Instruções em bulas destinadas ao uso de medicamentos para dispepsia e constipação durante a lactação / Instructions in package inserts intended for the use of medicines for dyspepsia and constipation during lactation / Instrucciones en prospectos destinados al uso de medicamentos para la dispepsia y el estreñimiento durante la lactancia

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

Association of adverse childhood experiences with irritable bowel syndrome in Mexican adults: A cross-sectional study.

BACKGROUND: Adverse childhood experiences (ACEs) are linked to the development of gastrointestinal disorders during adulthood, but there is limited research on the prevalence of ACEs in Latin American populations. This study aimed to assess the prevalence and impact of ACEs on Mexican adults with irritable bowel syndrome (IBS). METHODS: In this cross-sectional study, we recruited 290 Mexican adults (aged 18-65), including 90 individuals with IBS and 200 healthy controls. All participants completed four self-reported questionnaires: The Adverse Childhood Experiences Questionnaire (ACEs), Visceral Sensitivity Index, Irritable Bowel Syndrome Symptom Severity Scale, and Hospital Anxiety and Depression Scale. Statistical analyses included mean differences using either the Student's t-test or the Wilcoxon test, correlations assessed with Spearman's correlation coefficient, and logistic regression models. Statistical significance was defined as a p-value less than 0.05. KEY RESULTS: Among IBS subjects, the prevalence of ACEs was 80%, significantly higher than the 59% prevalence observed in controls (p < 0.0001). Individuals with ACEs exhibited elevated levels of anxiety and depression. Seventy-five percent of IBS subjects with severe symptoms reported four or more ACEs. The presence of four or more ACEs was found to be associated with an increased risk of IBS. CONCLUSIONS AND INFERENCES: ACEs are notably prevalent among Mexican individuals with IBS and are positively correlated with the severity of gastrointestinal pain. These findings underscore the critical significance of evaluating and addressing ACEs in the comprehensive management of IBS within Latin American populations.

Mapeo de superficie corporal gástrica (Alimetria®): una nueva forma de estudiar la función gastroduodenal / Body Surface Gastric Mapping (Alimetry®): a New Way to study the Gastroduodenal Function

Upper gastrointestinal symptoms affect 10% of the population, leading to significant costs and negatively impacting quality of life. Diagnosing disorders such as functional dyspepsia and gastroparesis is challenging due to overlapping symptoms. Gastric emptying scintigraphy (GES) has reproducibility issues. Body Surface Gastric Mapping (BSGM) is an advanced technique for precise and reliable electrophysiological mapping, overcoming the limitations of electrogastrography (EGG). Gastric Alimetry® measures gastric myoelectric potentials, providing valuable diagnostic data. BSGM uses an electrode array to capture gastric activity and requires a standardized protocol for comparable data. The metrics generated help identify specific gastric dysfunction phenotypes, improving diagnostic accuracy. These advancements promise to revolutionize the clinical management of chronic gastric symptoms, making this review essential reading for those interested in gastrointestinal research and treatment.

Los síntomas gastroduodenales afectan a más del 10% de la población, causando costos significativos e impac- tando negativamente la calidad de vida. Diagnosticar trastornos como la dispepsia funcional y la gastroparesia es complejo debido a la superposición de síntomas. El cintigrama de vaciamiento gástrico (CVG) y electrogas- trografía (EGG) tiene problemas de reproducibilidad. El Mapeo de superficie de Cuerpo Gástrico (MSCG) o conocida también como Alimetría gástrica, es una técnica avanzada que permite un mapeo electrofisiológico preciso y fiable, superando las limitaciones de la EGG. La Alimetría Gástrica mide los potenciales mioeléc - tricos gástricos, proporcionando datos útiles para el diagnóstico. El MGSC utiliza una matriz de electrodos para capturar la actividad gástrica y requiere un protocolo estandarizado para obtener datos comparables. Las métricas generadas ayudan a identificar fenotipos específicos de disfunción gástrica, mejorando la precisión diagnóstica. Estos avances prometen revolucionar el manejo clínico de los síntomas gástricos crónicos, ha - ciendo de esta revisión una lectura esencial para aquellos interesados en la investigación y tratamiento de problemas gastrointestinales

Analysis between symptoms of the upper gastrointestinal tract and endoscopic findings of patients undergoing upper digestive endoscopy in a reference center in the interior of Maranhão, Brazil

