Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome

Zhou, QiQi; Verne, Meghan L; Fields, Jeremy Z.; Lefante, John J.; Basra, Sarpreet; Salameh, Habeeb; Verne, G. Nicholas

doi:10.1136/gutjnl-2017-315136

Cited by 136 publications

(95 citation statements)

References 33 publications

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“…54 In a randomized controlled trial, Zhou et al recently showed the beneficial effect of glutamine supplementation on intestinal permeability and gastrointestinal symptoms in post-infectious IBS patients. 56 All these data are in accordance with previous studies showing that glutamine supplementation or deprivation is able to modify TJ protein expression and influence intestinal permeability. 50,57 The mechanisms of action for glutamine remain not completely understood and have been previously discussed.…”

Section: Discussionsupporting

confidence: 92%

Colonic Proteome Signature in Immunoproteasome-Deficient Stressed Mice and Its Relevance for Irritable Bowel Syndrome

et al. 2018

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A role for immunoproteasome in the regulation of intestinal permeability has been previously suggested both in mice during water avoidance stress (WAS) and in patients with irritable bowel syndrome (IBS). Here, we provide evidence that the ubiquitin-proteasome system (UPS) contributes to the pathophysiology of IBS. Indeed, we report that colonic proteome is altered in WAS mice and that β2i subunit deficiency modifies the proteome response that is associated with a limitation of colonic hyperpermeability. Interestingly, we show specific alterations of proteins involved in UPS, mitochondrial and energy metabolism. We also report changes in the pattern of colonic ubiquitome in diarrhea-predominant IBS patients (IBS-D), and particularly a reduced expression of ubiquitinated proteins involved in the NF-κB inflammatory signaling pathway. All these data suggest that immunoproteasome targeting may represent a new therapeutic strategy for the treatment of IBS patients with increased intestinal permeability.

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Section: Discussionsupporting

confidence: 92%

Colonic Proteome Signature in Immunoproteasome-Deficient Stressed Mice and Its Relevance for Irritable Bowel Syndrome

et al. 2018

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“…The use of l-Glutamine supplementation to support GI barrier function has received extensive examination [214]. Benefits have repeatedly been shown in humans following large intravenous L -glutamine infusions (~0.2-0.5 g•kg•day −1 ) in patients with critical illness indicative of glutamine deficiency, including severe burns [215,216], post-infectious irritable bowel syndrome [217], and major abdominal trauma [218]. In comparison, benefits are less prominent with low dose oral ingestion (<0.2 g•kg•day −1 ) in chronic GI diseases patients, whom are unlikely to be glutamine deficient and/or exposed to acute stress [219,220].…”

Section: Glutaminementioning

confidence: 99%

The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures

Ogden

Child

Fallowfield³

et al. 2020

Nutrients

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Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat-related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to disease pathophysiology. Contemporary research has focused to understand the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is strongly characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion-mediated ischemic injury, and neuroendocrine-immune alterations. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress.

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“…23 Although digestive health symptoms appear to lack association with IP, this should not undermine the association between gastrointestinal conditions and IP, especially provided the high correlation between the improvement of altered IP and a reduction in postinfectious IBS disease severity purported in the literature. 76 Conversely, many of the risk factors that resemble a metabolic-like condition were found to be associated with IP in the general population. 23,44,56 However, risk factors such as waist-to-hip ratio, waist circumference and elevated triglycerides, were less associated with IP in the general population when compared to a disease state.…”

Section: Strongest Risk Factors For Altered Intestinal Permeabilitymentioning

confidence: 99%

Risk factors associated with intestinal permeability in an adult population: A systematic review

et al. 2019

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Background Increased intestinal permeability (IP) involves the loss of integrity between the cells of the small intestine. IP has been suggested to contribute to the pathogenesis and exacerbation of many chronic diseases. Many potential risk factors for IP are proposed in contemporary literature. The purpose of this review is to identify the most significant risk factors for IP. Methods A systematic search of literature published up until September 2018 in the PubMed, EMBASE, CINAHL, and Scopus databases was conducted. Results A total of 47 articles met the inclusion criteria. Elevated levels of proinflammatory markers, dyslipidaemia, hyperglycaemia, insulin resistance, anthropometric measurements resembling obesity, advanced disease severity, comorbidity and the consumption of a Western‐style diet were identified as the strongest risk factors for altered intestinal integrity. The risk of IP increases when coupled with a multiple disease state or combined with other environmental risk factors. Furthermore, many of the identified risk factors such as anthropometric measurements and biomarkers were external from intestinal health and rather resembled a metabolic‐like condition. Conclusions This review identified a number of potential risk factors for IP, ranging from biomarkers to anthropometric measurements, demographics, dietary intake and chronic diseases. These risk factors warrant the attention of clinicians and other healthcare providers to aid the identification of potential patients at risk of altered IP. Further research needs to examine whether the identified risk factors are homogeneous with the diagnosis of IP or whether the disease state influences the association.

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Randomised placebo-controlled trial of dietary glutamine supplements for postinfectious irritable bowel syndrome

Cited by 136 publications

References 33 publications

Colonic Proteome Signature in Immunoproteasome-Deficient Stressed Mice and Its Relevance for Irritable Bowel Syndrome

Colonic Proteome Signature in Immunoproteasome-Deficient Stressed Mice and Its Relevance for Irritable Bowel Syndrome

The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures

Risk factors associated with intestinal permeability in an adult population: A systematic review

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