[Silent celiac disease among 21 patients with cryptogenic epilepsy]. / Enfermedad celíaca silente en epilepsia criptogénica del adulto.

BACKGROUND: Celiac disease (CD) is predominant in women and young people. Atypical, non-enteric symptoms are more common among adults. There is also an association between CD and neurological disorders, especially with cerebellar ataxia, polyneuropathy and epilepsy. AIM: To study the frequency of CD in a group of adults with cryptogenic epilepsy. MATERIAL AND METHODS: Twenty one patients with cryptogenic epilepsy, aged 20 to 65 years (14 women) were studied, measuring IgA-anti transglutaminase antibodies and deamidated gliadin peptide (DGP) IgG and IgA antibodies. RESULTS: One patient had elevated titers of both types of antibodies. Small bowel biopsy showed villous atrophy and lymphocytic infiltration compatible with CD. CONCLUSIONS: One of 21 adult patients with cryptogenic epilepsy had a silent CD.

[Skin and soft tissue infection caused by Streptococcus pneumoniae: report of 15 cases]. / Infección de piel y partes blandas por Streptococcus pneumoniae: presentación de 15 casos.

OBJECTIVE: Streptococcus pneumoniae is a very rare cause of skin and soft tissue infections (SSTI). The aim of this study was to determine the clinical and microbiological characteristics of these infections. METHODS: The medical records of patients with SSTIs due to S. pneumoniae diagnosed at the University Hospital of Guadalajara between January 2012 and December 2020 were retrospectively reviewed. Microbiological identification was performed using conventional procedures. Antimicrobial sensitivity was performed using the MicroScan WalkAway-96 plus automatic system and E-test strips following the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS: Fifteen cases of SSTIs were diagnosed. 73,3% of the cases presented underlying diseases, neoplasias being the most frequent. 60% of the cases presented predisposing factors, immunosuppression being the most common. The clinical presentations were: abscesses in different locations, ulcers, surgical wounds, lactational mastitis and necrotizing fasciitis. Polymicrobial infections were detected in 73.3% and the etiology was nosocomial in 6.6%. The clinical course was favorable in 90.9% of the cases. The antibiotics with the highest percentages of sensitivity against S. pneumoniae were cefotaxime, levofloxacin, vancomycin, linezolid and rifampicin. CONCLUSIONS: S. pneumoniae should be kept in mind as a possible causative agent of SSTIs, especially in patients with neoplasias and immunosuppression. Its involvement in infections such as lactational mastitis and necrotizing fasciitis should be highlighted. The clinical evolution is favorable in most patients, but it is important to pay special attention to cases of necrotizing fasciitis due to the severity of these infections.

Efecto perjudicial de la pandemia por SARS-CoV-2 en la sintomatología digestiva en pacientes con síndrome de intestino irritable / Detrimental impact of SARS-CoV-2 pandemic in the symptomatology of patients with irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a more frequent disorder in the brain-gut axis interaction in the world. COVID-19 has affected the population's mental health, and its impact on clinical severity in patients with IBS is unknown. Objective: To evaluate the effect of psychosocial stress produced by the pandemic on the severity of gastrointestinal symptoms. Methodology: 54 women and three men with IBS were interviewed by telephone. Factors associated with quality of life, comorbidities, IBS subtype, and COVID-19 diagnosis were asked. Calls were developed between June 2020 to January 2021. Results: 75% had Diarrheal IBS (IBS-D), 67% had comorbidities, 47% with busy work, and 70% in person, five patients (9%) were diagnosed with COVID-19. Of the total, 88% referred to change in gastrointestinal symptoms, 56% increased abdominal pain, and 95% bloating. Abdominal pain was negatively associated with quality of life (p < 0.036), and the incomplete evacuation's sensation positively with difficulty sleeping (p < 0.034). Conclusion: In this study, IBS patients interviewed by telephone reported higher abdominal pain and subjective bloating associated with the pandemic by SARS-CoV-2. Keywords: Irritable

