Efficacy, safety, and tolerability of fructooligosaccharides in the treatment of irritable bowel syndrome.

BACKGROUND: Interest in fructooligosaccharides as a health-promoting food component is increasing. Fructooligosaccharides are mainly indigestible and large amounts in the colon may provoke gastrointestinal symptoms. OBJECTIVE: The symptoms of irritable bowel syndrome (IBS) may be provoked by large quantities of carbohydrates in the colon. The objective of this study was to determine whether regular consumption of fructooligosaccharides worsens gastrointestinal symptoms in patients with IBS. DESIGN: A multicenter, prospective, randomized, double-blind, placebo-controlled parallel group comparison was conducted at 24 sites. The study consisted of a 2-wk, single-blind run-in phase and a 12-wk, double-blind comparative phase. Subjects were randomly assigned to receive 20 g fructooligosaccharides powder/d (n = 52) or a placebo (n = 46). Efficacy was based on the patients' overall response to treatment at completion of the study and on the severity and duration of individual symptoms (abdominal distension, abdominal rumbling, abnormal flatulence, and abdominal pain). RESULTS: Data from 96 patients (16 men and 80 women) were analyzed. After 4-6 wk of treatment, IBS symptoms improved more in the placebo group than in the fructooligosaccharide group. After completion of the study, there were no significant differences between the 2 groups: symptoms improved in 58% of the fructooligosaccharide group and in 65% of the placebo group and symptoms worsened in 8% of the fructooligosaccharide group and in 13% of the placebo group. CONCLUSION: Although symptoms worsened in patients with IBS at the onset of treatment with 20 g fructooligosaccharides/d, continuous treatment for 12 wk resulted in no worsening of symptoms.

Importance of colonic bacterial fermentation in short bowel patients: small intestinal malabsorption of easily digestible carbohydrate.

The small intestine's large capacity for glucose absorption and for adaptation seems to contradict the reported importance of carbohydrate malabsorption in short bowel (SB) patients. The aim of the present study was to investigate the occurrence of malabsorption in these patients ingesting realistic amounts of carbohydrates. We performed a dose-response study [ingestion of increasing amounts of glucose and complex carbohydrates (boiled rice and wheat bread), and the nonabsorbable disaccharide lactulose] in SB patients with an intact colon. The hydrogen (H2) -breath test and changes in serum acetate were used to evaluate colonic fermentation and, thus, indirectly, the lack of small intestinal carbohydrate assimilation. Blood glucose and plasma insulin were measured to evaluate absorption. Plasma concentrations of the ileal brake hormones--glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY)--were measured to test whether release of these hormones was related to colonic fermentation. Significant amounts of 25 g and 50 g glucose, and of the bread and rice meals were fermented rather than absorbed, as judged by the increases in end-expiratory H2. Serum acetate concentrations were significantly higher in SB patients than in healthy controls. The orocecal transit times of all test meals ranged from 15 to 120 min. GLP-1 and PYY releases in SB patients were significantly higher than in healthy volunteers. They were mutually parallel and paralleled the increase in insulin. They were not related to ongoing fermentation or to intraluminal carbohydrate content per se, but most probably to absorption of glucose in the distal bowel. In conclusion, well-adapted SB patients had pronounced small intestinal malabsorption of carbohydrate, even after ingestion of small amounts of easily absorbable carbohydrates. A fast small intestinal spreading of carbohydrates, once in the small intestine, and a spill-over to the colon seem to explain the data best.

Fructans of chicory: intestinal transport and fermentation of different chain lengths and relation to fructose and sorbitol malabsorption.

