DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE.

BACKGROUND: Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual's well-being. OBJECTIVE: To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. METHODS: A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. RESULTS: The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient's needs. CONCLUSION: CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study.

BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

CNS or classic drugs for the treatment of pain in functional dyspepsia? A systematic review and meta-analysis of the literature.

BACKGROUND: Recent evidence has suggested that pain in functional dyspepsia (FD) is associated with nervous system dysfunction; indicating that therapies aimed at nervous system modulation might be associated with pain relief in FD. OBJECTIVE: To conduct a systematic review and meta-analysis to quantify the efficacy of drugs targeting the central nervous system (antidepressants and antianxiety agents - referred as "CNS drugs") and drugs targeting gastric modulation (antisecretory and prokinetic - referred as "classic drugs") for the treatment of pain in FD and, in an exploratory way, compare these 2 modalities of treatment. METHODS: MEDLINE and reference lists were examined for relevant articles. We included prospective studies that evaluated the effects of either CNS drugs or classic drugs (subdivided in prokinetic and antisecretory drugs) on the symptoms of FD. RESULTS: Seven studies for CNS drugs and 11 studies for gastric drugs met our inclusion criteria. The analyses of these drugs showed that the 2 groups of drugs are associated with a significant reduction in dyspeptic symptoms. The pooled effect size (standardized mean difference between pre-treatment versus post-treatment means) from the random effects model was 1.25 (95% C.I., 0.83, 1.67) for CNS; 1.63 (95% C.I., 1.28, 1.97) for prokinetic, and 0.93 (95% C.I., 0.57, 1.29) for antisecretory drugs. The exploratory comparison between classes of drugs revealed no significant difference in dyspeptic symptoms reduction between CNS and prokinetic drugs; however CNS drugs were associated with a larger reduction in symptoms as compared with antisecretory drugs. CONCLUSIONS: The results show that both CNS and classic drugs are associated with a significant pain reduction in functional dyspepsia.

IVTH BRAZILIAN CONSENSUS CONFERENCE ON HELICOBACTER PYLORI INFECTION.

Significant progress has been obtained since the III Brazilian Consensus Conference on H. pylori infection held in 2012, in Bento Gonçalves, Brazil, and justify a fourth meeting to establish updated guidelines on the current management of H. pylori infection. Therefore, the Núcleo Brasileiro para Estudo do Helicobacter pylori e Microbiota (NBEHPM), association linked to Brazilian Federation of Gastroenterology (FBG) held its fourth meeting again in Bento Gonçalves, RS, Brazil, on August 25-27, 2017. Twenty-six delegates, including gastroenterologists, endoscopists, and pathologists from the five regions of Brazil as well as one international guest from the United States, participated in the meeting. The participants were invited based on their knowledge and contribution to the study of H. pylori infection. The meeting sought to review different aspects of treatment for infection; establish a correlation between infection, dyspepsia, intestinal microbiota changes, and other disorders with a special emphasis on gastric cancer; and reassess the epidemiological and diagnostic aspects of H. pylori infection. Participants were allocated into four groups as follows: 1) Epidemiology and Diagnosis, 2) Dyspepsia, intestinal microbiota and other afections, 3) Gastric Cancer, and, 4) Treatment. Before the consensus meeting, participants received a topic to be discussed and prepared a document containing a recent literature review and statements that should be discussed and eventually modified during the face-to-face meeting. All statements were evaluated in two rounds of voting. Initially, each participant discussed the document and statements with his group for possible modifications and voting. Subsequently, during a second voting in a plenary session in the presence of all participants, the statements were voted upon and eventually modified. The participants could vote using five alternatives: 1) strongly agree; 2) partially agree; 3) undecided; 4) disagree; and 5) strongly disagree. The adopted consensus index was that 80% of the participants responded that they strongly or partially agreed with each statement. The recommendations reported are intended to provide the most current and relevant evidences to management of H. pylori infection in adult population in Brazil.

