Yield of alarm features in predicting significant endoscopic findings among hospitalized patients with dyspepsia.

BACKGROUND: Dyspepsia is a very prevalent upper gastrointestinal tract symptoms complex. Some of these symptoms might arise from serious underlying diseases, so the promotion of evidence-based guidelines could potentially better align evaluation and treatment. AIM: To determine the value of alarm features as a predictive factor for significant endoscopic findings (SEFs) among hospitalized patients presenting with dyspepsia. METHODS: We conducted a retrospective case-control study including information about 6208 endoscopic procedures performed for hospitalized patients. Patients were divided into two groups, with and without SEFs, and compared to elucidate the ability of the different alarm features to predict SEFs. RESULTS: During the study, 605 patients fulfilled the inclusion criteria. When the demographics and clinical characteristics of the two groups were compared, tachycardia (P < 0.05), normocytic anemia, (P < 0.05), leukocytosis (P < 0.05), and hypoalbuminemia (P < 0.05) documented on admission prior to endoscopy were strong predictors of SEFs. Among the alarm features, upper gastrointestinal bleeding, persistent vomiting, odynophagia [odds ratio (OR) = 3.81, P < 0.05; OR = 1.75, P = 0.03; and OR = 7.81, P = 0.07, respectively] were associated with SEFs. Unexplained weight loss was strongly associated with malignancy as an endoscopic finding (OR = 2.05; P < 0.05). In addition, long-term use of anti-aggregate medications other than aspirin (P < 0.05) was correlated to SEFs. CONCLUSION: Novel predictors of SEFs were elucidated in this study. These parameters could be used as an adjunctive in decision making regarding performing upper endoscopy in hospitalized patients with dyspepsia.

Symptoms of functional dyspepsia and irritable bowel syndrome among medical students in Slovakia and their relation to diet and exercise.

INTRODUCTION: There is a substantial lack of data regarding the prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the region of Central/Eastern Europe. It is a well-described and known fact that environmental, ethnic, dietary, and cultural factors can influence the reporting of symptoms. Therefore, we aim to provide the first data documenting the prevalence of specific disorders of gut-brain interaction in Slovakia. METHODS: This is a multicenter-based study. The study population consists of medical students from three medical faculties in Slovakia, mainly with Slovakian and Scandinavian permanent residency. Data collection was performed by means of anonymous questionnaires consisting of several demographic questions. Two forms of questionnaires were used. One was in paper form, and the second was distributed via email. RESULTS: Altogether, 1061 students participated in this study. Symptoms of IBS were presented in 7.3% of students, and FD in 13%. In the Slovakian group, these were FD 12%, and IBS 7%. The subgroup from Scandinavia shows a prevalence of IBS of 11.7% and FD of 14.0%. A lack of exercise and a vegan diet are related to a higher presence of FD. CONCLUSION: The results of this multicentre study represent the first published data for the presence of symptoms of IBS and FD in Slovakia. Our data also show a significantly higher prevalence of IBS in students from Scandinavia compared with those from Central/Eastern Europe. A higher frequency of physical exercise is associated with a lower presence of symptoms of FD. On the other hand, the symptoms of FD were mostly prevalent in the group adhering to a vegan and vegetarian type diet.

Physical activity, sedentary behavior, and the risk of functional gastrointestinal disorders: A two-sample Mendelian randomization study.

OBJECTIVES: Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are prevalent functional gastrointestinal disorders (FGIDs). In this study we aimed to explore the causal association between physical activity or sedentary behavior and the risk of FD and IBS. METHODS: Mendelian randomization (MR) analysis was employed. Candidate genetic instruments for physical activity and sedentary behavior were retrieved from the latest published Genome-Wide Association Study (GWAS), which included up to 703 901 participants. Summary-level GWAS data for FD (8 875 cases and 320 387 controls) and IBS (9 323 cases and 301 931 controls) were obtained from the FinnGen study. The causal effects were mainly estimated by inverse variance weighted (IVW) method. Sensitivity analyses were implemented with Cochran's Q test, MR-Egger intercept test, leave-one-out analysis, and the funnel plot. RESULTS: No significant association of moderate-to-vigorous intensity physical activity (MVPA), leisure screen time (LST), sedentary behavior at work (SDW), and sedentary commuting (SDC) with the risk of FD was found. However, there was a suggestive correlation between MVPA and the decreased risk of FD (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.39-0.99, P = 0.047). Genetically predicted MVPA decreased the risk of IBS (OR 0.58, 95% CI 0.40-0.84, P = 0.004), while increased LST was positively associated with IBS risk (OR 1.33, 95% CI 1.15-1.53, P < 0.001). No causal effects of SDW or SDC on IBS risk were observed. CONCLUSION: MVPA and LST are causally linked to the development of IBS, which will facilitate primary prevention of IBS.

