Functional iron status of chronic kidney disease patients at the University of Ilorin Teaching Hospital, Ilorin, Nigeria

Background: Functional iron deficiency has been found to be a common cause of poor response to erythropoiesis stimulating agents in anaemic patients with chronic kidney disease (CKD). Objectives: Assess the functional iron status of patients with chronic kidney disease. Methods: This was a hospital based cross sectional study. The study subjects were chronic kidney disease patients with age and sex matched healthy controls. Full blood count, serum ferritin, soluble transferring receptor, C-reactive protein, serum iron and total iron binding capacity were measured in the patients and healthy controls. Data was analyzed with statistical package for the social sciences software version 22.0. And the level of statistical significance was set at p. value < 0.05. Results: The mean ± SD of the age of patient with CKD was 55.0 + 15.4 years, while that of controls was 52.7 + 13.6 years. The mean serum ferritin, serum iron, TIBC and CRP were significantly higher in patients compared with controls (p<0.001, 0.023, <0.001 and 0.001) respectively. Functional iron deficiency was seen in 19.5% of patients with CKD. Conclusion: The predominant form of iron deficiency in our study was functional iron deficiency

Assistência à saúde de pessoas com doenças colorretais no sistema público a perspectiva do usuário / Health care for people with colorectal diseases in the public system: the user's perspective

Trata-se de um estudo de desenho misto, do tipo sequencial explanatório, sendo que na etapa quantitativa descritiva e transversal, objetivou-se analisar a demanda de atendimento de assistência de pessoas com queixas colorretais em Unidades de Saúde da Família no Sistema Único de Saúde (SUS); e na etapa qualitativa exploratória, interpretar o mapa de cuidado de pessoas com adoecimento colorretal crônico no SUS (Parecer No. 210/2018 CEP/EERP-USP). Na etapa quantitativa aplicou-se um instrumento de coleta de dados, elaborado pelas pesquisadoras, com base na revisão de literatura, para caracterização sociodemográfica, clínica, terapêutica e de referência de participantes usuários da Estratégia Saúde da Família com queixas colorretais, mediante critérios de inclusão e exclusão, no período de abril a setembro de 2019. A análise estatística descritiva dos dados indicou, que do total de 107 participantes, predominou 78 (72,9%) que tinham idade acima de 60 anos, 64 (59,8%) eram do sexo feminino, 61 (57%) tinham até oito anos de estudos, 68 (63,65) com companheiro, 56 (52,3%) eram aposentados, 45 (42,1%) apresentavam renda de até um salário mínimo e 95 (88,8%) não possuíam plano de saúde privado, sendo que o encaminhamento para o nível secundário foi devido ao protocolo de rastreamento para 62 (57,9%) e 45 (42,1%) por queixa colorretal, todos haviam realizado a Pesquisa de Sangue Oculto e destes, 78% tiveram resultado positivo; todos os entrevistados haviam recebido encaminhamento para realizar a colonoscopia. Além disso, 78 (72,9%) eram sedentários; e 66 (61,7%) consumiam carne vermelha e 45 (42,1%) embutidos. A análise univariada da associação das variáveis hábitos de vida, resultado de colonoscopia, presença de alterações displásicas ou doença colorretal não foi estatisticamente significante entre consumo de carne vermelha, consumo de embutidos ou ambos com o desfecho de colonoscopia normal, displasia intestinal com potencial neoplásico e doença diverticular ou orificial. Estes resultados dimensionaram o contexto de atendimento desta clientela na Atenção Primária à Saúde (APS), auxiliando o refinamento dos critérios de seleção dos possíveis participantes da etapa qualitativa. A etapa qualitativa foi realizada, no período de junho de 2020 a julho de 2020, mediante os critérios de seleção: pessoas acima de 18 anos, de ambos os sexos, com diagnóstico colorretal crônico: Doença inflamatória intestinal ou Neoplasia colorretal em internação especialidade de Coloproctologia de um hospital universitário público, de assistência terciária/quaternária. Nesta etapa, os dados foram coletados por meio de entrevistas individuais em profundidade com 14 participantes, cuja caracterização sociodemográfica, clínica e terapêutica revelou internação para tratamento cirúrgico, com maior gravidade clínica, sendo que 13 apresentavam diagnóstico de Neoplasia colorretal. Utilizou-se questões norteadoras, diário de campo, observação não participante e participante para a obtenção dos dados, que foram interpretados com Análise Temática, fundamentado pela Epidemiologia Social. O Mapa de Cuidado construído por estes, iniciou-se com queixas e sinais/sintomas gastrointestinais, envolvendo situações de maior gravidade clínica, com sofrimento físico e psicoemocional; diagnosticados como parasitose, hemorroidas e anemia na APS, cujos tratamentos não foram resolutivos. Para esta interpretação, articulou-se as ações destes participantes às suas queixas, à condição socioeconômica, cultural e psicoemocional, assim como à capacidade de enfrentamento do adoecimento oncológico e dos tratamentos, no qual ocorreu a focalização da vida destes e de suas famílias nos acontecimentos clínicos e terapêuticos do contexto de atendimento terciário/quaternário. O acesso aos serviços do SUS ocorreu de diferentes maneiras, com utilização de estratégias que agilizaram e asseguraram a resolução do seu problema de saúde, sendo que o agir leigo foi uma produção social, no cotidiano do SUS, mediado pelos acontecimentos, pelas ações dos profissionais e de suas próprias ações ou pelo sistema de apoio social, enfatizando-se o sofrimento desta clientela na busca pela assistência à saúde. Este mapa de cuidado mostrou que o agir leigo constituiu uma regulação assistencial no SUS, tão importante quanto as outras formas, composto pelos vínculos dos pacientes com profissionais dos serviços dos níveis primário, secundário, terciário/quaternário, de suas necessidades e possibilidades, além dos pontos de acesso ao sistema. Estes resultados poderão contribuir na implementação da gestão de cuidados de pessoas com adoecimento colorretal crônico no SUS, dando voz e protagonismo àquele que busca pela assistência à saúde

