Small intestinal bacterial overgrowth in inactive Crohn's disease: influence of thiopurine and biological treatment.

AIM: To investigate the influence of thiopurines and biological drugs on the presence of small intestinal bacterial overgrowth (SIBO) in patients with inactive Crohn's disease (CD). METHODS: This was a prospective study in patients with CD in remission and without corticosteroid treatment, included consecutively from 2004 to 2010. SIBO was investigated using the hydrogen glucose breath test. RESULTS: One hundred and seven patients with CD in remission were included. Almost 58% of patients used maintenance immunosuppressant therapy and 19.6% used biological therapy. The prevalence of SIBO was 16.8%. No association was observed between SIBO and the use of thiopurine Immunosuppressant (12/62 patients), administration of biological drugs (2/21 patients), or with double treatment with an anti-tumor necrosis factor drugs plus thiopurine (1/13 patients). Half of the patients had symptoms that were suggestive of SIBO, though meteorism was the only symptom that was significantly associated with the presence of SIBO on univariate analysis (P < 0.05). Multivariate analysis revealed that the presence of meteorism and a fistulizing pattern were associated with the presence of SIBO (P < 0.05). CONCLUSION: Immunosuppressants and/or biological drugs do not induce SIBO in inactive CD. Fistulizing disease pattern and meteorism are associated with SIBO.

Omega 3 polyunsaturated fatty acids and body weight.

In animal studies, n-3 PUFA have been shown to influence body composition and to reduce the accumulation of body fat, thereby affecting body weight homeostasis. In addition, it has been suggested that an additional supply of n-3 PUFA during pregnancy or lactation, or both, would have a beneficial effect on birth weight and infant growth and development. The purpose of the present study was to systematically review interventional clinical trials on the effects of dietary n-3 PUFA supplementation on body weight in adult subjects and in infants whose mothers were supplemented with these fatty acids during pregnancy and/or lactation. A systematic search, focused on n-3 PUFA and body weight, and limited to controlled clinical trials, was performed in different databases. The quality of all included studies was assessed against set criteria, and results of eligible trials were compared. There were few studies targeting this topic. In adults, all of the five studies included, except for one, show no change in body weight by dietary supplementation with n-3 PUFA. Within those trials conducted in pregnant and/or lactating women in which a main outcome was birth weight or growth in infancy, two showed a modest increase in birth weight and the rest showed no effect. None of the trials showed an effect of maternal n-3 PUFA supplementation on infant's weight at the short term. However, it should be noted that a number of limitations, including a variety of experimental designs, type and doses of n-3 PUFA, and high attrition rates, among others, make impossible to draw robust conclusions from this review.

Effect of calcineurin inhibitors in the outcome of liver transplantation in hepatitis C virus-positive recipients.

BACKGROUND: There is a paucity of good studies evaluating the impact of calcineurin inhibitors on posttransplantation outcome in hepatitis C virus (HCV)-infected liver transplant (LT) recipients. METHODS: We sought to determine whether there are differences on posttransplantation survival and histologic recurrence in HCV-LT recipients based on initial immunosuppression (IS) by conducting a prospective study comparing tacrolimus (Tac) versus cyclosporine-based IS in patients undergoing LT between 2001 and 2007. Protocol liver biopsies were performed. RESULTS: Baseline characteristics (demographics, liver function at LT, genotype distribution, donor, surgery, and IS except for the type of calcineurin inhibitor) did not differ between groups. Severe disease (defined as bridging fibrosis, cirrhosis, cholestatic hepatitis, or allograft loss or death because of recurrent disease in the first year) was present in 67 of 253 (26.5%) and was equally distributed in the CsA and Tac groups (27% vs. 26%; P=0.68). Two thirds of protocol biopsies performed at 1 year showed some fibrosis without differences between CsA and Tac groups (75% vs. 70%). Advanced fibrosis (bridging fibrosis and cirrhosis) was diagnosed in 30% CsA and 24.5% Tac patients (P=NS). No differences in survival at 1 and 7 years were observed (83% and 67% vs. 78% and 64%, respectively, P=0.4). In summary, in patients undergoing LT for HCV-related liver disease, posttransplantation outcome is not related to the calcineurin inhibitor used.

