Intestinal Gas

肠气
  • 文章类型: Journal Article
    随着营养学研究的深入,膳食纤维(DF)在动物日粮中的重要性日益增加。DF由肠道微生物群发酵产生代谢产物,这对改善肠道健康很重要。本综述是使用体外和体内模型对DF在猪营养中的作用进行的系统综述。在体外模型中总结了DF的发酵特性及其代谢产物的代谢机制。并指出SCFA和气体是连接DF的重要代谢产物,肠道菌群,和肠道健康,它们在肠道健康中起着关键作用。同时,一些关于宿主-微生物相互作用的信息可以通过传统的动物体内模型得到改善,产生了对营养素最直接的反馈,证实了DF对母猪繁殖性能的有益作用,仔猪肠道健康,和种植猪肉的质量。最后,比较了不同发酵模式的优缺点。在未来的研究中,有必要灵活结合体内外发酵模型,深入研究DF对生物体的作用机理,以促进精准营养工具的发展,为DF在畜牧业中的深入、合理利用提供科学依据。要点:•综述了膳食纤维体外模型的发酵特性。•综述了代谢物的代谢途径及其在肠道中的作用。•综述了膳食纤维在猪不同阶段的作用。
    The importance of dietary fiber (DF) in animal diets is increasing with the advancement of nutritional research. DF is fermented by gut microbiota to produce metabolites, which are important in improving intestinal health. This review is a systematic review of DF in pig nutrition using in vitro and in vivo models. The fermentation characteristics of DF and the metabolic mechanisms of its metabolites were summarized in an in vitro model, and it was pointed out that SCFAs and gases are the important metabolites connecting DF, gut microbiota, and intestinal health, and they play a key role in intestinal health. At the same time, some information about host-microbe interactions could have been improved through traditional animal in vivo models, and the most direct feedback on nutrients was generated, confirming the beneficial effects of DF on sow reproductive performance, piglet intestinal health, and growing pork quality. Finally, the advantages and disadvantages of different fermentation models were compared. In future studies, it is necessary to flexibly combine in vivo and in vitro fermentation models to profoundly investigate the mechanism of DF on the organism in order to promote the development of precision nutrition tools and to provide a scientific basis for the in-depth and rational utilization of DF in animal husbandry. KEY POINTS: • The fermentation characteristics of dietary fiber in vitro models were reviewed. • Metabolic pathways of metabolites and their roles in the intestine were reviewed. • The role of dietary fiber in pigs at different stages was reviewed.
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  • 文章类型: Journal Article
    富含可发酵残留物的健康植物性饮食可能会诱发与气体有关的症状,可能是由肠道微生物群介导的。我们以前表明,食用含有动物双歧杆菌亚种的发酵乳制品(FMP)。乳酸CNCMI-2494和乳酸菌改善了胃肠道(GI)舒适度,以应对健康个体的肠胃性饮食挑战。为了研究FMP对这些参与者肠道微生物活性的影响,我们对粪便样本(n=262)进行了代谢组学分析,它们是在摄入习惯性饮食和两个为期3天的高残留挑战饮食期间收集的,在FMP消耗28天之前和之后。大多数FMP物种在消耗产品时被检测到或发现富集。FMP以几种方式减轻了气胀性饮食对气体相关症状的影响。首先,FMP消耗与产气细菌的消耗和氢向甲烷转化的增加有关。它还导致活动的上调,例如复制和与运动性和趋化性相关的功能的下调。此外,在FMP摄入时,代谢活动,如碳水化合物代谢,归因于动物芽孢杆菌和嗜热链球菌,丰富;这些活动被偶然发现与几种胃肠道症状呈负相关。最后,在FMP干预的应答者中发现了更紧密的微生物生态系统或微生物之间的相互关系。一起来看,这些发现表明,FMP的摄入通过与常驻肠道微生物群的积极相互作用,提高了对放气饮食的耐受性.
