Low-fat, lactose-free and leucine-enriched chocolate cow milk prototype: A preliminary study on sensorial acceptability and gastrointestinal complaints following exhaustive exercise.

BACKGROUND: Chocolate milk has gained recent scientific support as a recovery drink. However, it is known that high exercise-demand triggers gastrointestinal discomfort which continues post-exercise, thereby hindering this nutritional strategy. In addition, those who are lactose intolerant cannot benefit from a milk-based beverage. Thus, the aim of this preliminary study was to develop a low-fat, lactose-free, and leucine-enriched chocolate cow milk prototype (CML) representing nutrition-related recommendations for football players, as well as assess athletes' individual subjective outcomes for gastrointestinal complaints and sensorial acceptability in a field-based setting following strenuous team-sport physical demands. METHODS: This study followed a single group and repeated-measured design with 10 football players (23 ± 2 yrs., 74 ± 14 kg, 174 ± 5 cm) who consumed CML following a 90-min football match simulation protocol (FMP). The total CML intake to achieve 0.150 g leucine·kg [BW]·h- 1 occurred in aliquots of 50, 30 and 20% at 0-, 45- and 75-min post-FMP, respectively. Athletes were evaluated by the prevalence, the type and severity (bloating, nausea, flatulence, and gastric reflux) of gastrointestinal complaints and sensorial acceptability (overall perception, appearance, consistency, and flavour) after drinking each aliquot in a 4-h recovery period. RESULTS: The CML showed higher scores for "Product Acceptability Index" (88%) and sensorial acceptability (~ 8 in 9-point hedonic scale). Kendall's W with bootstrapped resample (95%CI) revealed agreement among respondents as "moderate" (overall perception, flavour) to "strong" (appearance, consistency) and with no significant agreement differences between rater response in the timeline analysis (0.57 up to 0.87; p > 0.05). Agresti-Caffo add-4 analysis (95% confidence interval, [95%CI]) revealed no differences in each time-point analysis versus baseline for athletes classified as having severe gastrointestinal symptoms, but confirmed concern with bloating (three athletes showed a transient response at 2-h and only one continued until 3-h; p = 0.051). CONCLUSIONS: These preliminary findings suggest that CML presents good taste and high acceptability by the sampled athletes. Thus, CML may be an alternative sport drink for immediate post-workout supplementation to overcome the energy deficit, offer co-ingested leucine, maintain palatability and adherence including lactose intolerance following a team sport-specific fatigue. TRIAL REGISTRATION: RBR-2vmpz9 , 10/12/2019, retrospectively registered.

[Correlation between the presence and intensity of symptoms and the results of hydrogen breath tests in the diagnosis of carbohydrate intolerance]. / Correlación entre los síntomas digestivos y los resultados de una prueba de hidrógeno en aliento en el diagnóstico de intolerancia a carbohidratos.

BACKGROUND: Hydrogen breath tests (HBT) are used to confirm the diagnosis of carbohydrate intolerance or small intestinal bacterial overgrowth (SIBO). OBJECTIVE: Determine the existence of a correlation between the presence and intensity of symptoms experimented by the patient after the ingestion of a carbohydrate load and the test result. MATERIALS AND METHODS: This is an observational, retrospective and analytic study, in which all patients' files from year 2008 to 2014 containing a report of a HBT performed at Hospital San José TEC de Monterrey were revised. Using a visual analogue scale (VAS), the patient reported the intensity of gastrointestinal symptoms during the test. Descriptive statistics were obtained, and exclusively for lactose HBTs, Pearson's correlation coefficient (r) between maximum hydrogen concentration in breath and symptom intensity was calculated. RESULTS: A HBT was performed in 33 patients: 23 with lactose, 5 with fructose, and 5 with lactulose as substrate. Of these, 10, 2, and 5 tests were positive, respectively. For lactose HBTs, the symptom with most sensitivity was flatulence (80%), which also had the greatest likelihood ratio for a positive test (1.73). Diarrhea had the greatest specificity (84.6%). A tendency for positivity was observed when patients presented symptoms. A moderately positive correlation between hydrogen ppm and symptom intensity was found (r=0.427, p=0.023). CONCLUSIONS: A correlation between symptom intensity and test positivity was found in patients with lactose intolerance. The presence of flatulence after lactose loading may be indicative of a positive test.