Fructans (fructooligosaccharides and inulin) are of increasing interest to clinical nutritionists as functional food additives. The chemically closely related food carbohydrates fructose and sorbitol are implicated in functional bowel disease. Intestinal handling of these carbohydrates is incompletely understood. Intestinal absorption, transit, and fermentation (breath hydrogen and methane, venous acetate, blood glucose, and urine fructans) after ingestion of 10-30 g short- and long-chain fructans from chicory were studied by single-blind, crossover randomization in 10 healthy adults. Responses were compared with responses after ingestion of lactulose, fructose, and sorbitol. Breath hydrogen and venous acetate production increased in proportion to increasing fructan dose and were similar to responses to lactulose. The transit times of long-chain fructans were longer than those of short-chain fructans (75 compared with 30 min, P<0.001). Semiquantitative estimates of unabsorbed carbohydrate were not significantly different with either short-chain fructans or lactulose as nonabsorbable standards. Venous acetate curves were less precise estimates of the magnitude of carbohydrate malabsorption than were breath-hydrogen curves (P<0.01). All subjects showed malabsorption of 50 g fructose, resulting in significantly more symptoms than 20 g fructose (P<0.05). Ingestion of sorbitol with equimolar amounts of glucose did not reduce malabsorption or abdominal distress. Abdominal symptoms after fructans increased with increasing dose and decreasing chain length. The overall gastrointestinal effects of short-chain fructans seem similar to those of lactulose. Fructans with different chain lengths may have different physiologic properties and further studies of fructans in disease states are warranted.

[Incidence and prevalence of symptomatic celiac disease among adults in Denmark]. / Incidens og praevalens af symptomgivende cøliaki blandt voksne i Danmark.

The purpose was: 1) to determine annual incidence rates of adult coeliac disease, 2) to calculate the risk of having developed coeliac disease in adult life, and 3) to calculate the life time prevalence by five-year birth cohorts. All patients fulfilling defined criteria for adult coeliac disease living in the county of Copenhagen and diagnosed during the years 1976-1991 were included. The reference population consisted of 503,283 subjects. The overall incidence had been stable during the period, and was 1.27/10(5). The figures for females and males were 1.55/10(5) and 0.96/10(5), respectively (p = 0.04). The median (range) age at the time of diagnosis was 40.1 (16-81). Age specific incidence rates varied considerably, with the peak rate located in the middle-aged population. The incidence rates were influenced by age at diagnosis (p = 0.01) and sex (p = 0.04), but not by the year when diagnosed. For a subject aged 89 years, the risk was 0.88/1000. The overall prevalence was 45.9/10(5). In conclusion, this incidence/prevalence is one of the lowest reported, and is definitely lower than prevalences reported from our neighbouring Scandinavian countries. Nothing points to higher incidence rates being present in Danish adults to compensate for the previously demonstrated very low rates in Danish children.

Fermentability of an enzymatically modified solubilised potato polysaccharide (SPP).

OBJECTIVE: To study processing and fermentability in the human gastro-intestinal tract of a newly isolated, enzymatically modified, soluble, and highly concentrated (> 80% dietary fibres) solubilised potato fibre (SPP). SETTING: Gastroenterological laboratory. DESIGN, SUBJECTS AND INTERVENTIONS: Seven healthy volunteers ingested in random order on seven different days: 20 g SPP; bread made of 180 g wheat flour served with 20 g raw SPP; bread baked of 180 g wheat flour and 20 g SPP; bread made from 180 g what flour; 20 g lactulose; 20 g oat bran; and 20 g wheat bran. The hydrogen breath test was used to evaluate oro-coecal transit time (OCTT) and fermentation. RESULTS: Fermentation of SPP yielded a measurable increase in end-expiratory H2. The total incremental increase in end expiratory H2 due to SPP was unaffected of whether SPP was served alone, as the raw flour served with bread, or baked into bread. The OCTT for raw SPP was significantly delayed compared to lactulose (P = 0.01). The OCTT for SPP baked into bread was significantly delayed compared to raw SPP (P = 0.01), indicating that SPP may be used as a marker of oro-coecal transit time for as well the fluid phase as the solid phase of a meal. CONCLUSIONS: SPP is a fermentable, highly concentrated soluble fibre source. Baking SPP did not interfere with the fermentable properties. Thus, SPP may be interesting as a fibre-supplement in fibre-poor diets. The change in oro-coecal transit time for SPP, depending on the composition of the total meal, makes SPP interesting as a marker in studies of gastrointestinal transit.

