Lactulose hydrogen breath test and functional symptoms in pediatric patients.

BACKGROUND: The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H(2) breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria. METHODS: Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H(2) concentration of 20 ppm over basal. RESULTS: There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p\0.05. In 39% of patients, rise of H(2) occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p\0.05). Symptoms were unrelated to time to 20-ppm change. CONCLUSIONS: An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.

Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico.

OBJECTIVES: Irritable bowel syndrome (IBS) has been reported to complicate bacterial diarrhea. Because of the frequency of international travel and the common occurrence of bacterial diarrhea, we studied the occurrence of chronic gastrointestinal complaints and post-diarrhea IBS in North U.S. travelers to Mexico. METHODS: One hundred and sixty-nine healthy students were followed prospectively for 5 wk for the occurrence and etiology of diarrhea while studying for 5 wk in Mexico. Subjects recorded their symptoms during travel and completed a gastrointestinal symptom questionnaire 6 months after returning to the United States to determine the presence of IBS using the Rome II criteria. RESULTS: Ninety-seven (57%) subjects returned a completed questionnaire. Sixty-one (63%) developed diarrhea while in Mexico, mostly due to enterotoxigenic and enteroaggregative Escherichia coli. Six months after travel the following chronic symptoms were reported: loose stools, abdominal pain, and fecal urgency in 17 (18%), 17 (18%), and 9 (9%) respectively. Of the 60 patients surveyed who had acquired diarrhea in Mexico, 7 (11%) met the criteria for IBS 6 months later of which 6 (10%) were newly diagnosed. No identified pathogen in the initial illness was associated with the development of IBS. CONCLUSIONS: Chronic gastrointestinal complaints including IBS are common in returning travelers having experienced diarrhea. Postinfectious complications of traveler's diarrhea require further study for etiology and strategy for prevention.

[Post-infectious irritable bowel syndrome. A review based on current evidence]. / Síndrome de intestino irritable postinfeccioso. Una revisión basada en evidencias.

INTRODUCTION: Pathophysiology of irritable bowel syndrome (IBS) is multifactorial. Recent investigations have associated episodes of infectious gastroenteritis with development of IBS. This condition is named post-infectious IBS (PI-IBS). The role of inflammation-infection in IBS pathogenesis is not well understood. AIM: To review published scientific evidence on PI-IBS regarding risk factors, causal agents, histopathological changes, and treatment. MATERIALS AND METHODS: An electronic search in MEDLINE and abstracts presented at national and international GI meetings was performed, looking for information published in the past 50 years including animal studies, cohort studies, case-control studies, and series of cases and case reports, using the key words post-infectious enteritis, post-dysenteric or post-infectious irritable bowel syndrome (PI-IBS), and post-infectious colitis. RESULTS: Fifty one papers were included. These studies were classified according to pathophysiologic mechanisms, infectious agents involved, animal or human studies, and treatment. CONCLUSIONS: Current evidence shows a strong association between colonic infection and inflammation with development of IBS. Approximately 25% of patients with IBS have a history of infectious enteritis. Microbial agents related with PI-IBS include bacteria (Campylobacter, Salmonella) and parasites (Trichinella spiralis). Increased number of enteroendocrine cells, CD3 lymphocytes and mast cells within the colonic muscle wall, release of pro-inflammatory substances, and increased number of inflammatory cells with intestinal nervous endings are the most common histopathologic findings. Patients developing PI-IBS have a higher frequency of psychological disorders and stressful events prior to the gastroenteritis episode. Therapeutic interventions with steroids, COX-2 inhibitors, antibiotics and probiotics require further investigation.

[Ogilvie's syndrome. A report of 3 cases]. / Síndrome de Ogilvie. Presentación de 3 casos.

INTRODUCTION: Lumbar spine surgery represents a common procedure in Neurosurgery. Ogilvie's Syndrome is an infrequent complication of lumbar disc surgery, characterized by acute paralytic ileum as a result of acute colonic dilatation without mechanical obstruction. CLINICAL CASES: We present the clinical data, surgical findings and evolution of three patients operated on for large lumbar disc herniation. They presented with unilateral lumbociatic pain related with physical effort and monoradicular deficit. Diagnosis was established by CT scan and all patients were operated on through a standard laminectomy. Abdominal pain, distention and lack of bowels sounds began on the second postoperatory day. This complication was avoided by conservative treatment and parenteral administration of neostigmine. Ogilvie's Syndrome appeared in 3 cases out of more than 1000 patients undergoing lumbar disc surgery and is characterized by acute colonic dilatation including cecal distention. Other lumbar disc surgery complications such as gastrointestinal perforation, urethral injury or intra-abdominal vessels damage were excluded. Conservative treatment including parenteral neostigmine was always sucessful.

Brain-gut interaction in irritable bowel syndrome: new findings of a multicomponent disease model.

Knowledge on the pathophysiology of irritable bowel syndrome has evolved, beginning with disturbances in motility to visceral hypersensitivity, and ultimately to alterations in brain-gut bi-directional communication, where neurotransmitters such as serotonin play a key role. Recently, a multicomponent disease model that integrates all these alterations was proposed. This model is divided into physiological, cognitive, emotional and behavioral components that explain the gastrointestinal as well as the constitutional symptoms. In recent years there has been an explosion of research together with new developments in pharmacological treatments for IBS that support each component of this model. This review presents recent data in favor of these alterations in IBS.

[The patient with irritable bowel syndrome. A difficult patient?]. / Paciente con síndrome de intestino irritable. Un paciente difícil?

