Improvement in Food Intolerance Resulting from Roux-En-Y Gastric Bypass after Speech Therapy Intervention in Chewing.

INTRODUCTION: Food intolerance is expected during the postoperative period following gastric bypass and may be associated with inadequate chewing. OBJECTIVE: To evaluate chewing before and after speech therapy intervention in subjects undergoing Roux-en-Y gastric bypass who present with food intolerance. MATERIALS AND METHODS: This was a randomized controlled trial, approved by the Brazilian Ethics and Research Committee under n. 438,600. The study population was allocated into two groups: the study group (SG), who received speech therapy intervention, and the control group (CG), who did not receive any intervention, in six visits at 7, 15, 30, 60, and 90 days (v7, v15, v30, v60, and v90) after the initial visit (v0). During v0 and v90, a chewing evaluation was performed according to the MBGR protocol adapted. The significance level adopted was 5%. RESULTS: A total of 30 females (88%) and 4 males (12%) were analyzed. The SG had 18 subjects, and the CG had 16, with mean ages of 50.17 ± 12.28 years and 45.69 ± 9.78 years, respectively. The postoperative time ranged from 4 to19 months. In the SG, a marked improvement in the number of episodes of food intolerance was observed (p < 0.001), an improvement in the intake of cereals and meats (p = 0.004 and p < 0.001, respectively), and an improvement in chewing capacity and swallowing (p = 0.002 and p = 0.011, respectively). CONCLUSION: Speech therapy intervention in chewing led to a marked improvement of food acceptance and food intolerance resulting from Roux-en-Y gastric bypass.

Preventing and Treating Colic.

Colic is a common and distressing functional gastrointestinal disorder during infancy. It is a behavioral phenomenon in infants aged 1-4 months involving prolonged inconsolable crying and agitated status with multifactorial etiology. Colic can be considered as a benign, self-limited process because the baby normally grows and feeds even with transient irritable mood. Nevertheless, infantile colic is a common difficulty causing anxiety during parenthood and a recurrent reason for them to seek medical help, especially if it is the first child. The causes of colic can be classified as non-gastrointestinal or gastrointestinal. The former includes altered feeding techniques, modified child-parent relationship, immaturity of central nervous system, behavioral etiology, and maternal smoking or nicotine replacement therapy. Instead, the latter involves inadequate production of lactase enzyme, cow's milk protein intolerance, alteration of intestinal microbiota, gastrointestinal immaturity, or inflammation which causes intestinal hyperperistalsis due to increase in serotonin secretion and motilin receptor expression.Probiotics may play a crucial part in the manipulation of the microbiota. Probiotic administration is likely to maintain intestinal homeostasis through the modulation of permeability and peristalsis, influencing the gut-brain axis and inhibiting hypersensitivity. This is a decisive field in the development of preventive and therapeutic strategies for infantile colic. However, further studies are needed for each specific formulation in order to better characterize pharmacodynamic and pharmacokinetic properties and to evaluate their application as a possible preventive strategy if administered early during infancy against the later development of pain-related FGIDs.

Síndrome do intestino irritável, intolerância alimentar e intolerância não celíaca ao glúten. Um novo desafio clínico / Irritable bowel syndrome, food intolerance and non- celiac gluten sensitivity. a new clinical challenge

ABSTRACT Approximately 80% of irritable bowel syndrome (IBS) patients report that their symptoms are triggered after ingesting one or specific food groups. Gluten, wheat and related proteins (e.g., amylase-trypsin inhibitors, and fermentable oligo-di-mono-saccharides and polyols (FODMAPs) are the most relevant IBS symptom triggers, although the true 'culprit(s)' is/are still not well established. The concept of causal relationship between gluten intake and the occurrence of symptoms in the absence of celiac disease and wheat allergy was termed non-celiac gluten sensitivity (NCGS). The borderline between celiac disease, wheat allergy, IBS and NCGS is not always clearly distinguishable, and the frequency and clinical identity of NGCS are still unclear. An overlap between IBS and NCGS has been detected. The incomplete knowledge of the etiopathogenesis of these clinical conditions, lack of data on their real epidemiology, as well as the absence of a gold standard for their diagnosis, make the overall picture difficult to understand "It is crucial to well define the interaction between IBS, food intolerance and NGCS, since the role of diet in IBS and its dietary management is an essential tool in the treatment of a large number of these patients". The objective of the present review is to provide an overview highlighting the interaction between IBS, food intolerance and NCGS in order to unravel whether gluten/wheat/FODMAP sensitivity represents 'facts' and not 'fiction' in IBS symptoms.

RESUMO Cerca de 80% dos pacientes com síndrome do intestino irritável (SII) relatam que seus sintomas são desencadeados após a ingestão de um ou grupos específicos de alimentos. Nesse grupo, glúten, trigo e proteínas relacionadas (como inibidores de amilase-tripsina e oligo-di-mono-sacarídeos e polióis fermentáveis (FODMAPs) são os fatores desencadeantes de sintomas mais relevantes da SII, embora o verdadeiro 'culpado(s)' ainda não seja conhecido. O conceito de relação causal entre a ingestão de glúten e a ocorrência de sintomas na ausência de doença celíaca e alergia ao trigo foi denominado sensibilidade ao glúten não celíaca (SGNC). A fronteira clínica entre doença celíaca, alergia ao trigo, SII e SGNC não está claramente distinguível, apesar da sobreposição entre SII e SGNC ser frequentemente relatada na literatura. O conhecimento incompleto da etiopatogenia dessas condições clínicas, a falta de dados sobre sua epidemiologia real, bem como a ausência de um padrão ouro para seu diagnóstico da associação SII/SGNC, dificultam a compreensão dessa nova entidade. "É de suma importância definir com precisão a interação entre SII, intolerância alimentar e SGNC, já que o papel da dieta no tratamento da SII é uma ferramenta essencial no tratamento de um grande número desses pacientes". A presente revisão tem como objetivo apresentar dados atuais a respeito da interação entre SII, intolerância alimentar e SGNC. Além disso questiona-se, com os dados disponíveis, a sensibilidade ao glúten/trigo/FODMAPs, representa "fato" e não "ficção" na geração de sintomas associados a SII.