High prevalence of gastrointestinal disorders in a large cohort of patients with joint hypermobility.

The gastrointestinal (GI) manifestations in children with hypermobile Ehlers-Danlos syndrome/joint hypermobility syndrome (hEDS/JHS) are not well described. We investigated the prevalence of GI disorders in children and young adults with hEDS/JHS through a single-center retrospective review. Demographic data, clinical history, symptoms, and diagnostic studies were reviewed. Of 435 patients with hEDS/JHS, 66% were females (age 5-28 years). We noted a high prevalence of constipation (61%), dysphagia (32%), dyspepsia and/or gastroparesis (25%), eosinophilic esophagitis (EoE) (21%), and celiac disease (4%) in our cohort. Upper endoscopy and gastric emptying scans had the highest yield to detect abnormalities. Motility studies were abnormal in 31% of the 80 patients who underwent them. Dysphagia symptoms are significantly associated with EoE. Thirty-three percent of dysphagia patients had EoE, versus 16% of non-dysphagia patients (p < 0.001). Screening hEDS/JHS patients for GI issues should be routine, with further investigations and referrals guided by identified symptoms.

Functional dyspepsia: How to manage the burn and the bloat.

Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.

Clinical and endoscopic characteristics of patients undergoing gastrointestinal endoscopic procedures in Egypt: a nationwide multicenter study.

BACKGROUND: Egypt faces a significant public health burden due to chronic liver diseases (CLD) and peptic ulcer disease. CLD, primarily caused by Hepatitis C virus (HCV) infection, affects over 2.9% of the population nationwide, with regional variations. Steatotic liver disease is rapidly emerging as a significant contributor to CLD, especially in urban areas. Acid-related disorders are another widespread condition that can significantly impact the quality of life. These factors and others significantly influence the indications and findings of gastrointestinal endoscopic procedures performed in Egypt. AIM: We aimed to evaluate the clinico-demographic data, indications, and endoscopic findings in Egyptian patients undergoing gastrointestinal endoscopic procedures in various regions of Egypt. METHODS: This study employed a retrospective multicenter cross-sectional design. Data was collected from patients referred for gastrointestinal endoscopy across 15 tertiary gastrointestinal endoscopy units in various governorates throughout Egypt. RESULTS: 5910 patients aged 38-63 were enrolled in the study; 75% underwent esophagogastroduodenoscopy (EGD), while 25% underwent a colonoscopy. In all studied patients, the most frequent indications for EGD were dyspepsia (19.5%), followed by hematemesis (19.06%), and melena (17.07%). The final EGD diagnoses for the recruited patients were portal hypertension-related sequelae (60.3%), followed by acid-related diseases (55%), while 10.44% of patients had a normally apparent endoscopy. Male gender, old age, and the presence of chronic liver diseases were more common in patients from upper than lower Egypt governorates. Hematochezia (38.11%) was the most reported indication for colonoscopy, followed by anemia of unknown origin (25.11%). IBD and hemorrhoids (22.34% and 21.86%, respectively) were the most prevalent diagnoses among studied patients, while normal colonoscopy findings were encountered in 18.21% of them. CONCLUSION: This is the largest study describing the situation of endoscopic procedures in Egypt. our study highlights the significant impact of regional variations in disease burden on the utilization and outcomes of GI endoscopy in Egypt. The high prevalence of chronic liver disease is reflected in the EGD findings, while the colonoscopy results suggest a potential need for increased awareness of colorectal diseases.

Postprandial symptoms in disorders of gut-brain interaction and their potential as a treatment target.

