fructooligosaccharide and Diarrhea

Diarrhoea is a common and serious complication of enteral tube feeding. Its pathogenesis involves antibiotic prescription, enteropathogenic colonization and abnormal colonic responses, all of which involve an interaction with the colonic microbiota. Alterations in the colonic microbiota have been identified in patients receiving enteral tube feeding and these changes may be associated with the incidence of diarrhoea. Preventing negative alterations in the colonic microbiota has therefore been investigated as a method of reducing the incidence of diarrhoea. Probiotics and prebiotics may be effective because of their suppression of enteropathogenic colonization, stimulation of immune function and modulation of colonic metabolism. Randomized controlled trials of probiotics have produced contrasting results, although Saccharomyces boulardii has been shown to reduce the incidence of diarrhoea in patients in the intensive care unit receiving enteral tube feeding. Prebiotic fructo-oligosaccharides have been shown to increase the concentration of faecal bifidobacteria in healthy subjects consuming enteral formula, although this finding has not yet been confirmed in patients receiving enteral tube feeding. Furthermore, there are no clinical trials investigating the effect of a prebiotic alone on the incidence of diarrhoea. Further trials of the efficacy of probiotics and prebiotics, alone and in combination, in preventing diarrhoea in this patient group are warranted.

Topics: Colon; Diarrhea; Enteral Nutrition; Food, Formulated; Humans; Oligosaccharides; Probiotics; Saccharomyces; Treatment Outcome

Bifidobacteria and lactobacilli are purportedly beneficial to human health and are called probiotics. Their survival during passage through the human gut, when administered in fermented milk products, has been investigated intensely in recent years. Well-controlled, small-scale studies on diarrhea in both adults and infants have shown that probiotics are beneficial and that they survive in sufficient numbers to affect gut microbial metabolism. Survival rates have been estimated at 20-40% for selected strains, the main obstacles to survival being gastric acidity and the action of bile salts. Although it is believed that the maximum probiotic effect can be achieved if the organisms adhere to intestinal mucosal cells, there is no evidence that exogenously administered probiotics do adhere to the mucosal cells. Instead, they seem to pass into the feces without having adhered or multiplied. Thus, to obtain a continuous exogenous probiotic effect, the probiotic culture must be ingested continually. Certain exogenously administered substances enhance the action of both exogenous and endogenous probiotics. Human milk contains many substances that stimulate the growth of bifidobacteria in vitro and also in the small intestine of infants; however, it is unlikely that they function in the colon. However, lactulose and certain fructose-containing compounds, called prebiotics, are not digested in the small intestine but pass into the cecum unchanged, where they are selectively utilized by probiotics. Beneficial effects may thus accrue from exogenously administered probiotics, often administered with prebiotics, or by endogenous bifidobacteria and lactobacilli, whose metabolic activity and growth may also be enhanced by the administration of prebiotics.

Topics: Adult; Bacterial Adhesion; Bifidobacterium; Bile Acids and Salts; Diarrhea; Digestive System; Digestive System Physiological Phenomena; Feces; Humans; Hydrogen-Ion Concentration; Infant; Inulin; Lactobacillus; Lactulose; Oligosaccharides; Probiotics; Survival

The purpose of the randomized double-blind placebo-controlled trial was to assess the effectiveness of synbiotic preparation containing probiotic

Topics: Adolescent; Adult; Bifidobacterium animalis; Bifidobacterium bifidum; Bifidobacterium longum; Defecation; Diarrhea; Double-Blind Method; Feces; Female; Flatulence; Humans; Irritable Bowel Syndrome; Lacticaseibacillus rhamnosus; Lactobacillus acidophilus; Male; Middle Aged; Oligosaccharides; Severity of Illness Index; Synbiotics; Treatment Outcome; Young Adult

