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BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is a common, yet underdiagnosed, gut condition caused by gut dysbiosis. A previous study has shown the potential of herbal therapy, providing equivalent results to rifaximin. OBJECTIVES: The objective of this study was to assess how the use of an oral botanical regimen may modulate the gut microbiome, facial erythema, and intestinal permeability in those with SIBO. METHODS: This was an open-label prospective study of adults that had lactulose breath test-confirmed SIBO. Participants received a 10-week oral supplementation of a Biocidin liquid tincture and GI Detox+. If participants were found to be non-responsive to treatment after 10 weeks with a persistently positive lactulose breath test, a third oral supplement, Olivirex, was administered for an additional 4 weeks. Lactulose breath tests were administered at baseline, weeks 6, 10, and 14 to assess for SIBO status. A high-resolution photographic analysis system was utilized to analyze changes in facial erythema. Stool sample collections and venipuncture were performed to analyze the gut microbiome and intestinal permeability. RESULTS: A total of 33 subjects were screened with breath testing, and 19 subjects were found to have SIBO. Three of the subjects withdrew during the screening period prior to baseline, and sixteen subjects enrolled. Four subjects dropped out after baseline. Hydrogen-dominant SIBO was the most common subtype of SIBO, followed by methane and hydrogen sulfide. The botanical regimen was most effective for hydrogen- and hydrogen sulfide-dominant SIBO, leading to negative breath test results at week 10 in 42.8% and 66.7% of participants, respectively. Compared to baseline, supplementation with the botanical regimen led to positive shifts in short-chain fatty acid-producing bacteria such as A. muciniphila, F. prausnitzii, C. eutectus, and R. faecis by 31.4%, 35.4%, 24.8%, and 48.7% percent at week 10, respectively. The mean abundance of Firmicutes decreased by 20.2%, Bacteroides increased by 30%, and the F/B ratio decreased by 25.4% at week 10 compared to baseline. At week 10, there was a trending 116% increase in plasma LPS/IgG (p = 0.08). There were no significant changes in plasma zonulin, DAO, histamine, DAO/histamine, LPS/IgG, LPS/IgA, or LPS/IgM. Facial erythema was not statistically different at week 6, but at week 10, there was a 20% decrease (p = 0.001) in redness intensity. Among the patients that extended to week 14, there was no statistical change in erythema. CONCLUSIONS: Supplementation with an antimicrobial botanical supplemental regimen may have therapeutic potential in hydrogen and hydrogen-sulfide subtypes of SIBO. Furthermore, the botanical supplemental regimen may reduce facial erythema, increase SCFA-producing bacteria, decrease the F/B ratio, and modulate markers of intestinal permeability.

ABSTRACT Overt hepatic encephalopathy (OHE) is a common complication of decompensated cirrhosis. This study aimed to assess the effects of probiotic, alone and in combination with zinc, on OHE recurrence, Model for End‐stage Liver Disease (MELD) score, ammonia level, health‐related quality of life (HRQoL), and sleep quality in patients with cirrhosis. We performed an open‐label randomized controlled trial on patients with decompensated cirrhosis with a previous history of OHE. Eligible patients (n = 45) were divided randomly into three equal groups to receive 30–45 mL lactulose syrup (2–4 times/day), lactulose and probiotic (4.5 × 1011 CFU of bacteria, 2 times/day), or a combination of lactulose, probiotic, and zinc (25 mg) for 3 months. In this study, probiotic, alone or in combination with zinc, had no effect on OHE recurrence, ammonia levels, and MELD score. Mental aspects and total score of HRQoL were improved following probiotic and its combination with zinc, even after adjustment for baseline values, age, and sex. However, physical aspects of HRQoL and sleep quality were only improved by probiotic and zinc combination compared to the lactulose alone. Our findings showed improved HRQoL after treatment with probiotic, alone or in combination with zinc. However, sleep quality was influenced only by probiotic and zinc combination.Trail Registration: This study has been registered in the Iranian registry of clinical trials (IRCT20170609034406N9). [ABSTRACT FROM AUTHOR]

Background: Breath testing for small intestinal bacterial overgrowth (SIBO) is typically performed using clinic-based equipment or single-use test kits. Aims: This study aimed to evaluate the utility of a portable, point-of-care breath analysis device (AIRE®, FoodMarble) in patients suspected to have SIBO. A technical assessment including a comparison to existing mail-in kits was first performed. Then, postprandial breath hydrogen levels of patients before and after antibiotic treatment were gathered and compared to levels seen in a healthy cohort. Methods: For the comparison, 50 patients suspected of having SIBO were provided with an AIRE device and performed concurrent LHBTs at-home with a mail-in breath test kit. For the postprandial analysis, twenty-four patients with chronic GI symptoms measured their postprandial hydrogen for 7 days prior to antibiotic treatment and for 7 days after treatment. 10 healthy controls also measured their postprandial hydrogen for 7 days. Results: Substantial agreement was demonstrated between AIRE and the mail-in kits for the performance of lactulose hydrogen breath tests (κ = 0.8). Prior to treatment, patients had significantly greater daily postprandial hydrogen than healthy controls (p < 0.001). The mean postprandial hydrogen of patients reduced significantly after treatment (p < 0.001). Conclusions: Measuring postprandial hydrogen shows potential as a means of differentiating patients with chronic GI symptoms from healthy controls and may be useful in monitoring patients before, during, and after treatment. Future studies could help determine if pre-treatment breath gas levels are predictive of response to antibiotic treatment. [ABSTRACT FROM AUTHOR]

