Gastroenterohepatic Npa 070905

7/24/2019 Gastroenterohepatic Npa 070905

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Asuhan Nutrisipada Saluran Cerna dan Hati

Nurpudji A Taslim

Bagian Gizi

Fakultas Kedokteran Unhas

@!!"


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Saluran Cerna dan Hati

#so$agus

%am&ungHati

#mpedu

'an(reas

Usus BesarUsus Ke(il


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)ietar* Histor*+clues to GI disease

s*mptom 'ossi&le disorder ,ngestion o$ solid $ood (auses

distress &ut li-uid do not

)i$$i(ult* in s.allo.ing

#pigastri( pain .hen eating'ain +" hours a$ter eating/

relie0ed a$ter eating

A&dominal pain se0eral hours

a$ter a $att* meal

Cramps/ distention/ $latulan(e 12+

3 a$ter drinking milk

Heat&urn a$ter eating a large o$

$att* meal

#sophageal stri(ture or tumor

#sophageal spasm/ a(halasia

Gastri( ul(er)uodenal ul(er

'an(reati( or &iliar* tra(t disease

%a(tose intoleran(e pro&a&l*

o.ing to la(tase de$i(ien(*

Hiatal hernia/ a(halasia/

esophageal motilit* pro&lem


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Nutritional care for Esophagitis

A0oid $ood 4 (aused o$ heart&urn#at small/ $re-uent meals to pre0ent stoma(h distentionand resultant gastri( a(id se(retion

A0oid high $at meals and de(rease $at in the diet

A0oid (ho(olate/ al(ohol and (a$$eine+(ontaining&e0erages 5(o$$ee/ tea and (ola drinks6

A0oid peppermint and spearmint oils

A0oid l*ing do.n/ &ending o0er/ or straining immediatel*a$ter eating

A0oid eating .ithin +7 hours o$ going to &ed

A0oid tight+$itting (lothing/ espe(iall* a$ter a meal

8edu(e .eight i$ o0er.eight

A0oid or -uit (igarette smoking


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Gastritis

Common (ause o$ Gastritis

Heli(o&a(ter p*loriaspirin

Chili

Al(oholCigarettes


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Nutritional care for GastritisHal yang perlu diperhatikan

19 Manajemen diet Keaktifan sekret lambung, usus kecil, pancreas, liver,dan empedu

Gerakan usus Bakteri flora usus rasa nyaman dan mudah dicerna

perbaikan dan maintenance mucosa usus! "engaruh makanan terhadap asam lambung

"rot # buffering efek $at % &H'# menurunkan pengosongan lambung E(tr daging, tannin )teh*, caffein )kopi* % alkohol

menyebabkan iritasi mucosa gaster

+! "engaruh makanan terhadap gerakan

lambung

! Efek makanan terhadap lesi

-! "engaruh makanan terhadap rasa tidak nyaman


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'#NATA%AKSANAAN.ujuan:

makanan adekuat; tidak merangsang; menurunkan

produksi asam lam&ung; menetralisir kele&ihan

asam lam&ung9

/yarat:

mudah di(erna/ porsi ke(il/ $rekuensi tinggi; protein

(ukup untuk mengganti jaringan rusak; tidakmerangsang 5mekanis/ termis < kimia6; memenuhi

ke&utuhan gizi Normal


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Faktor *ang =>eningkatkan? Asam

%am&ung dan 'roduksi #nz*m19 /timulasi kimia0i )E(trak 1aging,

"enyedap, Bumbu2bumbu, alkohol %

makanan kecut*!

! Makanan enak dan menarik selera

+! Keadaan bahagia! /uasana pada saat makan


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>eningkatkan Tone dan Gerakan Usus =

19 Makanan hangat

! Makanan &air dan lunak

+! Makanan Berserat! .inggi &H' dan rendah $at

-! "enyedap dan makanan manis

3! .akut, marah, dan stres


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Faktor =>enurunkan? Asam %am&ung dan

'roduksi #nz*m19 Makanan berlemak tinggi )gorengan,

kacang2kacangan*

! "orsi besar+! .idak dikunyah baik

! .idak menarik )bentuk dan

rasa*

-! .idak disukai

3! .akut, marah, dan sakit


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=>enurunkan? tone dan Gerakan Usus

19 Makanan dingin

! "adat dan kering

+! 4endah serat

! .inggi $at-! 1efisiensi 5itamin B &omp!

