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Butyric acid (butanoic acid) belongs to a group of short-chain fatty acids and is thought to play several beneficial roles in the gastrointestinal tract. Butyric anion is easily absorbed by enteric cells and used as a main source of energy. Moreover, butyric acid is an important regulator of colonocyte proliferation and apoptosis, gastrointestinal tract motility and bacterial microflora composition in addition to its involvement in many other processes including immunoregulation and anti-inflammatory activity. The pathogenesis of irritable bowel syndrome (IBS), the most commonly diagnosed functional gastrointestinal condition, is complex, and its precise mechanisms are still unclear. This article describes the potential benefits of butyric acid in IBS.
Przegląd Gastroenterologiczny 2013; 8 (6)
Review paper
Irritable bowel syndrome
Irritable bowel syndrome (IBS) is afunctional bow-
el disorder that generates asignificant health care
burden and is the most commonly diagnosed func-
tional gastrointestinal condition. Approximately 12%
of adults in the general population experience symp-
toms of IBS [1, 2]. Several definitions of IBS exist. Table
Ishows the most commonly used diagnostic criteria,
the so-called Rome III Criteria, for IBS in adults [3]. Ac-
cording to these criteria, IBS is classified into four sub-
types based on predominant stool patterns, as shown
in Table II. An American College of Gastroenterology
position statement published in 2009 defines IBS as an
abdominal pain or discomfort that occurs in associa-
tion with altered bowel habits over aperiod of at least
3 months [4]. The pathophysiological mechanisms of
IBS are still unknown. Brain–gut interactions, visceral
hypersensitivity, abnormal motility, intestinal inflam-
mation, post-infectious disturbances and alteration of
microflora have all been suspected to play arole in the
pathogenesis of this syndrome [5, 6]. Visceral hyper-
sensitivity is believed to be amajor contributing factor
to abdominal pain in patients with IBS. Psychosocial
factors seem to be also involved in the pathogenesis
of IBS [7].
Butyric acid in irritable bowel syndrome
Andrzej Załęski
, Aleksandra Banaszkiewicz
, Jarosław Walkowiak
Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Poland
Department of Paediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poland
Prz Gastroenterol 2013; 8 (6): 350–353
DOI: 10.5114/pg.2013.39917
Key words: butyric acid, sodium butyrate, irritable bowel syndrome.
Address for correspondence: Aleksandra Banaszkiewicz MD, PhD, Department of Paediatric Gastroenterology and Nutrition,
Medical University of Warsaw, 1 Działdowska St, 01-184 Warsaw, Poland, phone/fax: +48 22 452 33 10,
Butyric acid (butanoic acid) belongs to agroup of short-chain fatty acids and is thought to play several beneficial roles
in the gastrointestinal tract. Butyric anion is easily absorbed by enteric cells and used as amain source of energy. Moreover,
butyric acid is an important regulator of colonocyte proliferation and apoptosis, gastrointestinal tract motility and bacterial
microflora composition in addition to its involvement in many other processes including immunoregulation and anti-inflam-
matory activity. The pathogenesis of irritable bowel syndrome (IBS), the most commonly diagnosed functional gastrointestinal
condition, is complex, and its precise mechanisms are still unclear. This article describes the potential benefits of butyric
acid in IBS.
