Efecto perjudicial de la pandemia por SARS-CoV-2 en la sintomatología digestiva en pacientes con síndrome de intestino irritable / Detrimental impact of SARS-CoV-2 pandemic in the symptomatology of patients with irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a more frequent disorder in the brain-gut axis interaction in the world. COVID-19 has affected the population's mental health, and its impact on clinical severity in patients with IBS is unknown. Objective: To evaluate the effect of psychosocial stress produced by the pandemic on the severity of gastrointestinal symptoms. Methodology: 54 women and three men with IBS were interviewed by telephone. Factors associated with quality of life, comorbidities, IBS subtype, and COVID-19 diagnosis were asked. Calls were developed between June 2020 to January 2021. Results: 75% had Diarrheal IBS (IBS-D), 67% had comorbidities, 47% with busy work, and 70% in person, five patients (9%) were diagnosed with COVID-19. Of the total, 88% referred to change in gastrointestinal symptoms, 56% increased abdominal pain, and 95% bloating. Abdominal pain was negatively associated with quality of life (p < 0.036), and the incomplete evacuation's sensation positively with difficulty sleeping (p < 0.034). Conclusion: In this study, IBS patients interviewed by telephone reported higher abdominal pain and subjective bloating associated with the pandemic by SARS-CoV-2. Keywords: Irritable

El Síndrome de Intestino Irritable (SII) es uno de los trastornos en la interacción cerebrointestino más frecuentes en el mundo. La pandemia COVID-19 ha afectado la salud mental de la población, siendo desconocido su impacto en la severidad clínica en pacientes con SII. Objetivo: Evaluar el efecto del estrés psicosocial producido por la pandemia en la severidad de síntomas gastrointestinales de pacientes con SII. Metodología: 54 mujeres y 3 hombres con SII fueron entrevistados vía telefónica. Se preguntó por factores asociados a calidad de vida, comorbilidades, subtipo de SII y diagnóstico de COVID-19. Las llamadas se realizaron entre junio de 2020 hasta enero de 2021. Resultados: Un 75% presentó SII Diarreico (SII-D), el 67% comorbilidades, el 47% con trabajo activo y 70% presencial, 5 pacientes (9%) diagnosticados COVID-19. Del total, 88% refirió cambio en síntomas gastrointestinales, 56% aumentó el dolor abdominal y 95% la distensión abdominal. El dolor abdominal se asoció negativamente con la calidad de vida (p < 0,036), y la sensación de evacuación incompleta positivamente con la dificultad para dormir (p < 0,034). Conclusión: En este estudio, los pacientes con SII entrevistados vía telefónica reportaron mayor dolor y distensión abdominal subjetiva asociado a la pandemia por SARS-CoV-2.

Las alteraciones de la microbiota intestinal en la patogenia del hígado graso no alcohólico / Alterations of the intestinal microbiota in the pathogenesis of nonalcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is currently considered in Chile and worldwide, as the main cause of cirrhosis and liver transplantation. It is therefore one of the main public health objectives for reducing its prevalence. In last years, it was suggested that the intestinal microbiota (IM) might contribute to the pathophysiology of NAFLD, as well as in the progression toward nonalcoholic steatohepatitis (NASH) and cirrhosis. It is known that changes in the composition of IM are associated with alterations in intestinal permeability and the production of inflammatory metabolites. These alterations are part of the pathophysiological mechanisms leading to the development of NASH. However studies on MI in patients with NAFLD and NASH in Chile are scarce. Through a research grant, recently awarded at the Hospital Clínico Universidad de Chile, we aim to confirm and characterize the intestinal dysbiosis associated with NAFLD in Chilean patients and to establish the relationship between the changes in microbial composition with the progression of liver damage. The description of these alterations represents an opportunity to explore new therapeutic approaches for future interventions. In effect, through the restoration of an intestinal microbial environment towards homeostasis in these patients, we expect to reverse or improve the progression of damage provoked by this disease. (AU)

Calprotectina fecal: utilidad en el diagnóstico diferencial de enfermedad inflamatoria intestinal y síndrome intestino irritable en adultos / Fecal Calprotectin: utility in the differential diagnosis of inflammatory bowel disease and irritable bowel syndrome in adults

Differentiation between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can be complex as their symptoms are often similar and unspecific. Fecal biomarkers could be useful to select patients with suspected organic diseases for colonoscopy, with the aim to improve early diagnosis and to avoid unnecessary invasive studies. Fecal calprotectin (FC) is a protein found mainly in neutrophils that is released into the feces as a result of cell disruption and apoptosis. Currently, FC is a simple and non-invasive biomarker of intestinal inflammation. Inflammatory gastrointestinal disorders are associated with high levels of FC, as occurs in IBD. This review focuses on FC as a useful tool for differential diagnosis between IBS and IBD in adults. (AU)

