Intestinal blood flow in patients with chronic heart failure: a link with bacterial growth, gastrointestinal symptoms, and cachexia.

BACKGROUND: Blood flow in the intestinal arteries is reduced in patients with stable heart failure (HF) and relates to gastrointestinal (GI) symptoms and cardiac cachexia. OBJECTIVES: The aims of this study were to measure arterial intestinal blood flow and assess its role in juxtamucosal bacterial growth, GI symptoms, and cachexia in patients with HF. METHODS: A total of 65 patients and 25 controls were investigated. Twelve patients were cachectic. Intestinal blood flow and bowel wall thickness were measured using ultrasound. GI symptoms were documented. Bacteria in stool and juxtamucosal bacteria on biopsies taken during sigmoidoscopy were studied in a subgroup by fluorescence in situ hybridization. Serum lipopolysaccharide antibodies were measured. RESULTS: Patients showed 30% to 43% reduced mean systolic blood flow in the superior and inferior mesenteric arteries and celiac trunk (CT) compared with controls (p < 0.007 for all). Cachectic patients had the lowest blood flow (p < 0.002). Lower blood flow in the superior mesenteric artery and CT was correlated with HF severity (p < 0.04 for all). Patients had more feelings of repletion, flatulence, intestinal murmurs, and burping (p < 0.04). Burping and nausea or vomiting were most severe in patients with cachexia (p < 0.05). Patients with lower CT blood flow had more abdominal discomfort and immunoglobulin A-antilipopolysaccharide (r = 0.76, p < 0.02). Antilipopolysaccharide response was correlated with increased growth of juxtamucosal but not stool bacteria. Patients with intestinal murmurs had greater bowel wall thickness of the sigmoid and descending colon, suggestive of edema contributing to GI symptoms (p < 0.05). In multivariate regression analysis, lower blood flow in the superior mesenteric artery, CT (p < 0.04), and inferior mesenteric artery (p = 0.056) was correlated with the presence of cardiac cachexia. CONCLUSIONS: Intestinal blood flow is reduced in patients with HF. This may contribute to juxtamucosal bacterial growth and GI symptoms in patients with advanced HF complicated by cachexia.

Jerusalem artichoke and chicory inulin in bakery products affect faecal microbiota of healthy volunteers.

A study was conducted to test the effects of Jerusalem artichoke inulin (JA) or chicory inulin (CH) in snack bars on composition of faecal microbiota, concentration of faecal SCFA, bowel habit and gastrointestinal symptoms. Forty-five volunteers participated in a double-blind, randomized, placebo-controlled, parallel-group study. At the end of a 7 d run-in period, subjects were randomly assigned to three groups of fifteen subjects each, consuming either snack bars with CH or JA, or snack bars without fructans (placebo); for 7 d (adaptation period), they ingested one snack bar per day (7.7 g fructan/d) and continued for 14 d with two snack bars per day. The composition of the microbiota was monitored weekly. The consumption of CH or JA increased counts of bifidobacteria (+1.2 log10 in 21 d) and reduced Bacteroides/Prevotella in number and the Clostridium histolyticum/C. lituseburense group in frequency at the end of intervention (P < 0.05). No changes in concentration of faecal SCFA were observed. Consumption of snack bars resulted in a slight increase in stool frequency. Stool consistency was slightly affected in subjects consuming two snack bars containing CH or JA per day (P < 0.05). Consumption of CH or JA resulted in mild and sometimes moderate flatulence in a few subjects compared to placebo (P < 0.05). No structural differences were detected between CH and JA before and after processing. In conclusion, adaptation on increased doses of CH or JA in bakery products stimulates the growth of bifidobacteria and may contribute to the suppression of potential pathogenic bacteria.

Microbial and immunological responses relative to high-altitude exposure in mountaineers.

PURPOSE: High-altitude exposure is often associated with gastrointestinal disorders, inflammation, and an increased risk of infection. We suspected microbial and immunological responses to high-altitude exposure in mountaineers resulting from changes in the balance of the intestinal microflora. METHODS: We investigated fecal samples and serum of seven mountaineers who took part in a 47-d German expedition to the Nepalese Himalayas in 2002, for microbial response by changes in different fecal bacterial population groups (fluorescent in situ hybridization), immune response by serum levels of IgG-, IgM-, and IgA anti-LPS (E. coli J5), and inflammatory response by serum levels of C-reactive protein (CRP) (ELISA). In addition, measurements of body temperature, pulse rate, arterial oxygen saturation, and questionnaire (Lake Louise score for altitude illness) were performed. RESULTS: The data indicate a distinct alteration in the composition of the fecal microflora relative to high-altitude exposure above 5000 m. Bifidobacteria and species belonging to the Atopobium, Coriobacterium, and Eggerthella lenta group decreased, whereas potential pathogenic bacteria of the gamma subdivision of Proteobacteria and specific Enterobacteriaceae such as Escherichia coli increased. Possible endotoxemia resulting from the increase of the latter Gram-negative bacteria was indirectly indicated by the reduction in serum levels of IgM- and/or IgA anti-LPS. CRP was elevated relative to high-altitude exposure. The Lake Louise score correlated with the changes in CRP, IgA-, and IgM anti-LPS but did not correlate with the bacterial alterations. CONCLUSION: Changes in the composition of intestinal microbiota may be associated with indicators of an immunological challenge and may result in an increased health risk of mountaineers during exposure to very high altitude.

Jerusalem artichokes stimulate growth of broiler chickens and protect them against endotoxins and potential cecal pathogens.

Control of intestinal pathogens during the earliest phases of broiler production may be the best strategy for the reduction of human pathogens on processed broiler carcasses. The recent ban on antibiotics in poultry feed has served to focus much attention on alternative methods of controlling the gastrointestinal microflora. A field trial was conducted to evaluate the effect of the fructan-rich Jerusalem artichoke, or topinambur (administered as 0.5% topinambur syrup in drinking water), on cultural numbers of selected cecal bacteria (total aerobes, Enterobacteriaceae, Bdellovibrio spp., and Clostridium perfringens) and levels of bacterial endotoxins as well as on body weights and relative weights of organs (the pancreas and the bursa of Fabricius) of chickens in the first 35 days of life (with weekly investigations being conducted). One-day-old broiler chickens (Ross 308) were randomly assigned to experimental (with topinambur) and control (without topinambur) groups. They were allowed free access to a standard broiler diet without growth-promoting antibiotics. Topinambur treatment resulted in a significant increase (P < 0.01) in cecal counts of B. bacteriovorus, which parasitizes susceptible gram-negative pathogens. Topinambur led to significantly smaller numbers of total aerobes, Enterobacteriaceae, and C. perfringens as well as to reduced levels of endotoxins in the blood compared with those for control birds. Increased body weights resulting from topinambur consumption were observed on day 35 of the trial period (P < 0.05). The relative weights of the pancreas and the bursa of Fabricius, however, were higher (P < 0.05) for topinambur-treated broilers than for control birds at the ages of 14, 21, 28, and 35 days. These results indicate that a small amount of topinambur in broilers' drinking water has a beneficial effect on growth performance, reduces bacterial endotoxin levels, and suppresses potential pathogens in broilers' ceca.