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[Efficacy of pectin in the treatment of diarrhea predominant irritable bowel syndrome]

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[Efficacy of pectin in the treatment of diarrhea predominant irritable bowel syndrome]

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Abstract

To evaluate the efficacy of pectin, a kind of soluble dietary fiber, in diarrhea predominant irritable bowel syndrome(IBS-D). A total of 87 patients with IBS-D were selected in the Jinling Hospital between July 2011 and December 2013. Using a randomized, controlled trial, the efficacy of pectin for IBS-D was prospectively evaluated. Subjects were randomly assigned to receive 24 g pectin powder/d (n=46) or a placebo (n=41). Before and after 6 weeks of treatment, colonic microflora was examined by real-time PCR and compared between groups. Changes in stool frequency and form (Bristol stool scale), composite score of symptoms (Likert scale) and QOL scores (IBS-QOL questionnaire) were also monitored. Peripheral blood sample from patients with IBS-D was obtained to estimate the cytokines level, which was compared with that obtained from a group of age- and sex-matched healthy volunteers (n=20). Those patients randomized to pectin experienced a greater reduction in composite symptom scores and Bristol stool scale scores, as well as significant improvement in QOL scores (P<0.05). The pectin acted as prebiotics and significantly enhanced faecal bifidobacteria and decreased total Clostridium sp (P<0.05). At baseline, patients with IBS-D demonstrated an abnormal IL-10/IL-12 ratio, which was normalized by pectin feeding alone (P<0.01). Placebo did not exert these effects on the aforementioned parameters after treatment. No significant adverse effects were reported during the study. Pectin acts as a prebiotic in specifically stimulating gut bifidobacteria in IBS-D patients and is effective in alleviating clinical symptoms, balancing colonic microflora and relieving systemic inflammation. In view of its ability to re-establish a healthy gut ecosystem, pectin has the potential of being a therapeutic agent in IBS-D.

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... These consisted of 7 studies of ITF, 2 studies of β-galactooligosaccharides, and 1 study each of partially hydrolyzed guar gum and pectin powder. Of the studies, 10 were published in English and 1 in Chinese, which was then translated to English (29). There were 10 studies that were full articles, the other being in abstract form only (30). ...
... A range of integrative symptom scores [subjective global assessment, IBS severity scoring system (IBS-SSS), visual analog scales and Likert scales] were measured in 8 studies, and sufficient data were reported in 7 studies involving 538 patients (21,29,31,32,34,36,38). Prebiotics did not result in a significant difference in integrative symptom scores compared with placebo (Figure 2). ...
... The severity of individual gastrointestinal symptoms was reported as follows: abdominal pain in 10 studies, with sufficient data reported in 9 studies (628 patients) (21, 29-32, 34, 36-38); bloating in 9 studies, with sufficient data reported in 8 studies (551 patients) (21,29,30,32,34,(36)(37)(38); and flatulence in 7 studies, with sufficient data reported in 6 studies (374 patients) (21,32,34,36,38). Heterogeneity was high, and an outlier was identified for abdominal pain, bloating, and flatulence (34), so analysis with ( Figure 2) and without this outlier was performed (Supplemental Figure 1). ...