Pancreatitis recurrente por disquinesia hipertónica del esfínter de oddi: tratamiento endoscópico y seguimiento a largo plazo en un caso clínico / Recurrent pancreatitis caused by oddi sphincter’s hypertonic dyskinesia: case report of endoscopic treatment and long-term follow-up

It is frequently difficult to determine the exact cause of recurrent acute pancreatitis (RAP), which can be life threatening in several cases. Not detected biliary microlithiasis is the most frequent etiology, buthypertonic dyskinesis of Oddi’s sphincter also can cause RAP. Non-invasive diagnosis of this functional disorder is difficult, endoscopic manometry of Oddi’s sphincter allows measuring pressure in the choledochus,in the pancreatic duct and specifically in the sphincter region. Once hypertonic dyskinesis is demonstrated, the treatment option is the partial or total ablation of the sphincter, via endoscopic or surgical methods. This intervention results in an improvement or complete resolution in about 70 percent of the patients, preventing new bouts of acute pancreatitis and eventual progression to chronic disease. In this paper, we describe the history of one of our patients, who consulted more than ten years after cholecystectomy for recurrent abdominal pain and presented three episodes of acute pancreatitis. Endoscopic manometry of Oddi’s sphincter was performed in 1997, with the detection of very high pressure in biliary and pancreatic segments of the sphincter, demonstrating hypertonic dyskinesis involving both segments. A dual endoscopic sphincterotomy was performed, followed by marked reduction in the pressure of biliopancreatic ducts and Oddi’s sphincter and in abolition of choledocho-duodenal and pancreatic-duodenal gradient. She was asymptomatic till 2002, later on, she required endoscopic pneumatic dilatation of the sphincterotomy. She had no more acute pancreatitis episodes and CT scan in 2014 showed a normal pancreas.

Con frecuencia resulta difícil determinar la etiología de la pancreatitis aguda recurrente (PAR), que puede amenazar hasta la vida del paciente. Aparte de la patología litiásica biliar no diagnosticada, la disquinesia hipertónica del esfínter de Oddi (EO) causa con cierta frecuencia PAR. Su diagnóstico no invasivo es difícil, la manometría del esfínter de Oddi permite medir los valores de la presión en la vía biliar, en el conducto pancreático y en la región del esfínter. Una vez que la disquinesia hipertónica se demuestra, su tratamiento es la ablación parcial o total del esfínter, con método endoscópico o quirúrgico, con resolución del cuadro clínico en aproximadamente 70 por ciento de los pacientes, logrando evitar los nuevos brotes de pancreatitis aguda (PA) y la eventual progresión hacia pancreatitis crónica. En este trabajo describimos la historia de una paciente colecistectomizada, quien después de varios años de dolor abdominal recurrente, presentó tres brotes de PA. Manometría de EO fue realizada en 1997, detectando presiones muy elevadas, comprobando disquinesia hipertónica de los segmentos biliar y pancreático del esfínter. Se realizó esfinterotomía endoscópica doble, seguida por gran disminución de los valores de presión, abolición del gradiente colédoco-duodenal y pancreático-duodenal. Estuvo asintomática hasta el 2002, y posteriormente requirió dilatación neumática de los orificios de esfinterotomías. No ha tenido más recaídas de pancreatitis, la tomografía computada de control en noviembre de 2014 mostró un páncreas normal.

Presencia de síntomas digestivos en el Día Mundial de la Salud Digestiva / Presence of digestive symptoms in the World Digestive Health Day

Introduction: Gastrointestinal symptoms such as heartburn, indigestion/dyspepsia, constipation and bloating are very common in every community. Our group applied a questionnaire in order to identify the presence of gastrointestinal symptoms. Methodology: In 2012, during the World Digestive Health Day a survey of 13 questions given by the World Gastroenterology Organization (WGO) was administered to a group of people (E) at the Clinical Hospital of the University of Chile (HCUCH); the questions were based on the presence and frequency of digestive symptoms. The results were compared with two other groups, one rural (R) and another comprised of people that were accompanying the patients attending HCUCH (group A) for examinations. A χ2 test was used to compare variables by group. Results: Total E = 270, A = 100, R = 69. Women: E = 212 (79 percent), A = 66 (66 percent), R = 43 (62.4 percent). Age E = 48, A = 44, R = 53 (p = 0.0003). Digestive discomfort: E = 94.8 percent (256), A = 81 percent (81), R = 85.5 percent (59) p = 0.000. Distension/bloating E = 94.44 percent (255), A = 84 percent (84), R = 81.2 percent (56) p = NS. Abdominal pain/discomfort E = 89.6 percent (242), A = 75 percent (75), R = 82.6 percent (57) p = 0.000. Constipation: E = 80 percent (216), A = 71 percent (71), R = 63.7 percent (44) p = 0.01, with significant differences in sensation of incomplete evacuation in the 3 groups p = 0.001. Heartburn E = 75.2 percent (203), A = 67 percent(67), R = 68.1 percent (47) p = NS. Reflux E = 74 percent (200), A = 69 percent (69), R = 68.1 percent (47) p = NS. Interference with sleep: E = 62.2 percent (168), A = 45 percent (45), R = 56.5 percent (39) p = 0.012. Problems with soft/mushy/liquid stools = 65.92 percent (178), A = 61 percent (61), R = 68.11 percent (47) p = NS. Conclusions: Over 80 percent of respondents provided an upset stomach. The control group had the highest prevalence of digestive symptoms...

