Microbial composition and viability of natural whey starters used in PDO Comté cheese-making.

Natural whey starters (NWS) are cultures with undefined multiple-strains species commonly used to speed up the fermentation process of cheeses. The aim of this study was to explore the diversity and the viability of Comté cheese NWS microbiota. Culture-dependent methods, i.e. plate counting and genotypic characterization, and culture-independent methods, i.e. qPCR, viability-qPCR, fluorescence microscopy and DNA metabarcoding, were combined to analyze thirty-six NWS collected in six Comté cheese factories at two seasons. Our results highlighted that NWS were dominated by Streptococcus thermophilus (ST) and thermophilic lactobacilli. These species showed a diversity of strains based on Rep-PCR. The dominance of Lactobacillus helveticus (LH) over Lactobacillus delbrueckii (LD) varied depending on the factory and the season. This highlighted two types of NWS: the type-ST/LD (LD > LH) and the type-ST/LH (LD < LH). The microbial composition varied depending on cheese factory. One factory was distinguished by its level of culturable microbial groups (ST, enterococci and yeast) and its fungi diversity. The approaches used to estimate the viability showed that most NWS cells were viable. Further investigations are needed to understand the microbial diversity of these NWS.

Cultivable microbial communities in raw cow milk and potential transfers from stables of sixteen French farms.

The indigenous microflora in raw milk plays an important role in the diversity of cheese flavours and may protect against the growth of pathogens, but the sources of contamination and the factors that might affect the microbial communities in milk are not well known. The objectives of this study were to broaden knowledge of the microbial composition of milk and to assess microbial transfers from the stable to the milk. Air (collected in milking parlour and stable), dust (passively collected using plastic box), cow teat surface, and hay and milk samples were collected in 16 French farms with either stanchion barn or freestall barn configurations and plated on various culture media. Bacterial and fungal colonies were identified using phenotypic and DNA sequencing methods. Results showed that most of the fungal species and environmental bacteria found in the milk were also found in the stable and the milking parlour environments, indicating large microbial transfer from stable to milking parlour then to milk. However, milk from the stanchion barns were more contaminated than milk from freestall barns. Contrasting with other bacterial and fungal species, useful cheese-making bacteria--lactobacilli and PAB--were frequently identified in the milk and on the teat surface but were rarely found in other environments. In conclusion, milk contamination by the stable environment is considerable, even if it is lower in farms with a milking parlour. Besides this environmental contamination, the teat surface remains the main source of useful cheese-making bacteria.

KSHV/HHV8-associated intestinal Kaposi's sarcoma in patient with ulcerative colitis receiving immunosuppressive drugs: report of a case.

Kaposi sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV8), has been identified in all four forms of Kaposi's sarcoma (classic, endemic, HIV-associated and iatrogenic). We report the rare case of an intestinal (small intestine and rectosigmoid) Kaposi's sarcoma in a 62-year-old HIV-negative man with ulcerative colitis. This patient was receiving immunosuppressive therapy with steroids and azathioprine. To date, the causative role of KSHV/HHV8 in the pathophysiology of Kaposi's sarcoma associated with ulcerative colitis has only been proven for cutaneous lesions but not for intestinal lesions of Kaposi's sarcoma. We report for the first time, the expression of HHV8 (by using immunohistochemistry) in colonic Kaposi's sarcoma in a patient with an ulcerative colitis-related tumor. The patient underwent a total proctocolectomy. At laparotomy, numerous Kaposi's sarcoma lesions were found in the small intestine, which were left in situ. Forty months after surgery and following withdrawal of immunosuppressive therapy, the patient had no evidence of any disease and a normal abdominal and thoracic CT scan. Cases of colorectal Kaposi's sarcoma complicating inflammatory bowel disease should be managed with a conservative approach and discontinuation of the immunosuppressive treatment. However, discontinuation of the immunosuppression is not always possible and in those cases chemotherapy may be indicated.

