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The objective was to determine the effects of prebiotics and synbiotics on adults with functional constipation (FC). Medline, Embase and the Cochrane Library were searched for literature published up to February 2015. We selected randomized controlled trials (RCTs) that reported administration of prebiotics or synbiotics to adults with FC. The end points included stool frequency, stool consistency and other symptoms related to constipation. Mean differences (MD) or standard mean differences (SMD) were used for continuous outcomes and risk ratios for discontinuous outcomes using a random-effects model. The Cochrane Risk of Bias Tool was used to determine the quality of the trials. Funnel plots and Egger's test were used to analyze for publication bias. We included 5 RCTs involving 199 patients who were administered prebiotics and 8 RCTs involving 825 patients who were administered synbiotics. Prebiotics increased weekly stool frequency (MD: 1.01bowel movements/week, 95% CI: 0.04-1.99) and improved stool consistency (SMD: -0.59, 95% CI: -1.16 to -0.02). Subgroup analysis showed specific effects for galacto-oligosaccharides on stool frequency, consistency, ease of defecation and abdominal pain. Synbiotics significantly improved stool frequency (MD: 1.15bowel movements/week, 95% CI: 0.58-1.71), consistency (SMD: 0.63, 95% CI: 0.33-0.92) and reduced whole-gut transit time (MD: 13.52, 95% CI: -26.56 to -0.49) in patients with FC. Subgroup analysis showed specific effects for fructo-oligosaccharides and probiotic combinations on stool frequency, consistency, straining defecation and bloating. Galacto-oligosaccharides and synbiotics made up of fructo-oligosaccharides with probiotic combinations may improve stool frequency, consistency and some other symptoms related to constipation., (Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Aim: To investigate whether there is a link between diabetes mellitus (DM) and gastroesophageal reflux disease (GERD)., Methods: We conducted a systematic search of PubMed and Web of Science databases, from their respective inceptions until December 31, 2013, for articles evaluating the relationship between DM and GERD. Studies were selected for analysis based on certain inclusion and exclusion criteria. Data were extracted from each study on the basis of predefined items. A meta-analysis was performed to compare the odds ratio (OR) in DM between individuals with and without GERD using a fixed effect or random effect model, depending on the absence or presence of significant heterogeneity. Subgroup analyses were used to identify sources of heterogeneity. Publication bias was assessed by Begg's test. To evaluate the results, we also performed a sensitivity analysis., Results: When the electronic database and hand searches were combined, a total of nine eligible articles involving 9067 cases and 81 968 controls were included in our meta-analysis. Based on the random-effects model, these studies identified a significant association between DM and the risk of GERD (overall OR = 1.61; 95%CI: 1.36-1.91; P = 0.003). Subgroup analyses indicated that this result persisted in studies on populations from Eastern countries (OR = 1.71; 95%CI: 1.38-2.12; P = 0.003) and in younger patients (mean age < 50 years) (OR = 1.70; 95%CI: 1.22-2.37; P = 0.001). No significant publication bias was observed in this meta-analysis using Begg(')s test (P = 0.175). The sensitivity analysis also confirmed the stability of our results., Conclusion: This meta-analysis suggests that patients with DM are at greater risk of GERD than those who do not have DM.

Objective: To investigate the alterations of esophageal epithelial barrier during the process of reflux esophagitis (RE)., Methods: In total, 85 Sprague-Dawley rats were randomly divided into two groups, the sham-operation group (n = 25) and the RE group induced by incomplete pyloric ligation (n = 60). The establishment of RE model and the severity of esophagitis were evaluated by hematoxylin and eosin stain. Dilated intercellular spaces (DIS) in the esophageal epithelium were observed by transmission electron microscopy. The cellular distributions of ZO-1, occludin and claudin-1 were assessed by immunohistochemical stain. The expressions of these tight junction (TJ) proteins and the phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2), myosin light chain (MLC) and nonmuscular myosin light chain kinase (nmMLCK) were analyzed by Western blot., Results: DIS occurred gradually in the RE group. ZO-1, occludin and claudin-1 were incompletely or even not expressed in the RE group. TJ proteins were expressed in the membrane instead of the cytoplasm in many epithelial cells in RE. With Western, the expression of ZO-1, occludin and claudin-1 was increased gradually in the RE group (P < 0.05). The phosphorylation levels of nmMLCK, MLC and ERK1/2 were also increased (P < 0.05). There was no marked changes in the esophageal epithelium in the sham-operation group., Conclusions: TJ proteins could be used as sensitive markers of RE instead of DIS. ERK1/2 may participate in regulating TJ proteins in esophageal epithelia in RE., (© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)