This study aimed to perform lactose hydrolysis using free and immobilised β-galactosidase in cow and sheep milk with different fat levels, followed by lactulose synthesis through the isomerisation of glucose to fructose using immobilised glucose isomerase. There was no significant difference (P > 0.05) in lactose hydrolysis (>95%) using the free enzyme in the different types of milk. In contrast, significant differences were observed for the hydrolysis of whole cow milk (WCM) and skimmed cow milk (SCM) with the immobilised enzyme (IE). WCM required a longer hydrolysis time (43 h). Thus, the fat content may have affected the lactose hydrolysis of bovine milk with immobilised β-galactosidase. No difference was observed for whole sheep milk and skimmed sheep milk hydrolysed by IE, possibly due to the presence of smaller fat globules, which did not affect the lactose hydrolysis. No significant differences were observed for lactulose synthesis in whole milk from the different species evaluated. The lactulose synthesis in cow and sheep milk by the enzymatic route may be a promising alternative, though further studies are required to optimise the production of this prebiotic in situ. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Trial Number Bowel colonization with antimicrobial‐resistant bacteria has been associated with worse clinical outcomes in patients with cirrhosis; however, it has not been studied in patients with acute‐on‐chronic liver failure (ACLF). We evaluated whether fecal isolation of carbapenem‐resistant gram‐negative bacteria (CR‐GNB) among patients with ACLF affects short‐term outcomes.Patients of APASL‐ACLF (n = 339) were screened between June 2020 and December 2021, and 150 were included. Stool cultures were carried out at baseline and every 5 days thereafter until discharge or death. All surviving patients were followed until 60 days after discharge.Mean age was 44.8 (8.8) years, with 86% males and alcohol as etiology in 66%. CR‐GNB organisms were isolated from stool in 42% of hospitalized ACLF patients, with E. coli and Klebsiella pneumoniae as the most common species. Patients with CR‐GNB fecal carriage were associated with higher CTP, MELD, and DF scores but not with recent antibiotics, proton pump inhibitors, or lactulose use. Extraintestinal infections developed in 59.3% overall, most commonly UTI, pneumonia, and SBP. Infectious complications developed in 57.3% and 19.7% with and without CR‐GNB in the stool (RR: 5.5; p < 0.001). Peripheral cultures were positive in 60.7% with infections, with species concordant with the fecal isolates found in 90.7%. Isolation of CR‐GNB from stool and high bilirubin were independently associated with both in‐hospital mortality and 60‐day mortality (p = 0.05).Hospitalized ACLF patients with CR‐GNB in the stool have a significantly higher risk of extraintestinal infections, in‐hospital mortality, and short‐term mortality up to 60 days.[NCT04383106]. [ABSTRACT FROM AUTHOR]

Background/Aims: Polyethylene glycol (PEG) is considered the gold standard regimen for bowel preparation; however, due to the necessity of a large volume, patient tolerance is impaired. Therefore, lactulose is a novel alternative for colonoscopy preparation. This study aimed to investigate the efficacy and safety of lactulose-based bowel preparations in comparison with PEG for colonoscopy. Methods: This is a prospective, non-blinded, comparative study. Outpatients were randomly divided into two groups: group 1 (111 patients), PEG; and group 2 (111 patients), lactulose. The following clinical outcomes were assessed in each group: degree of bowel clearance using the Boston bowel preparation score, colorectal polyp detection rate, adenoma detection rate, tolerability, and side effects. Results: The rate of inadequate bowel preparation was 8.1% and 1.8% for the PEG and lactulose groups, respectively (p=0.030). The Boston bowel preparation score for the entire colon was 7.34±1.17 and 8.36±1.09 for the PEG and lactulose groups, respectively (p<0.001). The satisfactory overall experience rates were 27.9% and 62.2% for the PEG and lactulose groups, respectively (p<0.001). Conclusions: The novel bowel preparation with oral lactulose was superior to that with PEG in terms of colon cleansing, adenoma detection rate, tolerance, and patient experience. [ABSTRACT FROM AUTHOR]

Effects of lactose and lactulose on the casein glycation process at different times and specific glycation sites were investigated. Lactulose treatment generated higher levels of initial glycation products fructoselysine (1.160 μg/mL) and methylglyoxal (0.266 mg/mL) than lactose treatment which had 0.959 μg/mL and 0.140 mg/mL, respectively. The concentrations of intermediate products Nε‐(Carboxymethyl) lysine (0.654 μg/mL) and Nε‐(Carboxyethyl) lysine (0.154 μg/mL) in the lactulose treatment were approximately 2.5 and 1.1 times higher than these in the lactose treatment, respectively. The glycation induced by lactulose targeted Lys residues and had more glycated peptide fragments and wide‐ranging glycation sites in αs1‐casein. The high degree of casein glycation in lactulose treatment was attributed by the fructose on lactulose which had different pathways in the Maillard reaction, compared with the glucose on lactose. The findings revealed the differences of casein glycations by the two sugars and during thermal processing. The information could be helpful in developing potential approaches to monitor and control glycation reactions in dairy products. [ABSTRACT FROM AUTHOR]

