Metabolomic-Based Approach to Identify Biomarkers of Apple Intake.

SCOPE: There is an increased interest in developing biomarkers of food intake to address some of the limitations associated with self-reported data. The objective is to identify biomarkers of apple intake, examine dose-response relationships, and agreement with self-reported data. METHODS AND RESULTS: Metabolomic data from three studies are examined: an acute intervention, a short-term intervention, and a free-living cohort study. Fasting and postprandial urine samples are collected for analysis by 1 H-NMR and liquid chromatography-mass spectrometry (LC-MS). Calibration curves are developed to determine apple intake and classify individuals into categories of intake. Multivariate analysis of data reveals that levels of multiple metabolites increase significantly post-apple consumption, compared to the control food-broccoli. In the dose-response study, urinary xylose, epicatechin sulfate, and 2,6-dimethyl-2-(2-hydroxyethyl)-3,4-dihydro-2H-1-benzopyran increase as apple intake increases. Urinary xylose concentrations in a free-living cohort perform poorly at an individual level but are capable of ranking individuals in categories of intake. CONCLUSION: Urinary xylose exhibits a dose-response relationship with apple intake and performs well as a ranking biomarker in the population study. Other potential biomarkers are identified and future work will combine these with xylose in a biomarker panel which may allow for a more objective determination of individual intake.

Clinical, endoscopic, and histological differentiation between celiac disease and tropical sprue: A systematic review.

BACKGROUND AND AIM: While the prevalence of celiac disease (CD) is increasing globally, the prevalence of tropical sprue (TS) is declining. Still, there are certain regions in the world where both patients with CD and TS exist and differentiation between them is a challenging task. We conducted a systematic review of the literature to find out differentiating clinical, endoscopic, and histological characteristics between CD and TS. METHODS: Medline, PubMed, and EMBASE databases were searched for keywords: celiac disease, coeliac, celiac, tropical sprue, sprue, clinical presentation, endoscopy, and histology. Studies published between August 1960 and January 2018 were reviewed. Out of 1063 articles available, 12 articles were included in the final analysis. RESULTS: Between the patients with CD and TS, there was no difference in the prevalence and duration of chronic diarrhea, abdominal distension, weight loss, extent of abnormal fecal fat content, and density of intestinal inflammation. The following features were more common in CD: short stature, vomiting/dyspepsia, endoscopic scalloping/attenuation of duodenal folds, histological high modified Marsh changes, crescendo type of IELosis, surface epithelial denudation, surface mucosal flattening, thickening of subepithelial basement membrane and celiac seropositivity; while those in TS include anemia, abnormal urinary D-xylose test, endoscopic either normal duodenal folds or mild attenuation, histologically decrescendo type of IELosis, low modified Marsh changes, patchy mucosal changes, and mucosal eosinophilia. CONCLUSIONS: Both patients with CD and TS have overlapping clinical, endoscopic, and histological characteristics, and there is no single diagnostic feature for differentiating CD from TS except for celiac specific serological tests.

Phase IV noninferiority controlled randomized trial to evaluate the impact on diagnostic thinking and patient management and the test-retest reproducibility of the Gaxilose test for hypolactasia diagnosis.

BACKGROUND: The diagnostic accuracy of the Gaxilose test (GT) for hypolactasia diagnosis has already been proved. The objectives of this clinical trial were to demonstrate the noninferiority of the GT compared to the hydrogen breath test (HBT) on the impact on diagnostic thinking and patient management, to evaluate the GT reproducibility with urine accumulated from 0 to 4 hours and from 0 to 5 hours and to assess test safety. METHODS: We conducted a randomized, parallel, noninferiority clinical trial. Patients with clinical symptoms suggestive of lactose intolerance were screened for inclusion and randomly assigned to the GT arm or the HBT arm of the study. The impact on diagnostic thinking and patient management was analyzed with pretest and posttest questionnaires in which the investigators indicated their estimated probability of hypolactasia diagnosis and the intended management before and after the GT or the HBT (noninferiority margin: -10%). The primary outcome of the study was the impact on diagnostic thinking, expressed as the mean of the absolute values of the differences between the pretest and posttest probabilities of hypolactasia diagnosis. Patients randomized to the GT arm performed also the retest to evaluate the reproducibility of the GT. RESULTS: A total of 147 patients were included in the intend-to-treat (ITT) population. Among them, 74 performed the HBT and 73 performed the GT. The results proved the noninferiority of the GT compared to the HBT on the impact on diagnostic thinking (ImpactGT = 31.74 ±â€Š23.30%; ImpactHBT = 24.28 ±â€Š19.87%; ΔGT-HBT = 7.46%; 95% confidence interval of ΔGT-HBT: 1.55%, infinite) and on patient management. The test-retest reproducibility was better for the GT with urine accumulated from 0 to 5 h: the intraclass correlation coefficient (ICC) was 0.5761, and the Kappa coefficient was 0.7548, indicative of substantial agreement between both tests. No serious adverse events were reported during the study. CONCLUSIONS: The GT has an impact on diagnostic thinking and patient management noninferior to that of the HBT, is reproducible and well tolerated. These results prove the clinical benefit of its use in the clinical practice (ClinicalTrials.gov identifier: NCT02636413).

