Is it necessary to correct the intestinal microbiota disorders in chronic pancreatitis?

The frequency of intestinal microbiota disorders in patients with chronic pancreatitis (CP) is extremely high and can reach 97%. The bacterial overgrowth syndrome (SIBO) and the syndrome of increased epithelial permeability (SPEP), developing against the background of excretory insufficiency of the pancreas, affect the severity of the clinical picture of the disease, reduce the effectiveness of enzyme replacement therapy and generally contribute to the further progression of CP.The article presents a modern view on the mechanisms of the formation of SIBO and SPEP in CP. There is their aggravating effect on the course of the disease and the aggravation of disorders of the digestive and absorption processes that accompany them is shown and analyzed in the article.For decontamination of conditionally pathogenic and pathogenic flora, increasing the number and metabolic activity of indigenous microflora in patients with CP, the use of a non-absorbable broad-spectrum antibiotic rifaximin is effective. In order to restore the barrier function of the gastrointestinal mucosa, the drug of choice is rebamipid, a universal cytoprotector that affects all three levels of epithelial tissue protection (preepithelial, epithelial and subepithelial).Conclusion. CP is characterized by the complexity of its etiology and pathogenesis. Bacterial factors, in particular, SIBO and SPEP, play an essential role in the development of inflammatory changes in the pancreas. In the complex therapy of CP, it is advisable to take measures aimed at correcting disorders of the intestinal microbiota.

Image Quality of Abdominal Ultrasonography After Esophagogastroduodenoscopy is Preserved by Using Carbon Dioxide Insufflation

Because bowel gas deteriorates the image quality of abdominal ultrasonography (AUS), it is common to perform AUS prior to esophagogastroduodenoscopy (EGD). This one-way order limits the availability of examination appointments. To evaluate whether EGD using insufflation of carbon dioxide (CO2), which is rapidly absorbed by the gastrointestinal mucosa, preserves the image quality of AUS performed subsequently, we designed a non-inferiority test in which each subject underwent AUS, EGD with CO2 insufflation, and a second AUS. All saved AUS moving images were randomized and evaluated using a four-point Likert scale that divides the depiction rate by 25%. Sample size was calculated to be 26 and 30 subjects were enrolled. The mean and 95% confidence interval (CI) of the image quality score at pre- and post-EGD AUS were 3.54 [3.48–3.60] and 3.46 [3.39–3.52], respectively. The difference in the means was 0.08, corresponding to a 2% depiction rate. The effect size was 0.172. The image quality of post-EGD AUS was not inferior, as demonstrated by the 97.5% CI of the difference, which did not cross the non-inferiority margin of –0.40 corresponding to depiction rate of –10%. Because EGD using CO2 insufflation does not appreciably deteriorate the image quality of AUS performed subsequently, it is permissible to perform EGD prior to AUS.

Proton pump inhibitors usage and the risk of cancer

Introduction and purpose of the work:Proton pump inhibitors are used to reduce gastric acidity by irreversibly inhibiting the hydrogen-potassium ATPase present in the parietal cells of the stomach. These drugs are used more and more often, often not in accordance with the recommendations. There are reports suggesting a relationship between chronic PPI use and the occurrence of cancer. The aim of the study is to present information on the relationship between the use of proton pump inhibitors and the risk of developing cancer.State of knowledge:Recent field studies have shown that there is a significant relationship between PPI use and carcinogenesis. One possible mechanism is related to the sustained release of gastrin in large amounts, which in turn stimulates the production of substances with trophic effects on the gastrointestinal mucosa, and cell proliferation over time may lead to cancer formation. The relationship between high gastrin concentration and the formation of gastric neuroendocrine neoplasms, tumors of the liver, pancreas and esophagus has been proven.Summary:Proton pump inhibitors are considered safe drugs. Taking into account the described reports on the increased risk of developing certain cancers, when prescribing PPIs, the risk associated with their use should also be taken into account. However, it seems that the benefits of using these drugs outweigh the risks in most cases.

Geospatial Assessments of DNA Adducts in the Human Stomach: A Model of Field Cancerization

Background: Field cancerization is a popular concept regarding where cancer cells arise in a plane, such as the opened-up gastrointestinal mucosa. The geospatial distribution of DNA adducts, some of which are believed to initiate mutation, may be a clue to understanding the landscape of the preferred occurrence of gastric cancer in the human stomach, such that the occurrence is much more frequent in the lesser curvature than in the greater curvature. Methods: Seven DNA adducts, C5-methyl-2′-deoxycytidine, 2′-deoxyinosine, C5-hydroxymethyl-2′-deoxycytidine, N6-methyl-2′-deoxyadenosine, 1,N6-etheno-2′-deoxyadenosine, N6-hydroxymethyl-2′-deoxyadenosine, and C8-oxo-2′-deoxyguanosine, from different points and zones of the human stomach were semi quantitatively measured by liquid chromatography/tandem mass spectrometry. The differences in the quantity of these DNA adducts from the lesser and greater curvature, the upper, middle and lower third zones, the anterior and posterior wall of the stomach, and the mucosae distant from and near the tumor were compared to determine whether the location preference of cancer in the stomach could be explained by the distribution of these DNA adducts. Comparisons were conducted considering the tumor locations and operation methods. Conclusions: Regarding the DNA adducts investigated, significant differences in quantities and locations in the whole stomach were not noted; thus, these DNA adducts do not explain the preferential occurrence of cancer in particular locations of the human stomach.

