Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.
Bacterial Infections/physiopathology* ; Bile Acids and Salts/physiology* ; Cholestasis/physiopathology* ; Enteral Nutrition ; Gastrointestinal Microbiome/physiology* ; Humans ; Intestinal Diseases/physiopathology* ; Intestines/physiopathology* ; Liver/physiopathology* ; Liver Diseases/physiopathology* ; Parenteral Nutrition/adverse effects* ; Short Bowel Syndrome/physiopathology* ; Signal Transduction

Diabetes is a widespread, rapidly increasing metabolic disease that is driven by hyperglycemia. Early glycemic control is of primary importance to avoid vascular complications including development of retinal disorders leading to blindness, end-stage renal disease, and accelerated atherosclerosis with a higher risk of myocardial infarction, stroke and limb amputations. Even after hyperglycemia has been brought under control, "metabolic memory," a cluster of irreversible metabolic changes that allow diabetes to progress, may persist depending on the duration of hyperglycemia. Manipulation of bile acid (BA) receptors and the BA pool have been shown to be useful in establishing glycemic control in diabetes due to their ability to regulate energy metabolism by binding and activating nuclear transcription factors such as farnesoid X receptor (FXR) in liver and intestine as well as the G-protein coupled receptor, TGR5, in enteroendocrine cells and pancreatic β-cells. The downstream targets of BA activated FXR, FGF15/21, are also important for glucose/insulin homeostasis. In this review we will discuss the effect of BAs on glucose and lipid metabolism and explore recent research on establishing glycemic control in diabetes through the manipulation of BAs and their receptors in the liver, intestine and pancreas, alteration of the enterohepatic circulation, bariatric surgery and alignment of circadian rhythms.
Animals ; Bile Acids and Salts ; blood ; metabolism ; Blood Glucose ; drug effects ; metabolism ; Circadian Rhythm ; Diabetes Mellitus ; blood ; drug therapy ; metabolism ; Energy Metabolism ; Homeostasis ; Humans ; Hyperglycemia ; metabolism ; physiopathology ; Hypoglycemic Agents ; therapeutic use ; Intestinal Mucosa ; metabolism ; Intestines ; drug effects ; Lipid Metabolism ; Liver ; drug effects ; metabolism ; Receptors, Cytoplasmic and Nuclear ; metabolism ; Receptors, G-Protein-Coupled ; metabolism ; Signal Transduction

OBJECTIVETo explore the effect of Compound Tongtu Granule (CTG) on intestinal permeability in elderly sepsis patients.

METHODSEighty elderly sepsis patients were randomly assigned to the experimental group and the control group by randomized double blinded method, 40 in each group. On the basis of conventional antiseptic treatment program, patients in the experimental group took CTG, while those in the control group took placebos. The dosage for CTG or placebos was 14.3 g each package, one package each time, twice daily for 14 successive days. Patients' abdominal symptoms and signs, levels of serum inflammatory factors (high-sensitivity C-reactive protein and procalcitonin), levels of plasma endotoxin, and the intestinal permeability (IP, represented by urinary lactulose/mannitol excretion rate) were compared between the two groups before and after treatment.

RESULTSAfter 14-day treatment, patients in the experimental group had improved abdominal symptoms, increased frequency of defecation, significantly decreased levels of plasma endotoxin and IP, when compared with the control group (P < 0.05).

CONCLUSIONCTG could improve the intestinal barrier function in elderly sepsis patients.

Aged ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Calcitonin Gene-Related Peptide ; Defecation ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Endotoxins ; metabolism ; Humans ; Intestines ; metabolism ; Permeability ; Protein Precursors ; metabolism ; Sepsis ; drug therapy ; physiopathology

Child ; Humans ; Intestinal Diseases ; metabolism ; physiopathology ; Intestinal Mucosa ; metabolism ; physiopathology ; Intestines ; metabolism ; physiopathology ; Membrane Proteins ; metabolism ; Pediatrics ; Permeability ; Phosphatidylinositol 3-Kinases ; metabolism ; Respiratory Hypersensitivity ; metabolism ; physiopathology ; Tight Junctions ; metabolism ; physiology

OBJECTIVETo observe the improvements in constipation differentiated as intestine system syndrome and lung system syndrome treated with electroacupuncture (EA) and explore their correlation.