Postprandial, or meal-related, symptoms, such as abdominal pain, early satiation, fullness or bloating, are often reported by patients with disorders of gut-brain interaction, including functional dyspepsia (FD) or irritable bowel syndrome (IBS). We propose that postprandial symptoms arise via a distinct pathophysiological process. A physiological or psychological insult, for example, acute enteric infection, leads to loss of tolerance to a previously tolerated oral food antigen. This enables interaction of both the microbiota and the food antigen itself with the immune system, causing a localised immunological response, with activation of eosinophils and mast cells, and release of inflammatory mediators, including histamine and cytokines. These have more widespread systemic effects, including triggering nociceptive nerves and altering mood. Dietary interventions, including a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols, elimination of potential food antigens or gluten, IgG food sensitivity diets or salicylate restriction may benefit some patients with IBS or FD. This could be because the restriction of these foods or dietary components modulates this pathophysiological process. Similarly, drugs including proton pump inhibitors, histamine-receptor antagonists, mast cell stabilisers or even tricyclic or tetracyclic antidepressants, which have anti-histaminergic actions, all of which are potential treatments for FD and IBS, act on one or more of these mechanisms. It seems unlikely that food antigens driving intestinal immune activation are the entire explanation for postprandial symptoms in FD and IBS. In others, fermentation of intestinal carbohydrates, with gas release altering reflex responses, adverse reactions to food chemicals, central mechanisms or nocebo effects may dominate. However, if the concept that postprandial symptoms arise from food antigens driving an immune response in the gastrointestinal tract in a subset of patients is correct, it is paradigm-shifting, because if the choice of treatment were based on one or more of these therapeutic targets, patient outcomes may be improved.

Metastatic Melanoma of the Common Bile Duct Presented with Dyspepsia.

Malignant melanoma (MM) is an aggressive tumor that can metastasize to any organ, but biliary tract metastasis is scarce. We describe a very rare case of MM metastasis to the common bile duct (CBD), presented with only dyspeptic symptoms. The patient had mildly elevated alkaline phosphatase and gamma-glutamyl transferase levels. Magnetic resonance cholangiopancreatography demonstrated a dilated common bile duct with a distal stricture. The MM diagnosis was established with the ampulla of Vater biopsy specimens obtained by endoscopic retrograde cholangiopancreatography (ERCP), and the patient's symptoms were resolved after biliary stenting. Both primary CBD cancer and other cancer types like MM that metastasize to CBD can cause obstruction and can be manifested only by dyspeptic symptoms. MM metastasis to CBD can cause obstruction manifested only by dyspeptic symptoms without obstructive jaundice. ERCP can be employed as a promising option for treatment and diagnosis. New-onset dyspeptic symptoms in patients with a history of MM should be investigated thoroughly, especially in the context of biliary metastasis.

[Reflux symptoms and upper abdominal pain: Reflux, Gastritis and whatever could be behind it]. / Sodbrennen und Oberbauchschmerzen: Reflux, Gastritis und was noch infrage kommt.

Reflux symptoms and upper abdominal pain are very common symptoms in general population. Both symptoms are visceral and thus cannot be linked to an organ or a disease. Diagnostic work-up revealed organic disease in up to 30%, when patients present with dyspeptic symptoms. Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) represent the most frequent and important disorders in western countries, when diagnostic work-up is done in patients with reflux symptoms and abdominal pain.

The Association between Functional Dyspepsia and Metabolic Syndrome-The State of the Art.

Functional dyspepsia is a common functional disorder of the gastrointestinal tract that is responsible for many primary care visits. No organic changes have been found to explain its symptoms. We hypothesize that modern lifestyles and environmental factors, especially psychological stress, play a crucial role in the high prevalence of functional dyspepsia and metabolic syndrome. While gastrointestinal tract diseases are rarely linked to metabolic disorders, chronic stress, obesity-related metabolic syndrome, chronic inflammation, intestinal dysbiosis, and functional dyspepsia have significant pathophysiological associations. Functional dyspepsia, often associated with anxiety and chronic psychological stress, can activate the neuroendocrine stress axis and immune system, leading to unhealthy habits that contribute to obesity. Additionally, intestinal dysbiosis, which is commonly present in functional dyspepsia, can exacerbate systemic inflammation and obesity, further promoting metabolic syndrome-related disorders. It is worth noting that the reverse is also true: obesity-related metabolic syndrome can worsen functional dyspepsia and its associated symptoms by triggering systemic inflammation and intestinal dysbiosis, as well as negative emotions (depression) through the brain-gut axis. To understand the pathophysiology and deliver an effective treatment strategy for these two difficult-to-cure disorders, which are challenging for both caregivers and patients, a psychosocial paradigm is essential.

