Differential diagnosis of the association of gastrointestinal symptoms and ST segment elevation, in the absence of chest pain.

This is a review of the underlying causes of the association of ST segment elevation and gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and anorexia, in patients who do not have chest pain. The review was based on anecdotal reports in Googlescholar and Pubmed using the search terms, abdominal pain, nausea, vomiting, anorexia, ST elevation, myocardial infarction, and Takotsubo cardiomyopathy. Those patients who did not have acute myocardial infarction as the cause of the association of ST segment elevation and gastrointestinal symptoms were compared with counterparts with similar symptoms who had well authenticated acute myocardial infarction or Takotsubo cardiomyopathy as the underlying cause of ST segment elevation. The underlying causes of gastrointestinal symptoms which could be associated with ST segment elevation in the absence of either acute myocardial infarction or Takotsubo cardiomyopathy comprised pneumonia, pulmonary embolism, perforated gastric ulcer, intestinal obstruction, acute appendicitis, acute pancreatitis, acute cholecystitis, pheochromocytoma, bacterial meningitis, diabetic keto acidosis, and cannabis abuse. However, each of those disorders could also coexist either with acute myocardial infarction or with Takotsubo cardiomyopathy. The coexistence of ST segment elevation and gastrointestinal symptoms(without chest pain) was also documented in patients with esophageal perforation, mesenteric ischaemia, aortic dissection, Kounis syndrome, and in electrolyte disorders. In the context of presentation with gastroenterological symptoms but without concurrent chest pain, echocardiography appeared to be useful in distinguishing between "pseudo" myocardial infarction characterised by ST segment elevation in the absence of cardiac disease vs ST segment elevation attributable either to acute myocardial infarction or to Takotsubo cardiomyopathy.

Peryton: a manual collection of experimentally supported microbe-disease associations.

We present Peryton (https://dianalab.e-ce.uth.gr/peryton/), a database of experimentally supported microbe-disease associations. Its first version constitutes a novel resource hosting more than 7900 entries linking 43 diseases with 1396 microorganisms. Peryton's content is exclusively sustained by manual curation of biomedical articles. Diseases and microorganisms are provided in a systematic, standardized manner using reference resources to create database dictionaries. Information about the experimental design, study cohorts and the applied high- or low-throughput techniques is meticulously annotated and catered to users. Several functionalities are provided to enhance user experience and enable ingenious use of Peryton. One or more microorganisms and/or diseases can be queried at the same time. Advanced filtering options and direct text-based filtering of results enable refinement of returned information and the conducting of tailored queries suitable to different research questions. Peryton also provides interactive visualizations to effectively capture different aspects of its content and results can be directly downloaded for local storage and downstream analyses. Peryton will serve as a valuable source, enabling scientists of microbe-related disease fields to form novel hypotheses but, equally importantly, to assist in cross-validation of findings.

Prevalence and Associated Dietary Factors of Rome IV Functional Gastrointestinal Disorders in Rural Western Honduras.

BACKGROUND: The literature is limited regarding the prevalence of functional gastrointestinal disorders (FGIDs) in Central America, and the role of dietary factors. METHODS: The Rome IV diagnostic questionnaire and National Cancer Institute Diet History questionnaire were administered in one-on-one interviews to a distributed cross section of the general adult population of Western Honduras. Our aim was to estimate prevalence of common FGIDs and symptoms and their relationships to dietary habits. RESULTS: In total, 815 subjects were interviewed, of whom 151 fulfilled criteria for an FGID (18.5%). Gastroduodenal FGIDs were noted in 9.4%, with epigastric pain syndrome (EPS) more common than postprandial distress syndrome, 8.5% versus 1.6%. Among bowel disorders, functional abdominal bloating (FAB) was most prevalent (6.3%), followed by irritable bowel syndrome (3.6%), functional diarrhea (FDr; 3.4%), and functional constipation (1.1%). A significant inverse association was noted between regular bean intake and any FGID (OR 0.41, 95% CI 0.27-0.63), driven by IBS and FDr. Vegetable consumption was associated with lower prevalence of functional diarrhea (OR 0.12; 95% CI 0.04-0.35) and any diarrheal disorder (OR 0.11; 95% CI 0.04-0.31). Subjects with a median daily intake of ≥ 4 corn tortillas had 1.75 (95% CI 1.22-2.50) times the odds of having any FGID. CONCLUSIONS: FGIDs were common in this rural low-resource setting in Central America, with an intriguing distribution of specific FGIDs. EPS and FAB were common, but IBS was not. Local dietary factors were associated with specific FGIDs, suggesting that diet may play a role in global variations of FGIDs.

