Introduction

In patients with chronic constipation, slow colonic transit is hypothesised to be associated with altered colonic fermentation profiles. Green kiwifruit is known to have laxative effects. This could be caused by the modulation of colonic microbiota, which has a role in regulating colonic transit¹. The wireless motility capsule measures gastrointestinal anatomical landmarks through changes in pH and temperature, while a novel gas-sensing capsule measures anatomical landmarks and colonic fermentation^2,3. In this study, both technologies were used to investigate the effects of green kiwifruit on gastrointestinal transit and colonic fermentation profiles in participants with constipation.

Aims & Methods

Participants with chronic constipation (N = 62) were randomised to consume two green kiwifruit (Actinidia deliciosa, ~150g per serving, ~90 kcal) or
calorie-matched maltodextrin (~90 kcal = 25g) daily for four weeks. A subset of the participants (N = 21) consumed a standardised breakfast and ingested the wireless motility capsule or both wireless motility devices (wireless motility capsule and gas-sensing capsule) at baseline and post-intervention. Participants fasted six hours post-ingestion and wore data receivers until device excretion.

Results

Preliminary blinded results show that the wireless motility capsule measured colonic transit time decreased in participants on intervention A (median decrease = 1.4 hours, interquartile range (IQR) (-32.00, 9.12)) and increased on intervention B (median increase = 15.8 hours, IQR (-46.89, 23.48)), the change in colonic transit time was not significant (p = 0.628). There was no significant difference between the median colonic H₂ and CO₂ (% concentration/hour) at baseline and post-intervention (H₂: p = 0.50; CO₂: p =0.138). The difference between interventions was not significant for median colonic H₂ and CO₂ concentrations (H₂: p = 0.200; CO₂: p =0.800).

Conclusion

The wireless motility capsule and the gas-sensing capsule technologies assessed the differences in colonic transit time after dietary intervention. The gas-sensing capsule measured the colonic gas profile accurately and safely. The gas-sensing capsule has the potential to be used as a tool for measuring colonic fermentation profile. Despite encouraging results, this study had several limitations, including a small sample size, unusable data due to data loss, and transit time beyond the battery life of the capsules. Further analyses will explore the relationship of colonic gas concentration with colonic transit time and faecal microbiota.

References

1. Bayer, S. B., Gearry, R. B., & Drummond, L. N. (2018). Putative mechanisms of kiwifruit on maintenance of normal gastrointestinal function. Crit Rev Food Sci Nutr, 58(14), 2432-2452. https://doi.org/10.1080/10408398.2017.1327841
2. So, D., Yao, C. K., Ardalan, Z. S., Thwaites, P. A., Kalantar-Zadeh, K., Gibson, P. R., & Muir, J. G. (2022). Supplementing Dietary Fibers With a Low FODMAP Diet in Irritable Bowel Syndrome: A Randomized Controlled Crossover Trial. Clinical Gastroenterology & Hepatology, 20(9), 2112-2120.e2117. https://doi.org/10.1016/j.cgh.2021.12.016
3. Thwaites, P. A., Yao, C. K., Maggo, J., John, J., Chrimes, A. F., Burgell, R. E., Muir, J. G., Parker, F. C., So, D., Kalantar-Zadeh, K., Gearry, R. B., Berean, K. J., & Gibson, P. R. (2022). Comparison of gastrointestinal landmarks using the gas-sensing capsule and wireless motility capsule. Alimentary Pharmacology & Therapeutics, 56(9), 1337-1348. https://doi.org/10.1111/apt.17216

Disclosure

Jasjot Maggo and Hwei Ng - Received research support from Atmo Biosciences.
Simone Bayer - Received funding for project, travel and conference from Zespri^™ International Ltd.
Nicole Roy - Received funding from Zespri^™ International Ltd.
Richard Gearry - Received research funding from Atmo Biosciences and Zespri^™ International Ltd. He is an advisory board member for Zespri^™ International Ltd. He has received support for travel or educational planning/attendance at conferences from Zespri^™ International Ltd.