This is a study of mixed design, of an explanatory sequential type, and in the quantitative descriptive and transversal stage, the objective was to analyze the demand for assistance from people with colorectal symptoms in Family Health Units in the Unified System Health (SUS); and in the qualitative exploratory stage, interpret the care map for people with chronic colorectal illness in SUS (Note Nº. 210/2018 CEP / EERP-USP). In the quantitative stage, a data collection instrument was developed by the researchers, based on the literature review, for sociodemographic, clinical, therapeutic, and reference characterization of participating users of the Family Health Strategy with colorectal symptoms, considering inclusion and exclusion criteria, from April to September 2019. The descriptive statistical analysis of the data indicated that, out of a total of 107 participants, 78 (72.9%) predominated who were over 60 years old, 64 (59.8%) were female, 61 (57%) had up to eight years of study, 68 (63.65) with a partner, 56 (52.3%) were retired, 45 (42.1%) had an income of up to one minimum wage and 95 (88.8%) did not have a private health plan, and the referral to the secondary level was due to the screening protocol for 62 (57.9%) and 45 (42.1%) due to colorectal complaints, all had carried out the Occult Blood Survey and of these, 78% had a positive result; all respondents had been referred for colonoscopy. In addition, 78 (72.9%) were sedentary; and 66 (61.7%) consumed red meat and 45 (42.1%) sausages. The univariate analysis of the association of the variables life habits, the result of colonoscopy, presence of dysplastic changes or colorectal disease was not statistically significant between consumption of red meat, consumption of sausages or both with the outcome of normal colonoscopy, intestinal dysplasia with neoplastic potential and diverticular or artificial disease. These results have dimensioned the context of care for this clientele in Primary Health Care (PHC), helping to refine the selection criteria of possible participants in the qualitative stage. The qualitative stage was carried out, from June 2020 to July 2020, using the selection criteria: people over 18 years of age, of both sexes, with chronic colorectal diagnosis: Inflammatory bowel disease or Colorectal neoplasia in Coloproctology specialty hospitalization of a public university hospital, of tertiary/quaternary assistance. In this stage, data were collected through in-depth individual interviews with 14 participants, whose sociodemographic, clinical, and therapeutic characterization revealed hospitalization for surgical treatment, with greater clinical severity, with 13 presenting a diagnosis of colorectal neoplasia. Guiding questions, field diary, non-participant and participant observation were used to obtain the data, which were interpreted with Thematic Analysis, based on Social Epidemiology. The Care Map built by them started with gastrointestinal complaints and signs/symptoms, involving situations of greater clinical severity, with physical and psycho-emotional suffering; diagnosed as parasitosis, hemorrhoids, and anemia in PHC, whose treatments were not effective. For this interpretation, the actions of these participants were linked to their complaints, to their socioeconomic, cultural, and psycho-emotional condition, as well as to their ability to cope with oncological illness and treatments, in which the lives of these and their families were focused on the events and therapeutic aspects of the tertiary/quaternary care context. Access to SUS services occurred in different ways, using strategies that streamlined and ensured the resolution of their health problem, and the lay agency as social production, in the daily routine of SUS, mediated by events, by the actions of professionals and their actions or the social support system, emphasizing the suffering of this clientele in the search for health care. This care map showed that the lay act constituted an assistance regulation in SUS, as important as the other forms, composed by the bonds of patients with professionals from the services of the primary, secondary, tertiary/quaternary levels, of their needs and possibilities, in addition to the access points to the system. These results may contribute to the implementation of the care management of people with chronic colorectal illness in SUS, giving voice and leadership to those seeking health care.