Article
Background: Irritable bowel syndrome (IBS) and other functional bowel disorders (FBDs) are prevalent disorders with altered microbiota. Prebiotics positively augment gut microbiota and may offer therapeutic potential. Objectives: The aim of this study was to investigate the effect of prebiotics compared with placebo on global response, gastrointestinal symptoms, quality of life (QoL), and gut microbiota, via systematic review and meta-analysis of randomized controlled trials (RCTs) in adults with IBS and other FBDs. Methods: Studies were identified using electronic databases, back-searching reference lists, and hand-searching abstracts. RCTs that compared prebiotics to placebo in adults with IBS or other FBDs were included. Two reviewers independently performed screening, data extraction, and bias assessment. Outcome data were synthesized as ORs, weighted mean differences (WMDs) or standardized mean differences (SMDs) with the use of a random-effects model. Subanalyses were performed for type of FBD and dose, type, and duration of prebiotic. Results: Searches identified 2332 records, and 11 RCTs were eligible (729 patients). The numbers responding were 52/97 (54%) for prebiotic and 59/94 (63%) for placebo, with no difference between groups (OR: 0.62; 95% CI: 0.07, 5.69; P = 0.67). Similarly, no differences were found for severity of abdominal pain, bloating and flatulence, and QoL score between prebiotics and placebo. However, flatulence severity was improved by prebiotics at doses ≤6 g/d (SMD: -0.35; 95% CI: -0.71, 0.00; P = 0.05) and by non-inulin-type fructan prebiotics (SMD: -0.34; 95% CI: -0.66, -0.01; P = 0.04), while inulin-type fructans worsened flatulence (SMD: 0.85; 95% CI: 0.23, 1.47; P = 0.007). Prebiotics increased absolute abundance of bifidobacteria (WMD: 1.16 log10 copies of the 16S ribosomal RNA gene; 95% CI: 0.06, 2.26; P = 0.04). No studies were at low risk of bias across all bias categories. Conclusions: Prebiotics do not improve gastrointestinal symptoms or QoL in patients with IBS or other FBDs, but they do increase bifidobacteria. Variations in prebiotic type and dose impacted symptom improvement or exacerbation. This review was registered at PROSPERO as CRD42017074072.
... A recent study using a mixture of dried powdered slippery elm bark, lactulose, oat bran, and licorice root (C-IBS formula) significantly improved both bowel habit and IBS symptoms in patients with constipation predominant IBS [19]. Pectin, a nonfermentable, gel-forming fiber, has a bulking and prebiotic effect and has been shown to improve IBS symptoms [20] similarly to psyllium and guar gum [21][22][23][24]. Guar gum increased Lactobacillus and Bifidobacterium in IBS patients and improved quality of life (QoL) in IBS patients [25]. ...
... Our findings are consistent with the literature, whereby herbs and nutrients in the NC Gut Relief Formula, including curcumin, Aloe vera, slippery elm, guar gum, pectin, peppermint oil, and glutamine, have shown beneficial effects for the GI tract when taken individually [12,14,[18][19][20][21][22][23][24]26,27,46]. Our study is the first to investigate the combination of these herbs and nutrients on the GI system. ...
Article
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Gastrointestinal (GI) problems affect half of Western populations. Symptoms can vary from frequent reflux to irritable bowel syndrome. The Nutrition Care (NC) Gut Relief Formula contains a combination of herbs and nutrients including curcumin, Aloe vera, slippery elm, guar gum, pectin, peppermint oil, and glutamine shown to benefit the GI system. The 16-week pre-post study tested the hypothesis that the NC Gut Relief Formula would be tolerable and effective in improving GI symptoms and gut health in adults with digestive disorders. A total of 43 participants completed the study. After a control phase, participants took 5 g/d and then 10 g/d of the formula for 4 weeks. GI symptoms and GI health were assessed by a series of validated questionnaires, for example, Leeds Dyspepsia Questionnaire, Bristol Stool Chart, Birmingham IBS Symptom Questionnaire, and by intestinal permeability and gut microbiota profile. The NC Gut Relief Formula significantly improved the frequency and severity of upper and lower GI symptoms by 60%-80%, including indigestion, heartburn, nausea, constipation or diarrhea, abdominal pain, and troublesome flatulence, and significantly improved physical functioning, energy levels, mood, and sleep by 60%-80%. All participants with normal stool, 90% with hard stool, and 66% with soft stool recovered from intestinal permeability, evident by normal lactulose to mannitol ratios. The NC Gut Relief Formula generally improved microbial profile, with a marked increase in Lactobacillus, Clostridium, and Faecalibacterium prausnitzii. Almost half of the participants with upper GI symptoms taking proton pump inhibitors for heartburn no longer required proton pump inhibitors at the end of the study. A third of participants were able to reintroduce food triggers, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols garlic, onion, and beans, or reflux-causing acidic/spicy foods, for example, citrus, tomato, and caffeine, in their diet after 3 months without symptom aggravation. The NC Gut Relief Formula significantly improved GI symptoms and associated quality of life over 3 months while reducing intestinal permeability, improving the microbial profile, reducing the need for reflux medication, and enabling the consumption of previous food triggers.