El Síndrome de Intestino Irritable (SII) es uno de los trastornos en la interacción cerebrointestino más frecuentes en el mundo. La pandemia COVID-19 ha afectado la salud mental de la población, siendo desconocido su impacto en la severidad clínica en pacientes con SII. Objetivo: Evaluar el efecto del estrés psicosocial producido por la pandemia en la severidad de síntomas gastrointestinales de pacientes con SII. Metodología: 54 mujeres y 3 hombres con SII fueron entrevistados vía telefónica. Se preguntó por factores asociados a calidad de vida, comorbilidades, subtipo de SII y diagnóstico de COVID-19. Las llamadas se realizaron entre junio de 2020 hasta enero de 2021. Resultados: Un 75% presentó SII Diarreico (SII-D), el 67% comorbilidades, el 47% con trabajo activo y 70% presencial, 5 pacientes (9%) diagnosticados COVID-19. Del total, 88% refirió cambio en síntomas gastrointestinales, 56% aumentó el dolor abdominal y 95% la distensión abdominal. El dolor abdominal se asoció negativamente con la calidad de vida (p < 0,036), y la sensación de evacuación incompleta positivamente con la dificultad para dormir (p < 0,034). Conclusión: En este estudio, los pacientes con SII entrevistados vía telefónica reportaron mayor dolor y distensión abdominal subjetiva asociado a la pandemia por SARS-CoV-2.

Body composition of Peruvian children with short stature and high weight-for-height. II. Implications for the interpretation for weight-for-height as an indicator of nutritional status.

In some child populations, low height-for-age, suggesting chronic undernutrition, may paradoxically be accompanied by relatively high weight-for-height, suggesting obesity. This growth pattern was investigated with anthropometric assessment and body composition studies using H2(18)O stable isotope dilution in 139 preschool-age Peruvian children. Results suggested low height-for-age (15th percentile National Center for Health Statistics [NCHS]) and high weight-for-height (60th percentile NCHS). Skinfold thicknesses were lower whereas arm muscle areas were more similar to NCHS reference values. Total body water (as percent body weight) was greater than reference values, consistent with lower body fat. Differences in body proportions did not account adequately for the high weight-for-height. The data suggest that the high weight-for-height in these children is not obesity but is associated with lower body fat and greater lean tissue or lean tissue hydration that may reflect dietary, environmental, or genetic influences. Weight-for-height cutoffs for wasting or obesity may require different interpretations for different populations.

Body composition of Peruvian children with short stature and high weight-for-height. I. Total body-water measurements and their prediction from anthropometric values.

Total body water (TBW) was measured by 18O dilution in 139 undernourished, preschool Peruvian children with high weight-for-height. Values for TBW as a percent of body weight were relatively high, averaging 67.4 +/- 6.4%. Depending upon the method of calculation, mean values for the sample population for percent fat ranged from 9.4-18.5%. Regression of TBW on lean body mass suggested that hydration of the fat-free body was higher than for normally nourished children of comparable age. Thus, the increased weight-for-height in these children did not result from increased fat tissue, but from increased hydration of the fat-free body. TBW was most highly correlated with height and weight, both with r = 0.95. Equations predicting TBW from either height or weight were significantly different from those developed by other investigators to predict TBW for normal, well-nourished American children.

Cigarette smoking and bruxism.

Responses of 18 smokers and 165 nonsmokers to two items which assessed experience with symptoms of bruxism were compared. Smokers were about three times more likely to experience symptoms of bruxism but not over-all stressful experience.

Nightmare distress and stress-related health problems.

Responses of 289 university students to Belicki's Nightmare Distress Questionnaire and the Stress-related Health Problems Scale were used to test the hypothesis that persons who score high on nightmare distress are more likely to report psychological problems. Since relative to the Low Nightmare Distress group, the High Nightmare Distress group scored significantly higher on all seven of the sets of symptoms that are measured by the Stress-related Health Problems Scale, this hypothesis was supported.

[Vegetable food resources with agroindustrial potential from Guatemala. Manufacture of vegetable milk from the seed of morro fruit (Crescentia alata)]. / Recursos alimenticios vegetales con potencial de explotación agroindustrial de Guatemala. Elaboración de leche vegetal a partir de la semilla del fruto de morro (Crescentia alata).