INTESTINAL MICROBIOTA IN DIGESTIVE DISEASES.

BACKGROUND: In recent years, especially after the development of sophisticated metagenomic studies, research on the intestinal microbiota has increased, radically transforming our knowledge about the microbiome and its association with health maintenance and disease development in humans. Increasing evidence has shown that a permanent alteration in microbiota composition or function (dysbiosis) can alter immune responses, metabolism, intestinal permeability, and digestive motility, thereby promoting a proinflammatory state. Such alterations can mainly impair the host's immune and metabolic functions, thus favoring the onset of diseases such as diabetes, obesity, digestive, neurological, autoimmune, and neoplastic diseases. This comprehensive review is a compilation of the available literature on the formation of the complex intestinal ecosystem and its impact on the incidence of diseases such as obesity, non-alcoholic steatohepatitis, irritable bowel syndrome, inflammatory bowel disease, celiac disease, and digestive neoplasms. CONCLUSION:: Alterations in the composition and function of the gastrointestinal microbiota (dysbiosis) have a direct impact on human health and seem to have an important role in the pathogenesis of several gastrointestinal diseases, whether inflammatory, metabolic, or neoplastic ones.

PREVALENCE OF SMALL INTESTINE BACTERIAL OVERGROWTH IN PATIENTS WITH GASTROINTESTINAL SYMPTOMS.

BACKGROUND: Small intestine bacterial overgrowth is a heterogeneous syndrome characterized by an increase in the number and/or the presence of atypical microbiota in the small intestine. The symptoms of small intestine bacterial overgrowth are unspecific, encompassing abdominal pain/distension, diarrhea and flatulence. Due to the increased cost and complexity for carrying out the jejunal aspirate, the gold standard for diagnosis of the syndrome, routinely the hydrogen (H 2 ) breath test has been used, utilizing glucose or lactulose as substrate, which is able to determine, in the exhaled air, the H 2 concentration produced from the intestinal bacterial metabolism. However, due to a number of individuals presenting a methanogenic microbiota, which does not produce H 2 , the testing on devices capable of detecting, concurrently, the concentration of exhaled H 2 and methane (CH 4 ) is justified. OBJECTIVE: This study aimed to determine the prevalence of small intestine bacterial overgrowth in patients with digestive symptoms, through a comparative analysis of breath tests of H 2 or H 2 and CH 4 associated, using glucose as substrate . METHODS: A total of 200 patients of both sexes without age limitation were evaluated, being directed to a Breath Test Laboratory for performing the H 2 test (100 patients) and of exhaled H 2 and CH 4 (100 patients) due to gastrointestinal complaints, most of them patients with gastrointestinal functional disorders. RESULTS: The results indicated a significant prevalence of small intestine bacterial overgrowth in the H 2 test and in the test of exhaled H 2 and CH 4 (56% and 64% respectively) in patients with gastrointestinal symptoms, and higher prevalence in females. It found further that methane gas was alone responsible for positivity in 18% of patients. CONCLUSION: The data found in this study is consistent with the findings of the current literature and underscores the need for using devices capable of capturing the two gases (exhaled H 2 and CH 4 ) to improve the sensitivity and hence the accuracy of small intestine bacterial overgrowth diagnosis in daily medical practice.

Prevalence of dyspeptic symptoms and heartburn of adults in Belo Horizonte, Brazil.

