tenderness, recovery time of body temperature and recovery time of ascites white blood cell in observation group were significantly shorter than those in control group: (6.15±1.34) d vs. (8.26±1.19) d, (5.34±1.29) d vs. (7.18±1.35) d, (7.59±1.65) d vs. (9.86±1.80) d, (5.28±1.20) d vs. (6.39±1.12) d and (10.87±2.25) d vs. (12.18±1.67) d, and there were statistical differences ( P<0.01). The ALT, total bilirubin, AST, haptoglobin, procalcitonin, IL-6, NGAL, endotoxin, blood ammonia and diamine oxidase 1 and 2 weeks after treatment in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.01); there was no statistical difference in albumin between 2 groups ( P>0.05). There was no statistical difference in incidence of adverse reactions between2 groups ( P>0.05). Conclusions:The lactitol powder combined with piperacillin sodium and tazobactam sodium for SBP patients can more significantly improve the liver function and intestinal mucosal permeability, and promote the body microenvironment and the recovery of symptoms.
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Background@#Imbalance of intestinal microbiota was closely related to colitis. Under these circumstances, regulation of enteric flora may be beneficial to the repair of inflammation. We aimed to investigate the effects of probiotics (Bifidobacterium and Lactobacillus), prebiotics and their combination on inflammation, and microflora in mice of acute colitis.@*Methods@#C57BL/6J mice were divided into six groups randomly (blank control group, model control group, probiotics group, synbiotics group, lactitol group and probiotics + lactitol group). Each group was given 2.5% dextran sulfate sodium drinking water for 5 days other than the blank control group. Except for the model control group, the other four groups were intervened with probiotics, synbiotics (probiotics and inulin), lactitol, and probiotics + lactitol. Mice were sacrificed after 1 week of gavage, and pathologic scores were calculated. The feces of different periods and intestinal mucosa samples were collected to analyze the differences of intestinal microbiota by 16S rRNA sequencing. Differences of two groups or multiple groups were statistically examined through unpaired Student t test and analysis of variance (ANOVA), respectively. ANOVA, Tukey, Anosim, and metastats analysis were used to compare differences of microbiota among different groups.@*Results@#After gavage for 1 week, the pathologic scores of groups with the intervention were significantly lower than those in the model control group, and the difference was statistically significant (P < 0.05). The model control group was higher in the genus of Bacteroides (relative abundance: 0.3679 vs. 0.0099, P = 0.0016) and lower in Lactobacillus (relative abundance: 0.0020 vs. 0.0122, P = 0.0188), Roseburia (relative abundance: 0.0004 vs. 0.0109, P = 0.0157), compared with the blank control group. However, the same phenomenon was not found in groups gavaged with probiotics and lactitol. Compared with model control group, mice with intervention were increased with Bifidobacterium (relative abundance: 0.0172 vs. 0.0039, P = 0.0139), Lachnospiraceae_NK4A136_group (relative abundance: 0.1139 vs. 0.0320, P = 0.0344), Lachnospiraceae_UCG-006 (relative abundance: 0.0432 vs. 0.0054, P = 0.0454), and decreased with Alistipes (relative abundance: 0.0036 vs. 0.0105, P = 0.0207) in varying degrees. The mucosal flora was more abundant than the fecal flora, and genus of Mucispirillum (relative abundance: 0.0207 vs. 0.0001, P = 0.0034) was more common in the mucosa. Lactitol group showed higher level of Akkermansia than model control group (relative abundance: 0.0138 vs. 0.0055, P = 0.0415), probiotics group (relative abundance: 0.0138 vs. 0.0022, P = 0.0041), and synbiotics group (relative abundance: 0.0138 vs. 0.0011, P = 0.0034), while probiotics + lactitol group had more abundant Akkermansia than synbiotics group (relative abundance: 0.0215 vs. 0.0013, P = 0.0315).@*Conclusions@#Probiotics and prebiotics reduce the degree of inflammation in acute colitis mice obviously. Mice with acute colitis show reduced beneficial genera and increased harmful genera. Supplementation of probiotics and prebiotics display the advantage of increasing the proportion of helpful bacteria and regulating the balance of intestinal microbiota. Lactitol might promote the proliferation of Akkermansia.