The pathogenesis of enteritis after abdominal radiotherapy (RT) is unknown, although changes in fecal microbiota may be involved. Prebiotics stimulate the proliferation of Lactobacillus spp and Bifidobacterium spp, and this may have positive effects on the intestinal mucosa during abdominal RT.. We performed a randomized, double-blind, placebo-controlled trial involving patients with gynecological cancer who received abdominal RT after surgery. Patients were randomized to receive prebiotics or placebo. The prebiotic group received a mixture of fiber (50 inulin and 50% fructo-oligosaccharide), and the placebo group received 6 g of maltodextrin twice daily from 1 week before to 3 weeks after RT. The number of bowel movements and stool consistency was recorded daily. Diarrhea was evaluated according to the Common Toxicity Criteria of the National Cancer Institute. Stool consistency was assessed using the 7-point Bristol scale. Patients' quality-of-life was evaluated at baseline and at completion of RT using the EORTC-QLQ-C30 (European Organization for Research and Treatment of Cancer quality-of-life Questionnaire C30) test.. Thirty-eight women with a mean age of 60.3±11.8 years participated in the study. Both groups (prebiotic (n=20) and placebo (n=18)) were comparable in their baseline characteristics. The number of bowel movements per month increased in both groups during RT. The number of bowel movements per day increased in both groups. The number of days with watery stool (Bristol score 7) was lower in the prebiotic group (3.3±4.4 to 2.2±1.6) than in the placebo group (P=0.08). With respect to quality-of-life, the symptoms with the highest score in the placebo group were insomnia at baseline and diarrhea toward the end of the treatment. In the prebiotic group, insomnia was the symptom with the highest score at both assessments, although the differences were not statistically significant.. Prebiotics can improve the consistency of stools in gynecologic cancer patients on RT. This finding could have important implications in the quality-of-life of these patients during treatment.

Topics: Abdomen; Aged; Defecation; Diarrhea; Dietary Fiber; Double-Blind Method; Enteritis; Feces; Female; Genital Neoplasms, Female; Humans; Inulin; Middle Aged; Oligosaccharides; Prebiotics; Quality of Life; Radiation Injuries

We investigated the effect of a mixture of long-chain fructo-oligosaccharides, galacto-oligosaccharides and acidic oligosaccharides on the number and consistency of stools and on immune system biomarkers in 104 supplemented and non-supplemented subjects (aged 9-24 months) with acute diarrhea. Interleukin-1 (IL-1), IL-1RA, IL-6, IL-8, IL-10, TNF-α and sIL-2R cytokine levels were determined. The significant decrease in number of stools and increase in stool consistency in the supplemented group was of little clinical relevance. The only significant change in pro- and anti-inflammatory cytokines was decreased TNF-α levels in the supplemented group. Prebiotic supplementation during acute diarrhea episodes did not influence the clinical course.

Topics: Acute Disease; Child, Preschool; Cytokines; Diarrhea; Dietary Supplements; Double-Blind Method; Feces; Galactose; Humans; Infant; Interleukins; Oligosaccharides; Placebos; Prebiotics; Prospective Studies; Tumor Necrosis Factor-alpha

Acutely ill children (n = 129) aged 1-6 years receiving antibiotic therapy were randomized to receive a nutritional supplement with (PS) or without (P) synbiotics or a fruit-flavored drink (D) with their medications. Group PS had significantly greater weight gains (versus D) following antibiotic therapy. The percentages of subjects without bacterial illnesses 14 days following antibiotic therapy were as follows: 94.3% (PS), 87.8% (D), and 80.6% (P). PS (vs D) significantly increased fecal Lactobacillus in a subset of subjects. Oral supplements increase energy intake and promote weight gain in acutely ill children receiving antibiotics; synbiotics may confer additional benefits by increasing bifidobacteria levels.

Topics: Acute Disease; Bacterial Infections; Bifidobacterium; Child, Preschool; Constipation; Diarrhea; Dietary Supplements; Feces; Female; Humans; Infant; Lactobacillus; Male; Oligosaccharides; Otitis Media; Pharyngitis; Probiotics; Tonsillitis; Treatment Outcome; Vomiting; Weight Gain