[Medium-term management of protein-losing enteropathy of cardiac origin unresponsive to medical therapy in a patient awaiting heart transplantation]. / Manejo a medio plazo de la enteropatía pierde-proteínas de causa cardíaca, en un paciente que no responde al tratamiento médico, en espera de trasplante cardíaco.

Protein-losing enteropathy is characterized by excessive leaking of serum proteins into the gastrointestinal tract, as a result of disease progression in several diseases. We report the case of a 17-year-old-woman with hypoproteinemia, generalized edema and serosal effusions diagnosed as protein-losing enteropathy due to right ventricular failure secondary to previous surgical damage. All previously described therapies were ineffective in curing or relieving the disease or its symptoms, and the patient was listed for heart transplantation. During the 7-month period on the waiting list, the patient was managed as an outpatient, with fortnightly albumin infusions and intravenous furosemide administration, which allowed her a better quality of life during that period, avoiding further admissions.

Manejo a medio plazo de la enteropatía pierde-proteínas de causa cardíaca, en un paciente que no responde al tratamiento médico, en espera de trasplante cardíaco / Medium-term management of protein - losing enteropathy of cardiac origin unresponsive to medical therapy inapatienta waiting heart transplantation

La enteropatía pierde-proteínas se caracteriza por una pérdida excesiva de proteínas plasmáticas a través de la luz intestinal, como resultado de la progresión de diversas enfermedades. En este artículo, se recoge el caso de una mujer de 17 años con hipoproteinemia, edemas generalizados y derrames serosos, diagnosticada de enteropatía pierde-proteínas de causa cardíaca, secundaria a una insuficiencia cardíaca derecha, debida a una lesión quirúrgica previa del ventrículo derecho. Todos los tratamientos previamente descritos para este síndrome no fueron efectivos para la resolución o mejoría de esta enfermedad o sus síntomas, por lo que la paciente fue incluida en lista de espera para trasplante cardíaco. Durante los 7 meses de espera antes de la cirugía, la paciente fue tratada de forma ambulatoria, programándose visitas quincenales a nuestro servicio para la administración de perfusión de albúmina y furosemida intravenosas, lo que le proporcionó una mejor calidad de vida durante este tiempo, evitando nuevos ingresos hospitalarios (AU)

Protein-losing enteropathy is characterized by excessive leaking of serum proteins into the gastrointestinal tract, as a result of disease progression in several diseases. We report the case of a 17-year-old-woman with hypoproteinemia, generalized edema and serosal effusions diagnosed as protein-losing enteropathy due to right ventricular failure secondary to previous surgical damage. All previously described therapies were ineffective in curing or relieving the disease or its symptoms, and the patient was listed for heart transplantation. During the 7-month period on the waiting list, the patient was managed as an outpatient, with fortnightly albumin infusions and intravenous furosemide administration, which allowed her a better quality of life during that period, avoiding further admissions (AU)

[Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn's disease]. / Abscesos hepáticos fúngicos en un paciente con colangitis esclerosante primaria y enfermedad de Crohn.

Liver abscesses are a relatively infrequent complication of inflammatory bowel disease. These abscesses are usually multiple and of polymicrobial origin. The development of primary sclerosing cholangitis in inflammatory bowel disease, although provoking alterations in biliary morphology and a higher incidence of infections, does not predispose patients to the development of liver abscesses. We describe a new case of primary sclerosing cholangitis and Crohn's disease with multiple fungal liver abscesses caused by Candida albicans. The patient had developed a duodenal-biliary fistula. Antibiotic therapy produced clinical response and surgery was performed to repair the fistula.

Abscesos hepáticos fúngicos en un paciente con colangitis esclerosante primaria y enfermedad de Crohn / Fungal liver abscesses in a patient with primary sclerosing cholangitis and Crohn´s disease

Los abscesos hepáticos son una complicación bastante infrecuentede la enfermedad inflamatoria intestinal; suelen sermúltiples y de origen polimicrobiano. El desarrollo de unacolangitis esclerosante primaria en el seno de una enfermedadinflamatoria intestinal, pese a la alteración de la morfologíabiliar y la mayor incidencia de infecciones, no predisponea la aparición de abscesos hepáticos. En este trabajoexponemos un nuevo caso de un paciente con colangitis esclerosanteprimaria y enfermedad de Crohn, que presenta múltiplesabscesos hepáticos de origen fúngico, cuyo patógenoimplicado es Candida albicans. Tras el estudio se descubrióque el paciente había desarrollado una fístula duodenobiliar.Éste respondió clínicamente al tratamiento antibiótico administradoy requirió cirugía para reparar la lesión fistulosa

