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Background-Polyamines are essential for cell growth. Dietary and probably gut bacterial derived polyamines contribute significantly to the polyamine body pool. Aims-To evaluate the influence of dietary, luminal polyamines on growth and development of diVerent gastrointestinal organs in normally growing rats. Methods-Male suckling Wistar rats were randomly allocated to four treatment groups: polyamine deficient diet (PDD); PDD plus antibiotics (neomycin 2 g/kg and metronidazole 34 mg/kg); PDD plus polyamine supplementation at normal concentrations; or normal standard laboratory chow. After a six month feeding period 7-10 animals/group were sacrificed. Results-No diVerences in body weight gain, food consumption, or general behaviour could be observed between the four groups of animals. Feeding of PDD alone or PDD plus antibiotics resulted in a highly significant decrease in organ weight, protein content, and DNA content in small intestinal and colonic mucosa whereas no alterations were found in the liver. Conclusions-Long term feeding of polyamine deficient diets resulted in a significant hypoplasia of small intestinal and colonic mucosa. Dietary, luminal polyamines are important local factors for growth and the development of small intestinal and colonic mucosa. (Gut 1999;44:12-16)

Background : Modern pancreatin preparations consist of enteric‐coated microspheres to protect the enzymes from gastric acid. There are, however, no clinical trials comparing different sizes of pancreatin microspheres with regard to fat excretion and fat intake. Aim : To prove both equivalent efficacy and safety of conventional pancreatin microspheres and smaller pancreatin minimicrospheres in patients with exocrine insufficiency due to chronic pancreatitis. Methods : In this prospective, randomized, double‐blind, multicentre, crossover trial, patients with a stool fat excretion of > 7.5 g/day during a placebo period were randomly assigned either to the minimicrosphere/microsphere treatment sequence or vice versa. The primary end‐point was the coefficient of fat absorption, which was calculated from fat excretion and fat intake during the course of a standardized diet. Stool weight, clinical symptoms and the safety of the preparations were also evaluated. Results : Thirty‐seven patients entered the study, of whom 23 fulfilled the criteria for the crossover period. In the per protocol analysis (n=18), the 90% confidence intervals for the coefficient of fat absorption of both crossover periods lay entirely within the equivalence range (P=0.02). The intention‐to‐treat analysis revealed similar results, but the equivalence range was slightly missed (P=0.07). Similar results were obtained for the secondary parameters and the reported adverse events. Conclusions : Pancreatin minimicrospheres have been shown to be equally effective as microspheres in improving the coefficient of fat absorption in patients with exocrine insufficiency due to chronic pancreatitis.

After PEG placement at the Medical Department of the University Hospital in Kiel, 210 patients (mean age 61.3 years; 137 men, 73 women) were prospectively followed-up for 133+/-181 days. Close-meshed evaluations of the development of nutritional status, long-term outcome, complications, subjective acceptability, patient care after discharge from the hospital, survival, and nutritional long-term problems were performed. The PEG procedure (duration 13.3+/-4.2 min) was carried out for neurological (42%), ear-nose-throat (28%), and internal medical (30%) indications. Procedure-related mortality was 0%, while altogether 3.8% severe and 20.0% mild complications were observed. Body weight decreased by a mean of 11.4+/-1.5 kg in the three months before and increased by 3.5+/-1.7 kg one year after PEG placement with no significant differences between malignant or benign underlying diseases. Individual subjective acceptability was excellent in 83%, sufficient in 15%, and poor in 2% of patients only. One-year survival rate was 34.3%. The various results of the present prospective study demonstrate that long-term enteral feeding via PEG is a safe, effective, easy-to-practice, and highly acceptable method with excellent long-term results and distinct improvement of nutritional status. Individual decisions for PEG placement should be considered much earlier and more frequently in appropriate patients.