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Dietary fiber intake provides many health benefits. However, average fiber intakes for US children and adults are less than half of the recommended levels. Individuals with high intakes of dietary fiber appear to be at significantly lower risk for developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases. Increasing fiber intake lowers blood pressure and serum cholesterol levels. Increased intake of soluble fiber improves glycemia and insulin sensitivity in non-diabetic and diabetic individuals. Fiber supplementation in obese individuals significantly enhances weight loss. Increased fiber intake benefits a number of gastrointestinal disorders including the following: gastroesophageal reflux disease, duodenal ulcer, diverticulitis, constipation, and hemorrhoids. Prebiotic fibers appear to enhance immune function. Dietary fiber intake provides similar benefits for children as for adults. The recommended dietary fiber intakes for children and adults are 14 g/1000 kcal. More effective communication and consumer education is required to enhance fiber consumption from foods or supplements.

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OBJECTIVE: Refractory constipation is a common GI complaint seen by physicians in all practice settings. We have previously shown that p.d. colchicine (0.6 mg t.i.d.) increases the number of spontaneous bowel movements, hastens GI transit, and improves GI symptoms in patients with chronic constipation during an 8-wk, open-label therapeutic trial. The aim of this study was to determine if p.d. colchicine will increase spontaneous bowel movements and accelerate colonic transit in patients with idiopathic chronic constipation in a randomized, placebo-controlled, crossover trial. METHODS: A total of 16 patients (15 women, one man) with a mean age of 47 yr (age range 25-89) with chronic idiopathic constipation who were refractory to standard medical therapy participated in the study. Patients randomly received either colchicine 0.6 mg p.o. t.i.d. or an identical placebo p.o. t.i.d. for a total of 4 wk in a double-blind, crossover fashion. Patients recorded their daily number of bowel movements and daily symptoms of daily nausea, abdominal pain, and bloating. Mean colonic transit was calculated at baseline, weeks 6 and 12. RESULTS: Colchicine increased the number of bowel movements and accelerated colonic transit compared with baseline and placebo conditions. There were no significant differences between conditions on ratings of nausea and bloating. During colchicine administration, mean abdominal pain was greater than the baseline or placebo conditions, however, the pain decreased significantly by the last week the patient was on colchicine. CONCLUSION: Colchicine increases the frequency of bowel movements and hastens colonic transit in patients with chronic constipation. Colchicine may be an effective agent available to practitioners to treat a subset of patients with chronic constipation who are refractory to standard medical therapy.

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INTRODUCTION: The most common symptoms of chronic pancreatitis are abdominal pain, diarrhea, and weight loss. The abdominal pain has no consistent pattern, and nausea and vomiting commonly occur simultaneously. Gastroparesis may produce similar symptoms. These similar symptoms may cause diagnostic confusion, particularly with regard to patients with small-duct chronic pancreatitis, for whom diagnosis of chronic pancreatitis is most difficult. We have observed that coexistent gastroparesis may also interfere with the effectiveness of pancreatic enzyme therapy by failing to deliver proteases into the duodenum and therefore not restoring feedback control of pancreatic secretion. AIM: To estimate the prevalence of gastroparesis in patients with minimal-change chronic pancreatitis. METHODOLOGY: Patients with chronic pancreatitis diagnosed on the basis of secretin test results but with otherwise normal pancreatic imaging (ultrasonographic or computed tomographic) findings who had also undergone a gastric emptying study were retrospectively identified. An abnormal secretin test value was defined as a peak bicarbonate concentration in pancreatic secretions of <80 mEq/L after secretin stimulation. Gastroparesis was defined as an emptying half-time greater than 90 minutes. RESULTS: Fifty-six patients were identified. Twenty-five of the 56 patients (44%) had concomitant gastroparesis and small-duct chronic pancreatitis. Twenty-four of these 25 were women, and 22 of the 25 had idiopathic small-duct chronic pancreatitis. CONCLUSION: In our referral population, gastroparesis is frequently seen in patients with small-duct chronic pancreatitis. For patients with small-duct disease whose abdominal pain does not respond to pancreatic enzyme therapy, clinicians should consider an evaluation for gastroparesis.

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