Maldigestion and colonic fermentation of wheat bread in humans and the influence of dietary fat.

A fraction of wheat bread is malabsorbed in healthy humans. The malabsorbed fraction is bigger than what can be accounted for by in vitro measurements of dietary fibers and resistant starch. To determine whether it is a specific fraction defined by the structure of the starch molecule or a variable amount--which depends on the individual, the amount ingested, and other components of the meal--we performed a dose-response study on wheat bread in healthy human volunteers. Malabsorption was evaluated by using the breath-hydrogen test. Test meals were as follows: 20 g wheat bran mixed in 100 mL water; bread made from 25, 75, 100, 150, and 200 g white wheat flour (WWF); bread made from 0 g WWF and 20 g wheat bran; and bread made from 100 g WWF served with 11 or 26 g butter, corresponding to 20% or 35% of energy from fat in the meals. Three of seven volunteers malabsorbed a fraction of the bread made from 25 g WWF and five of seven a fraction of the bread made from 75 g WWF. All volunteers malabsorbed a fraction of the 100-g WWF bread, Bread made from 180 g WWF and 20 g wheat bran resulted in a breath-hydrogen response of the same magnitude as that from bread made from 200 g WWF alone. The 100-g WWF bread + 11 g butter resulted in a significantly higher breath-hydrogen response than did the bread alone, whereas the 100-g WWF bread + 26 g butter resulted in an average response of the same magnitude as that from bread alone. We conclude that the malabsorbed fraction of wheat bread was dependent on the amount ingested, the composition of the meal, and individual gastrointestinal handling. Fermentation of wheat bran resulted in a very low breath-hydrogen response compared with lactulose or wheat bread. Addition of 11 g butter to the bread seemed to increase the malabsorbed fraction of the starch, an effect that was abolished when the amount of butter was increased to 26 g.

Peptic ulcer in Greenland Inuit: evidence for a low prevalence of duodenal ulcer.

UNLABELLED: In an eight years period new peptic ulcer was diagnosed in 127 Inuit patients at the Central Hospital, Dronning Ingrids Hospital, Nuuk/Godthåb. The ratios: duodenal ulcers (DU): prepyloric ulcers (PPU): gastric ulcers (GU) were 17:22:88. The male:female ratio was 2:1. 46 of the patients were living permanently in Nuuk, 81 in The Districts. There were no significant differences in the type of ulcers among the two groups. The incidence of GU among the Nuuk population was comparable to the incidence in the Danish population (0.63/1000 inhabitants per year), whereas the mean age at the time of diagnosis was only 45 years, thus the patients were approximately 15 years younger than the Danish counterparts. The incidence of DU among the Inuits was 0.15/1000 inhabitants per year, significantly less than in the Danish population. The frequency of Helicobacter (H.) pylori infection among 56 Inuits with dyspeptic symptoms was: 0.61. Only 6/12 patients suffering from DU had a positive test for H. pylori infection. CONCLUSIONS: The incidence of duodenal ulcers in the Inuit population was only 10% of the incidence in a Danish population, whereas the incidence of gastric ulcers among the Inuits was comparable to the incidence among Danes. Only 50% of Inuit patients with proven DU had a positive test for H. pylori infection, whereas the frequency of H.pylori infection in a population with dyspeptic symptoms corresponded very well to the frequency reported from other populations.

Incidence and prevalence of adult coeliac disease within a defined geographic area in Denmark.