Irritable bowel syndrome
Because the pathogenesis of IBS is unclear, treat-
ment focuses on the relief of symptoms such as bloat-
ing, abdominal pain, diarrhoea and constipation. Treat-
ment difficulties are increased by the heterogeneity
of the IBS population (wide range of patient ages and
complaints, varying degrees of symptom severity), lack
of unequivocal treatment algorithms, and remarkably
high placebo response rate with short-term trials re-
porting response rates of 16–71.4% [8]. Therefore,
treatment strategies should be individualized with an
emphasis on developing agood doctor-patient rela-
tionship. The management of IBS consists of changes
in lifestyle, including eliminating high-gas foods such
as carbonated beverages, salads, raw fruits and veg-
etables (especially cabbage, broccoli and cauliflower),
and increasing physical activity. Ahigh-fibre diet, as
well as fibre supplements and osmotic laxatives that
increase stool frequency are recommended for consti-
pation-predominant IBS, while anti-diarrheal treatment
is recommended for diarrhoea-predominant IBS. More-
over, various medications, including anticholinergics, an-
tidepressants, antibiotics, simethicone and probiotics,
have all been used in the treatment of IBS. The vast
Przegląd Gastroenterologiczny 2013; 8 (6)
Butyric acid in irritable bowel syndrome
majority of these medications provide short-term relief,
but evidence for their long-term efficacy has not been
established. Evidence of the safety and tolerability of
these drugs is limited. For all of these reasons, there is
agreat need for new IBS therapies.
Butyrates in the treatment of irritable
bowel syndrome
Butyrates represent apotential new IBS therapy. To
date, afew trials have been performed to evaluate the
effectiveness of sodium butyrate on clinical symptoms
and quality of life in patients with IBS. Banasiewicz et
al. performed adouble-blind, randomized, placebo-con-
trolled study in which 66 adult patients with IBS re-
ceived microcapsulated butyric acid at adose of 300 mg
per day or placebo as an adjunct to standard therapy. At
four weeks, there was astatistically significant decrease
in the frequency of abdominal pain during defecation
in the butyric acid group (p = 0.0032). At 12 weeks, de-
creases in the frequency of spontaneous abdominal pain
(p = 0.0132), postprandial abdominal pain (p = 0.0031),
abdominal pain during defecation (p = 0.0002) and urge
after defecation (p = 0.0100) were observed [9, 10]. In
apreliminary report, Tarnowski et al. demonstrated an
improvement of abdominal pain, abdominal discom-
fort and defecation rhythm in patients with IBS treat-
ed with microcapsulated sodium butyrate for 6 weeks,
compared to those treated with placebo. In the same
study, higher quality of life was noted in patients treat-
ed with butyrate [11]. It is worth noting that no side
effects were observed during treatment with protected
sodium butyrate, which confirms the safety of its use in
clinical practice. Although the results of these two trials
seem to be promising, the effectiveness of butyrate in
the treatment of IBS needs to be confirmed. There is
also aneed for studies of the effectiveness of butyrate
in children and adolescents.
Butyric acid
Butyric, acetic and propionic acids account for ap-
proximately 83% of the short-chain fatty acids (SCFAs)
in the human colon [12].The concentration of these ac-
ids in the intestinal lumen ranges from 60 mmol/kg to
150 mmol/kg [13], and the acetate-propionate-butyrate
balance is relatively constant, with atypical ratio of 60
: 25 : 10 [14]. Short-chain fatty acids are rapidly ab-
sorbed by the epithelium of the gastrointestinal tract.
In the large bowel, absorption reaches peak levels in
the caecum and ascending colon by both active and
passive transport [15, 16]. Production levels of butyr-
ic acid in the sigmoid colon and the rectum are low.
Butyrate is the preferred energy source for colonic epi-
thelial cells [17]. Awell-balanced diet, rich in probiotics,
prebiotics and fibre, is the preferred source of butyrate.
