Anatomic-radiographic aspects and gastrointestinal transit time in Boa constrictor amarali Stull, 1932 (Squamata, Boidae) / [Aspectos anátomo-radiográficos e tempo de trânsito gastrointestinal em jiboia-cinzenta Boa constrictor amarali Stull, 1932 (Squamata, Boidae)]

The goal of this study was to describe the gastrointestinal transit technique in the Boa constrictor amarali. For that purpose, we obtained simple radiographic images of seven serpents, subsequently administering a 25mL/kg dose of barium sulfate and establishing a radiographic sequence at the following times: 5 minutes; 1, 2, 3, 6, 9, 24, 48, 72 and 96 hours, extending to 120 and 126 hours for one animal. The mean esophageal transit was 26.71±19.48 hours; the mean gastric filling time was 28.57±27.22 minutes and the emptying time was 60±12 hours; the mean filling time of the contrast medium in the small intestine was 3±2.16 hours and the emptying time was 97±15.65 hours. We also obtained the mean filling time of the large intestine, which was 40±11.31 hours. We found that the mean passage time of the contrast medium through the cranial gastrointestinal tract - until the complete elimination of barium sulfate from the small intestine -was 97±15.65 hours. In addition to determining the gastrointestinal transit time, the technique used allowed for the morphological identification of the alimentary canal.(AU)

O objetivo deste trabalho foi descrever a técnica de trânsito gastrointestinal em Boa constrictor amarali. Para tanto, foram obtidas radiografias simples de sete serpentes, e, subsequentemente a essas, foi administrado sulfato de bário na dose de 25mL/kg. A partir disso, foi estabelecida a sequência radiográfica nos seguintes tempos: cinco minutos; uma, duas, três, seis, nove, 24, 48, 72 e 96 horas, e em um animal estendeu-se para 120 e 126 horas. O trânsito esofágico médio foi de 26,71±19,48 horas, o tempo médio de preenchimento gástrico foi de 28,57±27,22 minutos, e o esvaziamento de 60±12 horas; a média de tempo de enchimento do meio de contraste no intestino delgado foi de 3±2,16 horas e, por fim, o esvaziamento foi de 97±15,65 horas, e ainda obteve-se o tempo médio de enchimento do intestino grosso igual a 40±11,31 horas. Desse modo, verificou-se que a média do tempo de passagem do contraste pelo trato gastrointestinal cranial - até a completa eliminação do sulfato de bário do intestino delgado - foi de 97±15,65 horas. Além da determinação do tempo de trânsito gastrointestinal, a técnica empregada permitiu a identificação morfológica do canal alimentar.(AU)

Structural bases of gastrointestinal motility changes in parkinson's disease: study in rats / Bases estruturais das alterações da motilidade gastrintestinal na doença de parkinson: estudo em ratos

ABSTRACT Background: Gastrointestinal disorders are frequently reported in patients with Parkinson's disease whose disorders reduce the absorption of nutrients and drugs, worsening the clinical condition of patients. However, the mechanisms involved in modifying gastrointestinal pathophysiology have not yet been fully explained. Aim: To evaluate its effects on gastrointestinal motility and the involvement of the vagal and splanchnic pathways. Methods: Male Wistar rats (250-300 g, n = 84) were used and divided into two groups. Group I (6-OHDA) received an intrastriatal injection of 6-hydroxydopamine (21 µg/animal). Group II (control) received a saline solution (NaCl, 0.9%) under the same conditions. The study of gastric emptying, intestinal transit, gastric compliance and operations (vagotomy and splanchnotomy) were performed 14 days after inducing neurodegeneration. Test meal (phenol red 5% glucose) was used to assess the rate of gastric emptying and intestinal transit. Results: Parkinson's disease delayed gastric emptying and intestinal transit at all time periods studied; however, changes in gastric compliance were not observed. The delay in gastric emptying was reversed by pretreatment with vagotomy and splanchnotomy+celiac gangliectomy, thus suggesting the involvement of such pathways in the observed motor disorders. Conclusion: Parkinson's disease compromises gastric emptying, as well as intestinal transit, but does not alter gastric compliance. The delay in gastric emptying was reversed by truncal vagotomy, splanchnotomy and celiac ganglionectomy, suggesting the involvement of such pathways in delaying gastric emptying.

RESUMO Racional: Distúrbios gastrintestinais são frequentemente relatados em pacientes com doença de Parkinson cujos distúrbios reduzem a absorção de nutrientes e fármacos, agravando o quadro clínico dos pacientes. No entanto, os mecanismos envolvidos na alteração da fisiopatologia gastrintestinal ainda não foram totalmente elucidados. Objetivo: Avaliar os seus efeitos sobre a motilidade gastrintestinal e o envolvimento das vias vagal e esplâncnica. Métodos: Ratos Wistar machos (250-300 g, n=84) foram utilizados e divididos em dois grupos. O grupo I (6-OHDA) recebeu injeção intraestriatal de 6-hidroxidopamina (21 µg/animal). O grupo II (controle) recebeu solução salina (NaCl, 0,9%) nas mesmas condições. O estudo do esvaziamento gástrico, trânsito intestinal, complacência gástrica e operações (vagotomia e esplancnotomia) foram realizadas 14 dias após a indução da neurodegeneração. Refeição teste (vermelho de fenol+glicose 5%) foi utilizada para avaliar a taxa de esvaziamento gástrico e o trânsito intestinal. Resultados: A doença de Parkinson retardou o esvaziamento gástrico e o trânsito intestinal em todos os tempos estudados; porém, alterações da complacência gástrica não foram observadas. O retardo do esvaziamento gástrico foi revertido por pré-tratamento com vagotomia e esplancnotomia+gangliectomia celíaca, sugerindo assim, o envolvimento de tais vias nos distúrbios motores observados. Conclusão: A doença de Parkinson compromete o esvaziamento gástrico, bem como o trânsito intestinal, mas não altera a complacência gástrica. O retardo do esvaziamento gástrico foi revertido pela vagotomia troncular, esplancnotomia e gangliectomia celíaca, sugerindo o envolvimento de tais vias no retardo do esvaziamento gástrico.