Relationship between Lifestyle Indicators and Un-investigated Dyspepsia Among Adult Patients in a Primary Care Setting in Northern Nigeria.

BACKGROUND: Un-investigated dyspepsia has remained a common encounter among patients seen in primary care in sub-Saharan Africa. A preventive approach through counselling patients on modifications of lifestyle factors related to dyspepsia could be a cost-effective approach to dyspepsia management in primary care in low- and middle-income settings. OBJECTIVES: The objectives were to describe the sociodemographic patterns of adult patients with un-investigated dyspepsia in the Family Medicine Clinics, Federal Medical Centre, Gusau, Nigeria, to describe the pattern of lifestyle factors among adult patients with un-investigated dyspepsia, to determine the relationship between lifestyle patterns and un-investigated dyspepsia and to describe the specific food types that precipitate dyspepsia among the respondents. METHODS: A hospital-based cross-sectional study using the Short Form Leeds Dyspepsia Questionnaire to describe the presence and severity of dyspepsia and the Simple Lifestyle Indicator Questionnaire to describe the lifestyle patterns of participants. RESULTS: Most respondents (66.9%) have healthy dietary patterns however more respondents 66(52.4%) engaged in unhealthy levels of physical exercise. The Stress level was intermediate in majority of respondents (66.1%). There was no statistically significant association between lifestyle indicators and severity of dyspepsia among the respondents although the linear regression model with p-value < 0.01 and < 0.05, revealed stress as a predictor of dyspepsia in this study. CONCLUSION: There was no relationship between lifestyle indicators and Uninvestigated dyspepsia among the study participants. However, some specific local foods were identified as precipitants of dyspepsia. Primary care physicians may consider a targeted dietary modification counselling approach in managing patients with uninvestigated dyspepsia.

CONTEXTE: La dyspepsie non explorée reste une rencontre courante parmi les patients en soins primaires en Afrique subsaharienne. Une approche préventive consistant à conseiller les patients sur les modifications des facteurs de mode de vie liés à la dyspepsie pourrait être une approche rentable pour la gestion de la dyspepsie en soins primaires dans des environnements à revenus faibles et moyens. OBJECTIFS: Les objectifs étaient de décrire les tendances sociodémographiques des patients adultes atteints de dyspepsie non explorée dans les cliniques de médecine familiale du Centre médical fédéral de Gusau, au Nigéria, de décrire les schémas de mode de vie chez les patients adultes atteints de dyspepsie non explorée, de déterminer la relation entre les schémas de mode de vie et la dyspepsie non explorée, et de décrire les types spécifiques d'aliments qui déclenchent la dyspepsie chez les personnes interrogées. MÉTHODES: Une étude transversale menée à l'hôpital utilisant le questionnaire abrégé Leeds Dyspepsia pour décrire la présence et la gravité de la dyspepsie, et le questionnaire Simple Lifestyle Indicator pour décrire le schéma de mode de vie des participants. RÉSULTATS: La plupart des répondants (66,9 %) présentaient des schémas alimentaires sains, cependant un nombre plus élevé de répondants (52,4 %) s'engageaient dans des niveaux malsains d'exercice physique. Le niveau de stress était intermédiaire pour la majorité des répondants (66,1 %). Aucune association statistiquement significative n'a été trouvée entre les indicateurs de mode de vie et la gravité de la dyspepsie. Cependant, le modèle de régression linéaire avec une valeur de p < 0,01 et < 0,05 a révélé que le stress était un prédicteur de la dyspepsie dans cette étude. CONCLUSION: Il n'y avait pas de relation entre les indicateurs de mode de vie et la dyspepsie non explorée chez les participants à l'étude, cependant certains aliments locaux spécifiques ont été identifiés comme des déclencheurs de la dyspepsie. Les médecins de soins primaires pourraient envisager une approche ciblée de conseil en modification alimentaire pour la prise en charge des patients atteints de dyspepsie non explorée. MOTS-CLÉS: Dyspepsie non explorée, Indicateurs de mode de vie.