)6tamanya B7*

3! 8elah

9! .akut, marah, dan sakit

:! /edentary habit


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Fa(tors that a$$e(t to Gastri( A(idit*

#$$e(t o$ $ood in the stoma(h

)istension o$ the $undusparietal (ellsprodu(e a(id

,n(reased alkalinit* o$ antrumrelease gastrinstimulates

gastri( a(id se(retion )istention o$ antrumrelease o$ gastrin

Su&stan(es in $ood and digesti0e produ(tsin(reased

a(idit*; (o$$ee/ al(ohol/ pol*peptides and amino a(ids

'rotein 4 has an initial &u$$ering e$$e(t

Fat/ a(id/ and h*per osmolarit* in the small intestinestimulate release o$ one or more gastrointestinal hormones

that inhi&it gastri( a(id se(retion


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'athogeneti( $a(tors in the de0elopment

o$ pepti( ul(er disease

Gasric ulcer 1uodenal ulcer

A&+N p*lori( $un(tion

Uodenopastri( re$lu

)e$e(ti0e gastri( mu(osal de$en(es)e(reased mu(osal prostaglandin

produ(tionde(reased mu(osal

&i(ar&onat produ(tion

)e(reased mu(ous gel la*er

Heli(o&a(ter p*lori in$e(tion

,n(reased a(id se(retor*

(apa(it*

,n(reased &asal a(idse(retion

,n(reased parietal (ell mass

and sensiti0it*

A&+N gastri( empt*ng

A&+n duodenal mu(osalde$en(es

)e(reased &i(ar&onate

se(retion


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'rin(iples o$ nutritional (are

$or 'epti( Ul(er )isease

#at three regular meals dail*

#at small meals to a0oid stoma(h distention

A0oid drinking (o$$ee and al(ohol

Cut do.n or -uit smoking (igarettesA0oid using large amounts o$ aspirin/ other NSA,) or

other drugs kno.n to damage the stoma(h lining

A0oid $oods or drinks that (aused dis(om$ort

#at meals in as relaed an atmosphere as possi&leTake anta(ids 1+7 hours a$ter meals and &e$ore

&edtime


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)umping s*ndrom

,s a (omple ph*siologi( response to presen(e o$undigested $ood in the jejunum

Follo.ing gastri( surger*4 7 o$ the stoma(hremo0ed

S*mptom; a&dominal $ullness/ nausea (ramp*a&dominal pain/ $ollo.ing &* diarrhea/ 1" minutesa$ter ingestion9

%*ing do.n immediatel* a$ter eating redu(es theses*mptoms &e(ause $ood remains longer in the

stoma(h pou(hAlimentar* h*pogl*(emiao((urs 1+ hours a$tereating+(aused &* the rapid digestion and a&sorptiono$ $ood espe(iall* o$ sugar


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Nutritional (are in intestinal disease

A&sorption+++ jejunum

Terminal ileum4 $ats/ &ile salts/ 0itaminB1

%arge intestine or (olon4 purpose

a&sor&ing .ater and e(reting the $e(almass


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Constipation

/ystemic /E of medication

Metabolic and endocrine ab2n)hypothyroidism,

uremia and hyperglycemia*

8ack of e(ercise

;gnoring the urge to defacate

5ascular disease of the large bo0el

/ystemic neuromuscular disease "oor diet lo0 in fiber

pregnancy


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Continues++

Gastrointestinal)iseases o$ upper G,T

Sprue/ duodenal ul(er/ gastri( ul(er/ C*sti( $i&rosis

)iseases o$ the large &o.el that result inFailure o$ propulsion along the (olon/ $ailure o$

passage through anore(tal stru(tures

,nitial &o.el s*ndrom

Anal $issures or hemorhoids

%aati0e a&use


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,NF%A>>AT8D BE#% ),S#AS#

C8HNS ),S#AS#

U%C#8AT,# C%,T,S


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C8HNS ),S#AS# U%C#8AT,# ),S#AS#