β-galactosidase from Kluyveromyces lactis has been immobilized on chitosan-glutaraldehyde particles employing different enzyme loadings (in a range of 0.7–7 mg/g of support). The biocatalysts had been later utilized to produce lactulose by transglycosylation using milk whey supplemented with fructose. The amount of produced lactulose decreased when the enzyme loading increased, from around 18 mg/mL using the biocatalysts with only 0.7 mg/g to around 7 mg/mL using the biocatalyst with a loading of 7 mg/mL. The results showed in this paper shows the great effect of the substrates and product concentration gradients inside the biocatalyst particle, not only lactulose, but also glucose and galactose. That is, the use of a excessive enzyme loading can lead to a significant worsening of the β-galactosidase biocatalyst performance in kinetically controlled synthesis. [Display omitted] • β-galactosidase was immobilized using different biocatalysts enzyme loadings. • The biocatalysts were used to produce lactulose from lactose and fructose. • The higher the enzyme loading, the lower the lactulose production. • The substrate and products internal gradients explain the results. [ABSTRACT FROM AUTHOR]

Lactulose is a synthetic disaccharide composed of galactose and fructose. Literature review of history, legal status and possible food applications of lactulose in functional foods, such as confectionery and beverages. In the colon, lactulose is fermented by the microbiota and acts as a selective modulator of bacterial growth, promoting the growth of Lactobacilli and Bifidobacteria. It generates organic acids, such as short-chain fatty acids and lactic acid, which lower the pH of the colon and act as an osmotic laxative. Lactulose was first used in 1957 as an ingredient in an infant formula. Later it was registered as a prescription drug and banned for food use in many countries. In 2012, lactulose received an EU (European union) health claim "contributes to acceleration of intestinal transit". It can be used in food and food supplements across all age groups, from infants to the elderly. Lactulose has favourable technological properties, such as sweetness of 48–62% sucrose without an aftertaste, high solubility, low cariogenic potential and stability. Lactulose gummy candy, without added sweeteners, has an overall likability comparable to classic sucrose/glucose-based candy. With more than 60 years of safe use in infant, child, adult and elderly population, lactulose is an ideal ingredient for prebiotic functional food. Its technological properties allow for development of functional candy and beverages almost indistinguishable from those made from sucrose. [ABSTRACT FROM AUTHOR]

Summary: Background: Although dietary emulsifiers are implicated in the pathogenesis of Crohn's disease, their effect has not been studied in humans. Aim: To determine the effects of high‐ and low‐emulsifier diets (HED, LED) on intestinal barrier function in healthy subjects in unstressed and acutely stressed states. Methods: We conducted a single‐blinded, cross‐over, controlled feeding trial in 22 healthy adults. After recording 7 days of their habitual diet, we randomised participants to HED or LED with ≥3‐week washout between diets. On dietary completion, acute stress was induced via intravenous corticotrophin‐releasing hormone. We assessed dietary adherence, effects on 2‐h urinary lactulose: rhamnose ratio (LRR), serum concentrations of lipopolysaccharide‐binding protein, soluble‐CD14 and markers of epithelial injury and inflammation. Results: Dietary adherence was excellent. In an unstressed state, median (interquartile range) LRR during HED was 0.030 (0.018–0.042); on LED, this was 0.042 (0.029–0.078; p = 0.04). LPB concentrations were lower on HED than LED (p = 0.026), but no differences were observed for epithelial injury or inflammation. Under acute stress, LRR increased by 89% (−1% to 486%) on HED (p = 0.004), differing (p = 0.001) from 39% (1%–90%) decrease on LED (p = 0.009). Soluble‐CD14 also increased (p < 0.001). The LED had a prolonged carry‐over effect on suppressing HED‐induced changes during stress. Similar changes in LRR and soluble‐CD14 were observed when HED was used as the first diet (both p < 0.01). Conclusion: High intake of emulsifiers improved barrier function in the unstressed state, but increased intestinal permeability to stress, without evidence of inflammation. A LED was protective of the stress effect. [ABSTRACT FROM AUTHOR]

There has been recent interest in using the β-galactosidase of Bacillus circulans to produce prebiotic oligosaccharides, including galactooligosaccharides (GOS), lactulose and lactosucrose. The types and amounts of the transgalactosylation products produced depend on the selectivities of the enzyme for the various transgalactosylation and hydrolysis reactions that occur. To date, the selectivities of the β-galactosidase of B. circulans for these reactions have not been adequately characterized. In the current work, we undertake four case studies using literature data for systems in which different product mixtures are produced (i) GOS; (ii) GOS and disaccharides; (iii) GOS and lactulose; and (iv) GOS and lactosucrose. We analyze this data to obtain quantitative estimates of the relevant selectivities. We show that, in the production of GOS, the isoform β-Gal-A is significantly less selective against hydrolysis reactions than the other β-galactosidase isoforms. In the production of lactulose, the β-galactosidase of B. circulans gives high lactulose yields, despite having a 19- to 33-fold preference for producing GOS over lactulose. In the production of lactosucrose, the β-galactosidase of B. circulans also prefers to produce GOS. [Display omitted] • β-galactosidase of B. circulans characterized in four transglycosylation processes. • Isoform β-Gal-A less selective against 1° and 2° hydrolysis than other isoforms. • High lactulose yields, despite preference for producing galactooligosaccharides. • Enzyme prefers producing galactooligosaccharides over lactosucrose. • Method for estimating selectivities unaffected by inhibition or denaturation. [ABSTRACT FROM AUTHOR]