BACKGROUND: - Medical literature has shown dyspepsia and heartburn-related symptoms occur among 15% to 40% of the population. These symptoms can occur at any age and are more prevalent in women. OBJECTIVE: - Investigate the prevalence of dyspeptic symptoms and heartburn among individuals over 18. METHODS: - Individuals over 18 were randomly selected in public venues in Belo Horizonte/MG to participate. A standardized questionnaire that included questions related to social-demographic characteristics, eating habits, digestive symptoms, medical appointments, medications, exams, previous surgeries and comorbidities was applied. A questionnaire about functional dyspepsia diagnosis (Rome III) was also applied. RESULTS: - A total of 548 individuals were interviewed. Among these, 58.4% were women, 59.3% were white, 55.9% were single and the average age was 36 years. Within this group, 376 individuals (68.6%) declared to have some symptom and/or use medication to relieve dyspepsia symptoms, and for these patients were applied the Rome III questionnaire. Based on the diagnostic criteria for the questionnaire proposed by the Rome III consensus, the symptom of postprandial fullness was reported by 6.7% of the individuals, early satiety (3.5%) and epigastric pain (10.6%). The overlap of these symptoms was very frequent. The prevalence of functional dyspepsia was 10.6% (postprandial discomfort syndrome (8.2%) and epigastric pain syndrome (2.4%). Among all participants, 52.5% reported heartburn, and 11.1% presented this symptom at least once a week. The most used drug was omeprazole. CONCLUSION: - The prevalence of dyspeptic symptoms and heartburn among a Brazilian adult urban population is similar to those described in other countries.

Diagnóstico e abordagem terapêutica da constipação idiopática crônica: uma revisão de especialistas brasileiros / Diagnosis and management of chronic idiopathic constipation: a narrative review from a brazilian expert task force

ABSTRACT Background Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual's well-being. Objective To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. Methods A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. Results The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient's needs. Conclusion CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

RESUMO Contexto A constipação idiopática crônica (CIC) é uma condição que afeta amplamente a população global, representa um grande custo econômico, causa substancial utilização de recursos em saúde e impacta o bem-estar do indivíduo. Objetivo Revisar os consensos de Sociedades de especialistas e diretrizes publicados sobre o diagnóstico e tratamento da CIC em adultos, buscando auxiliar o raciocínio e a tomada de decisão para a conduta médica frente ao paciente e oferecer um material prático de referência. Métodos Uma força tarefa médica brasileira realizou uma busca na literatura científica nas bases de dados eletrônicos Medline/PubMed, SciELO, Embase e Cochrane, tendo sido utilizados os seguintes descritores: chronic constipation, diagnosis, management of chronic constipation. Adicionalmente, foi realizada uma revisão de artigos sobre o mecanismo de ação, segurança e eficácia das opções terapêuticas disponíveis no Brasil. Resultados A abordagem diagnóstica e o entendimento da fisiopatologia presente na CIC são itens fundamentais para que seja indicada a terapêutica apropriada e seja compreendido o ecossistema de necessidades do paciente. Conclusão A CIC é uma condição comum em adultos, ocorrendo com maior frequência em idosos e mulheres. O manejo correto é definido pela anamnese e exame físico detalhados, juntamente com a terapêutica apropriada, independentemente de ser farmacológica ou não, conforme o melhor momento de indicação. Desta forma, o impacto na qualidade de vida também é otimizado.

High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study

Abstract BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

Cystic fibrosis, gastroduodenal inflammation, duodenal ulcer, and H. pylori infection: the "cystic fibrosis paradox" revisited.

BACKGROUND: In cystic fibrosis (CF) patients a duodenal impaired bicarbonate secretion and unbuffered gastric acid are always described and the development of duodenal ulceration is uncommon (CF paradox). Helicobacter pylori (HP) infection is the main cause for duodenal ulceration and its prevalence in CF patients is controversial. AIM: The objective of this study is to evaluate HP prevalence, gastric histology, and duodenal ulceration in adult FC patients. METHODS: 32 adult CF patients were submitted to (13)C-urea breath test and serum immunoblotting test for HP diagnosis. Among them, 20 patients were submitted to endoscopy. RESULTS: 19/32 (68%) patients showed positive serology. Endoscopy showed erosive duodenitis (15%), and duodenal ulcer scar in 10%. On duodenal histology, 94.5%, showed active inflammation and 66.7% gastric metaplasia. CONCLUSION: HP infection prevalence in adult CF patients was similar to that of general Brazilian population. CF patients have all the duodenal spectrum of alterations, including duodenal ulcer. CF paradox may not exist.