The treatment of patients with Irritable Bowel Syndrome has not been very successful because of the number of variations that are associated with the illness. Some of them are: Depression and Anxiety, intensity of the symptoms and colonic hypersensitivity, all this, added to the unknown etiology of the illness. This review expects to bring a global vision of the difficulty that has existed for Medicine or psychology to bring the best treatment to these patients. Diverse investigations had obtained successful results with different psychotherapeutic approaches (Hypnotherapy, Psychoanalysis, cognitive therapy, multicomponent therapy, etc.). Nevertheless these present methodological errors that put in doubt those results. It is thought that interdisciplinary treatment would be a good option for these patients.

Efeito da cisaprida na constipacao intestinal cronica funcional em criancas / Effect of cisapride on chronic functional constipation in children

O objetivo foi avaliar os efeitos da cisaprida no tratamento de criancas com constipacao intestinal cronica funcional (CICF). Estudaram-se 26 criancas, 10 meninas e 16 meninos com idades de...

Síndrome de Intestino Irritable / The irritable bowel syndrome

El síndrome de intestino irritable es una enfermedad muy frecuente en la práctica médica diaria dentro del medio militar, que afecta sobre todo a aquellos que tienen un nivel de responsabilidad elevado. Dada la gran variedad en cuanto a su forma de presentación y dificultad terapéutica, se realizó una revisión del tema que abarcó criterios diagnósticos, manifestaciones extradigestivas más frecuentes, formas clínicas y tratamientos más utilizados en el control de la enfermedad(AU)

Síndrome de Intestino Irritable / The irritable bowel syndrome

El síndrome de intestino irritable es una enfermedad muy frecuente en la práctica médica diaria dentro del medio militar, que afecta sobre todo a aquellos que tienen un nivel de responsabilidad elevado. Dada la gran variedad en cuanto a su forma de presentación y dificultad terapéutica, se realizó una revisión del tema que abarcó criterios diagnósticos, manifestaciones extradigestivas más frecuentes, formas clínicas y tratamientos más utilizados en el control de la enfermedad

Factores etiológicos en el síndrome de intestino irritable

El síndrome de intestino irritable es una entidad multicasual, donde a través del tiempo se ha dado mayor valor, en cada época, a algunos de estos elementos etiológicos. Se revisan los factores que inciden en su etiología como son: el factor psicológico mostrándose que éste no es génesis de la enfermedad pero si es un precipitante e intensificador de los síntomas; también muestra que es el factor determinante en la causa de consulta de los pacientes sintomáticos. También se ve cómo las alteraciones emocionales y el estrés inciden en la aparición de alteraciones motoras intestinales. El factor dietético mostrandocómo los componentes de la dieta especialmente el contenido de fibra de la misma y el control de la enfermedad. El factor motor, considerado hoy en día como el principal factor, pues es la base fundamental del síndrome, se le considera como una alteración en los patrones y comportamientos motores. Se ve también que estos pacientes presentan alteraciones importantes en la sensibilidad visceral, el manejo del gas intestinal y la percepción de dolor como a la distensibilidad. Las alteraciones de la flora intestinal se involucra ahora como un factor adicional en la aparición y severidad de los síntomas expuestos por el paciente. Finalmente se hace una revisión de las consideraciones para llegar al diagnóstico en cada paciente y algunas alusiones sobre el tratamiento

Lactase and placebo in the management of the irritable bowel syndrome: a double-blind, cross-over study.

A double-blind, cross-over, therapeutic, clinical trial of the efficacy of exogenous, microbial beta-D-galactosidase to reduce the symptoms of the irritable bowel syndrome (IBS) was conducted in 12 patients whose customary diets regularly included milk. Eight of the 12 subjects (67%) proved to be lactase-nonpersistent, lactose-maldigesters when challenged with a aqueous dose of 12.5 g. The study lasted 4 months, with the first month a non-intervention, control period and the latter 3 months alternating in the sequence, treatment/placebo/treatment, or placebo/treatment/placebo. When symptoms during trial months were analyzed by the cumulative sum procedure, gastrointestinal symptoms were found to be independent of lactase treatment. We found a positive temporal association of the severity of both gastrointestinal and non-gastrointestinal symptomatology. In populations with a high prevalence of lactose deficiency, IBS symptoms appear to be independent of lactose maldigestion.

Pseudoobstrucción de colon postcesarea: síndrome de Ogilvie / Pseudobstruction of the colon after cesarean section (Ogilvie's syndrome)

1. La pseudoobstrucción de colon es una complicación grave que debe sospecharse en cualquier puérpera de parto o cesárea que presente una marcada distensión abdominal con dolor abdominal y dificultad en la eliminación de gases o deposiciones. 2. La radiología es el método diagnóstico fundamental, evidenciando la dilatación neumática del colon en forma segmentaria, con un corte geralmente a la altura del ángulo esplénico del colon. 3. Esta distensión puede, en casos extremos, conducir a la perforación diástica del ciego, lo que conlleva altos índices de morbi-mortalidad. 4. El tratamiento inicialmente es conservador. El método quirúrgico descompresivo de elección es la cecostomía de tubo, en ausencia de necrosis o perforaciones múltiples. 5. Se analizan cinco casos de pseudoobstrución de colon postcesárea, tratados en el Servicio de Cirugía del Hospital Paula Jaraquemada y en la Assistencia Pública Alejandro del Río. 6. Se enfatizan los criterios de realimentación oral en la cirugía pélvica como factor preventivo de esta complicación