Nationwide Survey for Application of ROME IV Criteria and Clinical Practice for Functional Constipation in Children

BACKGROUND: This study aimed to investigate the awareness and application of ROME IV criteria for functional constipation (FC) in real-world practices and assessed differences between pediatric gastroenterologists (PGs) and general pediatricians. METHODS: A total of 239 (47.8%) out of 500 nationwide pediatricians answered a questionnaire for diagnosis and management of pediatric FC; 60 were PGs (75% of total PGs in Korea). RESULTS: A total of 16.6% of pediatricians were aware of the exact ROME IV criteria. Perianal examination and digital rectal examination were practiced less, with a higher tendency among PGs (P 6 months (63.8%) than 1-year were lactulose (59.1%), followed by polyethylene glycol (PEG) 4000 (17.7%), and probiotics (11.8%). Prescription priority significantly differed between PGs and general pediatricians; lactulose or PEG 4000 were most commonly prescribed by PGs (89.7%), and lactulose or probiotics (75.7%) were prescribed by general pediatricians (P < 0.001). For patients aged < 1-year, lactulose (41.6%) and changing formula (31.7%) were commonly prescribed. Most participants recommended diet modification, and PGs more frequently used defecation diary (P = 0.002). CONCLUSION: Discrepancies between actual practice and Rome IV criteria and between PGs and general pediatricians were observed. This survey may help construct practice guidelines and educational programs for pediatric FC.

Effect of food allergy early in life on visceral hyperalgesia in the developing rats and role of substance P abnormal expression in colon / 中华儿科杂志

<p><b>OBJECTIVE</b>To explore the effect of food allergy (FA) on the development of visceralgia sensibility and the substance P (SP) expression in colon of developing rats with FA.</p><p><b>METHOD</b>Three-week old female Sprague-Dawley (SD) rats were randomly divided into two groups (n = 10 in each). The rats in FA group were sensitized with ovalbumin (OVA) 40 µg and Al(OH)3 1 mg suspension solution (0.2 ml) intraperitoneal (i.p.) injection on day 0, only OVA 40 µg solution i.p. on day 2, 4, 7, 9, 11, respectively, and the rats were challenged by gavage with OVA solution 30 mg (2 ml) on day 20, 24, 28, 30. The rats in non-sensitized (NS) group were not challenged except handled in the same ways. The serum OVA-IgE were determined by enzyme-linked immuno sorbent assay (ELISA) on day 0, 30. Jejunum segments were used to observe morphological structure, the expression of eosinophils, and the density and the percentage of degranulation of mast cells (MC). The rats were appraised for the pain sensibility of intestinal tract under colorectal distension irritation by the electrophysiological method on external oblique in the 18-24 hr after the last challenge. Colons were used to analyze the expression of SP through immunohistochemical staining and computer image analyzing system.</p><p><b>RESULT</b>The serum OVA-IgE concentration and the eosinophils, mast cell, the percentage of mast cells degranulation in FA group were more than NS group (P < 0.01). The amplitudes of spike external oblique muscle of abdomen (EOMA, µV) of the FA group under the colorectal distension (CRD) pressures at 0, 15, 30, 45, 60, 75 mm Hg were (17.74 ± 0.72), (18.63 ± 1.72), (22.55 ± 1.70), (28.63 ± 7.00), (33.97 ± 7.34), (37.26 ± 8.40), and (17.43 ± 1.18), (17.27 ± 1.16), (17.73 ± 1.42), (19.55 ± 3.54), (23.29 ± 5.46), (25.20 ± 4.75) in NS group. With the CRD pressure increased, the amplitudes of spike EOMA increased significantly. There were significant differences between groups under the CRD pressures at 30, 45, 60, 75 mm Hg (F = 47.470, 13.367, 13.317, 15.390, P < 0.01). The expressions of colons SP in FA group and NS group are 247.12 ± 90.83 and 103.90 ± 58.94, respectively (t = 4.183, P < 0.01).</p><p><b>CONCLUSION</b>Sensitization through i.p. pathway and challenge by gavage with OVA in early life could result in FA in young SD rats. FA in early life enabled the amplitudes of spike EOMA and the expression of colons SP increase significantly. It may be related to increase in amount and degranulation of MC and SP abnormal expression in colon, which could lead to the development of visceralgia sensibility.</p>