Introducción: Síntomas digestivos como pirosis, indigestión/dispepsia, constipación y distensión son muy frecuentes en cada comunidad. Nuestro grupo aplicó un cuestionario con el objetivo de identificar la presencia de sintomatología digestiva. Metodología: En el año 2012, durante el día mundial de la salud digestiva (DMSD) se realizó en el Hospital Clínico de la Universidad de Chile (HCUCH), una encuesta propuesta por la Organización Mundial de Gastroenterología (OMGE) que incluía 13 preguntas basadas en la presencia y frecuencia de síntomas digestivos. La encuesta se hizo a un grupo de personas (E). Los resultados fueron comparados con otros dos grupos, uno rural (R) y otro conformado por acompañantes (A) de pacientes que acudieron a exámenes al HCUCH. Se realizó una prueba χ² para comparar variables por grupo. Resultados: Total E = 270; A = 100; R = 69. Mujeres: E = 212 (79 por ciento), A = 66 (66 por ciento), R = 43 (62,4 por ciento). Edad E = 48, A = 44, R = 53 (p = 0,0003). Molestias digestivas: E = 94,8 por ciento (256), A = 81 por ciento (81); R = 85,5 por ciento (59) p = 0,000. Distensión/hinchazón E = 94,44 por ciento (255), A = 84 por ciento (84), R = 81,2 por ciento (56) p = NS. Dolor/molestia abdominal E = 89,6 por ciento (242), A = 75 por ciento (75), R = 82,6 por ciento (57) p = 0,000. Constipación: E = 80 por ciento (216), A = 71 por ciento (71), R = 63,7 por ciento (44) p = 0,01, existiendo diferencias significativas en sensación de evacuación incompleta en los 3 grupos p = 0,001. Pirosis E = 75,2 por ciento (203), A = 67 por ciento (67), R = 68,1 por ciento (47) p = NS. Reflujo E = 74 por ciento (200), A = 69 por ciento (69), R = 68,1 por ciento (47) p = NS. Interferencia con el sueño: E = 62,2 por ciento (168), A = 45 por ciento(45), R = 56,5 por ciento (39) p = 0,012. Problemas de heces blandas/ pastosas/líquidas E = 65,92 por ciento (178), A = 61 por ciento (61), R = 68,11 por ciento (47) p = NS...

Sobrecrecimiento bacteriano intestinal y pseudoobstrucción intestinal crónica: una relación poco conocida / Small intestinal bacterial overgrowth and chronic intestinal pseudo-obstruction

Chronic intestinal pseudo-obstruction (CIP) is the most severe intestinal motility disorder. Small intestinal bacterial overgrowth (SIBO) is frequently associated to dysmotility. In spite of this association, there is scare data on the relation between CIP and SIBO. To establish occurrence of CIP in SIBO patients in inter-crisis periods. To compare clinical and manometric characteristics of SIBO and non-SIBO patients. Retrospective analysis of 40 CIP patients (average age: 41 years; range: 18-76 years; 75 percent women). The following elements were registered: symptoms (such as pain, distention, vomit, constipation, diarrhea and weight loss); findings of the intestinal manometry (neuropathic, miopatic and mix pattern; intestinal motility index); and SIBO using lactulose H2 breath test, defined as an increase > 20 ppm in 2 or more figures in the first 60 minutes. Statistical analysis: t-test y and comparison of two ratios. SIBO was observed in 60 percent of the patients with CIP. Three or more symptoms were observed in 70.8 percent of the patients with SIBO 50 percentwithout SIBO (p = NS). In patients with SIBO, the most frequent symptom was abdominal pain (70.8 percent p= 0.032). There were no differences between SIBO patients and the different motility patterns, however, the intestinal motility index was lower for the SIBO group (9.7 +/- 44 12.3 +/-7; p < 0.001). : There is a high prevalence of SIBO in CIP patients. This is associated to a major compromise of intestinal motility assessed by the intestinal motility index...