    Healthy plant-based diets rich in fermentable residues may induce gas-related symptoms, possibly mediated by the gut microbiota. We previously showed that consumption of a fermented milk product (FMP) containing Bifidobacterium animalis subsp. lactis CNCM I-2494 and lactic acid bacteria improved gastrointestinal (GI) comfort in response to a flatulogenic dietary challenge in healthy individuals. To study the effects of the FMP on gut microbiota activity from those participants, we conducted a metatranscriptomic analysis of fecal samples (n = 262), which were collected during the ingestion of a habitual diet and two series of a 3-day high-residue challenge diet, before and following 28-days of FMP consumption. Most of the FMP species were detected or found enriched upon consumption of the product. FMP mitigated the effect of a flatulogenic diet on gas-related symptoms in several ways. First, FMP consumption was associated with the depletion of gas-producing bacteria and increased hydrogen to methane conversion. It also led to the upregulation of activities such as replication and downregulation of functions related to motility and chemotaxis. Furthermore, upon FMP intake, metabolic activities such as carbohydrate metabolism, attributed to B. animalis and S. thermophilus, were enriched; these activities were coincidentally found to be negatively associated with several GI symptoms. Finally, a more connected microbial ecosystem or mutualistic relationship among microbes was found in responders to the FMP intervention. Taken together, these findings suggest that consumption of the FMP improved the tolerance of a flatulogenic diet through active interactions with the resident gut microbiota.
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  • 文章类型: Journal Article
    背景:婴儿肠道菌群产生的肠道气体和粪便短链脂肪酸(SCFA)可能对其健康产生重大影响。但是有关早产儿肠道气体的成分和体积以及SCFA谱的信息很少.目的:本研究研究了早产儿肠道菌群在生命的前4周内体外产生的肠道气体成分和体积以及SCFA谱的变化。方法:在五个时间点(3天内,1周,2周,3周,和4周)来自19名在上海市儿童医院新生儿重症监护病房(NICU)住院的早产儿,上海交通大学2020年5月至7月。这些样品最初接种到含有乳糖(LAT)的四种不同培养基中,低聚果糖(FOS),2'-岩藻糖基乳糖(FL-2),和低聚半乳糖(GOS),然后在厌氧条件下在37.8°C模拟大肠的条件下发酵24小时。总肠道气体的体积和单个二氧化碳(CO2)的浓度,氢气(H2),甲烷(CH4),和硫化氢(H2S)通过气体分析仪测量。总SCFA的浓度,单独的乙酸,丙酸,丁酸,异丁酸,戊酸,和戊酸通过气相色谱法(GC)测量。结果:肠道气体的总体积(在含LAT的培养基中为0.01至1.64ml;GOS为0-1.42ml;FOS为0-0.91ml;FL-2为0-0.44ml)以及CO2,H2,H2S的浓度,所有6种粪便SCFA随年龄增长而增加(p趋势<0.05)。其中,二氧化碳通常是主要的肠道气体,乙酸通常是主要的SCFA。按出生体重分层时(<1,500和≥1,500克),性别,和交付模式,与体重<1,500g的婴儿相比,体重≥1,500g的婴儿的CO2浓度更为明显(p趋势<0.05).结论:我们的发现表明,在生命的前4周内,早产儿肠道菌群在体外产生的肠道气体和SCFA随年龄增加。
    Background: The production of intestinal gases and fecal short-chain fatty acids (SCFAs) by infant gut microbiota may have a significant impact on their health, but information about the composition and volume of intestinal gases and SCFA profiles in preterm infants is scarce. Objective: This study examined the change of the composition and volume of intestinal gases and SCFA profiles produced by preterm infant gut microbiota in vitro during the first 4 weeks of life. Methods: Fecal samples were obtained at five time points (within 3 days, 1 week, 2 weeks, 3 weeks, and 4 weeks) from 19 preterm infants hospitalized in the neonatal intensive care unit (NICU) of Shanghai Children\'s Hospital, Shanghai Jiao Tong University between May and July 2020. These samples were initially inoculated into four different media containing lactose (LAT), fructooligosaccharide (FOS), 2\'-fucosyllactose (FL-2), and galactooligosaccharide (GOS) and thereafter fermented for 24 h under conditions mimicking those of the large intestine at 37.8°C under anaerobic conditions. The volume of total intestinal gases and the concentrations of individual carbon dioxide (CO2), hydrogen (H2), methane (CH4), and hydrogen sulfide (H2S) were measured by a gas analyzer. The concentrations of total SCFAs, individual acetic acid, propanoic acid, butyric acid, isobutyric acid, pentanoic acid, and valeric acid were measured by gas chromatography (GC). Results: The total volume of intestinal gases (ranging from 0.01 to 1.64 ml in medium with LAT; 0-1.42 ml with GOS; 0-0.91 ml with FOS; and 0-0.44 ml with FL-2) and the concentrations of CO2, H2, H2S, and all six fecal SCFAs increased with age (p-trends < 0.05). Among them, CO2 was usually the predominant intestinal gas, and acetic acid was usually the predominant SCFA. When stratified by birth weight (<1,500 and ≥1,500 g), gender, and delivery mode, the concentration of CO2 was more pronounced among infants whose weight was ≥1,500 g than among those whose weight was <1,500 g (p-trends < 0.05). Conclusions: Our findings suggested that the intestinal gases and SCFAs produced by preterm infant gut microbiota in vitro increased with age during the first 4 weeks of life.