Similarly to other SCFAs (acetic, propionic), endogenous
butyric acid is produced by the bacterial fermentation
of non-digestible carbohydrates and hexose oligomers
with varying degrees of polymerization, such as non-
starch polysaccharides, resistant starch, oligosaccha-
rides (inulin and oligofructose), disaccharides (lactose)
and sugar alcohols (sorbitol and mannitol) [13, 15]. Re-
sistant starch has been found to be particularly butyr-
ogenic. It occurs naturally in partially milled grains and
seeds, uncooked potatoes, green bananas and various
vegetables. The species of bacteria involved in the pro-
duction of butyrate are Clostridium spp., Eubacterium
spp., Fusobacterium spp., Butyrivibrio spp., Megasphaera
elsdenii, Mitsuokella multiacida, Roseburia intestinalis,
Faecalibacterium prausnitzii and Eubacterium hallii
[18]. Recently, an increased intake of highly processed,
low-fibre food products rich in simple sugars has been
observed, resulting in low levels of butyrate production
in the intestinal lumen. Therefore, butyrate supple-
mentation potentially represents agood alternative to
Table I. Diagnostic criteria* for irritable bowel syndrome
Recurrent abdominal pain or discomfort** at least 3 days per month in the last 3 months associated with 2 or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency of stools
3. Onset associated with a change in form (appearance) of stools
*Criteria fulfilled for the last 3 months with symptom/s onset at least 6 months prior to diagnosis
**Discomfort means an uncomfortable sensation not described as pain
In pathophysiology research and clinical trials, apain/discomfort frequency of at least 2 days aweek during screening evaluation for subject eligibility.
Table II. Subtyping IBS by predominant stool pattern
1. IBS with constipation (IBS-C) – hard or lumpy stools 25% and loose (mushy) or watery stools < 25% of bowel movements
2. IBS with diarrhoea (IBS-D) – loose (mushy) or watery stools 25% and hard or lumpy stool < 25% of bowel movements
3. Mixed IBS (IBS-M) – hard or lumpy stools 25% and loose (mushy) or watery stools 25% of bowel movement
4. Unsubtyped IBS – insufficient abnormality of stool consistency to meet criteria for IBS-C, D or M
Przegląd Gastroenterologiczny 2013; 8 (6)
Andrzej Załęski, Aleksandra Banaszkiewicz, Jarosław Walkowiak
dietary intake. Bird et al. documented an association
between increased consumption of resistant starch and
the amount of butyrate in faeces, and alack of associ-
ation with the incidence of diet-dependent disorders
Pure butyric acid has an extremely pungent smell,
which makes it very difficult to handle. It is quickly ab-
sorbed in the upper part of the gastrointestinal tract,
which reduces its positive effects in the colon. These
characteristics limit the clinical utility of pure butyric
acid. Recently, anew range of products has been de-
veloped, in which butyric acid is encapsulated in atri-
glyceride matrix, resulting in slow release during its
transport through the intestinal tract. Considering the
potential pathophysiological factors involved in the aeti-
ology of IBS, which include brain-intestine interactions,
visceral hypersensitivity, abnormal motility, intestinal in-
flammation, post-infectious disturbances and alteration
of microflora, in the next paragraph, we briefly summa-
rize the possible mechanisms of action of butyrate that
may be useful in the treatment of IBS.
Potential butyrate mechanisms
of action
Butyratedirectly influences the gastrointestinal
flora. The presence of butyrate-producing bacteria
species suppresses the growth of Escherichia coli,
Campylobacter spp., Salmonella spp. and Shigella spp.
[20]. Butyric acid may also play abeneficial role in
the treatment of gastrointestinal infections. In exper-
imental shigellosis, enteric supplementation of SCFAs
reduced congestion, infiltration of inflammatory cells,
and necrotizing features in the mucosa, which resulted
in areduced amount of faecal blood and mucus [21].
The efficacy of butyric acid in the prevention of water,
sodium, chlorine and potassium loss confirms observa-
tions made in animals with cholera [22]. The fact that
the passive absorption of water in the colon depends on
the presence of SCFAs may explain the potential role of
butyrate in clinical conditions involving diarrhoea [23].
The trophic effects of butyrate on intestinal cell pro-
liferation have been demonstrated in animal models.
Dietary supplementation with butyrate stimulated the
elongation of the villi in the ileum and crypt depth in
the caecum [24, 25]. Butyric acid has also been shown
to exert potent anti-inflammatory effects both in vitro
and in vivo. Its immunoregulatory and anti-inflammato-
ry activity is presumably based on the topical inhibition
of inflammatory mediators in the epithelium. The ability
of butyrate to decrease concentrations of pro-inflam-
matory cytokines such as interleukin 8 (IL-8) and tumor
necrosis factor-α (TNF-α) has been documented [26].