The objective of the present study was to establish the conditions for the preparation of vegetable milk from the morro or jicara seed, and to characterize the products, the milk and the residue for their partial chemical composition and acceptability. From the ripe fruit, the seeds were obtained by maceration in water for 3.5 hrs, obtaining seed yields of 80%. This seed contained 38% fat and 26% protein on a dry weight basis. The harvested seed was then dehydrated to 9-12% moisture by exposure to solar energy. A similar lot was lightly roasted by heating on a hot surface for 10 min at 90-110 degrees C. The seed was used for the extraction of solubles or the vegetable milk. Water extraction with up to 10 minutes of mechanical blending gave low yields of soluble solids (4.66 +/- 0.10 to 4.98 +/- 0.07%) and low contents of fat, protein and ash in the extract with sun dried seed and significantly lower with the lightly roasted seed (3.0 +/- 0.05 to 3.4 +/- 0.03%). Due to the low yields of total soluble solids and to the low nutrient content by aqueous extraction, new extractants were used consisting of buffer solutions at pH 7.8, or 8.5 with and without saline solution at 0.5% concentration. With these solutions greater amounts of solids were extracted with a higher content of nutrients. The milk prepared from the sun dried seed and extracted with buffer at pH 8.5 and saline solution (0.5%) gave an extract with 9.85% of total solids, 3.37% protein, 4.44% fat. The extraction with roasted seed gave significantly lower yields. The residue of the extraction contained 21.47% fat and 14.72% protein. With the use of buffers and saline solution the extracts had better acceptability, with the milk produced from sun dried seed having better organoleptic characteristics in comparison with soy milk (5.84 vrs 3.76), however it was of lower acceptability when tested against cows milk (5.7 vrs 7.7). The isoelectric point of the extracted protein was between 4 4.45.

Calprotectina fecal: utilidad en el diagnóstico diferencial de enfermedad inflamatoria intestinal y síndrome intestino irritable en adultos / Fecal Calprotectin: utility in the differential diagnosis of inflammatory bowel disease and irritable bowel syndrome in adults

Differentiation between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can be complex as their symptoms are often similar and unspecific. Fecal biomarkers could be useful to select patients with suspected organic diseases for colonoscopy, with the aim to improve early diagnosis and to avoid unnecessary invasive studies. Fecal calprotectin (FC) is a protein found mainly in neutrophils that is released into the feces as a result of cell disruption and apoptosis. Currently, FC is a simple and non-invasive biomarker of intestinal inflammation. Inflammatory gastrointestinal disorders are associated with high levels of FC, as occurs in IBD. This review focuses on FC as a useful tool for differential diagnosis between IBS and IBD in adults. (AU)

Las alteraciones de la microbiota intestinal en la patogenia del hígado graso no alcohólico / Alterations of the intestinal microbiota in the pathogenesis of nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is currently considered in Chile and worldwide, as the main cause of cirrhosis and liver transplantation. It is therefore one of the main public health objectives for reducing its prevalence. In last years, it was suggested that the intestinal microbiota (IM) might contribute to the pathophysiology of NAFLD, as well as in the progression toward nonalcoholic steatohepatitis (NASH) and cirrhosis. It is known that changes in the composition of IM are associated with alterations in intestinal permeability and the production of inflammatory metabolites. These alterations are part of the pathophysiological mechanisms leading to the development of NASH. However studies on MI in patients with NAFLD and NASH in Chile are scarce. Through a research grant, recently awarded at the Hospital Clínico Universidad de Chile, we aim to confirm and characterize the intestinal dysbiosis associated with NAFLD in Chilean patients and to establish the relationship between the changes in microbial composition with the progression of liver damage. The description of these alterations represents an opportunity to explore new therapeutic approaches for future interventions. In effect, through the restoration of an intestinal microbial environment towards homeostasis in these patients, we expect to reverse or improve the progression of damage provoked by this disease. (AU)