Microbiota intestinal nas doenças digestivas / Intestinal microbiota in digestive diseases

ABSTRACT BACKGROUND In recent years, especially after the development of sophisticated metagenomic studies, research on the intestinal microbiota has increased, radically transforming our knowledge about the microbiome and its association with health maintenance and disease development in humans. Increasing evidence has shown that a permanent alteration in microbiota composition or function (dysbiosis) can alter immune responses, metabolism, intestinal permeability, and digestive motility, thereby promoting a proinflammatory state. Such alterations can mainly impair the host's immune and metabolic functions, thus favoring the onset of diseases such as diabetes, obesity, digestive, neurological, autoimmune, and neoplastic diseases. This comprehensive review is a compilation of the available literature on the formation of the complex intestinal ecosystem and its impact on the incidence of diseases such as obesity, non-alcoholic steatohepatitis, irritable bowel syndrome, inflammatory bowel disease, celiac disease, and digestive neoplasms. CONCLUSION: Alterations in the composition and function of the gastrointestinal microbiota (dysbiosis) have a direct impact on human health and seem to have an important role in the pathogenesis of several gastrointestinal diseases, whether inflammatory, metabolic, or neoplastic ones.

RESUMO CONTEXTO: Nos últimos anos, especialmente a partir do desenvolvimento de sofisticados estudos metagenômicos, as pesquisas acerca da microbiota intestinal se intensificaram, transformando de forma radical os nossos conhecimentos sobre o microbioma e sua relação com a manutenção da saúde e o desenvolvimento de doenças no ser humano. Evidências crescentes demonstram que uma alteração permanente da composição ou da função da microbiota (disbiose) pode alterar as respostas imunológicas, o metabolismo, a permeabilidade intestinal e a motilidade digestiva, promovendo, dessa maneira, um estado pró-inflamatório. Tais alterações podem comprometer, sobretudo, as funções imunes e metabólicas do hospedeiro, favorecendo o aparecimento de doenças como diabetes, obesidade, doenças digestivas, neurológicas, autoimunes e neoplásicas. Este artigo de revisão é uma compilação da literatura disponível sobre a formação do complexo ecossistema intestinal e seu impacto na incidência de doenças como obesidade, esteatohepatite não alcoólica, síndrome do intestino irritável, doença inflamatória intestinal, doença celíaca e neoplasias digestivas. CONCLUSÃO: Alterações na composição e função da microbiota gastrointestinal (disbiose) têm um impacto direto sobre a saúde humana e parecem ter um papel importante na patogênese de várias doenças gastrointestinais, sejam elas inflamatórias, metabólicas ou neoplásicas.

Prevalence of small intestine bacterial overgrowth in patients with gastrointestinal symptoms / Prevalência de supercrescimento bacteriano do intestino delgado em pacientes com sintomas intestinais funcionais

ABSTRACT BACKGROUND Small intestine bacterial overgrowth is a heterogeneous syndrome characterized by an increase in the number and/or the presence of atypical microbiota in the small intestine. The symptoms of small intestine bacterial overgrowth are unspecific, encompassing abdominal pain/distension, diarrhea and flatulence. Due to the increased cost and complexity for carrying out the jejunal aspirate, the gold standard for diagnosis of the syndrome, routinely the hydrogen (H 2 ) breath test has been used, utilizing glucose or lactulose as substrate, which is able to determine, in the exhaled air, the H 2 concentration produced from the intestinal bacterial metabolism. However, due to a number of individuals presenting a methanogenic microbiota, which does not produce H 2 , the testing on devices capable of detecting, concurrently, the concentration of exhaled H 2 and methane (CH 4 ) is justified. OBJECTIVE This study aimed to determine the prevalence of small intestine bacterial overgrowth in patients with digestive symptoms, through a comparative analysis of breath tests of H 2 or H 2 and CH 4 associated, using glucose as substrate . METHODS A total of 200 patients of both sexes without age limitation were evaluated, being directed to a Breath Test Laboratory for performing the H 2 test (100 patients) and of exhaled H 2 and CH 4 (100 patients) due to gastrointestinal complaints, most of them patients with gastrointestinal functional disorders. RESULTS The results indicated a significant prevalence of small intestine bacterial overgrowth in the H 2 test and in the test of exhaled H 2 and CH 4 (56% and 64% respectively) in patients with gastrointestinal symptoms, and higher prevalence in females. It found further that methane gas was alone responsible for positivity in 18% of patients. CONCLUSION The data found in this study is consistent with the findings of the current literature and underscores the need for using devices capable of capturing the two gases (exhaled H 2 and CH 4 ) to improve the sensitivity and hence the accuracy of small intestine bacterial overgrowth diagnosis in daily medical practice.