The Antimicrobial Susceptibility and Detection of Virulence Genes of Escherichia coli O157:H7 Isolated from Leafy Green Vegetables

Vegetables can be vehicles for transmission of E. coli O157:H7 to humans, therefore, this study carried out in order to investigate the presence of Enterohemorrhagic E. coli in ten different types of leafy green vegetables, determined their susceptibility to thirteen antibiotics and detected the presence of some virulence genes. Method: Five-hundred samples of green leafy vegetables namely (Lettuce, Spanish, Rocket, Parsley, Mallow, Coriander, Portulaca, Lettuce, Dill, Basil and Chard) were examined for presence of E. coli O157:H7, by using standard microbiological tests (CHROMagarTM O157:H7), further detection of E. coli O157:H7 was done by Multiplex PCR (mPCR) for the detection of virulence genes (stx1, stx2, intmin and hlyA) These genes are causative factors of settlement, adhesion, and attack of STEC bacteria to gastrointestinal mucosa. Results: E. coli O157:H7 was isolated from eight (80%) out of ten types of green leafy vegetable as 12 (2.40%) in which the highest percentage of isolation was shown in Dill and Chards samples as (4.2%), Coriander and Mallow showed percentage of isolation as (3.33% and 3.03%) respectively, Parsley, Portulaca and Lettuce showed percentages of isolation as 2.43%, 1.92%, respectively, the least percentage of isolation was shown in Rocket (1.7%), No E. coli O157:H7, was detected in Spinach and Basil. Makkah collected samples showed isolation of 7 isolates out of 12 (58.33%). All isolates were resistant to Methicillin (5µg), Metronidazole (5 µg) and Ampicillin (10 µg). Stx2 (110 bp), Stx1 (349 bp), hly A (165 bp) genes were detected. All isolates showed negative results for presence of intimin gene (890 bp). This study concluded that there is a high risk for occurrence of E. coli O157:H7 outbreaks due to consumption of the green leafy vegetables sold in Jeddah Central Market.

Taxonomic and Functional Characteristics of the Gill and Gastrointestinal Microbiota and Its Correlation with Intestinal Metabolites in NEW GIFT Strain of Farmed Adult Nile Tilapia (Oreochromis niloticus)

The gill and gastrointestinal tract are primary entry routes for pathogens. The symbiotic microbiota are essential to the health, nutrition and disease of fish. Though the intestinal microbiota of Nile tilapia (Oreochromis niloticus) has been extensively studied, information on the mucosa-associated microbiota of this species, especially the gill and gastrointestinal mucosa-associated microbiota, is lacking. This study aimed to characterize the gill and gastrointestinal mucosa- and digesta-associated microbiota, as well as the intestinal metabolite profiles in the New Genetically Improved Farmed Tilapia (NEW GIFT) strain of farmed adult Nile tilapia by high-throughput sequencing and gas chromatography/mass spectrometry metabolomics. The diversity, structure, composition, and predicted function of gastrointestinal microbiota were significantly different across gastrointestinal regions and sample types (Welch t-test; p < 0.05). By comparing the mucosa- and digesta-associated microbiota, linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed that Pelomonas, Ralstoniapickettii, Comamonadaceae, and Staphylococcus were significantly enriched in the mucosa-associated microbiota, whereas many bacterial taxa were significantly enriched in the digesta-associated microbiota, including Chitinophagaceae, Cetobacterium, CandidatusCompetibacter, Methyloparacoccus, and chloroplast (LDA score > 3.5). Furthermore, Undibacterium, Escherichia–Shigella, Paeniclostridium, and Cetobacterium were dominant in the intestinal contents and mucosae, whereas Sphingomonasaquatilis and Roseomonasgilardii were commonly found in the gill and stomach mucosae. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt2) analysis revealed that the predictive function of digesta-associated microbiota significantly differed from that of mucosa-associated microbiota (R = 0.8152, p = 0.0001). In addition, our results showed a significant interdependence between specific intestinal microbes and metabolites. Notably, the relative abundance values of several potentially beneficial microbes, including Undibacterium, Crenothrix, and Cetobacterium, were positively correlated with most intestinal metabolites, whereas the relative abundance values of some potential opportunistic pathogens, including Acinetobacter, Mycobacterium, Escherichia–Shigella, Paeniclostridium, Aeromonas, and Clostridiumsensustricto 1, were negatively correlated with most intestinal metabolites. This study revealed the characteristics of gill and gastrointestinal mucosa-associated and digesta-associated microbiota of farmed Nile tilapia and identified a close correlation between intestinal microbes and metabolites. The results serve as a basis for the effective application of targeted probiotics or prebiotics in the diet to regulate the nutrition and health of farmed tilapia.

Hydrotropic Solubilization: An Emerging Approach

Drug development plays an important role in patient safety and effectiveness. The therapeutic suitability of a new drug depends on the solubility. The solubility of the sparingly soluble drug remains a problem in identifying new active compounds. Solubility plays an important role in achieving optimal drug concentration. Low solubility is not only a concern for the production of formulations, but also an obstacle from the outset when identifying active chemicals for therapeutic purposes. Due to its simplicity in terms of ease of administration and economy, the oral route is the preferred route of drug administration over other routes. Effective aqueous solubility is the first prerequisite for oral medication, since low solubility has poor absorption and bioavailability and unpredictable toxicity of the gastrointestinal mucosa. To avoid these crises, different methodologies are used to improve the solubility and bioavailability of poorly soluble drugs, and hydrotropic solubilization is one of them. Hydrotropic agents have the potential to improve the solubility of water-insoluble drugs. In this review, we try to address hydrotropic solubilization methodologies. Keywords: Hydrotropy, Micelles, Solubility, Formulation.