Tiempo de transito colonico con marcadores radiopacos serie de casos / Colonic transit time with radiopaque markers: case studies

El tiempo de tránsito colónico con marcadores radiopacos (TTCMRO) es un estudio que constituye una manera sencilla y efectiva de evaluar la motilidad del colon. Fue descrito en 1969 y sigue vigente como un método complementario de estudio en pacientes con estreñimiento. Se presentan nueve casos de pacientes en quienes se realizó este estudio como parte del diagnóstico clínico de estreñimiento en 2010; se revisan así mismo la técnica, el aporte diagnóstico y las indicaciones del examen. Aunque en la literatura no hay una estandarización satisfactoria de la técnica de examen, el aporte del estudio para determinar el papel del colon en el estreñimiento de cada paciente ha hecho que se incluya en las guías de trabajo de estreñimiento, lo cual hace aún más relevante la importancia de estandarizar la técnica y la presentación del estúdio.

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.

Study of the relationship between helicobacter pylori infection and irritable bowel syndrome

Irritable bowel syndrome [IBS] can be diagnosed at any age but a new diagnosis of IBS should be made in patients older than 60 years of age because other diseases [colon cancer, diverttculitis, inflammatory bowel may have similar presenting symptoms. Research studies consistently show that women are two to three times more likely than men to be diagnosed with IBS, Over 40 years ago, it was recognized that a percentage of patients with irritable colon developed typical IBS symptoms after an acute infective enteritis [eg, postdysentery IBS]. The aim of the present work to study the relationship between helicobacter pylori and irritable bowel syndrome. The present study was conducted on 30 subjects, They were stratified into 2 groups: group I [IBS groups], they were twenty patients with symptoms suggestive of irritable bowel syndrome according to Rome criteria II, they were 6 males [30%] and 14 females [70%] and their ages were ranging from 18 to 50 years with a mean value of [36.5 +/- 13.2 years] and this group underwent upper endoscopy and colonoscopy and random biopsies were taken from gastric and colonic mucosa for histological examination. Group II [control group] included ten healthy volunteers with no symptoms suggestive of irritable bowel syndrome, they were [5] males and [5] females matched by age They were chosen from referrals to the endoscopy unit of Menoufiya University Hospital. An informed consent was obtained from all included subjects. There was statistically significant difference in the results of histopathological examination of biopsies taken from the colon. There is increase in inflammatory cell infiltration of mucosa of the colon of IBS patient than control groups [lymphocyte infiltration, plasma cell and eosinophit. Helicobacter pylori [HP] did not colonize the colon mucosa. There was no a statistically significant difference in the results of hisiopathological examination of biopsies taken from the gastric antrum of IBS patient and control group [inflammatory cell infiltration]. There was no statistically significant difference of presence of HP in the gastric mucosa of IBS patients and healthy control. No direct correlation between HP infection and IBS but there was intense inflammatory response in the presence of HP

Corrección de prolapso rectal / correction rectal prolapse

Se presenta una panorámica de la operación de González Castellanos en el tratamiento de las pacientes con prolapso rectal. Nuestro estudio tiene dos objetivos: el primero, hacer una revisión de la literatura médica relacionada con esta patología y segundo, presentar nuestra experiencia en el tratamiento de pacientes con prolapso rectal.