Prevalence of anal incontinence in adults and impact on quality-of-life.

OBJECTIVE: To investigate the prevalence of anal incontinence in the general population and in patients consulting gastroenterologist and gynecologist practices in the Rhône Alpes area. METHODS: For the first study a questionnaire was sent to a sample of 2800 people selected randomly from the electoral roll. Another study of patients selected randomly among patients attending gynecology and gastroenterology consultations was performed. A Jorge & Wexner score above or equal to 5 was used to define anal incontinence. RESULTS: For the first study, a total of 706 questionnaires was analyzed: the prevalence of anal incontinence was 5.1% [95% CI: 3.6-7.0] and the scores of each dimension of the SF-12 Health Survey were significantly lower among incontinent people than among continent people. The prevalence was significantly higher for women (7.5% [5.0-10.7]) than for men (2.4% [1.1-4.7]). Eighty-four physicians returned 835 valid questionnaires. The prevalence was 13.1% [10.1-16.6] among patients attending gastroenterology consultations and 5.0% [3.1-7.6] among those attending gynecology consultations. For 84.8% of the incontinent patients, the physician was unaware of the patient's disorder. CONCLUSION: The prevalence figures we obtained coincide with data in the literature. This disorder is common and affects the patient's quality-of-life, but remains underestimated and under-diagnosed.

Intragastric balloon for "non-morbid" obesity: a retrospective evaluation of tolerance and efficacy.

BACKGROUND: One potential indication for intra-gastric balloon is weight reduction for mild to moderate obesity. The authors evaluated retrospectively the tolerance and efficacy of the BioEnterics intragastric balloon (BIB). METHODS: From February 1998 to July 2001, an intragastric balloon was placed under endoscopic control in 176 patients (mean BMI 31 kg/m(2)). It was filled with 500 ml saline in the first 142 patients and with 600 ml in the last 34. Removal was proposed between 4 and 6 months after balloon insertion. RESULTS: Balloon placement was uneventful. 13 patients were lost of follow-up (7.4%). Removal was performed endoscopically in 113 patients (64.2%), with 1 case of tracheal aspiration. Balloon evacuation was spontaneous in 49 cases. 1 BIB was removed at laparoscopic surgery for small bowel obstruction. Side-effects were: vomiting during the first week (90%), occasional vomiting for >3 weeks (18%), hypokalemia (8.5%), functional renal failure (1.1%), abdominal pain (12.5%), gastro-esophageal reflux (11.5%). There were 2 gastric ulcers, 1 sub-occlusion treated endoscopically and the 1 small bowel obstruction treated surgically, occurring after the theoretical date of removal in all cases. Mean excess weight loss was 38 +/- 28.5 % (35.4 +/- 27.3 % for 500-ml balloons and 48.8 +/- 31.0 % for 600-ml balloons (P <0.02)). CONCLUSIONS: The BIB appears to be safe provided that it is removed within the period specified by the manufacturer. Its efficacy to reduce weight in patients with non-morbid obesity may depend in part on the filling volume.

[Irritable bowel syndrome and healthcare consumption. An observational study in private gastroenterology]. / Troubles fonctionnels intestinaux et consommation de soins. Etude observationnelle en gastro-entérologie libérale.

AIM: Little data is available on the management of irritable bowel syndrome (IBS) in daily practice. The purpose of our study was to study the relationship between the severity of IBS and healthcare consumption. METHODS: During a cross-sectional epidemiological study undertaken by 330 private gastro-enterologists, the severity of IBS symptoms experienced by patients was quantified with Francis' score (limits 0-500) to study the relationship with the healthcare consumption. RESULTS: Data obtained from 1407 patients (mean age: 52.3 +/- 15 years, females: 68%) were analysed. Symptoms were usually long-lasting (mean duration: 134.1 +/- 128.4 months); they had required on average 5.7 +/- 4.5 medical visits in the past year including 2.3 +/- 2.1 visits to a gastroenterologist. The mean number of additional investigations performed by patient was 1.3 +/- 1.4. Ninety one percent of them took at least one medication. The mean severity score was 268.5 +/- 85.2. Patients' distribution according to severity showed that 47.3% of the patients had symptoms of moderate severity and 44.9% of high severity. There was a significant relationship between, in one hand, severity of symptoms and, in the other hand, the number of visits (P<0.001), the number of additional investigations (P<0.001) and the number of prescribed medications (P<0.001). CONCLUSION: There was a positive relationship between the severity of symptoms and the healthcare consumption in private gastroenterological practice. The data confirm the significant burden of IBS in France.

