Nutritional Aspects of Pediatric Gastrointestinal Diseases.

In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively "harmless" nature. Apart from a diet's therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical "side effects", however, it should be emphasized that any dietary modification might have negative consequences on children's growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.

Nutritional Lipids and Mucosal Inflammation.

Inflammatory bowel disease (IBD) is characterized by chronic relapsing inflammation in the intestine. Given their role in regulation of inflammation, long-chain n-3 polyunsaturated fatty acids (PUFAs) represent a potential supplementary therapeutic approach to current drug regimens used for IBD. Mechanistically, there is ample evidence for an anti-inflammatory and pro-resolution effect of long-chain n-3 PUFAs after they incorporate into cell membrane phospholipids. They disrupt membrane rafts and when released from the membrane suppress inflammatory signaling by activating PPAR-γ and free fatty acid receptor 4; furthermore, they shift the lipid mediator profile from pro-inflammatory eicosanoids to specialized pro-resolving mediators. The allocation of long-chain n-3 PUFAs also leads to a higher microbiome diversity in the gut, increases short-chain fatty acid-producing bacteria, and improves intestinal barrier function by sealing epithelial tight junctions. In line with these mechanistic studies, most epidemiological studies support a beneficial effect of long-chain n-3 PUFAs intake on reducing the incidence of IBD. However, the results from intervention trials on the prevention of relapse in IBD patients show no or only a marginal effect of long-chain n-3 PUFAs supplementation. In light of the current literature, international recommendations are supported that adequate diet-derived n-3 PUFAs might be beneficial in maintaining remission in IBD patients.

High-Salt Diet-Induced Gastritis in C57BL/6 Mice is Associated with Microbial Dysbiosis and Alleviated by a Buckwheat Diet.

SCOPE: A high-salt diet is a cause of gastritis, but the associated mechanism remains unclear. Recent studies have shown that gastric flora is associated with a variety of stomach diseases, but it is not known whether gastric flora is involved in gastritis induced by a high-salt diet. METHODS AND RESULTS: Gastritis is successfully induced in C57BL/6 mice fed a high-salt diet (salt: 5% NaCl) for four weeks. Through 16S rRNA gene sequencing, the composition of the stomach microbiota of mice fed normal and high-salt diets are compared, the results of which show that the high-salt diet induces significant changes in the gastric flora. Phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) is used to predict the function of the microbiota in the stomach of mice, and the results indicate that a high-salt diet leads to a decrease in the ability of the gastric microbiota to metabolize polysaccharides and vitamins. A buckwheat diet is used to treat gastritis. The results show gastritis induced by the high-salt diet is significantly alleviated, and the dysbiosis in the stomach also improved. CONCLUSION: Buckwheat diet may be one of the ways to prevent and treat gastritis caused by a high-salt diet.

Recent advances in complementary and replacement therapy with nutraceuticals in combating gastrointestinal illnesses.

The digestive system provides nourishment to the whole body. Disorders in this system would result in many associated illnesses as the body is deprived of essential nutrients. Gastrointestinal diseases, in particular, gastric ulceration, inflammatory bowel diseases and colorectal cancer have become more prevalent in all population age groups. While this can be attributed to diet and lifestyle changes, the measures to combat these illnesses with conventional drugs is losing popularity owing to the harsh side effects, drug resistance and lack of patient compliance. The focus of this review is to endorse promising nutraceutical dietary components such as phytosterols, polyphenols, anthocyanins and polyunsaturated fatty acids and their synergistic value, in combination with conventional management of key gastrointestinal diseases. As most of these nutraceuticals are labile compounds, the need for protection and delivery using a carrier system is stressed and the methods for targeting to specific parts of the gastrointestinal tract are discussed. A section has also been devoted to perspectives on co-encapsulation methods of drugs and nutraceuticals using different particle systems. Multilayered carrier systems like double layered and core shell particles have been proposed as an exemplary system to co-encapsulate both drugs and nutrients while keeping them segregated.

Dietary sulforaphane-rich broccoli sprouts reduce colonization and attenuate gastritis in Helicobacter pylori-infected mice and humans.

The isothiocyanate sulforaphane [SF; 1-isothiocyanato-4(R)-methylsulfinylbutane] is abundant in broccoli sprouts in the form of its glucosinolate precursor (glucoraphanin). SF is powerfully bactericidal against Helicobacter pylori infections, which are strongly associated with the worldwide pandemic of gastric cancer. Oral treatment with SF-rich broccoli sprouts of C57BL/6 female mice infected with H. pylori Sydney strain 1 and maintained on a high-salt (7.5% NaCl) diet reduced gastric bacterial colonization, attenuated mucosal expression of tumor necrosis factor-alpha and interleukin-1beta, mitigated corpus inflammation, and prevented expression of high salt-induced gastric corpus atrophy. This therapeutic effect was not observed in mice in which the nrf2 gene was deleted, strongly implicating the important role of Nrf2-dependent antioxidant and anti-inflammatory proteins in SF-dependent protection. Forty-eight H. pylori-infected patients were randomly assigned to feeding of broccoli sprouts (70 g/d; containing 420 micromol of SF precursor) for 8 weeks or to consumption of an equal weight of alfalfa sprouts (not containing SF) as placebo. Intervention with broccoli sprouts, but not with placebo, decreased the levels of urease measured by the urea breath test and H. pylori stool antigen (both biomarkers of H. pylori colonization) and serum pepsinogens I and II (biomarkers of gastric inflammation). Values recovered to their original levels 2 months after treatment was discontinued. Daily intake of sulforaphane-rich broccoli sprouts for 2 months reduces H. pylori colonization in mice and improves the sequelae of infection in infected mice and in humans. This treatment seems to enhance chemoprotection of the gastric mucosa against H. pylori-induced oxidative stress.

