Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) and coeliac disease are debilitating gastrointestinal diseases that seriously affect the quality of life of those affected. Under normal circumstances, the intestinal immune system is maintained in a state of controlled inflammation, whereby balance exists between protective immunity, mediated by effector cells, and tolerance mediated by cells with regulatory function. However, an aberrant immune response is believed to contribute to the intestinal inflammation present in individuals afflicted by these diseases. This thesis investigated the involvement of CD4⁺ CD25[superscript]high Foxp3⁺ Regulatory T cells (Treg) and Th17 Effector cells in both inflammatory bowel disease (IBD) and coeliac disease. The reciprocal relationship between Treg and Th17 cells under certain cytokine conditions, has prompted the exploration of these two cell types in IBD and coeliac disease. Previous studies have examined these factors individually in a range of diseases, however, to our knowledge the study of both Treg and Th17 in IBD and coeliac disease subjects represents a novel area of research. Crohn’s disease (CD), ulcerative colitis (UC) and coeliac disease subjects were recruited through the Department of Gastroenterology and Hepatology at The Queen Elizabeth Hospital (QEH) in Adelaide, South Australia. In total, one-hundred and seventeen subjects were enlisted in this study to donate blood samples. In addtion, intestinal biopsy samples were collected from fifty-six subjects undergoing colonoscopy at the QEH Department of Gastroenterology and Hepatology. All subjects participated, with informed consent and ethics approval. Treg and Th17 cell numbers were investigated in the peripheral blood of Crohn’s disease, ulcerative colitis, coeliac disease and control subjects using multi-colour, intracellular flow cytometry. A decrease in Treg cell numbers and an increase in Th17 cell numbers was observed in IBD, but not in coeliac disease. Closer investigation into the ratio of Treg and Th17 cells within patients identified a near 1:1 Treg/Th17 ratio in control subjects, but a lower Treg/Th17 ratio in IBD patients. This suggested a disturbance in regulatory and effector cell equilibrium. Furthermore, the excess of Th17 cells and deficiency of Tregs could contribute to the pathologies observed in IBD. The discovery of an imbalance in Treg and Th17 cell numbers in IBD prompted further investigation of these cells in intestinal biopsies collected from IBD, coeliac and control subjects. Real time RT-PCR of intestinal biopsy samples demonstrated increased expression of the Th17 cytokine, IL-17a, in both IBD and coeliac disease. Elevated levels of the Treg transcription factor Foxp3 were also identified in intestinal biopsies from IBD subjects. It was therefore hypothesised that Treg cells may have been actively recruited from the periphery in an attempt to control inflammation in the gut; however, the intestinal cytokine microenvironment may have restricted the regulatory function of these cells. Cytokines known to promote human Th17 differentiation, namely IL-1β, IL-6, TGF-β, IL-21 and IL-23, were explored in intestinal biopsy samples from IBD, coeliac and control subjects. High levels of IL-1β and IL-6 were detected in IBD patient samples, however, no change in levels of IL-21 or IL-23 were observed in IBD or coeliac disease subjects. Elevated levels of TGF-β were only identified in UC. No changes in cytokine expression were observed between control and coeliac subjects, except a significant decrease in IL-6 levels was identified in coeliac disease sufferers. The pro-inflammatory microenvironment identified in intestinal biopsies from IBD subjects may have promoted the continual differentiation and development of Th17 cells, whilst restricting Treg activity. Moreover, the observed deficiency of Treg in IBD patients may have impaired the ability of the immune system to limit excessive pathogenic Th17 driven immune responses in the intestinal mucosa. Therefore, therapeutic approaches that aim to re-establish regulatory and effector cell homeostasis by increasing Treg numbers in IBD patients, and specifically targeting Th17 cells, may prove effective in the treatment of IBD. Approaches such as these could provide greater focus to treatment strategies for IBD management compared to current broad-spectrum immunosuppressive therapies that could increase susceptibility to cancer or infection in IBD patients. In addition, the imbalance of regulatory and effector cells demonstrated in the peripheral blood of IBD patients may potentially provide new options for a noninvasive diagnostic tool. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457580 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Inflammatory bowel disease (including Crohn’s disease and ulcerative colitis) and coeliac disease are debilitating gastrointestinal diseases that seriously affect the quality of life of those affected. Under normal circumstances, the intestinal immune system is maintained in a state of controlled inflammation, whereby balance exists between protective immunity, mediated by effector cells, and tolerance mediated by cells with regulatory function. However, an aberrant immune response is believed to contribute to the intestinal inflammation present in individuals afflicted by these diseases. This thesis investigated the involvement of CD4⁺ CD25[superscript]high Foxp3⁺ Regulatory T cells (Treg) and Th17 Effector cells in both inflammatory bowel disease (IBD) and coeliac disease. The reciprocal relationship between Treg and Th17 cells under certain cytokine conditions, has prompted the exploration of these two cell types in IBD and coeliac disease. Previous studies have examined these factors individually in a range of diseases, however, to our knowledge the study of both Treg and Th17 in IBD and coeliac disease subjects represents a novel area of research. Crohn’s disease (CD), ulcerative colitis (UC) and coeliac disease subjects were recruited through the Department of Gastroenterology and Hepatology at The Queen Elizabeth Hospital (QEH) in Adelaide, South Australia. In total, one-hundred and seventeen subjects were enlisted in this study to donate blood samples. In addtion, intestinal biopsy samples were collected from fifty-six subjects undergoing colonoscopy at the QEH Department of Gastroenterology and Hepatology. All subjects participated, with informed consent and ethics approval. Treg and Th17 cell numbers were investigated in the peripheral blood of Crohn’s disease, ulcerative colitis, coeliac disease and control subjects using multi-colour, intracellular flow cytometry. A decrease in Treg cell numbers and an increase in Th17 cell numbers was observed in IBD, but not in coeliac disease. Closer investigation into the ratio of Treg and Th17 cells within patients identified a near 1:1 Treg/Th17 ratio in control subjects, but a lower Treg/Th17 ratio in IBD patients. This suggested a disturbance in regulatory and effector cell equilibrium. Furthermore, the excess of Th17 cells and deficiency of Tregs could contribute to the pathologies observed in IBD. The discovery of an imbalance in Treg and Th17 cell numbers in IBD prompted further investigation of these cells in intestinal biopsies collected from IBD, coeliac and control subjects. Real time RT-PCR of intestinal biopsy samples demonstrated increased expression of the Th17 cytokine, IL-17a, in both IBD and coeliac disease. Elevated levels of the Treg transcription factor Foxp3 were also identified in intestinal biopsies from IBD subjects. It was therefore hypothesised that Treg cells may have been actively recruited from the periphery in an attempt to control inflammation in the gut; however, the intestinal cytokine microenvironment may have restricted the regulatory function of these cells. Cytokines known to promote human Th17 differentiation, namely IL-1β, IL-6, TGF-β, IL-21 and IL-23, were explored in intestinal biopsy samples from IBD, coeliac and control subjects. High levels of IL-1β and IL-6 were detected in IBD patient samples, however, no change in levels of IL-21 or IL-23 were observed in IBD or coeliac disease subjects. Elevated levels of TGF-β were only identified in UC. No changes in cytokine expression were observed between control and coeliac subjects, except a significant decrease in IL-6 levels was identified in coeliac disease sufferers. The pro-inflammatory microenvironment identified in intestinal biopsies from IBD subjects may have promoted the continual differentiation and development of Th17 cells, whilst restricting Treg activity. Moreover, the observed deficiency of Treg in IBD patients may have impaired the ability of the immune system to limit excessive pathogenic Th17 driven immune responses in the intestinal mucosa. Therefore, therapeutic approaches that aim to re-establish regulatory and effector cell homeostasis by increasing Treg numbers in IBD patients, and specifically targeting Th17 cells, may prove effective in the treatment of IBD. Approaches such as these could provide greater focus to treatment strategies for IBD management compared to current broad-spectrum immunosuppressive therapies that could increase susceptibility to cancer or infection in IBD patients. In addition, the imbalance of regulatory and effector cells demonstrated in the peripheral blood of IBD patients may potentially provide new options for a noninvasive diagnostic tool. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1457580 / Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 2009