Role of anorectal myectomy in manegment of functional outlet obstruction

this work aim to study the value of anorectal myectomy in diagnosis and treatment of functional outlet obstruction, twenty five patients with functional outlet obstruction were subjected to anorectal myectomy and biopsies were taken and examined for ganglionic state. All patients were subjected preoperatively to colonoscopy or barium, flexible sigmoidoscopy, colon transit time, standard proctograhy, anorectal manometry, pre-operative scoring of their constipation. Postoperatively patients were followed up for at least one year, where colon transit time and anorectal manometry were redone, and rescoring of their constipation. There was clinical improvement in 15 patients [60%] of these 10 were males, and histopathological examination of the specimen proved to be aganglionic in 9 patients [60%]. There was no clinical improvement in the other 10 patients of these 7 were males, and biopsy was aganglionic in only 3 patients [30%].anorectal myectomy is a promising diagnostic and therapeutic options in cases of functional outlet obstruction, provided careful patient selection and adequate physiological tests were done to the selected patients

Prevalence of coeliac disease in adult patients with symptoms of irritable bowel syndrome: a pilot study

The aim of this work is to estimate the prevalence and the potential clinical consequences of coeliac disease testing in adult Arab patients with IBS, and estimating the efficacy of IgA and IgG anti-gliadin antibodies, anti endomysial antibodies [EMA] IgA and anti-TG2 [IgA and IgG] on diagnosing celiac disease. As few recent studies have found higher prevalence of coeliac disease among patients diagnosed as irritable bowel syndrome [IBS] than general population [3-11% vs. 0.2-0.6%]. Similar studies showed that coeliac disease is as common in Middle Eastern countries as in Europe; in both the general population and at-risk groups. This is a prospective pilot study including 320 Arab patients with features compatible with IBS as defined by Rome III criteria without any other co-morbidity. The age of patients ranged between18-70 years. All patients were subjected to good history taking, clinical examination, and some investigations if needed such as stool, urine, CBC, liver enzymes, kidney function tests, ECG, electrolytes, H pylori serology, upper and lower endoscopy when indicated. Those diagnosed as having persistent criteria of IBS were tested for coeliac disease by IgA and IgG anti-gliadin antibodies, anti endomysial antibodies [EMA] IgA and anti-TG2 [IgA and IgG]. Upper endoscopy and duodenal biopsies were done and gluten free diet was implemented for only those with positive serological test. The same tests were repeated after period of about 6 months. Anti-gliadin antibodies were found positive in 15/320[4.69%] patients [14 with IgA and 13 IgG], EMA IgA in 13/320 [4.06%], anti-TG2 IgA in 12/320 [3.76%] and anti- TG2 IgG in 13/320 [4.06%]. Abdominal pain, diarrhea, dyspepsia, postprandial distress, epigastric pain, distension and chronic diarrhea were significantly higher and more common in combinations in those with positive serology in comparison to serologically negative patients [P < 0.05]. Haemoglobin level, serum iron, albumin and calcium were found to be significantly lower in those with positive serology in comparison to serologically negative patients [P < 0.05]. All these parameters improved significantly after gluten free died [GFD] for about 6 months [P< 0.05]. Only 11 patients [74.44% of those with positive serology and 3.49% of total patients] were diagnosed by biopsies as compatible with coeliac disease of which, two patients have family history of coeliac disease in first degree relatives. After gluten free died [GFD] for about 6 months, seroconversion to negative tests occurred in 6 patients for AGA-IgA, 4 for AGA- IgG, 3 for EMA IgA, 5 for Anti-TG2 IgA and 5 for Anti-TG2 IgG. Also, the grade of histopathology showed complete healing in 4 patients and improvement to lower grades in 4 patients after GFD. Worsening occurred in one case and still 7 cases showed the same grade of the disease. It is concluded from this study that minimally symptomatic coeliac disease can easily be mistaken for IBS. The presence of many persistent gastrointestinal symptoms in addition to the lower serum levels of some nutritional parameters must alert the physicians to screen for coeliac disease. The efficacy of IgA and IgG anti-gliadin antibodies, anti endomysial antibodies [EMA] IgA and anti-TG2 [IgA and IgG] were nearly the same. So any serological test can be used for the screening, especially EMA TG2 as they are easier and cheap. But this must be confirmed by tissue diagnosis which is the gold standard for diagnosis. Finally, screening for coeliac disease among patients with IBS must be considered to offer better prognosis to those patients simply by gluten free diet