Pancreatitis recurrente por disquinesia hipertónica del esfínter de oddi: tratamiento endoscópico y seguimiento a largo plazo en un caso clínico / Recurrent pancreatitis caused by oddi sphincter’s hypertonic dyskinesia: case report of endoscopic treatment and long-term follow-up

It is frequently difficult to determine the exact cause of recurrent acute pancreatitis (RAP), which can be life threatening in several cases. Not detected biliary microlithiasis is the most frequent etiology, buthypertonic dyskinesis of Oddi’s sphincter also can cause RAP. Non-invasive diagnosis of this functional disorder is difficult, endoscopic manometry of Oddi’s sphincter allows measuring pressure in the choledochus,in the pancreatic duct and specifically in the sphincter region. Once hypertonic dyskinesis is demonstrated, the treatment option is the partial or total ablation of the sphincter, via endoscopic or surgical methods. This intervention results in an improvement or complete resolution in about 70 percent of the patients, preventing new bouts of acute pancreatitis and eventual progression to chronic disease. In this paper, we describe the history of one of our patients, who consulted more than ten years after cholecystectomy for recurrent abdominal pain and presented three episodes of acute pancreatitis. Endoscopic manometry of Oddi’s sphincter was performed in 1997, with the detection of very high pressure in biliary and pancreatic segments of the sphincter, demonstrating hypertonic dyskinesis involving both segments. A dual endoscopic sphincterotomy was performed, followed by marked reduction in the pressure of biliopancreatic ducts and Oddi’s sphincter and in abolition of choledocho-duodenal and pancreatic-duodenal gradient. She was asymptomatic till 2002, later on, she required endoscopic pneumatic dilatation of the sphincterotomy. She had no more acute pancreatitis episodes and CT scan in 2014 showed a normal pancreas.

Con frecuencia resulta difícil determinar la etiología de la pancreatitis aguda recurrente (PAR), que puede amenazar hasta la vida del paciente. Aparte de la patología litiásica biliar no diagnosticada, la disquinesia hipertónica del esfínter de Oddi (EO) causa con cierta frecuencia PAR. Su diagnóstico no invasivo es difícil, la manometría del esfínter de Oddi permite medir los valores de la presión en la vía biliar, en el conducto pancreático y en la región del esfínter. Una vez que la disquinesia hipertónica se demuestra, su tratamiento es la ablación parcial o total del esfínter, con método endoscópico o quirúrgico, con resolución del cuadro clínico en aproximadamente 70 por ciento de los pacientes, logrando evitar los nuevos brotes de pancreatitis aguda (PA) y la eventual progresión hacia pancreatitis crónica. En este trabajo describimos la historia de una paciente colecistectomizada, quien después de varios años de dolor abdominal recurrente, presentó tres brotes de PA. Manometría de EO fue realizada en 1997, detectando presiones muy elevadas, comprobando disquinesia hipertónica de los segmentos biliar y pancreático del esfínter. Se realizó esfinterotomía endoscópica doble, seguida por gran disminución de los valores de presión, abolición del gradiente colédoco-duodenal y pancreático-duodenal. Estuvo asintomática hasta el 2002, y posteriormente requirió dilatación neumática de los orificios de esfinterotomías. No ha tenido más recaídas de pancreatitis, la tomografía computada de control en noviembre de 2014 mostró un páncreas normal.