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  • 文章类型: Journal Article
    BACKGROUND: Understanding intestinal gases volume and composition may contribute to diagnosing digestive diseases and the microbiome\'s status. This meta-analysis aimed to define the composition of human intestinal gases and changes associated with diet.
    METHODS: Studies were identified by systematic research of the MEDLINE(Ovid), Scopus, and Cochrane databases. Studies that measured the concentration of intestinal gases in healthy adult humans were retrieved. The JBI critical appraisal tool was used to evaluate the risk of bias. The primary outcomes analysed were the concentration of the most prevalent colonic gases. Participants were divided into groups according to dietary fibre content.
    RESULTS: Eleven studies were included. The following gases were identified in similar concentrations across all studies (mean ± standard deviation): nitrogen (65.1 ± 20.89%), oxygen (2.3 ± 0.98%), carbon dioxide (9.9 ± 1.6%), hydrogen (2.9 ± 0.7%), and methane (14.4 ± 3.7%). Differences according to the dietary fibre were observed, with a positive correlation between fibre and volume of gas produced, particularly in fermented gases (carbon dioxide, hydrogen, and methane).
    CONCLUSIONS: The meta-analysis has found defined concentrations of the five most common gases present in human colonic gas. Limitations included heterogenic methodologies, a low number of participants, and few recent studies. These findings may be helpful in diagnostic applications where colonic gas volume and composition are crucial factors, including functional disorders, microbiome analyses, and bowel perforation diagnostics.
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  • 文章类型: Journal Article
    我们的目的是确定饮食对肠道微生物群的影响,消化功能和感觉,使用综合临床,宏基因组学和代谢组学方法。我们进行了交叉,关于西方饮食与富含纤维的地中海饮食的影响的随机研究。在20个健康的男人中,每次饮食给药2周,然后进行2周的清除饮食.记录了以下结果:(a)肛门气体排空次数;(b)消化感觉;(c)探头餐后排空的气体体积;(d)磁共振成像的结肠含量;(e)粪便样品的鸟枪测序的肠道微生物群分类学和代谢功能;(f)使用非靶向代谢组学的尿代谢物。与西方饮食相比,地中海饮食与(i)更多的肛门气体排出有关,(ii)肠胃胀气和borborygmi的感觉,(iii)餐后气体的体积较大和(iv)结肠含量较大。尽管两种饮食之间的微生物群组成差异相对较小,微生物代谢差异很大,如尿代谢物谱和丰富的微生物代谢途径所示。饮食的影响在具有强大的微生物(较高的β-多样性)的个体中不太明显。最后,健康个体可以耐受饮食变化,在组成水平上有较小的微生物修饰,但微生物代谢却有显着变化。
    Our aim was to determine the effect of diet on gut microbiota, digestive function and sensations, using an integrated clinical, metagenomics and metabolomics approach. We conducted a cross-over, randomised study on the effects of a Western-type diet versus a fibre-enriched Mediterranean diet. In 20 healthy men, each diet was administered for 2 weeks preceded by a 2-week washout diet. The following outcomes were recorded: (a) number of anal gas evacuations; (b) digestive sensations; (c) volume of gas evacuated after a probe meal; (d) colonic content by magnetic resonance imaging; (e) gut microbiota taxonomy and metabolic functions by shotgun sequencing of faecal samples; (f) urinary metabolites using untargeted metabolomics. As compared to a Western diet, the Mediterranean diet was associated with (i) higher number of anal gas evacuations, (ii) sensation of flatulence and borborygmi, (iii) larger volume of gas after the meal and (iv) larger colonic content. Despite the relatively little difference in microbiota composition between both diets, microbial metabolism differed substantially, as shown by urinary metabolite profiles and the abundance of microbial metabolic pathways. The effects of the diet were less evident in individuals with robust microbiotas (higher beta-diversity). To conclude, healthy individuals tolerate dietary changes with minor microbial modifications at the composition level but with remarkable variation in microbial metabolism.