Síndrome do ceco móvel e as doenças gastrintestinais funcionais / Mobile cecum sindrome and the functional gastrointestinal illnesses

O ceco móvel é uma variação anatômica embriológica do ceco e cólon ascendente resultante da descida incompleta desses segmentos do intestino grosso e da não fixação no peritônio da goteira parieto-cólica direita. A falta dessa fusão permite movimentação do ceco e/ou do cólon ascendente, facilitando a torção sobre seu eixo longitudinal ou a dobra medial do ceco sobre si, ficando encostado com sua borda medial à borda medial do cólon ascendente. Esse fato causa sintomas intermitentes de obstrução parcial do intestino ou, no caso de torção completa (volvo), de obstrução aguda com possível necrose do segmento envolvido. A anormalidade embriológica tem alta incidência (10 a 30 por cento na população), contudo só tem sido mencionada por ocasião da torção completa, inadequadamente denominada de volvo do ceco-ascendente, em geral com necrose cecal. Dessa forma, a ocorrência não é das mais comuns e está citada entre as causas de obstrução intestinal aguda, perfazendo, nos adultos e nas crianças, menos do que 2 por cento de todos os casos de obstruções intestinais, mas com a importância de destaque por causa do alto índice de morbi-mortalidade entre os pacientes afetados. O objetivo foi apresentar o ceco móvel como causa de dor abdominal intermitente, distensão, empachamento e cólica de origens obscuras em pessoas de aparência saudável, mas com uma longa história de distúrbios gastrintestinais funcionais, associados à constipação e/ou diarréia, portanto, com um quadro sintomatológico sobreponível ao da síndrome do cólon irritável. Além disso, propomos um marcador anatômico para a síndrome do cólon irritável, seja o subtipo com constipação predominante, seja o da diarréia predominante ou a forma em que há alternância entre constipação e diarréia e a possibilidade de alívio daqueles sintomas com a cecopexia.

Functional gastrointestinal (FGI) disorders are chronic or periodic conditions characterized by several symptoms whose structural and biochemical causes have not been determined. Indeed, although (FGI) disorders affect millions of people of all ages, their pathophysiological mechanisms are still unclear, so that no pathological conditions have been proven to be related to this kind of illness, nor biological markers have been found to identify their sufferers. Irritable bowel syndrome (IBS) has been shown to be one of the most common FGI illnesses. IBS is characterized by abdominal discomfort or pain and it has at least two of the following three features: pain relieved by bowel movements, more frequent stools with the onset of pain, and looser stools at the onset of pain - with no resultant inflammatory, metabolic or structural abnormalities. Since IBS diagnosis is fundamentally based on the description of symptoms reported by patients, it has been considered to be an exclusion diagnosis, despite the attempt to establish a connection between the origin of the illness and disorders caused by physical or sexual abuse or even by psychological disturbances. Although biochemical and hormone dosages have been performed in routine blood test for IBS, a precise biochemical marker has not been identified. Nevertheless, when the patients of this study were assessed by means of contrast intestinal radiography so as to observe topographic alterations in the cecum, it was possible to detect a mobile cecum in all of them. Would this be a coincident factor or could the mobile cecum - a widespread but misdiagnosed illness- explain the irritable bowel syndrome? The results of our study provide evidence that the majority of patients diagnosed as having IBS do not actually suffer from such illness, but rather from the mobile cecum syndrome.

Abdomen agudo médico / Acute abdominal pain

El dolor abdominal agudo es un síntoma habitual y muchas veces severo en la práctica médica. En ocasiones puede aparecer como un cuadro dramático asociado a numerosas enfermedades médicas o quirúrgicas. Al asistir a un paciente con dolor abdominal agudo el médico está obligado a establecer con premura un diagnóstico presuntivo y a elegir el tratamiento apropiado. El objetivo de este artículo es enunciar y clasificar las numerosas enfermedades médicas que pueden presentar dolor abdominal agudo como síntoma principal.

