gastrointestinal microbiome

Studies suggest that inducing gut microbiota changes may alter both muscle physiology and cognitive behaviour. Gut microbiota may play a role in both anabolic resistance of older muscle, and cognition. In this placebo controlled double blinded randomised controlled trial of 36 twin pairs (72 individuals), aged ≥60, each twin pair are block randomised to receive either placebo or prebiotic daily for 12 weeks. Resistance exercise and branched chain amino acid (BCAA) supplementation is prescribed to all participants. Outcomes are physical function and cognition. The trial is carried out remotely using video visits, online questionnaires and cognitive testing, and posting of equipment and biological samples. The prebiotic supplement is well tolerated and results in a changed gut microbiome [e.g., increased relative Bifidobacterium abundance]. There is no significant difference between prebiotic and placebo for the primary outcome of chair rise time (β = 0.579; 95% CI -1.080-2.239 p = 0.494). The prebiotic improves cognition (factor score versus placebo (β = -0.482; 95% CI,-0.813, -0.141; p = 0.014)). Our results demonstrate that cheap and readily available gut microbiome interventions may improve cognition in our ageing population. We illustrate the feasibility of remotely delivered trials for older people, which could reduce under-representation of older people in clinical trials. ClinicalTrials.gov registration: NCT04309292.

Author/s:

Mary Ni Lochlainn, Ruth C E Bowyer, Janne Marie Moll, María Paz García, Samuel Wadge, Andrei-Florin Baleanu, Ayrun Nessa, Alyce Sheedy, Gulsah Akdag, Deborah Hart, Giulia Raffaele, Paul T Seed, Caroline Murphy, Stephen D R Harridge, Ailsa A Welch, Carolyn Greig, Kevin Whelan, Claire J Steves

Management of acute diverticulitis

Aubrey Delammermore — Sat, 10 Sep 2022 05:00:00 +0000

Date Added:

September 10, 2022

Journal/Publication:

CMAJ

Publisher:

CMA Impact Inc

Publication Date:

September 6, 2022

Issue:

Volume:

194

Pages:

E1171

URL:

Management of acute diverticulitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1503/cmaj.220139

Keywords

Colonoscopy

abscess

Anti-Bacterial Agents

Bacterial translocation

sepsis

MeSH

gastrointestinal microbiome

Acute uncomplicated diverticulitis should be treated with non-opioid analgesics without antibiotics. James W. Mold, MD, MPH

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1 Emergency department visits and hospital admissions for acute
diverticulitis have increased
Emergency department visits for acute diverticulitis increased by 26.8% to
113.9 visits per 100 000 from 2006 to 2013 in the United States.1
Hospital admissions for diverticulitis increased 7.5% annually from 190 per 100 000 in 2008 to
310 per 100 000 in 2015 in Europe; the increase occurred predominantly among
patients aged younger than 60 years.2 Insufficient consumption of dietary fibre
is associated with this rise.
2 Symptoms of diverticulitis may be driven by inflammation rather
than infection
Contemporary evidence shows that use of antibiotics in uncomplicated cases of
diverticulitis neither accelerates recovery nor improves outcomes.2
A recent
study has suggested that chronic inflammation secondary to environmental risk
factors and alterations of the gut microbiome are now favoured causes over
microperforation or bacterial translocation.3
3 Most patients with uncomplicated diverticulitis can be treated as
outpatients with nonopiate analgesia rather than antibiotics
Cross-sectional imaging that shows inflamed colonic diverticula without perforation or abscess defines uncomplicated diverticulitis. Two randomized controlled trials that compared antibiotic and nonantibiotic treatment reported
no difference in recovery time, treatment duration or rate of recurrence.4,5
Updated guidelines recommend reserving antibiotics for patients taking
immunosuppressive medications and those with sepsis.1,2 Treating symptoms
with nonopiate analgesics avoids worsening bowel function and contributing
to opiate dependence.
4 Evidence of complicated diverticulitis should prompt emergent
surgical assessment and antibiotic treatment
Complicated diverticulitis, defined as radiologic evidence of perforation or intraabdominal abscess, has a 30-day mortality rate of 8.7%.2
Antibiotic therapy is indicated, and many patients require admission to hospital.1
Percutaneous drainage
of large abscesses (> 3 cm) or emergency surgery may be required.2
5 Colonoscopy and elective colon resection are not routinely required
after resolution of uncomplicated diverticulitis
Only 8.7% of patients with uncomplicated diverticulitis will present to hospital
with a second episode.1
Elective surgery should be determined by frequency
and severity of symptoms, rather than prevention of future complications.2
Risk of malignant disease after uncomplicated left-sided diverticulitis is similar to that of the general population (1%), and standard colon cancer screening guidelines should be followed.1
Complicated diverticulitis warrants an
interval colonoscopy, typically 6 weeks after resolution.1

Author/s:

Zondervan, N., Snelgrove, R., Bradley, N.