Introduction

The antioxidant, anti-inflammatory and modulatory effects of blueberries on gut microbiota are well known¹. In patients with DGBI blueberry ingestion for 6 weeks significantly relieved abdominal symptoms and improved Gastrointestinal Symptom Rating (GSRS) and quality-of-life and life functioning scores by Outcome Questionnaire (OQ 45.2) compared to placebo². Whether changes in gut microbiota are relevant in the symptomatic relief of blueberries in DGBI is unexplored.

Aims & Methods

Male and female patients aged 18 to 60 years with DGBI (irritable bowel syndrome or functional dyspepsia, Rome 4), were randomized to double-blind blueberry (30g freeze-dried powder = 180g fresh blueberries) or placebo daily for 6 weeks, with subsequent cross-over. GSRS and OQ-45.2 scales were assessed before and in week 6 of each treatment period. Responders were defined by improved GSRS and OQ-45.2 scores. Stool microbiome analysis was performed by DNA extraction and shotgun metagenomic sequencing. Quality controlled sequences were annotated with MetaPhlAn 4. Nonmetric multidimensional scaling ordination plots based on Bray-Curtis dissimilarity were generated at the species level with clinical covariates to visualize the intra- and inter-subject variability of microbiota. ANCOM-BC2 was used to estimate the differential abundance of the prevalent species. Pairwise networks before and after intervention were constructed and the frequency difference of positive and negative associations between responders and non-responders compared. Associations of gut microbial species with outcomes were analyzed (Spearman), stratifying data into before and after intervention, as well as responder and non-responder groups.

Results

	Baseline (#p<0.05)	During blueberry ingestion (#p<0.05)
GSRS outcome (gastrointestinal)	Responders > Non-responders: 55 species; #in: Butyricimonas faecihominis, Enterocloster lavalensis, Enterocloster citroniae, Mediterraneibacter glycyrrhizinilyticus	Increased in responders & decreased in non-responders: 16 species; #in: Butyricicoccus sp AM29_23AC, Clostridia bacterium UC5_1_1D1, Clostridium sp AF34_10BH, Oscillibacter sp ER4
GSRS outcome (gastrointestinal)	Non-responders > Responders: 56 species; #in: Lachnospiraceae bacterium AM48_27BH, Clostridiaceae bacterium Marseille_Q4143, Blautia glucerasea, Clostridium sp AF34_13, Ruminococcus sp AF41_9	Decreased in responders & increased in non-responders: 8 species; #Bacteroides eggerthii
OQ 45.2 outcome (well-being)	Responders > Non-responders: 35 species: #in: Lachnospira eligens, Vescimonas coporcola	Increased in responders & decreased in non-responders: 14 species; none significant
OQ 45.2 outcome (well-being)	Non-responders > Responders: 41 species; #in: Roseburia intestinalis, Phocaeicola massiliensis	Decreased in responders & increased in non-responders: 14 species; none significant

In 43 patients, microbiome alpha diversity of the gut microbiota taxa did not change significantly between visits with either treatment and did not differ between responder groups. However, at baseline, multiple species differed in abundance between responders and non-responders for both the GSRS and OQ-45.2 outcomes (table). During blueberry ingestion there were multiple species differences between responders and non-responders for either outcome.
There were distinct association patterns in the microbial co-occurrence networks with hub taxa, especially Anaerobutyricum hallii and Ruminococcus gnavus, in responders versus non-responders at baseline and during blueberry ingestion. Negative associations between microbiota in microbial co-occurrence networks were more common in non-responders than in responders at baseline and decreased after blueberry treatment, suggesting stabilisation of the microbiome.

Conclusion

Improved GI and general quality-of-life and life-functioning scores during blueberry ingestion in DGBI are associated with distinct gut microbiota taxa and co-occurrence networks at baseline and during treatment. Confirmatory studies are required to assess causality, but these data suggest that beneficial clinical effects seen in patients with DGBI during blueberry ingestion may be linked to changes in the gut microbiome and that GI and general benefits may be effected via distinct taxa.