BACKGROUND: In childhood coeliac disease highly varying incidence rates have recently been disclosed. Very low incidence rates (0.09/1000) were found in Denmark, in contrast to our neighbouring country Sweden (2.93/1000). Whether this was accounted for by the diagnosis being delayed until adult life was unknown. No studies concerning the epidemiology of adult coeliac disease in Denmark have been published so far. METHODS: The annual incidence rates of adult coeliac disease were determined in the county of Copenhagen during the years 1976-91. The risk of having developed coeliac disease in adult life, on the basis of age and sex, was calculated. The life time prevalences by 5-year birth cohorts were calculated. RESULTS: The overall incidence had been stable during the period and was 1.27/10(5). The figures for females and males were 1.55/10(5) and 0.96/10(5), respectively (p = 0.04). The median (range) age at the time of diagnosis was 40.1 (16-81) years. Age-specific incidence rates varied considerably, with the peak rate located in the middle-aged population. Low incidence rates were demonstrated in teenagers and young adults, and increasing rates was seen again in old age. The incidence rates were influenced by age at diagnosis (p = 0.01) and sex (p = 0.04) but not by the year when diagnosed. For a subject aged 89 years the risk was 0.88/1000. The corresponding figures for males and females, were 0.75/1000 and 1.0/1000, respectively. The overall prevalence was 45.9/10(5); males and females, 35.3/10(5) and 55.8/410(5), respectively. CONCLUSION: This incidence/prevalence is one of the lowest reported and is definitely lower than prevalences reported in our neighbouring Scandinavian countries. Nothing points to higher incidence rates being present in Danish adults to compensate for the previously demonstrated very low rates in Danish children.

Disaccharide digestion and maldigestion.

All food carbohydrates are hydrolysed to monosaccharides before transport across the microvillus membrane. The digestion of disaccharides and some oligosaccharides is undertaken by a number of small intestinal brush border enzymes: sucrase-isomaltase, lactase phlorizinhydrolase, maltase-glycoamylase and trehalase. The distribution of the enzymes in the small intestine has been investigated. Different disaccharide maldigestion syndromes have been described. Lactase deficiency in adults is a condition found in the majority of inhabitants of the world. However, the prevalence varies widely between different populations. Sucrase-isomaltase deficiency is a very rare congenital condition except in Greenland. Trehalose maldigestion is likewise rare outside Greenland. Different hypotheses regarding the molecular background of the maldigestion syndromes are discussed.

Symptoms and haematologic features in consecutive adult coeliac patients.

BACKGROUND: The aim of this study was to determine in a homogeneous adult population from Denmark, which is known to have very low incidence rates of coeliac disease, 1) the percentage of patients presenting with mild or atypical symptoms; 2) a possible change in clinical pattern over time; and 3) the delay in diagnosis and the age and sex distribution. METHODS: The symptoms, delay in diagnosis, age, sex, and haematologic features of 50 consecutive adult coeliac patients, diagnosed by the same person in a uniform manner, are presented. RESULTS: The median age was 40.5 (range, 17-82) years. The male to female sex ratio was 1:2.8. The median delay in diagnosis was 3 years. Fifty-eight per cent reported symptoms that could be attributed to coeliac disease during childhood. Presenting symptoms were tiredness, 78%; borborygmus, 72%; abdominal pain, 64%; diarrhoea, 56%; weight loss, 44%; vomiting, 16%; constipation, 12%; bone pain, 12%; and dermatitis herpetiformis, 10%. Weight gain after treatment was experienced by 84%. As a group the coeliac patients had many abnormal blood analysis results, but many patients had several test results inside the normal range. Only 22% had anemia. Liver involvement was not an uncommon feature (19% had increased transaminase levels). Low values were registered in s-iron (32%), p-folate (49%), c-folate (35%), p-vitamin B12 (11%), p-coagulation factors (II, VII, X) (32%), s-protein (21%), s-albumin (26%), s-calcium (43%), p-magnesium (13%), and s-zinc (31%). High/low IgG levels were 3%/8%; high, IgA 21%; high/low IgM, 65%/14%; and high IgE, 71%. The gliadin antibody test was the best screening test (81% positive). No changes in clinical pattern were demonstrated during the period. CONCLUSION: The percentage of patients presenting with anaemia (22%) and other haematologic signs of malabsorption was one of the lowest reported ever. This emphasizes the highly variable and subtle clinical expression of adult coeliac disease.

Breath hydrogen analysis in patients with ileoanal pouch anastomosis.