Purpose: To analyze clinical and endoscopic aspects of dyspeptic patients submitted to upper endoscopy in a reference center in the interior of Maranhão, Brazil. Methods: Observational, descriptive, and analytical research through interviews and endoscopic reports of 80 patients with dyspeptic complaints submitted to upper endoscopy. Results: Among the respondents, 66.25% were women, most were aged ≥ 40 years old and had epigastric pain as their main symptom, and 29.75% had no appropriate indication to perform upper endoscopy. Mild enanthematous gastritis of the antrum was the most frequent finding, and 92.5% had non-significant findings. Rapid urease test was positive in 25%. The following findings showed a statistically significant correlation (p < 0.05): age < 40 years old, female gender, and gastric lesion with positive urease test; smoking with gastric lesion and age less than 40 years old with normal examination. Patients with significant findings had appropriate indications for upper endoscopy. Conclusions: The correct indication of upper endoscopy is essential for satisfactory endoscopic yields and accurate diagnosis.

Frequency, distribution and determinants of Helicobacter pylori infection in adults and adolescents with gastric symptoms: cross-sectional epidemiological inquiry in district Haripur, Pakistan / Frequência, distribuição e determinantes da infecção por Helicobacter pylori em adultos e adolescentes com sintomas gástricos: inquérito epidemiológico transversal no distrito de Haripur, Paquistão

Helicobacter pylori (HP) is a vital element in the etiology of peptic ulcers and gastric cancer. This research aimed to determine the frequency, distribution, and determinants of HP infection in adults and adolescents with gastric symptoms in district Haripur, Khyber Pakhtunkhwa, Pakistan. This cross-sectional study was performed from June 2018 to June 2020 at the Medical Laboratory Technology Department, The University of Haripur, Pakistan. Presence of HP was a research variable, while sex, age groups, education status, overcrowding, dining habits, milk intake, drinking water source and animal contact were grouping variables. Immuno-chromatographic technique (ICT) was used to for serological detection of HP antibodies. All variables were represented by frequency and percentage with 95%CI. Prevalence of HP and its distribution by eight socio-demographic variables was testified by the chi-square goodness-of-fit test while association was testified by chi-square test of association. Out of total 1160 cases, 557 (48%) were positive for HP. Population prevalence was higher in men, in the age group 20-40 years, illiterate, family size ≤ 10 persons, taking restaurant food, using tetra pack, using municipal water, and having animal contact. The observed prevalence of HP was similar to its expected prevalence in the population. The observed distribution of HP in the sample was different from its expected distribution in population by eight socio-demographic variables. Presence of HP was associated with all eight socio-demographic variables besides age groups.

Helicobacter pylori (HP) é um elemento vital na etiologia de úlceras pépticas e câncer gástrico. Esta pesquisa teve como objetivo determinar a frequência, distribuição e determinantes da infecção por HP em adultos e adolescentes com sintomas gástricos no distrito de Haripur, Khyber Pakhtunkhwa, Paquistão. Este estudo transversal foi realizado de junho de 2018 a junho de 2020 no Departamento de Tecnologia de Laboratórios Médicos da Universidade de Haripur, Paquistão. A presença de HP foi uma variável de pesquisa, enquanto sexo, faixas etárias, escolaridade, superlotação, hábitos alimentares, ingestão de leite, fonte de água potável e contato com animais foram variáveis ​​de agrupamento. A técnica imunocromatográfica (TIC) foi utilizada para a detecção sorológica de anticorpos para HP. Todas as variáveis ​​foram representadas por frequência e percentual com IC 95%. A prevalência de HP e sua distribuição por oito variáveis ​​sociodemográficas foi comprovada pelo teste de ajuste do qui-quadrado, enquanto a associação foi verificada pelo teste de associação do qui-quadrado. Do total de 1.160 casos, 557 (48%) foram positivos para HP. A prevalência populacional foi maior em homens, na faixa etária de 20 a 40 anos, analfabetos, família ≤ 10 pessoas, consumindo comida de restaurante, usando tetra pack, usando água municipal e tendo contato com animais. A prevalência observada de HP foi semelhante à sua prevalência esperada na população. A distribuição observada de HP na amostra foi diferente de sua distribuição esperada na população por oito variáveis ​​sociodemográficas. A presença de HP foi associada a todas as oito variáveis ​​sociodemográficas além das faixas etárias.

Celiac disease seroprevalence in subjects with dyspeptic symptoms. A study on a Mexican population.