RESUMO CONTEXTO O supercrescimento bacteriano do intestino delgado é uma síndrome heterogênea, caracterizada pelo aumento no número e/ou presença de uma microbiota atípica no intestino delgado. Os sintomas do supercrescimento bacteriano do intestino delgado são inespecíficos englobando quadro de dor/distensão abdominal, diarreia e flatulência. Devido ao maior custo e complexidade para a realização do aspirado jejunal, padrão ouro para o diagnóstico da síndrome, tem sido utilizado rotineiramente o teste do hidrogênio (H 2 ) expirado, utilizando glicose ou lactulose como substrato, que é capaz de determinar, no ar expirado, a concentração de H 2 produzida a partir do metabolismo bacteriano intestinal. Entretanto, em decorrência de uma parcela de indivíduos apresentar uma microbiota metanogênica, não produtora de H 2 , justifica-se a realização do teste em aparelhos capazes de detectar, concomitantemente, a concentração de H 2 e metano (CH 4 ) expirados. OBJETIVO O presente estudo teve como objetivo determinar a prevalência de supercrescimento bacteriano do intestino delgado em pacientes com sintomas digestivos, através de uma análise comparativa dos testes respiratórios empregando H 2 ou H 2 e CH 4 associados, utilizando a glicose como substrato. MÉTODOS Foram avaliados 200 pacientes de ambos os sexos, sem limitação de idade, encaminhados a um Laboratório de Teste Respiratório para realização do teste de H 2 (100 pacientes) e de H 2 e CH 4 expirados (100 pacientes) devido a queixas gastrointestinais, a maioria deles portadores de distúrbios funcionais gastrointestinais. RESULTADOS Os resultados obtidos indicaram uma significativa prevalência do supercrescimento bacteriano do intestino delgado no teste do H 2 e no teste do H 2 e CH 4 expirados (56% e 64%, respectivamente) em pacientes com sintomas gastrointestinais, além de maior predominância no sexo feminino. Constatou-se ainda, que o gás metano foi isoladamente responsável pela positividade em 18% do total de pacientes. CONCLUSÃO Os dados encontrados no presente estudo demonstram condizentes com os achados da literatura atual e reforçam a necessidade da utilização de aparelhos capazes de captar os dois gases (H 2 e CH 4 expirados) para melhorar a sensibilidade e, consequentemente, a acurácia do diagnóstico de supercrescimento bacteriano do intestino delgado na prática médica diária.

Prevalence of dyspeptic symptoms and heartburn of adults in Belo Horizonte, Brazil / Prevalência de sintomas dispépticos e de pirose em uma população de adultos em Belo Horizonte, Brasil