Abdominal Pain of Functional Gastrointestinal Disorders in Dietary Diversity Patterns and Its Determinants among Healthy Adults in Jimma City, Southwest Ethiopia.

Background: Functional Gastrointestinal Disorders (FGIDs) and their risk factors vary from region to region. Therefore, this study aimed to determine the prevalence of abdominal pain of FGIDs in different dietary diversity score (DDS) and its determinant factors among adults in Jimma City, Southwest Ethiopia. Methods: A community-based cross-sectional study was conducted from July 17 to October 27, 2019. The study included systematically selected healthy adults aged ≥ 18years. Data were collected on gastrointestinal symptoms (Rome III), and DDS (24-dietary recall). Results: Of 865 healthy adults, the prevalence of abdominal pain symptoms co-occurrence was 168(19.4%), dyspepsia, 152(17.6%) and IBS, 133(15.4). Similarly, the co-occurrence was distributed as 81(9.4%) in middle, 64(7.4%) in high and 23(2.6%) in low DDS groups. Although this distribution was different in the DDS groups, it is not significantly associated. With potential confounders adjusted, the behavioral factors associated with the co-occurrence with an AOR (95% CI) were khat chewing: 7.37 (1.76 - 30.87), drinking alcohol: 3.24 (1.15 - 9.18), sedentary life: 12.28 (3.19 - 48.40) and less physical activity: 4.44 (1.43-13.75). Moreover, elevated TAG: 5.44 (2.78 - 8.10), elevated LDL: 4.26 (1.61-11.29), central obesity: 2.78 (1.08 -7), low HDL 5.89 (2.22-15.60), positive H.pylori stool test: 2.7 (1.86 -7.72), being diabetic: 2.7 (1.79 -7.79) and hypertensive: 2.79 (1.08 - 7.14) were associated with the co-occurrence. Conclusion: Abdominal pain and FGIDs had significant distribution among adults in Jimma City. Therefore, early screening and managing FGIDs in the community is recommendable.

Caracterización clínico-histopatológica de la gastritis crónica / Clinical-histopathological characterization of chronic gastritis

La gastritis es una enfermedad con una alta morbilidad a nivel mundial, el principal factor de riesgo es la infección por Helicobacter pylori. Objetivo: Describir las características clínicas, histopatológica y endoscópicas en una población con gastritis crónica. Material y métodos: Se realizó un estudio observacional de tipo descriptivo, retrospectivo, se incluyeron 49 pacientes que acudieron a la consulta externa del área de gastroenterología, de 18 a 65 años, a quienes se realizó el estudio histopatológico y endoscópico en el Servicio de Gastroenterología en el Hospital General Quevedo, de Los Ríos-Ecuador, durante septiembre 2017 ­ septiembre 2018. Resultados: Se observó predominio del género masculino (65%); en mayores de 40 años (55%), la epigastralgía y la sensación de acidez estomacal, 39% y 35% respectivamente, fueron los síntomas más frecuentes, La positividad para Helicobacter pylori, alcanzó el 86%, y la lesión no erosiva un 73%, existió mayor presencia de la forma no atrófica (84%) sobre la atrófica. Conclusiones: La gastritis crónica predominó en el grupo etario mayor a 40 años y de género masculino, siendo los factores de riesgo de mayor prevalencia la infección por Helicobacter pylori y los asociados al consumo de antiinflamatorios no esteroideos, mala alimentación, alcohol y tabaco, los síntomas como epigastralgía y la sensación de acidez estomacal fueron los más frecuentes. El hallazgo endoscópico fue mayor para las formas no erosivas, y de acuerdo a la histopatología la gastritis no atrófica antral moderada fue la más frecuente(AU)