Whether carbohydrate malabsorption causes diarrhea probably depends on the balance between the osmotic force of the carbohydrate and the compensatory capacity of the colon to dispose of the carbohydrate by bacterial fermentation. The present study evaluated the specific role of the osmolarity by comparing the severity of diarrhea after ingestion of two nonabsorbable carbohydrates, the fructooligosaccharide Idolax and the disaccharide lactulose. Both carbohydrates are readily fermented by the colonic flora but differ in osmolarity, the osmotic force being twice as high for lactulose as for Idolax. Twelve subjects were given increasing doses (0, 20, 40, 80, 160 g/d) of Idolax and lactulose in a crossover design. Every dose level was administered for three days with intervals of one week. Stools were collected on the third day to determine 24-hr volume, concentrations of short-chain fatty acids, L- and D-lactate, residues of Idolax or lactulose, sodium, potassium, pH, osmolarity, and in vitro productions of organic acids. Measured by short-chain fatty acid and lactate formation in a fecal incubation system, the fermentation of Idolax and lactulose was identical and very rapid compared with a range of reference carbohydrates. A laxative effect of both Idolax and lactulose was demonstrated. The increment in fecal volume as a function of the dose administered was twice as high for lactulose (slope of the regression line = 7.3, r = 0.64, P< 10(-5)) as for Idolax (slope = 3.7, r = 0.51, P<10(-3)), i.e., isosmolar doses of lactulose and Idolax had the same effect on fecal volume. The variation in fecal volume was substantial (lactulose 80 g/day: 110-1360 g/day; Idolax 160 g/day: 130-1440 g/day). High responders had earlier and larger fecal excretions of the saccharide compared with low-responders. Fecal volume in carbohydrate-induced diarrhea is proportional to the osmotic force of the malabsorbed saccharide, even though all or the majority of the saccharide is degraded by colonic bacteria. The capacity to modify the diarrhea varies considerably from person to person and is associated with colonic saccharide disposal, whereas the variation in response to isosmolar amounts of different saccharides is small within the same individual.

Topics: Adult; Cathartics; Colon; Cross-Over Studies; Diarrhea; Dietary Carbohydrates; Dose-Response Relationship, Drug; Fatty Acids, Volatile; Feces; Female; Fermentation; Humans; Intestinal Absorption; Lactulose; Male; Middle Aged; Oligosaccharides; Osmolar Concentration; Prospective Studies

This study was to illustrate the effects of fructooligosaccharide (FOS) on the antioxidant capacity, intestinal barrier function, and microbial community of weanling pigs. Results showed that FOS reduced the incidence of diarrhea (6.5 vs. 10.8%) of pigs (p < 0.05) but did not affect growth performance when compared with the control group. A diet supplemented with FOS increased ileal mRNA expression of occludin (1.7 vs. 1.0), claudin-1 (1.9 vs. 1.0), claudin-2 (1.8 vs. 1.0), and claudin-4 (1.7 vs. 1.0), as well as colonic mRNA expression of ZO-1 (1.6 vs. 1.0), claudin-1 (1.7 vs. 1.0), occludin (1.9 vs. 1.0), and pBD-1 (1.5 vs. 1.0) when compared with the control group (p < 0.05). FOS supplementation improved the anti-oxidase activity and expression of nuclear factor erythroid-2 related factor 2 (Nrf2), and decreased concentrations of D-lactate (3.05 U/L vs. 2.83 U/L) and TNF-α (59.1 pg/mL vs. 48.0 pg/mL) in the serum when compared with the control group (p < 0.05). In addition, FOS increased Sharpea, Megasphaera, and Bacillus populations in the gut when compared with the control group (p < 0.05). Association analysis indicated that mRNA expression of occludin and claudin-1 in the ileal mucosa were correlated positively with populations of Sharpea and Bacillus (p < 0.05). Furthermore, mRNA expression of occludin and claudin-1 in the colonic mucosa were correlated positively with abundances of Sharpea, Lactobocillus, and Bifidobacterium (p < 0.05). In conclusion, FOS activated Nrf2 signaling and increased the expression of specific tight junction proteins, which were associated with reduced diarrhea incidence.

Topics: Animals; Diarrhea; Occludin; Oligosaccharides; Swine; Tight Junction Proteins

Topics: Animals; Animals, Newborn; Bacteria; Bifidobacterium breve; Cultured Milk Products; Diarrhea; Female; Fermentation; Gastrointestinal Microbiome; Humans; Immunity; Infant; Infant Formula; Male; Milk; Oligosaccharides; Prebiotics; Probiotics; Rats, Inbred Lew; Rotavirus; Rotavirus Infections; Severity of Illness Index; Streptococcus thermophilus