In mice, the intrarectal administration of butyric acid
during an acute phase of experimental colitis attenu-
ated intestinal inflammatory parameters [27]. Some
anti-inflammatory effects of butyrate in the treatment
of ulcerative colitis and radiation proctitis were also
observed [28, 29]. The precise mechanisms underlying
these effects have not been fully elucidated. The relief
of abdominal pain seems to be avery important aspect
of IBS treatment. Butyrate has aprobable beneficial in-
fluence on the hypersensitivity of intestinal receptors,
which results in adecrease of intraintestinal pressure. It
improves bowel peristalsis and retractility of the circular
muscle layer [9].
In summary, butyrate supplementation seems to be
apromising therapy for IBS. However, data on its effec-
tiveness are still very limited.
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Received: 2.11.2013
Accepted: 5.12.2013
... Propionic acid was reported to exert immunosuppressive actions, improve tissue insulin sensitivity, and lower fatty acids concentration in liver and plasma, thus, could be an important effector in obesity and type 2 diabetes management (Sa'ad, Peppelenbosch, Roelofsen, Vonk, & Venema, 2010). Butyric acid has been demonstrated to serve as an important colonocytes energy source and play pivotal roles in the prevention of inflammatory bowel diseases by regulating colonocyte proliferation and apoptosis, gastrointestinal tract motility and antiinflammatory activity (Załęski, Banaszkiewicz, & Walkowiak, 2013). ...
This study aimed to examine the effects of sugarcane polyphenol and fiber (Phytolin+Fiber) on gut microbiota, short-chain fatty acids (SCFAs) production and phenolic metabolites production using in vitro digestion and fermentation model. Microbial profiling by 16S rRNA sequencing was used to analyze the pig faecal microbiota profile. SCFAs were identified and quantified by GC-FID, and phenolic metabolites were characterized by LC-ESI-QTOF-MS/MS. The results showed that Phytolin+Fiber exert synergistic effects on the pig gut microbiota by increasing the relative abundances of Lactobacillus and Catenibacterium, and decreasing the relative abundances of Mogibacterium, Dialister, and Escherichia-Shigella. Phytolin+Fiber also significantly increased the total SCFAs production, particularly the propionic and butyric acids. Production of phenolic metabolites related to major polyphenols in Phytolin were tentatively identified. These results suggest that Phytolin+Fiber could be beneficial to human colon health given the similarities between pig and human intestine in terms of physiology and microbiome.
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The gut microbiota in the human body is an important component that plays a pivotal role in the ability of the host to prevent diseases and recover from these diseases. If the human microbiome changes for any reason, it affects the overall functioning of the host. Healthy and vigorous gut microbiota require dietary fiber supplementation. Recently, oligosaccharides have been found to play a significant role in the modulation of microbiota. Several such oligosaccharides, i.e., xylooligosaccharides (XOS), mannooligosaccharides (MOS), and arabino-xylooligosaccharides (AXOS), are derived from hemicellulosic macromolecules such as xylan, mannan, and arabino-xylan, respectively. These oligosaccharides serve as substrates for the probiotic production of health-promoting substances (short-chain fatty acids, branched chain amino acids etc.), which confer a variety of health benefits, including the prevention of some dreaded diseases. Among hemicellulose-derived oligosaccharides (HDOs), XOS have been largely explored, whereas, studies on MOS and AXOS are currently underway. HDOs, upon ingestion, help reduce morbidities by lowering populations of harmful or pathogenic bacteria. The ATP-binding cassette (ABC) transporters are mainly utilized for the uptake of oligosaccharides in probiotics. Butyrate generated by the selective fermentation of oligosaccharides, along with other short-chain fatty acids, reduces gut inflammation. Overall, oligosaccharides derived from hemicelluloses show a similar potential as conventional prebiotics and can be supplemented as functional foods. This review summarizes the role of HDOs in the alleviation of autoimmune diseases (inflammatory bowel disease, Crohn's disease), diabetes, urinary tract infection, cardiovascular diseases, and antimicrobial resistance (AMR) through the modulation of the gut microbiota. The mechanism of oligosaccharide utilization and disease mitigation is also explained.