S*mptomati(all* similar

Gradual insidious de0t o$ episodediarrhea/ a&dominal pain/ .eight loss/&lood/ pus or mu(ous in the stool

Fo(al/ o$ten granulomatousin$lammation in mu(osal and su&+mu(osal la*ers in an* area o$

digesti0e tra(tGenerall* a$$e(ts the terminal ileum

and right (olon/ sometimes the entire&o.el/ rarel* the entire digesti0e tra(t

)iarrhea is less (ommon

Segmental in0ol0ement is (ommon

Stri(ture $ormationpalpa&le massin the lo.er right -uadrant

'atients tent to &e nonsmoker

S*mptomati(all* similar

Gradual insidious de0elopment o$episode diarrhea/ a&dominal pain/ .eightloss/ &lood/ pus or mu(ous in the stool

Al.a*s a$$e(ts the re(tum/ o$ten thesigmoid and des(ending (olon in(ontinuit* and sometimes entire (olon

)iarrhea is (ommon

Segmental in0ol0ement is rare

'atients tent to &e nonsmoker


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CIRROHIS HEPATIS

Final stage of liver injury & degeneration

& occurs 15% of heavy drinkers

Normal liver tissue destroyed replaced by

inactive fibrous connective tissue (scar

tissue)


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HEPATIC FAILURE

Menurunkan liver function +>> )phenylalanine tyrosine % free

tryptophan*Menurunkan B&>> )8ececene, valine, isoleucine*

menyebabkan false neurotransmitters sehingga

terjadi HE

Meningkatkan aminobatyric acid inhibitoryneurotransmitter HE

N B&>> # >>> + # 7


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>mino acids of importance in 8iver 1isease

Aromati( AA 5 AAA6 T*rosine/ phen*l alanine/ $ree tr*pthopan

Bran(hed (hain amino a(ids 5BCAA6 aline/ leu(ine/ isoleu(ine

Ammoniogeni( amino a(ids Glutamin/ histidine/ l*sine/ asparagine/ l*(ine/ serine/

threonin/

indispensable AA


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=itamin>ineral )e$i(its in

Hepati( Failure?itamin !"#N

A

D

E

K

BG

B12

Niacin

Folate

B1

Zn

Mg

Fe

Deratiti!" nig#t $lin%ne!!

O!teoalacia

E%ea" Perieral ne'ro&at#(

Blee%ing

M'co'! e$r le!ion!" %eratiti!

Megalo$la!tic an" glo!!iti!" CNS %(!)'nction

Megalo$la!tic an" glo!!iti!" irrita$ilit(

Deratiti!" %eentia" %iarr#ea

Ne'ro&at#(" a!cite!" e%ea" CNS %(!)'nction

I'no%e)" i&aire% ta!te" *o'n% #ealing" &rot !(nt#e!a

Ne(ron(!c'lar irrita$ilit(" #(&o+aleia" #(&ocalcei

Stoatiti!" icroc(tic aneia" alai!e


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Tujuan )iet 'en*akit Hati

&ukup makan mempercepat perbaikan hati/yarat#

7! .inggi Energi, &H' meningkat, $at sedang, "rotberangsur

! &ukup mineral dan vitamin

+! 4endah Na&l! Mudah dicerna, tidak merangsang

-! Hindari makan yang mengandung gas tinggi!