Efecto del endospermo de semilla de tara y polvo de hojas de Agave americana en el peso corporal y velocidad de tránsito intestinal en ratas / Effects of the endosperm of tara seeds and powder of Agave Americana leaves on body weight and intestinal transit time in holtzman rats

RESUMEN Objetivos. Evaluar el efecto del endospermo de semilla de tara (EST) y polvo de hojas del Agave americana (HAA) sobre el peso corporal y velocidad de tránsito intestinal en ratas Holtzman. Materiales y métodos Veinticinco ratas machos Holtzman distribuidas en cinco grupos y alojadas en jaulas individuales, fueron alimentadas durante 21 días con uno de los siguientes tratamientos: T1, dieta con 6% de alfa celulosa (control); T2, dieta con 6% de EST; T3, dieta con 6% de HAA; T4, dieta con 10% de EST y T5, dieta con 10% de HAA. Se registraron el consumo de alimento, ganancia de peso corporal, digestibilidad aparente de la grasa, características de las heces (contenido de grasa, peso, humedad, volumen y pH) y tiempo de tránsito intestinal. Se realizaron análisis de varianza (ANOVA) de una vía y a través de la comparación múltiple de medias de Tukey. Resultados Dietas con 6% y 10% del EST exhibieron una reducción en el consumo de alimento, digestibilidad aparente de la grasa y pH fecal, cuyos resultados tuvieron efectos en la reducción de la ganancia del peso corporal de 37,0% (p=0,008) y 50,9% (p=0,001) comparados con la dieta control. Dieta con 10% del polvo de HAA redujo el tiempo de tránsito intestinal de 642 min (control) a 532 min (p=0,242). Conclusiones Dietas que contienen EST regulan la ganancia del peso corporal; en cambio, dieta con polvo de HAA, no tuvo efectos sobre la velocidad de tránsito intestinal en ratas.

ABSTRACT Objective To evaluate the effects of endosperm of tara seeds (ETS) and powder of Agave americana leaves (AAL) on body weight and intestinal transit time in Holtzman rats. Materials and Methods Twenty-five male Holtzman rats, individually caged, and distributed into five groups were fed for 21 days with one of the following treatments: T1, diet with 6% alpha cellulose (Control); T2, diet with 6% ETS; T3, diet with 6% AAL; T4, diet with 10% ETS; and T5, Diet with 10% AAL. Feed intake, body weight gain, apparent digestibility of fat, characteristics of feces (fat content, weight, moisture, volume, and pH) and intestinal transit time were recorded. One-way analyses of variance (ANOVA) were performed, as well as Tukey's multiple means comparison. Results Diets with 6% and 10% of ETS resulted in a reduction of feed intake, apparent digestibility of fat, and fecal pH, and said results had an effect in the reduction of body weight gain of 37.0% (p=0.008) and 50.9% (0.001), compared with the control diet. The diet with 10% of AAL powder reduced the intestinal transit time from 642 min (control) to 532 min (p=0.242). Conclusions Diets containing EST regulated body weight gain, while the diet with AAL powder had no effects on the intestinal transit time in rats.

Effect of bisacodyl on rats with slow transit constipation

The effect of bisacodyl on the treatment of rats with slow transit constipation (STC) was studied. Forty-five female Wister rats were divided into control group, STC group, and STC bisacodyl group. The immunohistochemical method was used to determine interstitial cells of Cajal (ICC) and the expression of c-Kit protein. Body mass and the number of defecations were significantly decreased in the STC group compared with the control group on the 100th day after diphenoxylate administration, while dry weight of feces was significantly increased and the intestinal transit time was prolonged. There were significant differences in the number of defecations, dry weight of feces, and intestinal transit time among the three groups. The number of defecations was higher, dry weight of feces was lower, and intestinal transit time was shorter in the STC bisacodyl group compared to the STC group. In addition, ICC basement membrane dissolution occurred in the colon wall of the STC group. The connection between ICC and surrounding cells was destroyed, and the nucleus shrunken to different degrees. Moreover, c-Kit expression in the STC group was significantly lower than the control group. The connection between ICC and surrounding cells in the STC bisacodyl group was significantly stronger than the STC group, and the number of ICC and the expression of c-Kit were increased. Bisacodyl could reduce the severity of STC in rats by increasing the number of ICC and the expression of c-Kit.

Desenvolvimento de comprimidos de liberação prolongada de nimesulida contendo ferrita para avaliação do trânsito gastrintestinal por meio de técnica biomagnética / Development of prolonged release tablets of nimesulide containing ferrite for evaluation of gastrointestinal transit by means of biomagnetic technique

As Formas Farmacêuticas de Liberação Prolongada (FFLP) têm sido uma alternativa eficaz na terapia, pois proporcionam maior adesão do paciente ao tratamento em função da redução da frequência de dosagem ao longo do dia, sendo sua principal característica, a modulação da liberação/dissolução do fármaco. Entretanto, esta etapa pode ser influenciada por diferentes fatores, dentre eles: os físico-químicos relacionados ao fármaco; os farmacêuticos, principalmente relacionados aos excipientes empregados e às técnicas de obtenção da forma farmacêutica (FF) e os fisiológicos do trato gastrintestinal (TGI), como por exemplo, o pH dos líquidos do TGI, o tempo de esvaziamento gástrico, a motilidade intestinal, entre outros. Desse modo, a avaliação do trânsito da FF no TGI, após a sua administração, permite uma melhor compreensão dos fatores que podem afetar as etapas de liberação/dissolução do fármaco in vivo. Dentre as técnicas empregadas com esse objetivo, destacam-se: a cintilografia e os métodos biomagnéticos. A Biosusceptometria de Corrente Alternada (BAC) é um método biomagnético que tem se mostrado promissor para este tipo de estudo, por ser não invasivo, portátil, livre de radiação ionizante, e por apresentar acurácia e versatilidade. Diante do exposto, o presente trabalho teve como objetivos, desenvolver e caracterizar sob o aspecto biofarmacotécnico in vitro, um sistema de liberação prolongada contendo nimesulida (fármaco-modelo) e marcador magnético (ferrita), visando obtenção de ferramenta para avaliação do trânsito gastrintestinal por meio de técnica biomagnética. Para isto foram desenvolvidas quatro formulações de comprimidos de liberação prolongada contendo nimesulida, ferrita e diferentes concentrações de hidroxipropilmetilcelulose (HPMC): NF1 (30% HPMC); NF2 (23% HPMC); NF3 (17% HPMC) e NF4 (10% HPMC). Essas foram avaliadas quanto ao comportamento de dissolução por meio de ensaios com aparato 4 e avaliação da cinética e da eficiência de dissolução (ED%). Posteriormente, estudos biomagnéticos, in vitro e in vivo, foram conduzidos com emprego da técnica de BAC para a formulação selecionada. Os resultados obtidos mostraram que as 04 formulações desenvolvidas apresentaram porcentagens de dissolução distintas em função das diferentes concentrações de HPMC (NF1 = 13,2%; NF2 = 40,1%; NF3 = 72,5% e NF4 = 91,5%). A formulação NF4, com menor concentração de HPMC, foi escolhida para os estudos por meio de BAC em função dos resultados de ED% (54,3%) e por apresentar comportamento mais próximo de uma formulação de liberação prolongada. Em relação aos resultados de BAC in vitro, destaca-se que a formulação NF4 (10%HPMC) apresentou aumento de área magnética de forma independente do pH do meio, sugerindo que a hidratação/intumescimento da HPMC independe do pH. Em relação à avaliação do trânsito intestinal (estudo in vivo) foram obtidos os seguintes dados: Tempo médio de Residência Gástrica (TTR) - 89 minutos; Tempo médio do Trânsito Orocecal (TTO) - 313 minutos e Tempo médio do Trânsito Intestinal (TTI) - 224 minutos. Os dados de BAC in vivo permitiram observar que o aumento de área magnética atingiu um platô em cerca de 80 minutos após a administração da formulação NF4. A comparação dos dados de BAC in vitro e BAC in vivo, relacionados ao trânsito gastrintestinal, indica que a formulação NF4, após apresentar o ápice de intumescimento, foi capaz de manter sua estrutura permanente ao longo do TGI, favorecendo assim a liberação modulada do fármaco. Os resultados obtidos demonstraram que a formulação desenvolvida foi eficiente para avaliar e caracterizar o trânsito no TGI por meio da técnica de BAC e também permitiram uma estimativa do comportamento do fármaco em relação a solubilidade em cada porção do TGI, proporcionando assim uma ferramenta adequada para avaliação do trânsito do TGI e desenvolvimento de FFLP