References

¹Kalt W, Cassidy A, Howard LR, Krikorian R, Stull AJ, Tremblay F, Zamora-Ros R. Recent Research on the Health Benefits of Blueberries and Their Anthocyanins. Adv Nutr. 2020 Mar 1;11(2):224-236.
²Wilder-Smith CH, Materna A, Olesen SS. Blueberries Improve Abdominal Symptoms, Well-Being and Functioning in Patients with Functional Gastrointestinal Disorders. Nutrients. 2023 May 20;15(10):2396.

Disclosure

This study was supported by a research grant from the US Highbush Blueberry Council.

Introduction

Chronic constipation (CC) is a frequent gastrointestinal disorder which significantly affects patients' quality of life. International guidelines recommend the use of polyethylene glycol (PEG) as part of the first-line management of CC after the failure of diet and lifestyle modifications. However, limited data are available on how PEG is used in daily clinical practice. Therefore, a national survey among gastroenterologists (GEs) and general practitioners (GPs) was conducted to evaluate its use in the management of CC.

Aims & Methods

Members of Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and Italian Federation of General Practitioners (FIMMG) were invited to complete a 44-item online survey. The questionnaire was structured to explore several dimensions regarding the use of PEG (e.g. type of PEG used, formulations and dosages recommended, etc.).

Results

The survey was completed by 1188 physicians (317 GEs, 871 GPs). GEs were significantly younger (mean age 44.9 vs. 51.0 years, p<0.01) and more likely to have less than 10 years of experience compared to GPs.
PEG was prescribed as part of first-line treatment in addition to dietary and behavioral advice more frequently by GEs than GPs (92.4% vs. 82.9%, p<0.001). GPs preferred to prescribe PEG in the early morning or evening before bedtime compared to GEs (p<0.001), which preferred mid-morning or midafternoon (p<0.01). GPs more often recommended taking it away from other drugs and/or supplements compared to GEs (76.7% vs 61.5%, p<0.001).
GEs considered PEG products to be taken continuously more often than GPs (36.9% vs 18.6%, p<0.001) and were more inclined to avoid setting a fixed treatment duration (62.8% vs 38.2%, p<0.001), while GPs often recommend a short-term or an on-demand use. GEs also more often preferred to discontinue PEG gradually compared to GPs (74.8% vs. 63.0%, p<0.001)
PEG’s formulation choices varied: GEs favored the powder formulation less than GPs (58.7% vs 78.9%, p<0.001), and more often started therapy at higher dosages (Table 1). Moreover, GEs gave more importance on palatability compared to GPs (71.9% vs 60.4%, p<0.001).
Safety perceptions were similarly high across the groups, GEs were more likely to prescribe PEG than GPs to patients with comorbidities such as chronic kidney disease (75.7% vs 64.0%, p<0.001) and during pregnancy/lactation (71.3% vs 48.8%, p<0.001).

Table 1. Prescription of PEG as part of first line management of CC and PEG's initial dosage answers.

	Overall (N = 1180)		GEs (N = 317)			GPs (N = 871)			Difference between GEs and GPs		p-value
	N	%	N	%	95% CI	N	%	95% CI	%	95% CI
In the treatment of constipation, in addition to dietary and behavioral advice, do you prescribe a PEG-based product as first-line treatment?
Yes	1015	85.4	293	92.4	89.5 to 95.3	722	82.9	80.4 – 85.4	9.5	5.7 – 13.4	<0.001
When prescribing a PEG-based product, what initial dosage do you use?
Customized powder dose	263	22.1	49	15.4	11.5 to 19.4	214	24.6	21.7 to 27.4	-9.2	-14.1 to -4.2	0.001
10 g/day	344	29.0	90	28.4	23.4 to 33.4	254	29.1	26.1 to 32.2	-0.7	-6.6 to 5.0	0.796
13.8 g/day	438	36.9	121	38.2	32.8 to 43.5	317	36.4	33.2 to 39.6	1.8	-4.5 to 8.0	0.575
17.4 g/day	104	8.7	38	12.0	8.4 to 15.6	66	7.6	5.8 to 9.3	4.4	0.4 to 8.4	0.017
34.8 g/day	39	3.3	19	6.0	3.4 to 8.6	20	2.3	1.3 to 3.3	3.7	0.9 to 6.5	0.002

Conclusion

To the best of our knowledge, this is the first national survey to assess how PEG is prescribed by GEs and GPs in daily clinical practice. The survey highlighted a certain heterogeneity in prescription behaviors. GEs tended to adopt longer-term therapeutic strategy, starting with higher doses. Moreover, they paid greater attention to PEG palatability and were more confident on PEG safety in patients with chronic comorbidities. These findings underscored the need for shared knowledge and approaches to optimize constipation management across different care settings.