Adaptación transcultural del componente de síntomas gastrointestinales de la escala CTCAE versión 4. 02 / Transcultural adaptation of the component of gastrointestinal symptoms of the CTCAE scale version 4. 02

Resumen Objetivo: Realizar la traducción y adaptación transcultural del componente de síntomas gastrointestinales (SGI) de la escala CTCAE versión 4.02 en pacientes ambulatorios tratados con quimioterapia en el Instituto Nacional de Cancerología en Bogotá. Métodos: Se realizó una búsqueda manual en medios electrónicos de escalas en idioma inglés o español que evaluarán la presencia, frecuencia o intensidad de SGI en pacientes oncológicos. La selección de los ítems fue efectuada por consenso informal de un comité técnico, el cual verificó la concordancia entre los principales SGI descritos en la literatura y los incluidos en la escala, ya que estos podrían afectar el estado nutricional. Posteriormente, para la adaptación transcultural, se siguieron los pasos y recomendaciones del manual ISPOR y del grupo de calidad de vida EORTC. La prueba piloto se efectuó en 30 pacientes seleccionados por conveniencia, quienes cumplieron los criterios de inclusión. Resultados: El 52% eran hombres; la edad promedio fue de 54,2 años (+/- 15,3 años). Los cánceres más frecuentes fueron: colorrectal (28%), estómago (16%) y mama (12%). Los 14 SGI incluidos en la escala fueron experimentados por todos los pacientes, por lo cual se conservaron, y no se requirió adicionar ningún otro. El tiempo promedio de aplicación del instrumento fue de 5 minutos y el 90% de los participantes lo consideró adecuado. Conclusiones: Se generó un instrumento de 14 ítems para medir SGI en pacientes oncológicos ambulatorios sometidos a quimioterapia, el cual es de rápida aplicación y utiliza lenguaje de fácil comprensión para el paciente. Aunque todavía quedan por definir sus propiedades clinimétricas.

Abstract Objective: To carry out the translation and transcultural adaptation of the gastrointestinal symptoms component (GIS) of the CTCAE, scale version 4.02, in outpatient patients treated with chemotherapy at the National Cancer Institute, Bogotá (Colombia). Methods: It was performed a manual search of scales on electronic media, in English or Spanish languages, which will evaluate the presence and intensity of GIS in oncological patients. The selection of the items was made by an informal consensus of a technical committee, which verified the concordance between the main GIS described in the literature and those included in the scale, all of which could affect the nutritional status. For transcultural adaptation, there were followed the steps and recommendations of the ISPOR Handbook, as well as those of the EORTC quality of life group. The pilot test was conducted in 30 patients selected for convenience, who met the inclusion criteria. Results: 52% were men; the average age was 54.2 years (+/-15.3 years). The most frequent cancers were: colorectal (28%), stomach (16%) and breast (12%). The 14 GIS included in the scale were experienced by all patients, so they were retained, and no other addition was required. The average time of application of the instrument was 5 minutes, and 90% of the participants considered it appropriate. Conclusions: A 14-item instrument was generated to measure GIS in cancer patients who undergo outpatient chemotherapy, which is of fast application and uses a language that is easily understood by patients. Its clinimetrics properties remain to be defined.

Current role of colonoscopy in infants and young children: a multicenter study.

