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Familial Amyloidosis with Polyneuropathy was first recognized in Portugal and reported by Andrade in 1952. The disease is rare, but clustering of the patients has been reported from Portugal, Japan and northern Sweden. The gastrointestinal involvement in the Swedish form of the disease was studied in this investigation. In a study of 52 patients on their first admission 47 displayed gastrointestinal symptoms in the form of severely altered bowel habits (intractable diarrhea and/or constipation). Steatorrhea was found in 30 out of 52 patients (58%) and an impaired d-xylose absorption in 26 out of 50 patients (52%). The steatorrhea was correlated to the degree of peripheral polyneuropathy as expressed by EMG-score. No relation could be established between steatorrhea or impaired d-xylose absorption with oral lactose and glucose tolerance tests indicating an intact entero- cyte function. A follow-up study comprising 21 patients demonstrated that all patients ultimately developed gastrointestinal symptoms and that the prevalence of diarrhea became higher with the duration of the disease. In this study steatorrhea became more frequent and was significantly related to the duration. Bile acid breath test, fecal fat determination and d-xylose tests were performed on 13 patients. Six patients with results indicating an increased bile acid deconjugation in the small bowel were treated with antibiotics for one week, after which the results had returned to normal in all. Four out of five patients with impaired d-xylose absorption before treatment also returned to normal after antibiotics. Three patients with diarrhea 3-7 times daily were considerably relieved after treatment both concerning general well-being and bowel movements. The results give strong evidence that bacterial overgrowth of the small intestine is important in causing gastrointestinal dysfunction in this disease. A histopathological study of the small intestinal mucosa on 27 patients showed that 84 percent were amyloid positive. The degree of amyloid infiltration did not correlate to the symptomatic state, steatorrhea or impaired d-xylose absorption. The surface ultrastructure was normal in all of 21 investigated cases. Radiographical and endoscopi cal studies were performed on 43 patients altogether. Evidence of gastric stasis was found in 7 out of 37 patients investigated by means of gastric x-ray and in 7 out of 28 patients at gastroscopy. No characteristic radiological appearance of the disease could be shown in the small intestine, the colon or the gall bladder. Nine patients who were operated on with the construction of an enterostomy were reported. The diversion of the fecal stream when the patients had diarrhea and were incontinent meant a considerable relief. / <p>S. 1-46: sammanfattning, s. 47-128: 6 uppsatser</p> / digitalisering@umu

Key Points: (1) Nutrition management for individuals infected with HIV can be helpful in maintaining lean body weight, combating oxidative stress, reducing complications from hyperglycemia and hyperlipidemia, and managing gastrointestinal function. (2) Patients may need to be individualized to meet each individual's unique requirements. (3) Consideration should be given to including the expertise of a registered dietitian/nutritionist s part of the health care team to promote wellness in the individuals infected with HIV.

Significance: Nutrition is one of the most basic of medical issues and is often ignored as a problem in the management of our chronic wound patients. Unfortunately, malnutrition is widespread in our geriatric patients even in nursing homes in developed countries. Attention to basic nutrition and providing appropriate supplements may assist in the healing of our chronic wounds. Recent Advances: Recent research has revealed the epidemiology of malnutrition in developed countries, the similarities to malnutrition in developing countries, and some of the physiologic and sociologic causes for this problem. More information is now available on the biochemical effects of nutrient deficiency and supplementation with macronutrients and micronutrients. In some cases, administration of isolated nutrients beyond recommended amounts for healthy individuals may have a pharmacologic effect to help wounds heal. Critical Issues: Much of the knowledge of the nutritional support of chronic wounds is based on information that has been obtained from trauma management. Due to the demographic differences of the patients and differences in the physiology of acute and chronic wounds, it is not logical to assume that all aspects of nutritional support are identical in these patient groups. Before providing specific nutritional supplements, appropriate assessments of patient general nutritional status and the reasons for malnutrition must be obtained or specific nutrient supplementation will not be utilized. Future Directions: Future research must concentrate on the biochemical and physiologic differences of the acute and chronic wounds and the interaction with specific supplements, such as antioxidants, vitamin A, and vitamin D.