Cirrhosis is a prevalent, chronic condition with an asymptomatic compensated phase, in which patients may feel well, and a decompensated phase that begins with the onset of complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding). Because patients with cirrhosis may appear healthy with normal liver enzymes, alkaline phosphatase, and serum bilirubin levels, awareness of clinical signals is important. For example, patients with thrombocytopenia should be evaluated for chronic liver disease and cirrhosis. Early recognition and management of cirrhosis-related complications (eg hepatic encephalopathy, ascites, and/or variceal bleeding) are important, given their association with hospitalization and poor prognosis (eg increased odds of short-term mortality). Hepatic encephalopathy can be the most subtle cirrhosis-related complication and associated cognitive impairment may be misdiagnosed. Because hepatic encephalopathy can be associated with hospital readmissions, reducing readmission rates after hepatic encephalopathy–related hospitalizations is critical. This includes incorporating ongoing therapy (eg rifaximin plus lactulose) in postdischarge management plans to reduce the risk of hepatic encephalopathy recurrence. Strategies that mitigate cirrhosis progression and prevent the development of cirrhosis-related complications are key to improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background/Aims Polyethylene glycol (PEG) is considered the gold standard regimen for bowel preparation; however, due to the necessity of a large volume, patient tolerance is impaired. Therefore, lactulose is a novel alternative for colonoscopy preparation. This study aimed to investigate the efficacy and safety of lactulose-based bowel preparations in comparison with PEG for colonoscopy. Methods This is a prospective, non-blinded, comparative study. Outpatients were randomly divided into two groups: group 1 (111 patients), PEG; and group 2 (111 patients), lactulose. The following clinical outcomes were assessed in each group: degree of bowel clearance using the Boston bowel preparation score, colorectal polyp detection rate, adenoma detection rate, tolerability, and side effects. Results The rate of inadequate bowel preparation was 8.1% and 1.8% for the PEG and lactulose groups, respectively (p=0.030). The Boston bowel preparation score for the entire colon was 7.34±1.17 and 8.36±1.09 for the PEG and lactulose groups, respectively (p

Food processing, which generates both by-products and waste, requires a revision of modern processes in the framework of the development of non-residual, environmentally friendly processes. Dairy by-products require the development of complex zero-waste technologies. Electroactivation is an emerging process to overcome those challenges, which allows for non-residual processing of milk by-products. Electroactivation, managing both the technological regimes and the geometric/technical parameters of the electrolyzers used to process different types of whey, allows both the electrofractionation of the whey proteins recovered in protein mineral concentrates enriched, under certain process conditions, with a certain protein content, but also the simultaneous isomerization of lactose into lactulose following two mechanisms, and creating a closed process cycle. The geometry of the electrolyzers and the content of the secondary liquid (anodic liquid) influence both the extraction and the formation of protein compounds enriched with alpha-lactalbumin, as well as the formation of a complex between calcium and isomerized lactulose.

Listeria monocytognes is an emerging pathogen responsible for the serious foodborne disease, listeriosis. The commensal gut microbiota is the first line of defense against pathogen internalization. The gut microbiome can be modified by prebiotic substrates, which are frequently added to food products and dietary supplements. Prebiotics should selectively support the growth of beneficial microbes and thus improve host health. Nevertheless, little is known about their effect on the growth of L. monocytogenes. The aim of this study was to evaluate the growth ability of four L. monocytogenes strains, representing the most common serotypes, on prebiotic oligosaccharides (beta-(1,3)-D-glucan, inulin, fructooligosaccharides, galactooligosaccharides, lactulose, raffinose, stachyose and 2′-fucosyllactose and a mixture of human milk oligosaccharides) as a sole carbon source. The results showed that only beta-(1,3)-D-glucan was metabolized by L. monocytogenes. These cell culture data suggest that beta-(1,3)-D-glucan may not be selectively utilized by healthy commensal bacteria, and its role in intestinal pathogen growth warrants further exploration in vivo. [ABSTRACT FROM AUTHOR]