Introduction

Constipation is a common gastrointestinal concern associated with less frequent defecations, with reduced faecal bulk and harder stools, or both. It greatly affects quality of life, with a significant impairment of both mental and physical components. One way to relieve constipation can be by intake of probiotics. Lactiplantibacillus plantarum 299v (LP299V®) is one of the most clinically studied L plantarum strains and has been shown to have positive effects on IBS symptoms in several clinical trials (Arvidsson Nordström et al. 2021). In the present study, the effect of LP299V and a small amount of another L plantarum strain (LPGOS42) on occasional constipation was investigated. Gut transit time was also evaluated, using a novel marker (Asnicar et al. 2021).

Aims & Methods

The aim of the study was to investigate if LP299V and LPGOS42 (LP) could improve gastrointestinal function in adults with occasional constipation. After a 2-week run-in period, 100 subjects were randomized to receive either LP or placebo capsules for 8 weeks. The change in frequency of complete and spontaneous bowel movements (CSBM), frequency of bloating and flatulence, stool consistency, digestive function (modified Gastrointestinal Symptom Rating Scale (GSRS)) and the quality of life (Patient Assessment of Constipation Quality of Life questionnaire (PAC-QoL)) were followed. The gut transit time was assessed with a blue dye method (Asnicar et al. 2021).

Results

The number of weekly complete and spontaneous bowel movements increased significantly over time in both groups (LP +2.4, placebo +1.9, p=0.182 between groups at week 8). Stool consistency transitioned from hard to softer stools in both groups, with the mean score significantly higher after 8 weeks in the LP group, indicating softer stools in this group. The LP group also had significantly more bowel movements without hard lumpy stools compared to the placebo group at week 8. The frequency of flatulence was reduced over time in the LP group, reaching a significantly lower frequency of flatulence in the LP group vs placebo in week 8.
The subjects scored low for most of the symptoms in the GSRS, indicating that the study population were healthy subjects without abdominal pain, reflux, diarrhea or indigestion. The only subscale in GSRS where the mean score was over 1 (= more than occasional problems) was constipation and this decreased significantly over time in both groups, with a more pronounced decrease seen in the LP group (p=0.073 between groups at week 8).
The total score for PAC-QoL improved significantly over time in both groups, with no difference seen between the groups. The highest score detected among the four subscales was for satisfaction and it improved significantly more in the LP group compared to the placebo group (p=0.007 between groups in week 8).
Measuring the gut transit time with a blue dye method gave large differences between subjects and no significant changes over time or between groups could be detected.

Conclusion

In conclusion, this study demonstrates that intake of probiotics (L plantarum 299v and L plantarum GOS42) helps to alleviate constipation and flatulence, as well as improves quality of life in healthy subjects with occasional constipation.

References

Arvidsson Nordström E, Teixeira C, Montelius C, Jeppsson B and Larsson N. Lactiplantibacillus plantarum 299v (LP299V®): three decades of research. Benef Microbes 2021 Oct 11;12(5):441-465.
Asnicar F et al. Blue poo: impact of gut transit time on the gut microbiome using a novel marker. Gut 2021 Sep 70(9):1665-1674.

Disclosure

G Önning, C Montelius and C Vegge work at Probi AB, that owns the bacterial strains investigated in the study.

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) recommends colorectal cancer (CRC) screening for individuals at average risk, aged 50-75 years. However, recent trends indicate an increasing incidence of colorectal neoplasms among younger individuals.

