Utilidad del suplemento de probioticos (Lactobacillus acidophilus y bulgaricus) en el tratamiento del Síndrome de Intestino Irritable / Probiotic supplement (Lactobacillus acidophilus and bulgaricus) utility in the treatment of irritable bowel syndrome

El Sindrome de Intestino Irritable (SII), es un transtorno funcional muy común y causa frecuente de consulta en gastroenterología, su fisiopatología es multifactorial y se caracteriza por dolor abdominal, distensión y alteración de los hábitos defecatorios, su terapia es básicamente sintomática (loperamida, antiespasmódicos, antidepresivos,etc).Recientemente se ha incorporado al tratamiento, el uso de probióticos que podrían mejorar su sintomatología. POBLACIÓN Y MÉTODO: Ensayo Clínico doble ciego aleatorizado simple, multicentrico que incluyó pacientes con diagnóstico de SII basado en criterios de Roma III. A estos se les administró Bromuro de Pinaverio mas placebo o Bromuro de Pinaverio mas Probiótico. La intensidad de los síntomas y el efecto del tratamiento fue valorado de acuerdo a Score de Francis antes y al final del tratamiento. Los cálculos fueron hechos con el programa SPSS 12.0.IC 95% RESULTADO. Se evaluaron 51 pacientes con promedio de edad de 43 años, mayoritariamente mestizos, 75%(38) casados y 55%(28) del sexo femenino, se encontró diferencias significativas en 4 variables de comparación: Dolor abdominal, Severidad del dolor, Días de dolor, y el Score total al final del tratamiento. CONCLUSIONES Los Probióticos utilizados como suplemento son efectivos en mejorar la sintomatología del SII.

Background: Irritable bowel syndrome (IBS) is a very common functional condition and a frequent cause of consultation in gastroenterology. With a multifactorial pathophysiology IBS is characterized by abdominal pain, distension and altered bowel habits. Loperamide, antispasmodics and antidepressants are symptomatic relievers of this disorder. Recently probiotics were incorporated to therapy, and could improve the symptomatology. Methods: multicenter randomized placebo-controlled trial that included IBS patients, diagnosed with Rome III criteria. The patients were given pinaverium bromure and placebo or pinaverium bromure and probiotics for 3 weeks. The intensity of symptoms and the effect of therapy were evaluated with the Francis Score, before and after the treatment. Statistics were done with SPSS 12.0 (C.I 95%). Results: 51 patients were evaluated, with an average age of 43 years old, mostly mestizo, 75% (38) married and 55% (28) female. There were statistical differences in four variables: abdominal pain, intensity of pain, days of pain and total score at the end of therapy. Conclusions: Probiotics used as supplement are effective in improving symptomatology of IBS.

[Probiotic supplement (Lactobacillus acidophilus and bulgaricus) utility in the treatment of irritable bowel syndrome]. / Utilidad del suplemento de probioticos (Lactobacillus acidophilus y bulgaricus) en el tratamiento del sindrome de intestino irritable.

BACKGROUND: Irritable bowel syndrome (IBS) is a very common functional condition and a frequent cause of consultation in gastroenterology. With a multifactorial pathophysiology IBS is characterized by abdominal pain, distension and altered bowel habits. Loperamide, antispasmodics and antidepressants are symptomatic relievers of this disorder. Recently probiotics were incorporated to therapy, and could improve the symptomatology. METHODS: multicenter randomized placebo-controlled trial that included IBS patients, diagnosed with Rome III criteria. The patients were given pinaverium bromure and placebo or pinaverium bromure and probiotics for 3 weeks. The intensity of symptoms and the effect of therapy were evaluated with the Francis Score, before and after the treatment. Statistics were done with SPSS 12.0 (C.I 95%). RESULTS: 51 patients were evaluated, with an average age of 43 years old, mostly mestizo, 75% (38) married and 55% (28) female. There were statistical differences in four variables: abdominal pain, intensity of pain, days of pain and total score at the end of therapy. CONCLUSIONS: Probiotics used as supplement are effective in improving symptomatology of IBS.

[Clinical and evolutive profile of Crohn's disease in Hospital Rebagliati (Lima-Peru)]. / Perfil Clínico y Evolutivo de la Enfermedad de Crohn en el Hospital Rebagliati (Lima-Perú).