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Irritable Bowel Syndrome är en vanlig kronisk mag-tarmsjukdom som medför konsekvenser i det vardagliga livet för den som lever med sjukdomen. Än idag är orsaken till sjukdomen okänd, likväl finns inga tydliga riktlinjer för hur den ska behandlas. Syfte: Att belysa upplevelsen av att leva med Irritable Bowel Syndrome. Metod: Studien genomfördes som en systematisk litteraturstudie med induktiv ansats. Resultat: Resultatet baserades på nio kvalitativa vetenskapliga artiklar. Utifrån meningsenheter framkom tre huvudkategorier; Ett begränsat liv, Emotionell påverkan och Behov av förståelse och stöd med tillhörande sex underkategorier; Social isolering, Brist på energi, Rädsla och oro, Frustration, Att inte bli tagen på allvar av hälso- och sjukvårdspersonal och Att förstå och acceptera sin sjukdom. Slutsats: Att leva med Irritable Bowel Syndrome medförde begränsningar i det vardagliga livet. Det handlade både om professionella och privata områden. Att leva med den kroniska sjukdomen påverkade de drabbade individerna emotionellt eftersom de uttryckte att de inte kunde leva ett ”normalt” liv på grund av de oförutsägbara och genanta symtomen. I möten med hälso- och sjukvårdspersonal var det viktigt att ett personcentrerat förhållningssätt användes. Resultatet visade att individer med IBS uttryckte frustration över att inte få information och kunskap om deras sjukdom samt brist på evidensbaserad behandling. Därför behöver forskning bedrivas inom området. / Irritable Bowel Syndrome is a common chronic gastroinestinal disease that has consequenses in the everyday life for persons living with the condition. Still the cause of the disease is unknown, yet there is no clear guidelines how to treat it. Aim: To highlight the experience of living with Irritable Bowel Syndrome. Method: The study was conducted as a systematic literature study with inductive approach. Result: The result was based on nine qualitative scientific articles. Based on meaningful extracts three main categories were formed; A limited life, Emotional impact and The need for understanding and support. Six related subcategories were formed; Social isolation, Lack of energy, Fear and worry, Frustration, Not to be taken seriously by healthcare professionals and To understand and accept the disease. Conclusion: Living with Irritable Bowel Syndrome caused limitations in everyday life. It limited both the professional life and the private life. To live with a chronic disease affected the individuals emotionally because they expressed that they could not live a ”normal” life because of the unpredicable and embarrassing symptoms. In the meeting with healthcare it was important that a person-centered approach was used. The results showed that individuals living with IBS expressed frustration about not getting information and knowledge about their disease and treatment options. Because of this research needs to be conducted about the chronic condition and potential treatments.

Cancer treatments including chemotherapy and radiotherapy treat cancer by targeting rapidly dividing cells. Although these forms of treatment damage rapidly dividing cancer cells, they are also toxic to the cells of the gastrointestinal tract, leading to inflammation of the mucosal layer (mucositis) and causing nausea, vomiting, diarrhea, and abdominal pain. Improvement in symptoms may allow patients to have better performance status permitting ongoing treatment and possibly a better prognosis. This article describes the pathophysiology of chemotherapy-induced mucositis and includes 3 case reports of treatment of mucositis with serum bovine immunoglobulin.

Bakgrund   Irritable Bowel Syndrome (IBS) är en mag- och tarmsjukdom som drabbar cirka 18 procent av den svenska befolkningen och som medför en lägre livskvalitet. Irritable bowel syndrome är en komplex sjukdom med en multifaktoriell etiologi där vanliga symtom är exempelvis magsmärtor, förstoppning och diarré. I vården blir personer med IBS ofta felaktigt bemötta och det finns ett ökat behov av kunskap hos sjuksköterskor kring IBS för att kunna erbjuda en god och personcentrerad vård. Syfte Syftet med litteraturöversikten var att beskriva vuxna personers erfarenhet att leva med irritable bowel syndrome. Metod En icke-systematisk litteraturöversikt valdes som metod för att besvara studiens syfte där 12 vetenskapliga artiklar av både kvantitativ och kvalitativ metodansats inkluderades. Sökningen av artiklar genomfördes i databaserna PubMed och CINAHL där valda artiklar kvalitetsgranskades i enlighet med Sophiahemmet Högskolas bedömningsunderlag. Resultatet sammanställdes genom en integrerad dataanalys. Resultat Två huvudkategorier framkom i resultatet; Utmaningar i det dagliga livet och Mötet med hälso- och sjukvården. Personer upplevde att IBS påverkade negativt den fysiska och psykiska