Sobrecrecimiento bacteriano intestinal y pseudoobstrucción intestinal crónica: una relación poco conocida / Small intestinal bacterial overgrowth and chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIP) is the most severe intestinal motility disorder. Small intestinal bacterial overgrowth (SIBO) is frequently associated to dysmotility. In spite of this association, there is scare data on the relation between CIP and SIBO. To establish occurrence of CIP in SIBO patients in inter-crisis periods. To compare clinical and manometric characteristics of SIBO and non-SIBO patients. Retrospective analysis of 40 CIP patients (average age: 41 years; range: 18-76 years; 75 percent women). The following elements were registered: symptoms (such as pain, distention, vomit, constipation, diarrhea and weight loss); findings of the intestinal manometry (neuropathic, miopatic and mix pattern; intestinal motility index); and SIBO using lactulose H2 breath test, defined as an increase > 20 ppm in 2 or more figures in the first 60 minutes. Statistical analysis: t-test y and comparison of two ratios. SIBO was observed in 60 percent of the patients with CIP. Three or more symptoms were observed in 70.8 percent of the patients with SIBO 50 percentwithout SIBO (p = NS). In patients with SIBO, the most frequent symptom was abdominal pain (70.8 percent p= 0.032). There were no differences between SIBO patients and the different motility patterns, however, the intestinal motility index was lower for the SIBO group (9.7 +/- 44 12.3 +/-7; p < 0.001). : There is a high prevalence of SIBO in CIP patients. This is associated to a major compromise of intestinal motility assessed by the intestinal motility index...

Introducción: La pseudoobstrucción intestinal crónica (POIC) es el trastorno más grave de la motilidad intestinal. El sobrecrecimiento bacteriano intestinal (SBI) se asocia frecuentemente a estados de dismotilidad. A pesar de esta asociación existen escasos datos sobre la relación entre POIC y SBI. Objetivo: Determinar SBI en pacientes con POIC en período inter-crisis. Comparar características clínicas y manométricas de pacientes con y sin SBI. Material y Método: Análisis retrospectivo de 40 pacientes con POIC (edad promedio: 41 años, rango: 18-76 años; 75 por ciento mujeres). Se registraron síntomas (dolor, distensión, vómitos, constipación, diarrea, baja de peso), hallazgos en manometría intestinal (patrón neuropático, miopático o mixto, índice de motilidad intestinal (IMI)) y SBI con test de H2 con lactulosa, definido como la elevación > 20 ppm en 2 o más cifras en los primeros 60 min. Análisis estadístico: t-test y comparación de 2 proporciones. Resultados: Se observó SBI en 60 por ciento de los pacientes con POIC. Tres o más síntomas se presentaron en 70,8 por ciento de los pacientes con SBI vs 50 por ciento en POIC sin SBI (p = NS). El síntoma dolor abdominal fue más frecuente en pacientes con SBI (70,8 por ciento vs 31,2 por ciento, p = 0,032). No hubo diferencias entre pacientes con SBI y los distintos patrones de motilidad, sin embargo, el IMI fue menor para el grupo con SBI (9,7 +/- 1,44 vs 12,3 +/- 1,7, p < 0,001). Conclusiones: Existe una alta prevalencia de SBI en pacientes con POIC. Esto se relaciona con mayor compromiso de la motilidad intestinal evaluado por el IMI.

Presencia de síntomas digestivos en el Día Mundial de la Salud Digestiva / Presence of digestive symptoms in the World Digestive Health Day

Introduction: Gastrointestinal symptoms such as heartburn, indigestion/dyspepsia, constipation and bloating are very common in every community. Our group applied a questionnaire in order to identify the presence of gastrointestinal symptoms. Methodology: In 2012, during the World Digestive Health Day a survey of 13 questions given by the World Gastroenterology Organization (WGO) was administered to a group of people (E) at the Clinical Hospital of the University of Chile (HCUCH); the questions were based on the presence and frequency of digestive symptoms. The results were compared with two other groups, one rural (R) and another comprised of people that were accompanying the patients attending HCUCH (group A) for examinations. A χ2 test was used to compare variables by group. Results: Total E = 270, A = 100, R = 69. Women: E = 212 (79 percent), A = 66 (66 percent), R = 43 (62.4 percent). Age E = 48, A = 44, R = 53 (p = 0.0003). Digestive discomfort: E = 94.8 percent (256), A = 81 percent (81), R = 85.5 percent (59) p = 0.000. Distension/bloating E = 94.44 percent (255), A = 84 percent (84), R = 81.2 percent (56) p = NS. Abdominal pain/discomfort E = 89.6 percent (242), A = 75 percent (75), R = 82.6 percent (57) p = 0.000. Constipation: E = 80 percent (216), A = 71 percent (71), R = 63.7 percent (44) p = 0.01, with significant differences in sensation of incomplete evacuation in the 3 groups p = 0.001. Heartburn E = 75.2 percent (203), A = 67 percent(67), R = 68.1 percent (47) p = NS. Reflux E = 74 percent (200), A = 69 percent (69), R = 68.1 percent (47) p = NS. Interference with sleep: E = 62.2 percent (168), A = 45 percent (45), R = 56.5 percent (39) p = 0.012. Problems with soft/mushy/liquid stools = 65.92 percent (178), A = 61 percent (61), R = 68.11 percent (47) p = NS. Conclusions: Over 80 percent of respondents provided an upset stomach. The control group had the highest prevalence of digestive symptoms...

