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Objective: To determine the effect of folic acid, vitamin B 6 and B 12 fortified spreads on the blood concentrations of these vitamins and homocysteine. Design and setting: A 6-week randomized, double-blinded, placebo-controlled, parallel trial carried out in a clinical research center. Subjects: One hundred and fifty healthy volunteers (50% males). Interventions: For 6 weeks, the subjects consumed the test spreads (20 g/day): containing per 20 g (1) 200 mg folic acid, 2 mg vitamin B 12 and 1 mg vitamin B 6 , or (2) 400 mg folic acid, 2 mg vitamin B 12 and 1 mg vitamin B 6 or (3) no B-vitamins (control spread). Results: The B-vitamin status increased on using the test spreads, with the largest effect on the serum folate concentration: 48% in men and 58% in women on spread 1 and 92 and 146%, respectively, on spread 2 (P-values all o0.05). The plasma homocysteine decreased in the groups treated with the fortified spreads as compared to the control group. Average decreases were for males: 0.771.5 mmol/l (6.8%) on spread 1 and 1.771.7 mmol/l (17.6%) on spread 2 and for females: 1.471.2 mmol/l (14.2%) and 2.472.0 mmol/l (23.3%), respectively (P-values all o0.05). Conclusions: Consumption of a spread fortified with folic acid, vitamin B 6 and vitamin B 12 for 6 weeks significantly increases the blood concentrations of these vitamins and significantly decreases the plasma concentration of homocysteine. Fortified staple foods like spreads can contribute to the lowering of homocysteine concentrations.

Objective: To explore the feasibility of low-fat spreads as vehicles for folic acid (FA) fortification by determining the acute absorption of FA from a fortified spread. Design: Double blind, crossover study to test each of the following treatments administered at 1-weekly intervals: (A) 20 g lowfat (40%) spread fortified with 200 mg FA and a placebo tablet; (B) 20 g low-fat placebo spread and a 200 mg FA tablet; (C) 20 g low-fat placebo spread and a placebo tablet. Subjects: A total of 13 male volunteers, aged 31.8713.2 y. Main outcome measures: Plasma total folate concentrations, measured before and up to 10 h after each treatment (n ¼ 10 samples per treatment). Results: Plasma folate concentrations were significantly increased compared with baseline values 1 h after administration of the FA tablet, and 1.5 h after the FA spread, and remained significantly higher than the baseline values for up to 7 h after both treatments. The maximum plasma folate response (R max ), corrected for baseline values and 'placebo response', was established between 1 and 3 h postprandially in response to both FA spread and FA tablet, and no significant difference in R max was found between the two treatments (13.4 vs 14.4 nmol/l, P ¼ 0.9). The acute absorption of FA from fortified spread relative to that from the tablet, calculated on the basis of area under the plasma folate response curve, was 67% (P ¼ 0.04). Conclusion: The absorption of FA from fortified low-fat spread, although lower than from a tablet, is effective. These results suggest that low-fat spreads, typically associated with fat-soluble vitamin fortification, may also be considered feasible as vehicles for FA fortification.

Bleeding from the small intestine is still a very difficult diagnostic problem, even with the most advanced diagnostic procedures. This report suggests the use of intraoperative endoscopy of the small intestine by the introduction of a colonoscope through the mouth. The whole length of the small intestine can be invaginated on the advancing colonoscope and even intramural lesions can be identified and treated accordingly.

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CASE: Introduction:Fecal calprotectin is a known inflammatory marker used to evaluate patients with Inflammatory Bowel Disease (IBD). In fact, ACG Clinical Guideline for management of Crohn’s disease recommend fecal calprotectin (FC) as a helpful test to distinguish IBD versus functional disorder such as Irritable Bowel Syndrome. Studies have also shown association of fecal calprotectin with colon cancer. Recent study proposed fecal calprotectin could be a reliable marker for ruling out organic disease with high negative predictive value. CASE DESCRIPTION: We present a patient case of a Caucasian, thirty-five years of age male with PMHx of GERD on Prilosec who presented due to acute abdominal pain, nausea, emesis and watery, nonbloody diarrhea of four days duration. Initially, patient had unknown family history of colon cancer which later was revealed that patient’s father had a colon cancer diagnosis in his fifties. On admission, patient had stable vitals with routine labs showing leukocytosis, iron deficiency anemia, normal CRP, and elevated fecal calprotectin of 986mcg/gm. Abdominal imaging with CT abdomen with contrast showed diffuse dilation of ileum and thickening of the distal ileum up to the level of the ileocecal junction, suggestive of enteritis from infectious or inflammatory etiology such as Crohn’s. Patient was managed conservatively, stool studies were negative otherwise and discharged with outpatient endoscopy due to high suspicion for Inflammatory Bowel Disease. Within one week, patient had a subsequent readmission for now partial small bowel obstruction at the level of ileum. Due to high suspicion of Crohn’s, patient was empirically started on IV steroids. Decision for inpatient colonoscopy was made with colonoscopy showing completely obstructing, circumferential, large mass found in the cecum extending into ascending colon. Final pathology revealed invasive mucinous adenocarcinoma, moderately differentiated. Patient subsequently underwent right hemicolectomy with lymph node resection and adjuvant chemotherapy treatment for stage 3 colon. DISCUSSION: We present here a case where a common cancer was found in an otherwise healthy, young male with acute abdominal pain and altered bowel habits. While initial symptoms, imaging and laboratory findings pointed towards a biased high suspicion for Inflammatory Bowel Disease, patient's ultimate diagnosis was stage 3 adenocarcinoma of colon requiring surgical resection and chemotherapy. Fecal calprotectin is a known marker for colon inflammation and associated with both IBD and colon cancer. It is important to keep in mind that while fecal calprotectin may have elevated negative predictive value and be used to rule out organic disease, elevation of fecal calprotectin is not always specific for IBD. We want to emphasize the importance of considering colon cancer on the differential despite a patient’s age and diagnostic bias. Lastly, we also want to highlight the importance of tissue diagnosis prior to long term therapy use.

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