hälsan, yrkes- och privatlivet samt att det fanns brister i sjukvården. Sjukdoms påverkan över det dagliga livet är dubbelriktad där psykosociala faktorer samspelar med symtomen. Personer som sökt vård för IBS besvär upplever att de inte får tillräckligt med stöd och att de inte blir tagna på allvar. Resultatet diskuterades sedan med stöd av Erikssons teori om lidande så kallad Caritativ vårdande. Slutsats Denna litteraturöversikt belyste vuxna personers erfarenheter av att leva med IBS. Resultatet påvisade att IBS har en komplex påverkan på personernas dagliga liv och brister i mötet med sjukvårdspersonal. Genom ökad kunskap kring detta skulle sjuksköterskor kunna arbeta mer personcentrerat för att kunna bemöta och stötta personer med IBS. / Background Irritable Bowel Syndrome (IBS) is a gastrointestinal disorder that affects approximately 18 percent of the Swedish population and leads to a lower quality of life. Irritable bowel syndrome is a complex disease with multifactorial etiology, where common symptoms include abdominal pain, constipation, and diarrhea. People with IBS are often wrongly treated in the healthcare system, where there is an increased need for knowledge among nurses about IBS in order to offer good and person-centered care.  Aim The aim of the literature review was to describe adults’ experiences of living with irritable bowel syndrome. Method  A non-systematic literature review was chosen as the method to answer the purpose of the study where 12 scientific articles with a quantitative and qualitative approach were included. The search for articles was carried out in the databases PubMed and CINAHL and selected articles were quality checked in accordance with Sophiahemmet University’s assessment document. The results were compiled through an integrated data analysis.  Results Two main categories emerged in the results: Challenges in their daily lives and The encounter with healthcare. People experienced that IBS negatively affected their physical and mental health, work and personal life, and that there were shortcomings in healthcare. The impact of the disease on daily life is bidirectional, where psychosocial factors interact with the symptoms. People seeking care for IBS problems often feel that they do not receive enough support and that they are not taken seriously. The result was discussed with the support of Eriksson´s theory about suffering, known as Caritative caring.   Conclusions This literature review emphasizes adult’s experiences of living with IBS. The results showed that IBS has a complex impact on a person’s daily life and can create challenges when interacting with healthcare professionals. By increasing knowledge about this, nurses could work more patient-centered in order to meet and support people with IBS.

Diss. Linköping : Linköpings universitet, 2005.

Este estudo teve por objetivo avaliar o hábito intestinal e os fatores de risco para incontinência anal (IA) em adultos da população geral, residentes na área urbana da cidade de Londrina - PR. Estudo epidemiológico de base populacional, de corte transversal, realizado após a aprovação do Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo. Dois mil cento e sessenta e dois indivíduos, com idade igual ou superior a 18 anos, condições físicas e mentais adequadas e que aceitaram a participar do estudo, compuseram a amostra, estabelecida a partir de amostragem estratificada por conglomerado, constituídos pelas ruas sorteadas aleatoriamente dentro dos 390 setores censitários do município. Todos os residentes nos domicílios das ruas sorteadas, que atenderam aos critérios de inclusão foram entrevistados utilizando-se dois instrumentos: Dados demográficos e o Hábito intestinal na comunidade (adaptado e validado para a língua portuguesa por Domansky e Santos, 2007). Os dados foram submetidos aos testes de Qui-Quadrado e Exato de Fischer. O predomínio foi do sexo feminino (1203 / 56%); média etária de 40,6±16,4; brancos (1591/74%); união estável (1290 / 60%); 9 a 12 anos de estudo (784/ 36%); 37% pessoas sem ocupação definida; 44% tinham remuneração entre 2 e 3,9 SM; 38% com renda per capita entre 0,6 a 1 salário mínimo. Para o padrão intestinal normal (1.875/87%; p<,0001), predominância de uma evacuação por dia (1.133/52%; p<0,0001), entre as mulheres (968/52%; p<0,0001); os brancos (1591/85%; p<0,0001), ausência de esforço evacuatório (1956/90%), exonerações de fezes macias (1379/64%), esvaziamento retal completo (1938/90%). Padrão intestinal constipado (261/12,1%), entre mulheres (219/84%), esforço evacuatório (99/41,8%), fezes endurecidas (176/67%); esvaziamento retal incompleto (99/38%). Padrão intestinal diarréico (26/1,2%), sem esforço evacuatório (26/100%) fezes líquidas e amolecidas (5/19%), esvaziamento retal completo (16/61%). A prevalência das doenças anorretais, foi de 