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  • 文章类型: Journal Article
    益生元对人类健康有益,通常通过促进产生对人体有价值的代谢产物的肠道细菌的生长,例如短链脂肪酸(SCFA)。虽然益生元的选择非常注重最大限度地提高SCFA的产量,对气体的关注较少,SCFA生产的副产品,对人体也有生理影响。这里,我们研究了人类肠道微生物群产生气体的含量和体积如何受到益生元的化学组成和微生物群的群落组成的影响。我们首先构建了基于质量和电子平衡的线性系统模型,并比较了两种益生元的理论乘积范围,菊粉和果胶。建模表明,果胶在产品空间上受到更多限制,H2潜力较小,但CO2生产潜力较大。离体实验系统显示,果胶降解产生的H2明显少于菊粉,但是二氧化碳产量超出了理论产品范围,提示粪便碎片的发酵。微生物群落组成也影响了结果:甲烷的产生取决于甲烷细菌的存在,而菊粉降解过程中H2产生的个体差异是由Lachnospileaceae分类单元驱动的。总的来说,这些结果表明,益生元的化学成分和微生物群的组成都与产气有关。在微生物组中相对普遍的代谢过程,例如H2生产,将更多地依赖于底物,而罕见的代谢,如甲烷生成更强烈地依赖于微生物组的组成。重要性肠道中的益生元发酵通常导致短链脂肪酸(SCFA)和气体的共同产生。虽然过量的气体产生可能是功能性肠道疾病患者的潜在问题,在益生元设计过程中很少考虑天然气生产。在这项研究中,我们结合使用理论模型和离体实验平台来说明益生元的化学组成和人类肠道菌群的群落组成都可以影响益生元发酵过程中气体产生的体积和含量。具体来说,更普遍的代谢过程,如产氢受到益生菌氧化状态的强烈影响,而甲烷产生等稀有代谢受底物化学性质的影响较小,完全依赖于微生物群中甲烷细菌的存在。
    Prebiotics confer benefits to human health, often by promoting the growth of gut bacteria that produce metabolites valuable to the human body, such as short-chain fatty acids (SCFAs). While prebiotic selection has strongly focused on maximizing the production of SCFAs, less attention has been paid to gases, a by-product of SCFA production that also has physiological effects on the human body. Here, we investigate how the content and volume of gas production by human gut microbiota are affected by the chemical composition of the prebiotic and the community composition of the microbiota. We first constructed a linear system model based on mass and electron balance and compared the theoretical product ranges of two prebiotics, inulin and pectin. Modeling shows that pectin is more restricted in product space, with less potential for H2 but more potential for CO2 production. An ex vivo experimental system showed pectin degradation produced significantly less H2 than inulin, but CO2 production fell outside the theoretical product range, suggesting fermentation of fecal debris. Microbial community composition also impacted results: methane production was dependent on the presence of Methanobacteria, while interindividual differences in H2 production during inulin degradation were driven by a Lachnospiraceae taxon. Overall, these results suggest that both the chemistry of the prebiotic and the composition of the microbiota are relevant to gas production. Metabolic processes that are relatively prevalent in the microbiome, such as H2 production, will depend more on substrate, while rare metabolisms such as methanogenesis depend more strongly on microbiome composition.IMPORTANCE Prebiotic fermentation in the gut often leads to the coproduction of short-chain fatty acids (SCFAs) and gases. While excess gas production can be a potential problem for those with functional gut disorders, gas production is rarely considered during prebiotic design. In this study, we combined the use of theoretical models and an ex vivo experimental platform to illustrate that both the chemical composition of the prebiotic and the community composition of the human gut microbiota can affect the volume and content of gas production during prebiotic fermentation. Specifically, more prevalent metabolic processes such as hydrogen production were strongly affected by the oxidation state of the probiotic, while rare metabolisms such as methane production were less affected by the chemical nature of the substrate and entirely dependent on the presence of Methanobacteria in the microbiota.