Analytical Validation of a New Enzymatic and Automatable Method for d-Xylose Measurement in Human Urine Samples.

Hypolactasia, or intestinal lactase deficiency, affects more than half of the world population. Currently, xylose quantification in urine after gaxilose oral administration for the noninvasive diagnosis of hypolactasia is performed with the hand-operated nonautomatable phloroglucinol reaction. This work demonstrates that a new enzymatic xylose quantification method, based on the activity of xylose dehydrogenase from Caulobacter crescentus, represents an excellent alternative to the manual phloroglucinol reaction. The new method is automatable and facilitates the use of the gaxilose test for hypolactasia diagnosis in the clinical practice. The analytical validation of the new technique was performed in three different autoanalyzers, using buffer or urine samples spiked with different xylose concentrations. For the comparison between the phloroglucinol and the enzymatic assays, 224 urine samples of patients to whom the gaxilose test had been prescribed were assayed by both methods. A mean bias of -16.08 mg of xylose was observed when comparing the results obtained by both techniques. After adjusting the cut-off of the enzymatic method to 19.18 mg of xylose, the Kappa coefficient was found to be 0.9531, indicating an excellent level of agreement between both analytical procedures. This new assay represents the first automatable enzymatic technique validated for xylose quantification in urine.

Development of a new method for d-xylose detection and quantification in urine, based on the use of recombinant xylose dehydrogenase from Caulobacter crescentus.

The gene xylB from Caulobacter crescentus has been cloned and expressed in Escherichia coli providing a high yield of xylose dehydrogenase (XylB) production and excellent purity (97%). Purified recombinant XylB showed an absolute dependence on the cofactor NAD(+) and a strong preference for d-xylose against other assayed mono and disaccharides. Additionally, XylB showed strong stability when stored as freeze-dried powder at least 250days both at 4°C and room temperature. In addition, more than 80% of the initial activity of rehydrated freeze-dried enzyme remained after 150days of incubation at 4°C. Based on these characteristics, the capability of XylB in d-xylose detection and quantification was studied. The linearity of the method was maintained up to concentrations of d-xylose of 10mg/dL and the calculated limits of detection (LoD) and quantification (LoQ) of xylose in buffer were 0.568mg/dL and 1.89mg/dL respectively. Thus, enzymatic detection was found to be an excellent method for quantification of d-xylose in both buffer and urine samples. This method can easily be incorporated in a new test for the diagnosis of hypolactasia through the measurement of intestinal lactase activity.

Improvement and validation of d-xylose determination in urine and serum as a new tool for the noninvasive evaluation of lactase activity in humans.

BACKGROUND: The phloroglucinol assay is the current method for d-xylose determination in urine/plasma/serum. However, its sensitivity is limited when low amounts of d-xylose are to be measured, such as in the noninvasive evaluation of intestinal lactase with 4-galactosylxylose (gaxilose). An improved assay was therefore needed. METHODS: We developed and validated a modified version of the phloroglucinol-based assay for quantification of d-xylose in urine/serum samples. A method for gaxilose determination by gas chromatography (GC) was also optimized. RESULTS: Linearity ranged from 0.125 to 5.0 mg/l (5-200 mg/l in original sample). Accuracy at LOQ (0.125 mg/l) was 0.97/2.49% in spiked urine/serum; for other quality controls (QC), it was <1.27%. Intra- and interassay precision at LOQ were 6.02% and 6.45% for urine, and 8.86% and 10.00%, respectively, for serum; for other QC, precision was <2.15%. Linearity of gaxilose determination by GC was 3.90-195.17 for urine and 9.75-195.17 mg/l for serum with acceptable sensitivity and reproducibility. The method proved adequate for the d-xylose determination in healthy and hypolactasic subjects after oral administration of gaxilose. CONCLUSIONS: The modified method provides high sensitivity and robustness for d-xylose quantification in urine/serum for routine clinical use especially in the noninvasive diagnosis of intestinal lactase deficiency with the gaxilose test.