INTRODUCTION AND AIMS: Celiac disease (CD) is an autoimmune enteropathy that develops in genetically susceptible individuals. The typical gastrointestinal manifestation is diarrhea but symptoms of dyspepsia, such as epigastric pain, nausea, or satiety, can sometimes appear. Previous studies have reported that the prevalence of CD in patients with dyspepsia can be as high as 7%. The aim of the present study was to evaluate CD seroprevalence in subjects with dyspeptic symptoms and a control group in a Mexican population. MATERIAL AND METHODS: A case-control study was conducted on blood donors that answered the PAGI-SYM questionnaire for dyspepsia and in whom IgA antibodies to tissue transglutaminase 2 (IgA anti-tTG2) and IgG antibodies to deamidated gliadin peptide (IgG anti-DGP) were determined. CD seroprevalence in subjects with dyspeptic symptoms and in asymptomatic subjects was compared. RESULTS: A total of 427 subjects (76.3% men), with a mean patient age of 34 years (range of 18-65 years) were included. Of those participants, 87 (20.3%) had symptoms of dyspepsia (group A) and 340 (79.6%) were asymptomatic (group B). Antibodies were positive in one (1.15%) of the group A subjects (1/87, 95% CI 0.2-6 %), whereas they were positive in 4 (1.18%) of the group B subjects (4/340, 95% CI 0.4-2.9%, p = 0.59). CONCLUSIONS: CD seroprevalence in the study population with dyspeptic symptoms (1%) was not different from that of the control population. Thus, CD screening in Mexican patients with dyspepsia is not justified.

Sarcina ventriculi en estómago: Un visitante inesperado y potencialmente peligroso / Sarcina ventriculi in the stomach: An unexpected and potentially dangerous visitor

RESUMEN Introducción: Sarcina ventriculi es un coco Gram (+), anaerobio, inmóvil, con un metabolismo fermentativo de carbohidratos, que sobrevive y crece sin problemas en ambientes con pH ácido. Es un agente etiológico conocido en patología veterinaria, sin embargo, su rol patogénico en humanos es controversial. En años recientes, se ha reportado en humanos, cada vez con mayor frecuencia el hallazgo de éste microorganismo en diferentes lugares anatómicos, a predominio del tubo digestivo superior, principalmente en el estómago, en pacientes con dispepsia y/o retardo en vaciamiento gástrico, algunos de éstos casos con evolución grave, incluso mortal. Caso clínico: Reportamos el caso de una paciente con sintomatología dispéptica, en cuya biopsia gástrica se identifica Sarcina ventriculi y cuyo tratamiento farmacológico dirigido terminó con las molestias descritas. A lo mejor de nuestro conocimiento, éste es el primer caso reportado en Perú.

ABSTRACT Introduction: Sarcina ventriculi is a Gram (+), anaerobic, non-motile cocci, with a fermentative carbohydrate metabolism, that survives and grows without problems in environments with acidic pH. It is a known etiological agent in veterinary pathology, however its pathogenic role in humans is controversial. In recent years, the finding of this microorganism in different anatomical places has been reported in humans with increasing frequency, predominantly in the upper digestive tract, mainly in the stomach, in patients with dyspepsia and/or delayed gastric emptying, some of these cases with serious evolution, even fatal. Clinical case: we report the case of a patient with dyspeptic symptoms, whose gastric biopsy identified Sarcina ventriculi and whose targeted pharmacological treatment ended the discomfort described. To the best of our knowledge, this is the first case reported in Perú.

Association between genetic polymorphisms of NOD1, Interleukin-1B, and cagA strain with low-grade duodenal eosinophilia in Helicobacter pylori-related dyspepsia.

BACKGROUND: Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and host genetic polymorphism of innate and pro-inflammatory cascade, nucleotide-binding oligomerization domain 1 (NOD-1), and interleukin-1 beta (IL-1ß) in HpD was not explored. AIM: To evaluate the association of NOD1-796G>A and IL-1B-511C>T gene variants and low-grade duodenal eosinophilia in HpD. METHODS: A multicenter cross-sectional study was conducted. A total of 253 patients who met Rome-IV criteria were selected before upper endoscopy and 98 patients were included after unremarkable upper endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori cagA and duodenal histology, were evaluated. RESULTS: Sixty-four (65%) patients had epigastric pain syndrome (EPS), 24 (25%) postprandial distress syndrome (PDS), and 10 (10%) EPS/PDS overlap. FD subtypes were not associated with NOD1-796G>A and IL-1B-511C>T gene variants. Low-grade duodenal eosinophilia was significantly increased in NOD1-796 GG versus single A-allele, but not in IL-1B-511 single T-allele or CC-allele. This association is dependent of cagA infection, since harboring cagA strain was significantly associated with low-grade duodenal eosinophilia with isolated variants NOD1-796 GG and IL-1B-511 single T-allele, but not without cagA. When we performed combined polymorphism analysis with NOD1-796 GG/IL-1B-511 single T-allele, a synergistic effect on low-grade duodenal eosinophilia was found between these two loci irrespective of cagA strain status in HpD. CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is significantly associated with NOD1-796 GG allele specially in cagA strain and with allelic combination NOD1-796 GG/IL-1B-511 single T-allele independent of cagA strain infection in HpD patients.

Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study.

BACKGROUND: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. METHODS: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs. KEY RESULTS: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7-44.9) vs. without: 14.5% (12.0-17.0); and in subjects with distension by VDs: 29.4% (25.4-33.3) vs. without: 17.2% (14.9-19.5). Among subjects with bowel disorders, those with IBS reported bloating/distension by pictograms the most (93.8%) and those with functional diarrhea the least (71.4%). CONCLUSIONS & INFERENCES: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research.

Comparison of the epidemiology of disorders of gut-brain interaction in four Latin American countries: Results of The Rome Foundation Global Epidemiology Study.

BACKGROUND: In Latin America, there are scarce data on the epidemiology of DGBI. The Rome Foundation Global Epidemiology Study (RFGES) Internet survey included 26 countries, four from Latin America: Argentina, Brazil, Colombia, and Mexico, with a 40.3% prevalence of Rome IV DGBI. We aimed at comparing the prevalence of DGBI and associated factors among these countries. METHODS: The frequency of DGBI by anatomical region, specific diagnoses, sex, age, diet, healthcare access, anxiety, depression, and HRQOL, were analyzed and compared. RESULTS: Subjects included Argentina n = 2057, Brazil = 2004, Colombia = 2007, and Mexico = 2001. The most common DGBI were bowel (35.5%), gastroduodenal (11.9%), and anorectal (10.0%). Argentina had the highest prevalence of functional diarrhea (p = 0.006) and IBS-D; Brazil, esophageal, gastroduodenal disorders, and functional dyspepsia; Mexico functional heartburn (all <0.001). Overall, DGBI were more common in women vs. men and decreased with age. Bowel disorders were more common in the 18-39 (46%) vs. 40-64-year (39%) groups. Diet was also different between those with DGBI vs. those without with subtle differences between countries. Subjects endorsing criteria for esophageal, gastroduodenal, and anorectal disorders from Mexico, more commonly consulted physicians for bowel symptoms vs. those from Argentina, Brazil, and Colombia. General practitioners were the most frequently consulted, by Mexicans (50.42%) and Colombians (40.80%), followed by gastroenterologists. Anxiety and depression were more common in DGBI individuals in Argentina and Brazil vs. Mexico and Colombia, and they had lower HRQOL. CONCLUSIONS: The prevalence of upper and lower DGBI, as well as the burden of illness, psychological impact and HRQOL, differ between these Latin American countries.

Comparación de dos tipos de clasificación en dispepsia funcional; distrés postprandial o dolor epigástrico vs. un análisis multidimensional por conglomerados utilizando aprendizaje no supervisado

Los métodos de inteligencia artificial utilizando herramientas de aprendizaje no supervisado pueden apoyar la resolución de problemas al establecer patrones de agrupación o clasificación no identificados, que permiten tipificar subgrupos para manejos más individualizados. Existen pocos estudios que permiten conocer la influencia de síntomas digestivos y extradigestivos en la tipificación dispepsia funcional; esta investigación realizó un análisis de aprendizaje no supervisado por conglomerados basándose en dichos síntomas, para discriminar subtipos de dispepsia y comparar con una de las clasificaciones actualmente más aceptadas. Se realizó un análisis exploratorio de conglomerados en adultos con dispepsia funcional según síntomas digestivos, extradigestivos y emocionales. Se conformaron patrones de agrupación de tal manera que dentro de cada grupo existiera homogeneidad en cuanto a los valores adoptados por cada variable. El método de análisis de conglomerados fue bietápico y los resultados del patrón de clasificación se compararon con una de las clasificaciones más aceptadas de dispepsia funcional. De 184 casos, 157 cumplieron con criterios de inclusión. El análisis de conglomerados excluyó 34 casos no clasificables. Los pacientes con dispepsia de tipo 1 (conglomerado uno), presentaron mejoría al tratamiento en el 100% de los casos, solo una minoría presentaron síntomas depresivos. Los pacientes con dispepsia de tipo 2 (conglomerado dos) presentaron una mayor probabilidad de falla al tratamiento con inhibidor de bomba de protones, padecieron con mayor frecuencia trastornos de sueño, ansiedad, depresión, fibromialgia, limitaciones físicas o dolor crónico de naturaleza no digestiva. Esta clasificación de dispepsia por análisis de clúster establece una visión más holística de la dispepsia en la cual características extradigestivas, síntomas afectivos, presencia o no de trastornos de sueño y de dolor crónico permiten discriminar el comportamiento y respuesta al manejo de primera línea.