METHODSSeventy cases of severe functional constipation were randomized into an EA group and a pseudo-EA group, 35 cases in each one. In the EA group, the needles were inserted deeply at Tianshu (ST 25) and Fujie (SP 14) on bilateral sides, and directly went to parietal peritoneum. EA was attached to the needles, dense-disperse wave, 2 Hz/15 Hz, and 0.1 to 1.0 mA. The perpendicular insertion was done at Shangjuxu (ST 37), 25 mm in depth. After qi arrival, the needle was lifted, thrusted and rotated once every 10 min, for 3 times totally. The needles were retained for 30 min. In the pseudo-EA group, the pseudo-points lateral to Tianshu (ST 25), Fujie (SP 14) and Shangjuxu (ST 37) on bilateral sides were punctured shallowly. The electric stimulation was pretended to connect but with the electric wire cutting off. The needles were retained for 30 min. The treatment was given 5 times weekly in the first two weeks and 3 times weekly in the later 6 weeks. Totally, 28 treatments were required. TCM intestine and lung syndrome scale was used for evaluation. The changes in TCM syndromes were observed before and after treatment in the patients of the two groups.

RESULTSThe total score of intestine and lung syndrome and the score of individual syndrome were all reduced after treatment as compared with those before treatment in the two groups (both P<0.01). The improvements of the EA group in the total score of intestine system syndrome, the scores of large. intestine syndrome and stomach syndrome, the total score of lung system syndrome and the score of lung dysfunction in dispersing and descending syndrome were superior to those of the pseudo-EA group (P<0.01, P<0.05). The differences in the scores of lung qi deficiency syndrome and throat syndrome were not significant between the two groups (all P>0.05). Simultaneously, the very strong positive correlation (P<0.01) and positive linear correlation (P<0.01) were presented in the total score of intestine and lung syndrome of the two groups.

CONCLUSIONEA obviously improves in intestine system syndrome (including large intestine syndrome and stomach syndrome), as well as lung system syndrome (lung dysfunction in dispersing and descending) in the treatment of constipation. But the improvements are not apparent in the treatment of lung qi deficiency and throat disorder. Additionally, the obvious correlation is displayed in the improvements in intestine and lung syndrome.

Acupuncture Points ; Adult ; Aged ; Constipation ; physiopathology ; therapy ; Electroacupuncture ; Female ; Humans ; Intestines ; physiopathology ; Lung ; physiopathology ; Male ; Middle Aged ; Young Adult

OBJECTIVETo observe the effect of N-acetylcysteine (NAC) on intestine injury induced by cardiopulmonary bypass (CPB) in rats.

METHODSThirty-two rats were randomly divided into sham-operated group, NAC control group, CPB model group, and CPB plus NAC treatment group (n=8). In the latter two groups, the rats were subjected to CPB for 1 h. The rats received intraperitoneal injections of normal saline or NAC (0.5 g/kg) as appropriate for 3 successive days prior to CPB, and those in CPB plus NAC group were given NAC (100 mg/kg) in CPB prime followed by infusion at 20 mgsol;(kg·h) until the cessation of CPB. Intestinal and blood samples were collected 2 h after CPB for pathological analysis and measurement of intestinal concentrations of malondialdehyde (MDA), tumor necrosis factor (TNF)-α, interlukin (IL)-6 and activity of superoxide dismutase (SOD), glutathione (GSH), and glutathione peroxidase (GSH-Px) and serum levels of diamine oxidase (DAO).

RESULTSEvident oxidative stress and pathological damages of the intestines were observed in rats after CPB. NAC treatment obviously alleviated intestinal damages induced by CPB, decreased the levels of intestinal MDA, TNF-α, IL-6 and serum DAO and increased activity of SOD, GSH, and GSH-Px in the intestines.

CONCLUSIONPerioperative NAC treatment can alleviate intestinal injury induced by CPB in rats by suppressing oxidative stress and inflammatory response.

