Bowel bacterial overgrowth as another cause of malnutrition, inflammation, and atherosclerosis syndrome in peritoneal dialysis patients.

Bowel bacterial overgrowth syndrome (BBOS) is an important cause of gastrointestinal (GI) abnormalities. Proinflammatory cytokines (PICs) are excessively produced and accumulate because of kidney failure in dialysis patients who experience chronic infections such as BBOS. We explored the association between GL function, BBOS, and the malnutrition, inflammation, and atherosclerosis (MIA) syndrome. We studied GI malabsorption and maldigestion by analyzing fecal starch, sugar, fat, and nitrogen; intestinal protein permeability (alpha1-antitrypsin fecal clearance); and fecal chymotrypsin. We evaluated BBOS by breath hydrogen test (BHT) after a 3-day fat-and-carbohydrate-overload diet. Positive BHT was present in 10 patients, showing a high prevalence of GI macronutrient malabsorption and maldigestion, and compared with the other patients, the highest plasma levels of tumor necrosis factor alpha and interleukin 6 and lower levels of albumin and prealbumin. Those 10 patients were treated with a combination of several antibiotics, including neomycin, amoxicillin-clavulanate, and quinolones. Between 2 and 3 months later, the BHT, markers of nutrition, and PIC were re-tested. All treated patients showed an improvement in nutrition status and a lesser inflammatory pattern. The BBOS infectious process is found frequently in dialysis patients in association with GI malabsorption and maldigestion, malnutrition, and systemic inflammation. Hyperproduction of PIC because of BBOS induces MIA through a double pathway: GI disorders and deleterious systemic effects.

Efectividad de intervenciones psicológicas en mujeres con trastorno por atracón: una revisión sistemática / Effectiveness of psychological interventions in women with binge eating disorder: a systematic review

Resumen Objetivo: Examinar la efectividad, contenido, tipos de intervención y calidad de los tratamientos psicológicos de trastorno por atracón (TPA) en mujeres, que se han realizado en los últimos 20 años. Método: La revisión sistemática se realizó basada en la guía PRISMA y fue llevada acabo de Septiembre de 2018 a Junio de 2020 en las bases de datos: Medline, Scopus, Sciencedirect, Scielo, Redalyc y LILACS. Resultados: Se identificaron 206 artículos potencialmente relevantes, se seleccionó 15 que cumplían los criterios de inclusión. En el análisis de resultados se identificó que la mayoría de los estudios tuvo como objetivo probar la efectividad de las intervenciones. Los enfoques clínicos más utilizados fue la Terapia Cognitivo Conductual, la Terapia Dialéctica Conductual, la Terapia de Imagen Corporal y el Psicoanálisis. Los cuestionarios más utilizados para medir el TPA fueron el Eating Disorder Examination, la entrevista clínica basada en el DSM y la Escala de Atracón (BES). Discusión: Se observan retos en el trabajo multidisciplinario, además de resaltar la importancia del compromiso colaborativo con el paciente. Se plantea la necesidad de mayores estudios que consoliden y profundicen en la evaluación y tratamiento temprano del trastorno, así como ahondar en el enfoque emocional.

Abstract Objective: To examine the effectiveness, content, types of intervention and quality of psychological treatments for binge eating disorder (BED) in women, which have been carried out in the last 20 years. Method: The systematic review was carried out based on the PRISMA guide and was carried out from September 2018 to June 2020 in the databases: Medline, Scopus, ScienceDirect, Scielo, Redalyc and LILACS. Results: 206 potentially relevant articles were identified, 15 were selected that met the inclusion criteria. In the analysis of results, it was identified that the majority of the studies aimed to test the effectiveness of the interventions. The most widely used clinical approaches were Cognitive Behavioral Therapy, Dialectical Behavioral Therapy emphasizing the emotional component and interpersonal relationships, finally Body Image Therapy and Psychoanalysis. The most widely used questionnaires to measure BED were the Eating Disorder Examination, the DSM-based clinical interview and the Binge Eating Scale. Discussion: Challenges in multidisciplinary work are observed, in addition to highlighting the importance of collaborative commitment with the patient. There is a need for further studies that consolidate and deepen the early evaluation and treatment of the disorder, as well as delving into the emotional approach.