BACKGROUND: The general assumption that prebiotics reach the colon without any alterations has been challenged. Some in vitro and in vivo studies have demonstrated that 'non‐digestible' oligosaccharides are digested to different degrees depending on their structural composition. In the present study, we compared different methods aiming to assess the digestibility of oligosaccharides synthesized by β‐galactosidase (β‐gal) of Lactobacillus delbruecki subsp. bulgaricus CRL450 (CRL450‐β‐gal) from lactose, lactulose and lactitol. RESULTS: In the simulated gastrointestinal fluid method, no changes were observed. However, the oligosaccharides synthesized by CRL450‐β‐gal were partially hydrolyzed in vitro, depending on their structure and composition, with rat small intestinal extract (RSIE) and small intestinal brush‐border membrane vesicles (BBMV) from pig. Digestion of some oligosaccharides increased when mixtures were fed to C57BL/6 mice used as in vivo model; however, lactulose‐oligosaccharides were the most resistant to the physiological conditions of mice. In general β (1→6) linked products showed higher resistance compared to β (1→3) oligosaccharides. CONCLUSION: In vitro digestion methods, without disaccharidases, may underestimate the importance of carbohydrates hydrolysis in the small intestine. Although BVMM and RSIE digestion assays are appropriate in vitro methods for these studies, in vivo studies remain the most reliable for understanding what actually happens in the digestion of oligosaccharides. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Introduction: Understanding intestinal permeability is paramount for elucidating gastrointestinal health and pathology. The size and nature of the molecule traversing the intestinal barrier offer crucial insights into various acute and chronic diseases, as well as the evolution of some conditions. This study aims to assess the urinary excretion kinetics of gluten immunogenic peptides (u-GIP), a unique class of dietary peptides detectable in urine, in volunteers under controlled dietary conditions. This evaluation should be compared to established probes like lactulose, a non-digestible disaccharide indicative of paracellular permeability, and mannitol, reflecting transcellular permeability. Methods: Fifteen participants underwent simultaneous ingestion of standardized doses of gluten (10 g), lactulose (10 g), and mannitol (1 g) under fasting conditions for at least 8 hours pre-ingestion and during 6 hours post-ingestion period. Urine samples were collected over specified time intervals. Excretion patterns were analyzed, and correlations between the lactulose-to-mannitol ratio (LMR) and u-GIP parameters were assessed. Results: The majority of u-GIP were detected within the first 12 hours postingestion. Analysis of the variability in cumulative excretion across two sample collection ranges demonstrated that lactulose and u-GIP exhibited similar onset and excretion dynamics, although GIP reached its maximum peak earlier than either lactulose or mannitol. Additionally, a moderate correlation was observed between the LMR and u-GIP parameters within the longest urine collection interval, indicating potential shared characteristics among permeability pathways. These findings suggest that extending urine collection beyond 6 hours may enhance data reliability. Discussion: This study sheds light on the temporal dynamics of u-GIP in comparison to lactulose and mannitol, established probes for assessing intestinal permeability. The resemblance between u-GIP and lactulose excretion patterns aligns with the anticipated paracellular permeability pathway. The capacity to detect antigenic food protein fragments in urine opens novel avenues for studying protein metabolism and monitoring pathologies related to the digestive and intestinal systems. [ABSTRACT FROM AUTHOR]

Camel milk yoghurts were created using probiotic lactic acid bacteria (LAB) with exopolysaccharide (EPS) production capabilities. Lacticaseibacilluscasei ATCC 393, identified as the most efficient EPS producer, was incorporated into conventional yoghurt culture. We compared the effects of adding L. casei ATCC 393 with EPS powder (SLLP) against lactulose. Evaluations included LAB, yeast, mould, cytotoxicity and IC50 values in the samples. The results demonstrated increased bacterial counts, LAB viability, viscosity, antiproliferative effects and a lower IC50 in SLLP, indicating the potential application of EPS‐producing L. casei ATCC 393 and its derived EPS in the development of functional foods. [ABSTRACT FROM AUTHOR]

Objective: To compare polyethylene glycol 4000 versus lactulose in chronic constipation during pregnancy. Methods: Women at 28–32 weeks' gestation attending antenatal clinic for routine care were screened using the Rome IV chronic constipation criterion. Eligible women were approached and consented. Participants were randomized to oral polyethylene glycol (10 g/day) or lactulose (10 g/day) for 4 weeks. A bowel movement diary was kept and outcomes using the Patient Assessment of Constipation Symptoms questionnaire (PAC‐SYM), Patient Assessment of Constipation Quality of Life questionnaire (PAC‐QoL) and Bristol Stool Form Scale (BSFS), which were evaluated at the start and end of the four‐week period. Relative risks (RR) were determined for the coprimary outcomes of complete spontaneous bowel movement (CSBM) and PAC‐SYM mean score improvement (decrease in score of >1 from the baseline). Results: A total of 4323 women underwent screening, of which 780 fulfilled the Rome IV criterion, and 360 consented to participate (180 randomized to PEG and lactulose, respectively). Data from 247 women who completed the study were analyzed. CSBM was achieved in 107/124 (86.3%) versus 102/123 (82.9%) (RR 1.04, 95% CI: 0.93–1.16, P = 0.464) for PEG and lactulose trial arms, respectively. PAC‐SYM mean score improvement was 62/118 (52.5%) in the PEG arm versus 44/118 (37.3%) in the lactulose arm (RR 1.40, 95% CI: 1.05–1.88). Of secondary outcomes, a significant difference was found in favor of PEG, with respect to PAC‐SYM abdominal symptoms subscale, normal stool versus loose stool consistency and side effects of vomiting and diarrhea. After controlling for parity, baseline PAC‐SYM, PAC‐QoL scores, characteristics different at baseline, only diarrhea and loose stools remained significant. Conclusion: Both PEG 4000 and lactulose are effective laxatives in pregnancy with similar performance after adjusted analysis. Diarrhea and loose stools are less frequently reported with PEG. Synopsis: Polyethylene glycol 4000 and lactulose are similarly effective as laxatives for constipation in pregnancy; diarrhea and loose stools are less frequent encountered with polyethylene glycol. [ABSTRACT FROM AUTHOR]