BACKGROUND: To evaluate the role of colonoscopy in infants and young children and clarify the distribution of colonoscopy-requiring diseases in this age group. METHODS: Cohorts of colonoscopies performed at three children's hospitals in Japan between April 2011 and March 2016 including infants and children younger than six years of age were retrospectively reviewed. RESULTS: In total, 453 colonoscopies were performed in 276 infants and young children. Of these 275 (60.8%) were for diagnostic purposes, 177 (39.2%) were performed as follow-up, and one case was performed for treatment. The median patient age at the time of diagnostic colonoscopy was 2.49 years, and there was a male-to-female ratio of 1.72:1. Abnormal macroscopic and/or histopathological findings were noted in 212 (77.1%) cases. Of these, definite diagnoses were established for the presence of eosinophilic gastrointestinal disorders (EGIDs), inflammatory bowel disease (IBD), and polyp/polyposis in 23, 18.5, and 14% of patients, respectively. Among 51 IBD cases, ulcerative colitis, Crohn's disease, and IBD-unclassified were identified in 47.1, 33.3, and 7.8%, retrospectively via endoscopic examination. Of these, 11 (22%) were eventually diagnosed with monogenic diseases via genetic testing. Of those with rectal bleeding, EGIDs, polyps/polyposis, and IBD were found in 27, 19, and 18%, retrospectively. There were significantly more cases of EGIDs and fewer ones of IBD and polyps/polyposis in patients with rectal bleeding younger than two years of age. Furthermore, 68% of all follow-up colonoscopies were performed in children with IBD. There were no serious complications in our study cohort. CONCLUSION: We determined the role of colonoscopy in infants and young children. Diseases diagnosed using colonoscopy in this age group included IBD, EGIDs, and polyps/polyposis. The increasing trend of patients with IBD and EGIDs worldwide means that the role of colonoscopy in infants and younger children will be more important in the future.

Desnutrição e complicações clínicas em pacientes cirúrgicos com doença colorretal / Malnutrition and clinical outcomes in surgical patients with colorectal disease

ABSTRACT BACKGROUND: Malnutrition is a frequent condition among hospitalized patients and a factor of increased risk of postoperative complication. OBJECTIVE: This study aimed to evaluate the impact of malnutrition on phase angle (PA), body water distribution and clinical outcomes in surgical patients with colorectal disease. METHODS: This retrospective study was performed in a tertiary hospital with 40 patients admitted electively. In the preoperative evaluation, global subjective assessment and bioelectrical impedance analysis were performed to determine nutritional status, PA, extracellular water (ECW), intracellular water (ICW) and total body water (TBW). In postoperative evaluation, the length of hospital stay and severe complications, according to Clavien-Dindo classification, were determined. The optimal PA cutoff for malnutrition screening was determined by ROC curve analysis. RESULTS: Seventeen (42.5%) patients were diagnosed as malnourished and 23 (57.5%) as well-nourished according to global subjective assessment. Twelve (30.0%) patients developed severe complications. The malnourished group presented lower values of serum albumin (P=0.012), hematocrit (P=0.026) and PA (P=0.002); meanwhile, ECW/ICW (P=0.019) and ECW/TBW (P=0.047) were higher. Furthermore, 58.8% of malnourished patients developed severe postoperative complications compared to 8.7% of well-nourished. Malnutrition was independent predictor of severe postoperative complications (OR=15.00, IC: 2.63-85.68, P=0.002). The optimal PA cutoff obtained was 6.0º (AUC=0.82, P=0.001), yielding sensitivity, specificity, positive predictive value and negative predictive value of 76.5%, 87.0%, 81.3% and 83.4%, respectively. CONCLUSION: Malnutrition was an independent predictive factor for severe complications in patients underwent to elective major coloproctological surgery. Besides that, malnutrition was associated with lower PA values and greater ratio of ECW. The PA provided great accuracy in nutritional screening, implying a useful marker of malnutrition.