... 55 Furthermore, pectin as a prebiotic was effective in relieving systemic inflammation via Table I normalization of the abnormal IL-10/IL-12 ratio among patients with IBS-D. 56 Thus, evidence from clinical trials shows that pro-and prebiotics help in immunomodulation via increasing the level of IL-10, which alleviates systemic inflammation, improves symptoms of IBS, and maintains gut flora. 56 Probiotics may also be used as a vehicle for delivering antiinflammatory cytokine (IL-10) in several inflammatory diseases. ...
... 56 Thus, evidence from clinical trials shows that pro-and prebiotics help in immunomodulation via increasing the level of IL-10, which alleviates systemic inflammation, improves symptoms of IBS, and maintains gut flora. 56 Probiotics may also be used as a vehicle for delivering antiinflammatory cytokine (IL-10) in several inflammatory diseases. 53,57 Lactic acid bacteria have been used for eliciting both systemic and mucosal immune responses. ...
Article
Purpose: Pro- and antiinflammatory cytokines are important modulators of the immune response and play a major role in conditions of intestinal inflammation, such as irritable bowel syndrome (IBS). Cytokine production is regulated genetically, and imbalances in cytokine secretion may affect disease susceptibility and clinical outcomes of various conditions. There is a rapidly growing body of evidence to support an etiologic role for gastrointestinal infection and the associated immune activation in the development of postinfectious IBS. Other factors such as psychological stress, anxiety, and depression may likely be involved in the altered profiles of pro- and antiinflammatory cytokines that lead to chronic IBS. Methods: We searched the literature using PubMed, MEDLINE, and Google Scholar with related key terms and prepared this review article on that basis. Findings: Interleukin (IL)-10 is a regulatory cytokine that inhibits both antigen presentation and the release of proinflammatory cytokines. Therefore, it is proposed as a potent antiinflammatory biological therapy for IBS. Implications: Recently, a strong interest in the therapeutic potential of IL-10 for IBS has developed. The diverse roles of IL-10 in IBS are reviewed here. We conducted an in-depth review on IL-10 and IBS to address this question. Future studies of IL-10 may provide new insights into IBS therapy.
... Sachets (4 g inulin or maltodextrin/sachet); x 3/day for 4 weeks A significant increase of stool frequency was documented, which was accompanied by a softening of stool consistency, which had a positive impact on the quality of life, primarily increasing the satisfaction [115] Irritable bowel syndrome (IBS) Short-chain fructo-oligosaccharide Powder; 5 g/day for 4 weeks Rectal discomfort threshold and IBS and quality of life scores were significantly improved [116] Pectin powder Powder; 26 g/day for 6 weeks Pectin acts as a prebiotic in specifically stimulating gut bifidobacteria in IBS-diarrhea patients and is effective in alleviating clinical symptoms, balancing colonic microflora, and relieving systemic inflammation. In view of its ability to re-establish a healthy gut ecosystem, pectin has the potential of being a therapeutic agent in IBS-diarrhea [117] L. acidophilus La-5 ® and Bifidobacterium BB-12 ® and Beneo dietary fibres ...
Article
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It is known and accepted that the gut microbiota composition of an organism has an impact on its health. Many studies deal with this topic, the majority discussing gastrointestinal health. Adenomatous colon polyps have a high prevalence as colon cancer precursors, but in many cases, they are hard to diagnose in their early stages. Gut microbiota composition correlated with the presence of adenomatous colon polyps may be a noninvasive and efficient tool for diagnosis with a high impact on human wellbeing and favorable health care costs. This review is meant to analyze the gut microbiota correlated with the presence of adenomatous colon polyps as the first step for early diagnosis, prophylaxis, and treatment.