ABSTRACT BACKGROUND Medical literature has shown dyspepsia and heartburn-related symptoms occur among 15% to 40% of the population. These symptoms can occur at any age and are more prevalent in women. OBJECTIVE Investigate the prevalence of dyspeptic symptoms and heartburn among individuals over 18. METHODS Individuals over 18 were randomly selected in public venues in Belo Horizonte/MG to participate. A standardized questionnaire that included questions related to social-demographic characteristics, eating habits, digestive symptoms, medical appointments, medications, exams, previous surgeries and comorbidities was applied. A questionnaire about functional dyspepsia diagnosis (Rome III) was also applied. RESULTS A total of 548 individuals were interviewed. Among these, 58.4% were women, 59.3% were white, 55.9% were single and the average age was 36 years. Within this group, 376 individuals (68.6%) declared to have some symptom and/or use medication to relieve dyspepsia symptoms, and for these patients were applied the Rome III questionnaire. Based on the diagnostic criteria for the questionnaire proposed by the Rome III consensus, the symptom of postprandial fullness was reported by 6.7% of the individuals, early satiety (3.5%) and epigastric pain (10.6%). The overlap of these symptoms was very frequent. The prevalence of functional dyspepsia was 10.6% (postprandial discomfort syndrome (8.2%) and epigastric pain syndrome (2.4%). Among all participants, 52.5% reported heartburn, and 11.1% presented this symptom at least once a week. The most used drug was omeprazole. CONCLUSION The prevalence of dyspeptic symptoms and heartburn among a Brazilian adult urban population is similar to those described in other countries.

RESUMO CONTEXTO Tem sido relatado que cerca de 15% a 40% da população geral apresenta alguma queixa dispéptica e/ou pirose. Os sintomas dispépticos podem surgir em qualquer idade e são mais prevalentes no sexo feminino. OBJETIVO Investigar a prevalência de sintomas dispépticos e pirose em indivíduos com idade superior a 18 anos. MÉTODOS Foram selecionados aleatoriamente indivíduos com idade superior a 18 anos, entrevistados em praças públicas de Belo Horizonte/MG, por meio de um questionário que abordou características sócio-demográficas, questões relacionadas aos hábitos alimentares, sintomas digestivos, consultas médicas, medicamentos, exames, antecedentes cirúrgicos, comorbidades e questionário específico para diagnóstico de dispepsia funcional (Roma III). RESULTADOS Foram entrevistados 548 participantes. Destes, 58,4% eram mulheres, 59,3% da raça branca, 56% solteiros e a idade média foi de 36 anos. Neste grupo, 376 indivíduos (68,6%) declararam ter algum sintoma e/ou utilizar algum medicamento para aliviar sintomas dispépticos. Para esses indivíduos, foi utilizado o questionário Roma III para o diagnóstico de dispepsia sendo sintoma de plenitude pós-prandial (6,7%), saciedade precoce (3,5%) e a dor ou queimação no estômago (azia) presente em 10,6%. A sobreposição desses sintomas foi muito frequente. A prevalência de dispepsia funcional foi de 10,6% (síndrome de desconforto pós-prandial (8,2%), síndrome da dor epigástrica (2,4%)). Dentre os participantes, 52,5% relatavam pirose, sendo que desses 11,1% apresentavam este sintoma, no mínimo, uma vez por semana. O medicamento mais utilizado foi o Omeprazol. CONCLUSÃO A prevalência dos sintomas dispépticos e pirose na população urbana adulta brasileira é semelhante a descrita em outros países.

3rd Brazilian consensus on Helicobacter pylori / 3º Consenso Brasileiro para Estudo do Helicobacter pylori

Significant progress has been obtained since the Second Brazilian Consensus Conference on Helicobacter pylori Infection held in 2004, in São Paulo, SP, Brazil, and justify a third meeting to establish updated guidelines on the current management of H. pylori infection. The Third Brazilian Consensus Conference on H pylori Infection was organized by the Brazilian Nucleus for the Study of Helicobacter, a Department of the Brazilian Federation of Gastroenterology and took place on April 12-15, 2011, in Bento Gonçalves, RS, Brazil. Thirty-one delegates coming from the five Brazilian regions and one international guest, including gastroenterologists, pathologists, epidemiologists, and pediatricians undertook the meeting. The participants were allocated in one of the five main topics of the meeting: H pylori, functional dyspepsia and diagnosis; H pylori and gastric cancer; H pylori and other associated disorders; H pylori treatment and retreatment; and, epidemiology of H pylori infection in Brazil. The results of each subgroup were submitted to a final consensus voting to all participants. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Seventy per cent and more votes were considered as acceptance for the final statement. This article presents the main recommendations and conclusions to guide Brazilian doctors involved in the management of H pylori infection.