Extended Release (ER) dosage forms have been an effective alternative in therapy, since they provide greater patient adherence to treatment as a function of the reduction of the frequency of dosing throughout the day, its main characteristic being the release / dissolution modulation of the drug. However, this stage can be influenced by different factors, among them: the physical and chemical related to the drug; the pharmacists, mainly related to the excipients employed and the techniques of obtaining the form dosage and the physiological ones of the gastrointestinal tract (GI tract), as for example, the pH of the liquid of the GI tract, gastric emptying time, intestinal motility, among others. Thus, assessment of dosage forms transit in GI tract after its administration allows a better understanding of the factors that may affect the drug release / dissolution steps in vivo. Among the techniques used for this purpose, the following stand out: scintigraphy and biomagnetic methods. Alternating Current Biosensiometry (ACB) is a biomagnetic method that has shown promise for this type of study, since it is non-invasive, portable, free of ionizing radiation, and because of its accuracy and versatility. In view of the above, the aim of this work was to develop and characterize a sustained release system containing nimesulide (study drug) and magnetic marker (ferrite) under the in vitro biopharmaceutical aspect, aiming to obtain a tool to evaluate the GI tract transit through means of biomagnetic technique. For this, four formulations of extended release tablets containing nimesulide, ferrite and different concentrations of hydroxypropylmethylcellulose (HPMC): NF1 (30% HPMC) were developed; NF2 (23% HPMC); NF3 (17% HPMC) and NF4 (10% HPMC). These were evaluated for dissolution behavior by apparatus 4, assays and kinetics and dissolution efficiency (ED%). Subsequently, biomagnetic studies, in vitro and in vivo, were conducted using the ACB technique for the selected formulation. The results showed that the formulations developed showed different percentages of dissolution as a function of the different concentrations of HPMC (NF1 = 13.2%, NF2 = 40.1%, NF3 = 72.5% and NF4 = 91.5%). The NF4 formulation, with a lower concentration of HPMC, was chosen for the ACB studies as a function of ED% results (54,3%) and because of the behavior of a sustained release formulation. In relation to the in vitro ACB results, the NF4 formulation (10% HPMC) showed an increase in magnetic area independently of the pH of the medium, suggesting that the HPMC hydration / swelling is independent of pH. In relation to intestinal transit evaluation (in vivo study) the following data were obtained: Mean Time of Gastric Residency (TTR) - 89 minutes; Mean Time of Orocecal Transit (OCTT) - 313 minutes and Mean Time of lntestinal Transit (TTI) - 224 minutes. ACB data in vivo showed that the increase in magnetic area reached a plateau in about 80 minutes after administration of the NF4 formulation. Comparison of in vitro ACB and ACB data in vivo, related to gastrointestinal transit, indicates that the NF4 formulation, after showing the swelling apex, was able to maintain its permanent structure throughout the GI tract, thus favoring the modulated release of the drug. The obtained results demonstrated that the developed formulation was efficient to evaluate and characterize the transit in the GI tract by means of the ACB technique and allowed a prediction of the behavior of the drug in relation to the solubility in each portion of the GI tract, thus providing a suitable tool for evaluation of the GI tract transit and the development of sustained release formulation

Effect of swallwwed bolus viscosity and body poition on esophageal transit, coontraction and perception of transit / Efeito da viscosidade do bolo e da posição corporal no trânsito, contrações do esôfago e na percepção do trânsito

Background The esophagus has a different response in relation to the characteristics of a swallowed bolus. Bolus viscosity and body position may affect esophageal contraction and transit. Objectives To investigate the effect of bolus viscosity and body position on esophageal contraction, transit and perception. Methods Esophageal contraction, transit and perception of transit were evaluated in 26 asymptomatic volunteers, 13 men and 13 women aged 18-60 years, mean: 33.6 (12.2) years. Esophageal contraction (manometry) and transit (impedance) were measured with a solid state catheter with sensors located 5, 10, 15, and 20 cm from the lower esophageal sphincter. Each volunteer swallowed in duplicate and in random sequence a 5 mL low viscous (LV) liquid bolus of an isotonic drink with pH 3.3, and a 5 mL high viscous (HV) paste bolus, which was prepared with 7.5 g of instant food thickener diluted in 50 mL of water (pH: 6.4). Results Total bolus transit time, in the sitting position, was longer with the HV bolus than with the LV bolus. Esophageal transit was longer in the supine position than in the sitting position. Bolus head advance time was longer with the HV bolus than with the LV bolus in both positions. Contraction esophageal amplitude was higher in the supine position than in the sitting position. The perception of bolus transit was more frequent with the HV bolus than with the LV bolus, without differences related to position. Conclusions The viscosity of the swallowed bolus and body position during swallows has an influence on esophageal contractions, transit and perception of transit. .

Contexto O esôfago tem resposta diferente relacionada às características do bolo deglutido. A viscosidade do bolo e a posição corporal podem afetar a contração do esôfago e o trânsito. Objetivos Investigar o efeito da viscosidade do bolo e da posição corporal sobre a contração do esôfago e no trânsito. Métodos A contração do esôfago, o trânsito e a percepção do trânsito foram avaliadas em 26 voluntários assintomáticos, 13 homens e 13 mulheres com idade entre 18 e 60 anos, média: 33,6 (12,2) anos. A contração do esôfago (manometria) e trânsito (impedância) foram medidas com um cateter de estado sólido com sensores localizados a 5, 10, 15 e 20 cm do esfíncter esofágico inferior. Cada voluntário deglutiu, em duplicata, 5 mL de bolo líquido (baixa viscosidade - BV, pH: 3,3) e 5 mL de bolo pastoso (alta viscosidade - AV, pH: 6,4). Resultados O tempo de trânsito total do bolo, na posição sentada, foi mais longo com o bolo AV do que com bolo BV. O trânsito pelo esôfago foi mais longo na posição supina do que na posição sentada. O tempo de avanço da cabeça do bolo foi mais longo com bolo AV do que com bolo BV, em ambas as posições. A amplitude da contração do esôfago foi maior na posição supina do que na posição sentada. A percepção do trânsito do bolo foi mais frequente com o bolo AV do que com o bolo BV, sem diferença relacionada com a posição. Conclusões A viscosidade do bolo deglutido e a posição do corpo durante a deglutição têm influência sobre as contrações esofágicas e no trânsito pelo esôfago. .