... This increase could be explained by the increased levels of butyrateproducing Eubacterium and Lactobacillus spp. 15,[65][66][67] Butyrate is an important source of energy for colonic epithelial cells, and it affects the immune response, modulates the oxidative stress of the host, and decreases intestinal-cell permeability and intestinal motility. 61,64 Moreover, butyrate modulates colonic hypersensitivity, and treatment with butyrate reduces abdominal pain in patients with IBS. ...
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Background Irritable bowel syndrome (IBS) is a common gastrointestinal functional disorder. Although IBS is a benign condition, it reduces the quality of life considerably. While there is currently no effective treatment for this disorder, fecal microbiota transplantation (FMT) seems to be promising. Purpose The aim of this review was to analysis possible factors affecting the success or failure of the randomized controlled trials (RCTs) of FMT for IBS and highlighting the gaps in our knowledge that need to be filled and of sketching a possible model for successful FMT in IBS patients. Methods A systematic search was conducted of literature published in English from January 2015 to December 2020 using the keywords: fecal microbiota transplantation, randomized trials, and IBS. Key Results Seven randomized controlled trials (RCTs) on the efficacy of FMT for IBS were found in the literature. Four of the seven RCTs found various positive effects, while the other three did not find any effect. Conclusions and Inferences The efficacy of FMT for IBS appears to be donor-dependent. The effective (super) donor would need to have a favorable microbiota signature, and 11 clinical criteria that are known to be associated with a favorable microbiota have been suggested for selecting FMT donors for IBS. Comparing the microbiota of the effective donors with those of healthy subjects would reveal the favorable microbiota signature required for a super-donor. However, the studies reviewed were not designed to compare efficacy of different donor types. The dose of the fecal transplant is also an important factor influencing the outcome of FMT for IBS. However, further studies designed to test the effect of fecal transplant dose are needed to answer this question. Administering the fecal transplant to either the small or large intestine seems to be effective, but the optimal route of administration remains to be determined. Moreover, whether single or repeated FMT is more effective is also still unclear. A 1-year follow-up of IBS patients who received FMT showed that adverse events of abdominal pain, diarrhea, and constipation were both mild and self-limiting.
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Although the first observations of gastrointestinal symptoms associated with morphological lesions were made by Sir William Osler as early as 1892, the last decade was when the research on aetiology of irritable bowel syndrome (IBS) emerged. Especially the infective background deserves attention. Intestinal pathogens such as Enterobacteriaceae are known to provoke enterochromaffin cells' hyperplasia, leading to production of excess amounts of serotonin, and diarrhoea, the most common symptom of IBS, then follows. Especially people with SERT gene mutations are at risk. Patients with IBS undergo laborious diagnostic workup in order to exclude cancer, especially of the gastrointestinal tract. Treatment consists of well established modalities (diet, pharmacotherapy), and one should not forget antimicrobial prophylaxis during travels to areas with poor hygiene levels.