RESUMO CONTEXTO: A desnutrição é uma condição frequente entre pacientes hospitalizados e é um fator de risco para complicações pós-operatórias. OBJETIVO: Este estudo tem como objetivo avaliar o impacto da desnutrição sobre o ângulo de fase (AF), a distribuição de água corporal e complicações clínicas em pacientes cirúrgicos com doença colorretal. MÉTODOS: Trata-se de um estudo retrospectivo realizado em um hospital universitário terciário com 40 pacientes admitidos eletivamente. Na avaliação pré-operatória, foram realizadas a avaliação subjetiva global e análise de bioimpedância elétrica com a finalidade de determinarem o estado nutricional, AF, água extracelular (AEC), água intracelular (AIC) e água corporal total (ACT). Na avaliação pós-operatória, o tempo de internação hospitalar e a presença de complicações graves, segundo a classificação de Clavien-Dindo, foram determinados. O melhor ponto de corte do AF para o rastreamento de desnutrição foi obtido a partir da análise da curva ROC. RESULTADOS: Dezessete (42,5%) pacientes foram diagnosticados como desnutridos e 23 (57,5%), como bem nutridos de acordo com a avaliação subjetiva global. Doze (30,0%) pacientes desenvolveram complicações pós-operatórias graves. O grupo desnutrido apresentou menores valores de albumina sérica (P=0,012), hematócrito (P=0,026) e AF (P=0,002); enquanto que as relações de AEC/AIC (P=0,019) e AEC/ACT (P=0,047) estiveram elevadas. Além disso, 58,8% dos pacientes desnutridos desenvolveram complicações pós-operatórias graves em comparação a 8,7% dos pacientes bem nutridos. A desnutrição foi fator preditivo independente para o desenvolvimento de complicações pós-operatórias graves (OR=15,00, IC: 2,63-85,68; P=0,002). O melhor ponto de corte do AF obtido foi 6.0º (AUC=0,82; P=0,001) com sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de 76,5%, 87,0%, 81,3% e 83,4%, respectivamente. CONCLUSÃO: A desnutrição foi fator preditivo para o desenvolvimento de complicações graves em pacientes submetidos à cirurgia eletiva coloproctológica de grande porte. Além disso, a desnutrição foi associada a menores valores de AF e maior proporção de AEC. O AF forneceu boa acurácia no rastreamento da desnutrição, sugerindo seu uso como potencial marcador de desnutrição.

Expert consensus document: Advances in the diagnosis and classification of gastric and intestinal motility disorders.

Disturbances of gastric, intestinal and colonic motor and sensory functions affect a large proportion of the population worldwide, impair quality of life and cause considerable health-care costs. Assessment of gastrointestinal motility in these patients can serve to establish diagnosis and to guide therapy. Major advances in diagnostic techniques during the past 5-10 years have led to this update about indications for and selection and performance of currently available tests. As symptoms have poor concordance with gastrointestinal motor dysfunction, clinical motility testing is indicated in patients in whom there is no evidence of causative mucosal or structural diseases such as inflammatory or malignant disease. Transit tests using radiopaque markers, scintigraphy, breath tests and wireless motility capsules are noninvasive. Other tests of gastrointestinal contractility or sensation usually require intubation, typically represent second-line investigations limited to patients with severe symptoms and are performed at only specialized centres. This Consensus Statement details recommended tests as well as useful clinical alternatives for investigation of gastric, small bowel and colonic motility. The article provides recommendations on how to classify gastrointestinal motor disorders on the basis of test results and describes how test results guide treatment decisions.

[Establishment of comprehensive prediction model of acute gastrointestinal injury classification of critically ill patients].