53 (2%) abscessos, 22 (1%) fístulas, 81 (3%) fissuras, 20(1%) prolapsos retais, 30 (1%) traumas anais; 229 (11%) doença hemorroidária, 58 (3%) cirurgias anorretais, para todas o predomínio foi feminino. O histórico de parto e ginecológico: 886 (74%) tiveram partos, 709 (73%) com padrão intestinal normal; 432 (49%) entre 31 e 50 anos; 168 (14%) tiveram um parto normal; destas 33 (3%) tiveram laceração anal pós-parto que necessitou de intervenção cirúrgica; porém mantiveram o padrão intestinal normal (25/75%); 109 (9%) fizeram histerectomia (109 /9%), 90 (90%) padrão intestinal normal e menos de um por cento tiveram retocele e quatro (50%) eram constipadas. Os fatores de risco para incontinência anal: 35 (2%) radioterapia pélvica, 133 (6%) diabetes mellitus, 330 (15%) doenças ou distúrbios do sistema nervoso, 291 (13%) lesão na coluna espinhal e 29 (1%) relataram o acidente vascular encefálico (AVE), para todos os fatores houve predomínio do padrão intestinal normal, predomínio feminino para distúrbios do sistema nervoso e AVE. Este estudo permitiu conhecer o hábito intestinal da população geral de uma cidade no norte do Paraná, os fatores de risco para IA que estão expostos, cooperando para a elucidação do tema entre a população, ampliando os conhecimentos daqueles que atuam na área, e colaborando para o desenvolvimento de programas de prevenção ou diagnóstico precoce das doenças intestinais / The objective of this study was to evaluate the bowel habits and anal incontinence (AI) risk factors in adults living in the urban area of Londrina, PR, Brazil. This population-based, transversal epidemiological study was carried out after being approved by the University of São Paulo Nursing School Ethics Committee. Population sample established from a stratified sampling procedure by a conglomerate constituted of streets taken randomly from 390 county census sectors, included 2162 individuals , 18 years old and over, in adequate physical and mental conditions, who accepted to participate in the study. All residents in the selected streets who met the inclusion criteria established by the study were interviewed, using two instruments: Demographic data and the Bowel function in the community (adapted and validated for the Portuguese language by Domansky and Santos, 2007). Data were submitted to Chi-square and Fischer exact tests. There was a predominance of female subjects (1203/56%); ages 40,6 ± 16,4; white (1591/74%); with a stable relationship (1290/60%), with 9 to 12 years of formal education ( 784/36%), subjects without a defined job (37%) with salaries around 2 to 3,9 / minimum wage (44%) and per capita income between 0,6 to one/minimum wage (38%). As for normal intestinal pattern (1.875/87%; p<0,0001), there was the predominance of one bowel movement per day (1.133/52%; p<0,0001), among women (968/52%; p<0,0001); whites (1591/85%; p<0,0001), absence of defecation strain (1956/90%), soft feces (1379/64%), total rectal emptying (1938/90%). Constipated intestinal pattern (261/12,1%), among women (219/84%), defecation strain (99/41,8%), hard feces (176/67%); incomplete rectal emptying (99/38%). Diarrheic intestinal pattern (26/1,2%), no defecation strain (26/100%) liquid and soft feces (5/19%), total rectal emptying (16/61%). Prevalence of anorectal diseases was 53 (2%) abscesses, 22 (1%) fistules, 81 (3%) fissures, 20(1%) rectal prolapse, 30 (1%) anal traumas; 229 (11%) hemorrhoidal disease 58 (3%) ; anorectal surgeries, mainly among females. Gynecological and delivery history, 886 (74%) had deliveries, 709 (73%) with normal intestinal pattern; 432 (49%) between 31 and 50 years old; 168 (14%) had normal deliveries; 33 (3%) with postpartum laceration that needed surgical intervention; however, they maintained a normal intestinal pattern (25/75%); 109 (9%) had hysterectomy (109 /9%), 90 (90%) normal intestinal pattern and less than one percent had rectocele and four (50%) were constipated. Anal incontinence risk factors, 35 (2%) pelvic radiotherapy, 133 (6%) diabetes mellitus, 330 (15%) nervous systems diseases and dysfunctions, 291 (13%) spinal cord lesion and 29 (1%) reported having had an encephalic vascular stroke. In all factors there was the predominance of the normal intestinal pattern; however, females presented more nervous system dysfunctions and encephalic vascular strokes. This study reports on the bowel habits of a general population in a city in Northern Paraná, and the AI risk factors they are exposed to, bringing more information about the topic to the population and to those who work in the area , helping develop prevention programs or early diagnoses of intestinal diseases