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  • 文章类型: Journal Article
    绿色猕猴桃是一种富含纤维的水果,已被证明可有效治疗便秘。然而,结肠细菌对纤维的发酵可能会使通常相关的与气体有关的腹部症状恶化。
    确定绿色猕猴桃对人类肠道气体运输和耐受性的影响。
    在11个健康个体中,进行了两次气体挑战测试:(a)在低平稳性饮食和每天摄入2种绿色猕猴桃2周后,以及(b)在不摄入猕猴桃的类似饮食2周后。气体挑战测试包括以12mL/min的速度将气体混合物连续注入空肠2小时,同时测量直肠气体排空,腹部症状,和腹胀.在每次气体挑战测试前的2周内(猕猴桃和猕猴桃外),大便的数量和一致性,并记录了腹部症状。
    猕猴桃的摄入与每天更多的排便相关(1.8±0.1vs1.5±0.1关猕猴桃;P=.001)和一些较松散的粪便(Bristol评分3.3±0.2vs2.8±0.1关猕猴桃;P=.072),无相关的腹部症状。气体输注产生类似的气体排空(1238±254毫升和1172±290毫升;P=.4355),对症状的感知(评分1.2±0.2和1.3±0.3;P=.2367),和腹胀(17±7毫米和17±6毫米;P=.4704),而猕猴桃或猕猴桃。
    在健康的受试者中,绿色猕猴桃可增加粪便频率,对肠道气体转运和耐受性无相关影响。如果在患者中得到证实,这些水果可能为便秘提供一种天然且耐受性良好的治疗方法。
    Green kiwifruit is a fiber-rich fruit that has been shown effective for treatment of constipation. However, fermentation of fibers by colonic bacteria may worsen commonly associated gas-related abdominal symptoms.
    To determine the effect of green kiwifruit on transit and tolerance to intestinal gas in humans.
    In 11 healthy individuals, two gas challenge tests were performed (a) after 2 weeks on a low-flatulogenic diet and daily intake of 2 green kiwifruits and (b) after 2 weeks on a similar diet without intake of kiwifruits. The gas challenge test consisted in continuous infusion of a mixture of gases into the jejunum at 12 mL/min for 2 hours while measuring rectal gas evacuation, abdominal symptoms, and abdominal distension. During the 2 weeks prior to each gas challenge test (on-kiwifruit and off-kiwifruit), the number and consistency of stools, and abdominal symptoms were registered.
    Intake of kiwifruits was associated with more bowel movements per day (1.8 ± 0.1 vs 1.5 ± 0.1 off-kiwifruit; P = .001) and somewhat looser stools (Bristol score 3.3 ± 0.2 vs 2.8 ± 0.1 off-kiwifruit; P = .072) without relevant abdominal symptoms. Gas infusion produced similar gas evacuation (1238 ± 254 mL and 1172 ± 290 mL; P = .4355), perception of symptoms (score 1.2 ± 0.2 and 1.3 ± 0.3; P = .2367), and abdominal distension (17 ± 7 mm and 17 ± 6 mm; P = .4704) while on-kiwifruit or off-kiwifruit.
    In healthy subjects, green kiwifruit increases stool frequency without relevant effects on intestinal gas transit and tolerance. If confirmed in patients, these fruits may provide a natural and well-tolerated treatment alternative for constipation.
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  • 文章类型: Journal Article
    Patients with functional dyspepsia are believed to have increased sensitivity of the gastrointestinal tract, and some also have functional constipation. We investigated whether in patients with functional dyspepsia, correction of dyssynergic defecation can reduce postprandial fullness.
    We performed a parallel trial at 2 referral centers in Spain, from June 2016 through January 2018 of 50 patients who fulfilled the Rome IV criteria for functional dyspepsia with postprandial distress syndrome and functional constipation and dyssynergic defecation. After a 2-week pretreatment phase, the patients were randomly assigned to groups that learned to correct dyssynergic defecation (2-3 sessions of biofeedback combined with instructions for daily exercise; n = 25) or received dietary fiber supplementation (3.5 g plantago ovata per day; n = 25) for 4 weeks. The primary outcome was change in postprandial abdominal fullness, measured daily on a scale of 0-10, during the last 7 days treatment phase vs the last 7 days of the pretreatment phase. Anal gas evacuations were measured (by an event marker) during the last 2 days of the pretreatment vs treatment phases.
    Biofeedback treatment corrected dyssynergic defecation in 19/25 patients; corrected dyssynergic defection reduced postprandial fullness by 22%±1% in these patients (P < .001), and reduced the number of anal evacuations by 21%±8% (P = .009). Fiber supplementation did not reduce postprandial fullness or anal evacuations (P ≤ .023 between groups for both parameters in the intent to treat analysis).
    Diagnosis and correction of dyssynergic defecation reduces dyspeptic symptoms by more than 20% in patients with functional dyspepsia and associated constipation. Dietary fiber supplementation does not reduce symptoms in these patients. ClinicalTrials.gov no: NCT02956187.