OBJECTIVE: To develop the comprehensive prediction model of acute gastrointestinal injury (AGI) grades of critically ill patients. METHODS: From April 2015 to November 2015, the binary channel gastrointestinal sounds (GIS) monitor system which has been developed and verified by the research group was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of Chinese PLA General Hospital. Also, the AGI grades (Grande I(-IIII(, the higher the level, the heavier the gastrointestinal dysfunction) were evaluated. Meanwhile, the clinical data and physiological and biochemical indexes of included patients were collected and recorded daily, including illness severity score (APACHE II( score, consisting of the acute physiology score, age grade and chronic health evaluation), sequential organ failure assessment (SOFA score, including respiration, coagulation, liver, cardioascular, central nervous system and kidney) and Glasgow coma scale (GCS); body mass index, blood lactate and glucose, and treatment details (including mechanical ventilation, sedatives, vasoactive drugs, enteral nutrition, etc.) Then principal component analysis was performed on the significantly correlated GIS (five indexes of gastrointestinal sounds were found to be negatively correlated with AGI grades, which included the number, percentage of time, mean power, maximum power and maximum time of GIS wave from the channel located at the stomach) and clinical factors after standardization. The top 5 post-normalized main components were selected for back-propagation (BP) neural network training, to establish comprehensive AGI grades models of critically ill patients based on the neural network model. RESULTS: The 60 patients aged 19 to 98 (mean 54.6) years and included 42 males (70.0%). There were 22 cases of multiple fractures, 15 cases of severe infection, 7 cases of cervical vertebral fracture, 7 cases of aortic repair, 5 cases of post-toxicosis and 4 cases of cerebral trauma. There were 33 emergency operation, 10 cases of elecoperectomy and 17 cases of drug treatment. There were 56 cases of diabetes(93.3%). Forty-five cases (75.0%) used vasoactive drugs, 37 cases (61.7%) used mechanical ventilation and 44 cases (73.3%) used enteral nutrition. APACHE II( score were 4.0 to 28.0(average 16.8) points. Four clinical factors were significantly positively related with AGI grades, including lactic acid level (r=0.215, P=0.000), SOFA score (r=0.383, P=0.000), the use of vascular active drugs (r=0.611, P=0.000) and mechanical ventilation (r=0.142, P=0.014). In addition to the five indexes of gastric bowel sounds which were found to be negatively correlated with AGI grades, the characteristics of 333 by 9 were composed of these nine indexes with high correlation of AGI grades. Five main components were selected after principal component analysis of these nine correlated indexes. A comprehensive AGI grades model of critically ill patients with a fitting degree of 0.967 3 and an accuracy rate of 82.61% was built by BP artificial neural network. CONCLUSION: The comprehensive model to classify AGI grades with the GIS is developed, which can help further predicting the classification of AGI grades of critically ill patients.

MALNUTRITION AND CLINICAL OUTCOMES IN SURGICAL PATIENTS WITH COLORECTAL DISEASE.

BACKGROUND: Malnutrition is a frequent condition among hospitalized patients and a factor of increased risk of postoperative complication. OBJECTIVE: This study aimed to evaluate the impact of malnutrition on phase angle (PA), body water distribution and clinical outcomes in surgical patients with colorectal disease. METHODS: This retrospective study was performed in a tertiary hospital with 40 patients admitted electively. In the preoperative evaluation, global subjective assessment and bioelectrical impedance analysis were performed to determine nutritional status, PA, extracellular water (ECW), intracellular water (ICW) and total body water (TBW). In postoperative evaluation, the length of hospital stay and severe complications, according to Clavien-Dindo classification, were determined. The optimal PA cutoff for malnutrition screening was determined by ROC curve analysis. RESULTS: Seventeen (42.5%) patients were diagnosed as malnourished and 23 (57.5%) as well-nourished according to global subjective assessment. Twelve (30.0%) patients developed severe complications. The malnourished group presented lower values of serum albumin (P=0.012), hematocrit (P=0.026) and PA (P=0.002); meanwhile, ECW/ICW (P=0.019) and ECW/TBW (P=0.047) were higher. Furthermore, 58.8% of malnourished patients developed severe postoperative complications compared to 8.7% of well-nourished. Malnutrition was independent predictor of severe postoperative complications (OR=15.00, IC: 2.63-85.68, P=0.002). The optimal PA cutoff obtained was 6.0º (AUC=0.82, P=0.001), yielding sensitivity, specificity, positive predictive value and negative predictive value of 76.5%, 87.0%, 81.3% and 83.4%, respectively. CONCLUSION: Malnutrition was an independent predictive factor for severe complications in patients underwent to elective major coloproctological surgery. Besides that, malnutrition was associated with lower PA values and greater ratio of ECW. The PA provided great accuracy in nutritional screening, implying a useful marker of malnutrition.

Current Issues of Gastroenterology in Indonesia.

Indonesia is one of the most populous developing countries in the world. Similar with other developing countries, Indonesia has been suffered from the high incidence of gastroenterology diseases that mainly due to infection. In the recent years, Indonesia had also increased number of non-infectious gastroenterology diseases cases such as inflammatory bowel disease, gastroesophageal reflux disease, and colorectal cancer. Nevertheless, the developments of diagnostic and therapeutic modality along with the cooperation between sectors have undergone rapid progress as an effort in improving digestive health in Indonesia.

Morphological classifications of gastrointestinal lesions.