... Although short chain highly fermentable prebiotic supplements should be restricted to avoid the risk of a rapid increase in gas, bloating/distension, and abdominal pain/discomfort, the consumption of long-chain or complex, soluble and more slowly fermentable, butyrate producing fibers, such as fruit pectin may have a role in helping to control IBS symptoms [71,72]. A Chinese RCT (IBS diarrhea) found that pectin significantly increased Bifidobacteria, decreased total Clostridium sp (p < 0.05), reduced IBS symptoms, normalized cytokine levels, and improved Bristol stool scale score and quality of life assessments [73]. Another RCT (IBS-constipation) showed that 2 kiwi fruit/day significantly shortened colon transit time, increased defecation frequency and improved overall bowel function [74]. ...
Article
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Less than 10% of most Western populations consume adequate levels of whole fruits and dietary fiber with typical intake being about half of the recommended levels. Evidence of the beneficial health effects of consuming adequate levels of whole fruits has been steadily growing, especially regarding their bioactive fiber prebiotic effects and role in improved weight control, wellness and healthy aging. The primary aim of this narrative review article is to examine the increasing number of health benefits which are associated with the adequate intake of whole fruits, especially fruit fiber, throughout the human lifecycle. These potential health benefits include: protecting colonic gastrointestinal health (e.g., constipation, irritable bowel syndrome, inflammatory bowel diseases, and diverticular disease); promoting long-term weight management; reducing risk of cardiovascular disease, type 2 diabetes and metabolic syndrome; defending against colorectal and lung cancers; improving odds of successful aging; reducing the severity of asthma and chronic obstructive pulmonary disease; enhancing psychological well-being and lowering the risk of depression; contributing to higher bone mineral density in children and adults; reducing risk of seborrheic dermatitis; and helping to attenuate autism spectrum disorder severity. Low whole fruit intake represents a potentially more serious global population health threat than previously recognized, especially in light of the emerging research on whole fruit and fruit fiber health benefits.
... With the increasing popularity of TCM formulas serving as IBS therapies, TCM formulas are demanded at a high degree of scrutiny that is similar to the standard of Western medicine. Recently, more and more well-designed RCTs have been carried out to prove the effectiveness of TCM formulas as therapies of IBS (Leung et al., 2006;Wang et al., 2006a,b;Liang et al., 2009;Chen et al., 2010;Zhang et al., 2010;Hua, 2013;Huang and Li, 2013;Li and Jiang, 2013;Peng et al., 2013;Wang et al., 2013). As shown in Fig. 1, we searched EMBASE, Ovid MEDLINE (R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE (R), CJA Full-Text Database, and Chongqing VIP Database, covering the period from 1998 to September 2013, and included RCTs evaluating TCM formulas for the treatment of adults diagnosed with IBS according to Rome II or Rome III criteria, published in any language, as either full articles or abstracts. ...
Article
Full-text available
Traditional Chinese Medicine (TCM) serves as the most common alternative therapeutic approach for Western medicine and benefits IBS patients globally. Due to the lack of scientific evidence in the past, TCM formulas were not internationally well recognized as promising IBS remedies. In this review, firstly, we present the etiology and therapy of IBS in terms of traditional Chinese medical theory. Secondly, we summarize the clinical randomized controlled trials (RCTs) of TCM formulas for IBS patients that are available in the literature (from 1998 to September 2013), in which 14 RCTs conducted of high quality were discussed in detail. Of the 14 selected trials, 12 of those concluded that TCM formulas provided superior improvement in the global symptoms of IBS patients over the placebo or conventional medicines. As well, all 14 RCTs suggested that TCM formulas have good safety and tolerability. Last but not least, we explore the pharmacological mechanisms of the anti-IBS TCM formulas available in the literature (from 1994 to September, 2013). Collectively, in combating IBS symptoms, most TCM formulas exert multi-targeting actions including the regulation of neurotransmitters and hormones in the enteric nervous system (ENS), modulation of smooth muscle motility in the gastrointestinal (GI) tract, modulation of the hypothalamic-pituitary-adrenal (HPA) axis, attenuation of intestinal inflammation and restoration of intestinal flora, etc. In conclusion, TCM formulas appear to be promising for IBS treatment. This review provides a useful reference for the public in furthering a better understanding and acceptance of TCM formulas as IBS remedies.