Liver abscesses are a relatively infrequent complication ofinflammatory bowel disease. These abscesses are usuallymultiple and of polymicrobial origin. The development ofprimary sclerosing cholangitis in inflammatory bowel disease,although provoking alterations in biliary morphologyand a higher incidence of infections, does not predispose patientsto the development of liver abscesses. We describe anew case of primary sclerosing cholangitis and Crohn’s diseasewith multiple fungal liver abscesses caused by Candidaalbicans. The patient had developed a duodenal-biliary fistula.Antibiotic therapy produced clinical response and surgerywas performed to repair the fistula

Membrane lipid composition of pancreatic AR42J cells: modification by exposure to different fatty acids.

Dietary fat type influences fatty acids in rat pancreatic membranes, in association with modulation of secretory activity and cell signalling in viable acini. We aimed to confirm whether AR42J cells are a valid model to study the interactions between lipids and pancreatic acinar cell function. For this purpose we have (i) compared the baseline fatty acid composition of AR42J cells with that of pancreatic membranes from rats fed a standard chow; (ii) investigated if fatty acids in AR42J membranes can be modified in culture; and (iii) studied if similar compositional variations that can be evoked in rats when dietary fat type is altered occur in AR42J cells. Weaning Wistar rats were fed for 8 weeks either a commercial chow (C) or semi-purified diets containing virgin olive oil (VOO) or sunflower oil (SO) as fat source. AR42J cells were incubated for 72 hrs in medium containing unmodified fetal calf serum (FCS, AR42J-C cells), FCS enriched with 18:1 n-9 (AR42J-O cells), or FCS enriched with 18:2 n-6 (AR42J-L cells). Fatty acids in crude membranes from rat pancreas and AR42J cells were determined by gas-liquid chromatography. Differences in membrane fatty acids between C rats and AR42J-C cells can be explained in part by variations in the amount of fatty acids in the extracellular environment. Supplementation of FCS with 18:1 n-9 or 18:2 n-6 changed the fatty acid spectrum of AR42J cells in a manner that resembles the pattern found, respectively, in VOO and SO rats, although AR42J-L cells were unable to accumulate 20:4 n-6. The AR42J cell line can be a useful tool to assess the effect of membrane compositional changes on acinar cell function. However, differences in baseline characteristics, and perhaps fatty acid metabolism, indicate that results obtained in AR42J cells should be confirmed with experiments in the whole animal.

Involvement of ryanodine-operated channels in tert-butylhydroperoxide-evoked Ca2+ mobilisation in pancreatic acinar cells.

Reactive oxygen species and related oxidative damage have been implicated in the initiation of acute pancreatitis, a disease characterised in its earliest stages by disruption of intracellular Ca2+ homeostasis. The present study was carried out in order to establish the effect of the organic pro-oxidant, tert-butylhydroperoxide (tBHP), on the mobilisation of intracellular Ca2+ stores in isolated rat pancreatic acinar cells and the mechanisms underlying this effect. Cytosolic free Ca2+ concentrations ([Ca2+]c) were monitored using a digital microspectrofluorimetric system in fura-2 loaded cells. In the presence of normal extracellular Ca2+ concentrations ([Ca2+]o), perfusion of pancreatic acinar cells with 1 mmol l-1 tBHP caused a slow sustained increase in [Ca2+]c. This increase was also observed in a nominally Ca2+-free medium, indicating a release of Ca2+ from intracellular stores. Pretreatment of cells with tBHP abolished the typical Ca2+ response of both the physiological agonist CCK-8 (1 nmol l-1) and thapsigargin (TPS, 1 micromol l-1), an inhibitor of the SERCA pump, in the absence of extracellular Ca2+. Similar results were observed with carbonyl cyanide p-trifluoromethoxyphenylhydrazone (FCCP, 0.5 micromol l-1), a mitochondrial uncoupler. In addition, depletion of either agonist-sensitive Ca2+ pools by CCK-8 or TPS or mitochondrial Ca2+ pools by FCCP were unable to prevent the tBHP-induced Ca2+ release. By contrast, simultaneous administration of TPS and FCCP clearly abolished the tBHP-induced Ca2+ release. These results show that tBHP releases Ca2+ from agonist-sensitive intracellular stores and from mitochondria. On the other hand, simultaneous application of FCCP and of 2-aminoethoxydiphenylborane (2-APB), a blocker of IP3-mediated Ca2+ release, was unable to suppress the increase in [Ca2+]c induced by tBHP, while the application of 50 micromol l-1 of ryanodine (which is able to block the ryanodine channels) inhibits tBHP-evoked Ca2+ mobilisation. These findings indicate that tBHP releases Ca2+ from non-mitochondrial Ca2+ pools through ryanodine channels.