[Ventramine and lipid peroxidation in children with erosive gastroduodenitis].

43 patients and 20 healthy children, aged 11-15, were examined. Increased contents of primary, secondary, intermediary and final products of lipid peroxidation (LPO) in serum lipids as well as an intensified antioxidant activity were registered in children with erosive gastroduodenitis. Ventramine, when used in the treatment of erosive gastroduodenitis in children, arrests rapidly the clinical signs of the disease and normalizes LPO.

Tromboprofilaxis en cirugía de cadera con Heparina de bajo peso molecular: enoxaparina sódica / Thromboprophylaxis in hip surgery with a low molecular weight heparin: sodium enoxaparin

El objeto del estudio es determinar la seguridad de una heparina de bajo peso molecular (HBPM) Enoxaparina sódica, en cirugía ortopédica mayhor mediante un estudio cánico experimental aleatorizado con 71 pacientes hospitalizados para cirugía de cadera en el Servicio de Ortopedia y Traumatología del Hospital Nacional Guillermo Almenara Irigoyen - IPSS, entre Diciembre 1996 y Marzo 1997. Se incluyeron en el grupo-profilaxis 35 pacientes que recibieron Enoxaparina sódica 40 mg/d desde 12 hrs antes de la operación y 36 pacientes en el grupo-control que siguieron el esquema convencional sin usar anticoagulantes. El volumen de sangrado intra y postoperatorio, sangrado mayor operatorio, y las alteraciones en el perfil de coagulación no mostraron diferencias estadísticamente significativas entre los dos grupos. Tampoco se presentó sangrado extraoperatorio, ni reacciones adversas al fármaco. Eln porcentaje de fallecidos en el grupo-control fue de 2.7 por ciento y cero en el grupo-profilaxis. La profilaxis de tromboembolismo venosos en cirugía de cadera con Enoxaparina sódica, mostró seguridad, tolerancia y facilidad de manejo sin necesidad de monitoreo de laboratorio

Tratamiento dietético con Alicina en la gastritis crónica por Helicobacter pylóri en el Hospital IPSS Tacna / Alicine diethetical therapy for helicobacter pylori chronic gastritis at SSPI Tacna Hospital

Se realizó un estudio prospectivo experimental ciego, en pacientes que acudieron a la consulta gastroenterológica del Hospital II IPSS - Tacna por presentar cuadro clínico de gastritis. Se estudiaron 18 pacientes quiénes tuvieron endoscopía y biopsia antes y después de la administración de alicina (un diente de ajo) por 20 días, con un grupo de control de 15 pacientes. Los resultados mostraron negativización de Helicobacter pylóri en el 71 por ciento de pacientes que recibieron alicina, frente al grupo control que sólo negativizó el 16 por ciento. Este estudio demostroó la influencia dietética de algunos elementos como la alicina en el curso natural de la lenfermedad y una alternativa que debe se considerada como tratamiento en poblaciones grandes con escasos recursos económicos

[Effect of diet therapy on the changes of vitamin C content in the blood and urine of patients with chronic gastritis and peptic ulcer]. / Izmenenie v soderzhanii vitamina C v krovi i moche bolnykh khronicheskimi gastritami, iazvennoi bolezníu zheludka i dvenadtsatiperstnoi kishki v protsesse dietoterapii.

Estimation and analytical methods were employed to investigate real rations of patients with gastroduodenal ulcer. Chemical composition of diet N 1 was found unsatisfactory both by ascorbic acid and carbohydrates content responsible for low-caloric value of the diet. The ration correction with additional provision of vegetables, fruit, greens raised vitamin C intake by the patients though the deficiency was not abolished.

[Effect of a "green" diet on various clinical and metabolic indicators in patients with gastrointestinal diseases]. / Vliianie "diety s zelen'iu" na nekotorye klinicheskie i obmennye pokazateli u bol'nykh s gastrointestinal'nymi zabolevaniiami.

The authors recommend that patients with all chronic diseases of the alimentary organs, particularly with colonic function abnormalities should receive, with the exception of patients with disease exacerbations, salads from raw vegetables (100 g 3 times a day) before meal being a constituent part of the balanced diet. The diet containing salad from raw vegetables was received by 93 inpatients with different chronic diseases of the alimentary tract, gastroduodenal ulcer included. The patients did not exhibit intolerance provided the salad was made properly. Pain and meteorism disappeared or were relieved, intestinal evacuation returned to normal in the majority of patients.