Noninvasive diagnosis of hypolactasia with 4-Galactosylxylose (Gaxilose): a multicentre, open-label, phase IIB-III nonrandomized trial.

GOALS AND BACKGROUND: Hypolactasia affects over half of the world population. Diagnosis remains problematic as currently available tests, such as the hydrogen breath test, have low reliability and lactose intolerance symptoms are unspecific. We evaluated the diagnostic performance and safety of a new noninvasive diagnostic test based on urine or serum measurement of D-xylose after lactase cleavage of orally administered 4-galactosylxylose (gaxilose). STUDY: In a multicentre, open-label, nonrandomized, phase IIb-III study, consecutive patients with symptoms suggestive of lactose intolerance sequentially underwent intestinal biopsy for direct measurement of lactase activity (reference standard), hydrogen breath test, and blood glucose test after lactose challenge, 4- and 5-hour urine-based gaxilose test, and blood-based gaxilose test. For the gaxilose tests, 0 to 4 and 4 to 5 hours urine samples were taken after a 0.45 g gaxilose dose, whereas serum samples were taken 90 minutes after a 2.7 g dose for D-xylose determination. Genetic testing of hypolactasia was also assessed. RESULTS: Of the 222 patients enrolled, 203 completed all diagnostic tests; 108 were hypolactasic according to biopsy. The sensitivities and specificities and positive and negative predictive values of the gaxilose tests were all >90% versus 69% to 85% for the hydrogen breath test and the blood glucose test. The area under the ROC curve was significantly higher for the gaxilose tests (>0.9, P≤0.007). These tests also had higher sensitivity than genetic testing for hypolactasia and were well tolerated. CONCLUSIONS: The diagnostic performance of the gaxilose tests is excellent and can substantially improve the diagnosis of hypolactasia.

Small intestinal malabsorption in chronic alcoholism: a retrospective study of alcoholic patients by the ¹4C-D-xylose breath test.

OBJECTIVE: The ¹4C-D-xylose breath test was used at Ullevål University Hospital in the period from 1986 TO 1995 for malabsorption testing. The objective of this retrospective study was to reveal whether patients with chronic alcoholism may have intestinal malabsorption. MATERIALS AND METHODS: The consecutive ¹4C-D-xylose breath test database was reviewed and patients with the diagnosis of chronic alcoholism were identified. ¹4C-D-xylose breath test results of the alcoholic patients were compared with the results of untreated celiac patients and patient and healthy controls. In the ¹4C-D-xylose breath test, ¹4C-D-xylose was dissolved in water and given orally after overnight fast. Breath samples were taken at 30-min intervals for 210 min, and ¹4CO2 : ¹²CO2 ratios were calculated for each time point, presenting a time curve for ¹4C-D-xylose absorption. Urine was collected after 210 min and the fraction of the total d-xylose passed was calculated (U%). ¹4CO2 in breath and ¹4C-D-xylose in urine were analyzed using liquid scintillation. RESULTS: Both breath and urine analysis revealed a pattern of malabsorption in alcoholics comparable with untreated celiac patients, with significantly reduced absorption of d-xylose compared with patient and healthy controls. CONCLUSION: Alcoholic patients have a significantly reduced ¹4C-D-xylose absorption, comparable with untreated celiac patients. This indicates a reduced intestinal function in chronic alcoholism.

Spectrum of malabsorption in India--tropical sprue is still the leader.