Prevalência da síndrome do cólon irritável em pacientes com fibromialgia / Prevalence of irritable bowel syndrome in patients with fibromyalgia

INTRODUÇAO: a síndrome da fibromialgia (FM) é uma síndrome dolorosa crônica comum na população em geral. Não apresenta qualquer processo inflamatório, distrófico ou degenerativo, e é considerada como conseqüente a disfunções neurofisiológicas envolvendo, principalmente, o sistema nervoso central (SNC). A síndrome do cólon irritável (SCI) é considerada como uma entidade disfuncional visceral, caracterizada por fenômenos motores do trânsito gastrointestinal, possivelmente relacionados a alterações neurofisiológicas nas mesmas vias do SNC. OBJETIVO: estudar a prevalência da SCI em portadores de FM e verificar as suas características clínicas. PACIENTES E MÉTODOS: foram estudados 200 portadores da síndrome da FM. RESULTADOS: verificou-se que, entre esses pacientes, 134 (67 por cento) apresentaram, concomitantemente, a SCI; entre esses, a maioria (121 = 90,2 por cento) sofria o subtipo constipativo da moléstia. Traço de personalidade e estado emocional associados à ansiedade e depressão foram evidenciados numa substancial proporção desses pacientes. CONCLUSAO: entre os pacientes com FM, não houve diferenças clínicas entre aqueles com e sem a SCI.

Will the Diagnosis of Functional Gastrointestinal Disorders be Disappeared? / 대한소화기학회지

No abstract availble.

Relación entre síntomas de Síndrome de Intestino Irritable y síntomas depresivos en pacientes hospitalizados / Relation between irritable bowel syndrome symptons and depressive symptons in hospitalized patients

El síndrome de intestino irritable (SII) y la depresión son desórdenes frecuentes en la práctica médica. Existe una elevada frecuencia de diagnósticos psiquiátricos en los pacientes con SII. Los objetivos del presente estudio son describir la prevalencia de síntomas gastrointestinales bajos (SII) y de síntomas depresivos en pacientes internados en el Hospital Arzobispo Loayza y estudiar la relación entre dichos síntomas. Realizamos un estudio de tipo transversal de prevalencia de síntomas gastrointestinales bajos y de síntomas depresivos, así como un anáisis de casos y controles para estudiar la relación entre los síntomas ya descritos. Se realizaron encuestas a 282 pacientes, en cada encuesta se describían los criterios de Roma II y el Inventario de Beck. Hallamos 67.4 por ciento de casos con síntomas depresivos y 31.9 por ciento de casos con síntomas de SII. En 24.1 por ciento de pacientes se encontró asociación significativa entre síntomas depresivos y gastrointestinales bajos (p<0.05). Concluimos que los síntomas depresivos y gastrointestinales bajos tienen una alta frecuencia en pacientes hospitalizados y que hay asociación significativa entre ellos.

Enzimas pancreáticas: revisión y análisis de sus acciones atenuantes sobre la secreción ácida gástrica, el dolor pancreático, el colon irritable y trastornos digestivos múltiples / Pancreatic Enzymes: useful therapeutical agents to a wider spectrum of functional digestive disorders. Revision and analysis

Las enzimas pancreáticas constituyen agentes terapéuticos de utilidad clínica dentro de un espectro mucho más amplio del que se acepta habitualmente. En este trabajo se trata de demostrar que ejercen una influencia benéfica en un variado grupo de entidades... y que la asociación de una mejora en el mecanismo del proceso digestivo, especialmente de los carbohidratos, y el consecutivo alivio de los fenómenos dispépticos fermentativos, ello en conjunción con una atenuación de la hipersensibilidad del sistema nervioso aferente, cambio muy ligado a una depresión liberadora sobre la CCK, explican el valor terapéutico innegable que poseen los fermentos pancreáticos en el enfoque terapéutico del colon irritable

Síndrome de intestino irritable: aspectos psicológicos / Irritable bowel syndrome: psychological aspects