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ABSTRACT Introduction: Colonoscopy is the screening gold standard to investigate several conditions in the colon. The excellence of preparation is a determining factor for a quality colonoscopy. Objective: Compare the quality of colon preparations for colonoscopy with different kinds of laxative medications in a public hospital of Belo Horizonte, Brazil. Method: A prospective double blind randomized clinical trial was conducted from June 2016 to March 2017. A total of 117 Patients were randomised in four groups to receive a type of preparation (Sodium picosulfate, Mannitol, Lactitol, Lactulose). The patients answered a questionnaire and peripheral blood samples were collected before and after the preparation.The quality of the cleansing was accessed according to the Boston Bowel Preparation Scale. Results: 99.1% of patients have taken the recommended dose and 79.5% reported a good tolerability. Endoscopists performed complete colonoscopy in 89.7%, with an polipectomy rate of 47%. The total effectiveness rate of the solutions were 88%. There were no statistically significant differences between groups (p = 0.271). Regarding the laboratory parameters, differences were seen in the pre- and post-test values of sodium, chlorine and creatinine but without exceeding reference values. Conclusion: The four preparations were effective for colon cleansing, with good acceptance, differing only as for costs.
RESUMO Introdução: a colonoscopia é o padrão ouro de triagem para pesquisa de várias doenças colônicas. A excelência de preparação é um fator determinante para uma colonoscopia de qualidade. Objetivo: Comparar a qualidade das preparações do cólon para colonoscopia com diferentes tipos de medicamentos laxantes em um hospital público de Belo Horizonte, Brasil. Método: Foi realizado um ensaio clínico randomizado duplo cego prospectivo de junho de 2016 a março de 2017. Um total de 117 pacientes foi randomizado em quatro grupos para receber um tipo de preparação (picossulfato sódico, manitol, lacticol, lactulose). Os pacientes responderam a um questionário e amostras de sangue periférico foram coletadas antes e depois da preparação. A qualidade da limpeza foi acessada de acordo com a Boston Bowel Preparation Scale. Resultados: 99,1% dos pacientes tomaram a dose recomendada e 79,5% relataram boa tolerabilidade. Os endoscopistas realizaram colonoscopia completa em 89,7%, com taxa de polipectomia de 47%. A taxa de eficácia total das soluções foi de 88%. Não houve diferenças estatisticamente significantes entre os grupos (p = 0,271). Em relação aos parâmetros laboratoriais, foram observadas diferenças nos valores pré e pós-teste de sódio, cloro e creatinina, mas sem exceder os valores de referência. Conclusão: As quatro preparações foram eficazes para limpeza do cólon, com boa aceitação, diferindo apenas quanto aos custos.
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Humans , Male , Female , Polyethylene Glycols , Colonoscopy , Lactulose , Mannitol , IntestinesABSTRACT
Objective@#To investigate the effects of probiotics, lactitol of different concentrations, and their combination on intestinal microbiota in mice. @*Methods@#Fifty C57BL/6J mice were divided into blank control group, probiotics group, lactitol of standard concentration group, lactitol of high concentration group, and combination of probiotics and lactitol group, 10 mice in each group, with no intervention, gavaged with 1×109 colony-forming units(CFU)/d probiotics, with lactitol of standard concentration (6.6 g·kg-1·d-1), with lactitol of high concentration (10.0 g·kg-1·d-1), with probiotics (5×108 CFU/d) and lactitol (3.3 g·kg-1·d-1) for two weeks, respectively. The feces before gavage and one week and two weeks after gavage were collected. And intestinal mucosa samples were also collected at two weeks after gavage for 16S rRNA sequencing. Alpha diversity analysis, principal component analysis (PCA) and taxonomy were used for analysis of the changes of microbiota. @*Results@#The results of alpha diversity analysis showed there was no statistically significant difference in feces between before gavage and at one week after gavage (P=0.552, 0.062). The results of alpha diversity analysis and PCA indicated that there was no statistically significant difference in intestinal microbiota between lactitol of standard concentration group and lactitol of high concentration group (P=0.270 and 0.085). One week and two weeks after gavage, compared lactitol of standard concentration group and lactitol of high concentration group with blank control group and probiotics group, Akkermansia in feces both increased (one week after gavage, 0.114 3 vs. 0.003 9 and 0.013 1, 0.071 3 vs. 0.003 9 and 0.013 1; P<0.01, P=0.001 and P=0.001, 0.005; two weeks after gavage, which was 0.094 0 vs. 0.030 5 and 0.018 9, 0.142 4 vs. 0.030 5 and 0.018 9; P=0.044, 0.016 and 0.001, <0.01). Compared combination of probiotics and lactitol group with lactitol of standard concentration group and high concentration group, Bacteroides in feces increased (one week after gavage, 0.115 9 vs. 0.037 5 and 0.041 6, P=0.013 and 0.015; two weeks after gavage, 0.058 0 vs. 0.023 2 and 0.014 4, P=0.047 and 0.009). The increase of Lachnospiraceae appeared earlier in combination of probiotics and lactitol group (at one week after gavage). Two weeks after gavage, compared with that of blank control group, lactitol of standard concentration group and high concentration group, Lachnospiraceae in feces of probiotics group increased (all P<0.05). Compared with that of probiotics group, Akkermansia of mucosa in lactitol of standard concentration group increased (0.018 0 vs. 0.001 8, P=0.012). Akkermansia of mucosa in lactitol of high concentration group also increased compared with that of blank control group and probiotics group (0.037 0 vs. 0.010 0 and 0.001 8, P=0.002, <0.01). Comparing combination of probiotics and lactitol group with blank control group, lactitol of standard concentration group and lactitol of high concentration group, and comparing probiotics group with lactitol of high concentration group, Mucispirillum in mucosa all increased (0.040 0 vs. 0.014 8, 0.013 7 and 0.009 9, 0.019 6 vs. 0.009 9; P=0.041, 0.040, 0.018 and 0.011). @*Conclusions@#Supplementary probiotics, lactitol and combination of them all have obvious regulative role in mucosal flora of mice. Exogenous probiotics can not easily colonized in the intestine. Lactitol can obviously promote the proliferation of Akkermansia in feces and intestine.
