UEG Week Virtual 2021 Congress Review - 10

Scientific Programme Highlights
Xyloglucan and pea protein
improve markers of gut
function in animal model
of abdominal pain and
distension
A plant-based preparation containing
xyloglucan (derived from tamarind tree seeds)
and pea protein (XP) significantly decreased
intestinal permeability and improved markers
of gut barrier integrity in a murine model of
abdominal pain and distention. Researchers
from Messina University in Italy used SpragueDawley
rats that were subjected to partial
restraint stress to assess viscerosomatic
responses after colonic distention. Gut barrier
function was assessed using a lactulose/
mannitol test. The aim of the study was to
investigate whether XP could potentially
restore intestinal barrier function in order
to prevent stress-induced abdominal
distention and visceral hypersensitivity - key
factors involved in the etiology of functional
gastrointestinal disorders such as functional
abdominal bloating and distension (FABD).
Pre-treatment with XP twice-daily for 5
days prevented stress-induced visceral
hypersensitivity, significantly reducing
the number of stress-induced abdominal
contractions in response to colonic distention
compared with vehicle. XP also restored the
expression of multiple tight junction proteins,
including claudin-1, occludin, and E-cadherin,
in both the small and large intestine, thereby
potentially stabilising or improving intestinal
barrier integrity. The lactulose/mannitol ratio
was significantly reduced after XP treatment
compared with vehicle, suggesting restoration
of normal intestinal permeability in the
stressed rats.
" This compound represents a novel
therapeutic strategy for FABD that should be
further explored in patients to improve the
quality of life, " concluded Michela Campolo,
who presented the study findings.
UDCA prophylaxis prevents symptomatic
gallstone disease after bariatric surgery
Prophylactic use of ursodeoxycholic acid (UDCA) for 6 months
significantly reduces the risk of symptomatic gallstone disease
in bariatric surgery patients who do not have gallstones prior
to surgery. Patients who have asymptomatic gallstones at the
time of surgery do not benefit from UDCA prophylaxis.
A multicentre, randomised, double-blind study (UPGRADE) enrolled 985
patients with an intact gallbladder who were scheduled for laparoscopic Rouxen-Y
gastric bypass (RYGB) or sleeve gastrectomy, and randomised patients
to received UDCA 900 mg daily for 6 months (n=492) or placebo (n=493).
Randomisation was stratified by the presence of asymptomatic gallstones at
baseline (assessed by ultrasound) and type of surgery. The primary endpoint
was symptomatic gallstone disease, which was defined as biliary disease
requiring a hospital visit or admission, within 24 months of surgery. Analyses
were performed on the modified intention-to-treat (mITT) population, which
included patients with no protocol violation in eligibility and at least one postrandomisation
measurement.
At baseline, the mean age of the mITT population was 45 ± 11 years, 80% of the
population were women, and the mean BMI was 116 ± 18 kg. Asymptomatic
gallstones were observed in 20% of patients at baseline, and 92% of the patients
received a RYGB procedure. Symptomatic gallstone disease developed in 31/475
(6.5%) patients who received UDCA and in 47/484 (9.7%) patients who received
placebo (relative risk [RR]: 0.67; 95% CI: 0.44-1.04; p=0.07) within 24 months.
A prespecified logistic regression analysis revealed a significant interaction
between UDCA and the presence of asymptomatic gallstones at baseline. In
patients without gallstones at baseline, UDCA significantly reduced the risk of
developing symptomatic gallstones after bariatric surgery (odds ratio: 0.45; 95%
CI: 0.24-0.82); p=0.01). In this subgroup of patients, 16/381 (4.2%) of those who
received UDCA developed symptomatic gallstones within 24 months compared
with 35/392 (8.9%) of those who received placebo (RR: 0.47; 95% CI: 0.27-0.84;
p=0.008), yielding a relative risk reduction of 53% and a number needed to treat
(NNT) of 21. UDCA was well tolerated, and side effects were rare.
" Based on the number needed to treat of 21, we consider the use of UDCA
desirable in patients without gallstones at baseline, " said investigator, Sylke
Haal, from the University of Amsterdam in the Netherlands. She concluded
that, based on the results of this study, UDCA does reduce the occurrence
of symptomatic gallstone disease after bariatric surgery, but only in (RYGB)
patients without gallstones prior to surgery.
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10

https://www.ueg.eu/library/evaluating-the-efficacy-of-xyloglucan-and-pea-protein-on-a-murine-model-of-abdominal-pain-and-distension/248072 https://www.ueg.eu/library/ursodeoxycholic-acid-for-the-prevention-of-symptomatic-gallstone-disease-after-bariatric-surgery-a-multicentre-double-blind-randomised-placebo-controlled-superiority-trial/248417 https://virtualweek.ueg.eu/exhibition/dashboard#/missed_a_session

UEG Week Virtual 2021 Congress Review

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