INTRODUCTION: Two decades ago tropical sprue, Immunoproliferative Small Intestinal Disease (IPSID) and infections were common causes of malabsorption in India. It is possible that implementation of preventive health measures and improved sanitation may have changed the spectrum of disorders causing malabsorption. The aim of this study therefore was to assess the spectrum of malabsorption seen at our center during the past nine years. METHODOLOGY: Patients seen at our center with malabsorption from January 2000 to December 2008 were included in this study. The etiological, clinical and investigation details were recorded on uniform structured data forms. The data obtained was retrospectively analyzed. RESULTS: Malabsorption was detected in 124 patients during the study period. The mean age of patients was 31.9+16 years and 60.5% were males. Tropical sprue was the commonest etiology (29%) followed by celiac and Crohn's disease (15.3% each). Other important etiologies included parasitic infestations (9.7%) and immune deficiency disorders (5.6%). Intestinal tuberculosis was seen in only 2.4% patients. CONCLUSIONS: We are witnessing a change in etiological spectrum of malabsorption . Celiac disease and inflammatory bowel disorders are emerging as important causes and ImmunoProliferative Small Intestinal Disease (IPSID) and intestinal tuberculosis are on the decline. Tropical Sprue however continues to be the commonest cause as in the past.

[Effects of Sijunzi Decoction on urine's xylose excretion rate and ATP in mucosa of spleen deficiency rats].

OBJECTIVE: To observe the effects of Sijunzi Decoction on D-xylose excretion rate and ATP content in the mucosa membranes of small intestines of rats with spleen deficiency. METHODS: Spleen deficiency model rats were made by reserpine injection. D-xylose excretion rate was measured with p-bromoaniline method, and the ATP content of small intestines mucosa was detected with bioluminescence method. The correlation between D-xylose excretion rate and ATP content of mucosa was also analyzed. RESULTS: Rats' body weight and D-xylose excretion rate decreased after reserpine injection (P < 0.01, vs control group), but increased after treated with Sijunzi Decoction (P < 0.05, vs model group). The ATP content of mucosa showed no significant difference between model group and control group. There was obviously positive correlation between the change of urine's D-xylose excretion rate and mucosa ATP content. CONCLUSION: Sijunzi Decoction has the activity of improving xylose absorption in spleen deficiency rats, but no obvious effect on their mucosa ATP content. The reducing of urine's D-xylose excretion rate in spleen deficiency rats is accompanied with the decrease of mucosa ATP content.

Severe acute pancreatitis: the life after.

BACKGROUND: The present study reports functional and morphological changes noted over long-term follow-up in patients with severe acute pancreatitis. METHODS: Thirty patients who had completed at least 6 months after recovery were included. Fecal fat, urinary D-xylose, blood sugar, C-peptide, pancreatic changes, and recurrences were studied. RESULTS: Etiology was gallstones (12), alcohol (10), both gallstone and alcohol (3), and idiopathic (5). Five patients were managed conservatively while 25 underwent surgery. Mean follow-up was 31.3 months. Exocrine and endocrine insufficiencies were noted in 12 (40%) and were more common in no-necrosis group compared to necrosis group (p = 0.04 and 0.28, respectively) and infected compared to sterile pancreatitis (45% vs. 25%, p = 0.55 and 50% vs. 12%, p = 0.15, respectively). Higher frequency was noted in nonvisualized, partly visualized, and dilated segment of duct. Significant proportion (8/12) had both exocrine and endocrine abnormalities and their incidence decreased as duration of follow-up increased. Urinary D-xylose excretion was abnormal in 16% and noted >1 year postrecovery. Thirty percent required >1 readmission and pain was the commonest cause. CONCLUSIONS: Forty percent had functional abnormality; 16% had mucosal absorption abnormality while 30% required >1 readmission. Exocrine and endocrine insufficiencies were more prevalent in first year, and a significant proportion had both. A trend for higher functional insufficiency was observed in infected necrosis, complete or incomplete visualization of main pancreatic duct (MPD), dilated segment of MPD, and pseudocyst.

Effect of intestinal pacing on small bowel transit and nutrient absorption in healthy volunteers.