Tempo de passagem de duas dietas no trato gastrointestinal do peixe-boi da Amazônia Trichechus inunguis (Natterer, 1883) em cativeiro / Transit time of two diets in the gastrointestinal tract of the Amazonian manatee Trichechus inunguis (Natterer, 1883) in captivity

The objective of this study was to determine the transit time of two diets in the digestive tract of the Amazonian manatee in captivity. We tested separately two different diets: one composed exclusively of grass of the genus Brachiaria (experimental diet - ED- A 1) and the other composed of grass Brachiaria added with small portions of extruded pellets for horses (experimental diet ED- A 2). Two healthy adult manatees were selected and isolated from the rest and underwent a period of food acclimation with the experimental diets for 15 days. After this period, the experimental diet was marked with a plastic colored tape of 10-cm length and given to the animals. The manatees were monitored at intervals of 1 hour and all fecal material was collected until recovery of the markers. The mean transit time of ED - A1 was 123h57min , about 5.16 days and ED - A 2 was 125h04min or 5.21 days. There was no statistical difference (P <0.05) between the transit time of the two diets provided. The transit time observed (approximately 5 days) has also been reported by other authors for this species and is considered a strategy to increase the absorption time of food nutrients. Despite the small sample size, the results suggest that the use of pellets in the diet of the Amazonian manatee did not affect the transit time of the grass. Therefore, it is reasonable to believe that the introduction of concentrated food (pellets) does not affect the efficiency of the animal to digest and absorb food properly.

Com o objetivo de testar o tempo de passagem do alimento no trato digestório de peixes-bois da Amazônia em cativeiro, foram testadas separadamente duas dietas distintas. Uma composta exclusivamente de capim do gênero Brachiaria (dieta experimental - DE 1) e outra de capim do gênero Brachiaria acrescentado de pequenas porções de ração extrusada para eqüinos (dieta experimental - DE 2). Foram selecionados do plantel do INPA dois animais adultos machos sadios, os quais foram isolados dos demais e submetidos a um período de aclimatação às dietas experimentais por 15 dias. Após este período, as dietas foram marcadas com uma fita plástica de 10 cm e fornecidas aos animais que foram monitorados em intervalos de uma hora. Todo material fecal foi coletado até a recuperação dos marcadores plásticos. A média do tempo de passagem da DE 1 foi de 123h57min, cerca de 5,15 dias e da DE 2 foi de 125h04min ou 5,21 dias. Não houve diferença estatística (P<0,05) entre as dietas fornecidas. O tempo de passagem observado (aproximadamente 5 dias) coincide com o relatado por outros autores para a espécie, sendo esse tempo considerado uma estratégia para aumentar o tempo de absorção nutricional dos alimentos. Apesar do número reduzido de amostras, os resultados sugerem que o uso da ração na alimentação não interfere no tempo de passagem do capim pelo trato digestório do peixe-boi. Com isso, sugere-se que a introdução de alimento concentrado (ração) não afeta a eficiência na digestão e absorção correta do alimento.

Constipação intestinal / Constipation

A constipação intestinal acomete cerca de 20% da população mundial e constitui um dos sintomas mais frequentes de procura ao médico. É mais comum em mulheres e idosos e se encontra entre as doenças funcionais do intestino. Pode ser referida pelo paciente como fezes endurecidas, esforço excessivo no ato evacuatório, evacuações infrequentes ou sensação de evacuação incompleta. Subdivide-se em primária e secundária, tendo essa última causa bem definida, como doenças endócrinas e neurológicas ou uso inadvertido de substâncias obstipantes. É importante orientarmos nossos pacientes para a necessidade de uma dieta rica em fibras e de uma hidratação adequada. O manejo farmacológico pode incluir suplementação de fibras, laxativos osmóticos, emolientes e laxativos irritativos

Constipation occurs in about 20% of the world population and it is a common reason for seeking medical attention. It is more common in women and in the elderly and may be part of a generalized gastrointestinal dysmotility syndrome. Patients may define constipation as hard stools, excessive straining, infrequent stools, or a sense of incomplete evacuation. There are two main types of constipation - primary or secondary, the latter caused by systemic disorders such as endocrine disorders, neurologic dysfunction, or as a side effect of medications. Proper dietary fiber and fluid intake should be emphasized. Pharmacologic management of constipation may include fiber laxatives, osmotic laxatives, stool surfactants, or stimulant laxatives

Gastric emptying of water in children with severe functional fecal retention

The objective of this study was to evaluate gastric emptying (GE) in pediatric patients with functional constipation. GE delay has been reported in adults with functional constipation. Gastric emptying studies were performed in 22 children with chronic constipation, fecal retention and fecal incontinence, while presenting fecal retention and after resuming regular bowel movements. Patients (18 boys, median age: 10 years; range: 7.2 to 12.7 years) were evaluated in a tertiary pediatric gastroenterology clinic. Gastric half-emptying time of water (reference range: 12 ± 3 min) was measured using a radionuclide technique immediately after first patient evaluation, when they presented fecal impaction (GE1), and when they achieved regular bowel movements (GE2), 12 ± 5 weeks after GE1. At study admission, 21 patients had reported dyspeptic symptoms, which were completely relieved after resuming regular bowel movements. Medians (and interquartile ranges) for GE1 and GE2 were not significantly different [27.0 (16) and 27.5 (21) min, respectively (P = 0.10)]. Delayed GE seems to be a common feature among children with chronic constipation and fecal retention. Resuming satisfactory bowel function and improvement in dyspeptic symptoms did not result in normalization of GE data.

Establishment of a Protocol for Determining Gastrointestinal Transit Time in Mice Using Barium and Radiopaque Markers

OBJECTIVE: The purpose of this study was to establish a minimally invasive and reproducible protocol for estimating the gastrointestinal (GI) transit time in mice using barium and radiopaque markers. MATERIALS AND METHODS: Twenty 5- to 6-week-old Balb/C female mice weighing 19-21 g were used. The animals were divided into three groups: two groups that received loperamide and a control group. The control group (n = 10) animals were administered physiological saline (1.5 mL/kg) orally. The loperamide group I (n = 10) and group II (n = 10) animals were administered 5 mg/kg and 10 mg/kg loperamide orally, respectively. Thirty minutes after receiving the saline or loperamide, the mice was administered 80 microL of barium solution and six iron balls (0.5 mm) via the mouth and the upper esophagus by gavage, respectively. Afterwards, the mice were continuously monitored with fluoroscopic imaging in order to evaluate the swallowing of the barium solution and markers. Serial fluoroscopic images were obtained at 5- or 10-min intervals until all markers had been excreted from the anal canal. For analysis, the GI transit times were subdivided into intestinal transit times (ITTs) and colon transit times (CTTs). RESULTS: The mean ITT was significantly longer in the loperamide groups than in the control group (p < 0.05). The mean ITT in loperamide group II (174.5 +/- 32.3) was significantly longer than in loperamide group I (133.2 +/- 24.2 minute) (p < 0.05). The mean CTT was significantly longer in loperamide group II than in the control group (p < 0.05). Also, no animal succumbed to death after the experimental procedure. CONCLUSION: The protocol for our study using radiopaque markers and barium is reproducible and minimally invasive in determining the GI transit time of the mouse model.