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Hepatic encephalopathy is described by a broad spectrum of neurological and psychiatric aberrations resulting due to advanced liver dysfunction. It is a neurological disorder due to hepatic insufficiency and/or portosystemic shunts. Its clinical presentation includes neuropsychiatric dysfunction ranging from subclinical changes to comatose state. It is a sign of poor prognosis in cirrhotics with a high 1-year mortality. Each episode of hepatic encephalopathy leads to high hospitalization rate, poor prognosis and raised burden of healthcare. Primary prophylaxis is prevention of initial occurrence and secondary prophylaxis is prevention of reappearance of hepatic encephalopathy in subjects who had prior history. Early detection and management of triggers is very important in the treatment of hepatic encephalopathy. The initial choice of treatment is still lactulose, as it is effective in minimal, overt, and recurrent hepatic encephalopathy. Rifaximin is equally effective as lactulose in managing hepatic encephalopathy and is better tolerated. Branch chain amino acids are beneficial in subjects who are protein intolerant. L-ornithine L-aspartate and probiotics are also useful in the management of hepatic encephalopathy. Rifaximin along with lactulose is effective in managing overt and recurrent hepatic encephalopathy. Large portosystemic shunts embolization and liver transplant is efficacious in certain group of patients. Nutritional therapy and fecal microbiota transplantation are newer therapies for hepatic encephalopathy but the evidences are limited, more research is required to prove their efficacy. Involvement of hospital pharmacists, telemedicine, and providing education are also beneficial in managing hepatic encephalopathy. [ABSTRACT FROM AUTHOR]

Objective: Constipation is often inadequately treated in childhood, which can lead to psychological problems. This study aimed to evaluate the adequacy of prescribed drugs, dosing, usage, and responses to these drugs in children with functional constipation. Methods: This research comprised children who had consulted a pediatric gastroenterologist for functional constipation and had previously undergone constipation therapy. The name of the drug used, duration of drug usage, method of measurement, and what they took the drug with, the dose of drug, and response to the drug were recorded. Results: Eighty-seven percent of the patients had received lactulose treatment. Only 31% of the patients received a medication dose greater than 1 mL/kg. In 58.3% of cases, the duration of drug use was shorter than one month. There was not a response in 62.9% of cases, a partial response in 23.1%, and a full response in 13.8% of cases. When the patients were compared based on response, there was a significant difference in the duration of drug usage, what they drank the drug with, the daily dose of the drug, and the daily dosage per weight of the drug. Patients who measured the drug using a milliliter scale responded better. The response to the drug increased as the drug dosage per weight increased. Response was obtained in 73% of patients who had no response or partial response after drug or dose adjustments. Conclusion: For a comprehensive response, parents must be carefully taught the dosage of the drug and how to measure it. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic encephalopathy (HE) is a severe neuropsychiatric complication of liver diseases characterized by neuroinflammation. The efficacies of nonabsorbable rifaximin (RIF) and lactulose (LAC) have been well documented in the treatment of HE. [18F]PBR146 is a translocator protein (TSPO) radiotracer used for in vivo neuroinflammation imaging. This study investigated anti‐neuroinflammation effect of RIF or/and LAC in chronic HE rats by [18F]PBR146 micro‐PET/CT. Methods: Bile duct ligation (BDL) operation induced chronic HE models, and this study included Sham+normal saline (NS), BDL+NS, BDL+RIF, BDL+LAC, and BDL+RIF+LAC groups. Behavioral assessment was performed to analyze the motor function, and fecal samples were collected after successfully established the chronic HE model (more than 28 days post‐surgery). In addition, fecal samples collection and micro‐PET/CT scans were performed sequentially. And we also collected the blood plasma, liver, intestinal, and brain samples after sacrificing the rats for further biochemical and pathological analyses. Results: The RIF‐ and/or LAC‐treated BDL rats showed similar behavioral results with Sham+NS group, while the treatment could not reverse the biliary obstruction resulting in sustained liver injury. The RIF or/and LAC treatments can inhibit IFN‐γ and IL‐10 productions. The global brain uptake values of [18F]PBR146 in BDL+NS group was significantly higher than other groups (p <.0001). The brain regions analysis showed that the basal ganglia, hippocampus, and cingulate cortex had radiotracer uptake differences among groups (all p <.05), which were consistent with the brain immunohistochemistry results. Sham+NS group was mainly enriched in Christensenella, Coprobacillus, and Pseudoflavonifractor. BDL+NS group was mainly enriched in Barnesiella, Alloprevotella, Enterococcus, and Enterorhabdus. BDL+RIF+LAC group was enriched in Parabacteroides, Bacteroides, Allobaculum, Bifidobacterium, and Parasutterella. Conclusions: RIF or/and LAC had anti‐neuroinflammation in BDL‐induced chronic HE rats with gut microbiota alterations. The [18F]PBR146 could be used for monitoring RIF or/and LAC treatment efficacy of chronic HE rats. [ABSTRACT FROM AUTHOR]

Gut microbiota plays a crucial role in human health homeostasis, and the result of its alteration, known as dysbiosis, leads to several pathologies (e.g., inflammatory bowel disease, metabolic syndrome, and Crohn's disease). Traditional methods used to assess dysbiosis include the dual sugar absorption test and the urinary lactulose/mannitol ratio (LMR) measurement using mass spectrometry. Despite its precision, this approach is costly and requires specialized equipment. Hence, we developed a rapid and reliable spectrofluorimetric method for measuring LMR in urine, offering a more accessible alternative. This spectrofluorimetric assay quantifies the fluorescence of nicotinamide adenine dinucleotide (NADH) and nicotinamide adenine dinucleotide phosphate (NADPH) produced during the enzymatic oxidation of mannitol and lactulose, respectively. The assay requires 100 µL of urine samples and detects LMR values lower (eubiosis) and higher (dysbiosis) than 0.05, ultimately being amenable to high-throughput screening and automatization, making it practical for clinical and research settings. A validation of the method demonstrated its high precision, accuracy, and robustness. Additionally, this study confirmed analyte stability under various storage conditions, ensuring reliable results even with delayed analysis. Overall, this spectrofluorimetric technique reduces costs, time, and the environmental impact associated with traditional mass spectrometry methods, making it a viable option for widespread use in the assessment of dysbiosis. [ABSTRACT FROM AUTHOR]