BACKGROUND: Intestinal pacing (IP) has been previously shown to delay gastric emptying and reduce food intake in animals. The aims of this study were to investigate the effect and mechanism of IP on nutrient absorption in healthy volunteers. METHODS: Twelve healthy volunteers (six men, six women) were involved in a two-session (one session without IP and one with IP) study. At the beginning of each session, a nasal-duodenal feeding tube, with two ring electrodes (used for IP) on the tip of the tube, was incubated into the duodenum under endoscopy. After a complete recovery from the incubation, the duodenum was infused via the feeding tube with 150 ml 30% intralipid + 25 g D-xylose within 30 min, and the stool was collected for 24 h for the analysis of fecal lipid during which a controlled meal was taken. Then 100 ml 1mCi(99)Tc-labeled non-absorbable solution was infused within 3 min. The subject was asked to lie under a gamma camera for at least 1 h for the measurement of small bowel transit. The movement of isotopes was monitored by gamma camera at an interval of 10 s. The first appearance of isotopes in the cecum was considered as small intestinal transit time. The order of the two sessions was randomized and 1 week apart. In the IP session, intestinal pacing was performed via the pair of the ring electrodes for 2 h initiated at the beginning of infusion with a pacing frequency of 13 pulses/min, pulse width of 300 ms and amplitude of 5 mA. RESULTS: (1) IP significantly reduced lipid and D-xylose absorption. The fecal lipid was 6.6 +/- 4.6 g without IP and almost doubled with IP (11.1 +/- 6.5 g, P = 0.047). Similarly, the D-xylose in urine was 3.46 +/- 2.22 g with IP, which was significantly lower than that without IP (6.63 +/- 5.06 g, p = 0.049). (2) IP accelerated intestinal transit. The transit time was 39 +/- 17 min in the control session and reduced to 28 +/- 10 min in the IP session (p < 0.03). (3) Diarrhea was reported in one subject without IP but in six subjects with IP (p < 0.05). CONCLUSIONS: The increased fecal lipid and induction of diarrhea with intestinal pacing suggest that intestinal pacing is capable of inducing malabsorption. This effect maybe contributed to the acceleration of intestinal transit.

Intestinal permeability and vitamin A absorption in patients with chemotherapy-induced diarrhea.

OBJECTIVE: Gastrointestinal toxicity is one of the most common side effects of anticancer therapy. Measurement of intestinal permeability represents one of the potential methods of noninvasive laboratory assessment of gastrointestinal toxicity. The aim of the present study was to investigate intestinal permeability and vitamin A absorption in patients with chemotherapy-induced diarrhea (CID). METHODS: We have assessed intestinal permeability, by measuring absorption of lactulose, mannitol, xylose, and vitamin A absorption, in 11 patients with CID, 10 healthy controls, and 24 untreated patients with gastrointestinal tumors. Urinary lactulose, mannitol and xylose were measured by capillary gas chromatography and serum retinol and retinyl esters were determined by high performance liquid chromatography. The results obtained in patients and controls were compared by Mann-Whitney U test. RESULTS: Lactulose/mannitol and lactulose/xylose ratios were increased and retinol esters (retinyl palmitate and retinyl stearate) were decreased significantly in patients with CID. CONCLUSIONS: Measurements of intestinal permeability and vitamin A absorption may represent sensitive tools in the assessment of CID.

Early gut mucosal dysfunction in patients with acute pancreatitis.

OBJECTIVES: A clinical study was made to test the hypothesis that gut mucosal damage happens and correlates with endotoxemia, systemic inflammation, severity of disease, septic complication, and outcome in acute pancreatitis (AP) patients. METHODS: Patients were divided into 3 groups according to severity: grade 1 (n = 26, mild), grade 2 (n = 18, severe AP [SAP] without organ dysfunction), and grade 3 (n = 18, SAP with organ dysfunction). Twenty healthy volunteers were enrolled as control group. The intestinal lactulose and mannitol absorption ratio, d-xylose absorption, endotoxin, and tumor necrosis factor alpha were detected in parallel to clinical data collection. RESULTS: Lactulose and mannitol absorption ratio increased in patients with AP, and the increase was more pronounced in SAP (grade 1: 0.044 +/- 0.017, grade 2: 0.39 +/- 0.16, grade 3: 0.48 +/- 0.22, control: 0.024 +/- 0.009; P < 0.01 between control and AP, P < 0.01 between mild and severe group). d-Xylose absorption decreased in pancreatitis groups (P < 0.01) especially in severe groups (P < 0.01 between mild and SAP). We also observed a significant positive correlation of mucosal permeability with endotoxin (r = 0.902, P < 0.001) and tumor necrosis factor alpha changes (r = 0.862, P < 0.001). The severity and septic complication in AP patients were different accompanied with severity of gut mucosal damage. CONCLUSIONS: Intestinal mucosal function is injured in early phase of AP especially in patients with organ dysfunction, which may be a stimulus for development of multiple organ dysfunction and correlate with bad outcome in AP patients.

Intestinal permeability and its association with the patient and disease characteristics in Crohn's disease.

