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The objective of this study was to investigate whether ingestion of fructose and fructans (such as inulin) can exacerbate irritable bowel syndrome (IBS) symptoms. The aim was to better understand the origin of these symptoms by magnetic resonance imaging (MRI) of the gut. A total of 16 healthy volunteers participated in a four-way, randomized, single-blind, crossover study in which they consumed 500 ml of water containing 40 g of either glucose, fructose, inulin, or a 1:1 mixture of 40 g glucose and 40 g fructose. MRI scans were performed hourly for 5 h, assessing the volume of gastric contents, small bowel water content (SBWC), and colonic gas. Breath hydrogen (H2) was measured and symptoms recorded after each scan. Data are reported as mean (s.d.) (95% CI) when normally distributed and median (range) when not. Fructose increased area under the curve (AUC) from 0-5 h of SBWC to 71 (23) l/min, significantly greater than for glucose at 36 (11-132) l/min (P<0.001), whereas AUC SBWC after inulin, 33 (17-106) l/min, was no different from that after glucose. Adding glucose to fructose decreased AUC SBWC to 55 (28) l/min (P=0.08) vs. fructose. Inulin substantially increased AUC colonic gas to 33 (20) l/min, significantly greater than glucose and glucose+fructose (both P<0.05). Breath H2 rose more with inulin than with fructose. Glucose when combined with fructose significantly reduced breath H2 by 7,700 (3,121-12,300) p.p.m./min relative to fructose alone (P<0.01, n=13). Fructose but not inulin distends the small bowel with water. Adding glucose to fructose reduces the effect of fructose on SBWC and breath hydrogen. Inulin distends the colon with gas more than fructose, but causes few symptoms in healthy volunteers.

This study reports the effects of early-life lactoferrin (LF) intervention on the colonic microbiota, intestinal function and mucosal immunity in suckling piglets. A total of 60 Duroc × Landrace × Yorkshire suckling piglets from six sows were assigned to the control (CON) and LF groups in litters. The LF group piglets were fed 0.5 g/kg body weight of LF solution per day, and the CON group piglets were fed the same dose of physiological saline for a week. Six piglets from the two groups were randomly chosen and euthanised on days 8 and 21. The LF group piglets had higher ACE and Chao1 indices of colonic microbiota than the CON group piglets (P < 0.05). In addition, the LF group piglets had a higher abundance of Roseburia (P < 0.05) and a lower abundance of Escherichia–Shigella (P < 0.05) in the colonic digesta. The LF group piglets also had a higher concentration of butyrate (P < 0.05) in the colonic digesta. Moreover, the LF group piglets had a higher gene expression of occludin (P < 0.05) in the colonic mucosa. In addition, the gene expression of MUC4 was upregulated in the LF group piglets compared with that in the CON group on day 21 (P < 0.05), and the lower gene expression of TLR-4 was found in the LF group compared with the CON group on day 8 (P < 0.05). Furthermore, the concentration of IL-10 was increased in the LF group on day 8 (P < 0.05), while the LF group piglets had a higher concentration of sIgA and lower concentrations of IL-1α and IL-1β (P < 0.05) in the colonic mucosa. These results suggest that early-life LF intervention can modulate the composition of colonic microbiota and improve the intestinal function in suckling piglets.Key Points• Early-life LF intervention significantly modulated colon microbiota.• Early-life LF intervention can improve the colon health.• The colon microbiota plays an important role in host health.