Os avanços significativos ocorridos desde o Segundo Consenso Brasileiro sobre H. pylori realizado em 2004, em São Paulo, justificam este terceiro consenso. O evento foi organizado pelo Núcleo Brasileiro para Estudo do Helicobacter, departamento da Federação Brasileira de Gastroenterologia, tendo sido realizado em Bento Gonçalves, RS, nos dias 12 a 15 de abril de 2011. Contou com a participação de 30 delegados provenientes das cinco regiões brasileiras e um convidado internacional, incluindo gastroenterologistas, patologistas, epidemiologistas e pediatras. Os participantes foram alocados em um dos cinco subgrupos do evento, a saber: Helicobacter pylori, dispepsia funcional e diagnóstico; Helicobacter pylori e câncer gástrico; Helicobacter pylori e afecções não-gastroduodenais; Helicobacter pylori, tratamento e retratamento, e, epidemiologia da infecção por Helicobacter pylori no Brasil. Após extensa discussão, todas as recomendações e conclusões emanadas tinham definidas a força da recomendações e seu grau de evidência científica. As conclusões de cada subgrupo foram referendadas em votação final com todos os participantes. Foi adotado como consensual as decisões que atingissem 70% ou mais de concordância entre os participantes. Este artigo apresenta as principais recomendações e conclusões para orientação aos profissionais brasileiros envolvidos com a infecção por H. pylori.

Síndrome do intestino irritável - diagnóstico e tratamento / Irritable bowel syndrome - diagnosis and treatment

Síndrome do Intestino Irritável (SII) é um transtorno funcional crônico do tubo digestivo, caracterizado pela presença de dor e/ou desconforto abdominal associados à alteração do hábito intestinal ou à modificação das características das evacuações. A sua etiologia permanece desconhecida, mas provavelmente é multifatorial. A prevalência estimada da SII na população geral é de 10 a 20%, acometendo predominantemente mulheres entre 20 e 40 anos. O diagnóstico é feito baseado na sintomatologia predominante, adotando-se critérios clínicos bem estabelecidos (Roma III). O tratamento visa aliviar o sintoma predominante. Os antiespasmódicos representam as drogas de primeira escolha para o alívio da dor e do desconforto abdominal. Os antidepressivos tricíclicos têm se mostrado superiores ao placebo para os pacientes com SII e predomínio de diarreia, e a loperamida é eficaz em reduzir a frequência das evacuações nestes casos. Para os pacientes com SII e predomínio de constipação ou forma mista, as fibras solúveis representam a primeira opção. Probióticos e novos serotoninérgicos representam outras opções terapêuticas promissoras. Relatamos o caso de uma paciente do sexo feminino portadora de SII com diarreia predominante.

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, characterized by abdominal pain and change in bowel habit, with a fluctuating natural history. The exact etiology remains unknown, but it is unlikely there is a single unifying explanation. IBS affects 10-20% of the general population, with women 20-40 years old accounting for the majority of patients. The diagnosis should be made on clinical grounds, using Rome III diagnostic criteria. The clinical approach is based on treatment of the prevalent symptom. When pain predominates, antispasmodics are the first choice. Tricyclic antidepressants are more effective than placebo for patients with diarrhea predominant IBS, and loperamide is useful for reducing bowel frequency in this patients. Soluble fiber represents the first option in subjects with IBS and constipation or mixed IBS. Dietary integrators composed of probiotics and serotonin precursors are a promising therapeutic option. We report a case of a female patient with IBS-diarrhea predominant.

