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Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging.

ABSTRACT: BACKGROUND:Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence. METHODS:An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions. KEY RESULTS:Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents. CONCLUSION AND INFERENCES:Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.

SUBMITTER: Barba E

PROVIDER: S-EPMC6899808 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging.

Barba Elizabeth E Sánchez Borja B Burri Emanuel E Accarino Anna A Monclus Eva E Navazo Isabel I Guarner Francisco F Margolles Abelardo A Azpiroz Fernando F

Neurogastroenterology and motility 20190811 12

<h4>Background</h4>Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.<h4>Methods</h4>An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative ...[more]

PMID: 31402544

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Project description:The enteric nervous system (ENS) regulates the motor, secretory and defensive functions of the gastrointestinal tract. Enteric neurons integrate mechanical and chemical inputs from the gut lumen to generate complex motor outputs. How intact enteric neural circuits respond to changes in the gut lumen is not well understood. We recorded intracellular calcium in live-cell confocal recordings in neurons from intact segments of mouse intestine in order to investigate neuronal response to luminal mechanical and chemical stimuli. Wnt1-, ChAT- and Calb1-GCaMP6 mice were used to record neurons from the jejunum and colon. We measured neuronal calcium response to KCl (75 mM), veratridine (10 μM), 1,1-dimethyl-4-phenylpiperazinium (DMPP; 100 μM) or luminal nutrients (Ensure®), in the presence or absence of intraluminal distension. In the jejunum and colon, distension generated by the presence of luminal content (chyme and faecal pellets, respectively) renders the underlying enteric circuit unresponsive to depolarizing stimuli. In the distal colon, high levels of distension inhibit neuronal response to KCl, while intermediate levels of distension reorganize Ca2+ response in circumferentially propagating slow waves. Mechanosensitive channel inhibition suppresses distension-induced Ca2+ elevations, and calcium-activated potassium channel inhibition restores neuronal response to KCl, but not DMPP in the distended colon. In the jejunum, distension prevents a previously unknown tetrodotoxin-resistant neuronal response to luminal nutrient stimulation. Our results demonstrate that intestinal distension regulates the excitability of ENS circuits via mechanosensitive channels. Physiological levels of distension locally silence or synchronize neurons, dynamically regulating the excitability of enteric neural circuits based on the content of the intestinal lumen. KEY POINTS: How the enteric nervous system of the gastrointestinal tract responds to luminal distension remains to be fully elucidated. Here it is shown that intestinal distension modifies intracellular calcium levels in the underlying enteric neuronal network, locally and reversibly silencing neurons in the distended regions. In the distal colon, luminal distension is integrated by specific mechanosensitive channels and coordinates the dynamics of neuronal activation within the enteric network. In the jejunum, distension suppresses the neuronal calcium responses induced by luminal nutrients. Physiological levels of distension dynamically regulate the excitability of enteric neuronal circuits.

Project description:UnlabelledIntestinal gas is a frequent cause of poor visualization during gastrointestinal ultrasound (US). The enzyme alpha-galactosidase may reduce intestinal gas production, thereby improving abdominal US visualization. We compared the efficacies of alpha-galactosidase and active charcoal in improving US visualization in patients with previous unsatisfactory abdominal US scans caused by excessive intestinal gas.Materials and methods45 patients with poor visualization of at least one target organ: pancreas, hepatic lobes (score 0-2) or common bile duct (CBD) (score 0-1) were enrolled in a prospective randomized, crossover, observer-blinded study. The patients received alpha-galactosidase (Sinaire Forte, Promefarm, Milan, Italy) 600 GalU t.i.d. for 2 days before abdominal US plus 900 GalU the morning of exam or active charcoal 448 mg t.i.d., for 2 days before the exam plus 672 mg the morning of the exam. Visualization was graded as follows: 0 = none (complete gas interference); 1 = severe interference, 2 = moderate interference, 3 = mild interference; 4 = complete (no gas interference).Results42 patients completed the study. Both alpha-galactosidase and active charcoal improved the visualization of target organs. Visualization of the right hepatic lobe, CBD and pancreatic tail was significantly improved (vs. baseline) only by alpha-galactosidase (p < 0.01). Scores ≥3 for all parts of the pancreas and both hepatic lobes were achieved in only 12.5% of the patients after both treatments. Both products were well tolerated.ConclusionAlpha-galactosidase and active charcoal can improve US visualization of abdominal organs in patients whose scans are frequently unsatisfactory due to excessive intestinal gas. Visualization of the pancreatic tail and right hepatic lobe was significantly improved only by alpha-galactosidase. However, both treatments allowed adequate visualization of all target organs during the same examination only in a few patients.

Project description:BackgroundAbdominal lymph node partition is highly relevant to colorectal cancer (CRC) metastasis, which may further affect patient prognosis and survival quality. In the traditional diagnostic process, medical radiologists must partition all lymph nodes from the computed tomography (CT) images for further diagnostics. The manual interpretation of abdominal nodes is experience-dependent and time-consuming, especially for node partition. Therefore, automated partition methods are desirable to make the diagnostic process more accessible. Automatic abdominal lymph node partition is a challenging task due to the subtle morphological features of the nodes and the complex relative position information of the abdominal structure.MethodsIn this paper, a node-oriented dataset containing 6,880 nodes with partition labels was constructed by seasoned professionals through 2-round annotation due to there being no dataset with node-oriented labels to perform the partition task. In addition, specific masking strategies and attention mechanisms were proposed for the primary deep neural networks (DNNs). The specific masking strategy could utilize the positional and morphological information more substantially, which intensively exploits prior knowledge and hones the relative positional information in the lower abdomen. The comprehensive attention mechanism could introduce direction-aware information to enhance the inter-channel relationship of features and capture rich contextual relationships with multi-scale kernels.ResultsThe experiments were based on the node-oriented dataset. The proposed method achieved superior performance [accuracy (ACC): 89.74%; F1 score (F1): 85.95%; area under the curve (AUC): 88.23%], which is significantly higher than the baseline model with several masking strategies (ACC: 62.05-86.16%; F1: 51.77-80.86%; AUC: 60.44-83.94%). For exploration of attention, the proposed method also outperformed the state-of-the-art convolutional block attention module (CBAM; ACC: 88.90%; F1: 84.09%; AUC: 86.86%) with the same proposed input form.ConclusionsExperimental results indicate that the innovative method performs better in experimental metrics than other prevalent methods. The proposed method is expected to be introduced in future medical scenarios, which will help doctors to optimize the diagnosis workflow and improve partition sensitivity.

Dataset Information

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging.

Publications

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging.

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