Use of PCR-based methods and PFGE for typing and monitoring homofermentative lactobacilli during Comté cheese ripening.

This study investigated the genotypic characteristics of selected and wild homofermentative thermophilic lactobacilli strains during ripening of Comté cheeses, made into two cheese plants. Both amplification and restriction analysis of the 16S rRNA gene (PCR-ARDRA) and classical biochemical tests were used to identify isolates. Diversity within homofermentative lactobacilli was not found in their species composition since the same two species Lactobacillus helveticus and L. delbrueckii susbp. lactis were isolated from cheeses. In cheeses made with natural whey starter, it appeared that the most likely sources of L. helveticus and L. delbrueckii susbp. lactis were the starter and raw milk, respectively. The examination of RAPD profiles of lactobacilli strains revealed 19 RAPD groups among 50 isolates, which were different from selected starter strains. Using RAPD, REP-PCR, and PFGE to identify selected starter strains during cheese ripening, we showed that L. helveticus decreased quickly while L. delbrueckii susbp. lactis sustained high viability during ripening. The use of selected L. delbrueckii susbp. lactis strains diminished the genetic diversity among strains isolated from cheese, probably in preventing the raw milk microflora from growing.

[Patient-doctor relationship in the irritable bowel syndrome. Results of a French prospective study on the influence of the functional origin of the complaints]. / Relation médecin-malade dans le syndrome de l'intestin irritable.

UNLABELLED: The attention given by the physician and the quality of the patient-physician relationship mainly determine the outcome of a consultation. Care seeking is a main characteristic of patients with functional bowel disorders, including irritable bowel syndrome (IBS), while patients with suspected organic disease (Org) would rather expect a precise answer about their condition. The aim of this study was thus to evaluate the outcome of the consultation with a gastroenterologist in IBS patients, as compared to a group of patients with suspected organic disease. PATIENTS AND METHODS: A prospective multicenter cross-sectional study "one given week" included 158 patients consulting for the first time 18 gastroenterologists. Patients were consulting for abdominal pain and were classified as IBS or Org on the basis of the physician's clinical impression. Questionnaires including 27 common questions were distributed to the patients and the physicians at the end of the consultation and filled separately. RESULTS: The diagnosis of IBS was done in 110 patients and that of Org in 48. Groups were comparable for the characteristics, the intensity and the frequency of attacks of abdominal pain. The index of satisfaction of the patients was not different between groups (IBS: 8.7 +/- 1.4; Org: 9.1 +/- 1.4; P=0.16). The intensity of abdominal pain was reported in the same range by the patient (IBS: 5.1 +/- 2.9; Org: 4.5 +/- 2.8) and the physician (IBS: 4.6 +/- 2.3; Org: 4.8 +/- 2.6) in both groups. Digestive and extra-digestive symptoms were quoted equally by physicians, whatever the group the patient belonged to. Information given by the physician on diagnosis and therapy were equally well perceived by patients of both groups. However, the physician tended to evaluate the efficacy of the prescribed therapy to be lower in IBS (7.1 +/- 2.0) than in Org patients (8.0 +/- 1.7; P<0.01). CONCLUSION: In this study, the consultation with a gastroenterologist is equally well perceived by IBS and Org patients and it seems to meet the expectancy of the patient in most cases. However, the physician appeared less confident in the efficacy of the therapy proposed to IBS patients.