Introducción: La pseudoobstrucción intestinal crónica (POIC) es el trastorno más grave de la motilidad intestinal. El sobrecrecimiento bacteriano intestinal (SBI) se asocia frecuentemente a estados de dismotilidad. A pesar de esta asociación existen escasos datos sobre la relación entre POIC y SBI. Objetivo: Determinar SBI en pacientes con POIC en período inter-crisis. Comparar características clínicas y manométricas de pacientes con y sin SBI. Material y Método: Análisis retrospectivo de 40 pacientes con POIC (edad promedio: 41 años, rango: 18-76 años; 75 por ciento mujeres). Se registraron síntomas (dolor, distensión, vómitos, constipación, diarrea, baja de peso), hallazgos en manometría intestinal (patrón neuropático, miopático o mixto, índice de motilidad intestinal (IMI)) y SBI con test de H2 con lactulosa, definido como la elevación > 20 ppm en 2 o más cifras en los primeros 60 min. Análisis estadístico: t-test y comparación de 2 proporciones. Resultados: Se observó SBI en 60 por ciento de los pacientes con POIC. Tres o más síntomas se presentaron en 70,8 por ciento de los pacientes con SBI vs 50 por ciento en POIC sin SBI (p = NS). El síntoma dolor abdominal fue más frecuente en pacientes con SBI (70,8 por ciento vs 31,2 por ciento, p = 0,032). No hubo diferencias entre pacientes con SBI y los distintos patrones de motilidad, sin embargo, el IMI fue menor para el grupo con SBI (9,7 +/- 1,44 vs 12,3 +/- 1,7, p < 0,001). Conclusiones: Existe una alta prevalencia de SBI en pacientes con POIC. Esto se relaciona con mayor compromiso de la motilidad intestinal evaluado por el IMI.

[Silent celiac disease among 21 patients with cryptogenic epilepsy]. / Enfermedad celíaca silente en epilepsia criptogénica del adulto.

BACKGROUND: Celiac disease (CD) is predominant in women and young people. Atypical, non-enteric symptoms are more common among adults. There is also an association between CD and neurological disorders, especially with cerebellar ataxia, polyneuropathy and epilepsy. AIM: To study the frequency of CD in a group of adults with cryptogenic epilepsy. MATERIAL AND METHODS: Twenty one patients with cryptogenic epilepsy, aged 20 to 65 years (14 women) were studied, measuring IgA-anti transglutaminase antibodies and deamidated gliadin peptide (DGP) IgG and IgA antibodies. RESULTS: One patient had elevated titers of both types of antibodies. Small bowel biopsy showed villous atrophy and lymphocytic infiltration compatible with CD. CONCLUSIONS: One of 21 adult patients with cryptogenic epilepsy had a silent CD.

Enfermedad celíaca silente en epilepsia criptogénica del adulto / Silent celiac disease among 21 patients with cryptogenic epilepsy

Background: Celiac disease (CD) is predominant in women and young people. Atypical, non-enteric symptoms are more common among adults. There is also an association between CD and neurological disorders, especially with cerebellar ataxia, polyneuropathy and epilepsy. Aim: To study the frequency of CD in a group of adults with cryptogenic epilepsy. Material and Methods: Twenty one patients with cryptogenic epilepsy, aged 20 to 65years (14 women) were studied, measuring IgA-anti transglutaminase antibodies and deamidated gliadin peptide (DGP) IgG and IgA antibodies. Results: One patient had elevated titers of both types of antibodies. Small bowel biopsy showed villous atrophy and lymphocytic infiltration compatible with CD. Conclusions: One of 21 adult patients with cryptogenic epilepsy had a silent CD.

Motilidad intestinal y microflora / Intestinal motility and microflora

La microflora es el conjunto de colonias microbacterianas que cubren la superficie del tubo digestivo. Cada sujeto humano alberga unos 100 billones de colonias de unas 400 especies distintas, biodiversidad que facilita la vida y el desarrollo del conjunto. La concentración de bacterias va aumentando a lo largo del tubo digestivo, alcanzando concentraciones de 1012 UFC/ml. en el colon. La motilidad del intestino delgado es propulsiva con una fase de barrido que no permite el crecimiento de bacterias. Por el contrario, la motilidad del colon es muy lenta y no propulsiva durante el ayuno y el sueño. Sólo en vigilia y en período postprandial existen ondas de contracción de alta amplitud y rápidamente progresivas en dirección oral-anal. La interacción entre las bacterias presentes en el lumen y las ondas de contracción motora es muy difícil de evaluar. Este efecto se ha estudiado en base a los fármacos que alteran la motilidad y que al aumentar ésta, barren con la flora bacteriana presente. En ese sentido se sabe que el uso de cisaprida acelera el tránsito, reduciendo la densidad de bacterias metanogénicas con un aumento de la excreción de hidrógeno. En cambio, loperamida disminuye el tránsito, aumentando la flora metanogénica (hecho que representa lo que sucede a pacientes constipadas, que tienen flora mayoritariamente productora de metano). Conclusión: La interacción entre motilidad y flora bacteriana es compleja y está poco estudiada fundamentalmente debido a dificultades técnicas.