Effects of the type of dietary fat on acetylcholine-evoked amylase secretion and calcium mobilization in isolated rat pancreatic acinar cells.

Olive oil is a major component of the Mediterranean diet, and its role in human health is being actively debated. This study aimed to clarify the mechanism of pancreatic adaptation to dietary fat. For this purpose, we examined whether dietary-induced modification of pancreatic membranes affects acinar cell function in response to the secretagogue acetylcholine (ACh). Weaning male Wistar rats were assigned to one of two experimental groups and fed for 8 weeks with a commercial chow (C) or a semisynthetic diet containing virgin olive oil as dietary fat (OO). The fatty acid composition of pancreatic plasma membranes was determined by gas-liquid chromatography. For assessment of secretory function, viable acini were incubated with ACh and amylase of supernatant was further assayed with a substrate reagent. Changes in cytosolic Ca(2+) concentration in response to ACh were measured by fura-2 AM fluorimetry. Compared to C rats, pancreatic cell membranes of OO rats had a higher level of monounsaturated fatty acids and a lower level of both saturated and polyunsaturated fatty acids, thus, reflecting the type of dietary fat given. Net amylase secretion in response to ACh was greatly enhanced after OO feeding, although this was not paralleled by enhancement of ACh-evoked Ca(2+) peak increases. In conclusion, chronic intake of diets that differ in the fat type influences not only the fatty acid composition of rat pancreatic membranes but also the responsiveness of acinar cells to ACh. This mechanism may be, at least in part, responsible for the adaptation of the exocrine pancreas to the type of fat available.

Effect of the type of dietary fat on biliary lipid composition and bile lithogenicity in humans with cholesterol gallstone disease.

OBJECTIVE: The effect of the type of dietary fat on bile lipids and lithogenicity is unclear. This study compared the effects of two dietary oils that differed in fatty acid profile on biliary lipid composition in humans. METHODS: Female patients who had cholesterol gallstones and were scheduled for elective cholecystectomy were studied. For 30 d before surgery, subjects were kept on diets that contained olive oil (olive oil group, n = 9) or sunflower oil (sunflower oil group, n = 9) as the main source of fat. Gallbladder bile and stones were sampled at surgery. After cholecystectomy, duodenal samples were collected by nasoduodenal intubation during fasting and after administration of mixed liquid meals that included the corresponding dietary oil. Duodenal and gallbladder bile samples were analyzed for cholesterol, phospholipids, and total bile acids by established methods. Individual bile acid conjugates in gallbladder bile were measured by high-performance liquid chromatography. Gallstones were analyzed by semiquantitative polarizing light microscopy. RESULTS: Despite marked differences in the absolute concentration of biliary lipids and total lipid content, manipulation of dietary fat ingestion did not influence the cholesterol saturation or the profile of individual bile acids in gallbladder bile obtained from patients who had gallstones. All but one subject had mixed cholesterol stones. A cholesterol saturation index of hepatic bile in fasted cholecystectomized patients was similar in both dietary groups and indicative of supersaturation. In response to the test meal, the cholesterol saturation index decreased significantly in patients given the olive oil diet, reaching values lower than one at 120 min postprandially. In contrast, hepatic bile secreted by patients who consumed sunflower oil appeared supersaturated (cholesterol saturation index >1.5) throughout the experiment. CONCLUSIONS: Our results suggest that the type of dietary fat habitually consumed can influence bile composition in humans. In gallbladder, this influence was noted in the presence of more concentrated bile in the olive oil group. However, this was not translated into a modification of cholesterol saturation, which is likely due to the fact that cholesterol gallstones were present by the time the dietary intervention started. The finding that a typical postprandial variation in hepatic bile lithogenicity occurred only in olive oil patients was revealing. While keeping in mind the methodologic limitations of this part of the study, some gastrointestinal and metabolic mechanisms for this effect are discussed.