In the era of spreading adoption of gastrointestinal endoscopy screening worldwide, endoscopists encounter an increasing number of complex lesions in the gastrointestinal tract. For decision-making on optimal treatment, precise lesion characterization is crucial. Especially the assessment of potential submucosal invasion is of utmost importance as this determines whether endoscopic removal is an option and which technique should be used. To describe a lesion and stratify for the risk of submucosal invasion, several morphological classification systems have been developed. In this manuscript, we thoroughly discuss a systematic approach for the endoscopic assessment of a lesion, which include location, size, Paris classification, lateral spreading tumor classification if applicable and evaluation of the surface pattern with advanced endoscopic imaging techniques. The use of advanced imaging techniques improves the characterization of mucosal surface patterns and helps to determine whether lesions are amenable to endoscopic resection.

[Videolaparoscopy in diagnosis and treatment of diseases simulating acute appendicitis]. / Vozmozhnosti videolaparoskopii v diagnostike i lechenii zabolevanii, simuliruiushchikh ostryi appenditsit.

AIM: To analyze videolaparoscopic diagnosis and treatment of abdominal pathology simulating acute appendicitis (AA). MATERIAL AND METHODS: For the period 2008-2015 at Sklifosovsky Research Institute of Emergency Care 2784 patients with suspected AA underwent clinical, laboratory and ultrasonic examination. Depending on survey results patients were divided into 2 groups. Group I included 1352 (48.6%) patients with AA, group II - 1432 (51.4%) patients with suspected AA. All of them underwent videolaparoscopy. RESULTS AND DISCUSSION: Videolaparoscopy confirmed AA in 1308 (96.7%) patients of group I and 856 (59,8%) patients of group II. In the 1st group 36 (2.7%) patients had pathology simulating AA and 8 (0.6%) patients had not organic changes; in the 2nd group these values were 462 (32.3%) and 114 (7.9%) respectively. Absence of organic changes was explained by functional bowel disorders. In 95 (3.4%) out of 498 (17.9%) patients of both groups with simulating diseases videolaparoscopy was made and in 49 (1.8%) cases indications for laparotomy were established. In 354 (12.7%) patients with simulating diseases and 122 (4.4%) patients without organic changes operations were not carried out. CONCLUSION: Videolaparoscopy in patients scheduled for appendectomy or with unclear clinical picture allows to diagnose various forms of AA, simulating diseases and to perform necessary surgery.

Sim brasil study - women's gastrointestinal health: gastrointestinal symptoms and impact on the brazilian women quality of life / Saúde Gastrointestinal da Mulher: sintomas gastrointestinais e o impacto na qualidade de vida da mulher brasileira

ABSTRACT BACKGROUND Gastrointestinal symptoms seem to affect more women, due to hormonal and emotional issues, impacting the quality of life. The emotional state can affect the bowel functioning through a bidirectional communication system between the gut and the brain involving the neuroendocrine system. Altered bowel functioning and gastrointestinal symptoms can alter quality of life. OBJECTIVE The SIM study aimed to describe, characterize and quantify gastrointestinal symptoms reported by Brazilian women, their causes, feelings and impact. METHODS A structured electronic questionnaire was developed following qualitative phase for semantic formatting, and was administered to volunteer women in ten Brazilian cities. Descriptive and Bayesian statistics analyses were used. RESULTS From the 3029 respondent, 66% reported gastrointestinal symptoms. The most prevalent symptoms were gases (46%), abdominal distention and constipation (43%). The main causes were lifestyle and eating habits. Gastrointestinal symptoms affected quality of life in most women (62%), especially constipation (mood (89%), concentration (88%) and sexual life (79%)). Most common solutions were drinking water, teas, eating foods rich in fiber and probiotics. CONCLUSION Gastrointestinal symptoms are highly prevalent in Brazilian women and negatively impact different aspects of quality of life (mood, concentration and sexuality). The bowel is an important emotional catalyst that can modulate the psychologic behavior. Better understanding of the interaction between the gut and the brain should help in the management of gastrointestinal symptoms to improve women’s quality of life.