Microflora is the set of microbacterium colonies covering the digestive tract surface. Each human subject hosts ca. 100 billions of colonies of 400 different species, b23wiodiversity that facilitates life and development of the whole. Bacteria concentration increases throughout the digestive tract, reaching concentrations of 1012 CFU/ml in the colon. Motility of the small intestine is propulsive with a sweeping phase, allowing for the growth of bacteria. On the contrary, motility of the colon is very slow and non-propulsive during fasting and sleeping. Only during wakefulness and postprandial period there are wide-ranging and quickly progressive contraction waves in oral-anal direction. Interaction between bacteria present in lumen and the contraction waves is very hard to assess. This effect has been studied based on drugs that alter motility, and when it increases, they sweep the existing gut flora. In this sense, it is known that the use of cisapride accelerates the transit, reducing the density of methanogenic bacteria with an increase in the hydrogen excretion. On the other hand, loperamide slows down transit, causing an increase of the methanogenic flora (which represents what happens to constipated patients with flora that produces mainly methane). Conclusion: Interaction between motility and gut flora is complex and has not been enough studied mainly due to technical difficulties.

La prolongación del test de hidrógeno en aire espirado mejora la sensibilidad del diagnóstico de malabsorción de lactosa / Extension of hydrogen breath test improves sensibility of lactose malabsorption diagnosis

Hydrogen breath test (HBT) for diagnosis of lactose malabsorption (LM), is usually performed over a 180 min standard period. However, studies have suggested that extending the observation time, the sensibility of the test is improved. Aims: To determine if the time extension of the lactose hydrogen breath test, can improve sensibility of the test. Patients and method: One thousand and two hundred and ninety three patients were included, mean age 33.1 years (range: 3-90 years), 73.3 percent women, 26.8 percent were younger than 15years. Lactose HBT was performed for a standard period, which was prolonged to 240 min when patients presented a flat curve at 180 min. Results: Seven hundred and thirty one patients (56.5 percent) had a positive breath test for LM during 180 min. The extension of the HBT to 240 min showed an increase of 13.3 percent (p < 0.05) of patients with LM diagnosis. Conclusion: This study shows that an additional hour increases sensibility of the test, and decreases the false negative results.

El test de hidrógeno en aire espirado (TH2) para el diagnóstico de malabsorción de lactosa (ML) se realiza por un período estándar de 180 min. Sin embargo, se ha sugerido que estudios de mayor duración podrían mejorar la sensibilidad del test. Objetivos: Determinar si la prolongación del TH2 con lactosa, puede mejorar la sensibilidad del diagnóstico de ML. Pacientes y Métodos: Se estudiaron 1293pacientes, edad promedio 33,1 años (rango 3 a 90 años), 73.3 por ciento mujeres, 26,8 por ciento menores de15 años. Para determinar la presencia de ML se realizó el TH2 con lactosa estándar, extendiéndolo a 240 min en pacientes con una curva plana a los 180 min. Resultados: Setecientos treinta y un pacientes (56,5 por ciento) tuvieron un TH2 concordante con ML durante el período de 180 min. En aquellos que se extendió el examen a 240 min se observó un aumento de 13,3 por ciento de ML (p< 0,05). Conclusión: Este estudio demuestra que la prolongación del TH2 en una hora mejora la sensibilidad del examen y disminuye el número de falsos negativos.

Estudio comparativo de dos equipos para el test de H2 en aire espirado / Evaluation of breath H2 measured by means of two different analyzers

El test de hidrógeno (H2) en aire espirado es ampliamente utilizado en el estudio de malabsorción de hidratos de carbono, sobrecrecimiento bacteriano intestinal (SBI) y tiempo de tránsito orocecal (TTOC). Objetivo: Comparar los resultados obtenidos por dos equiposde detección de H2, uno de ellos de introducción reciente en nuestro medio. Material y Métodos: 50 pacientes, edad promedio 38,5 +/- 5,2 años (rango 7-77 años), 40 mujeres, se les realizó el test de H2 en aire espirado en paralelo con ambos equipos bajo métodos estandarizados. En 25 de ellos se investigó la presencia de malabsorción de lactosa, y en los otros 25, la presencia de SBI con lactulosa. Se evaluaron los valores de H2 obtenidos con ambos equipos. Resultados: Las lecturas de H2 con ambos equipos no mostraron diferencias significativas tanto para lactosa (p > 0,1), como para lactulosa (p > 0,5). Tampoco hubo diferencias en el TTOC de los pacientes (90 +/- 33,75 min v/s 90.8 +/- 32,42 min) (p > 1). Se obtuvo un índice de concordancia Kappa de 0,92 entre ambos equipos con el test con lactosa y con lactulosa. Conclusión: El equipo portátil es altamente confiable, entregando resultados con una excelente concordancia con respectoal equipo de referencia.