Aims & Methods

The primary aim of this cross-sectional study is to record the prevalence of polyps, adenomas, and advanced neoplasia (high-grade dysplasia and CRC) in individuals up to 49 years old, and secondarily to identify predictors of neoplasia and high-grade dysplasia. The data were collected retrospectively through the hospital’s electronic database. All serial colonoscopies, with cecum intubation, from 1/1/2018 until 31/12/2024 were included. Endoscopies in patients with diagnosed familial polyposis syndromes, inflammatory bowel disease and those with poor bowel preparation were excluded. Patients’ demographics, CRC family history and the recorded polyps' size, location, Paris classification, and pathology reports were collected. SPSS 23 (IBM, Armonk, NY, USA) was used for the statistical analysis.

Results

Table. Polyps, adenomas and advanced adenomas by age groups
	<25 (n=36)	25-29 (n=31)	30-34 (n=61)	35-39 (n=76)	40-44 (n=146)	45-49 (n=218)	Total (n=568)	P
Polyps, n (%)	0 (0)	2 (6.5)	6 (9.8)	20 (26.3)	52 (35.6)	86 (39.4)	166 (29.2)	<0.001
Adenoma, n (%)	0 (0)	1 (3.2)	2 (3.3)	9 (11.8)	21 (14.4)	36 (16.5)	68 (12.1)	0.006
Advanced adenoma, n (%)	0 (0)	1 (3.2)	0 (0)	3 (3.9)	4 (2.8)	12 (5.6)	20 (3.5)	0.266

A total of 568 colonoscopies were included, involving 306 male patients (53.8%), with a median age of 42 years (IQR: 36-46). Of these, 71 patients (12.5%) had a family history of CRC. At least one polyp was identified in 166 patients (29.2%), with adenomas observed in 68 patients (12.1%) and advanced neoplasia in 20 patients (3.5%), including 3 patients (0.5%) diagnosed with CRC (Table). Advanced adenomas were more frequently detected in colonoscopies performed due to visible blood in stools (8.5%) and as follow-up after diverticulitis (7.1%). In multivariate analysis, in which age, family history of CRC, and bowel preparation quality were included as variables, the presence of adenomas and advanced adenomas was significantly associated with age (adenoma OR = 1.08; 95% CI: 1.04-1.13 and advanced adenoma OR = 1.08; 95% CI: 1.00-1.18).
In total 271 polyps were identified. Ninety-four were adenomas of which 74 had low-grade dysplasia and 20 high-grade dysplasia or cancer. Sixteen of 177 not-adenomatous polyps were found to be serrated and 2 of those had low-grade dysplasia. “Large” polyps [≥10mm] had a higher probability of being adenomas (71.4%) compared to “small” [5-9mm] (26.2%) and “diminutive” [<5mm] (24.4%), Chi square P<0.001. Regarding the Paris classification Ip and Isp presented a higher probability to be adenomas (87.5% and 86.4% respectively) in contrast to Is and 0-IIa (35.6% and 12.2% respectively), Chi square P<0.001.
The resected adenomas were also categorized according to the type of reported dysplasia to identify predictors of high-grade dysplasia. High-grade dysplasia was present in 42.5% of large polyps compared to 4.5% of small and 6.2% of diminutive (Chi square P<0.001). High-grade dysplasia was also present in a higher frequency in polyps resected from the “left” colon (26.2%) compared to the “right” (10.3%) and in 0-IIa (66.7%) and Ip (38.1%) compared to Isp (21.1%) and Is (12.5%) polyps according to the Paris classification, but not in a statistically significant degree (Chi square P<0.010).

Conclusion

Despite the relatively small sample size of our study, initiation of screening at a younger age should be considered to be lowered, since adenoma and advanced adenoma were identified in 15% and 4.3% of individuals aged 35-49.

Disclosure

GB: Advisor/lecturer for Janssen, Pfizer, Takeda, Abbvie, MSD, Mylan, Genesis Pharma, Adacyte Therapeutics, Amgen, Ferring, Cooper; Funding (Grants/Honoraria): Pfizer, Takeda, Abbvie, Aenorasis; Research/Clinical Trials: Abbvie, Takeda.