Bahan makanan tidak boleh diberikan #

a! Makanan mengandung fat tinggi )babi, dagingkambing*

b! Makanan mengandung gas )ubi, kacang merah,kol, sa0i, lobak, ketimun, durian, nangka*


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NUT8,T,N CA8# %,#8 ),SS

$ep%&errh &oma rep

Rationale

Kcal

CHO

Prot

Fat

,it-in

Fl'i%

. re&air li/er !el. !&are &rot

. $alance e%ea 0 a!ater

3 4 -%

.4 g-%l 5678

1.2 g-+gBB

li$er-'!e MCT ril

B co&9

Fat !ol'lle /it

,it C 0 Zn

Re!tract i: e%ea - recite!;


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GA%% B%A))#8 ),SS

Fs : men*impan empedu meta& < degest $at

#nz : (hole(*stkinine

Ienis 'en*:7! Biliary dyskinesia )spasme sp! 'ddi*

! &holelithiasis )batu empedu*

+! &holecystitis )imflamasi GB*

! &holedocholithiasis )batu pada sp! 'ddi*-! cholecystectomi!


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Nutrition (are in Gall&ladder disease

.ujuan# Memberi istirahat kantung empedu, mengurangi rasa sakit

$ood ade?uate

/yarat#

.inggi fat )mudah dicerna* mengurangi kontraksi

E, prot, &H' cukup

.inggi )larut lemak*

.inggi cairan

.idak merangsang dalam porsi kecil


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>cute @ related to obstruction#makanan per oral sementara dihentikan

hindari makanan *ang mengandung lemak

diet rendah lemak

!+7!J dari kalori 5$at tidal le&ih dari "! gd6

&hronic22cholecystiasis8endah lemak 5"J dari total kalori6

Turunkan BB &ila o0er.eight

'rotein sesuai dengan ke&utuhsn

CH disesuaikan dgn ke&utuhsn utkmempertahankan BB normal

Batasi makanan *ang mengandung gas

Supl9 itamin *ang larut dalam $at5A)#K6


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'an(reatitis

,n$lammation (hara(terized &*;

edema/(ellular eudate/and $at ne(rosis

,t (an &e mild and sel$ limiting or se0ere .ith

ne(rosis o$ pan(raeti( tissue

Can &e a(ute or (hroni(+++pan(reati(

destru(tion4de(reased endo(rine and

eo(rine pan(reati( $un(tion/ steatorrhea ordia&etes results


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Nutrition (are in 'an(reatitis disease

A(ute and se0ere atta(ks4 oral $eeding is .ithheld

and h*dration is maintained intra0enous

A$ter 3+32 hours 4 (lear li-uid diet as toleran(e

Formula diet (onsisting o$ amino a(id/ glu(ose/ and

small amount o$ $at .ill not stimulate pan(reati(

se(retions9

'rolonged se0ere pan(reatitisT'N

Fat emulsion (an &e used as long as 4a(ute

pan(reatittis is not the &asis $or h*pertrigl*(eridemia


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The Role of Probiotic In

Immunity System


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God Bless us with Lactobacillus

and Bedobacteria. They benetmankind in many ways, thouh

medical science knows !ery littleabout these bacteria.

Professor "itsuokaBadobacteria # $ealth

"orinaa %o.


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&'(I)ITI*)

Probiotics are food that contain li!ebacteria which are benet to health

Prebiotics are substances such aslactulose, lactitol, +ylitol, inulin, andcertain nondiestible oliosaccharidesthat selecti!ely stimulate the rowth of

bidobacteria in the colon.Symbiotic is a combination of -robioticsand -rebiotic.