Introducción: Síntomas digestivos como pirosis, indigestión/dispepsia, constipación y distensión son muy frecuentes en cada comunidad. Nuestro grupo aplicó un cuestionario con el objetivo de identificar la presencia de sintomatología digestiva. Metodología: En el año 2012, durante el día mundial de la salud digestiva (DMSD) se realizó en el Hospital Clínico de la Universidad de Chile (HCUCH), una encuesta propuesta por la Organización Mundial de Gastroenterología (OMGE) que incluía 13 preguntas basadas en la presencia y frecuencia de síntomas digestivos. La encuesta se hizo a un grupo de personas (E). Los resultados fueron comparados con otros dos grupos, uno rural (R) y otro conformado por acompañantes (A) de pacientes que acudieron a exámenes al HCUCH. Se realizó una prueba χ² para comparar variables por grupo. Resultados: Total E = 270; A = 100; R = 69. Mujeres: E = 212 (79 por ciento), A = 66 (66 por ciento), R = 43 (62,4 por ciento). Edad E = 48, A = 44, R = 53 (p = 0,0003). Molestias digestivas: E = 94,8 por ciento (256), A = 81 por ciento (81); R = 85,5 por ciento (59) p = 0,000. Distensión/hinchazón E = 94,44 por ciento (255), A = 84 por ciento (84), R = 81,2 por ciento (56) p = NS. Dolor/molestia abdominal E = 89,6 por ciento (242), A = 75 por ciento (75), R = 82,6 por ciento (57) p = 0,000. Constipación: E = 80 por ciento (216), A = 71 por ciento (71), R = 63,7 por ciento (44) p = 0,01, existiendo diferencias significativas en sensación de evacuación incompleta en los 3 grupos p = 0,001. Pirosis E = 75,2 por ciento (203), A = 67 por ciento (67), R = 68,1 por ciento (47) p = NS. Reflujo E = 74 por ciento (200), A = 69 por ciento (69), R = 68,1 por ciento (47) p = NS. Interferencia con el sueño: E = 62,2 por ciento (168), A = 45 por ciento(45), R = 56,5 por ciento (39) p = 0,012. Problemas de heces blandas/ pastosas/líquidas E = 65,92 por ciento (178), A = 61 por ciento (61), R = 68,11 por ciento (47) p = NS...

Sarcoma de Kaposi en mucosas en pacientes PPVI: a propósito de 2 casos: revisión de bibliografía / Kaposi´s Sarkoma (KS) in patiens living with HIV: apropos of 2 cases: review of literature

El Sarcoma de Kaposi (SK) es un tumor vascular que puede comprometer la piel. En 1872 el dermatólogo vienés Moritz Kaposi describió por primera esta entidad. Tradicionalmente se la ha considerado un proceso crónico, decurso lento, que afecta sobre todo a hombres ancianos del este de Europa. No recibió mayor atención hasta que apareció como epidemia en hombres que tienen sexo con hombres (HSH) en la década de los 80 y fue reconocido como marcador clínico de SIDA. Describimos nuestra experiencia en la Unidad de Atención y Control en Salud Sexual (UNACESS) de dos varones PPVI: uno con lesión en cara mucosa del prepucio y otro con lesiones palatinas.