[Forty-four years of advances in pathogenesis, diagnosis and treatment of flatulence syndrome]. / 44 años de avances en etiopatogenia, diagnóstico y tratamiento del síndrome flatulencia.

In the present paper, the author reminds investigations performed, since forty-four years ago, to clarify the etiopathogenesis and to improve the diagnosis and treatment of the flatulence syndrome.

44 años de avances en Etiopatogenia, Diagnóstico y Tratamiento del Síndrome Flatulencia / Forty-four years of advances in pathogenesis, diagnosis and treatment of Flatulence Syndrome

En el presente artículo, el autor recuerda trabajos de investigación realizados, desde hace cuarenticuatro años, para aclarar la etiopatogenia y mejorar el diagnóstico y tratamiento del síndrome flatulencia.

In the present paper, the author reminds investigations performed, since forty-four years ago, to clarify the ethiopathogenesis and to improve the diagnosis and treatment of the flatulence syndrome.

[Gastrointestinal syndromes (3): flatulence (2)]. / Grandes síndromes gastrointestinales (3): flatulencia (2).

The second part of the article on flatulence reviewed aspects of the pathogenesis, diagnosis and treatment of this syndrome.

[Gastrointestinal syndromes (3): flatulence (1)]. / Grandes síndromes gastrointestinales (3): flatulencia (1).

Now we expose important data on definition and cardinal symptoms of the flatulence syndrome and, besides, on accumulated knowledge in relation to digestive tract gases.

[Flatulence]. / Flatulencia.

At present physicians focus their medicine studies in well defined illnesses as peptic ulcer, gastric cancer, ulcerative colitis and so on. However, patients reveal their discomfort to us, that is their symptoms or group of symptoms (syndromes). For this reason, our concern for many years has been the study of symptoms and syndromes. In this review we will be looking at the concepts and information gathered with respect to intestinal gases, clinically known as flatulence.

Resultados de la colecistectomía a 10 años plazo / Clinical status of patients subjected to cholecystectomy 10 years after

Background: The post cholecystectomy syndrome comprises a series of vague symptoms referred by patients subjected to this surgical procedure. These symptoms are unspecific and their association with the operation is dubious. Aim: To assess the frequency of digestive symptoms among patients subjected to a cholecystectomy ten years ago. Patients and methods: One hundred patients subjected to a cholecystectomy between 1987 and 1990, were contacted by mail. They were invited to a clinical interview and to an abdominal ultrasound examination. Results: Two invited patients had died of an acute myocardial infarction. Therefore, 98 patients (78 women), aged 30 to 85 years old, were assessed. Seventy two percent had diverse dyspeptic symptoms, 90 percent had no food intolerance and 94 percent had gained weight after the operation. Ninety six percent was satisfied with the surgical results, 3 percent had severe symptoms due to gastroesophageal reflux or depression. One patient had a residual choledocholithiasis and refused any treatment. Conclusions: Cholecystectomy is well tolerated and has good long term results

[Pneumatosis intestinalis. Report of 3 cases]. / Neumatosis intestinal. Informe de tres casos.