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INFLUENCES OF THE HUMAN INTESTINALMICROBIOTA ON THE HOST

Benefcial eects Harmul eects

Ini!iti"n " #at"$ens C"nsti#ati"n

Stimulati"n i immune s%stem &iarr"ea

S%ntesis " 'itamins Inecti"n

Ai( in (i$esti"n Li'er (ama$e

Pr"(uce meta!"lic uel "r

enter"c%tes

Cancer

Maintain sta!ilit% " ec"s%stem Flatulence

Meta!"lise (ru$s

Patricia L. Conway, Selection Criteria for probiotic microorganisms,

Asia Pacic J Clin Nutr (1!" #$ 1#%1


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MECHANISMS OF PROBIOTICFUNCTIONALIT) AN& ITS BENEFICIAL

EFFECTS

Mecanisms "Functi"nalit%

Benefcial Eects

Antimicr"!ial acti'it%

C"ntr"l " r"ta'irus an(cl"stri(ium (i*cile

C"ntr"l " ulcer relate( t"H+#

Anti!i"tic tera#%

Treatment " (iarr"eaass"ciate(

,it tra'el

C"l"ni-ati"n resistance Balancin$ " c"l"nicmicr"!i"ta

&. 'ubillaga et al., Nutrition esearc) *1 (*++1" #!%#


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MECHANISMS OF PROBIOTICFUNCTIONALIT) AN& ITS BENEFICIAL

EFFECTS

Mecanisms "Functi"nalit%

Benefcial Eects

Immune eects

A(.u'ant eect

C%t"/ine e0#ressi"nStimulati"n "#a$"c%t"sis !% #eri#eral!l""( leuc"c%tes

Secret"r% I$A

1accine a(.u'ant eect

Enance immune res#"nse

Enance immune res#"nse

In2uence "n en-%me acti'it% Re(ucti"n " ecal en-%mesim#licate( in cancerinitiati"n

En-%me (eli'er% Re(ucti"n " serumc"lester"l

Ameli"rati"n " lact"se mala!s"r!ti"n s%m#t"ms

&. 'ubillaga et al., Nutrition esearc) *1 (*++1" #!%#


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PUTATI1E MECHANISMS OF THE ACTIONOF FUNCTIONAL FOO&S

Functi"nal""(s 3e$+Pr"!i"tic4

Increase tee0#ressi"n

Su#er"0i(e(ismutase56lutati"nPer"0i(ase an(Catalase

Pr"(ucti"n "7uencers

6lutati"nre(uctase5 1it+ A5E5 C5 etc

Ca#tati"n " Ir"nan( Lact"errine

In2uence "n cell si$nali-ati"n

Free ra(icals5 nitric "0i(e5 /inases5 an( c%clic nucle"ti(s

E0#ressi"n " transcri#ti"nal act"rsNeut"#il Fact"r 8/9B5 Anti #r"tease5 etc

In2uence "n $enic trans(ucti"n

3C%t"/ines5 En-%mes5 Cellular mar/ers4

Pase I

Pase III

Pase II

Pase I1

&. 'ubillaga et al. - Nutrition esearc) *1 (*++1" #!%#


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PRO&UCTION OF ANTI9MICROBIALSUBSTANCES B) PROBIOTIC

BACTERIOCIN PRO&UCEROR6ANISM

PROPERTIES

)isin Lactococcus latis

Subs-. Lactis T%%//010

Lantibiotic, broads-ectrum,

chromosome2-lasmidmediated, bactericidal,-roduced late in therowth cycle

Pediocin Pediococcus

Pentosaceus

(BB3/ and L4567

Broad s-ectrum,-lasmid mediated

Pediocin c$ Pediococcus

Acidilactici $

Broad s-ectrum,-lasmid mediated

Table Properties of some well characterized bacteriocins

C. &is)ra an J. Lambert, Asia Pacic J Clin Nutr (1!" #$*+%*/


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PRO&UCTION OF ANTI9MICROBIALSUBSTANCES B) PROBIOTIC

BACTERIOCIN PRO&UCEROR6ANISM

PROPERTIES

Leucocin Leuconostoc

Gelidum 8L /94

Broad s-ectrum,

-lasmid mediated,bacteriostatic,-roduced early in therowth cycle

$el!eticin : Lb. helveticus 09/ )arrow s-ectrum,chromosomally

mediated, bacteridal

%ernobacteriocin Carnobacterium

Pisciola L ;/4

)arrow s-ectrum,chromosomallymediated, bacteridal

C. &is)ra an J. Lambert, Asia Pacic J Clin Nutr (1!" #$*+%*/

Table Properties of some well characterized bacteriocins


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I""8)' S


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I""8)' S


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T$' '(('%T *( PR*BI*TI%S *)