The possible influence on functional outcomes of hydrogen production in the ileoanal pouch after restorative proctocolectomy was investigated by means of lactulose H2 breath tests. Eight of 15 patients had significant increases in breath hydrogen after 10 g lactulose. One patient declined to participate in further investigations, the remaining seven responders had no evidence of small bowel bacterial overgrowth after glucose H2 breath tests. The ability to produce hydrogen by anaerobic fermentation of lactulose in the pouch was unrelated to the age of the patients or of the pouch. Seven of eight responders had successive breath tests after ingestion of lactulose 20 g and wheat starch 100 g. Five of seven had significant increases after lactulose but none after wheat starch. The overall function of the pouch continence, spontaneity of defecation, and 24 hour stool frequency was significantly better in responders than in non-responders. The absence of H2 production of 100 g wheat starch may indicate either increased absorption or defective fermentation.

[The effect on health of dietary antioxidants and antioxidant supplements]. / Den sundhedsmaessige betydning af antioxidanter i levnedsmidler og som kosttilskud.

Reactive free oxygen radicals are formed in the reactions involved in normal cell metabolism. This formation is closely regulated e.g. by dietary antioxidants. Present knowledge suggests that an imbalance, with surplus of free radicals, can play a role in the pathogenesis of certain types of cancer, atherosclerosis, and cataract. A number of epidemiological studies have demonstrated a reduced risk of developing these diseases in persons who consume a diet with a high content of vegetables and fruit, which contains large quantities of the antioxidants: beta-carotene, vitamins C and E. Intervention studies, using supplements of these antioxidants, have so far not been able to show a beneficial effect. The apparently protective effect of fruit and vegetables may be due to other active ingredients. In Denmark the average intake of vegetables and fruit is low, and it is estimated that an increased consumption of these foods could reduce the occurrence of certain cancer types and atherosclerosis. In contrast, there is no evidence that antioxidant supplements would provide protection against disease, and their safety remains to be established.

Intestinal transport and fermentation of resistant starch evaluated by the hydrogen breath test.

OBJECTIVE: To study fermentability of different samples of resistant starch (RS), compared to one another and to lactulose, and to study the effect on gastric emptying of addition of RS to test meal. Finally to study if adaptation to RS results in a measurable change in fermentation pattern, (H2/CH4 production). Sources of RS: Raw potato starch (RPS), 58% RS; corn flakes (CF), 5% RS; hylon VII high amylomaize starch, extrusion cooked and cooled (HAS) 30% RS; highly retrograded hylon VII high amylomaize starch (HRA) 89% RS. DESIGN: (1) Fermentation: seven healthy volunteers ingested in randomized order 50 g RPS, 100 g CF, 75 g HAS, 25 g HRA. End-expiratory H2/CH4 was measured every 30 min for 12 to 22 hours post-ingestion as a measure of fermentation. A dose-response study of RPS, 5, 10, 25, 50, 75 and 100 g was performed. (2) Adaptation: In five 3-week periods seven volunteers added daily to their usual diet 50 g of either RPS, HAS, oat bran, wheat bran or common maize starch. The polysaccharides were administered in randomized order. The test periods were separated by 1 week's wash out. Basic end-expiratory H2/CH4 was measured once a week prior to and during the test periods. (3) Gastric emptying: The rate of increase in blood glucose was measured after test meals consisting of 50 and 100 g of RPS, 50 g HAS and 50 g glucose dissolved in a gel, alone, and mixed with 25 g of RPS. As controls we chose wheat bran and oat bran. RESULTS: (1) We found that RPS is fermentable, although the cumulated excessive H2 production after 50 g RPS corresponding to 29 g RS was clearly less than after 10 g lactulose. The time from ingestion of RPS to a sustained increase in end-expiratory H2 (apparent transit time; 5-11 h) was longer than lactulose (1-4 h), indicating either a slow passage through the small intestine or a slow fermentation rate. 100 g of corn flakes (4.6 g RS) resulted in a measurable increase in H2 production, equivalent to 10-20 g RPS, whereas neither of the two samples of hylon VII high amylomaize resulted in any significant increase in H2 production. The dose-response study with RPS showed that even 5 g of RPS resulted in a measurable increase in end-expiratory H2, and increasing doses from 5 g to 100 g resulted in a seemingly exponential increase in H2 production. (2) 3 weeks' daily administration of HAS resulted in a slightly elevated increase in basic end-expiratory H2, although the increase did not reach statistical significance. RPS resulted in a sustained increase in basic end-expiratory H2. Both RS samples increased measurable end-expiratory CH4 in volunteers with measurable CH4 production after a lactulose load, but 3 weeks' daily challenge with these slowly fermentable substrates did not increase measurable CH4 in volunteers, who prior to the study only produced CH4 intermittently. (3) The rate of increase in blood sugar was unaffected by addition of RS or non-starch-polysaccharides to the test meal, indicating that addition of the polysaccharides does not affect gastric emptying. CONCLUSIONS: A fraction of RPS is resistant to digestion in the small intestine, and it is fermentable by the colonic microbial flora. RS from CF, HAS and RPS give very different H2 responses, either due to differences in digestion patterns or fermentation patterns. Short-term adaptation (3 weeks) to HAS or RPS does not change the H2/CH4 response. RS does not affect gastric emptying of a test meal consisting of glucose dissolved in a gel.