Artificial intelligence methods using unsupervised learning tools can support problem solving by establishing unidentified grouping or classification patterns that allow typing subgroups for more individualized management. There are few studies that allow us to know the influence of digestive and extra-digestive symptoms in the classification of functional dyspepsia. This research carried out a cluster unsupervised learning analysis based on these symptoms to discriminate subtypes of dyspepsia and compare with one of the currently most accepted classifications. An exploratory cluster analysis was carried out in adults with functional dyspepsia according to digestive, extra-digestive and emotional symptoms. Grouping patterns were formed in such a way that within each group there was homogeneity in terms of the values adopted by each variable. The cluster analysis method was two-stage and the results of the classification pattern were compared with one of the most accepted classifications of functional dyspepsia. Of 184 cases, 157 met the inclusion criteria. The cluster analysis excluded 34 unclassifiable cases. Patients with type 1 dyspepsia (cluster one) presented improvement after treatment in 100% of cases, only a minority presented depressive symptoms. Patients with type 2 dyspepsia (cluster two) presented a higher probability of failure to treatment with proton pump inhibitor, suffered more frequently from sleep disorders, anxiety, depression, fibromyalgia, physical limitations or chronic pain of a non-digestive nature. This classification of dyspepsia by cluster analysis establishes a more holistic vision of dyspepsia in which extradigestive characteristics, affective symptoms, presence or absence of sleep disorders and chronic pain allow discriminating behavior and response to first-line management.

Wilkie's and Nutcracker's syndromes overlapping a case of functional dyspepsia

We present the case of a patient suffering from a mixed-type functional dyspepsia who markedly reduced his diet to improve his symptoms leading him to malnourishment and a subsequent Wilkie's and Nutcracker's syndromes which exacerbated his pain. Our aim by presenting this case is to raise awareness as to what extent a so-called functional dyspepsia can evolve and of the possible overlap with these two entities in case of severe malnutrition.

Presentamos el caso de un paciente diagnosticado de dispepsia funcional de tipo mixto, el cual redujo marcadamente su dieta para mejorar sus síntomas, llevándolo a una desnutrición y a un posterior síndrome de Wilkie y del Cascanueces que agudizó su dolor. Nuestro objetivo con la presentación de este caso es concienciar de hasta qué punto puede evolucionar una denominada dispepsia funcional y del posible solapamiento de estas dos entidades en caso de desnutrición severa.

Low-grade duodenal eosinophilia is associated with cagA in Helicobacter pylori-related dyspepsia.

BACKGROUND AND AIM: Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and H. pylori virulence genes in HpD was not explored. We aim to evaluate the association of H. pylori virulence genes and low-grade duodenal eosinophilia in HpD. METHODS: A multi-center cross-sectional study was conducted. A total of 301 patients who meet Rome-III criteria were selected before upper endoscopy, and 95 patients were included after normal endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori virulence genes (cagA, oipA, and vacA) and duodenal histology were evaluated. RESULTS: Sixty-nine (72%) patients had epigastric pain syndrome (EPS), 17 (18%) post-prandial distress syndrome (PDS) and 9 (10%) EPS/PDS overlap. FD syndromes were not associated with cagA or oipA strains. A significantly trend of vacA s1/m1 (78%) and s1/m2 (80%) positive strains in EPS was observed. Histological duodenal grading of chronic inflammation, low-grade duodenal eosinophilia and intra-epithelial lymphocytes showed no difference in oipA and vacA strains. Low-grade duodenal eosinophilia was significant in cagA positive strain, and the OR for low-grade duodenal eosinophilia with H. pylori cagA positive strain was 4.2 (95% CI, 1.78-9.93). Adjusting for age, gender, smoking, diabetes, alcohol, PPI, and NSAID, the OR was 5.44 (1.989-14.902). CONCLUSION: Our findings suggest that low-grade duodenal eosinophilia is significantly associated with cagA strain in HpD.

Inflammatory map of the gastroduodenal mucosa in patients with upper gastrointestinal symptoms. The role of H. pylori infection.