The importance of oxygen free radicals in the etiopathogenesis of diversion colitis in rats / A importância dos radicais livres de oxigênio na etiopatogenia da colite de exclusão em ratos

PURPOSE: Quantify the levels of oxidative DNA damage of epithelial colon cells comparing segments with and without fecal stream. METHODS: Sixty Wistar rats were subjected to deviation of fecal stream by proximal colostomy and a distal mucosal fistula. Animals were divided into three experimental groups that were sacrificed 6, 12 and 24 weeks after surgery. In each experimental group, five animals underwent laparotomy without intestinal deviation (sham subgroup). The diagnosis of colitis was made by histopathological analysis and the inflammatory activity index by graduated scale. The neutrophil infiltration was determined by myeloperoxidase tissue levels and the intensity of oxidative DNA damage by comet assay. The Mann-Withney and Student t test were used to compare the results among experimental subgroups and the Kruskal-Wallis test for variance analysis, adopting a significance level of 5 percent (p<0.05). RESULTS: Colon segments without fecal stream was shown higher histological inflammatory score of the colon wall after 12 and 24 weeks (p=0.001) that increased with the time of diversion (p=0.01). The activity of myeloperoxidase in segments without fecal stream decreased with the time (p=0.001). Oxidative DNA damage levels were significantly higher in the segments without fecal stream, (p=0.0001), independent of time of colon diversion, and increase with the time (p=0.0007). CONCLUSIONS: Colon segments without fecal stream showed high levels of oxidative DNA damage related to histological alterations observed in diversion colitis. The levels of oxidative DNA damage in segments devoid of the fecal stream increase with the time of intestinal exclusion.

OBJETIVO: Quantificar os níveis de dano oxidativo ao DNA em células epiteliais da mucosa cólica comparando segmentos com e sem trânsito fecal. MÉTODOS: Sessenta ratos Wistar foram submetidos à derivação do trânsito intestinal por colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo terem sido sacrificados 6, 12 e 24 semanas após a cirurgia. Em cada grupo experimental, cinco animais foram submetidos à laparotomia isolada sem derivação fecal (grupo sham). O diagnóstico de colite foi estabelecido por análise histopatológica e o índice de atividade inflamatória por escala graduada. A infiltração neutrofílica foi determinada pelos níveis teciduais da mieloperoxidase e a intensidade do dano oxidativo ao DNA pelo ensaio em cometa. Utilizaram-se os testes de Mann-Withney e o teste t de Student para comparar os resultados encontrados entre os subgrupos experimentais e o teste de Kruskal-Wallis para análise de variância, adotando-se nível de significância de 5 por cento (p<0,05). RESULTADOS: Os segmentos cólicos, sem trânsito fecal apresentaram maior escore histológico de inflamação após 12 e 24 semanas (p=0,001), que aumentou com o tempo de derivação (p=0,01). A atividade da mieloperoxidase nos segmentos sem trânsito fecal diminuiu com o progredir do tempo (p=0,001). Os níveis de dano oxidativo ao DNA foram significativamente maiores nos segmentos sem trânsito fecal (p=0,0001), independente do tempo de exclusão considerado, aumentando com o progredir do tempo de exclusão (p = 0,0007). CONCLUSÕES: Segmentos cólicos desprovidos de trânsito fecal apresentam níveis elevados de dano oxidativo ao DNA relacionados às alterações histológicas observadas na colite de exclusão. Os níveis de dano oxidativo ao DNA nos segmentos desprovidos de trânsito fecal aumentam com o decorrer do tempo de exclusão.

Tránsito colónico en individuos sanos / Colonic transit in healthy individuals

El tránsito colónico es la medición objetiva del tiempo en el que trascurre el contenido intestinal a través del colon y representa un adelanto muy importante en la evaluación de pacientes con trastornos en el hábito intestinal. Valores normales de tránsito colónico (TC). Determinar valores normales de TC en voluntarios sanos en la ciudad de Caracas. En el Hospital Universitario de Caracas (HUC). Estudio descriptivo, transversal; se empleó anillos metálicos de 8Fr (2.7mm), como marcadores radioopacos, introducidos en capsulas de gelatina tamaño 00 largo (24 anillos/cápsula), se tomaron al azar 30 voluntarios sanos, personal médico y de enfermería del HUC, con edades entre 18 y 50 años, agrupados por género: 15 masculino y 15 femenino. Se realizó radiografías de abdomen simple en posición decúbito dorsal a las 72, 96 y 120 horas posteriores a la ingesta de la cápsula, cuantificando la cantidad de marcadores eliminados. Para el análisis de los resultados se aplicó la prueba no paramétrica U de Mann-Whitney; con un nivel de significación del 95%. No se realizó modificaciones en la dieta durante el estudio. 21 voluntarios (70%) evacuaron más del 80% de los marcadores radiopacos a las 96 horas. 20% (6 voluntarios) registraron la eliminación total de los marcadores antes de las 96 horas. 70% presentó la eliminación de más del 80% de los marcadores de TC a las 96 horas. No se evidenció diferencias estadísticas significativas entre los grupos etarios ni género. Los valores obtenidos son inferiores a los aceptados como normales, reportados en la literatura mundial (eliminación del 80% de los marcadores antes de las 120 horas), y superiores en comparación con un estudio mexicano semejante (eliminación del 80% de los marcadores a las 48 horas)...

The colonic transit is the objective measurement of the time lag in the intestinal contents through the colon and represents an important advancement in the evaluation of patients with intestinal disorders of habit. Normal colonic transit (CT). To determine normal values of CT in healthy volunteers in the city of Caracas. Hospital Universitario de Caracas (HUC). A descriptive cross-functional study; 8Fr (2.7mm) metal rings were used as radiopaque markers, placed into gelatin capsules of 00 long (24 rings / capsule), 30 healthy volunteers, medical and nursing staff of HCU, aged between 18 and 50 years, matched by gender were randomly taken: 15 male and 15 female. A simple abdominal radiography was performed on dorsal decubitus position at 72, 96 and 120 hours after ingesting the capsule, quantifying the amount of markers removed. For the analysis of the results we used the nonparametric Mann-Whitney U test, with a significance level of 95%. No changes were made in the diet during the study. 21 volunteers (70%) evacuated more than 80% of the radiopaque markers at 96 hours. 20% (6 volunteers) reported the total elimination of the markers prior to 96 hours. 70% eliminated over 80% of the markers of the CT at 96 hours. No statistically significant differences were found between age groups or gender. The values obtained are below the ones accepted as normal, reported in the literature (80% elimination of the markers before the 120 hours) and higher compared to a similar Mexican study (80% elimination of the markers at 48 hours)...

Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar / Effects of conventional treatment of chronic functional constipation on total and segmental colonic and orocecal transit times

OBJETIVO: Avaliar o efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito colônico total e segmentar e no tempo de trânsito orocecal. MÉTODOS: Foram incluídos 34 pacientes com constipação funcional atendidos consecutivamente em ambulatório especializado. O tempo de trânsito colônico total e segmentar foi avaliado com marcadores radiopacos. O tempo de trânsito orocecal da lactulose e do feijão foi avaliado com teste do hidrogênio no ar expirado. O tratamento constou de desimpactação, orientações gerais e de consumo de dieta rica em fibra alimentar e administração de óleo mineral. RESULTADOS: Na admissão, dismotilidade colônica foi encontrada em 71,9 por cento (23/32) dos pacientes. Todos os pacientes que realizaram corretamente o tratamento apresentaram melhora clínica na sexta semana do tratamento quando 82,6 por cento (19/23) daqueles com dismotilidade na admissão apresentaram normalização ou diminuição da gravidade no padrão de trânsito colônico. Observou-se redução do tempo de trânsito (medianas) entre a admissão e a oitava semana de tratamento: trânsito orocecal da lactulose (de 70 para 50 minutos, p = 0,002), orocecal do feijão (de 240 para 220 minutos, p = 0,002) e colônico total (de 69,5 para 37,0 horas, p = 0,001). A necessidade de uso de óleo mineral para controle da constipação aos 12 meses de tratamento associou-se com persistência de trânsito colônico total superior a 62 horas na oitava semana de tratamento (p = 0,014). CONCLUSÃO: O programa terapêutico convencional proporcionou bons resultados independentemente da presença ou não de dismotilidade colônica na admissão ao estudo. As anormalidades da motilidade digestiva na constipação funcional da criança podem apresentar reversibilidade e ser de natureza secundária.

OBJECTIVE: To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time. METHODS: A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration. RESULTS: At admission, colonic dysmotility was found in 71.9 percent (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6 percent (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014). CONCLUSION: The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.

Estudio comparativo de dos equipos para el test de H2 en aire espirado / Evaluation of breath H2 measured by means of two different analyzers

El test de hidrógeno (H2) en aire espirado es ampliamente utilizado en el estudio de malabsorción de hidratos de carbono, sobrecrecimiento bacteriano intestinal (SBI) y tiempo de tránsito orocecal (TTOC). Objetivo: Comparar los resultados obtenidos por dos equiposde detección de H2, uno de ellos de introducción reciente en nuestro medio. Material y Métodos: 50 pacientes, edad promedio 38,5 +/- 5,2 años (rango 7-77 años), 40 mujeres, se les realizó el test de H2 en aire espirado en paralelo con ambos equipos bajo métodos estandarizados. En 25 de ellos se investigó la presencia de malabsorción de lactosa, y en los otros 25, la presencia de SBI con lactulosa. Se evaluaron los valores de H2 obtenidos con ambos equipos. Resultados: Las lecturas de H2 con ambos equipos no mostraron diferencias significativas tanto para lactosa (p > 0,1), como para lactulosa (p > 0,5). Tampoco hubo diferencias en el TTOC de los pacientes (90 +/- 33,75 min v/s 90.8 +/- 32,42 min) (p > 1). Se obtuvo un índice de concordancia Kappa de 0,92 entre ambos equipos con el test con lactosa y con lactulosa. Conclusión: El equipo portátil es altamente confiable, entregando resultados con una excelente concordancia con respectoal equipo de referencia.

The hydrogen (H2) breath test (BT) is widely used to investigate carbohydrates malabsorption, small intestinal bacterial overgrowth (SIBO) and orocaecal transit time (OTT). Aim: To compare the results of two hydrogen breath devices, one of them, of recent introduction in our country. Methods: Fifty patients were included, mean age 38.5 +/- 5.2years (range 7-77 yrs), 40 women, H2 BT was performed in parallel with both analyzers under standardized methods. Lactose malabsorption was investigated in 25 patients with lactose, and the presence of SIBO in the resting 25 patients, with lactulose, hydrogen values obtained with both devices were evaluated. Results: No differences were observed between the H2 concentrations for lactose BT (p > 0.1) as well as lactulose BT (p > 0.5)and also between the OTT measured by the two devices (90 +/- 33.75 min. v/s 90.8 +/- 32.42 min) (p > 1). We detected a Kappa concordance index of 0.92 for both equipments. Conclusion: The portable device is highly reliable to detect the presence of breath hydrogen, giving results with an excellent concordance to the reference device.

Colectomía total laparóscopica para el tratamiento de inercia colónica: resultados quirúrgicos y funcionales / Laparoscopic total colectomy for colonia inertia: immediate and late results

Introducción: El abordaje laparoscópico en el tratamiento de la inercia colónica (IC) es una técnica que ha demostrado ser una excelente alternativa al abordaje clásico. Objetivo: Presentar la experiencia de la IC y los resultados funcionales obtenidos a mediano plazo luego de una colectomía total con ileorecto anastomosis (CT+IRA) por vía laparóscopica. Material y Método: Se analizaron todos los pacientes operados con diagnóstico de IC a los que se les realizó una CT+IRA vía laparóscopica, en el período 2002 al 2007. Todos poseían un completo estudio para constipación (Historia clínica, manometría ano-rectal, enema baritado, defecografía, estudio radiológico del tránsito colónico y de intestino delgado). Se analizaron las variables preoperatorios y quirúrgicas. Se realizó un seguimiento telefónico evaluando el puntaje según la escala de Wexner para constipación e incontinencia, la recomendación de la cirugía a terceros y satisfacción con el procedimiento (Escala de 1 a 10). Análisis estadístico: Test T de Student. Resultados: En el período mencionado se intervinieron 20 pacientes, todos de sexo femenino. La edad promedio fue de 41,5 años (i: 18-52). El tiempo operatorio fue de 248 minutos (i: 170-360). Hubo una conversión (5 por ciento) por dificultad anatómica. El tiempo medio hasta la expulsión de gases y la realimentación fue al 2º (i: 1-4) y 3º (i: 2-6) día respectivamente. La mediana de estadía postoperatoria fue de 7 días. Se complicaron 7 pacientes (35 por ciento) (3 íleo postoperatorios, 1 trombosis portal, 1 rectorragia, 1 colección peri anastomotica y 1 hemoperitoneo). Hubo una relaparotomía por trombosis portal, una punción percutánea por colección perianastomotica y una relaparoscopía por hemoperitoneo. No hubo mortalidad postoperatoria. Seguimiento a una mediana de 25 meses (i: 1-60); puntaje de Wexner para constipación en el preoperatorio fue 22,3 (i: 19-29) y al control postoperatorio 1,8 (i: 0-6) (p < 0,01). El nivel medio de satisfacción...