$eliobacter -ylori

T" a'e a stimulat"r% eect "n te m"t"ran( em#t%in$ uncti"n " te $astric

stum# ,ereas mil/ an( mil/ ,e%5c"tta$e5 ceese5 an( !utter ,as s",n t"a'e ini!it"r% eects

Te (iatetic mana$ement " te #atientsun(er$"in$ $astric "#erati"ns "r ,it H+#%l"ri c"l"ni-ati"n s"ul( !e carrie( "ut"n a strictl% in(i'i(uali-e( !asis


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SHORT9CHAIN FATT) ACI&S PRO&UCE& B)INTESTINAL BACTERIA

SCFA SPECIFIC EFFECT BENEFIT

T"tal L",erin$ " #H &iminise( !i"a'aila!ilit%

" al/aline c%t"t"0ic

c"m#"un(s

Ini!iti"n " 6r",t "

#H sensiti'e "r$anism

Acetate P"ssi!le increase in Ca

an( M$ a!s"r#ti"n

Rela0ati"n "resistance

'essels

&iminise( aecal l"ss "

Ca an( M$

6reater c"l"nic an(

e#atic #"rtal 'en"us

!l""( 2",

Pr"#i"nate Enance c"l"ricmuscular

c"ntracti"n

Rela0ati"n "resistance

'essels

Easier la0ati"n5 relie "

c"nsti#ati"n

6reater c"l"ric an(e#atic

#"rtal 'en"us !l""( 2",

6a7i L. 8opping Asia Pacic J Clin Nutr (1!" #$ 1#%1

Table General and Specic health benets of SCFA in the colon


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SHORT9CHAIN FATT) ACI&S PRO&UCE& B)INTESTINAL BACTERIA

6a7i L. 8opping Asia Pacic J Clin Nutr (1!" #$ 1#%1

SCFA SPECIFIC EFFECT BENEFIT

Pr"#i"nate Stimulati"n " c"l"nic

muscular c"ntracti"n

C"l"nic e#itlial

#r"lierati"n

6reater i"n an( 2ui(

a!s"r#ti"n5 #re'enti"n "

(iarr"ea

P"ssi!le $reater

a!s"r#ti'e ca#acit%But%rate Rela0ati"n "

resistance

'essels

Meta!"lism n%

c"l"n"c%tes

6reater c"l"nic an(

e#atic 'en"us !l""( 2",

Maintenance " muc"sal

inte$rit%5 re#air "

(i'ersi"n an( ulcerati'e

c"litis5 c"l"n"c%te

#r"lierati"n

Maintenance " n"rmal

c"l"n"c%te #en"t%#e

Stiulati"n " c"l"nic

electr"l%te trans#"rt

&iminise( ris/ "mali$nanc%

6reater i"n an( 2ui(

a!s"r#ti"n5 #re'enti"n "

(iarr"ea


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HABITUAL INTA8E OF LACTIC ACI&BACTERIA AN& RIS8 RE&UCTION OF

BLA&&ER CANCER

T" assess te #re'enti'e eect " te inta/e" L+ casei5 ,i(el% ta/en as ermente( mil/#r"(ucts in :a#an5 a$ainst !la((er cancer5c"n(ucte( a case c"ntr"l stu(%

Te O((s rati"n " sm"/in$ ,as ;5?c"nf(ence inter'al@ ;+;9+


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SAFET) OF PROBIOTIC BACTERIA

Pr"!i"ticstrain

Re#"rte( eects

Saet% stu(ies

In 'itr" Animalstu(ies

Humanstu(ies

Lactobacilus

aciop)ilus

NCFB ;DG

Treatment "c"nsti#ati"n5 alle'iati"n" ra(i"tera#% relate((iarr"ea5 l",erin$ "aecal en-%mes

Lactobacilus

Casei sir"ta

Balancin$ intestinal

micr"2"ra5 #re'enti"n" intestinal(istur!ances treatment" su#erfcial !la((ercancer

6ono)ue 6C an S. Salminen, Asia Pacic J. Clin Nutr (1!" #$ *#%*

Gastroenterohepatic Npa 070905

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