Abstract Rationale Underinflation of the tracheal cuff frequently occurs in critically ill patients and represents a risk factor for microaspiration of contaminated oropharyngeal secretions and gastric contents that plays a major role in the pathogenesis of ventilator-associated pneumonia (VAP). Objectives To determine the impact of continuous control of tracheal cuff pressure (Pcuff) on microaspiration of gastric contents. Methods Prospective randomized controlled trial performed in a single medical intensive care unit. A total of 122 patients expected to receive mechanical ventilation for at least 48 hours through a tracheal tube were randomized to receive continuous control of Pcuff using a pneumatic device (intervention group, n = 61) or routine care of Pcuff (control group, n = 61). Measurements and Main Results The primary outcome was microaspiration of gastric contents as defined by the presence of pepsin at a significant level in tracheal secretions collected during the 48 hours after randomization. Secondary outcomes included incidence of VAP, tracheobronchial bacterial concentration, and tracheal ischemic lesions. The pneumatic device was efficient in controlling Pcuff. Pepsin was measured in 1,205 tracheal aspirates. Percentage of patients with abundant microaspiration (18 vs. 46%; P = 0.002; OR [95% confidence interval], 0.25 [0.11–0.59]), bacterial concentration in tracheal aspirates (mean ± SD 1.6 ± 2.4 vs. 3.1 ± 3.7 log10 cfu/ml, P = 0.014), and VAP rate (9.8 vs. 26.2%; P = 0.032; 0.30 [0.11–0.84]) were significantly lower in the intervention group compared with the control group. However, no significant difference was found in tracheal ischemia score between the two groups. Conclusions Continuous control of Pcuff is associated with significantly decreased microaspiration of gastric contents in critically ill patients.

Objective Evaluate the impact of reduced gastric acid secretion after administration of two acid-reducing agents on the physicochemical characteristics of contents of upper gastrointestinal lumen of fasted adults. Materials and Methods Eight healthy male adults, fasted from food for 12 h, participated in a three-phase crossover study. Phase 1: No drug treatment prior to aspirations. Phase 2: Oral administration of 40 mg pantoprazole at ~9 am the last 3 days prior to aspirations and at ~7 am on aspiration day. Phase 3 : Oral administration of 20 mg famotidine at ~7 pm prior to aspirations and at ~7 am on aspiration day. Samples from the contents of upper gastrointestinal lumen were aspirated for 50 min, after administration of 240 ml table water at ~9 am. Results Reduction of gastric acid secretion was accompanied by reduced buffer capacity, chloride ion concentration, osmolality and surface tension in stomach and by increased pH (up to ~0.7 units) in upper small intestine during the first 50 min post-water administration. The mechanism of reduction of acid secretion seems to be important for the buffer capacity in stomach and for the surface tension in upper gastrointestinal lumen. Conclusions Apart from gastric pH, reduced acid secretion affects physicochemical characteristics of contents of upper gastrointestinal lumen which may be important for the performance of certain drugs/products in the fasted state.

This study aimed to assess whether elevating the head of the bed to 45° was associated with sensitivity >90% of the qualitative ultrasound assessment for the diagnosis of gastric fluid volume > 1.5 ml.kg−1. We also assessed the performance of qualitative assessment, composite ultrasound scale, and clinical algorithm, for the diagnosis of fluid volume > 1.5 ml.kg−1 according to whether the head of the bed was elevated to 45° or not. Prospective randomized observer-blind crossover trial. Hospices Civils de Lyon, France. Healthy adult volunteers. Two separate study sessions in fasting volunteers: with and without head-of-bed elevation to 45°, in a randomized order. Each session consisted of three tests, each corresponding to a randomized and different volume of water (either 0, 50, 100, 150 or 200 ml); the same volumes were used in both sessions and in a randomized order. Gastric ultrasounds were performed three minutes after the ingestion of water by an investigator blinded to the volume ingested. Diagnostic performance of each approach for the diagnosis of gastric fluid volume > 1.5 ml.kg−1. Twenty volunteers were included, and 120 measurements were analyzed. The sensitivity of the qualitative assessment for the diagnosis of gastric fluid volume > 1.5 ml.kg−1 with and without head-of-bed elevation was 91% (95%CI: 75–98) and 75% (95%CI: 57–89), respectively. The clinical algorithm with head-of-bed elevation had significantly better sensitivity than the qualitative assessment with no head-of-bed elevation; there was no significant difference for other comparisons. The results suggest that qualitative examination of gastric antrum in the supine position with head-of-bed elevation to 45° can discriminate between low and high gastric fluid volume with high sensitivity, while neither the composite ultrasound scale nor the clinical algorithm improved the diagnostic performance of gastric ultrasound for the diagnosis of gastric fluid volume > 1.5 ml.kg−1. •Three approaches have been described for interpretation of gastric ultrasound•These approaches are of increasing complexity and their diagnostic performances is unclear•Qualitative assessment had high sensitivity to detect fluid volume > 1.5 ml.kg−1•Composite scale and clinical algorithm had similar diagnostic performance