Background: Total colectomy with Neo-recto anastomosis has the best results in the treatment of colonic inertia but it is a complex procedure. Laparoscopic approach is a less invasive alternative. Aim: To report the results of laparoscopic total colectomy with Neo rectal anastomosis for the treatment of colonic inertia. Material and Methods: Review of medical records of patients with colonic inertia subjected to a laparoscopic total colectomy with Neo rectal anastomosis. All had a complete preoperative study for constipation. A telephone follow up was performed asking for constipation, fecal incontinence and if they would recommend the procedure to other patients. Results: Twenty female patients aged 18 to 52 years were operated. Mean operative time was 248 minutes. In 5 percent of patients, conversion to open surgery was required. The lapse for gas expulsion and resumption of oral feeding was two and three days after surgery, respectively. Mean hospital stay was seven days. Seven patients (35 percent) has complications (a postoperative ileus in three, a portal vein thrombosis in one, hematochezia in one and hemoperitoneum that required a new laparoscopy in one). The Wexler score for constipation was 22.3 (range 19-29) in the preoperative period and decreased to 1.8 (range 0-6) in the telephone follow up. The mean level of satisfaction was 8 (range 2-10) and only one patient would not recommend the procedure to other patients. Conclusions: Laparoscopic total colectomy for colonic inertia has a 35 percent rate of complications in immediate postoperative period and good functional results in the long term follow up.

Evaluation by computerized morphometry of histopathological alterations of the colon wall in segments with and without intestinal transit in rats / Avaliação por morfometria computadorizada das alterações histopatológicas da parede cólica em segmentos com e sem trânsito intestinal em ratos

PURPOSE: To evaluate histopathological alterations of the colon wall in segments with and without intestinal transit, by computer-assisted imaging, and to correlate these with the length of time diversion. METHODS: Thirty male Wistar rats were subjected to intestinal transit diversion by a proximal colostomy and distal mucosa fistula. The animals were divided into three experimental groups according to how long after the initial surgical procedure they were sacrificed: six, twelve and eighteen weeks. Colon segments with and without transit were subjected to histopathological study. The variables colon crypt length, mucosal ulceration, muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria, vascular congestion, number of caliciform cells, inflammatory grade and degree of inflammation, comparing the two colon segments in the different experimental groups were studied. Intestinal crypt length, muscle layer thickness of the mucosa, submucosa and muscularis propria and caliciform cells were measured by computer-assisted imaging method. Mean equality, variance analysis and correlation tests were used in the statistical analysis, and the significance level was set at 5 percent. RESULTS: Comparison between segments with and without transit showed that the latter presented reduced length of colon crypts and increased muscle layer thickness of the muscularis mucosa, submucosa and muscularis propria. There were greater quantities of ulceration of the mucosal and greater degree of inflammation with increasing time without transit. Mucosal ulceration, submucosal vascular congestion, increased thickness of the submucosal and muscularis propria layers, presence of caliciform cells, inflammatory infiltrate and inflammatory grade correlated significantly with the length of time without transit. CONCLUSIONS: Histological alterations occurred in all layers of the colon wall, in the segments without intestinal transit. Ulcerations...

OBJETIVO: Avaliar por método de imagem assistida por computador as alterações histopatológicas da parede cólica em segmentos providos e desprovidos de trânsito intestinal e relacioná-las ao tempo de exclusão. MÉTODOS: Trinta ratos Wistar machos foram submetidos à derivação do trânsito no cólon esquerdo por meio de colostomia proximal e fístula mucosa distal. Os animais foram divididos em três grupos experimentais segundo o sacrifício ter sido realizado seis, doze e dezoito semanas após o procedimento cirúrgico inicial. Segmentos dos cólons providos e desprovidos de trânsito foram submetidos a estudo histopatológico. Foram analisadas as variáveis: comprimento das criptas cólicas, ulceração na mucosa, espessura das camadas muscular da mucosa, submucosa e muscular própria, congestão vascular, número de células caliciformes e graduação inflamatória comparando os dois segmentos cólicos nos diferentes grupos experimentais. As variáveis, comprimento das criptas intestinais, espessura das camadas muscular da mucosa, submucosa e muscular própria foram mensuradas por método de imagem assistida por computador. Na análise estatística foram utilizados testes de igualdade de médias e medianas, análise de variância e correlação estabelecendo-se nível de significância de cinco por cento. RESULTADOS: A exclusão de trânsito mostrou-se associada à redução do comprimento das criptas cólicas, aumento da espessura das camadas muscular da mucosa, submucosa e muscular própria. Verificou-se maior quantidade de ulcerações na mucosa e maior grau de inflamação com o progredir do tempo de exclusão. Houve correlação significante entre as ulcerações da mucosa, congestão vascular da submucosa, aumento da espessura das camadas submucosa e muscular própria, presença de células caliciformes, infiltrado inflamatório, graduação inflamatória e o tempo de exclusão de trânsito. CONCLUSÕES: Alterações histológicas ocorrem em todas as camadas da parede cólica, em segmentos sem...

The small bowel flora in individuals with cecoileal reflux / Estudo da flora do delgado em doentes com refluxo cecoileal

BACKGROUND: The observation of cecoileal reflux to barium enema is not rare; however, its causes and consequences have not been widely investigated. Considering that ileocecal junction exerts a function as barrier to invasion of bacteria from colon to small bowel, it seems interesting to study the intestinal microflora in subjects carrying cecoileal reflux. AIMS: This study aims at evaluating the ileal flora in individuals with cecoileal reflux. METHODS: A group of 36 subjects comprising 30 females and 6 males with a mean age of 54 years was assessed. Twenty-five individuals with cecoileal reflux and 11 without cecoileal reflux were submitted to small intestine contamination evaluation through the breath test with lactulose-H2 and measurement of the orocecal transit time by means of alternate current biosusceptometry. Small intestine bacterial overgrowth was characterized by orocecal transit time-H2 shortening. RESULTS: Comparison of basal H2, orocecal transit time-H2 and orocecal transit time-alternate current biosusceptometry measurements did not statistically differ between the groups with and without cecoileal reflux. Orocecal transit time-H2 was significantly smaller than orocecal transit time-alternate current biosusceptometry, particularly in individuals with cecoileal reflux. A significant correlation between the two methods was observed only in relation to control, not existing in relation to cecoileal reflux group. CONCLUSIONS: Smaller orocecal transit time-H2 and the loss of correlation with orocecal transit time-alternate current biosusceptometry observed in the individuals with cecoileal reflux suggest a differentiated behavior for such group relative to control, which could be associated with small intestine bacterial overgrowth.