Kaposi’s Sarcoma (KS) is a vascular tumor that can involve the skin. In 1872 the Viennese dermatologist Moritz Kaposi first described this entity. Traditionally it has been considered a chronic, slow flowing, mainly affecting elderly men of Eastern Europe. KS received no more attention until it appeared as an epidemic among men who have sex with men (MSM) in the 80s and was recognized as a clinical marker of AIDS. We describe our experience in Care and Control Unit Sexual Health (UNACESS) in two men living with VIH infection, one with penile mucosa injury and another with palatal lesions.

[Small intestine bacterial overgrowth in patients with chronic pancreatitis]. / Sobrecrecimiento bacteriano intestinal en pacientes con pancreatitis crónica.

BACKGROUND: Previous reports describe 30-40% of small intestine bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP), SIBO is a cause of persistent symptoms in this group of patients even when they are treated with pancreatic enzymes. AIM: To asses the frequency of SIBO in patients with CP. PATIENTS AND METHODS: We studied 14 patients with CP using an hydrogen breath test with lactulose to detect SIBO, a nonabsorbable carbohydrate, whose results are not influenced by the presence of exocrine insufficiency. Main symptoms and signs were bloating in 9 (64%), recurrent abdominal pain in 8 (57%), intermittent diarrhea in 5 (36%) and steatorrhea in 5 (36%). At the same time we studied a healthy control group paired by age and sex. RESULTS: SIBO was present in 13 of 14 patients with CP (92%) and in 1 of 14 controls (p<0.001). The only patient with CP and without SIBO was recently diagnosed and had minimal morphologic alterations in computed tomography and endoscopic pancreatography. CONCLUSIONS: SIBO is common in CP and may be responsible for persistent symptoms. Proper diagnosis and treatment could alleviate symptoms and improve quality of Ufe.

[Rectal barostat in irritable bowel syndrome]. / Barostato rectal en el síndrome de intestino irritable.

BACKGROUND: Many patients with irritable bowel syndrome (IBS) have lowered sensory thresholds to rectal distention when compared to control subjects, a phenomenon called visceral hypersensitivity. AIM: To investigate the usefulness of a rectal barostat as a diagnostic tool in IBS and if there are differences in visceral hypersensitivity in different groups of IBS patients. PATIENTS AND METHODS: Ten healthy subjects and 19 IBS patients, defined using Rome II criteria (12 with constipation, three with diarrhea and four alternating between diarrhea and constipation), were studied. Sequential isobaric rectal distentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reported pain, were carried out. Visceral hypersensitivity was defined as a pain threshold under 38 mmHg. RESULTS: Only 26% of IBS patients had visceral hypersensitivity (16% and 43% of patients with IBS and constipation and IBS and diarrhea or alternating symptoms, respectively, p =NS). Pain threshold in controls, patients with IBS and constipation and patients with IBS and diarrhea or alternating symptoms was 43.8+/-6.6, 45.3+/-9.2 and 40.8+/-9.2 mmHg, respectively (p =NS). CONCLUSIONS: Our results do not support the usefulness of the electronic rectal barostat as a diagnostic method to diagnose IBS.

Enfermedad celíaca silente en epilepsia criptogénica del adulto / Silent celiac disease among 21 patients with cryptogenic epilepsy

Background: Celiac disease (CD) is predominant in women and young people. Atypical, non-enteric symptoms are more common among adults. There is also an association between CD and neurological disorders, especially with cerebellar ataxia, polyneuropathy and epilepsy. Aim: To study the frequency of CD in a group of adults with cryptogenic epilepsy. Material and Methods: Twenty one patients with cryptogenic epilepsy, aged 20 to 65years (14 women) were studied, measuring IgA-anti transglutaminase antibodies and deamidated gliadin peptide (DGP) IgG and IgA antibodies. Results: One patient had elevated titers of both types of antibodies. Small bowel biopsy showed villous atrophy and lymphocytic infiltration compatible with CD. Conclusions: One of 21 adult patients with cryptogenic epilepsy had a silent CD.

[Small intestinal bacterial overgrowth. An update]. / Sobrecrecimiento bacteriano intestinal.

Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions.