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      Effect of Chicory-derived Inulin on Abdominal Sensations and Bowel Motor Function

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          Abstract

          Goal:

          To determine the effect of a prebiotic chicory-derived inulin-type fructan on the tolerance of intestinal gas.

          Background:

          Subjects with gas-related complaints exhibit impaired handling of intestinal gas loads and we hypothesized that inulin would have a beneficial effect.

          Study:

          Placebo-controlled, parallel, randomized, double-blind trial. Subjects with abdominal symptoms and reduced tolerance of intestinal gas (selected by a pretest) received either inulin (8 g/d, n=18) or maltodextrin as a placebo (8 g/d, n=18) for 4 weeks. A gas challenge test (4 h jejunal gas infusion at 12 mL/min while measuring abdominal symptoms and gas retention for 3 h) was performed before and at the end of the intervention phase. Gastrointestinal symptoms and bowel habits (using daily questionnaires for 1 wk) and fecal bifidobacteria counts were measured before and at the end of the intervention.

          Results:

          Inulin decreased gas retention during the gas challenge test (by 22%; P=0.035 vs. baseline), while the placebo did not, but the intergroup difference was not statistically significant ( P=0.343). Inulin and placebo reduced the perception of abdominal sensations in the gas challenge test to a similar extent (by 52% and 43%, respectively). Participants reported moderate gastrointestinal symptoms and normal bowel habits during baseline examination, and these findings remained unchanged in both groups during the intervention. Inulin led to a higher relative abundance of bifidobacteria counts ( P=0.01 vs. placebo).

          Conclusions:

          A daily dose of inulin that promotes bifidobacteria growth and may improve gut function, is well tolerated by subjects with gastrointestinal complaints.

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          Most cited references24

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          Effects of inulin and lactose on fecal microflora, microbial activity, and bowel habit in elderly constipated persons.

          Constipation is an ailment encountered often in elderly people. A study was initiated to test the effects of lactose or inulin on the bowel habits of constipated elderly patients and to correlate these effects with several variables measured in feces such as microflora composition, concentration of lactate and short-chain fatty acids (SCFAs), pH, and the activities of beta-glucosidase and beta-glucuronidase, Groups of 15 and 10 patients received lactose and inulin, respectively, for a period of 19 d. The dose, 20 g/d from days 1 to 8, was gradually increased to 40 g/d from days 9 to 11 and was kept at this dose from days 12 to 19. There was considerable interindividual variations with this kind of dietary intervention. Inulin increased bifidobacteria significantly from 7.9 to 9.2 log10/g dry feces, but decreased enterococci in number and enterobacteria in frequency. In individuals consuming lactose, a noticeable increase in fecal counts of enterococci and a decrease in lactobacilli and clostridia was detected. Total bacterial counts remained unchanged. No changes in the concentrations of fecal SCFAs and lactate were observed. SCFAs showed a slight trend toward higher molar ratios of acetate to butyrate in response to the intake of lactose or inulin. The fecal pH and the beta-glucosidase and beta-glucuronidase activities were not influenced by sugar intake. Inulin showed a better laxative effect than lactose and reduced functional constipation with only mild discomfort.
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            Placebo effects and their determinants in gastrointestinal disorders.

            Placebo effects in clinical trials have sparked an interest in the placebo phenomenon, both in randomized controlled trials (RCTs) and in experimental gastroenterology. RCTs have demonstrated similar short-term and long-term placebo response rates in gastrointestinal compared to other medical diagnoses. Most mediators and moderators of placebo effects in gastrointestinal diseases are also of similar type and size to other medical diagnoses and not specific for gastrointestinal diagnoses. Other characteristics such as an increase in the placebo response over time and the placebo-enhancing effects of unbalanced randomization were not seen, at least in IBS. Experimental placebo and nocebo studies underscore the 'power' of expectancies and conditioning processes in shaping gastrointestinal symptoms not only at the level of self-reports, but also within the brain and along the brain-gut axis. Brain imaging studies have redressed earlier criticism that placebo effects might merely reflect a response bias. These findings raise hope that sophisticated trials and experiments designed to boost positive expectations and minimize negative expectations could pave the way for a practical and ethically sound use of placebo knowledge in daily practice. Rather than focusing on a 'personalized' choice of drugs based on biomarkers or genes, it might be the doctor-patient communication that needs to be tailored.
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              Is Open Access

              Anal gas evacuation and colonic microbiota in patients with flatulence: effect of diet

              Objective To characterise the influence of diet on abdominal symptoms, anal gas evacuation, intestinal gas distribution and colonic microbiota in patients complaining of flatulence. Design Patients complaining of flatulence (n=30) and healthy subjects (n=20) were instructed to follow their usual diet for 3 days (basal phase) and to consume a high-flatulogenic diet for another 3 days (challenge phase). Results During basal phase, patients recorded more abdominal symptoms than healthy subjects in daily questionnaires (5.8±0.3 vs 0.4±0.2 mean discomfort/pain score, respectively; p=<0.0001) and more gas evacuations by an event marker (21.9±2.8 vs 7.4±1.0 daytime evacuations, respectively; p=0.0001), without differences in the volume of gas evacuated after a standard meal (262±22 and 265±25 mL, respectively). On flatulogenic diet, both groups recorded more abdominal symptoms (7.9±0.3 and 2.8±0.4 discomfort/pain, respectively), number of gas evacuations (44.4±5.3 and 21.7±2.9 daytime evacuations, respectively) and had more gas production (656±52 and 673±78 mL, respectively; p<0.05 vs basal diet for all). When challenged with flatulogenic diet, patients’ microbiota developed instability in composition, exhibiting variations in the main phyla and reduction of microbial diversity, whereas healthy subjects’ microbiota were stable. Taxa from Bacteroides fragilis or Bilophila wadsworthia correlated with number of gas evacuations or volume of gas evacuated, respectively. Conclusions Patients complaining of flatulence have a poor tolerance of intestinal gas, which is associated with instability of the microbial ecosystem.
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                Author and article information

                Journal
                J Clin Gastroenterol
                J. Clin. Gastroenterol
                MCG
                Journal of Clinical Gastroenterology
                Wolters Kluwer Health, Inc
                0192-0790
                1539-2031
                August 2017
                10 July 2017
                : 51
                : 7
                : 619-625
                Affiliations
                [* ]Digestive System Research Unit, University Hospital Vall d’Hebron, Barcelona
                []Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) (Virtual Center for Biomedical Research Hepatic and Digestive Diseases), Madrid
                []Department de Medicina, Universitat Autònoma de Barcelona (Department of Medicine, Autonomous University of Barcelona), Bellaterra (Cerdanyola del Vallès), Spain
                [§ ]BENEO-Institute, Obrigheim, Germany
                Author notes
                Address correspondence to: Fernando Azpiroz, MD, Digestive System Research Unit, Hospital General Vall d’Hebron, 08035-Barcelona, Spain (e-mail: azpiroz.fernando@ 123456gmail.com ).
                Article
                00010
                10.1097/MCG.0000000000000723
                5499961
                27680592
                b3b907c4-a192-43aa-a431-f5bd427fce28
                Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
                History
                : 11 March 2016
                : 16 August 2016
                Categories
                ALIMENTARY TRACT: Original Articles

                intestinal motility,intestinal sensitivity,intestinal microbiota,intestinal gas,functional gut symptoms

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