This study aims to develop a novel and rapid method which uses enzymatic spectrophotometric assay and high-performance liquid chromatography (HPLC) for differentiating adulterated milk from pure fresh milk. Furthermore, this study will use the lactulose and Maillard-derived compounds as indicators to distinguish reconstituted milk from fresh milk. In bottle-sterilized milk, lactulose concentration decreased with the increasing addition of reconstituted skim milk. In addition, the content of lactulose in raw, low-temperature long-time (LTLT), and high-temperature short-time (HTST) skim milk samples increased with the proportion of reconstituted milk. Furosine, which had a retention time (RT) of 4.686 min in standard solution, had the RTs of 4.908, 4.926, 4.940, and 4.973 min in raw, LTLT, HTST, and bottle-sterilized milk samples, respectively. The RT peak increased along with the content of reconstituted milk in raw, LTLT, and HTST milk samples but decreased in bottle-sterilized milk. In conclusion, this work represents an important step toward detecting adulterated milk and tightening food safety regulations.

INTRODUCTION: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College of Gastroenterology, aims to inform clinicians and patients by providing evidence-based practice recommendations for the pharmacological treatment of CIC in adults. METHODS: The American Gastroenterological Association and the American College of Gastroenterology formed a multidisciplinary guideline panel that conducted systematic reviews of the following agents: fiber, osmotic laxatives (polyethylene glycol, magnesium oxide, lactulose), stimulant laxatives (bisacodyl, sodium picosulfate, senna), secretagogues (lubiprostone, linaclotide, plecanatide), and serotonin type 4 agonist (prucalopride). The panel prioritized clinical questions and outcomes and used the Grading of Recommendations Assessment, Development, and Evaluation framework to assess the certainty of evidence for each intervention. The Evidence to Decision framework was used to develop clinical recommendations based on the balance between the desirable and undesirable effects, patient values, costs, and health equity considerations. RESULTS: The panel agreed on 10 recommendations for the pharmacological management of CIC in adults. Based on available evidence, the panel made strong recommendations for the use of polyethylene glycol, sodium picosulfate, linaclotide, plecanatide, and prucalopride for CIC in adults. Conditional recommendations were made for the use of fiber, lactulose, senna, magnesium oxide, and lubiprostone. DISCUSSION: This document provides a comprehensive outline of the various over-the-counter and prescription pharmacological agents available for the treatment of CIC. The guidelines are meant to provide a framework for approaching the management of CIC; clinical providers should engage in shared decision making based on patient preferences as well as medication cost and availability. Limitations and gaps in the evidence are highlighted to help guide future research opportunities and enhance the care of patients with chronic constipation.

Objective: The study aims to understand the effect of new antibiotic-substituting supplements in feeding chickens of the Hisex Brown cross in industrial conditions. Materials and Methods: A total of 216 hatched chicks were randomly selected and distributed into Control, Test I, and Test II groups, with 3 replicates of 24 birds in three treatments. Results: At the end of the experiment, BW of T1/T2 birds was higher by 6.12% (p [J Adv Vet Anim Res 2024; 11(2.000): 429-438]

Background: Hepatic Encephalopathy (HE), a neuropsychiatric complication of hepatic failure, is currently managed with lactulose as first-line treatment followed by other adjuncts if needed. In this meta-analysis, we determined the effect of lactulose and rifaximin combination in terms of efficacy and mortality reduction compared to lactulose alone. Materials and Methods: We searched databases (PubMed, BioMed Central, and Cochrane-Central) until July, 2022 for original studies inspecting the effects of Rifaximin and Lactulose (combination therapy) vs. lactulose as a monotherapy in the treatment of HE on outcomes of clinical efficacy, hospital stay length, HE recurrence, drugs’ side effects and mortality. Data was analyzed via Review Manager (version5.4.1) and OpenMetaAnalyst. Relative risks (RR) and weighted mean differences (WMD) with 95% confidence intervals were calculated. Results: Fifteen studies with 4327 patients were included. Pooled analysis showed combination therapy to be associated with a significantly lower mortality rate in patients having HE when compared to lactulose alone (RR 0.71 95% CI 0.58-0.88, P=0.002, I2= 68%), and clinical efficacy was also improved in the combination group (RR 1.33, 95%CI 1.19-1.48, P

Background: Hyponatremia portends a poor prognosis in decompensated cirrhosis and is an independent predictor of mortality. Multiple modalities have been evaluated in the management of hyponatremia, including albumin infusion. However, the effect of albumin infusion on the resolution of hyponatremia is unclear. We conducted a systematic review to explore the available literature on the use of albumin infusion in hyponatremia. Methods: We performed a comprehensive search up to 31st December 2022 using MEDLINE, EMBASE, and Scopus for studies reporting the effectiveness of albumin infusion in the resolution of hyponatremia. The impact of albumin infusion of any dose, administration frequency, and duration of therapy was recorded. The study protocol was prospectively registered (CRD42021245914). Results: The literature search yielded 1322 references after duplicate removal. Only seven studies (three randomized trials, three cohort studies, and one case series) satisfied the predefined selection criteria after a full-text review. While hyponatremia was clearly defined as serum sodium < 130 meEq/L in all studies, two studies explicitly defined hyponatremia resolution (serum sodium > 135 mEq/L). No differentiation was made between the types of hyponatremia. The strength of the albumin infusion used was 5% and 20%. All but one study reported significant improvement in hyponatremia with albumin infusion. A subgroup analysis showed albumin infusion improved 30-day survival (odds ratio 0.43, 95% CI 0.25–0.74, I2 = 0.) No studies reported adverse events or the impact of concomitant associations (diuretic withdrawal, lactulose use, sepsis). Conclusion: Despite available literature on the use of albumin infusion for the resolution of hyponatremia, the level of evidence remains low. Large prospective studies with pre-defined selection criteria and endpoints are required to generate the evidence. [ABSTRACT FROM AUTHOR]