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  • 文章类型: Journal Article
    The aim of this study is to evaluate the effect of rice, mung bean, and wheat noodle ingestion on intestinal gas production and postprandial gastrointestinal (GI) symptoms in non-constipation irritable bowel syndrome (IBS) patients.
    METHODS: Twenty patients (13 F, 46 ± 11 y) underwent 8 h breath test studies and GI symptom evaluations after standard rice, wheat, or mung bean noodle meals at 8:00 a.m. in a randomized crossover study with a 1-week washout period. The same meal was ingested at 12:00 p.m.
    RESULTS: The H2 and CH4 concentration in the breath samples were similar at baseline (rice:wheat:mung bean, H2 = 3.6 ± 0.5:4.1 ± 0.5:4.0 ± 0.7 ppm, CH4 = 1.3 ± 0.3:2.1 ± 0.4:1.9 ± 0.4 ppm, p > 0.05). Beginning at the fifth hour after breakfast, H2 and CH4 concentrations significantly increased after wheat compared to rice and mung bean (8 h AUC H2 = 4120 ± 2622:2267 ± 1780:2356 ± 1722, AUC CH4 = 1617 ± 1127:946 ± 664:943 ± 584 ppm-min, respectively) (p < 0.05). Bloating and satiety scores significantly increased after wheat compared to rice (p < 0.05), and increased but did not reach statistical significance compared to mung bean (p > 0.05). A higher bloating score after wheat compared to rice and mung bean was observed clearly after lunch but not after breakfast.
    CONCLUSIONS: Wheat ingestion produced more intestinal gas and more bloating and satiety scores compared to rice and mung bean, especially after lunch. This provides insight into the role of intestinal gas in the development of bloating symptoms in IBS.
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  • 文章类型: Comparative Study
    有些病人抱怨吃生菜,给他们气体和腹胀。我们的目的是确定患者的断言在多大程度上被证据所维持。
    一项体外研究通过制备预消化生菜的人类结肠微生物群(n=3)来测量发酵过程中产生的气体量,与豆类相比,高释放气体的基质,肉,低气体释放基质,和无营养阴性对照。一项针对食用生菜后抱怨腹胀的患者的临床研究(n=12)测量了生菜引起的腹胀发作期间腹部CT扫描中的肠道气体量和腹腔形态与基础条件相比。
    生菜在体外通过微生物群发酵产生的气体与肉类相似(P=0.44),低于豆类(78±15%;P<.001),高于无营养对照(25±19%;P=.05)。吃生菜后抱怨腹胀的患者周长增加(比基础大35±3mm;P<.001),而结肠气体含量没有显着增加(增加39±4mL;P=.071);腹胀与隔膜下降(下降7±3mm;P=.027)有关,腹部内容物正常。
    生菜是微生物群发酵的低气体释放底物,生菜诱导的腹胀是由腹壁的不协调活动产生的。纠正躯体反应可能比当前的饮食限制策略更有效。
    Some patients complain that eating lettuce, gives them gas and abdominal distention. Our aim was to determine to what extent the patients\' assertion is sustained by evidence.
    An in vitro study measured the amount of gas produced during the process of fermentation by a preparation of human colonic microbiota (n = 3) of predigested lettuce, as compared to beans, a high gas-releasing substrate, to meat, a low gas-releasing substrate, and to a nutrient-free negative control. A clinical study in patients complaining of abdominal distention after eating lettuce (n = 12) measured the amount of intestinal gas and the morphometric configuration of the abdominal cavity in abdominal CT scans during an episode of lettuce-induced distension as compared to basal conditions.
    Gas production by microbiota fermentation of lettuce in vitro was similar to that of meat (P = .44), lower than that of beans (by 78 ± 15%; P < .001) and higher than with the nutrient-free control (by 25 ± 19%; P = .05). Patients complaining of abdominal distension after eating lettuce exhibited an increase in girth (35 ± 3 mm larger than basal; P < .001) without significant increase in colonic gas content (39 ± 4 mL increase; P = .071); abdominal distension was related to a descent of the diaphragm (by 7 ± 3 mm; P = .027) with redistribution of normal abdominal contents.
    Lettuce is a low gas-releasing substrate for microbiota fermentation and lettuce-induced abdominal distension is produced by an uncoordinated activity of the abdominal walls. Correction of the somatic response might be more effective than the current dietary restriction strategy.
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