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Chapter
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Chapter
The significant rise in burden of age-related chronic degenerative disorders is increasing the need for products that support active and healthy aging. Today’s sedentary lifestyle enhances the propensity to aging related diseases and premature death. Accumulating data establishes a beneficial relationship between food and health. The modern consumer has become aware of the valuable impact of Mediterranean diet (MD) on healthy aging. MD is largely plant based and rich in sources of unsaturated fatty acids like nuts and extra virgin olive oil, legumes, whole grains, fish, and fresh vegetables and fruits and it discourages the use of red and processed meat, added sugars as well as refined grains, has been associated with decreased risk of developing various chronic degenerative age-related disorders and increased life expectancy. With the advent of modern medicine and technological advancements the life expectancy has increased in the past few decades but the gap between the healthy life years and the extra years added to the life still remains there. Aging is a process that increases the vulnerability of an organism to challenges. During this process the oxidative stress leads towards various degenerative cascades that result in functional decline in aging population that is mainly associated with under nutrition in older people. Cognitive function declines, reduced mobility and sensory alterations are seen, oral and GI functions and health become compromised, and chronic diseases and age-related illness like osteoarthritis, diabetes type II, cardiovascular diseases, and certain types of cancer are also exhibited. The active and healthy aging is a prerequisite in order to enhance the quality of life as people age. The MD has proven to be the best tool to counteract the degenerative processes and promote an active healthy aging. Major effectors of MD are reduced caloric intake, decreased consumption of saturated fatty acids, microbiota derived metabolites, less amino acid utilization, and an increase in phytochemical consumption. MD protects against oxidative damage, injury, and inflammation and platelet aggregation, lowers lipid levels, modifies the hormones as well as growth factors that are involved in cancer pathogenesis, and inhibits the nutrient sensing pathway via restriction of specific amino acid as well as produces certain metabolites by gut microbiota and it influences the metabolic health. Thus, the molecular and metabolic health is chiefly associated with what we eat. Restriction of the calories can enhance the life span as well as the health span only if it is coupled with sufficient intake of all the essential nutrients and the micronutrients.
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Background. Tongxieyaofang (TXYF), a prescription originated from traditional Chinese medicine (TCM), has been widely used on treating Diarrhea Predominant Irritable Bowel Syndrome (IBS-D). The purpose of this meta-analysis was to investigate whether TXYF was effective and safe for IBS-D. Methods. We searched seven electronic databases including CENTRAL, MEDLINE, PubMed, CNKI, VIP, CBM, and Wanfang Data up to 26 July 2017. Randomized controlled trails (RCTs) were eligible, regardless of blinding. Risk of bias of included trials was evaluated according to the Cochrane Handbook. Results. The total number of participants analyzed in the meta-analysis was 3062, of which 1556 received TXYF, while 1506 received ordinary treatment. The primary outcome was clinical effective rate. Compared with conventional medication which included probiotics, pinaverium bromide, trimebutine, and Oryzanol, TXYF significantly improved the clinical effective rate (n=37, OR: 4.61; 95% CI: 3.67–5.78; P < 0.00001) and decreased the adverse events (n=10, OR: 0.26; 95% CI: 0.08–0.86; P = 0.03). There was not significant association with the score of abdominal pain, defecating frequency, fecal property, and total symptom. Conclusions. We suggested a moderate recommendation for TXYF on IBS-D, due to the fact that the risk of bias of the finally included trails was not high. Considering that all identified studies were not of high qualities and large samples, further rigorously designed and large scale RCTs were necessary to improve the applicability of our study results.