Carbohydrate malabsorption: quantification by methane and hydrogen breath tests.

BACKGROUND: Previous studies in small series of healthy adults have suggested that parallel measurement of hydrogen and methane resulting from gut fermentation may improve the precision of quantitative estimates of carbohydrate malabsorption. Systematic, controlled studies of the role of simultaneous hydrogen and methane measurements using end-expiratory breath test techniques are not available. METHODS: We studied seven healthy, adult methane and hydrogen producers and seven methane non-producers by means of end-expiratory breath test techniques. Breath gas concentrations and gastrointestinal symptoms were recorded at intervals for 12h after ingestion of 10, 20 and 30 g lactulose. RESULTS: In the seven methane producers the excretion pattern was highly variable; the integrated methane responses were disproportional and not reliably reproducible. However, quantitative estimates of carbohydrate malabsorption on the basis of individual areas under the methane and hydrogen excretion curves (AUCs) tended to improve in methane producers after ingestion of 20 g lactulose by simple addition of AUCs of methane to the AUCs of the hydrogen curves. Estimates were no more precise in methane producers than similar estimates in non-producers. Gastrointestinal symptoms increased significantly with increasing lactulose dose; correlation with total hydrogen and methane excretion was weak. CONCLUSIONS: Our study suggests that in methane producers, simple addition of methane and hydrogen excretion improves the precision of semiquantitative measurements of carbohydrate malabsorption. The status of methane production should, therefore, be known to interpret breath tests semiquantitatively. The weak correlation between hydrogen and methane excretion and gas-related abdominal complaints suggests that other factors than net production of these gases may be responsible for the symptoms.

The clinical significance of disaccharide maldigestion.

The prevalence of lactose maldigestion is lowest in Scandinavia and Northwest Europe (3-8%) and close to 100% in most of Southeast Asia. In Europe the frequency increases in the southern and eastern directions, reaching 70% in southern Italy and Turkey. There is also a high prevalence of lactose maldigestion in the people of Africa with the exception of cattle-raising nomads. Lactose maldigestion causes uncharacteristic abdominal symptoms such as bloating, borborygmus, colic, flatulence, and diarrhea. The degree of discomfort depends on the amount of lactose consumed, but also on an individual sensitivity to lactose. The symptoms of irritable bowel syndrome (IBS) and lactose maldigestion are similar. Consequently, most investigations indicate an increased frequency of lactose maldigestion in patients suffering from IBS. Recurrent abdominal pain (RAP) in children corresponds to IBS in adults. Lactose maldigestion is a frequent cause of RAP in regions with a high prevalence of lactose maldigestion in early childhood. Diffuse small-intestinal damage in celiac disease or kwashiorkor leads to a proportional decrease of all disaccharidase activities, with the most pronounced being decrease of lactase. The consumption of milk may then cause abdominal discomfort and increased diarrhea. Several investigations have indicated an increased frequency of lactose maldigestion in patients with osteoporosis. A connection between lactose maldigestion and decreased absorption of calcium has not been proven, however. The increased tendency toward osteoporosis is more likely caused by a lower calcium intake because of milk intolerance. Milk and dairy products with reduced lactose content are better tolerated by patients with lactose maldigestion.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of the gliadin antibody test for diagnosing coeliac disease.