Two-hour minimum fasting policy for clear fluids before surgery may prolong fasting and cause negative experiences for children. One-hour minimum and/or liberal fasting policies for clear fluids can significantly shorten the fasting time. However, their effectiveness and safety remain inadequately validated. This study investigated the effects of the above three regimens on the gastric fluid volume (GFV) before anesthesia induction in children. This prospective randomized controlled trial involved 147 children (1–13 years old, ASA I or II) undergoing elective tonsillectomy and adenoidectomy and were randomly allocated to three groups: Group 2: fasting clear fluids for a minimum of 2 h, Group 1: fasting clear fluids for a minimum of 1 h, and Group 0: liberal fluid fasting. Water intake was measured within 6 h before surgery. The primary outcome was GFV before anesthesia induction. Secondary outcomes included water intake behavior and adverse events. Among the three groups, there was no evidence for differences in GFVs. The total water intake volume within 6 h before surgery was 80.0 (IQR: 40.0–160.0) mL for Group 2, 150.0 (IQR: 72.5–300.0) mL for Group 1, and 85.0 (IQR: 40.0–180.0) mL for Group 0. The total number of water intake episodes was 1.0 (1.0–2.5), 2.5 (1.0–4.0), and 2.0 (1.0–3.0) for Group 2/1/0, respectively. The last water intake volume before surgery in Group 2/1/0 was 60 (IQR: 30–100) mL, 60 (IQR: 30–100) mL, and 40 (IQR: 20–60) mL, respectively. There were no increases in adverse events among groups. Compared to fasting with clear fluids for 2 h, the 1-h and liberal fluid fasting regimens do not increase GFV in children before induction. Trial registration: This prospective randomized controlled trial was registered at the Chinese Clinical Trial Registration (No. ChiCTR2300078309; Date: December 5, 2023). [Display omitted] •Three fasting regimens before anesthesia induction in children yield comparable GFV measurements.•1-h minimum and liberal fasting regimens do not increase gastric fluid volume compared to the standard 2-h minimum fasting.•Water intake behavior shows significant improvements among children adhering to shorter fasting regimens.

There is no clear consensus in the current guidelines published by major international anaesthetic associations on what is the most appropriate time for a patient to stop chewing gum. This open-label balanced-group randomised controlled trial aimed to evaluate whether the chewing of sugar-free gum caused an increased volume or reduced pH of residual gastric fluid in fasting patients. For this study 212 patients undergoing elective gastroscopy were randomised into a control group who followed routine fasting instructions and an intervention group who were asked to chew gum while fasting. Residual gastric fluid was aspirated under direct vision via a gastroscope under anaesthesia. The primary outcome was the incidence of a gastric residual volume >50 ml in participants who chewed gum compared with a control group. Secondary outcomes were variability in the overall gastric volume distribution and gastric pH distribution between the two groups. Nine out of 110 (8.2%) in the chewing gum group and six out of 102 (5.9%) in the control group had a residual gastric fluid volume >50 ml: incidence rate ratio 1.39 (95% confidence intervals (CI) 0.51-3.77; 'P' = 0.60). However, only one patient (in the control group) had a residual gastric volume >73 ml. There was no statistically significant difference in gastric volume distribution between groups, odds ratio 1.60 (95% CI 0.99-2.58; 'P' = 0.054) or in the distribution of gastric pH measurement, odds ratio 0.90 (95% CI 0.57-1.44; 'P' = 0.67). These results indicate that if there is an increase in the incidence of residual gastric volume >50 ml in patients who chew gum preoperatively, it is likely to be small. Moreover, the absence of any patients in our chewing gum group with a residual gastric volume >73 ml is reassuring.

