Colonic content in health and its relation to functional gut symptoms

Bendezú, R. A.; Barba, Elizabeth; Burri, Emanuel; Cisternas, Daniel; Accarino, Anna; Quiroga, S.; Monclús, Eva; Navazo, Isabel; Malagelada, Juan R.; Azpiroz, Fernando

doi:10.1111/nmo.12782

Cited by 17 publications

(20 citation statements)

References 13 publications

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“…As in previous studies, intraluminal content was evenly distributed along the colon, and the distribution was not affected by diet. However, the mass of non‐gaseous colonic content was influenced by the amount of non‐absorbable residues in the diet; the change was considerable and rapid, and already significant (by over 30%) after a 3‐day intervention period.…”

Section: Discussionsupporting

confidence: 83%

“…Non‐gaseous colonic content was measured in T1 colonic images, and gaseous colonic content was measured by subtracting T1 from T2 colonic volumes. A three‐dimensional reconstruction program with 360° rotation over the three dimensions, previously developed for morphovolumetric analysis of CT images, was adapted for MRI analysis to facilitate measurement of volumes in selected regions of the colon . The different blocks of the analysis program underwent a series of interim validation steps during the development phase.…”

Section: Methodsmentioning

confidence: 99%

“…Abdominal CT imaging is useful for detecting variations in colonic content in relation to physiologic stimuli, i.e. meal ingestion in healthy subjects, as well as in relation to symptoms, particularly in patients complaining of abdominal bloating and distension . However, the radiation involved in CT limits its application for repeat imaging.…”

Section: Introductionmentioning

confidence: 99%

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Colonic content: effect of diet, meals, and defecation

Bendezú

Mego

Monclús

et al. 2016

Neurogastroenterology Motil

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Background: The metabolic activity of colonic microbiota is influenced by diet; however, the relationship between metabolism and colonic content is not known. Our aim was to determine the effect of meals, defecation, and diet on colonic content. Methods:In 10 healthy subjects, two abdominal MRI scans were acquired during fasting, 1 week apart, and after 3 days on low-and high-residue diets, respectively. With each diet, daily fecal output and the number of daytime anal gas evacuations were measured. On the first study day, a second scan was acquired 4 hours after a test meal (n=6) or after 4 hours with nil ingestion (n=4). On the second study day, a scan was also acquired after a spontaneous bowel movement.Results: On the low-residue diet, daily fecal volume averaged 145 ± 15 mL; subjects passed 10.6 ± 1.6 daytime anal gas evacuations and, by the third day, non-gaseous colonic content was 479 ± 36 mL. The high-residue diet increased the three parameters to 16.5 ± 2.9 anal gas evacuations, 223 ± 19 mL fecal output, and 616 ± 55 mL non-gaseous colonic content (P<.05 vs low-residue diet for all). On the low-residue diet, non-gaseous content in the right colon had increased by 41 ± 11 mL, 4 hours after the test meal, whereas no significant change was observed after 4-hour fast (−15 ± 8 mL; P=.006 vs fed). Defecation significantly reduced the non-gaseous content in distal colonic segments. Conclusion & Inferences:Colonic content exhibits physiologic variations with an approximate 1/3 daily turnover produced by meals and defecation, superimposed over diet-related day-to-day variations. K E Y W O R D Scolonic content, diet, fecal output, intestinal gas, meals

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Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Colonic content: effect of diet, meals, and defecation

Bendezú

Mego

Monclús

et al. 2016

Neurogastroenterology Motil

Self Cite

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“…The increase in gas content observed was probably related to the arrival into the colon of complex carbohydrates resistant to small bowel digestion. The amount of colonic gas and the intraluminal distribution of the gaseous mass, both during basal conditions as well as after eating lettuce, was within the normal range observed in healthy subjects during fasting and after a regular meal …”

Section: Discussionsupporting

confidence: 65%

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Barba

Sánchez

Burri

et al. 2019

Neurogastroenterology Motil

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BackgroundSome patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients' assertion is sustained by evidence.MethodsAn in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas‐releasing substrate, to meat, a low gas‐releasing substrate, and to a nutrient‐free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce‐induced distension as compared to basal conditions.Key ResultsGas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient‐free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.Conclusion and InferencesLettuce is a low gas‐releasing substrate for microbiota fermentation and lettuce‐induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.

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“…An experimental gas challenge test (high-rate exogenous gas infusion directly into the jejunum) has shown that patients with functional dyspepsia who complain of bloating have impaired handling of intestinal gas, that is, gas retention, abdominal symptoms or both 165 . However, studies using abdominal CT and MRI scanning in clinical conditions could not corre late abdominal symptoms with excessive intestinal gas in these patients, as in the majority of the patients the volume and distribution of intestinal gas were within the normal ranges 166,167 . Hence, the perception of abdominal bloating could be related to a poor tolerance of normal gut content.…”

Section: Gas-related Symptomsmentioning

confidence: 82%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

260

247

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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Colonic content in health and its relation to functional gut symptoms

Cited by 17 publications

References 13 publications

Colonic content: effect of diet, meals, and defecation

Colonic content: effect of diet, meals, and defecation

Abdominal distension after eating lettuce: The role of intestinal gas evaluated in vitro and by abdominal CT imaging

Functional dyspepsia

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