The hydrogen (H2) breath test (BT) is widely used to investigate carbohydrates malabsorption, small intestinal bacterial overgrowth (SIBO) and orocaecal transit time (OTT). Aim: To compare the results of two hydrogen breath devices, one of them, of recent introduction in our country. Methods: Fifty patients were included, mean age 38.5 +/- 5.2years (range 7-77 yrs), 40 women, H2 BT was performed in parallel with both analyzers under standardized methods. Lactose malabsorption was investigated in 25 patients with lactose, and the presence of SIBO in the resting 25 patients, with lactulose, hydrogen values obtained with both devices were evaluated. Results: No differences were observed between the H2 concentrations for lactose BT (p > 0.1) as well as lactulose BT (p > 0.5)and also between the OTT measured by the two devices (90 +/- 33.75 min. v/s 90.8 +/- 32.42 min) (p > 1). We detected a Kappa concordance index of 0.92 for both equipments. Conclusion: The portable device is highly reliable to detect the presence of breath hydrogen, giving results with an excellent concordance to the reference device.

[Small intestine bacterial overgrowth in patients with chronic pancreatitis]. / Sobrecrecimiento bacteriano intestinal en pacientes con pancreatitis crónica.

BACKGROUND: Previous reports describe 30-40% of small intestine bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP), SIBO is a cause of persistent symptoms in this group of patients even when they are treated with pancreatic enzymes. AIM: To asses the frequency of SIBO in patients with CP. PATIENTS AND METHODS: We studied 14 patients with CP using an hydrogen breath test with lactulose to detect SIBO, a nonabsorbable carbohydrate, whose results are not influenced by the presence of exocrine insufficiency. Main symptoms and signs were bloating in 9 (64%), recurrent abdominal pain in 8 (57%), intermittent diarrhea in 5 (36%) and steatorrhea in 5 (36%). At the same time we studied a healthy control group paired by age and sex. RESULTS: SIBO was present in 13 of 14 patients with CP (92%) and in 1 of 14 controls (p<0.001). The only patient with CP and without SIBO was recently diagnosed and had minimal morphologic alterations in computed tomography and endoscopic pancreatography. CONCLUSIONS: SIBO is common in CP and may be responsible for persistent symptoms. Proper diagnosis and treatment could alleviate symptoms and improve quality of Ufe.

El uso de inhibidores de bomba de protones y el hábito de fumar no modifican la tasa de sobrecrecimiento bacteriano intestinal en pacientes con patología digestiva funcional / Small intestinal bacterial overgrowth is not influenced by proton pump inhibitors and smoking habit in patient with funtional gastrointestinal disorders

Background: Drug induced inhibition of acid secretion has been associated to small intestinal bacterial overgrowth (SIBO). Smoking is followed by an increase of exhaled and orocecal transit time (OCTT). Aim: To investigate if the use of proton pump inhibitiors (PPI) and smoking can modifie the incidence of SIBO in patients with functional gastrointestinal disease. Patients and Methods: Questionnaires performed before a study for SIBO in patients with functional gastrointestinal disorders were analyzed. The use PPI and the smoking habit were recorded. The presence of SIBO and the OCTT was determined by means of the lactulose hydrogen breath test. Results: 437 patients, mean age 45 years (range: 14-93), 337 (77 percent) female, entered in the study SIBO was present in 356 patients, and 81 patients had normal H2 breath test. Both groups had a similar distribution of gender and age. The percentage of SIBO was no different in patients using PPI or presenting smoking habit Conclusions: Use of PPI and smoking habit are not risk factors for the development of SIBO in patients with functional disorders.

Los fármacos que inhiben la secreción gástrica favorecen el sobrecrecimiento bacteriano intestinal (SBI), mientras que el habito de fumar puede aumentar los niveles de H2 espirado y el tiempo de transito orocecal (TTOC). Objetivo: Investigar si el uso de inhibidores de la bomba de protones (IBP) y el habito de fumar modifican la incidencia de SBI en pacientes con trastornos digestivos funcionales. Pacientes y Métodos: Se analizaron encuestas de pacientes con patología digestiva funcional previas a un estudio de SBI Se consignaron el uso de IBP Y el hábito tabáquico en los 6 meses que precedieron al examen. La presencia de SBI y el tiempo de transito orocecal (TTOC) se determinaron con el test de hidrógeno en aire espirado con lactulosa. Resultados: 437 pacientes, con edad x 45 años (rango: 14-93),337 (77 por ciento) mujeres. Con SBI 356 pacientes, sin SBI 81 pacientes. Ambos grupos fueron comparables en cuanto a distribución por sexo y edad. El porcentaje de pacientes con SBI no fue diferente en pacientes con antecedente de uso de IBP o con hábito tabaquito. Conclusiones: El antecedente del uso de IBP y el tabaquismo no constituyen un factor de riesgo para SBI en pacientes con patología digestiva funcional.

