Functional abdominal pain: what clinicians need to know.

Abdominal pain in childhood is extremely common and presents frequently to both primary and secondary care, with many children having recurrent pain which impacts on daily functioning. Despite this most children have no discernible underlying pathology. We discuss the underlying mechanism for functional abdominal pain (visceral hypersensitivity), the evidence base linking parental anxiety and patient symptoms, and how parents can be supported in managing their children's symptoms by addressing questions commonly asked by children and families. We look at the evidence for a one-stop rational approach to investigation including a coeliac screen, inflammatory markers and consideration of stool faecal calprotectin, in the absence of red flags. We evaluate commonly used treatments for functional abdominal pain, within a context of managing family expectations. Given the limitations in pharmacological treatment options, trials of probiotics, peppermint oil, mebeverine and (for short-term use only) hyoscine butylbromide may be appropriate. Psychological interventions including cognitive-behavioural therapy, distraction techniques and hypnotherapy have a better evidence base. There is also some evidence for other complementary therapies in children, including yoga and neurostimulation. Outcome is generally good providing there is child and family acceptance of the multiple factors implicated in the aetiology of the pain.

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

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

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

Proteção do dano oxidativo hepático induzido por ferro pelo extrato aquoso da planta Plectranthus barbatus / Protection against hepatic oxidative damage induced by iron by the aqueous extract of Plectranthus barbatus

Plectranthus barbatus Andrews (Lamiaceae) é uma planta muita utilizada na medicina popular para o tratamento de doenças gastrointestinais e hepáticas. O objetivo do presente trabalho foi estudar o efeito protetor do extrato aquoso de P. barbatus (EAPB) sobre os danos hepáticos causados pela sobrecarga de ferro provocada pelo ferro-dextran em ratos. O tratamento com ferro-dextran induziu uma redução significativa na concentração de glutationa reduzida nos animais tratados em relação ao grupo controle e o tratamento prévio dos animais com o EAPB protegeu o fígado do efeito provocado pelo ferro neste parâmetro. Com relação à lipoperoxidação, houve aumento significativo na concentração de malondialdeído (MDA) nos animais tratados em relação ao controle, entretanto, quando os animais receberam o tratamento prévio com o EAPB, houve redução significativa na concentração do MDA. A análise histopatológica mostrou que o grupo tratado com ferro-dextran apresentou grânulos de ferro no citoplasma das células de Kupffer com alargamento das mesmas e algumas com os núcleos hipertróficos. O tratamento prévio com EAPB resultou no desaparecimento dos sinais de danos às células de Kupffer sem nenhum núcleo hipertrófico, mas com a presença de grânulos de ferro totalmente fagocitados, o que demonstra uma aparência morfológica normal. Portanto, o EAPB pode ser útil na prevenção de danos hepáticos induzidos por sobrecarga de ferro.

The Plectranthus barbatus Andrews (Lamiaceae) is a plant largely used in folk medicine to treat gastrointestinal and liver diseases. The objective of this work was to study the protective effect of the aqueous extract of P. barbatus (EAPB) against damage caused by iron overload induced by iron dextran in rat liver. Treatment with iron-dextran induced a significant reduction in the glutathione levels in treated animals compared to control group, and the pretreatment of animals with EAPB protected the liver from the effects caused by iron in this parameter. With respect to lipid peroxidation, a significant increase in the malondialdehyde (MDA) levels in treated animals compared to control was observed; however, when the animals were pretreated with EAPB, there was a significant reduction in the MDA levels. Histopathological analysis showed that the group treated with iron-dextran showed iron granules in the cytoplasm of the Kupffer cells and some of them presented enlarged nuclei. The group previously treated with EAPB showed the disappearance of the signs of damage to the Kupffer cells with no nucleus hypertrophy but with the presence of iron granules completely phagocytosed by these cells, which showed a normal morphological appearance. Therefore, the EAPB may be useful in the prevention of liver damage induced by iron overload.

Acupuncture for functional gastrointestinal disorders.