Understanding the interactions between hydrogen producers and consumers in the rumen ecosystem is important for ruminant production and methane mitigation. The present study explored the relationships between rumen protozoa, methanogens and fermentation characteristics. A total of six donor sheep harbouring (F, faunated) or not (D, defaunated) protozoa in their rumens (D animals were kept without protozoa for a period of a few months (D − ) or for more than 2 years (D+)) were used in in vitro and in vivo experiments. In vitro the absence of protozoa decreased NH3 and butyrate production and had no effect on methane. In contrast, the liquid-associated bacterial and methanogens fraction of D+ inocula produced more methane than D −  and F inoculum (P < 0·05). In vivo fermentation parameters of donor animals showed the same trend on NH3 and butyrate and showed that D+ animals were high methane emitters, while D −  were the lowest ( − 35 %). The concentration of dissolved dihydrogen measured after feeding followed the opposite trend. Methane emissions did not correlate with the relative abundance of methanogens in the rumen measured by quantitative PCR, but there was a trend for higher methanogens concentration in the solid-associated population of D+ animals compared with D −  animals. In contrast, PCR-denaturing gradient gel electrophoresis profiles of methanogens' methyl coenzyme-M reductase A gene showed a clear clustering in liquid-associated fractions for all three groups of donors but fewer differences in solid-associated fractions. These results show that the absence of protozoa may affect differently the methanogen community and methane emissions in wethers.

We have previously reported on the low lipid bioaccessibility from almond seeds during digestion in the upper gastrointestinal tract (GIT). In the present study, we quantified the lipid released during artificial mastication from four almond meals: natural raw almonds (NA), roasted almonds (RA), roasted diced almonds (DA) and almond butter from roasted almonds (AB). Lipid release after mastication (8.9% from NA, 11.8% from RA, 12.4% from DA and 6.2% from AB) was used to validate our theoretical mathematical model of lipid bioaccessibility. The total lipid potentially available for digestion in AB was 94.0%, which included the freely available lipid resulting from the initial sample processing and the further small amount of lipid released from the intact almond particles during mastication. Particle size distributions measured after mastication in NA, RA and DA showed most of the particles had a size of 1000 µm and above, whereas AB bolus mainly contained small particles (<850 µm). Microstructural analysis of faecal samples from volunteers consuming NA, RA, DA and AB confirmed that some lipid in NA, RA and DA remained encapsulated within the plant tissue throughout digestion, whereas almost complete digestion was observed in the AB sample. We conclude that the structure and particle size of the almond meals are the main factors in regulating lipid bioaccessibility in the gut.

Organic short and medium chain fatty acids are used in diets for piglets because they have an impact on the digestive processes and the intestinal microbiota. In this study, 48 pens (2 piglets/pen) were assigned randomly to 4 diets, without additive (control), with organic acids (OA; 0.416% fumaric and 0.328% lactic acid), with medium chain fatty acids (MCFA; 0.15% caprylic and capric acid), and a combination of OA and MCFA, to assess changes in the gastrointestinal microbiota with 12 pens per diet. Eight to nine piglets from each group were euthanized after 4 wk. Organic acids, MCFA, and pH in the digesta were determined and the intestinal microbiota was quantified by real-time PCR. The different diets had no effect on the growth performance. Concentration of added fumaric acid was below the detection limit in the upper small intestine whereas the concentration of lactic acid in the digesta was not affected by the treatments. The added MCFA was recovered in the MCFA treated groups in the stomach, but the concentrations declined in the upper small intestine. Concentration of short chain fatty acids was reduced in the colon digesta in piglets fed diets with OA compared with those fed unsupplemented diets (P = 0.029). The MCFA resulted in a pH reduction of the digesta, likely because of the effect on bacterial acid production. The addition of OA increased cell counts of Bacteroides-Porphyromonas-Prevotella group and clostridial clusters XIVa, I, and IV in the stomach, the clostridial cluster XIVa in the jejunum, and Bacteroides-Porphyromonas-Prevotella in the ileum and reduced counts of Streptococcus spp. in the colon (P < 0.05). The MCFA induced only minor changes in the gastrointestinal microbiota but increased cell counts for the Escherichia-Hafnia-Shigella group in the jejunum and the clostridial cluster XIVa in the colon digesta (P < 0.05). In the colon of piglets fed diets with organic OA, reduced mean cell counts of STb (est-II) positive Escherichia coli were found. In conclusion, OA and MCFA had effects on the intestinal microecology in piglets. The decrease of the intestinal pH and the reduction of E. coli virulence genes by OA could make the combination of short chain fatty acids and MCFA as interesting gut flora modifiers, which can eventually prevent postweaning diarrhea.