INTRODUCTION AND AIM: The gastric mucosa has been studied since the pre-Helicobacter pylori (H. pylori) era, but the complete descriptions of the stomach and duodenum have been anecdotal, and those of the distal duodenum, exceptional. Our aim was to evaluate the different epidemiologic characteristics and the gastroduodenal inflammatory status in patients with upper gastrointestinal symptoms. MATERIALS AND METHODS: We studied 138 patients divided into: the non-ulcer group (functional dyspepsia [n = 77] and GERD [n = 27]) and the ulcer group (peptic ulcer [n = 13] and duodenal ulcer [n = 21]). Ten biopsy samples (2 from the corpus, 3 from the antrum, 3 from the proximal duodenum, and 2 from the distal duodenum) were taken in each patient for histologic and/or microbiologic study. RESULTS: The prevalence of dyspepsia, functional dyspepsia, and H. pylori was 80.4%, 69.4%, and 82.6%, respectively. The frequency of superficial chronic gastritis in the corpus was significantly higher in the ulcer group vs. the non-ulcer group, whereas there was more chronic atrophic gastritis in the antrum in the ulcer group (P < 0.05). Duodenitis was significantly more frequent in the ulcer group vs. the non-ulcer group, in both the proximal and distal duodenum. Pangastroduodenitis was a significant finding in the ulcer group. In both groups, chronic gastritis (corpus and antrum) and duodenitis (proximal and distal) were significantly related to the presence of H. pylori. Proximal duodenitis is not an uncommon finding in functional dyspepsia (37.7%) and is twice as frequent as distal duodenitis (16.9%). CONCLUSIONS: The ulcer group presented with a gastroduodenal inflammatory map different from that of the non-ulcer group and was characterized by a higher frequency of superficial chronic gastritis in the corpus, chronic atrophic gastritis in the antrum, and a very high frequency of proximal duodenitis.

Reduced mastication is a risk factor for Rome IV postprandial distress syndrome in patients investigated with upper endoscopy.

BACKGROUND AND AIMS: Reduced mastication could force the stomach to do extra work on crushing food and contribute to dyspeptic symptoms. This study aimed to assess the relationship between mastication and dyspepsia. METHODS: This cross-sectional study involved 209 consecutive patients referred for elective upper endoscopy. Before endoscopy, an expert dentist performed an oral examination and scored chewing function in three levels (normal, regular, and reduced), and applied questionnaires for assessment of dyspepsia (Rome IV), xerostomia, and mastication (normal, regular, and reduced). A reduced masticatory function was defined when an oral examination or mastication questionnaire rated the chewing as poor. Associations between mastication, confounders, and dyspepsia were estimated by prevalence ratio [PR (95% Confidence Interval)] using Poisson regression. RESULTS: Thirty-four patients showed relevant organic conditions in the upper gastrointestinal tract (moderate to severe reflux oesophagitis, peptic ulcer, neoplasia, and surgical modification) and were excluded. Among 175 patients with non-organic diseases (aging 51.3 ± 15.7 years; 61.7% women), 50 (28.6%) had reduced mastication, and 125 (71.4%) had normal/regular mastication. After adjusting for age and xerostomia, reduced mastication was associated with postprandial distress syndrome [PR = 1.93 (95%CI 1.27 - 2.91)] but not with epigastric pain syndrome [PR = 1.09 (95%CI 0.75 - 1.60)]. CONCLUSIONS: In patients referred for upper digestive endoscopy, reduced mastication was associated with postprandial distress syndrome but not with epigastric pain syndrome. An interdisciplinary approach with dentists and physicians might benefit dyspeptic patients with postprandial distress syndrome.

Prevalencia de dispepsia funcional en adolescentes cubanos / Prevalence of Functional Dyspepsia in Cuban Adolescents

Resumen Introducción: los trastornos digestivos funcionales son frecuentes en niños; sin embargo, hay escasos datos sobre la dispepsia funcional (DF) en adolescentes cubanos. Objetivo: determinar la prevalencia de DF en adolescentes cubanos y sus posibles asociaciones. Metodología: se usó el cuestionario para síntomas digestivos pediátricos de Roma IV en español para identificar la presencia de DF en adolescentes de 3 centros escolares de La Habana, Cuba. Se tuvieron en cuenta variables sociodemográficas, personales, familiares, clínicas y epidemiológicas. Resultados: de los 318 adolescentes que participaron en el estudio, 11 adolescentes (3,5 %) de 11,4 ± 1,2 años de edad, 81,8 % de sexo femenino, presentaron DF. La DF fue más frecuente en el sexo femenino (odds ratio [OR]: 5,33; intervalo de confianza [IC] 95 %: 1,06-51,45; p = 0,019). El síndrome de dificultad posprandial (SDP) fue mayor que el síndrome de dolor epigástrico (SDE) en una proporción 1,8:1. En el 63,6 % se presentó superposición entre DF y estreñimiento funcional. Hubo predominio de DF en los niños con padres separados/divorciados (OR: 4,74; IC 95 %: 1,09-28,31; p = 0,014). Conclusión: la DF es más común en adolescentes femeninas, el SDP es el subtipo más frecuente y su presencia está asociada con padres separados/divorciados.