Managing nonspecific abdominal pain in children and young people

Devin Evans — Mon, 07 Dec 2020 06:00:00 +0000

Date Added:

December 7, 2020

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

November 30, 2020

Issue:

Volume:

192

Pages:

1639-1640

URL:

Managing nonspecific abdominal pain in children and young people

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.202555

Keywords

children

Emergency Care

PMID (1):

33257330

MeSH

gastrointestinal microbiome

A concise review of what is known about the diagnosis and management of chronic abdominal pain in children. James W. Mold, MD, MPH

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KEY POINTS

• Children present frequently to primary and emergency care with nonspecific abdominal pain.

• Only a few treatment options exist to manage colicky, undifferentiated pain; however, most children will not present more than once or twice to health services for this problem.

• Undifferentiated abdominal pain is poorly understood but likely multifactorial, arising from a combination of sensitizing medical events, psychosocial events and visceral hyperalgesia.

• Among children who seek health care for this problem, 20%–25% go on to be diagnosed with a disorder of the brain–gut axis, “a functional gastrointestinal disorder,” for which international guidelines exist to guide management.

• At first consultation, it is important to establish a positive therapeutic relationship between the clinician and the child and their parents, focusing on optimizing symptom control over unnecessary investigation and medicines.

Author/s:

Chanchlani, Neil, Walters, Thomas D., Russell, Richard K.

Metabolic Effects of Intermittent Fasting

John Bayhi — Thu, 16 Jan 2020 16:35:23 +0000

Date Added:

January 16, 2020

Journal/Publication:

Annual Review of Nutrition

Publisher:

Annual Reviews

Publication Date:

August 21, 2017

Volume:

Pages:

371-393

URL:

Metabolic Effects of Intermittent Fasting

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1146/annurev-nutr-071816-064634

Keywords

circadian rhythm

gut microbiome

modifiable lifestyle behavior

postprandial

PMID (1):

28715993

MeSH

gastrointestinal microbiome

Humans

male

sleep

An evidence-based review of what we currently know about the metabolic effects of intermittent fasting. James W. Mold, MD, MPH

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The objective of this review is to provide an overview of intermittent fasting regimens, summarize the evidence on the health benefits of intermittent fasting, and discuss physiological mechanisms by which intermittent fasting might lead to improved health outcomes. A MEDLINE search was performed using PubMed and the terms "intermittent fasting," "fasting," "time-restricted feeding," and "food timing." Modified fasting regimens appear to promote weight loss and may improve metabolic health. Several lines of evidence also support the hypothesis that eating patterns that reduce or eliminate nighttime eating and prolong nightly fasting intervals may result in sustained improvements in human health. Intermittent fasting regimens are hypothesized to influence metabolic regulation via effects on (a) circadian biology, (b) the gut microbiome, and (c) modifiable lifestyle behaviors, such as sleep. If proven to be efficacious, these eating regimens offer promising nonpharmacological approaches to improving health at the population level, with multiple public health benefits.

Author/s:

Patterson, RE, Sears, DD

Making Sense of Probiotics and Prebiotics – What We Know, Have Yet to Learn

Jeffrey Wilson — Tue, 28 Aug 2018 19:39:37 +0000

Date Added:

August 28, 2018

Journal/Publication:

Individualized Medicine Blog

Publisher:

Mayo Clinic

Publication Date:

September 21, 2017

URL:

Making Sense of Probiotics and Prebiotics – What We Know, Have Yet to Learn

Type:

Patient Education Materials

Format:

Web Page

Keywords

MeSH

gastrointestinal microbiome

This article published in the Mayo Clinic Newsletter defines and explains the terms, probiotics, prebiotics, and synbiotics.

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They are everywhere – foods and supplements containing bacteria that claim to improve your gut health and overall wellness. Can these bacteria improve your digestion, boost your immune system and even combat disease?

Author/s:

Rosen, Sharon