articles epidemiology led to the hypothesis that Methanobrevibacter smithii may be a therapeutic target for the reduction of energy harvest in obese humans (25,26), as M. smithii is the major representative of the human gut methanogens (27).The purpose of this study was to investigate whether the proposed role of SCFA and microbiota composition in obesity, which was based on proof of principle experiments, can be confirmed in a larger study which did not exclude all confounding factors. Methods and Procedures Volunteer recruitmentLean and obese volunteers of both sexes were recruited from the Institute of Microecology and from the obesity consultation hours at the University of Giessen and Marburg. In total 98 volunteers (34 males and 64 females) took part in the study. All of the samples collected were analysed. The volunteers were aged 47 ± 13 year (mean ± s.e.m.: range 14-74 year). The BMI in kg/m 2 of 30 volunteers was within the normal range (18.5-24.9), while 35 were overweight (25.0-29.9) and 33 were obese (≥30.0). Of the latter, 17 were classified as obesity class 1 (30-35), 11 as class 2 (35-40), and 5 as class 3 (>40). No antibiotics had been taken in the 6 months prior to the study. All participants subsisted primarily on a western diet and all volunteers provided informed, signed consent.

The 2016 HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research.

Hydrolysis of triglycerides by pancreatic lipase and formation of free fatty acids that induce inflammatory changes are postulated to account for the development of HTGP, yet the exact pathophysiology remains unclear. The clinical features of patients with HTGP are generally not different from patients with acute pancreatitis of other causes, and there is some evidence that HTGP is associated with a higher severity or a higher complication rate. There is no clear evidence as to which HTG patients will develop pancreatitis. Several studies have evaluated the effect of apheresis, the benefit of insulin and/or heparin treatment and the use of different antihyperlipidemic agents in HTGP. Dietary modifications resemble the key features in the long-term management of HTG. Whether HTG may cause chronic pancreatitis in the long-term follow-up remains controversial.

Diabetes mellitus secondary to pancreatic diseases (especially chronic pancreatitis) seems more common than generally believed with a prevalence of 9.2% among the subjects studied here. Because the awareness of this diabetes type is poor, misclassification is quite frequent. A common problem seems to be the differentiation between type 2 and type 3. Yet, the right classification of diabetes mellitus is important, because there are special therapeutic options and problems in patients with diabetes secondary to pancreatic diseases.