<p>Denna uppsats behandlar den dolda folksjukdomen IBS och dess konsekvenser för individens sociala delaktighet. Syftet med studien är att studera individens upplevelse av delaktighet och erfarenhet av att leva med sjukdomen. IBS är en så kallad funktionell mag- och tarmsjukdom och står för Irritable Bowel Syndrome (Colon/Kolon irritabile), Irriterad tarm i svenskt tal och kännetecknas av återkommande eller kroniska symtom från mag- tarmkanalen. Medicinskt sett anses IBS vara en godartad sjukdom, men den kan vara besvärlig att leva med och ibland ge nästintill handlingsförlamande konsekvenser för individen och dennes sociala livsvärld. Forskarna vet inte orsaken bakom IBS och det finns inget medicinskt test som visar att det är IBS som en patient lider av, men man vet att individens sjukdomshistoria ofta är typisk och att sjukdomen är vanligast bland kvinnor. Av världens alla invånare lever det många människor med sjukdomen IBS, som kommit att bli en ny folksjukdom, då man beräknar att närmare 10-20 procent av den vuxna befolkningen har IBS. Individens upplevelse av vad som är normalt kontra avvikande när det gäller det friska och det sjuka visar en bild av hur samhället tycks vara skapat. Individens hälsotillstånd påverkar livskvaliteten och diagnosen bidrar till en förändrad identitet, och för varje individ som lever med IBS har begreppet delaktighet; att vara social med andra och i samhället i stort, fått en helt ny mening i och med deras sjukdom. <strong> </strong></p><p>Min förhoppning är att denna studie ska uppmärksamma läsaren kring den nya folksjukdomen IBS och hur den påverkar individens sociala liv.</p><p> </p> / <p>This essay deals with the new widespread disease IBS and its consequences for the social participation of the individual. The purpose of the study is to look at the experience of social participation of the individual and her experience of living with this disease. IBS is a so-called dynamic/functional belly- and intestinal disease, which stands for Irritable Bowel Syndrome, and is symbolized by recurrent or chronical symptom from the belly- and intestinal canal. From a medical view IBS is considered as a benign disease, but it can be tricky to live with and sometimes give heavy problems for the individual and its social life. The scientists doesn`t know what the cause is behind the disease and it doesn`t exist any medical test who can prove that a patient is suffering by IBS, but they do know that the case-history of the individual is very typical and that the disease is more common among women. From a social view studies show that the social life of the individual is strongly affected, and that the identity and how she look at normalcy/variation is no longer the same as it was when she was healthy. For every individual whos is living with this disease has also the concept of participation; to be social with other people and in society at large, got a whole new meaning as a result of their disease.</p>

<p>One of the main obstacles to maintaining patients with short bowel syndrome on parenteral nutrition, or successfully transplanting these patients with a small bowel graft, is the many severe infections that occur. Evidence is accumulating that translocating bacteria from the patient’s bowel causes a significant part of these infections. In this thesis bacterial translocation is studied in a Thiry-Vella loop of defunctionalised small bowel in the rat. </p><p>Bacterial translocation to the mesenteric lymph nodes (MLNs) occurs in almost 100% of the rats after three days. No systemic spread of bacteria is observed unless there is additional immunosupression with depletion of Kupffer cells in the liver. However, blocking the function of α/β T cells does not increase the translocation. Removal of MLNs does not either aggravate bacterial translocation in the Thiry-Vella loop model. Conversely, after small bowel transplantation translocating bacteria spread systemically if the MLNs are removed. </p><p>The Thiry-Vella loop should also be a suitable model for the testing of potentially translocation-inhibiting substances. Reinforcement of the intestinal barrier with glutamine or phosphatidylcholine proved insufficient in decreasing bacterial translocation. Even selective bowel decontamination with tobramycin failed to abolish bacterial translocation. Thus, it seems that the driving force for translocation in this model is strong regardless of the relatively small trauma of intestinal defunctionalisation.</p><p>Flow cytometric studies of the immune cells in the spleen MLNs showed a decrease in MHC class II positive T cells in the MLNs of the Thiry-Vella loop. Concurrently the number of macrophages increased with time as observed by immunohistochemistry. The fraction of MHC class II negative macrophages increased in the spleens of rats treated with glutamine. </p><p>In conclusion, the Thiry-Vella loop model offers possibilities of immunological as well as mechanistic studies on bacterial translocation from small intestine.</p>