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KyberPlus: For unclear abdominal discomfort • mikrooek.de

FOR MEDICAL COMMUNITY

KyberPlus for unclear abdominal discomfort

The intestinal mucosa covers several hundred square meters through the body. However, if the mucous membrane is inflamed, permeable to allergens and pathogens or other noxae, this has a serious impact on health. This may lead to a reduced protection against infections.

The KyberPlus is a modular system composed of various biochemical parameters for the diagnosis of unclear abdominal discomfort.

The KyberPlus diagnostics are suitable for the clarification of:

 

 

    •     Maldigestion
    •     Pancreatic insufficiency
    •     Chronic pancreatitis
    •     Reduced mucus protection
    •     Acute and chronic intestinal infections
    •     Prognosis in Crohn's disease
    •     Necrotizing enterocolitis
    •     Enteral protein loss syndrome
    •     Permeability disorders of the intestinal mucosa
    •     Gluten-sensitive enteropathy
    •     Intestinal parasitoses
    •     Differentiation between food allergy and food intolerance

      KyberPlus parameter

      Digestion residues

      The quantitative detection of digestion residues in stool is useful in the case of unclear gastrointestinal symptoms. As a rule, only a small amount of undigested food residues are present in faeces; daily fat and nitrogen excretion is relatively constant in healthy persons. However, if it increases to pathologically high concentrations, a digestion disorder such as maldigestion can occur. Maldigestion may lead to a malabsorption if it persists - with the consequence being a lack in vitamins, minerals and trace elements.

      The causes of a maldigestion are:

      •     Exocrine pancreatic insufficiency or
      •     Bile acid deficiency

      In the case of exocrine pancreatic insufficiency, digestive enzymes are deficient and the corresponding food components are no longer sufficiently utilized. High molecular weight fats and proteins are no longer absorbed and thus accumulate in the stool.

      Bile acid deficiency occurs if the gut flora degrades conjugated bile acids. This is the case if the small intestine is overgrown by bacteria of the colon - the so-called Overgrowth syndrome. In ileum dysfunction, bile acid resorption in the terminal ileum may be disturbed. In both cases, not enough bile acid is produced to emulsify food fats to a sufficient amount. This increases the fat concentration in faeces.

      Reference range: Fat: increased > 3.5%, nitrogen: increased > 1.0%, water: increased > 80.0%

       

       

      Bile acids

      The bile acid concentration in faeces can be determined if a bile acid loss syndrome is suspected.

      The body produces roughly 700 ml of bile daily, about 12 percent of bile are bile acids or bile salts. The bile acids are subject to the enterohepatic circulation. This means that most of the bile acids secreted into the duodenum are resorbed in the terminal ileum and thus return to the liver. About 0.6 g of bile acids are lost daily in stool and must be synthesized anew.
      An ileum dysfunction means that the bile acids are insufficiently absorbed.  

      Common causes of bile acid loss are:

      •     Ileitis in Crohn's disease
      •     Resection of the terminal ileum
      •     Bacterial small intestine overgrowth (small bowel overgrowth = SBOG)

      Compensated bile acid loss syndrome: If the body can replace the lost bile acids in sufficient quantity, the fat digestion still works. Large amounts of bile acids can be detected in the faeces, fats are in the normal range.

      Decompensated bile acid loss syndrome: The liver no longer manages to synthesize enough new bile acids. The disease results in a functional deficiency of bile acid and thereby in a disturbed fat digestion.

      The bile acids are osmotically active in the colon, which leads to a chologenic diarrhea. If a functional deficiency of bile acids has already taken place, the disturbed fat absorption results in a steatorrhoea.

      The reduced fat absorption also causes a deficiency of fat-soluble vitamins (hypovitaminosis) and a weight loss. As the anus is irritated, anal eczema can also occur. If the emulsifying bile acids are absent, the bile has increased lithogenicity. Bile stones may result.

      Reference values:                                  bile acids

      •      <66 μmol / 100 ml                 reduced
      •     66 - 715 μmol / 100ml            normal
      •     715.1 - 900 μmol / 100ml       slightly increased
      •     900.1 - 1200 μmol / 100ml     significantly increased
      •     > 1200 μmol / 100ml              highly increased

      Pancreas Specific Elastase 1

      A decreased concentration of pancreas-specific elastase 1 in stool suggests chronic pancreatitis or pancreatic insufficiency. Pancreatic insufficiency leads to a maldigestion as described above. For this reason, a determination of the pancreas-specific elastase 1 as a precautionary test is recommended to patients with risk factors – such as diabetes or bile stones. Due to the reduced calcium absorption, an examination is indicated for patients with osteoporosis risk.