The purpose of this study was to evaluate the diagnostic value of gliadin antibodies (GA) in coeliac disease. The test was a diffusion in gel enzyme-linked immunosorbent assay (DIG-ELISA), with combined determination of IgA and IgG. The sensitivity, specificity, and positive and negative predictive value of the test were determined, as used on a well-described, consecutive material of 100 adult patients, admitted for small-intestinal biopsy. For comparison, the positive predictive value of the test, when used on a larger Danish patient material of adults and children, was determined. One hundred and eighteen adults and 55 children with increased or borderline GA were included. For adults the positive predictive value was 71-90%, the negative predictive value 97%, sensitivity 77%, and specificity 95%. For children the positive predictive value was 74%. A graded interpretation, improving the usefulness of the test, is proposed. It is concluded that GA are useful in screening for coeliac disease (CD). It is still necessary to perform at least one small-intestinal biopsy to establish the diagnosis. Highly elevated GA levels strongly indicate CD, whereas a result well below limits makes CD unlikely.

The diagnostic value of the gliadin antibody test in celiac disease in children: a prospective study.

Serum gliadin antibodies (IgA/IgG) were determined in 191 consecutive children (median age, 2.75 years; range, 0.33-15.5 years) admitted for a small-intestinal biopsy on suspicion of celiac disease. The test was a diffusion-in-gel enzyme-linked immunosorbent assay (DIG-ELISA). Of these 191, 14 (7.3%) appeared to have untreated celiac disease. Depending on the choice of cut-off value of the test (combined determination of IgA and IgG), the sensitivity was 86-100%, the specificity was 97-99%, and the positive/negative predictive values were 70-92% and 99-100%, respectively. No variation according to age was found. Gliadin antibodies were determined in 47 children who had well-treated celiac disease. Fourteen of these children were also investigated when challenged with gluten. Gliadin antibodies (IgA or IgG) decreased significantly in 13 of 13 cases when the patients shifted from a gluten-containing diet to a gluten-free one. During the gluten challenge, the IgG and IgA increased in 14 of 14 and 11 of 14 cases, respectively (two patients suffered from IgA deficiency). In eight patients who later appeared to be free of celiac disease, the gliadin antibodies were determined on gluten-free diet and during gluten challenge; no significant differences in gliadin antibodies were found. We conclude that this test is useful in selecting patients with symptoms suggesting celiac disease for a small-intestinal biopsy. The test seems to be of some value in monitoring the effects of a gluten-free diet and during gluten challenge.

[Dimethicone in lactulose-induced dyspepsia. Effect on H2 production and symptoms]. / Dimetikon ved laktuloseinduceret dyspepsi. Effekt på H2-produktion og symptomer.

The results of studies of the effect of simethicone on abdominal gas-related symptoms have been contradictory. In a randomized, double-blind, cross-over study, ten healthy volunteers were given 30 g lactulose and 600 mg simethicone or placebo. End-expiratory breath samples were collected and analyzed for H2, and gastrointestinal symptoms registered. There were no differences in biochemical parameters or symptom score between simethicone and placebo. In contrast to previous studies, we used a sufficiently large dose of lactulose to produce gastrointestinal symptoms, a higher dose of simethicone and placebo tablets containing the same additives as the simethicone tablets. There was no demonstrable effect of simethicone on symptoms or intestinal gas production caused by carbohydrate malabsorption.