Síndrome de rumiación: dificultades diagnósticas y terapéuticas de un proceso no tan infrecuente / Rumination syndrome: Diagnostic and therapeutic difficulties of a not so uncommon disorder

Introducción: El Síndrome de rumiación es un trastorno gastrointestinal funcional poco común. De diagnóstico difícil, por el desconocimiento del mismo dentro del colectivo médico, acaba conllevando la realización de múltiples pruebas complementarias, la aplicación de diferentes tratamientos, y diagnósticos tardíos o erróneos, en la mayoría de los casos. Su tratamiento es difícil y complejo dada su naturaleza multifactorial. El objetivo de este estudio es presentar nuestra casuística analizando sus datos clínicos, diagnósticos y terapéuticos. Pacientes y método: Estudio descriptivo y retrospectivo de todos los casos diagnosticados entre enero del 2010 y mayo del 2016, controlados en las unidades de Gastroenterología Pediátrica del Consorci Sanitari de Terrassa y del Hospital Materno-Infantil Vall d'Hebron. Resultados: Se analizó a un total de 12 pacientes. Una media de edad al inicio de los síntomas de 9 anos y un mes, con un tiempo medio de evolución antes de llegar al diagnóstico de 2 años y 3 meses, y una media de pruebas complementarias realizadas hasta del diagnóstico de 8,1. En 10 de los 12 pacientes se había probado, antes del diagnóstico de rumiación, algún tipo de tratamiento que resultó ineficaz en todos los casos. Como novedad terapéutica, 10 de nuestros casos se sometieron a un tratamiento experimental de biofeedback. Conclusiones: Debido al conocimiento limitado de esta entidad, entre nuestros profesionales, en cuanto a su presentación clínica, diagnóstico y tratamiento, estos pacientes son frecuentemente mal diagnosticados y, a menudo, se ven sometidos a pruebas complementarias y tratamientos evitables, invasivos y costosos (AU)

Introduction: Rumination syndrome is an uncommon gastrointestinal functional disorder that may be difficult to diagnose, as not many physicians are aware of this condition. In many cases, patients undergo numerous tests and are prescribed several treatments based on erroneous diagnoses. When the correct diagnosis is eventually made, therapy for the syndrome can be difficult and complex because of its multifactorial nature. The aim of this study was to present our experience with this condition, by presenting an analysis of the clinical, diagnostic, and therapeutic data of our patients. Patients and method: A prospective and retrospective study was conducted on all cases of rumination syndrome diagnosed between January 2010 and May 2016 in patients attending the Paediatric Gastroenterology Departments of two hospitals: Consorci Sanitari de Terrassa and Hospital Materno-Infantil Vall d’Hebron (Barcelona, Spain). Results: The analysis included 12 patients, with a mean age at the onset of symptoms of 9 years and 1 month, and the mean time period to make the diagnosis was 2 years and 3 months. A mean of 8.1 complementary tests were carried out before establishing the diagnosis. In 10 of the 12 patients, some type of treatment had been given before the diagnosis of rumination syndrome, but was unsuccessful in all cases. Ten of our patients underwent the novel, experimental biofeedback therapy. Conclusions: Due to the limited knowledge of this condition among attending professionals in terms of the clinical presentation, diagnosis, and treatment, patients with rumination syndrome are often misdiagnosed and undergo numerous avoidable complementary tests, and invasive, costly treatments (AU)

Diseño y validación de las escalas de evaluación del impacto psicológico de sucesos vitales pasados: el papel del pensamiento rumiativo y el crecimiento personal / Design and validation of the scales for the assessment of the psychological impact of past life events: the role of ruminative thought and personal growth

Introducción. El malestar emocional de las personas mayores se relaciona frecuentemente con procesos de rumiación acerca de episodios vitales acaecidos a lo largo de su vida. El tipo de afrontamiento desplegado ante tales episodios podría contribuir a explicar el bienestar emocional actual de las personas mayores: pueden percibir que han crecido personalmente tras el episodio y/o pueden presentar pensamientos rumiativos sobre tales episodios, que generan malestar emocional. Este trabajo describe el desarrollo y análisis de las propiedades psicométricas de las escalas de evaluación del impacto psicológico de sucesos vitales pasados (EEIPSV): la escala de ocurrencia de sucesos vitales (EO), la escala de pensamiento rumiativo (EPR) y la escala de crecimiento personal (ECP). Material y métodos. Participaron 393 personas mayores no institucionalizadas, residentes en la comunidad de Madrid (edad media: 71,5 años; DE: 6,9). Además de las EEIPSV, se evaluaron las variables: sintomatología depresiva, ansiedad, bienestar psicológico, satisfacción con la vida, función física y vitalidad. Resultados. Los resultados del análisis interjueces sugieren la existencia de 2 factores en la EO: sucesos positivos y negativos. Los análisis factoriales confirmatorios respaldan esta estructura bidimensional tanto para la escala EPR como la ECP. Se obtuvieron buenos índices de consistencia interna para cada escala y subescala, así como buenos índices de validez de criterio y convergente. Conclusiones. Tanto el pensamiento rumiativo sobre sucesos vitales pasados como el crecimiento personal se relacionan con el bienestar emocional de las personas mayores. Las EEIPSV presentan buenas propiedades psicométricas que justifican su uso con población mayor(AU)

Introduction. Older people's emotional distress is often related to rumination processes focused on past vital events occurred during their lives. The specific coping strategies displayed to face those events may contribute to explain older adults’ current well-being: they can perceive that they have obtained personal growth after those events and/or they can show a tendency to have intrusive thoughts about those events. This paper describes the development and analysis of the psychometric properties of the Scales for the Assessment of the Psychological Impact of Past Life Events (SAPIPLE): the past life events-occurrence scale (LE-O), ruminative thought scale (LE-R) and personal growth scale (LE-PG). Material and methods. Participants were 393 community dwelling elderly (mean age=71.5 years old; SD=6.9). In addition to the SAPIPLE scales, depressive symptomatology, anxiety, psychological well-being, life satisfaction, physical function and vitality have been assessed. Results. The inter-rater agreement's analysis suggests the presence of two factors in the LE-O: positive and negative vital events. Confirmatory Factor Analysis (CFA) supported this two-dimensional structure for both the LE-R and the LE-PG. Good internal consistency indexes have been obtained for each scale and subscale, as well as good criterion and concurrent validity indexes. Conclusions. Both ruminative thoughts about past life events and personal growth following those events are related to older adults’ current well-being. The SAPIPLE presents good psychometric properties that justify its use for elderly people(AU)

Assessment of pediatric dysphagia and feeding disorders: clinical and instrumental approaches.

Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns. Interdisciplinary team approaches allow for coordinated global assessment and management decisions. Underlying etiologies or diagnoses must be delineated to every extent possible because treatment will vary according to history and current status in light of all factors that are often interrelated in complex ways. A holistic approach to evaluation is stressed with a primary goal for every child to receive adequate nutrition and hydration without health complications and with no stress to child or to caregiver. Instrumental swallow examinations that aid in defining physiological swallowing status are needed for some children. Successful oral feeding must be measured in quality of meal time experiences with best possible oral sensorimotor skills and safe swallowing while not jeopardizing a child's functional health status or the parent-child relationship.