Introduction: The topic of this thesis is the Prevention of Osteoporosis in Malabsorption Syndrome. The thesis is divided into two parts; theoretical and practical. The theoretical work in the first part deals with osteoporosis and osteoporosis risk factors with a focus on nutritional factors. Osteoporosis is a systemic metabolic disease of the skeleton characterised by decreased bone mass and changes in the quality of bone tissue. The etiology of osteoporosis is multifactorial. Malabsorption syndrome causes the small intestine, which is essential for absorbing nutrients, to malfunction. In the second part of the theoretical work, attention is paid to malabsorption syndrome and diseases that lead to its development. Objective: The objective of this work is to draw a comparison between the intake of calcium and other important nutrients in relation to bone metabolism for people with lactose intolerance, and compare this with recommended values and a control group of people without lactose intolerance. Methods: Dietary habits were evaluated using a questionnaire method and a detailed analysis of a four-day diet. The Nutriservis Professional programme was used to evaluate diets (determine energy values, amount of essential nutrients, fibre, calcium, plus other minerals and vitamins). Bone mineral...

In cystic fibrosis (CF), pancreatic insufficiency and a diminished bile acid pool cause malabsorption of important nutrients and dietary components leading to deficiency, poor nutritional status, and oxidative stress. Of particular significance is the malabsorption of fat-soluble nutrients and antioxidants, which are important for normal immune and neurologic function. Patients with CF often are deficient in these compounds despite supplementation with the current standard of care therapy. The objective was to compare the pharmacokinetic profile of this water-soluble vitamin E formulation (Aqua-E) with an oil-based softgel formulation in a malabsorbing patient population. Patients with CF who had documented malabsorption were recruited for participation in this pharmacokinetic study. Patients who met inclusion and exclusion criteria discontinued vitamin E supplementation, except for that in a multivitamin, for 7 to 21 days before the day of dosing. Patients were randomized to a single dose of 20 ml of Aqua-E or three oil-based softgels, which contained equivalent amounts of tocopherols. Blood was drawn from patients at time 0, 2, 4, 8, 24, 48, and 168 hr and analyzed for tocopherols. Eight patients were enrolled in the study and randomized to Aqua-E or softgels. The primary outcome, the absorption of γ-tocopherol in Aqua-E (AUC=115 μg/ml*hr), was significantly greater than that of oil-based softgels (AUC=25.3 μg/ml*hr; P=0.013). Total-tocopherols (α+γ +δ) in Aqua-E (AUC=294 μg/ml*hr) showed a strong trend toward increased absorption compared with that of oil-based softgels (AUC=117 μg/ml*hr; P=0.09). In conclusion, this novel, water-soluble formulation showed a marked and statistically significant increase in absorption of γ-tocopherol in malabsorbing patients with CF compared with an oil-based formulation.

-- Thèse fournie sans page de titre --Afin de mieux comprendre la physiopathologie des causes gastriques de malabsorption de la vitamine B12, nous nous sommes intéressés au déficit congénital en facteur intrinsèque, une maladie rare caractérisée par une diminution de la sécrétion de facteur intrinsèque (FI) fonctionnel dans le suc gastrique. Dans cette étude, nous rapportons cinq cas porteurs hétérozygotes du variant GIF c.290T>C (p.M97T) et deux cas porteurs hétérozygotes du variant GIF c.435_437delGAA (p.K145_N146delinsN). L'étude fonctionnelle des FI recombinants mutés produits par mutagenèse dirigée a mis en évidence une diminution de l'affinité du FI p.K145_N146delinsN pour la vitamine B12 n'expliquant toutefois pas totalement le phénotype observé chez les sujets. Par ailleurs, une association a été récemment décrite entre le polymorphisme rs601338, c.461 G>A du gène FUT2, codant pour une [alpha]1,2-fucosyltransférase, et les taux plasmatiques de vitamine B12. Afin de compléter notre étude, nous avons évalué l'influence du polymorphisme FUT2 c.461 G>A sur les taux de vitamine B12, de folates et d'homocystéine dans les populations Européennes et Africaines chez 1466 sujets. Notre étude démontre un effet du polymorphisme FUT2 c.461 G>A sur les taux plasmatiques de vitamine B12 et de folates indépendamment de l'âge, du sexe et de l'origine géographique. En conclusion, nos résultats démontrent que le gène du FI (GIF) n'est pas le seul gène impliqué dans la physiopathologie du déficit congénital en facteur intrinsèque. L'étude des malabsorptions d'origine gastrique de la vitamine B12 passe par une approche polygénique dans laquelle le gène FUT2 occupe une place importante / There are multiple causes of gastric vitamin B12 malabsorption. To get a better understanding of their physiopathology, we are interested in inherited gastric intrinsic factor (GIF) deficiency, a vitamin B12 absorption defect characterized by GIF impaired activity. In this study, we report five cases heterozygous carriers of the variant GIF c.290T>C (p.M97T) and two cases heterozygous carriers of the variant GIF c.435_437delGAA (p.K145_N146delinsN). The study of recombinant mutated GIF produced by site-directed mutagenesis evidenced a reduced affinity for vitamin B12 in the case of GIF p.K145_N146delinsN which does not explain fully the phenotypes observed in our subjects. Recently, an association was described between the FUT2 polymorphism rs601338, c.461 G>A, coding for a fucosyltransferase, and plasma levels of vitamin B12. To complete our study, we assessed the influence of FUT2 c.461 G>A polymorphism on vitamin B12, folate and homocysteine in European and African populations in 1466 subjects. Our study demonstrate a clear effect of FUT2 c.461 G>A polymorphism on both plasma levels of vitamin B12 and folate, regardless of age, gender, and geographic origin. In conclusion, our results demonstrate the GIF gene is not the only gene involved in the physiopathology of inherited GIF deficiency. It is necessary to study the gastric causes of vitamin B12 malabsorption through a polygenic approach, in which the FUT2 gene is an important element