Abstract Introduction: functional gastrointestinal disorders (FGID) are common in children. However, data on functional dyspepsia (FD) in Cuban adolescents is scarce. Objective: to determine the prevalence of FD in Cuban adolescents and their possible associations. Methodology: the questionnaire for pediatric digestive symptoms of Rome IV was used in Spanish to identify the presence of DF in adolescents from 3 schools in La Havana, Cuba. Sociodemographic, personal, family, clinical, and epidemiological variables were considered. Results: of the 318 adolescents who participated in the study, 11 (3.5%) aged 11.4 ± 1.2 years, 81.8% female, presented FD. Functional dyspepsia was more frequent in females (odds ratio [OR]: 5.33; 95% confidence interval [CI]: 1.06-51.45; p = 0.019). The postprandial distress syndrome (PDS) was higher than the epigastric pain syndrome (SDE) by a 1.8:1 ratio. There was an overlap between DF and functional constipation in 63.6% of the patients. There was an FD predominance in children with separated or divorced parents (OR: 4.74; 95% CI: 1.09-28.31; p = 0.014). Conclusion: functional dyspepsia is most common in female adolescents, PSD is the most frequent subtype, and its presence is associated with separated or divorced parents.

Effects of a Modern Kefir on Conditions Associated with Moderate Severe Spastic Quadriparesis Cerebral Palsy.

Cerebral palsy (CP) in children constitutes a set of movement and body posture disorders caused by brain injury, which in turn is associated with a series of intestinal, respiratory, and malnutrition conditions. Twenty-four children were selected and included for the present study and subdivided into two groups: (1) children who included modern kefir (containing 12 probiotic species) in their diet; and (2) control group (not including kefir in their diet). The group supplemented with modern kefir received a beverage with multi probiotic species and the control group received commercial yogurt (which included the 2 typical lactic acid bacteria) for 7 weeks. Anthropometric variables, resting energy expenditure, presence, and diagnosis of functional digestive disorders (FDD), frequency of respiratory problems, presence of elevated C-reactive protein, differential count of leukocytes were evaluated. A significant increase in weight and height was found in the kefir group at the final time point. In addition, kefir intake promoted a significant reduction in functional constipation and stool hardness and increased the absolute value of blood lymphocytes. Since the fermented milk beverage modern kefir improves constipation, which is the most important FDD in children with CP and the nutritional and immune status, it could be considered an important strategy to improve health in these children.

O papel da endoscopia na síndrome dispéptica de crianças e adolescentes / The role of endoscopy in dyspeptic syndrome in children and adolescentes

ABSTRACT Background Dyspepsia is pain or discomfort in the epigastric region, and can be subdivided into organic and functional. The diagnosis of functional dyspepsia is based on the criteria defined by the Rome committee. In the pediatric population, functional dyspepsia is more common than organic dyspepsia, in addition to being part of a set of diseases called defined gastrointestinal disorders, defined by the Rome IV criteria. The most efficient diagnostic method of functional dyspepsia in the pediatric population is still uncertain since endoscopy is an important test to rule out organic changes, but it is invasive to be performed on a large scale. Objective To evaluate the role of endoscopy in the diagnosis of functional dyspepsia in pediatric patients, aiming at preventing invasive procedures and reaching high specificity in the result, which is important to determine the best diagnostic guideline for these patients. Methods: Narrative literature review study performed by searching for articles in the PubMed/Medline and LILACS database using the PRISMA method. Results A total of 102 articles were found in PubMed, 15 of which were selected for the study. In the LILACS database, nine articles were found and one was selected. Thus, 16 articles were selected for the study. The most appropriate indications for endoscopy, how to differentiate organic from functional dyspepsia without endoscopy, the main endoscopic findings of the studies, the differences between Rome III and Rome IV criteria, and the prevalence and factors possibly associated with functional dyspepsia were approached through the selected articles. Conclusion The main indication for endoscopy is the presence of alarm symptoms in pediatric patients with dyspepsia and the Rome clinical criteria are efficient for the diagnosis of functional dyspepsia. However, there is still no standardized diagnostic guideline to be followed in this age group.