Dietary virgin olive oil enhances secretagogue-evoked calcium signaling in rat pancreatic acinar cells.

OBJECTIVE: We evaluated the long-term effects of a fat-enriched diet (virgin olive oil) on calcium mobilization and amylase secretion induced by cholecystokinin-octapeptide (CCK-8) in rat pancreatic acinar cells. Olive oil is a major component of the Mediterranean diet, and its role in human health is actively being debated. METHODS: Weaning male Wistar rats (21 d old) were assigned to one of two experimental groups and fed for 8 wk with a commercial chow (control group) or an experimental diet (olive group) containing 100 g/kg of virgin olive oil as dietary fat. Intracellular free calcium [Ca(2+)](i) levels were determined by loading the pancreatic cells with the fluorescent ratio-metric calcium indicator Fura-2 on an inverted fluorescent microscope. For measurement of amylase secretion, cells were incubated with the appropriate secretagogue for 30 min, and amylase activities in the supernatant were determined by the Phadebas blue starch method. Analysis of variance was used to test differences between groups. RESULTS: Compared with the control group, the CCK-8-induced increase in [Ca(2+)](i) occurred in cells from rats in the olive group (P < 0.05). This stimulatory effect of dietary virgin olive oil was observed in calcium oscillations and large [Ca(2+)](i) transients induced by low (20 pM/L) and high (10 nM/L) concentrations of CCK-8, respectively. In addition to the effects of dietary virgin olive oil on calcium mobilization, it increased (P < 0.05) amylase secretion in response to CCK-8. Olive oil treatment did not significantly alter resting [Ca(2+)](i) or amylase release values compared with the control group. Similar results were obtained when pancreatic acinar cells were stimulated with a high concentration of acetylcholine (10 microM/L). CONCLUSION: The present results demonstrate that a diet supplemented with virgin olive oil can modify pancreatic cell function as assessed by [Ca(2+)](i) mobilization and amylase release evoked by secretagogues in rat pancreatic acinar cells. A role for fatty acids in calcium signaling is suggested.

Dietary-induced changes in the fatty acid profile of rat pancreatic membranes are associated with modifications in acinar cell function and signalling.

The effects of dietary lipids on the fatty acid composition of rat pancreatic membranes and acinar cell function were investigated. Weaning rats were fed for 8 weeks on one of two diets which contained 100 g virgin olive oil (OO) or sunflower-seed oil (SO)/kg. Pancreatic plasma membranes were isolated and fatty acids determined. Amylase secretion and cytosolic concentrations of Ca(2+) and Mg(2+) were measured in pancreatic acini. Membrane fatty acids were profoundly affected by the diets; the rats fed OO had higher levels of 18 : 1n-9 (42.86 (sem 1.99) %) and total MUFA compared with the animals fed SO (25.37 (sem 1.11) %). Reciprocally, the SO diet resulted in greater levels of total and n-6 PUFA than the OO diet. The most striking effect was observed for 18 : 2n-6 (SO 17.88 (sem 1.32) %; OO 4.45 (sem 0.60) %), although the levels of 20 : 4n-6 were also different. The proportion of total saturated fatty acids was similar in both groups, and there was only a slight, not significant (P=0.098), effect on the unsaturation index. Compared with the OO group, acinar cells from the rats fed SO secreted more amylase at rest but less in response to cholecystokinin octapeptide, and this was paralleled by reduced Ca(2+) responses to the secretagogue. The results confirm that rat pancreatic cell membranes are strongly influenced by the type of dietary fat consumed and this is accompanied by a modulation of the secretory activity of pancreatic acinar cells that involves, at least in part, Ca(2+) signalling.