RACIONAL: Fato de observação não rara, é o encontro de refluxo cecoileal durante realização de enema opaco. As causas e conseqüências deste achado têm sido pouco estudadas. OBJETIVOS: Sabendo que a junção ileocecal exerce função de barreira e proteção contra a invasão do delgado pela flora colônica, realizou-se o presente estudo com a finalidade de investigar se existe contaminação ileal em indivíduos com refluxo cecoileal ao enema opaco. MÉTODOS: Investigaram-se 36 indivíduos, 30 mulheres e 6 homens, idade média de 54 anos, 25 com e 11 com ausência refluxo cecoileal. Todos submetidos a pesquisa de contaminação bacteriana do delgado por intermédio de teste respiratório com lactulose-H2 e a determinação do tempo de trânsito orocecal por meio de biossusceptometria de corrente alternada. A caracterização da contaminação do delgado foi baseada no encurtamento do tempo de trânsito orocecal medido pelo teste da lactulose-H2. RESULTADOS: A comparação dos valores basais do H2, do tempo de trânsito orocecal-H2 e tempo de trânsito orocecal-biossusceptometria de corrente alternada não diferiram estatisticamente entre os grupos com e sem refluxo cecoileal. Quando comparados os tempo de trânsito orocecal-H2 e tempo de trânsito orocecal-biossusceptometria, foi observado aumento de tendência de redução do primeiro em relação ao último nos grupos com refluxo cecoileal e correlação significante entre os dois métodos apenas no grupo-controle, inexistindo nos com refluxo cecoileal. CONCLUSÃO: Encurtamento do tempo de trânsito orocecal-H2 e sua perda de correlação com o tempo de trânsito orocecal-biossusceptometria observado em indivíduos com refluxo cecoileal, sugerem comportamento diferenciado deste grupo em relação ao grupo-controle. Possível explicação para as diferenças registradas entre os grupos, seria a presença de flora anômala nos indivíduos com refluxo cecoileal.

El uso de inhibidores de bomba de protones y el hábito de fumar no modifican la tasa de sobrecrecimiento bacteriano intestinal en pacientes con patología digestiva funcional / Small intestinal bacterial overgrowth is not influenced by proton pump inhibitors and smoking habit in patient with funtional gastrointestinal disorders

Background: Drug induced inhibition of acid secretion has been associated to small intestinal bacterial overgrowth (SIBO). Smoking is followed by an increase of exhaled and orocecal transit time (OCTT). Aim: To investigate if the use of proton pump inhibitiors (PPI) and smoking can modifie the incidence of SIBO in patients with functional gastrointestinal disease. Patients and Methods: Questionnaires performed before a study for SIBO in patients with functional gastrointestinal disorders were analyzed. The use PPI and the smoking habit were recorded. The presence of SIBO and the OCTT was determined by means of the lactulose hydrogen breath test. Results: 437 patients, mean age 45 years (range: 14-93), 337 (77 percent) female, entered in the study SIBO was present in 356 patients, and 81 patients had normal H2 breath test. Both groups had a similar distribution of gender and age. The percentage of SIBO was no different in patients using PPI or presenting smoking habit Conclusions: Use of PPI and smoking habit are not risk factors for the development of SIBO in patients with functional disorders.

Los fármacos que inhiben la secreción gástrica favorecen el sobrecrecimiento bacteriano intestinal (SBI), mientras que el habito de fumar puede aumentar los niveles de H2 espirado y el tiempo de transito orocecal (TTOC). Objetivo: Investigar si el uso de inhibidores de la bomba de protones (IBP) y el habito de fumar modifican la incidencia de SBI en pacientes con trastornos digestivos funcionales. Pacientes y Métodos: Se analizaron encuestas de pacientes con patología digestiva funcional previas a un estudio de SBI Se consignaron el uso de IBP Y el hábito tabáquico en los 6 meses que precedieron al examen. La presencia de SBI y el tiempo de transito orocecal (TTOC) se determinaron con el test de hidrógeno en aire espirado con lactulosa. Resultados: 437 pacientes, con edad x 45 años (rango: 14-93),337 (77 por ciento) mujeres. Con SBI 356 pacientes, sin SBI 81 pacientes. Ambos grupos fueron comparables en cuanto a distribución por sexo y edad. El porcentaje de pacientes con SBI no fue diferente en pacientes con antecedente de uso de IBP o con hábito tabaquito. Conclusiones: El antecedente del uso de IBP y el tabaquismo no constituyen un factor de riesgo para SBI en pacientes con patología digestiva funcional.

Revisión crítica de los métodos utilizados en el estudio del tránsito colónico / Colonic transit assesment: a chritical review

Functional constipation is a disorders frequently observed in clinical practice. In the management of a group of patients who do not respond to established medical treatment, is important to investigate colonic transit A critical review of the main technical approach for colonic transit estimation is presented. Two main methods are actually availables: isotopic markers, and radiological techniques with radiopaque markers, the last one being the most extensively used. The most basic technique consist in a single administration of markers and a plain abdominal Rx. Information about percentage of markers observed five days after ingestion (normal 20%) and distribution, provide important information: diffuse overall the colon (slow transit constipation) or localized distally (outlet obstruction).Using repeated doses of markers and one or more Rx, colonic transit time segmental or total can be established. This information may be useful in the assessment of certain pathological conditions, pharmacological effects and diets.

La constipación funcional es una manifestación clínica frecuente. En algunos pacientes que no responden a las. medidas terapéuticas habituales, es necesario para su manejo contar con una evaluación del tránsito colónico. Revisamos en forma crítica en esta presentación las principales técnicas utilizadas en la actualidad con este fin. Existen principalmente dos métodos: el uso de marcadores isotópicos y técnicas radio lógicas con marcadores radiopacos, esta última es la más ampliamente utilizada. La técnica con marcadores radiopacos más simple consiste en utilizar una dosis de marcadores y una radiografía, informa sobre el porcentaje de retención de marcadores (normal 20% a los 5 días) y su distribución: difusa (constipación por tránsito lento), localizada distalmente, que sugiere un trastorno del tracto de salida. Usando dosis repetidas de marcadores y una o más radiografías, se puede establecer el tiempo de tránsito para los diferentes segmentos del colon y total, lo que puede ser de utilidad en la evaluación de determinadas condiciones patológicas, fármacos y dietas.

Manejo de la constipación crónica del adulto: Actualización: [revisión] / Constipation in adults: An update: [review]

Constipation affects 2 percent to 27 percent of individuals. It is associated to irritable bowel syndrome in 59 percent of cases, to a pelvic floor dysfunction in 29 percent and to a low transit time in 13 percent. During assessment of patients with constipation the effects of medications and chronic diseases must be discarded and the ideal is to determine which type of functional disorder it present. An algorithm for the management of chronic idiopathic constipation, that includes a recommendation to increase fiber and liquid intake as an initial approach and an orientation to the use of different laxatives, is presented. The usefulness of biofeedback in patients with pelvic floor dysfunction and without organic cause of constipation, is also discussed.