RESUMO Contexto: A dispepsia é a dor ou desconforto na região epigástrica, e pode ser subdividida em orgânica e funcional. O diagnóstico de dispepsia funcional é realizado com base nos critérios definidos pelo comitê de Roma. Na população pediátrica a dispepsia funcional é mais comum que a orgânica, além de que está dentro de um conjunto de doenças denominado distúrbios gastrointestinais funcionais, definidos pelos critérios de Roma IV. O método diagnóstico de dispepsia funcional mais eficiente na população pediátrica, ainda é incerto uma vez que a endoscopia é um exame importante para descartar alterações orgânicas, porém invasivo para ser realizado em alta escala, por isso a importância desse estudo, que visa definir a melhor conduta. Objetivo: Avaliar o papel da endoscopia no diagnóstico da dispepsia funcional em pacientes pediátricos, visando prevenir procedimentos invasivos e atingir alta especificidade no resultado, o que é importante para determinar a melhor diretriz diagnóstica para esses pacientes. Métodos: Estudo de revisão narrativa da literatura, realizada por meio de buscas de artigos na base de dados PubMed/Medline e LILACS, utilizando o método PRISMA. Resultados: No PubMed foram encontrados 102 artigos, sendo 15 selecionados para o estudo. Na base de dados LILACS foram encontrados nove artigos e selecionado um. Dessa forma, 16 artigos foram selecionados ao estudo, sendo abordado por meio deles quais são as indicações mais adequadas para a endoscopia, como diferenciar dispepsia orgânica de funcional sem endoscopia, quais os principais achados endoscópicos dos estudos, quais as diferenças entre os critérios de Roma III e Roma IV, qual a prevalência e os fatores possivelmente associados à dispepsia funcional. Conclusão A principal indicação para endoscopia foi a presença de fatores de alarme nos pacientes pediátricos com dispepsia e os critérios clínicos de Roma mostraram-se eficientes para o diagnóstico de dispepsia funcional. Porém, ainda não existe uma diretriz diagnóstica padronizada a ser seguida nessa faixa etária.

Sports and physical exercise on the treatment of digestive system diseases / Esportes e atividade física no tratamento de doenças do sistema digestivo / Deportes y actividad física en el tratamiento de enfermedades del sistema digestivo

ABSTRACT Introduction: Regular and moderate exercise can keep the body in good function and prolong life. The therapeutic effect of exercise on digestive system diseases is also obvious. In particular, it can alleviate the anxiety of patients with functional dyspepsia. Objective: To explore how moderate physical exercise can reduce the anxiety caused by functional dyspepsia. The causes of anxiety in patients with this disease are also analyzed. Methods: A questionnaire was applied to patients with functional dyspepsia who attend our hospital and develops exercise programs. The regression analysis method was used to analyze the influence of physical exercise on the anxiety caused by functional dyspepsia. Results: The anxiety of patients with functional dyspepsia who did not do physical exercise was significantly different from the anxiety after exercise. Conclusion: Exercise can reduce the anxiety of patients with functional dyspepsia. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Atividade física moderada e regular pode manter o bom funcionamento do corpo e prolongar a expectativa de vida. O efeito terapêutico da atividade física nas doenças do sistema digestivo também é evidente. Ela pode, em particular, diminuir a ansiedade de pacientes com dispepsia funcional. Objetivo: Explorar como atividade física moderada pode diminuir a ansiedade causada por dispepsia funcional. As causas da ansiedade em pacientes com essa doença também foram analisadas. Métodos: Aplicou-se um questionário aos pacientes com dispepsia funcional que frequentam nosso hospital e desenvolveu-se um programa de exercícios. O método de análise de regressão foi usado para avaliar a influência da atividade física na ansiedade causada por dispepsia funcional. Resultados: A ansiedade de pacientes com dispepsia funcional que não praticavam atividades físicas foi significativamente diferente daquela de pacientes após os exercícios. Conclusão: A atividade física pode diminuir a ansiedade de pacientes com dispepsia funcional. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: La actividad física moderada y regular puede mantener el buen funcionamiento del cuerpo y prolongar la expectativa de vida. El efecto terapéutico de la actividad física en las enfermedades del sistema digestivo también es evidente. Esta puede, en particular, disminuir la ansiedad de pacientes con dispepsia funcional. Objetivo: Explorar cómo la actividad física moderada puede disminuir la ansiedad causada por dispepsia funcional. Las causas de la ansiedad en pacientes con esta enfermedad también fueron analizadas. Métodos: Se aplicó un cuestionario a los pacientes con dispepsia funcional que frecuentan nuestro hospital y se desarrolló un programa de ejercicios. El método de análisis de regresión fue usado para evaluar la influencia de la actividad física en la ansiedad causada por dispepsia funcional. Resultados: La ansiedad de pacientes con dispepsia funcional que no practicaban actividades físicas fue significativamente diferente de aquella de pacientes después de los ejercicios. Conclusión: La actividad física puede disminuir la ansiedad de pacientes con dispepsia funcional. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study

Abstract BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.