RESUMO CONTEXTO Sintomas gastrointestinais parecem afetar mais as mulheres, devido a problemas hormonais e emocionais, afetando a qualidade de vida. O estado emocional pode afetar o funcionamento do intestino por meio de um sistema de comunicação bidirecional entre o intestino e o cérebro que envolve o sistema neuroendócrino. Alterações da função intestinal e sintomas gastrointestinais podem afetar a qualidade de vida. OBJETIVO O estudo SIM teve como objetivo descrever, caracterizar e quantificar os sintomas gastrointestinais relatados por mulheres brasileiras, suas causas, sentimentos e impacto. MÉTODOS Questionário eletrônico estruturado foi desenvolvido após a fase qualitativa para formatação semântica, e foi administrado a mulheres voluntárias em 10 cidades brasileiras. Foram realizadas análises estatísticas descritivas e Bayesiana. RESULTADOS A partir dos 3029 respondentes, 66% relataram sintomas gastrointestinais. Os sintomas mais prevalentes foram gases (46%), distensão abdominal e constipação (43%). As principais causas relatadas foram estilo de vida e hábitos alimentares. Sintomas gastrointestinais afetaram a qualidade de vida da maioria das mulheres (62%), especialmente a constipação (humor (89%), concentração (88%) e vida sexual (79%)). As soluções mais comuns adotadas foram beber água, chás, comer alimentos ricos em fibras e probióticos. CONCLUSÃO Sintomas gastrointestinais são altamente prevalentes nas mulheres brasileiras e impactam negativamente diferentes aspectos da qualidade de vida (humor, concentração e sexualidade). O intestino é um catalisador emocional importante que pode modular o comportamento psicológico. Melhor compreensão da interação entre o intestino e o cérebro pode ajudar na gestão dos sintomas gastrointestinais para melhorar a qualidade de vida das mulheres.

[Radical oncological stomach, liver and pancreatic surgery in patients over 80 years old]. / Radikal'nye onkologicheskie vmeshatel'stva na zheludke, pecheni i podzheludochnoi zheleze u patsientov v vozraste 80 let i starshe.

AIM: To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old. MATERIAL AND METHODS: For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay. RESULTS: Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days. CONCLUSION: Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.

[How to Manage Chronic Diarrhoea]. / Abklärung der chronischen Diarrhö.

The differential diagnosis of chronic diarrhoea is broad and the evaluation of these patients represents a diagnostic challenge. This review provides a practical approach to reduce unnecessary testing while minimising the oversight of an important disease. Initial investigations include a detailed history, physical examination, and basic laboratory tests. Most younger patients (<50) with normal initial screen have functional diarrhoea. In patients above age 50, colonoscopy is recommended complementary for initial evaluation. In the absence of an identifiable cause, categorizing patients by having inflammatory or non-inflammatory chronic diarrhoea is helpful in directing further evaluation.

Gastro-intestinal manifestations in cystic fibrosis patients.

Cystic fibrosis (CF) is a life-limiting disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR). This defective chloride channel, present in different organ systems such as respiratory system, gastrointestinal tract, reproductive system and sweat glands, disturbs the ion and water transport over the membranes leading to the well known CF symptoms. CF has outgrown paediatric care, as half of CF patients are currently adults. The CF gastrointestinal tract has its own particularities. Some gastrointestinal manifestations are the direct consequence of the CFTR defect whilst others are secondary to treatment. The gastrointestinal diseases are classified according to the way they usually present in symptoms at diagnosis, acute and chronic abdominal pain and silently evolving conditions. (Acta gastroenterol. belg., 2016, 79, 481-486).

Etnobotânica de espécies vegetais medicinais no tratamento de transtornos do sistema gastrointestinal / Ethnobotany of medicinal species in the treatment of gastrointestinal system disorders