Comparison of the effects of dietary sunflower oil and virgin olive oil on rat exocrine pancreatic secretion in vivo.

The aim of this study was to investigate the functional consequences in vivo of adapting the rat exocrine pancreas to different dietary fats. Weanling rats were fed diets containing 10 wt% virgin olive oil or sunflower oil for 8 wk. We then examined resting and cholecystokinin-octapeptide (CCK-8)-stimulated pancreatic secretion in the anesthetized animals. To confirm a direct influence of the type of fat upon the gland, the FA composition of pancreatic membranes as well as tissue protein and amylase content were determined in separate rats. The membrane FA profile was profoundly altered by the diets, reflecting the type of dietary fat given, although this was not paralleled by variations in the pancreatic content of protein or amylase. Nevertheless, dietary intake of oils evoked different effects on in vivo secretory activity. Resting flow rate and amylase output were significantly (P < 0.05) enhanced by sunflower oil feeding. Time course changes in response to CCK-8 infusion also showed a different pattern in each group. Secretion of fluid, protein, and amylase increased markedly in all animals, reaching a maximum within 20-40 min of infusion that was followed by a dramatic decline in both groups. In the sunflower oil group, this resulted in values reaching the resting level as soon as 60 min after CCK-8 infusion was begun. However, after the initial decline, olive oil group values showed a prolonged plateau elevation above the baseline (P < 0.05) that was maintained for at least the infusion time. In addition, a positive correlation between flow rate and both protein concentration and amylase activity existed in the olive oil group, but not in the sunflower oil group. The precise mechanism by which these effects are produced remains to be elucidated.

Effect of sodium nitroprusside and 8-bromo cyclic GMP on nerve-mediated and acetylcholine-evoked secretory responses in the rat pancreas.

The effects of sodium nitroprusside (SNP) and 8-bromo-guanosine 3'5' cyclic monophosphate (8-Br-cyclic GMP) on nerve-mediated and acetylcholine (ACh)-evoked amylase secretion, tritiated choline ([3H]-choline) release and on intracellular free calcium concentration ([Ca2+]i) in the isolated rat pancreas were investigated. Electrical field stimulation (EFS; 10 Hz) and ACh (1 x 10(-5) M) caused large increases in amylase output from pancreatic segments. The response to ACh was blocked by atropine (1 x 10(-5) M) whereas the EFS-evoked response was markedly reduced but not abolished. In contrast, pretreatment with tetrodotoxin (1 x 10(-6) M) abolished the secretory effect of EFS. Either SNP (1 x 10(-3) M) or 8-Br-cyclic GMP (1 x 10(-4) M) inhibited amylase secretion compared to basal. Combining either SNP or 8-Br-cyclic GMP with EFS resulted in a marked decrease in amylase output compared to EFS alone. In contrast, either SNP or 8-Br-cyclic GMP had no significant effect on the amylase response to ACh. When extracellular Ca2+ concentration ([Ca2+]o) was elevated from 2.56 mM to 5.12 mM, SNP failed to inhibit the response to EFS. EFS stimulated the release of 3H from pancreatic segments preloaded with [3H]-choline. Either SNP or 8-Br-cyclic GMP had no effect on basal 3H release but significantly reduced the EFS-evoked response. In fura-2 loaded acinar cells, SNP elicited a small decrease in [Ca2+]i compared to basal and had no effect on the ACh-induced [Ca2+]i peak response. Nitric oxide may modulate the release of endogenous neural ACh in response to EFS in the rat pancreas.

Distribution of Nitric Oxide Synthase and Secretory Role of Exogenous Nitric Oxide in the Isolated Rat Pancreas.

Exocrine pancreatic secretion is controlled for themost part by the autonomic neurons and by I and Stype enteroendocrine cells (1). In addition to the classic neurotransmitters and various neuropeptides that are apparently produced and stored in the pancreaticnerve cells (2), there is morphological evidencethat nitric oxide (NO) containing (nitrergic) nervesare also present in the pancreas (3). Nitric oxide synthase(NOS) containing perikarya and fibers havebeen shown in the pancreas of several species usingenzymehistochemical and immunohistochemicalmethods (4). In the present study the nitrergic nervesof the rat pancreas were demonstrated by NOSimmunohistochemistry.