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Small bowel transit of a bran meal residue in humans: sieving of solids from liquids and response to feeding.

ABSTRACT: BACKGROUND: Ileal motor patterns are adapted to the propulsion of viscous meal residue, such as bran, which accumulates in the distal ileum postprandially. AIMS: To examine the effects of a second liquid/solid meal on ileal emptying. SUBJECTS AND METHODS: Eleven healthy fasting subjects consumed a 1.47 MJ pancake containing 15 g bran and 5 MBq Technetium-99m labelled amberlite resin (meal A). Gastric emptying and transit through the left upper quadrant (proximal) and right lower quadrant (distal) small bowel regions and colon were assessed scintigraphically. Transit was compared with and without a second Indium-111 liquid/solid DTPA labelled 2.28 MJ meal (B) given three hours after the first meal. RESULTS: Gastric emptying of meal A was slower than meal B (the time for 50% of the activity to leave the stomach (T50) being 113 (11) minutes versus 48 (3) minutes respectively, p < 0.01, n = 11). Both meals passed rapidly through the proximal small bowel (T50 meal A = 57 (14) minutes versus T50 meal B = 42 (11) minutes). Transit of meal A through the distal small bowel was much slower (T50 more than 390 minutes versus 176 (29) minutes for meal B, p < 0.01), resulting in meal B overtaking meal A and entering the colon earlier. Ingestion of the second meal (B) resulted in significantly less meal A marker entering the colon (5 (3)%) at 11 hours than when meal A was taken alone (18 (4)%) (p < 0.05, n = 8). CONCLUSIONS: The distal small bowel selectively retains bran, allowing liquid phase markers through to the colon. Consuming a second liquid/solid meal does not stimulate ileal transit of bran which seems to be propelled quicker by fasting motor patterns.

SUBMITTER: Hebden JM

PROVIDER: S-EPMC1727089 | biostudies-other | 1998 May

REPOSITORIES: biostudies-other

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Project description:Abstract Background Small bowel capsule endoscopy (CE) has limited recording time and does not visualize the entire length of the small intestine in approximately 16.5% of the cases. We hypothesize that bacon-chewing is potent stimulus of cephalic response, which may reduce capsule transit times and improve complete examination rate (CER). Aims To determine if sham feeding with bacon-chewing improves small bowel transit time and completion rate in patients undergoing capsule endoscopy. Methods A prospective, single-blinded, randomized controlled trial at St. Paul’s Hospital in Vancouver, BC has been recruiting since 01/2015. Inclusion: outpatient CE, age ≥ 19. Exclusion criteria: ongoing use of motility-enhancing or slowing drugs, active bowel obstruction, bowel resection, swallowing disorder, diabetes with end-organ damage, untreated thyroid disorder, and endoscopic placement of capsule camera. Given Imaging PillCam SB3TM (Yoqneam, Israel) were used. Participants were assigned to either bacon or control group via concealed allocation based on unrestricted randomization sequence generated prior to study initiation. All subjects underwent bowel preparation with 2L PEG3350 with electrolytes the day before, and fasted ≥ 2h prior to the procedure. They were allowed to drink clear fluids and resume normal diet 2h and 4h post-capsule ingestion, respectively. Immediately after swallowing the capsule, subjects in the bacon group were asked to chew and spit 10 pieces of bacon, each over 30 seconds at one-minute intervals. This process was repeated an hour after ingesting the capsule. Gastric transit time (GTT), small bowel transit time (SBTT), and CER were compared between the groups. This study was approved by institutional research ethics board and registered on clinicaltrials.gov (NCT02353208). Results Between 01/2015 to 09/2016, 109 CE’s were included in the study, 89 of which were for GI bleeding. CE did not pass the pylorus in four patients in the bacon group during the recording, and were excluded from further transit time analyses. One and two additional CE’s in the control and bacon group, respectively, did not reach cecum during recording and were excluded from SBTT analysis. There was no statistically significant difference in GTT, SBTT, or CER. Conclusions Sham feeding by chewing and spitting bacon does not alter transit times or CER, and therefore should not be used in an attempt to improve CE yield. ResultsControl (n=54)Bacon (n=55)P valueAge (mean ± SD)57.2 ± 15.657.9 ± 17.50.83Female (%)30 (55.6%)30 (54.5%)0.92Charlson Comorbidity Index3.4 ± 2.43.3 ± 2.80.99GTT (minutes)mean ± SDmedian (IQR)41.4 ± 47.224.7 (13.9, 55.7)56.7 ± 126.517.2 (10.3, 68.6)0.20SBTT (minutes)mean ± SDmedian (IQR)230.0 ± 106.2217.6 (157.4, 282.3)223.1 ± 128.5198.5 (119.6, 294.8)0.38CER (%)53 (98.1%)49 (89.1%)0.054 Funding Agencies None

Project description:Disturbance of the gut microbiota is common in liver cirrhosis (LC) patients, the underlying mechanisms of which are yet to be unfolded. This study aims to explore the relationship between small bowel transit (SBT) and gut microbiota in LC patients. Cross-sectional design was applied with 36 LC patients and 20 healthy controls (HCs). The gut microbiota was characterized by 16S rRNA gene sequencing. The Firmicutes/Bacteroidetes (F/B) ratio and the Microbial Dysbiosis index (MDI) were used to evaluate the severity of microbiota dysbiosis. The scintigraphy method was performed in patients to describe the objective values of SBT. Patients were then subdivided according to the Child-Pugh score (threshold = 5) or SBT value (threshold = 0.6) for microbiota analysis. LC patients were characterized by an altered gut microbiota; F/B ratios and MDI were higher than HC in both Child_5 (14.00 ± 14.69 vs. 2.86 ± 0.99, p < 0.01; 0.49 ± 0.80 vs. -0.47 ± 0.69, p < 0.01) and Child_5+ (15.81 ± 15.11 vs. 2.86±0.99, p < 0.01; 1.11 ± 1.05 vs. -0.47 ± 0.69, p < 0.01) sub-groups in patients. Difference in the gut microbiota between Child_ 5 and Child_5+ patients was inappreciable, but the SBT was relatively slower in Child_5+ patients (43 ± 26% vs. 80 ± 15%, p < 0.05). Compared with the Child-Pugh score indicators, SBT showed stronger associations with bacterial genera. A clear difference in the gut microbiota was observed between SBT_0.6- and SBT_0.6+ patients [Pr(>F) = 0.0068, pMANOVA], with higher F/B ratios and MDI in SBT_0.6- patients (19.71 ± 16.62 vs. 7.33 ± 6.65, p < 0.01; 1.02 ± 0.97 vs. 0.20 ± 0.58, p < 0.01). Similar results were observed between the SBT_0.6- and SBT_0.6+ sub-groups of patients with normal liver function and a Child-Pugh score of 5. SBT was negatively correlated with both the F/B ratio and MDI (r = -0.34, p < 0.05; r = -0.38, p < 0.05). Interestingly, an increased capacity for the inferred pathway "bacterial invasion of epithelial cells" in patients, was highly negatively correlated with SBT (r = -0.57, p < 0.01). The severity of microbiota dysbiosis in LC patients depends on SBT rather than Child-Pugh score. SBT per se might be significantly related to the gut microbiota abnormalities observed in patients with LC.

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Small bowel transit of a bran meal residue in humans: sieving of solids from liquids and response to feeding.

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