Functional gastrointestinal (GI) symptoms are common in the general population. Especially, motor dysfunction of the GI tract and visceral hypersensitivity are important. Acupuncture has been used to treat GI symptoms in China for thousands of years. It is conceivable that acupuncture may be effective in patients with functional GI disorders because it has been shown to alter acid secretion, GI motility, and visceral pain. Acupuncture at the lower limbs (ST-36) causes muscle contractions via the somatoparasympathetic pathway, while at the upper abdomen (CV-12) it causes muscle relaxation via the somatosympathetic pathway. In some patients with gastroesophageal reflux disease (GERD) and functional dyspepsia (FD), peristalsis and gastric motility are impaired. The stimulatory effects of acupuncture at ST-36 on GI motility may be beneficial to patients with GERD or FD, as well as to those with constipation-predominant irritable bowel syndrome (IBS), who show delayed colonic transit. In contrast, the inhibitory effects of acupuncture at CV-12 on GI motility may be beneficial to patients with diarrhea-predominant IBS, because enhanced colonic motility and accelerated colonic transit are reported in such patients. Acupuncture at CV-12 may inhibit gastric acid secretion via the somatosympathetic pathway. Thus, acupuncture may be beneficial to GERD patients. The antiemetic effects of acupuncture at PC-6 (wrist) may be beneficial to patients with FD, whereas the antinociceptive effects of acupuncture at PC-6 and ST-36 may be beneficial to patients with visceral hypersensitivity. In the future, it is expected that acupuncture will be used in the treatment of patients with functional GI disorders.

Antiulcerogenic activity of Indigofera truxillensis Kunth / Atividade altiulcerogênica de Indigofera truxillensis Kunth

The genus Indigofera (Fabaceae) is used in folk medicine to treat gastrointestinal pain. In this study, we investigated the antiulcerogenic properties of Indigofera truxillensis Kunth. Oral administration of MeOH extract did not produce any signals of acute toxicity. The antiulcerogenic activity was assessed in different models of acute gastric ulcers (100 percent ethanol, piroxicam 30 mg.kg-1, hypothermic restraint stress and pylorus ligature) in mice and rats. The animals were treated with the drugs lanzoprazole (30 mg.kg-1) or cimetidine (100 mg.kg-1) as positive controls depending on the performed model. In another experiment with ethanol-induced ulcers in rats, N-ethylmaleimide (NEM), a sulfhydryl group blocker, was also used. The MeOH extract, at doses of 250, 500 and 1000 mg.kg-1, inhibited the gastric lesions in all experiments: a) by 62 percent, 69 percent and 32 percent, respectively, in piroxicam-induced lesions, b) by 43 percent, 71 percent and 98 percent, in ethanol-induced lesions, c) by 69 percent, 64 and 89 percent, in hypothermic-restraint stress-induced lesions, d) by 73 percent, 82 percent and 84 percent, in pylorus ligature lesions. Significant changes in the total gastric acid levels were also found after intraduodenal administration of the MeOH extract in the ligated pylorus model. Pre treatment with NEM reduced partially the antiulcerogenic activity of the MeOH extract in ethanol-induced gastric lesions. This result indicates an increase in the levels of non-protein sulfhydryl groups by MeOH extract in the gastric mucosa. These results indicate that the MeOH extract has antisecretory and citoprotective effects that may be related to the presence of flavonoids detected by phytochemical analysis.

O gênero Indigofera (Fabaceae) é utilizado na medicina tradicional para distúrbios gastrintestinais. Em nosso trabalho foi investigada a propriedade antiulcerogênica da Indigofera truxillensis Kunth. A administração oral do extrato metanólico (MeOH) não produziu efeitos tóxicos. A atividade antiulcerogênica foi avaliada em diferentes modelos agudos de úlcera gástrica (etanol 100 por cento, piroxicam 30 mg.kg-1, estresse por retenção e frio e ligadura do piloro) em camundongos e ratos. Os animais foram tratados com lansoprazol (30 mg.kg-1) ou cimetidina (100 mg.kg-1), que foram utilizados como controle positivo dependendo do modelo testado. Em outro experimento com úlcera induzida por etanol em ratos, N-etilmaleimida (NEM), um bloqueador dos compostos sulfidríla, também foi utilizado. O extrato metanólico, nas doses de 250, 500 e 1000 mg.kg-1, inibiu significativamente as lesões gástricas em todos os experimentos: a) 62 por cento, 69 por cento e 32 por cento, respectivamente, nas lesões gástricas induzidas por piroxicam, b) 43 por cento, 71 por cento e 98 por cento, nas lesões gástricas induzidas por etanol, c) 69 por cento, 64 por cento e 89 por cento, nas lesões gástricas induzidas por estresse por contenção e frio, d) 73 por cento, 82 por cento e 84 por cento, nas lesões gástricas induzidas por ligadura de piloro. Alterações significativas foram observadas na concentração total de ácido gástrico após a administração via intraduodenal do extrato MeOH no modelo de ligadura do piloro. Pré-tratamento com NEM reduziu parcialmente a atividade antiulcerogênica do extrato MeOH na úlcera induzida por etanol, o que sugere um aumento nos níveis de compostos sulfidríla pelo extrato MeOH na mucosa gástrica. Os resultados indicam que o extrato MeOH possui um efeito antisecretor e citoprotetor, e que tais efeitos podem estar relacionados com a presença de flavonóides detectados por análise fitoquímica no extrato MeOH.