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Objective To evaluate the efficacy of combined application of lactitol oral solution and polyethylene glycol electrolyte (PEG) powder compared with conventional method in bowel preparation before colonoscopy. Methods 205 patients who underwent colonoscopy were randomly divided into experimental group and control group. The experimental group (n = 102) were given lactitol and polyethylene glycol electrolyte powder, whereas the patients in control group (n = 103) were given polyethylene glycol electrolyte powder only. The visibility and adverse effects during colonoscopy were observed. Results The cleaning satisfaction rate was not statistically significant between the two groups. The proportion of cleanliness to grade 1 in experimental group was higher than that in control group. The incidence of adverse effects in experimental group was lower, and there was no effect on sleeping night. The compliance and tolerance of hospitalized patients were significantly improved. Conclusion Lactitol combined with polyethylene glycol electrolyte (peg) powder is safe, effective, with low incidence of adverse effect for bowel preparation in hospitalized patients.
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Objective To analyze the roles and mechanisms of lactitol and Bifidobacterium infantis in the treatment of rat constipation and to investigate their effects on aquaporin3 (AQP3) and interstitial cells of Cajal (ICC) in colon tissues.Methods Thirty SD male rats were recruited in this study,6 of which were randomly selected as the control and the rest were given 4 mg/kg.d of loperamide for 5 consecutive days to construct the rat model of constipation.The rats with constipation were randomly divided into four groups including model group,lactitol treatment group,Bifidobacterium infantis treatment group and lactitol in combination with Bifidobacterium infantis treatment group.General indexes including food intake,water intake,body weight,fecal water content and intestinal transit rate of each rat were measured after receiving corresponding treatments for 7 consecutive days.The levels of substance P (SP) and vasoactive intestinal peptide (VIP) in serums samples were detected by ELISA.The expression of protein kinase A (PKA) and neurokinin-1 receptor (NK-1) at mRNA level in colon tissues were detected by real-time polymerase chain reaction (real-time PCR).Western blot assay and real-time PCR analysis were used to detect the expression of AQP3 and c-kit at protein and mRNA levels,respectively.Results Compared with the rats in model group,the levels of fecal water content and intestinal transit rate,the concentrations of SP and VIP in serums samples,the expression of PKA and NK-1 at mRNA level and the expression of AQP3 and c-kit at mRNA and protein levels were significantly increased in rats from the three treatment groups (P＜0.05).The most effective treatment was lactitol in combination with Bifidobacterium infantis,followed by the lactitol treatment and then the Bifidobacterium infantis treatment.Conclusion The combination therapy with lactitol and Bifidobacterium infantis increased the serum levels of SP and VIP in rats with constipation.SP could enhance the contraction of gastrointestinal smooth muscles and improve the intestinal motility by binding to the NK-1 receptor on the membrane of ICC.VIP could promote the absorption of water in intestinal tracts,soften stools and alleviate constipation by upregulating the expression of AQP3 at both protein and mRNA levels via the cyclic adenosine monophosphate-PKA (cAMP-PKA) signaling pathway.
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Objective: To synthesize asialoglycoprotein receptor (ASGPR) ligand cholesterol-vinyl sebacate-lactitol (CH-VS-LA) by using enzymatic reaction in organic phase and to optimize its synthesis process. Methods: MS and 13C-NMR were used to identify the structure of product, enzymatic synthesis conditions were optimized via single-factor test and orthogonal experimental design. Results: The enzymatic optimum conditions were as following: the molar ratio of cholesterol-vinyl sebacate (CH-VS) and lactitol (LA) was 4:1, the amount of lipase Novozym 435 was 25 mg, reactional time was 32 h, and productive rate was 92%. Conclusion: The method is highly effecient, the reaction conditions are reasonable, and the process produces no by-product.