Enterografia por tomografia computadorizada: experiência inicial na avaliação das doenças do intestino delgado / CT enterography: a preliminary experience in the evaluation of small bowel diseases

OBJETIVO: O objetivo deste estudo é demonstrar a importância da enterografia por tomografia computadorizada (entero-TC) e como este exame pode contribuir na elucidação diagnóstica e avaliação clínica de pacientes com doenças do intestino delgado. MATERIAIS E MÉTODOS: Análise retrospectiva de 35 pacientes submetidos a entero-TC realizadas em aparelho multidetector de 16 canais, entre maio de 2008 e março de 2009. Utilizou-se meio de contraste iodado venoso e oral neutro (polietilenoglicol). As principais indicações foram avaliação de doença de Crohn, diarreia de origem indeterminada e suspeita de neoplasias. RESULTADOS: Houve boa correlação dos achados à entero-TC relacionados à atividade da doença em pacientes com doença de Crohn, quando comparados com dados clínicos, laboratoriais e endoscópicos. Em 15 casos identificaram-se alterações compatíveis com doença de Crohn, 9 deles sugerindo atividade. Dos pacientes com diarreia, o exame elucidou a maioria dos casos. Identificaram-se dois casos de tumor carcinoide. CONCLUSÃO: A entero-TC é método simples e eficaz para estudo das doenças inflamatórias/neoplásicas do intestino delgado, sobretudo na avaliação da doença de Crohn, indicando atividade da doença. Uma de suas principais vantagens é a possibilidade de avaliação de alterações mesentéricas e extraintestinais associadas.

OBJECTIVE: The present study was aimed at demonstrating the value of computed tomography enterography (CT enterography) and how this imaging method can be useful in the diagnostic elucidation and assessment of patients with small bowel diseases. MATERIALS AND METHODS: Retrospective evaluation of 35 patients submitted to CT enterography in a 16-row multidetector CT equipment from May/2008 to March/2009. All the patients received intravenous and neutral oral iodinated contrast agents (polyethylene glycol). Main indications were: Crohn's disease, diarrhea of undetermined origin and suspicion of neoplasia. RESULTS: A good correlation was observed between CT enterography findings and clinical, laboratory and endoscopic data related to the disease activity in patients with Crohn's disease. In 15 cases alterations compatible with Crohn's disease were identified, nine of them suggesting disease activity. A diagnosis was achieved in the majority of the patients with diarrhea. Carcinoid tumors were identified in two patients. CONCLUSION: CT enterography is a simple and effective method in the evaluation of inflammatory/neoplastic small bowel diseases, particularly in cases of Crohn's disease, indicating disease activity. One of the main advantages of this method is the possibility of evaluating associated mesenteric and extraintestinal alterations.

Síndrome do intestino irritável / Irritable Bowel Syndrome

A síndrome do intestino irritável é uma entidade clínica de natureza funcional diagnosticada a partir dos critérios de Roma III, que considera a dor e/ou desconforto abdominal por, pelo menos, três vezes/mês nos últimos três meses e que melhoram com a evacuação, associados a alteração no aspecto das fezes. A depender do hábito intestinal, pode apresentar-se com predomínio de diarreia, constipação ou alternância dessas manifestações. A fisiopatologia, que é complexa e não totalmente esclarecida, é multifatorial envolvendo hipersensibilidade visceral, alterações na flora bacteriana, infecções intestinais prévias e distúrbios psicológicos e psiquiátricos. O diagnóstico é estabelecido pela história clínica (Critérios de Roma III) e, eventualmente, exames laboratoriais básicos, com atenção para a ocorrência de sinais de alarme, porque, quando presentes, estes sugerem afecção orgânica que deve ser investigada apropriadamente. O tratamento é essencialmente sintomático, visando a normalização do hábito intestinal e redução da dor ou desconforto intestinal. Podem ser empregados probióticos e fármacos (antiespasmódicos, antidepressivos etc.). As possibilidades da medicina alternativa e complementar são mencionadas.