      The enzyme pancreas-specific elastase 1 is produced in the pancreas and excreted into the duodenum via the papilla vateri. Since the enzyme is not degraded, it is detectable in faeces. The pancreas-specific elastase 1 is a proteolytic glycoprotein with a molecular weight of about 28 kilodaltons (kDa).

      Reference range for pancreas-specific elastase 1 (E1):

      •     ≥ 200 μg E1 / g Stool: Normal exocrine pancreatic function
      •     100 to 200 μg E1 / g Stool: Slight to moderate exocrine pancreatic insufficiency
      •     <100 μg E1 / g Stool: Severe exocrine pancreatic insufficiency

       

       

       

      Zonulin

      The regulator protein Zonulin is a suitable marker to determine the permeability of the intestinal mucosa. Zonulin regulates the exchange of fluid, macromolecules and leukocytes between the bloodstream and the intestinal lumen. It also protects the subepithelial layers. Various stimuli cause the intestinal epithelial cells to deliver zonulin into the intestinal lumen and into the blood vessels. Examples are direct contact with bacteria in the case of missing or interrupted intestinal mucus layer and contact with gliadin. The zonulin binds to receptors on the surface of the intestinal epithelial cells and triggers a signal cascade which leads to cell contraction of the cytoskeleton. As a result, the Tight junctions open. If the zonulin-mediated opening of the tight junctions is repeated and intensified, the Leaky gut syndrome develops.

      Reference range: ≥ 78.0 ng / ml stool or> 48.0 ng / ml serum

       

       

      Secretory IgA

      The production of the secretory immunoglobulin A (sIgA) is reduced in recurrent infections of the mucous membranes, atopies and humoral immune deficiencies. Effective sIgA production is important for effective mucous membrane protection. Each day the human being secretes between 5 and 15 g of sIgA on the mucous membranes: the lacrimal fluid, the mother's milk, the saliva, the mucus of the bronchi, the urogenital tract, and the gastrointestinal tract contain the immunoglobulin. SIgA binds to bacteria or viruses that have penetrated into the gastrointestinal tract or the bronchi; Then the peristalsis of the intestine and the ciliated epithelium of the bronchi transport the sIgA together with bound pathogens. The secretory immunoglobulin A consists of two IgA molecules, the J chain and a secretory component. Polymerization to the sIgA takes place only in the mucous membranes; It is necessary for transport through the epithelial cells. The IgA molecules bind at the lumen-facing side to a receptor and are passed through the cell. When released in the lumen, a part of the receptor remains attached to the resulting IgA dimer - the secretory component. It protects the immunoglobulins from decomposition by digestion enzymes and from microbial attacks. Reference range: increased from> 2040 μg / ml sIgA in the faeces

       

       

       

      β-defensin 2

      The skin and the mucous membranes of the human body produce antibiotic substances - the defensins. They are part of the chemical barrier, which together with the physical barrier of the epithelial cells protect against intruders. Malfunction of defensin production plays a role in allergies such as neurodermatitis or bronchial asthma, and in inflammatory diseases. The β-defensins are the most widespread of all defensin types. Skin and mucosa form β-defensin 2 when they come into contact with bacteria or when an inflammatory reaction starts. Specific bacteria-containing preparations can stimulate defensin synthesis in the intestine and thus strengthen the mucosal barrier. Reference range: increased from> 60 ng / ml

       

       

      Inflammatory markers

      KyberPlus diagnostics also consists the following five inflammatory markers. Advantage of these fecal inflammation markers: the sample collection is simple and non-invasive and the tests are cost-effective.

       

       

      Eosinophil protein X

      The amount of circulating eosinophil protein X (EPX) reflects the inflammatory status of the body. EPX is suitable

      •     For the detection of acute or chronic inflammation
      •     For differentiation between food allergy and food intolerance
      •     For testing the effectiveness of an elimination diet
      •     For the detection of intestinal parasitosis.