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Background Despite the experimental evidence that certain dietary compounds lower the risk of radiation-induced damage to the intestine, clinical data are missing and dietary advice to irradiated patients is not evidence-based. Materials and methods We have previously identified 28 intestinal health-related symptoms among 623 gynaecological-cancer survivors (three to fifteen years after radiotherapy) and 344 matched population-based controls. The 28 symptoms were grouped into five radiation-induced survivorship syndromes: defecation-urgency syndrome, fecal-leakage syndrome, excessive mucus discharge, excessive gas discharge and blood discharge. The grouping was based on factor scores produced by Exploratory Factor Analysis in combination with the Variable Cutoff Method. Frequency of food intake was measured by a questionnaire. We evaluated the relationship between dietary intake and the intensity of the five syndromes. Results With the exception of excessive mucus discharge, the intensity of all syndromes declined with increasing intake of citrus fruits. The intensity of defecation-urgency and fecal-leakage syndrome declined with combined intake of vegetables and citrus fruits. The intensity of excessive mucus discharge was increased with increasing intake of gluten. Conclusion In this observational study, we found an association between a high intake of citrus fruits and vegetables and a lower intensity of the studied radiation-induced cancer survivorship syndromes. Our data suggest it may be worthwhile to continue to search for a role of the diet before, during and after radiotherapy to help the cancer survivor restore her or his intestinal health after irradiation.
Chapter
Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder occurring in people <45 years. Diverticular disease is among the most clinically and economically significant gastroenterological conditions in people ≥65 years of age. Having a history of IBS appears to increase the risk of diverticular disease in older age. IBS, previously called colitis, does not generally show visible structural or anatomic abnormalities, but is characterized by abdominal pain, bloating, distension, and changes in bowel habits. Celiac disease may be confounding and difficult to distinguish from IBS symptoms. Diverticular disease may evolve from colonic diverticulae (herniate pouches) potentially caused by high colonic intraluminal pressure which occurs in most people with aging but only approximately 20% of individuals with diverticulae develop abdominal symptoms (symptomatic uncomplicated diverticular disease). A smaller percentage of older individuals eventually develop complications such as severe bouts of diverticulitis or bleeding that may lead to sepsis and death. Healthy dietary patterns and low intake of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) may help to lower the risk and alleviate symptoms associated with IBS and diverticular disease. For IBS, psyllium is the fiber source most consistently found to help provide moderate relief of symptoms. For uncomplicated diverticular disease, fiber-rich healthy diets and low red or processed meat consumption decrease the risk, and fiber-rich diets, and foods or supplements containing wheat bran, psyllium or methylcellulose may help to alleviate diverticular disease symptoms and/or improve bowel function. Fiber related mechanisms that may help reduce risk or manage symptoms of IBS or uncomplicated diverticular disease are related to: (1) improved colonic health by promoting better laxation and stool bulk, and a healthier microbiota ecosystem with higher fecal ratio of probiotic to pathogenic bacteria and higher butyrate concentrations associated with lower colonic inflammation and improved colonocyte structure and function; and (2) reduced risk or rate of annual body weight and central abdominal fat gains (or promotion of a gradual lowering of body weight and waist size in overweight or obese individuals).
Chapter
Irritable bowel syndrome (IBS) is the most common gastrointestinal disorder occurring in people <45 years.
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Objective: To discuss the role of intestinal flora imbalance in the pathogenesis of pouchitis. Methods: The pouchitis rat model was established and the faeces sample and the mucous membrane sample were collected regularly, in which the bacterial nucleic acids were extracted for quantitative analysis of the intestinal flora in the samples through using the real-time quantitative PCR technique and high energy sequencing technology. Results: The disorder phenomenon of the intestinal flora appeared at the 7th day of the experiment, and the pouchitis was presented at the 21st day of the experiment. At the 31st day of the experiment, compared to control group and non-pouchitis group, the quantity of Bifidobacterium and the Lactobacillus of the pouchitis model rats in the mucous membrane sample and the faeces sample were significantly decreased (P < 0.05), and the Bacteroidetes, Faecalibacterium prausnitzii and XIV Clostridium leptum subgroup in the mucous membrane of pouchitis were significantly decreased (P < 0.05). The IV Clostridium coccoides group was the main flora in the mucous membrane of pouchitis, the bacterial diversity of non-pouchitis group and control group was significantly higher than that of the pouchitis group (P < 0.05). Conclusions: The intestinal flora imbalance is one of the factors that cause the incidence of the pouchitis; this study provides a clue of the pathogenesis and treatment direction of the intestinal inflammatory disease.
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