Crohn's Disease (CD) is uncommon in Peru, in that respect, we don't know its clinical and developmental profile. This is a descriptive, retrospective, transversal and observational patients diagnosed with CD in the last 20 years in the Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins'. For the small size of the population, we used a census record. The diagnosis was made using the criteria of Lennard-Jones. We present seventeen cases, most female (11 / 6). The average age was 39.9 years (60% over 40 years). Only one patient had family history (second degree of consanguinity). Sixteen were latins and one white. Clinical manifestations were abdominal pain (88.2%), diarrhea (76.5%), weight loss (76, 5%), bleeding (58.8%) and fever (58.8%). Laboratory findings showed: anemia (76.5%), thrombocytosis (58.8%), hypoalbuminemia (52.9%), leukocytosis (23.5%), nitrogen retention (11.7%), leukopenia (5.9%), and elevated acute phase reactants ( c-reactive protein or erythrocyte sedimentation rate) 76.5%. Extraintestinal manifestations were cutaneous (29.4%), articular diseases (17.6%) and hepatobiliary (11.7%). Five patients (29.4%) received treatment of tuberculosis without success (before diagnosis). Nine patients (52.9%) had acute complications requiring emergency care. The phenotypic pattern type (Montreal's classification) was: non-stricturing non-penetrating 35.3%, stricturing 35.3% and penetrating 29.4%. Inflammation of the ileon was found in 70.5% (47% ileocolonic and ileal 23.5%), nine (53%) had perianal lesions. The activity at diagnosis was mild moderate disease in 8 (47.0%), moderate severe disease in 7 (41.2%) and severe ulminant 2 (11.8%). The macroscopic lesions were predominant stenosis 13 (76.5%), followed by ulcers in 12 (70.6%), erosive erythematous inflammation 11 (64.7%) and thickening of folds in 10 (58.8 %), seven (41%) had fistulas. As initial treatment were used aminosalicylates (13 patients) and systemic corticosteroids in 6 patients (35.3%). Azathioprine was used as maintenance therapy in two patients, infliximab was used successfully in a patient with fulminant disease. During the evolution of the EC twelve patients (70.5%) required surgery, two (11.7%) percutaneous abscess drainage and two anorectal endoscopic dilation.

Perfil clínico y evolutivo de la enfermedad de Crohn en el Hospital Rebagliati (Lima-Perú) / Clinical and evolutive profile of Crohn's disease in Hospital Rebagliati (Lima-Peru)

La Enfermedad de Crohn (EC) no es frecuente en el Perú, por ese motivo desconocemos su perfil clínico y evolutivo. El presente es un estudio descriptivo, retrospectivo, transversal y observacional de los pacientes diagnosticados con EC en los últimos 20 años en el Departamento del Aparato Digestivo del Hospital Nacional Edgardo Rebagliati Martins (EsSALUD). Por el tamaño pequeño de la población realizamos un registro censal; el diagnóstico se realizó utilizando los criterios de Lennard -Jones. Presentamos diecisiete casos, la mayoría del género femenino (11/6), edad promedio 39.9 años (60 por ciento mayores de 40 años). Solo un paciente presentó antecedente familiar (segundo grado de consanguinidad). La distribución racial mostró a dieciseis mestizos latinos y uno blanco. Las manifestaciones diagnósticas fueron: dolor abdominal 88,2 por ciento, diarrea 76,5 por ciento, pérdida de peso 76, 5 por ciento, sangrado 58,8 por ciento y fiebre 58,8 por ciento. Los hallazgos de laboratorio indicaron: anemia 76,5 por ciento, trombocitosis 58,8 por ciento, hipoalbuminemia 52,9 por ciento, leucocitosis 23,5 por ciento, retención nitrogenada 11,7 por ciento, leucopenia 5,8 por ciento y elevación de reactantes de fase aguda (proteina c reactiva o velocidad de sedimentación globular) 76,5 por ciento . Las manifestaciones extraintestinales fueron dermatológicas (29,4 por ciento), articulares (17,6 por ciento) y hepatobiliares (11,7 por ciento). Cinco pacientes (29.4 por ciento) recibieron tratamiento antituberculoso sin éxito (antes del diagnóstico). Nueve pacientes (52,9 por ciento) presentaron complicaciones agudas que requirieron atención de emergencia. El tipo de patrón fenotípico (Clasificación de Montreal) fue: no estenosante y no fistulizante 35,3 por ciento , estenosante 35, 3 por ciento y fistulizante 29,4 por ciento...

Crohn's Disease (CD) is uncommon in Peru, in that respect, we don't know its clinical and developmental profile. This is a descriptive, retrospective, transversal and observational patients diagnosed with CD in the last 20 years in the Department of Gastroenterology, Hospital Nacional Edgardo Rebagliati Martins. For the small size of the population, we used a census record. The diagnosis was made using the criteria of Lennard-Jones. We resent seventeen cases, most female (11 / 6). The average age was 39.9 years (60 percent over 40 years). Only one patient had family history (second degree of consanguinity). Sixteen were latins and one white. Clinical manifestations were abdominal pain (88.2 percent), diarrhea (76.5 percent), weight loss (76, 5 percent), bleeding (58.8 percent) and fever (58.8 percent). Laboratory findings showed: anemia (76.5 percent), thrombocytosis (58.8 percent), hypoalbuminemia (52.9 percent),leukocytosis (23.5 percent), nitrogen retention (11.7 percent), leukopenia (5.9 percent), and elevated acute phase reactants ( c-reactive protein or erythrocyte sedimentation rate) 76.5 percent.Extraintestinal manifestations were cutaneous (29.4 percent), articular diseases (17.6 percent) and hepatobiliary (11.7 percent). Five patients (29.4 percent) received treatment of tuberculos is without success (before diagnosis). Nine patients (52.9 percent) had acute complications requiring emergency care. The phenotypic pattern type (Montreal's classification) was: non-stricturing non-penetrating 35.3 percent, stricturing 35.3 percent and penetrating 29.4 percent. Inflammation of the ileon was found in 70.5 percent (47 percent ileocolonic and ileal 23.5 percent), nine(53 percent) had perianal lesions...