Acetylcysteine ; pharmacology ; Animals ; Cardiopulmonary Bypass ; adverse effects ; Glutathione ; metabolism ; Glutathione Peroxidase ; metabolism ; Inflammation ; drug therapy ; Interleukin-6 ; metabolism ; Intestines ; drug effects ; physiopathology ; Malondialdehyde ; metabolism ; Oxidative Stress ; drug effects ; Rats ; Superoxide Dismutase ; metabolism ; Tumor Necrosis Factor-alpha

Acupuncture Therapy ; Adult ; Aged ; Female ; Hiccup ; physiopathology ; therapy ; Humans ; Intestines ; physiopathology ; Male ; Middle Aged ; Qi ; Stomach ; physiopathology ; Young Adult

Chronic radiation enteritis(CRE) is a common complication after pelvic radiotherapy, which severely affects patients' quality of life. Surgical treatment of CRE is challenging both for surgical skills and perioperative treatment strategy. Proper preoperative nutrition support therapy can reduce the morbidity of postoperative complication and the use of stoma, while postoperative nutrition support therapy can avoid the intestinal failure. Enteral nutrition should be the primary route of perioperative nutrition support therapy in CRE as possible. Pharmaconutrients aiming at intestinal commensal microbiota and its metabolites may play a role in the management of radiation enteritis.
Humans ; Intestines ; physiopathology ; Nutritional Support ; Postoperative Complications ; Quality of Life ; Radiation Injuries ; therapy

OBJECTIVETo investigate a new bowel management program for children patients with fecal incontinence.

METHODSClinical data of 19 children with fecal incontinence undergoing bowel management program in our center between January 2012 and January 2013 were retrospectively analyzed. The main outcome measure was clinical efficacy of this program.

RESULTSFifteen out of 19 cases were genuine fecal incontinence and required continuous treatment by enema. The other 4 cases were false fecal incontinence. After treatment with this program, stool dirty and constipation were improved in genuine incontinence. Two cases of false continence could control defecation independently by oral administration of antispasmodic drug. Two cases of false continence were cured and did not need medical interference.

CONCLUSIONSBowel management program is an effective treatment for pediatric patients with fecal incontinence. The key of success is maintenance of perianal hygiene for 24 hours by continual adjustment of the elements and volumes of enemas.

Child ; Constipation ; Enema ; Fecal Incontinence ; therapy ; Humans ; Intestines ; physiopathology ; Retrospective Studies

OBJECTIVEBased on the observation that coagulation necrosis occurs in the majority of neonatal necrotizing enterocolitis (NEC) patients, it is clear that intestinal ischemia is a contributing factor to the pathogenesis of NEC. However, the published studies regarding the role of intestinal ischemia in NEC are controversial. The aim of this paper is to review the current studies regarding intestinal microcirculatory dysfunction and NEC, and try to elucidate the exact role of intestinal microcirculatory dysfunction in NEC.

DATA SOURCESThe studies cited in this review were mainly obtained from articles listed in Medline and PubMed. The search terms used were "intestinal microcirculatory dysfunction" and "neonatal necrotizing enterocolitis".

STUDY SELECTIONMainly original milestone articles and critical reviews written by major pioneer investigators in the field were selected.

RESULTSImmature regulatory control of mesentery circulation makes the neonatal intestinal microvasculature vulnerable. When neonates are subjected to stress, endothelial cell dysfunction occurs and results in vasoconstriction of arterioles, inflammatory cell infiltration and activation in venules, and endothelial barrier disruption in capillaries. The compromised vasculature increases circulation resistance and therefore decreases intestinal perfusion, and may eventually progress to intestinal necrosis.

CONCLUSIONIntestinal ischemia plays an important role through the whole course of NEC. New therapeutic agents targeting intestinal ischemia, like HB-EGF, are promising therapeutic agents for the treatment of NEC.

Endothelin-1 ; physiology ; Endothelium, Vascular ; physiopathology ; Enterocolitis, Necrotizing ; drug therapy ; etiology ; pathology ; Heparin-binding EGF-like Growth Factor ; Humans ; Infant, Newborn ; Intercellular Signaling Peptides and Proteins ; therapeutic use ; Intestines ; blood supply ; Ischemia ; complications ; Microcirculation ; physiology ; Nitric Oxide ; physiology ; Splanchnic Circulation