Objective: The study aims to understand the effect of new antibiotic-substituting supplements in feeding chickens of the Hisex Brown cross in industrial conditions. Materials and Methods: A total of 216 hatched chicks were randomly selected and distributed into Control, Test I, and Test II groups, with 3 replicates of 24 birds in three treatments. Results: At the end of the experiment, BW of T1/T2 birds was higher by 6.12% (p <0.01) and 10.29% (p <0.001) than CON. In comparison with the control hens, T1/T2 birds had a higher feed conversion rate and digestibility of nutrients. The blood indicators of T1/T2 hens exceeded those in control. Prebiotic supplementations were positively influenced in the immune indices of birds. IgA, IgG, IgM increased in groups T1/T2. Similar regularity was found in the natural resistance of chicks fed S1/S2. In the caecum, the Lactobacilli number was higher than in CON by 17.03% (p <0.01) in T1 and by 18.47% (p <0.01)--in T2; Bifidobacteria--by 17.94 (p <0.001) and 19.09% (p <0.01), respectively; at the same time, the number of E. coli decreased by 21.05% (p <0.01) and 24.21% (p <0.01). The concentration of emitted excreta noxious gases decreased: ammonia by 22.40%-24.95% (p <0.01); hydrogen sulfide by 10.67%-16.00% (p <0.01); and mercaptans by 12.90%-17.74% (p <0.05). Conclusion: These findings support the use of lactulose-based supplements as antibiotic alternatives to improve production in poultry farming and to reduce the toxic load on the environment. [ABSTRACT FROM AUTHOR]

Epilactose is a disaccharide composed of galactose and mannose, and it is currently considered an "under development" prebiotic. In this study, we described the prebiotic potential of epilactose by in vitro fermentation using human fecal inocula from individuals following a Mediterranean diet (DM) or a Vegan diet (DV). The prebiotic effect of epilactose was also compared with lactulose and raffinose, and interesting correlations were established between metabolites and microbiota modulation. The production of several metabolites (lactate, short-chain fatty acids, and gases) confirmed the prebiotic properties of epilactose. For both donors, the microbiota analysis showed that epilactose significantly stimulated the butyrate-producing bacteria, suggesting that its prebiotic effect could be independent of the donor diet. Butyrate is one of the current golden metabolites due to its benefits for the gut and systemic health. In the presence of epilactose, the production of butyrate was 70- and 63-fold higher for the DM donor, when compared to lactulose and raffinose, respectively. For the DV donor, an increase of 29- and 89-fold in the butyrate production was obtained when compared to lactulose and raffinose, respectively. In conclusion, this study suggests that epilactose holds potential functional properties for human health, especially towards the modulation of butyrate-producing strains. [ABSTRACT FROM AUTHOR]

Lactulose-based hepatic encephalopathy treatment requires bowel movements/day titration, which is improved with Bristol stool scale (BSS) incorporation. Dieta app evaluates artificial intelligence (AI)-based BSS (AI-BSS) with stool images. Initially, controls (N 5 13) and cirrhosis patients on lactulose/not on lactulose (n 5 33) were trained on the app. They entered self-reported BSS (self-BSS) with AI-BSS communicated. Lactulose dose changes were tracked. A subset (n512) was retested with AI communication blocked. Most subjects were comfortable with the app. Self/AIBSS and lactulose dose/AI-BSS correlation increased with app use. AI-BSS communications improved insight into self-BSS over time. Dieta app to gauge stool AI characteristics was acceptable and increased insight into lactulose dose and BSS in cirrhosis. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Management of hepatic encephalopathy relies on self-titration of lactulose. In this feasibility trial, we assess an artificial intelligence--enabled tool to guide lactulose use through a smartphone application. METHODS: Subjectswith hepatic encephalopathy onlactulose captured bowelmovementpicturesduring lead-in and intervention phases. During the intervention phase, daily feedback on lactulose titration was delivered through the application. Goals were determined according to number of bowel movement and Bristol Stool Scale reports. RESULTS: Subjects completed the study with more than 80% satisfaction. In the lead-in phase, less compliant subjects achieved Bristol Stool Scale goal on 62/111 (56%) of days compared with 107/136 (79%) in the intervention phase (P50.041), while themost compliant subjects showed no difference. Severe/recurrent hepatic encephalopathy group achieved Bristol Stool Scale goal on 80/104 (77%) days in the lead-in phase and90/110(82%)days inthe intervention phase (P5NS), comparedwith89/143(62%)days and86/127 (68%) days in the stable group. DISCUSSION: Dieta application is a promising tool for objective Bowel Movement/Bristol Stool Scale tracking for hepatic encephalopathy and may potentially be used to assist with lactulose titration. [ABSTRACT FROM AUTHOR]