Sobrecrecimiento bacteriano intestinal en pacientes con pancreatitis crónica / Small intestine bacterial overgrowth in patients with chronic pancreatitis

Background: Previous reports describe 30-40 percent of small intestine bacterial overgrowth (SIBO) in patients with chronic pancreatitis (CP), SIBO is a cause of persistent symptoms in this group of patients even when they are treated with pancreatic enzymes. Aim: To asses the frequency of SIBO in patients with CP. Patients and methods: We studied 14 patients with CP using an hydrogen breath test with lactulose to detect SIBO, a nonabsorbable carbohydrate, whose results are not influenced by the presence of exocrine insufficiency. Main symptoms and signs were bloating in 9 (64 percent), recurrent abdominal pain in 8 (57 percent), intermittent diarrhea in 5 (36 percent) and steatorrhea in 5 (36 percent). At the same time we studied a healthy control group paired by age and sex. Results: SIBO was present in 13 of 14 patients with CP (92 percent) and in 1 of 14 controls (p<0.001). The only patient with CP and without SIBO was recently diagnosed and had minimal morphologic alterations in computed tomography and endoscopic pancreatography Conclusions: SIBO is common in CP and may be responsible for persistent symptoms. Proper diagnosis and treatment could alleviate symptoms and improve quality of life.

Revisión crítica de los métodos utilizados en el estudio del tránsito colónico / Colonic transit assesment: a chritical review

Functional constipation is a disorders frequently observed in clinical practice. In the management of a group of patients who do not respond to established medical treatment, is important to investigate colonic transit A critical review of the main technical approach for colonic transit estimation is presented. Two main methods are actually availables: isotopic markers, and radiological techniques with radiopaque markers, the last one being the most extensively used. The most basic technique consist in a single administration of markers and a plain abdominal Rx. Information about percentage of markers observed five days after ingestion (normal 20%) and distribution, provide important information: diffuse overall the colon (slow transit constipation) or localized distally (outlet obstruction).Using repeated doses of markers and one or more Rx, colonic transit time segmental or total can be established. This information may be useful in the assessment of certain pathological conditions, pharmacological effects and diets.

La constipación funcional es una manifestación clínica frecuente. En algunos pacientes que no responden a las. medidas terapéuticas habituales, es necesario para su manejo contar con una evaluación del tránsito colónico. Revisamos en forma crítica en esta presentación las principales técnicas utilizadas en la actualidad con este fin. Existen principalmente dos métodos: el uso de marcadores isotópicos y técnicas radio lógicas con marcadores radiopacos, esta última es la más ampliamente utilizada. La técnica con marcadores radiopacos más simple consiste en utilizar una dosis de marcadores y una radiografía, informa sobre el porcentaje de retención de marcadores (normal 20% a los 5 días) y su distribución: difusa (constipación por tránsito lento), localizada distalmente, que sugiere un trastorno del tracto de salida. Usando dosis repetidas de marcadores y una o más radiografías, se puede establecer el tiempo de tránsito para los diferentes segmentos del colon y total, lo que puede ser de utilidad en la evaluación de determinadas condiciones patológicas, fármacos y dietas.

Sobrecrecimiento bacteriano intestinal un factor de riesgo de peritonitis bacteriana espontánea y mortalidad en pacientes con cirrosis hepática / Intestinal bacterial overgrowth is a risk factor for spontaneous bacterial peritonitis and mortality in patients with liver cirrhosis

Spontaneous bacterial peritonitis (SBP) is a major and serious complication of liver cirrhosis. Small intestinal bacterial overgrowth (SIBO) has been shown to occur with increased frequency in patients with cirrhosis. Studies have suggested that SIBO may contribute to the development of SBP. Aims: to assess the prevalence of SIBO and its relationship with the mortality in patients with cirrhosis. Patients and Methods: One hundred three cirrhotic patients, 62 male, mean age 56.6 (range 35-89) entered in the study in a four year period with a mean follow-up of 22.2 months (range 3-76). SIBO was evaluated by breath hydrogen test (BHT) with lactulose. A positive BHT was defined as an increase of 20 ppm during the first 60 min after lactulose ingestion. SBP was diagnosed by a polymorphonuclear leukocyte count greater than or equal to of 250 cells/mm3 in ascitic fluid. Results: A 50 percent of cirrhotic patients had SIBO at the beginning of follow-up period. The prevalence of SIBO was similar in patients with Child-Pugh class A, B, or C (48 percent 51 percent and 48 percent patients respectively). The presence of SBP was significantly higher in patients with SIBO (17/54 patients) than patients without SIBO (1/53 patients), p < 0.05. The mortality of cirrhotic patients was higher in the SIBO group than in the non-SIBO group (25/50 versus 16/35 patients. p < 0.05). Conclusions: The results of this study confirm that the presence of SIBO is a risk factor for SBP and mortality in patients with liver cirrhosis. SIBO should be investigated and treated during the follow-up in these patients.