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Existe un creciente uso de los alcohol-azúcares como el lactitol en la industria de los alimentos. El estrés oxidativo juega un papel importante en la génesis de patologías digestivas que van desde inflamación hasta cáncer. El propósito de este estudio fue determinar el efecto del lactitol sobre el malondialdehído (MDA), óxido nítrico (NO), glutation reducido (GSH), ácido ascórbico y ácido dehidroascórbico como marcadores del balance oxidación/antioxidación. Para ello se utilizaron 80 ratas macho Sprague-Dawley divididas en cuatro grupos , tres experimentales de 20 animales, a los cuales se les administró por sonda orogástrica, lactitol en dosis de 0,3; 1,0 y 5,0 g/Kg/día durante 12 semanas y un grupo control que recibió solución salina fisiológica por el mismo período de tiempo. El lactitol administrado en dosis de 0,3; 1,0 y 5,0 g/Kg/día produjo un incremento significativo (P<0,05) del GSH (326,5 ± 13,0 µg/ml; 328,5 ± 9,2 µg/ml y 398,2 ± 11,8 µg/ml) al ser comparado con sus respectivos valores basales (285,8 ± 4,0 µg/ml; 280,0 ± 6,2 µg/ml y 279,5 ± 9,1 µg/ml). El lactitol a dosis de 5 g/Kg/día produjo el más alto incremento de la concentración de GSH y al mismo tiempo provocó una disminución significativa del los niveles de NO (33,0 ± 1,2 µM) cuando se comparó con su concentración basal (46,2 ± 2,8 µM). No fueron observados cambios significativos sobre el resto de los marcadores del balance oxidación/antioxidación. Aunque el lactitol es un alcohol-azúcar que no se absorbe a nivel del tracto gastrointestinal, es posible que los productos finales obtenidos luego de su metabolismo por las bacterias intestinales, induzcan efectos sistémicos que pueden afectar el balance oxidación/antioxidación a favor de la antioxidación.
Sugar alcohols such as lactitol are increasingly being used in the food industry. Tissue oxidative stress is an important contributor to the genesis of inflammatory bowel disease and cancer. The purpose of this study was to determine the effect of lactitol on malondialdehyde (MDA), reduced glutathione (GSH), nitric oxide (NO), dehydroascorbic and ascorbic acid as redox markers. Eighty Sprague Dawley rats were divided into four groups; three experimental groups which received lactitol through an oral catheter at doses of 0.3; 1.0; 5 g/kg/day and an experimental group to which saline solution was administered during 12 weeks. Lactitol at doses of 0.3; 1.0; 5 g/kg/day produced a significant increase (P<0.05) on GSH (326.5 ± 13.0 µg/ml; 328.5 ± 9.2 µg/ml y 398.29 ± 11.8 µg/ml respectively) when compared with their respective basal values (285.8 ± 4.0 µg/ml; 280.0 ± 6.2 µg/ml y 279.5 ± 9.1 µg/ml). Lactitol dose of 5g/kg/day produced the highest increase on GSH levels and at the same time elicited a significant decrease on NO levels (33.0 ± 1.2 µM) when compared with basal values (46.2 ± 2.8 µM). No significant changes were observed on the remaining redox markers. Although lactitol is a sugar alcohol that is not absorbed in the small bowel, it is possible that its metabolisms end products, under intestinal bacterial effects, alter the redox balance in favor of antioxidants.
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Animals , Rats , Sugar Alcohols/analysis , Sugar Alcohols/adverse effects , Antioxidants/adverse effects , Glutathione Reductase , Oxidants/adverse effects , Nitric Oxide/deficiency , Rats, Sprague-DawleyABSTRACT
Pneumatosis cystoides intestinalis is an uncommon condition of unknown etiology, characterized by the presence of multiple gas filled cysts in the gastrointestinal tract. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical, pulmonary, and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. The condition has been associated with the therapeutic uses of lactulose, steroids, and various cancer chemotherapeutic regimens. Lactitol is a disaccharide analogue of lactulose which is available as a pure crystalline powder. There are three previous case reports suggestive of lactulose causing pnumatosis intestinalis. We report a case of recurrent pneumatosis cystoides intestinalis associated with benign recurrent pneumoperitoneum developed probably secondary to lactitol therapy.