OBJECTIVE: To describe the clinical, radiological, morphological, and immunohistochemical characteristics of three cases of pneumatosis intestinalis. METHODS: From 1982 to 1999, cases diagnosed as pneumatosis cystoides intestinalis were reviewed. The laboratory results, X-ray findings, clinical course, treatment and evolution were obtained from the clinical charts. Slides and macroscopic photos were obtained from the surgical pathology files. New slides were obtained from the paraffin blocks for immunohistochemical detection of endothelial cells (CD 31) and macrophagic cells (CD 68). RESULTS: We found three patients with pneumatosis intestinalis associated to a history of abdominal surgeries from 936 enteral resections (0.3%). These three patients showed clinical features of intestinal obstruction. Morphological and immunohistochemical analysis showed pseudocysts without an epithelial and endothelial lining. Some spaces were lined by multinucleated giant cells positive for CD 68 and endothelial cells that were CD 31 positive. CONCLUSIONS: Antecedent of obstruction and abdominal surgeries were the constant association with pneumatosis cystoides intestinalis. Most lesions were pseudocysts without epithelial or endothelial lining.

Absceso hepático formador de gas en el paciente diabético. Una asociación clínica poco reconocida / Gas forming hepatic abscess in the diabetic patient. a rarely known clinical association

El absceso hepático piógeno, frecuentemente es secundario a infecciones intrabdominales. Sin embargo, en el paciente diabético, esta asociación no es un requisito. Los gérmenes formadores de gas afectan al diabético produciendo diversas entidades nosológicas como colecistitis enfisematos, apendicitis gangrenosa, abscesos perinefríticos, fascitis necrosante entre otros. Presentamos el caso de un paciente diabético de 47 años de edad al que se le diagnosticó un absceso hepático por gérmenes formadores de gas que se trató mediante punción percutánea y antibióticos. Se analizan los factores predisponentes a la aparición de esta asociación, así como la forma de manejo en la actualidad

Evaluation of the effect of a fiber-enriched formula on infant colic.

Because infants with colic appear to have abdominal pain similar to that of adults with irritable bowel syndrome, who may benefit from the addition of fiber to their diet, we tested whether fiber added to infant formula would alleviate colic. Twenty-seven normal, term infants (aged 2 to 8 weeks; 14 girls) with colic, defined as crying plus fussing for more than 3 hours a day for at least 3 days of a 6-day baseline period, were enrolled. Infants were randomly assigned in 9-day periods to a sequence of placebo (Isomil formula) followed by fiber-supplemented formula (Isomil plus soy polysaccharide) (n = 12) or the reverse (n = 15). Daily diaries of crying, fussing, sleeping, formula, intake, and stooling were kept. Twenty-two infants completed three lactulose breath hydrogen tests at the end of the baseline period and after each study period. The crossover trial was followed by 30 to 35 days of use of the study formula chosen by the parents as most beneficial but unknown to the investigators. Growth was monitored throughout. Serum cholesterol, calcium, phosphate, albumin, iron, and zinc concentrations were measured at the conclusion. There were no significant differences in average daily time spent by the infants in fussing and crying during ingestion of the fiber-supplemented formula. However, parents of 18 of 27 infants chose fiber-supplemented formula as most beneficial in ameliorating symptoms of colic. While the infants were consuming fiber-supplemented formula, stool frequency increased, and breath hydrogen excretion increased significantly, in response to lactulose. Growth and serum biochemical measurements were normal in all infants. Supplementation of infant formula with the level of soy polysaccharide used in this study may have reduced crying and fussing in some infants but did not affect colicky behavior in the majority of infants, who continued to cry and fuss excessively.

Lactose intolerance among Mexican Americans.

Thirty-three Mexican Americans between the ages of 9 and 60 were interviewed and tested for lactose intolerance. The participants of the study included 16 children and 17 persons not related by birth, including the parents of the children. Determination of lactose intolerance was based on a rise of less than 25mg/100 ml of blood glucose as measured by an Ames Dextrostix/Reflectance Meter following consumption of a lactose load. Forty-seven percent of the 17 nonrelated Mexican Americans were lactose intolerant. There was a marked relationship between low rise in blood glucose and symptoms of diarrhea, flatulence, and distention. Sixteen children from four families had an incidence of 50 per cent intolerance. The findings of intolerance in two successive generations of three families and in both sexes of the families adds support to the contention that lactose intolerance has a genetic basis, without sex predilection.