La peritonitis bacteriana espontánea (PBE) es una complicación frecuente y grave en pacientes con cirrosis hepática. El sobrecrecimiento bacteriano intestinal (SBI) ha sido descrito con frecuencia en pacientes con cirrosis. Estudios han sugerido que el SBI puede ser un factor importante en el desarrollo de la PBE. Objetivos: Evaluar la prevalencia de SBI y su relación con la mortalidad en pacientes con cirrosis hepática. Pacientes y métodos: Ciento tres pacientes cirróticos, 67 hombres, edad promedio 58,6 (rango 35-89) entraron al estudio en un período de cuatro años con un seguimiento promedio de 22,2 meses (rango 3-76). El SBI fue evaluado por test de hidrógeno en aire espirado (THE) con lactulosa. Un examen era considerado positivo con un nivel mayor de 20 ppm después de la ingesta de lactulosa en los primeros 60 min. El diagnóstico de PBE se fundamentó en un recuento de polimorfonucleares mayor o igual que 250 células/mm3 en muestra de líquido ascítico. Resultados: El 50 por ciento de los pacientes cirróticos presentó SBI al comienzo de su seguimiento. La prevalencia de SBI fue similar en pacientes cirróticos Child-Pugh A, B, o C (48 por ciento, 50 por ciento y 50 por ciento respectivamente). La presencia de PBE fue significativamente mayor en pacientes con SBI (17/50 pacientes) que en pacientes sin SBI (1/53 pacientes). p < 0,05. La mortalidad de los pacientes cirróticos fue mayor en el grupo con SBI que en el grupo sin SBI (25/50 versus 16/53 pacientes, p < 0,05). Conclusiones: Los resultados de este estudio confirman que la presencia de SBI es un factor de riesgo de PBE y mortalidad en pacientes con cirrosis hepática. El SBI debería ser investigado y tratado durante el seguimiento de estos pacientes.

Enfermedad inflamatoria intestinal y enfermedad celíaca: una asociación infrecuente / Inflammatory bowel disease and celiac disease: an uncommon association

The prevalence of inflammatory bowel disease (IBD) and celiac disease (CD) have increased during the last decades; however the occurrence of both conditions together is uncommon. In spite of this fact, the literature has suggested an association between IBD and CD because an aberrant innate immune reaction is a contributory risk factor in both diseases. The combined presentation of IBD and CD in five patients is presented and we analyzed the clinical and laboratory characteristics of this condition. The occurrence of both diseases should be kept in mind at the time of diagnosis and at relapse, or when the remission is difficult to maintain.

La prevalencia de las enfermedades inflamatorias intestinales (EII) y de la enfermedad celiaca (EC) ha aumentado durante las ultimas décadas; sin embargo la asociación de ambas condiciones es infrecuente. A pesar de ello, la literatura ha sugerido una asociación entre ambas entidades, ya que una respuesta inmune innata aberrante es un factor de riesgo de ambas enfermedades. Presentamos cinco pacientes con la presentación combinada de EII y EC y se analizan las características clínicas y de laboratorio de esta condición. La presencia de ambos cuadros debe ser tenida en mente al momento del diagnostico, recaída de la enfermedad sin causa clara o si existe alguna dificultad en mantener la etapa de remisión de la enfermedad.

Prevalencia de la infección por helicobacter pylori según ensayo de la ureasa en pacientes derivados a la Unidad de Endoscopía del Hospital Clínico de la Universidad de Chile / Prevalence of infection by helicobacter pylori by urease test in patients derivates to the endoscopic section of Hospital Clínico de la Universidad de Chile

Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. In Chile about 79 percent of the population is colonized. Aims: This study evaluate the prevalence of the H. pylori infection in symptomatic outpatients. Materials and Methods: 276 non selected patients were enrolled from Endoscopic Unit of Clinical Hospital of the University of Chile. The bacterium was detected by urease test. Results: H. pylori infection was found in 44,9 percent patients. Infection was higher in younger patients, 53,8 percent between 21-60 years, and was lower in older patients, 25,6 percent in older than 60 years. The risk of being H. pylori carrier is twofold higher in persons younger than 60 years as compared to those older than 60 years. Conclusion: The age would be modifier factors for H. pylori infection risk.

Barostato rectal en el síndrome de intestino irritable / Rectal barostat in irritable bowel syndrome

Background: Many patients with irritable bowel syndrome (IBS) have lowered sensory thresholds to rectal distention when compared to control subjects, a phenomenon called visceral hypersensitivity. Aim: To investigate the usefulness of a rectal barostat as a diagnostic tool in IBS and if there are differences in visceral hypersensitivity in different groups of IBS patients. Patients and Methods: Ten healthy subjects and 19 IBS patients, defined using Rome II criteria (12 with constipation, three with diarrhea and four alternating between diarrhea and constipation), were studied. Sequential isobaric rectal distentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reported pain, were carried out. Visceral hypersensitivity was defined as a pain threshold under 38 mmHg. Results: Only 26 percent of IBS patients had visceral hypersensitivity (16 percent and 43 percent of patients with IBS and constipation and IBS and diarrhea or alternating symptoms, respectively, p =NS). Pain threshold in controls, patients with IBS and constipation and patients with IBS and diarrhea or alternating symptoms was 43.8±6.6, 45.3±9.2 and 40.8±9.2 mmHg, respectively (p =NS). Conclusions: Our results do not support the usefulness of the electronic rectal barostat as a diagnostic method to diagnose IBS.