AIM: To assess the intestinal permeability (IP) in patients with Crohn's disease (CD) and study the association of IP with the patient and disease characteristics. METHODS: One hundred and twenty five consecutive patients of CD (Males: 66) were diagnosed on the basis of a combination of standard clinical, endoscopic, imaging and histological features. CD activity index (CDAI) was used to calculate the activity of the disease while the behavior of the disease was assessed by the modified Montreal classification. IP was measured by the ratio of the percentage excretion of ingested doses of lactulose and mannitol in urine (LMR). The upper limit of normality of LMR (0.037) was derived from 22 healthy controls. RESULTS: Thirty six percent of patients with CD had increased IP. There was no significant difference in mannitol excretion (patients vs controls=12.5% vs 14.2%, P=0.4652), but lactulose excretion was significantly higher in patients compared to healthy controls (patients vs controls=0.326% vs 0.293%, P=0.0391). The mean LMR was also significantly higher in the patients as compared to healthy controls [0.027 (0.0029-0.278) vs 0.0164 (0.0018-0.0548), P=0.0044]. Male patients had a higher LMR compared to females [0.036 (95% CI 0.029, 0.046) vs 0.022 (95% CI 0.0178, 0.028) (P=0.0024), though there was no difference in the number of patients with abnormal IP in both the sexes. Patients with an ileo-colonic disease had a higher LMR than those with only colonic disease [0.045 (95% CI 0.033, 0.06) vs 0.021 (95% CI 0.017, 0.025) (P<0.001)]. Of patients with ileo-colonic disease, 57.8% had an abnormal IP, compared to 26.7% with colonic and 15.6% with small intestinal disease. Patients with a stricturing disease had significantly higher LMR compared to non-fistulising non-stricturing disease [0.043 (95% CI 0.032, 0.058) vs 0.024 (95% CI 0.019, 0.029) (P=0.0062)]. There was no correlation of IP with age, disease activity, duration of illness, D-xylose absorption, upper GI involvement, perianal disease, and extra-intestinal manifestations. On multiple regression analysis, male gender and ileo-colonic disease were independent factors associated with increased IP. Gender, location, behavior of the disease and upper GI involvement could explain up to 23% of variability in IP (R2=0.23). CONCLUSION: IP was increased in 36% of patients with CD. Male gender and an ileo-colonic disease were the independent factors associated with increased IP.

Comparison of D-xylose hydrogen breath test with urinary D-xylose test in Indian children with celiac disease.

D-xylose hydrogen breath test (H2BT) may be better parameter in screening for intestinal malabsorption in patients with celiac disease. This study sought to compare D-xylose H2BT with urinary D-xylose tests in screening for intestinal malabsorption in patients with celiac disease. A total of 68 children with confirmed celiac disease were enrolled for this study. Five-gram urine D-xylose test and D-xylose H2BT were performed simultaneously according to standard methods. Institute ethical clearance and informed consent was taken before starting this study. Of 68 children, 41 were boys and 27 girls of age range 5-14 years; 5-g urine D-xylose test was abnormal in 50% of cases and 5-g D-xylose H2BT in 69.9% of cases. D-xylose H2BT was able to pick up 19.9% more cases of malabsorption in Indian children with celiac disease. This study indicates that performance of 5-g D-xylose H2BT is a better test than 5-g urinary D-xylose test in screening for intestinal malabsorption in patients with celiac disease.

[Impact of dehelminthization on pancreatic incretory and excretory functions in patients with psoriasis concurrent with chronic opisthorchiasis].

A hundred and thirty patients, including 60 patients with psoriasis concurrent with chronic opisthorchiasis, 40 with psoriasis without helminthiasis, and 30 with chronic opisthorchiasis, and 15 healthy individuals were examined. To evaluate the pancreas, its incretory and excretory functions were studied. In patients with psoriasis concurrent with chronic opisthorchiasis, the pancreatic level of hormones and enzymes was significantly lower than those in patients with psoriasis without helminthiasis. Twelve months after dehelminthization, a follow-up of the parameters of the incretory function revealed their significant increase in 43 patients. Following dehelminthization, the excretory function in terms of amylase and lipase was significantly greater than that before dehelminthization. By taking into account steatorrhea, pancreatic excretory dysfunction showed significantly less fecal fat losses after a course of anthelminthic therapy. Malabsorption diminished in patients after anthelminthic therapy, as confirmed by increased urinary D-xylose excretion. Pancreatic proteolytic activity improved after dehelminthization, as supported by a significant increase in urinary PABA excretion. No improvement was observed in patients receiving no anthelminthic therapy; on the contrary, deterioration was established in half of them. Therefore, a year after dehelminthization, helminthological cure in patients with psoriasis concurrent with chronic opisthorchiasis causes a significant improvement in pancreatic incretory and excretory functions and promotes regression of psoriatic manifestation.