RESUMO O estudo objetivou selecionar na comunidade Rio Urubueua de Fátima, Abaetetuba-Pará, as espécies vegetais utilizadas no tratamento de transtornos do sistema gastrointestinal, em determinado contexto de uso, associado a um conhecimento construído localmente. A pesquisa foi realizada com 35 informantes entre 28 e 93 anos, selecionados pelo método bola de neve. Os dados foram obtidos por observação participante e entrevistas semiestruturadas. Para a importância relativa das espécies vegetais, calculou-se a porcentagem de concordância quanto aos usos principais (CUP) e concordância quanto aos usos principais corrigida (CUPc). Os interlocutores indicaram várias receitas terapêuticas, e, destas, foram escolhidas as mais empregadas no tratamento da diarreia, por ser doença recorrente na comunidade. Foi investigado o potencial químico das plantas por meio de literatura científica e bancos de dados. “Boldo” e “Anoerá” apresentaram valor máximo de CUP (100%), enquanto a “Hortelã” obteve maior CUPc (87,5%). Das 79 espécies vegetais empregadas como medicinais, nove estão na lista do SUS. Os remédios são preparados exclusivamente sob a forma de chá, sendo a folha a parte da planta mais utilizada (65%). Para o tratamento de diarreia, 12 espécies utilizadas pelos interlocutores têm compostos químicos comprovados por literatura especializada. A comunidade de Rio Urubueua de Fátima faz uso das plantas medicinais para curar doenças, apropriando-se de conhecimentos obtidos, na maioria dos relatos, de seus antepassados. Estes saberes tradicionais contribuem no conhecimento cultural da região e na pesquisa e desenvolvimento de novos fármacos.

ABSTRACT This study aimed to select the plants used to treat disorders of the gastrointestinal system, in the Rio Urubueua community of Fatima, Abaetetuba, and Pará for their particular context of use, combined with local knowledge. The survey was conducted with 35 informants between the ages of 28 and 93, selected using the snowball method.Data was obtained by participant observation, semi-structured interviews and by non-specific induction. To show the relative importance of plant species, we calculated the percentage of agreement on the main uses (CUP) and agreement with regards to the corrected main uses (cUPC).The interlocutors indicated various therapeutic recipes, and from these, those most used in the treatment of diarrhea were chosen, due to having recurrent cases of this disease in the community. The chemical potential of plants was investigated using scientific documents and databases. “Boldo” and “Anoerá” showed a maximum CUP value (100%), while the “Hortelã” obtained a higher cUPC (87.5%). Of the 79 plant species used in traditional medicine in this community, nine are used by the national healthcare service(SUS). The drugs are prepared only in the form of tea, with the leaves being the most widely used plant parts (65%).For the treatment of diarrhea, the 12 species used by the interlocutors have chemical compositions that are supported by specialized literature. The Rio Urubueua community of Fatima makes use of medicinal plants to cure diseases, from knowledge obtained, in most cases, from their ancestors. This traditional knowledge contributes to the cultural knowledge of the region and to the research and development of new drugs.

Diamine oxidase levels in different chronic urticaria phenotypes.

BACKGROUND: Diamine oxidase (DAO) is a polyamine-degrading enzyme also implicated in histamine metabolism. Chronic urticaria (CU) has a wide spectrum of clinical presentations and causes. Anisakis sensitisation associated chronic urticaria (CU+) has been characterised as a phenotype with different clinical and immunological characteristics and possibly associated with previous acute parasitism. We aimed to analyse serum DAO levels in different CU phenotypes. We further analysed the possible association of DAO with fish eating habits. METHODS: We studied 35 CU+ patients and 39 non-sensitised CU patients (CU-) as well as 19 controls. We analysed fish-eating frequency as well as fish intake associated exacerbation of CU (FIAE) or gastro-intestinal complaints (GI). DAO levels were further analysed with respect to lymphoproliferative responses, cytokine and specific IgE production. RESULTS: DAO levels were not different between CU and controls, but were significantly higher in CU+ than in CU-. CU+ patients with FIAE had lower DAO levels, but no differences were detected in patients with GI. DAO levels correlated positively with oily and canned fish consumption in CU-. In CU+, DAO levels correlated positively with specific Anisakis IgE, percentages of proliferation in Anisakis stimulated peripheral blood lymphocytes, serum IL-2 and IL-6, but correlated negatively with mitogen stimulated TGF-ß in supernatants. CONCLUSIONS: DAO levels in CU depend on fish-eating habits and in CU+ on the amount of specific IgE production. In the CU+ phenotype, lower levels of DAO predispose to urticaria exacerbation after fish intake, probably due to a relative insufficient enteric availability of this enzyme.