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Butyric acid, a short-chain fatty acid and one of the main metabolites of intestinal microbial fermentation of dietary fiber, has been shown to have an important role in maintaining the integrity of the intestinal mucosa, while it also has been shown to exert potent anti-inflammatory effects both in vitro and in vivo. However, the precise mechanisms underlying those effects have not been fully identified. We exposed colonic epithelial cells to butyric acid, then extracted total RNA samples, and subsequently hybridized them to microarray chips. Among the upregulated genes, milk fat globule-epidermal growth factor 8 (MFG-E8) was elevated by approximately fivefold. We previously reported that the potential therapeutic benefits of MFG-E8 in intestinal tissue injury were dependent not only on enhanced clearance of apoptotic cells but also required diverse cellular events for maintaining epithelial integrity. The influence of butyric acid on cell function is often attributed to its inhibition of histone deacetylases (HDACs). We found that acetylation on histone 3 lysine 9 (acetyl-H3K9) around the MFG-E8 promoter was significantly increased with butyric acid exposure. Experimental colitis was induced by administration of dextran sodium sulfate (DSS) in C57BL/6N (MFG-E8(+/+)) and MFG-E8(-/-) mice. Although the colonic bacterial compositions in wild-type (WT) and MFG-E8(-/-) mice were not significantly different, intrarectal administration of butyric acid during an acute phase of colitis attenuated intestinal inflammatory parameters and inhibited body weight loss in the WT mice. Our novel findings suggest that butyric acid has significant anti-inflammatory effects partly via MFG-E8 on DSS-induced murine experimental colitis.Laboratory Investigation advance online publication, 10 June 2013; doi:10.1038/labinvest.2013.70; published online 10 June 2013.
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16S rRNA-targeted oligonucleotide probes were designed for butyrate-producing bacteria from human feces. Three new cluster-specific probes detected bacteria related to Roseburia intestinalis, Faecalibacterium prausnitzii, and Eubacterium hallii at mean populations of 2.3, 3.8, and 0.6%, respectively, in samples from 10 individuals. Additional species-level probes accounted for no more than 1%, with a mean of 7.7%, of the total human fecal microbiota identified as butyrate producers in this study. Bacteria related to E. hallii and the genera Roseburia and Faecalibacterium are therefore among the most abundant known butyrate-producing bacteria in human feces
Introduction: Both the irritable bowel syndrome (IBS) and celiac disease (CD) are diseases whose incidence has increased significantly over the past several decades. Growing body of evidence suggests that in some IBS patients, the undiagnosed celiac disease can be the cause of their symptoms. Aim: To determine the prevalence of gluten intolerance and celiac disease types in patients with irritable bowel syndrome. Material and methods: The study was conducted among gastroenterological surgery patients with irritable bowel syndrome diagnosed based on Rome II criteria treated in the Gastroenterology Clinic of Regional Brodnowski Hospital in Warsaw. One hundred and fifty IBS subjects were randomly selected for serological tests - in each patient, serum IgA autoantibodies against tissue transglutaminase (anti-tTG) and gliadin (AGAs) concentration were determined. These tests were also performed among 50 healthy subjects who served as the control group. In 20 patients with positive serological tests results for celiac disease the duodenoscopy with duodenal mucosa biopsy was performed. Results: The incidence of positive serological test results for celiac disease was significantly higher in IBS patients compared to healthy control (32 vs. 0, p < 0.001). Duodenal mucosa histology in all patients who agreed to duodenoscopy (n = 20) was normal. Conclusions: In IBS patients, gluten intolerance occurs significantly more often than in the general population, so it is advisable to perform serological tests for celiac disease in these patients. The most common celiac disease form in persons with IBS is the latent.
Small intestinal bacterial overgrowth syndrome (SIBO) is defined as an increase in the number and/or changes of the type of bacteria in the small intestine. There are similarities of some symptoms between SIBO and irritable bowel syndrome (IBS). SIBO is also frequently found in patients with IBS and we can observe an improvement after the therapy with some kind of antibiotics in persons with IBS. Some researchers created the bacterial overgrowth hypothesis of IBS. According to this hypothesis SIBO is the primary condition and the symptoms of IBS are secondary. This hypothesis would explain many elements of IBS. Opponents of this hypothesis think that IBS is a primary factor and IBS creates good conditions for proliferation of bacteria and lead to bacterial overgrowth. This article presents the hypothesis and results of re search about SIBO and IBS. Relations between SIBO and IBS are unclear and further studies are needed.