Le by-pass gastrique Roux-en-Y (BPG) est une chirurgie de l'obésité qui induit des améliorations spectaculaires de l'homéostasie glucidique indépendamment de la perte de poids. Un mécanisme proposé pour expliquer ces améliorations est une augmentation de la production intestinale de glucose (PIG) qui induit des effets bénéfiques sur l'organisme (satiété, amélioration de la sensibilité hépatique à l'insuline). Cette augmentation de la PIG, retrouvée chez la souris ayant subi un BPG simplifié, est également responsable des effets bénéfiques des régimes enrichis en protéines via l'inhibition des récepteurs mu-opioïdes (RMO) par les peptides. Nous avons donc testé l'hypothèse selon laquelle les effets bénéfiques du BPG dépendraient d'une inhibition des RMO par les protéines alimentaires et nous avons également testé le rôle causal de la PIG dans ces améliorations métaboliques. Pour cela, nous avons réalisé un by-pass duodéno-jéjunal (BDJ), ie un BPG sans restriction gastrique, chez des souris sauvages (WT), des souris invalidées pour le gène du RMO (MOR-/-) et des souris dépourvues de PIG (I-G6pc-/-). Chez les souris obèses, Le BDJ induit une forte perte de poids (–30%), en partie expliquée par une malabsorption lipidique, ainsi qu'une amélioration des paramètres glucidiques dépendante de cette perte de poids. Au contraire, chez la souris de poids normal, le BDJ n'induit ni perte de poids ni malabsorption mais améliore la tolérance au glucose. Les effets sont les mêmes chez les souris WT, MOR-/- et I-G6pc-/- ce qui montre que les récepteurs mu-opioïdes et la PIG ne semblent pas avoir de rôle causal dans les améliorations du métabolisme énergétique et glucidique après BDJ / Roux-en-Y gastric bypass procedure (GBP) is an obesity surgery that induces dramatic glucose homeostasis improvements independently of weight loss. A proposed mechanism to explain these glucose homeostasis improvements is an increase in intestinal glucose production (IGP) that induces beneficial effects on metabolism (satiety, improved liver insulin sensitivity). This increase in IGP is found in mice that have undergone a simplified GBP and is also responsible for the beneficial effects of protein-enriched diets through the inhibition of mu-opioid receptors (MOR) by alimentary peptides. We therefore hypothesized that the beneficial effects of GBP could depend on MOR inhibition by dietary proteins and we also tested the causal role of IGP in these metabolic improvements. For this purpose, we performed a duodenal-jejunal bypass surgery (DJB), ie GBP without gastric restriction, in wild-type mice (WT), in mice lacking MOR gene (MOR-/-) and in mice lacking IGP (IG6pc-/-). In obese mice, DJB induced a rapid and substantial weight loss (-30%), partly explained by fat malabsorption, and weight loss-dependent improvements of glucose homeostasis. In contrast, in the non-obese mice, DJB did not induce weight loss nor malabsorption but improved glucose tolerance. Effects were similar in WT, MOR-/- and I-G6pc-/- mice showing that mu-opioid receptors and IGP did not appear to have a causal role in glucose and energy metabolism improvements after DJB