Gastritis is a disease with high morbidity worldwide, the main risk factor is Helicobacter pylori infection. Objective: To describe the clinical, histopathological and endoscopic characteristics in a population with chronic gastritis. Material and methods: An observational, descriptive, retrospective study was carried out, including 49 patients who attended the outpatient consultation of the gastroenterology area, aged 18 to 65 years, who underwent a histopathological and endoscopic study in the Gastroenterology Service at the Quevedo General Hospital, Los Ríos-Ecuador, during September 2017 - September 2018. Results: A predominance of the male gender was observed (65%); In people over 40 years of age (55%), epigastralgia and the sensation of heartburn, 39% and 35% spectively, were the most frequent symptoms, the positivity for Helicobacter pylori, reached 86%, and the non-erosive lesion 73 %, there was a greater presence of the non-atrophic form (84%) over the atrophic one. Conclusions: Chronic gastritis predominated in the age group over 40 years of age and male, the most prevalent risk factors being Helicobacter pylori infection and those associated with the consumption of non-steroidal anti-inflammatory drugs, poor diet, alcohol and tobacco. symptoms such as epigastric pain and the sensation of heartburn were the most frequent. The endoscopic finding was greater for non-erosive forms, and according to histopathology, moderate antral non-atrophic gastritis was the most frequent(AU)

Alterações gastrointestinais durante o acompanhamento nutricional de pacientes oncológicos em acompanhamento ambulatorial de quimioterapia / Gastrointestinal changes during nutritional follow-up of cancer patients undergoing outpatient chemotherapy

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.

Erradicación de Helicobacter pylori en pacientes con dispepsia funcional / Helicobacter pylori eradication in patients with functional dyspepsia

La dispepsia constituye un motivo de consulta frecuente en atención primaria. A propósito de un paciente con diagnóstico de dispepsia funcional, la autora se plantea si el tratamiento de erradicación del Helicobacter pylori podría mejorar los síntomas. Luego de una búsqueda rápida se encontró evidencia que señala que el tratamiento de la infección por este germen podría ser beneficiosa para aliviar los síntomas de la dispepsia funcional a largo plazo, aunque con mayor riesgo de efectos adversos, por lo que otros tratamientos alternativos continúan siendo ser una opción válida en el manejo de los pacientes con este problema de salud. (AU)

Divertículo de Meckel como causa de dolor abdominal recurrente / Meckel's diverticulum as a cause of recurring abdominal pain

El divertículo de Meckel constituye la anomalía congénita gastrointestinal más frecuente. Aunque la forma clínica de presentación más común es la hemorragia digestiva, también puede manifestarse como obstrucción intestinal o como proceso inflamatorio agudo. Su correcto diagnóstico y tratamiento requiere un elevado índice de sospecha clínica. Presentamos el caso de un varón de 19 años con un cuadro de dolor abdominal recurrente al que posteriormente fue extirpado un divertículo de Meckel

Meckel's diverticulum is the most frequent gastrointestinal congenital anomaly. Although its most common clinical presentation is gastrointestinal bleeding, it also manifests with bowel obstruction or acute inflammatory process. Correct diagnosis and treatment require a high degree of clinical suspicion. We present the case of a 19-year-old man with recurring abdominal pain, who eventually had a Meckel's diverticulum removed

Trastornos gastrointestinales funcionales después de un episodio de dengue no grave sin signos de alarma / Post-infectious functional gastrointestinal disorders in children after a non-severe dengue episode without warning signs

RESUMEN Introducción. La patogenia de los trastornos funcionales gastrointestinales involucra agentes infecciosos como los virus. Objetivo. Investigar el desarrollo de trastornos funcionales gastrointestinales en niños, a los 3, 6, 9 y 12 meses después de un episodio de dengue no grave sin signos de alarma. Materiales y métodos. Se hizo un estudio de cohorte de 73 niños con diagnóstico de dengue no grave sin signos de alarma atendidos en el Hospital Universitario del Valle "Evaristo García" y de 62 niños sanos de Cali, Colombia. Mediante el 'Cuestionario para síntomas gastrointestinales pediátricos Roma III' (Questionnaire for Pediatric Gastrointestinal Symptoms Rome III, QPGS-III), se determinaron los trastornos gastrointestinales funcionales a los 3, 6, 9 y 12 meses de seguimiento después de un episodio de dengue no grave sin signos de alarma. Se calcularon las medidas de tendencia central, riesgo relativo y prueba de ji al cuadrado, y se usó la prueba exacta de Fisher con un nivel de significación (p) menor de 0,05. Resultados. Se incluyeron 135 niños de 10,7±1,9 años; 51,1 % de ellos correspondía al sexo masculino y 19,3 % presentaba algún trastorno funcional gastrointestinal (9,6 % con dolor abdominal relacionado). El riesgo de presentar algún trastorno funcional gastrointestinal con dolor abdominal relacionado a los 3, 6, 9 y 12 meses de seguimiento en niños con dengue no grave sin signos de alarma fue mayor que sin dicho antecedente, pero sin diferencias significativas. Conclusión. Los resultados del estudio sugieren que el dengue no grave sin signos de alarma no incrementó el riesgo de trastornos gastrointestinales funcionales y dolor abdominal relacionado a lo largo de 12 meses de seguimiento.