      Eosinophils are members of the leukocytes. They occur frequently during inflammation and in response to infections with parasites. The cytoplasm of eosinophils consists of granules with positively charged proteins. These granulaproteins are alkaline and bind to strongly acidic dyes. The special affinity to the red-orange dye eosin gave the eosinophils their name. In degranulation, the eosinophils deposit EPX into the surrounding tissue. Granulaproteins such as the EPX can kill parasites but also cause tissue damage associated with inflammatory diseases. Activation of the eosinophils can be observed in many inflammatory processes. Examples are bronchial asthma, atopic dermatitis, rhinitis, allergic eye infections, allergic otitis media, parasite and bacterial infections, autoimmune diseases and the chronic fatigue syndrome. Reference range: increased from 1700 ng EPX / ml stool

       

       

       

      α-1-antitrypsin

      A-1-antitrypsin (α-1-AT) is a marker for inflammation and permeability disorders:

      •     Inflammatory disorders of the gastrointestinal tract
      •     Crohn's disease (prediction of a push)
      •     Necrotizing enterocolitis
      •     Suspicion of enteral protein loss syndrome
      •     Permeability disorders of the intestinal mucosa
      •     Gluten-sensitive enteropathy.

      The liver forms the protein α-1-antitrypsin. It accounts for up to 90 percent of all α-1 globulins. Α-1-Antitrypsin is a protease inhibitor, thus inhibiting proteolytic enzymes and thus preventing the decomposition of blood protein. Α-1-antitrypsin inhibits the enzyme elastase with decreasing effectiveness but also the enzymes trypsin, plasmin, thrombin and plasminogen. As a protease inhibitor, α-1-antitrypsin itself is only slightly degraded and is therefore well suited as a marker. In cases of inflammation, the body produces α-1-antitrypsin. Reference range: increased from 56 mg α-1-AT / dl stool

       

       

      Calprotectin

      Calprotectin is suitable for the diagnosis and follow-up in chronic inflammatory diseases such as Crohn's disease and ulcerative colitis. In addition, it serves as an exclusion criteria for irritable bowel syndrome.

      The neutrophilic granulocytes and the monocytes form the fecal calprotectin as a calcium-binding protein complex. Calptrotectin is a sensitive marker for inflammatory diseases. In one study, calprotectin showed a sensitivity of 82% and a specificity of 87% in the differentiation of irritable bowel syndrome and inflammatory diseases.

      Applications:

      • Acute inflammatory processes in the delimitation of functional complaints     
      • Activity monitoring of already known, chronic inflammatory diseases such as Crohn's disease and ulcerative colitis

      Reference range: increased from 50 μg calprotectin / g stool

      Lysozyme

      The lysozyme values in faeces are an indicator of leukocyte migration into the intestinal lumen. Colitis ulcerosa- and Crohn's patients show elevated lysozyme levels in faeces.

      Lysozyme is detectable in neutrophils, macrophages and paneth cells and occurs in saliva, sweat, nasal secretion and tear fluid. The enzyme cleaves sugar chains in the bacterial cell wall and thus initiates the lysis of the bacterial cell. However, the enzyme attacks only Gram-positive bacteria, such as streptococci and staphylococci: In Gram-negative bacteria their outer membrane protects the sugar chains from degradation.

      In addition, lysozyme is indirectly bactericidal as it enhances the activity of the immuno-antibodies. Dissolving the agglutination of microorganisms improves uptake and destruction by macrophages.

      Reference range: increased from 600 ng /ml lysozyme in the stool.

      Lactoferrin

      The lactoferrin concentration in faeces can be used to assess the disease activity in patients with chronic inflammatory diseases (CID). The parameter is also suitable for monitoring the success of a CED therapy.

      Lactoferrin is an iron-binding protein of the secondary granules of the neutrophil granulocytes. It is thus part of the congenital immune defense on the mucous membranes. During inflammation, the neutrophil granulocytes emit lactoferrin to kill pathogens. Due to its  iron binding capacity lactoferrin acts antimicrobially.

      Inflammation
      in the intestine increases the lactoferrin values in faeces. In the case of a non-inflammatory disease, such as the irritable bowel syndrome, the lactoferrin values stay in the normal range.

      Applications:

      •     Acute inflammatory processes in the delimitation of functional complaints
      •     Acute bacterial infections of the colon
      •     Activity monitoring of already known, chronic inflammatory diseases such as Crohn's disease
            and ulcerative colitis
      •     Tumors in combination with the tumor marker M2-PK

      Reference range: increased from 7.24 μg per g of faeces.