<p>Autoimmune polyendocrine syndrome type I (APS) is a monogenous, recessively inherited disease characterised by endocrine and non-endocrine autoimmune manifestations. One fifth of APS I patients suffer from periodic intestinal dysfunction with varying degrees of malabsorbtion, steatorrhea and constipation. Alopecia areata is found in one third of APS I patients. By immunoscreening human cDNA libraries derived from normal human duodenum and scalp with APS I sera, we identified tryptophan hydroxylase (TPH) as an intestinal autoantigen and tyrosine hydroxylase (TH) as a dermal autoantigen. Forty-eight percent (38/80) of the APS I patients had TPH antibodies (Ab) and 44% (41/94) showed TH immunoreactivity. No reactivity against TPH or TH was seen in healthy controls. TPH-Abs showed a statistically significant correlation with gastrointestinal dysfunction (p<0.0001) and TH-Abs were significantly correlated to alopecia (p=0.02). TPH-Ab positive APS I sera specifically immunostained TPH containing enterochromaffin cells in normal duodenal mucosa. In affected mucosa a depletion of the TPH containing EC cells was seen. In enzyme inhibition experiments TPH and TH activity <i>in vitro</i> was reduced by adding APS I sera. TPH and TH together with phenylalanine hydroxylase (PAH) constitute the group of pteridine dependent hydroxylases. These are highly homologous enzymes involved in the biosynthesis of neurotransmitters. Immunoprecipitation of PAH expressed <i>in vitro</i> showed that 27% (25/94) of APS I patients had antibodies reacting with PAH, but no associations with clinical manifestations was observed. An immunocompetition assay showed that the PAH reactivity reflects a cross-reactivity with TPH.</p><p>In conclusion, we have identified TPH and TH as intestinal and dermal autoantigens in APS I, coupled to gastrointestinal dysfunction and alopecia. We have also demonstrated immunoreactivity against PAH in APS I patient sera reflecting a cross-reactivity with TPH.</p>

Autoimmune polyendocrine syndrome type I (APS) is a monogenous, recessively inherited disease characterised by endocrine and non-endocrine autoimmune manifestations. One fifth of APS I patients suffer from periodic intestinal dysfunction with varying degrees of malabsorbtion, steatorrhea and constipation. Alopecia areata is found in one third of APS I patients. By immunoscreening human cDNA libraries derived from normal human duodenum and scalp with APS I sera, we identified tryptophan hydroxylase (TPH) as an intestinal autoantigen and tyrosine hydroxylase (TH) as a dermal autoantigen. Forty-eight percent (38/80) of the APS I patients had TPH antibodies (Ab) and 44% (41/94) showed TH immunoreactivity. No reactivity against TPH or TH was seen in healthy controls. TPH-Abs showed a statistically significant correlation with gastrointestinal dysfunction (p&lt;0.0001) and TH-Abs were significantly correlated to alopecia (p=0.02). TPH-Ab positive APS I sera specifically immunostained TPH containing enterochromaffin cells in normal duodenal mucosa. In affected mucosa a depletion of the TPH containing EC cells was seen. In enzyme inhibition experiments TPH and TH activity in vitro was reduced by adding APS I sera. TPH and TH together with phenylalanine hydroxylase (PAH) constitute the group of pteridine dependent hydroxylases. These are highly homologous enzymes involved in the biosynthesis of neurotransmitters. Immunoprecipitation of PAH expressed in vitro showed that 27% (25/94) of APS I patients had antibodies reacting with PAH, but no associations with clinical manifestations was observed. An immunocompetition assay showed that the PAH reactivity reflects a cross-reactivity with TPH. In conclusion, we have identified TPH and TH as intestinal and dermal autoantigens in APS I, coupled to gastrointestinal dysfunction and alopecia. We have also demonstrated immunoreactivity against PAH in APS I patient sera reflecting a cross-reactivity with TPH.