ABSTRACT Introduction: The pathogenesis of functional gastrointestinal disorders involves infectious agents such as viruses. Objective: To study the development of functional gastrointestinal disorders 3, 6, 9 and 12 months after an episode of non-severe dengue without warning signs in children. Materials and methods: We conducted a cohort study in 73 children diagnosed with non-severe dengue without warning signs at Hospital Universitario del Valle "Evaristo García" and 62 healthy children from Cali, Colombia. Using the Questionnaire for Pediatric Gastrointestinal Symptoms Rome III (QPGS-III) in Spanish we identified functional gastrointestinal disorders 3, 6, 9, and 12 months after non-severe dengue without warning signs. Measurements of central tendency, relative risk, chi square, and Fisher's exact test were performed, with p<0.05 being significant. Results: We included 135 children who were 10.7±1.9 years old; 51.1% of them were male and 19.3% had a functional gastrointestinal disorder (9.6% of them had abdominal pain related to functional gastrointestinal disorders). There was a greater risk to present a functional gastrointestinal disorder and related abdominal pain in children after non-severe dengue without warning signs at 3, 6, 9, and 12 months of follow-up, but without significant differences. Conclusion: Our study suggests that non-severe dengue without warning signs does not increase the risk of functional gastrointestinal disorders and related abdominal pain for up to 12 months of follow-up.

Rehabilitación protésica de adultos mayores con dispepsia funcional / Prosthetics rehabilitation in elderly with functional dyspepsia

Se realizó un estudio descriptivo y transversal de 71 adultos mayores con dispepsia funcional, atendidos en el Servicio de Gastroenterología del Policlínico Sur Asdrúbal López Vázquez de la provincia de Guantánamo, desde mayo de 2012 hasta igual mes de 2014, con el objetivo de evaluar la efectividad de la rehabilitación protésica en estos pacientes. En la serie predominaron el sexo femenino (53,7 por ciento), el grupo etario de 60-69 años (53,7 por ciento), la sensación de plenitud y la saciedad precoz como síntomas principales, así como los dientes perdidos, según el índice de mortalidad dentaria (30,4 por ciento). El tratamiento rehabilitador permitió eliminar casi el total de los síntomas encontrados, por lo cual resultó efectivo y constituye un elemento a tener en cuenta para eliminar o disminuir los síntomas en ancianos con este trastorno

A descriptive and cross-sectional study of 71 elderly with functional dyspepsia, assisted in the Gastroenterology Service of Asdrúbal López Vázquez Southern Polyclinic in Guantánamo, was carried out from May, 2012 to the same month in 2014, with the objective of evaluating the effectiveness of the prosthetics rehabilitation in these patients. In the series there was a prevalence of the female sex (53.7 percent), 60-69 age group (53.7 percent) and early sensation of filling as main symptoms, as well as the lost teeth, according to the dental mortality rate (30.4 percent). The rehabilitative treatment allowed to eliminate almost all the symptoms found, reason why it was effective and constitutes an element to take into account to eliminate or diminish the symptoms in elderly with this disorder

Patologías funcionales post-infecciosas: epidemiología, factores de riesgo y tratamiento / Post-infectious functional gastrointestinal disorders: epidemiology, risk factors and treatment

Infectious gastroenteritis is a risk factor for developing post-infectious functional gastrointestinal disorders (PI-FGDs), mainly irritable bowel syndrome (IBS) and functional dyspepsia (FD). It is a significant subgroup of patients due to frequent episodes of gastrointestinal infections. Symptoms in PI-FGD patients can prevail for more than twelve months, especially if infective agents are bacteria or parasites. Symptoms are indistinguishable from their non-infective equivalents (IBS and FD). Risk factors for developing PI-FGD are: female gender, type and severity of the gastrointestinal infection, high anxiety levels and younger age. Main pathogenic mechanisms are alteration of permeability and immunity. Mucosa inflammation prevails only at early stage; however, with follow-up it can be reduced or normalized. Nevertheless, certain alterations prevail, such as hypersensitivity. These events are treated in the same way as IBS or FD.