El síndrome de intestino irritable es un trastorno funcional de la motilidad intestinal que constituye una problemática que compromete la calidad de vida al presentar una sintomatología física muy variada que únicamente ha sido manejada desde el punto de vista médico. La presente investigación abordó la vinculación de las variables psicológicas con el síndrome de intestino irritable. Ahondando en una intervención de la problemática conductual de la persona que posee ese diagnóstico, para caracterizar el síndrome de intestino irritable y establecer relaciones entre las dimensiones del comportamiento y la prevalencia de la sintomatología física. Para la intervención, se construyó una Guía de Entrevista que describía la sintomatología experimentada, los hábitos alimenticios, eliminatorios, laborales, sociales, sexuales y su manejo emocional. Luego de la validación, la guía se administró a 17 pacientes diagnosticados con síndrome de intestino irritable. Los resultados indican que los hábitos de alimentación, eliminación, sexuales y de manejo emocional se ven afectados por el síndrome de intestino irritable a diferencia de lo que sucede con los hábitos laborales y sociales. En consecuencia, existe una reducción sustancial de algunos patrones del paciente que son objeto del abordaje por el psicólogo clínico

Functional abdominal pain

The most widely used diagnostic term for chronic abdominal pain in children is "recurrent abdominal pain" [RAP]. Recurrent abdominal pain is a broad descriptive term to define a heterogeneous group of patients who experience at least 3 episodic attacks of abdominal pain over a period of at least 3 months. The great majority of patients who seek medical attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of gastro intestinal tract provoked by a variety of physical and psychological stimuli. When evaluated critically there are three distinct clinical presentations: Functional paroxysmal abdominal pain, functional dyspepsia and irritable bowel syndrome. There are adequate data to support the view of medical history, physical examination and selected laboratory, radiological and endoscope evaluation allows a positive diagnosis of each type of functional disorder to estimate the magnitude of the problems. Clinical approach to children with RAP. Estimate the morbidity of RAP and its effect on daily activities of the children The study was conducted on two hundred fifty six children aged 4-12 years attended out patient clinic and inpatient of national hepatology and tropical medicine research institute [NHTMRI] during the period from July to December 2003 through careful examination and investigation of 800 children with RAP 256 fit our criteria for functional abdominal pain the children had normal physical Examination and normal laboratory investigation and experienced at least 3 episodic attacks of abdominal pain over a period of at least 3 months. All the children subjected to investigation to exclude organic causes. All children were subjected to a structured questionnaire designed specially for the study. Medical history was reviewed thorough clinical examination was carried out. The following laboratory tests were done for all the children: CBC., Routine and microscopic stool and urine analysis, ESR, urine culture and psychosocial evaluation Showed that out of 800 children attended NHTMRI suffering from RAP. 256 [32%] of them were have functional abdominal pain. Female represented 53.1% and males only 46.9%. The children between [4-6] years having RAP were 38.3% females and 30% males, while in group between [6-12] years females were 61.7. Functional Isolated abdominal pain represented 60.5% of our patients. Functional dyspepsia were 21.5% and irritable bowel syndrome was only 18%. Clinical presentation of in RAP. Showed Symptoms associated with functional Isolated abdominal pain were headache 19% pallor 13% fatigability 22.5% In group having functional dyspepsia epigastric pain were 54% children suffering irritable bowel syndrome had constipation in 65% diarrhea in 32% and sense of incomplete evacuation in 21%. The duration of pain in the studied subjects ranging between 1-3 hours less than I hours account for 55.5% of children and less than 3 hours in 40% of cases, continuous pain represented only 4.5%. Periumblical and mid epigastric were the most frequent location in RAP represented 58.9 and 23.9 respectively. 16.8% of children had positive psychosocial dysfunction. The pain interfere in daily activities of children in 68.3 Chronic abdominal pain is the one of the most commonly encountered symptoms in childhood. The great majority of patients who seek medial attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of gastro intestinal tract provoked by a variety of physical and psychological stimuli. There are adequate data to support the view of medical history, physical examination and selected laboratory, radiological and endoscopic evaluation allows a positive diagnosis of each type of functional disorder. Most children who are brought to primary care physicians for chronic abdominal pain are unlikely to require diagnostic testing