Vascular lesions of the gastrointestinal tract.

Vascular lesions of the gastrointestinal (GI) tract include arterio-venous malformations as angiodysplasia and Dieulafoy's lesion, venous ectasias (multiple phlebectasias and haemorroids), teleangiectasias which can be associated with hereditary hemorrhagic teleangiectasia (HHT), Turner's syndrome and systemic sclerosis, haemangioma's, angiosarcoma's and disorders of connective tissue affecting blood vessels as pseudoxanthoma elasticum and Ehlers-Danlos's disease. As a group, they are relatively rare lesions that however may be a major source of upper and lower gastrointestinal bleeding. Clinical presentation is variable, ranging from asymptomatic cases over iron deficiency anaemia to acute or recurrent bleeding that may be life-threatening. Furthermore, patients may present with other symptoms, e.g. pain, dysphagia, odynophagia, the presence of a palpable mass, intussusception, obstruction, haemodynamic problems resulting from high cardiac output, lymphatic abnormalities with protein loosing enteropathy and ascites, or dermatological and somatic features in syndromal cases. Diagnosis can usually be made using endoscopy, sometimes with additional biopsy. Barium radiography, angiography, intraoperative enteroscopy, tagged red blood cell scan, CT-scan and MRI-scan may offer additional information. Treatment can be symptomatic, including iron supplements and transfusion therapy or causal, including therapeutic endoscopy (laser, electrocautery, heater probe or injection sclerotherapy), therapeutic angiography and surgery. The mode of treatment is of course depending on the mode of presentation and other factors such as associated disorders. If endoscopic or angiographic therapy is impossible and surgical intervention not indicated, pharmacological therapy may be warranted. Good results have been reported with different drugs, albeit most of them have not been tested in large trials.

[Clinical-epidemiological study of the efficacy of thermal therapy in gastroenterologic diseases]. / Indagine clinico-epidemiologica sulla efficacia della terapia termale nella patologia gastroenterologica.

PURPOSE: To evaluate the therapeutic effects of drinking mineral water, its influence on gastrointestinal drug consumption as well as on working days missed in patients with dyspeptic syndrome or chronic constipation due to irritable bowel syndrome. MATERIALS AND METHODS: A questionnaire was sent to 1500 physicians and 965 forms were available concerning patients who had mineral water treatment at Montecatini. RESULTS: Mineral water therapy determined a striking short- and medium-term improvement on clinical symptoms. Furthermore, this treatment reduced gastrointestinal drug consumption per year, as well as the number of working days missed. CONCLUSIONS: This epidemiological study confirms the utility of drinking mineral water in the treatment of some gastrointestinal syndromes either in the short and in the medium run.

Symposium: disease prevention in calves. Factors affecting susceptibility of calves to disease.

Enteric and respiratory disorders are the main hazards to successful calf rearing. The many interrelated factors in the etiology of these disorders are reviewed, and an attempt has been to classify the factors into those of a microbiological, immunological, nutritional, genetic, physical, or psychological nature. No one would dispute that enteric and respiratory disorders are the two main hazards to calf health, but many would argue about the relative importance of specific pathogens and other predisposing factors in the etiology of these disorders.