La gastroenteritis infecciosa es un factor de riesgo para desarrollar un trastorno digestivo funcional postinfeccioso (TDF-PI), principalmente síndrome de intestino irritable (SII) y dispepsia funcional (DF). Es un subgrupo de pacientes relevante debido a lo frecuente que son las infecciones gastrointestinales. Los síntomas en los pacientes con TDF-PI se pueden prolongar por más de un año, especialmente cuando los agentes infecciosos son bacterias o parásitos. Los síntomas son indistinguibles con respecto a los de sus equivalentes no infecciosos (SII y DF). Los factores de riesgo para desarrollar TDF-PI son el sexo femenino, el tipo y la severidad de la infección gastrointestinal, los niveles altos de ansiedad, y la menor edad. Los principales mecanismos patogénicos son la alteración de la permeabilidad y de inmunidad. La inflamación de la mucosa predomina solo al principio pero con el seguimiento esta disminuye o se normaliza, a pesar de lo cual ciertas alteraciones como la hiperensibilidad permanecen. Estos cuadros se tratan de la misma manera que un SII o DF.

Estrés laboral y su correlación con la prevalencia de dispepsia funcional en militares en actividad que acudieron al hospital geriátrico del ejército / Relationship between the frequency of work-related stress and prevalence of functional dyspepsia in Lima Geriatric Army Hospital

Objetivo: Determinar la relación existente entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en una muestra de 218 militares mayores de 50 años durante el año 2010 en el Hospital Militar Geriátrico de Lima. Materiales y métodos: Investigación descriptiva- explicativa; para la obtención de datos acerca del estrés se empleó la Escala de Sucesos Vitales de Holmes-Rahe y fichas clínicas para el registro clínico y de endoscopia alta que cumplan criterios de Roma III para dispepsia funcional. Para el procesamiento y análisis de datos se empleó el paquete de programas estadísticos SPSS (Statistical Packagefor Social Sciences). Resultados: el 100% de militares presentaron algún nivel de estrés laboral durante el año de estudio; así, el 36,7% presentó un alto nivel, el 31,2% nivel medio o moderado, y el 32,1% presentó nivel bajo de estrés; de estos porcentajes los niveles medio y alto de estrés representaron el 67,9%. Estos resultados permiten establecer que el estrés laboral es un malestar frecuente en la población estudiada (Chi2 tabular = 3,841, chi2 observado = 27,908). Con relación a la dispepsia funcional se determinó una prevalencia de 37,2%, porcentaje que indica que es una patología frecuente en dichos militares (Z tabular = 1,96, Zc = 9,163). Conclusiones: Existe una relación significativa entre la frecuencia de estrés laboral y la prevalencia de dispepsia funcional en militares en actividad mayores de 50 años (Chi2 tabular= 5,991, chi2 observado =28,878, coeficiente de contingencia=0,342).

Objective: To determine the relationship between the frequency of work-related stress and prevalence of functional dyspepsia in a sample of 218 military older 50 years in 2010 in Lima Military Hospital Geriatric. Materials and methods: Descriptive and explanatory study and for the data collection on stress, were used the Vital Events Scale Holmes-Rahe and clinical records for clinical and upper endoscopy registration that comply the criteria of Rome III for functional dyspepsia. For processing and data analysis the statistical software package SPSS (Statistical Package for Social Sciences) was used. Results: 100% of military showed some level of work stress during the study year; thus, 36.7% had a high level, 31.2% medium or moderate level, and 32.1% had low stress level; these percentages medium and high stress levels accounted for 67.9%. These results establish that job stress is a common discomfort in the study population (tabulated Chi2 = 3.841, chi2 observed = 27,908). Regarding functional dyspepsia prevalence of 37.2%, which indicates that it is a common condition in those military (tabular Z = 1.96, Z c = 9.163) it was determined. Conclusions: There is a significant relationship between the frequency of work-related stress and prevalence of functional dyspepsia in military activity in older than 50 years (tabulated Chi2 = 5.991, chi2 observed = 28,878, contingency coefficient = 0.342).