Introduction: There are no published data on the prevalence of common gastrointestinal disorders such as dyspepsia, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), constipation and bloating in the Polish population. Aim: The aim of this study was to determine the prevalence of these most common abdominal symptoms. Material and methods: The study involved a population sample aged 21 years or older from a medium-sized city. A total of 850 people (age range: 21-76 years) were interviewed. Demographic and anthropometric data, symptoms specific to dyspepsia, GERD, constipation, diarrhoea, bloating, IBS, as well as nutritional habits, alcohol and tobacco use, and presence of concomitant diseases were studied in a face-to-face interview. Results: Approximately 23% of participants suffered from dyspepsia, 36% had GERD, constipation was present in 13% of participants, and bloating in 31%. Only 7 participants reported chronic diarrhoea and 13% of participants had IBS symptoms. All the above-mentioned complaints were slightly more common in diabetic patients, but the difference was not significant. Conclusions: The prevalence of gastrointestinal symptoms in the Polish population is high, and similar to the rates reported by investigators from other countries.
PURPOSE: Short chain fatty acids are the main energy source of coloncytes and their use may be impaired in chronic radiation proctitis. The aim of the present study was to evaluate the therapeutic effect of short chain fatty acid enemas in patients with chronic radiation proctitis. METHODS: A prospective, randomized, double-blind trial comparing short chain fatty acid enemas with placebo was conducted in 19 patients with chronic radiation proctitis. Short chain fatty acid enemas contained 60 mM sodium acetate, 30 mM sodium propionate, and 40 mM sodium butyrate. The treatment period lasted five weeks and patients were followed up for six months. RESULTS: On admission, both groups were similar regarding all parameters evaluated. After five weeks short chain fatty acid-treated patients showed a significant decrease in the number of days with rectal bleeding from the previous week (4.41.8 to 1.42.2;P=0.001) and an improvement of endoscopic score (4.81.4 to 2.21.2;P=0.001). Hemoglobin values were also significantly higher in short chain fatty acid-treated patients (13.10.9 g/dlvs. 10.72.1 g/dl;P=0.02). Mucosal DNA and protein concentrations decreased in both groups but significantly so only in placebotreated patients (P=0.05). Changes in histologic parameters were not significant in either group. Although short chain fatty acid-treated patients did not get worse in the next six months, placebo-treated ones gradually improved, and at the end of six months, differences between the two groups were no longer observed. CONCLUSIONS: Short chain fatty acid enemas can accelerate the process of healing in chronic radiation proctitis, but treatment has to be continuous if a complete and sustained clinical, endoscopic, and histologic response is to be obtained.
The metabolic end products of the large bowel microbiota contribute significantly to human health. After weaning to solid foods, some of the most important of these are the short chain fatty acids (SCFA) produced by the fermentation of undigested dietary components and endogenous secretions. The main SCFA are acetate, propionate and butyrate which have numerous documented effects promoting large bowel function. Of the major acids, butyrate seems especially important. It is a major metabolic fuel for colonocytes and promotes a normal phenotype in these cells, potentially lowering the risk of diseases such as colo-rectal cancer. Imbalances in the microbiota are thought to predispose to large bowel dysfunction and probiotics are being developed to correct this. However, most commercial products contain bacteria (lactobacilli and bifidobacteria) which are dominant species in milk-fed infants but have limited roles in adults. Prebiosis is defined usually by the specific stimulation of these bacteria. However, the end products of most probiotics do not include butyrate or propionate which raises questions about their effectiveness in promoting bowel health in adults. Resistant starch (RS) is a dietary fibre component and its fermentation generally favours butyrate production. Dietary RS intakes and faecal butyrate levels are high in populations at low risk of diet-related large bowel diseases. Conversely, RS intakes and faecal butyrate levels are very low in high risk groups. This raises the possibility that greater RS consumption could be of health benefit. RS is not regarded widely as a prebiotic but (according to the accepted definition) most forms show the requisite features in stimulating specific bacteria, giving raised total SCFA and butyrate levels and a consequent benefit to the host. Current efforts to improve public health through increasing RS consumption could be facilitated by greater recognition of its prebiotic role.