OBJECTIVES Dysbiosis leading to abnormal intestinal fermentation has been suggested as a possible etiological mechanism in irritable bowel syndrome (IBS). We aimed to investigate the location and magnitude of altered intestinal bacterial fermentation in IBS and its clinical subtypes. METHODS One hundred fourteen IBS patients who satisfied Rome III criteria and 33 healthy controls (HC) were investigated. Intestinal fermentation was assessed using two surrogate measures: intestinal intraluminal pH and fecal short chain fatty acids (SCFAs). Intraluminal pH and intestinal transit time were measured in the small and large bowel using a wireless motility capsule (SmartPill™) in 47 IBS and 10 HC. Fecal SCFAs including acetate, propionate, butyrate and lactate were analyzed by capillary gas chromatography in all enrolled subjects. Correlations between intestinal pH, fecal SCFAs, intestinal transit time and IBS symptom scores were analyzed. RESULTS Colonic intraluminal pH levels were significantly lower in IBS patients compared to HC (total colonic pH, 6.8 for IBS vs. 7.3 for HC, P = 0.042). There were no differences in total and segmental pH levels in the small bowel between IBS patients and HC (6.8 vs. 6.8, P = NS). The intraluminal colonic pH differences were consistent in all IBS subtypes. Total SCFAs level was significantly lower in C-IBS patients than in D-IBS and M-IBS patients and HC. The total SCFAs level in all IBS subjects was similar with that of HC. Colonic pH levels correlated positively with colon transit time (CTT) and IBS symptoms severity. Total fecal SCFAs levels correlated negatively with CTT, and positively with stool frequency. CONCLUSIONS Colonic intraluminal pH is decreased, suggesting higher colonic fermentation, in IBS patients compared with HC. Fecal SCFAs are not a sensitive marker to estimate intraluminal bacterial fermentation.

We report on four cases of severe lung injury and respiratory failure attributed to E-cigarette use that presented between July and August, 2019. The patients described were relatively healthy without clinically significant history of lung disease. Each developed severe acute respiratory distress shortly following E-cigarette use. In each case, the patients initially presented with considerable hypoxia and infectious-appearing pattern with elevated inflammatory markers on laboratory values. Imaging studies demonstrated a consistent pattern of widespread bilateral interstitial infiltrates with a medial distribution. All but one of the cases involved the admitted use of THC oil in E-cigarettes. There was rapid progression of illness requiring increased supplemental oxygen and in two cases, requiring urgent intubation and mechanical ventilation. No infectious organism was isolated in any case, and patients improved rapidly with the initiation of steroids. These are among the first cases reported in South Carolina and are consistent with similar cases that have been reported around the country.

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