[Clinical research on effects of yunpi zhixie granule in children with diarrhea].

OBJECTIVE: To investigate the clinical effect of Yunpi Zhixie Granule (YZG) on children's diarrhea. METHODS: Three hundred diarrhea cases were randomly divided into two groups equally, the treated group treated by YZG orally and the control group by smacta, both for 7 days. The clinical efficacy was observed, routine scatologic analysis, scatologic cultivation, rotavirus antigen and urinary D-xylose content were detected. RESULTS: Clinical results showed the effective rate in treating the chronic or Pi-deficiency diarrhea as well as the negative conversion rate and improvement rate of routine scatologic analysis were all higher in the treated group than those in the control group (P < 0.05); while no significant difference was found in negative conversion rate of scatologic cultivation and rotavirus antigen and urinary D-xylose content after treatment, compared with those before treatment (P > 0.05). CONCLUSION: YZG was effective in treating children' s diarrhea, especially on chronic diarrhea and diarrhea of Pi-deficiency type.

Clinical features of celiac disease in Indian children: are they different from the West?

OBJECTIVE: This study was designed to prospectively evaluate the clinical features of celiac disease (CD) in a large group of Indian children and to compare them with those from the West. PATIENTS AND METHODS: Over a period of 5 years, a total of 549 children (< or = 14 years) with a clinical suspicion of CD were evaluated. Their detailed clinical features, investigations, and follow-up data were recorded. Complete hemogram, endoscopic duodenal biopsy, and celiac serology were done in all of the cases. Celiac disease was diagnosed on the basis of modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition criteria. RESULTS: Celiac disease was diagnosed in 300 children; 39 were excluded because of lack of follow-up or poor response to gluten-free diet. The remaining 210 had normal villous architecture and served as controls. The mean (+/- standard deviation) age of children with CD was 6.7 +/- 3 years, and the mean duration of symptoms was 3.5 +/- 2.5 years. The majority (84%) presented with diarrhea; other features were failure to thrive in 91%, anemia in 84%, wasting in 87%, and stunting in 60% of cases. Among the serological tests, the best results were obtained with tissue transglutaminase. On follow-up (19.4 +/- 15.5 months), symptoms subsided in all cases of CD with a significant weight and height gain. CONCLUSIONS: Indian children with CD present late, with a significant delay in diagnosis. The majority presents with classic symptoms of diarrhea, failure to thrive, and anemia. There is a need for increasing awareness to pick up the atypical forms of the disease.

[Assessment of nutritional status and of intestinal absorption in asymptomatic patients infected with the human immunodeficiency virus (HIV) with and without chronic hepatitis]. / Valoración del estado nutricional y de la absorción intestinal en pacientes asintomáticos infectados por el virus de la inmunodeficiencia humana (VIH) con y sin hepatitis C crónica.

OBJECTIVE: To compare nutritional status and intestinal absorption in asymptomatics HIV patients co-infected or not with hepatitis C virus. MATERIAL AND METHODS: 15 patients (9 men and 6 women) HIV seropositive in A1-A2 stage were classified in two groups, A were asymptomatics HIV patients and B were asymptomatic HIV patients with chronic hepatitis C. Nutritional status was determined by weight, height, % ideal weight, body mass index, triceps skinfold, midarm muscle circumference, grip dynamometry and body composition measured by bioelectrical impedance. Intestinal absorption was assesses with D-xilosa test in urine collected over 5 hours after fasting ingestion of 5 grams of D-xylosa. Statistical analysis was made with SPSS (v.11.0). RESULTS: Not statistically significative differences were found in the nutritional status between the two groups of patients. Asymptomatics HIV patients with chronic hepatitis C eliminate less D-xylosa in urine than patients without chronic hepatitis C, being this difference statistically significative. Three out of the eight patients (37.5%) of group B presented malabsorption (< 1.2 grams of D-xylosa in urine). In group A any patient had malabsorption. DISCUSSION: In our study, asymptomatic HIV patients have a good nutritional status, without differences between patients co-infected or not with hepatitis C virus. Intestinal absorption is altered in patients co-infected and this should be considered because of its potential clinical consequences.