Resistant glucan (RG) and hydrogenated resistant glucan (HRG) are newly developed non-digestible carbohydrate materials that decrease lifestyle-related diseases. The bioavailability of RG and HRG was investigated by in vitro experiments using human and rat small intestinal enzymes and by in vivo experiments using rats in the present study. Oligosaccharides, which are minor components of RG and HRG, were hydrolysed slightly by small intestinal enzymes of humans and rats, and the hydrolysing activity was slightly higher in rats than in humans. The amount of glucose released from HRG was greater than that from RG. However, the high-molecular-weight carbohydrates of the main components were hardly hydrolysed. Furthermore, neither RG nor HRG inhibited disaccharidase activity. When rats were raised on a diet containing 5 % of RG, HRG, resistant maltodextrin or fructo-oligosaccharide (FOS) for 4 weeks, all rats developed loose stools and did not recover during the experiment, except for the FOS group. Body weight gain was normal in all groups and was not significantly different compared with the control group. Caecal tissue and content weights were significantly increased by feeding RG or HRG, although other organ and tissue weights were not significantly different among the groups. In conclusion, RG and HRG consist of small amounts of glucose and digestible and non-digestible oligosaccharides, and large amounts of glucose polymers, which were hardly hydrolysed by α-amylase and small intestinal enzymes. RG and HRG, which were developed newly as dietary fibre materials, had no harmful effects on the growth and development of rats.

Topics: alpha-Amylases; Animals; Cecum; Diarrhea; Dietary Carbohydrates; Dietary Fiber; Digestion; Disaccharidases; Glucans; Humans; Hydrogenation; Hydrolysis; Intestine, Small; Male; Molecular Structure; Oligosaccharides; Organ Size; Polysaccharides; Rats; Rats, Wistar; Weight Gain

Prebiotics potentially increase the growth of bifidobacteria, which may minimise the risk of diarrhoea in patients receiving enteral nutrition (EN). The present study aimed to compare the concentrations of faecal microbiota and short-chain fatty acids (SCFA) in patients receiving EN with either a standard formula or one enriched with fructo-oligosaccharides (FOS) and fibre.. Forty-one hospitalised adult patients (25 males, 16 females) who were on exclusive EN for at least 12 days were recruited to a cross-sectional study. Faecal samples were collected and analysed for major groups of microbiota using fluorescent in situ hybridisation and SCFA concentrations were analysed using gas liquid chromatography.. There were generally low concentrations of the major bacterial groups, including bifidobacteria, in all patients receiving either standard or FOS/fibre-enriched formula [bifidobacteria: 6.6 (1.3) versus 7.0 (2.0) log(10) cells g(-1) dry faecal, P=0.199]. However, faecal butyrate concentrations were higher in patients receiving the FOS/fibre-enriched formula compared to standard formula [20.5 (21.6) versus 4.6 (6.7) μmol g(-1) dry faecal, P=0.006].. Low concentrations of faecal bifidobacteria were identified in these patients, which potentially increases their risk of diarrhoea. Other microbiota groups may utilise FOS/fibre, leading to different butyrate concentrations between the two cohorts.

Topics: Adult; Aged; Bacterial Load; Bifidobacterium; Cross-Sectional Studies; Diarrhea; Dietary Fiber; Enteral Nutrition; Fatty Acids, Volatile; Feces; Female; Food, Formulated; Hospitalization; Humans; In Situ Hybridization, Fluorescence; Male; Middle Aged; Oligosaccharides; Prebiotics

Forty-five Holstein calves were fed milk replacers containing either antibiotics [MRA (oxytetracycline at 138 mg/kg and neomycin at 276 mg/kg), n = 22)] or Enteroguard [MRE, a blend of fructooligosaccharides, allicin, and gut-active microbes at (129 mg/kg, n = 23)] from birth to 5 wk of age to compare effects on average daily gain and on incidence of scours. Performance was evaluated by measuring weight gain, feed efficiency, and fecal scores. The overall body weight gains and severity of scours were not different between treatments, nor were there differences in starter intake or mean body weight gain. During wk 2, the average gain of calves fed MRA was less than that of calves fed MRE (0.07 vs. 0.09 kg/d, P = 0.09), and greater during wk 5 (0.62 vs. 0.51 kg/d, P < 0.01); however, total gain for calves fed MRE was not different from calves fed MRA. Likewise, average feed efficiencies (gain/dry matter intake) were not different. Severity of scours, as measured by fecal scores, and concentrations of serum proteins, an indirect measure of immunoglobulins, were similar for calves fed MRA and MRE. The results suggest that antibiotics in milk replacers can be replaced with compounds such as fructooligosaccharides, probiotics, and allicin to obtain similar calf performance.

Topics: Animal Feed; Animal Nutritional Physiological Phenomena; Animals; Animals, Newborn; Anti-Bacterial Agents; Anti-Infective Agents; Cattle; Diarrhea; Disulfides; Feces; Female; Food, Formulated; Incidence; Male; Neomycin; Oligosaccharides; Oxytetracycline; Probiotics; Random Allocation; Sulfinic Acids; Weight Gain