Síndrome do intestino irritável / Irritable bowel syndrome

O diagnóstico clínico da síndrome do intestino irritável (SII) é realizado com base na presença de sintomas de dor abdominal crônica ou recorrente e alteraçöes do hábito intestinal: o padräo de alternância entre constipaçäo e diarréia é comum; lesöes estruturais e bioquímicas näo podem estar presentes.(au)

Visceral hyperalgesia in children with functional abdominal pain.

OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.

Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children.

In a randomized, double-blind controlled trial, 42 children with irritable bowel syndrome (IBS) were given pH-dependent, enteric-coated peppermint oil capsules or placebo. After 2 weeks, 75% of those receiving peppermint oil had reduced severity of pain associated with IBS. Peppermint oil may be used as a therapeutic agent during the symptomatic phase of IBS.

[Association between irritable intestinal syndrome and depressive symptoms in a population of high socioeconomical level of Lima]. / Asociación entre síndrome de intestino irritable y síntomas depresivos en una población de nivel socioeconómico alto de Lima.

Irritable Small Bowel (ISB) is the most common disorder in the gastroenterological practice. On the other hand, depression, is also common, and can produce somatic symptoms that could mislead the physician with respect to bowel diseases, particularly of the digestive system. The main objective of this work was to determine the relationship between lower digestive tract symptoms and symptoms of depression in a population of high socio-economic status in five districts of Lima. A cross-sectional study on the prevalence of lower digestive tract symptoms and symptoms of depression was carried out, together with a case-control study to evaluate the relationship between lower digestive tract symptoms and symptoms of depression. It included 300 individuals. The Beck Inventory for Depression and the Manning Criteria for ISB were used. Significant association (p<0.05) between lower digestive tract symptoms and symptoms of mild depression was found, with a OR=10.9 and significant statistical association between symptoms of moderate depression and lower digestive tract symptoms (p=0.01 and OR=3.48). It is concluded that there is a connection between lower digestive tract symptoms and symptoms of depression, in a population of high socio-economic status in five districts of Lima.

Arrowroot as a treatment for diarrhoea in irritable bowel syndrome patients: a pilot study.

OBJECTIVES: Arrowroot is an old-fashioned remedy for diarrhoea, but no clinical studies have been done to evaluate its effectiveness. The aim of this pilot study was to assess its efficacy as a treatment for diarrhoea in 11 patients, all of whom had irritable bowel syndrome with diarrhoea as a feature. METHODS: The patients were interviewed and a questionnaire completed on entry into the trial. They then took 10 mL arrowroot powder three times a day for one month and discontinued the treatment for the subsequent month. Questionnaires were completed after one month on treatment and at the end of the trial after one month off treatment. RESULTS: Arrowroot reduced diarrhoea and had a long-term effect on constipation. It also eased abdominal pain. CONCLUSION: Arrowroot is an effective treatment for diarrhoea. Its action could be explained by several theories which relate to an increase in faecal bulk and thus a more efficient bowel action. The number of patients was small, and further studies are needed to substantiate preliminary results.

Electromanometry of the rectosigmoid in colonic diverticulosis.

In order to better understand the rectosigmoid motor activity in diverticular disease of the colon, we studied 186 patients, grouped according to their intestinal habit, the presence of diverticular disease and previous crisis of sigmoid diverticulitis. The intestinal habit was classified as: normal habit, irritable colon syndrome, diarrhea and constipation. The group of diverticulosis was classified by their intestinal habit and by diverticula localization (localized or generalized). The presence of systemic diseases or drug ingestion that could modify intestinal motility, were considered criteria for exclusion. The manometric study was preceded by food stimulus, with 650 kcal meal, by mechanic intestinal cleansing, with 500 ml of saline solution enema and by one hour resting period. A manometric catheter, was introduced by rectosigmoidoscopy, with open ended orifices situated at the sigmoid and upper rectum, respectively. The catheter was perfused by a capillary infusion system and the bowel pressures were registered for 30 minutes, in a thermal paper physiograph. We analyzed the % of activity, mean amplitude and motility index, by non parametric tests. No significant difference was observed between sexes. Difference or close to it were found for the groups with constipation, with or without diverticulosis, and for the latter in its subdivisions (localized, generalized and sigmoid diverticulitis). The rectal motor activity was similar in all groups. There was no difference for diverticulosis and its subdivision, when we take into account the several kinds of intestinal habits and the diverticula localization. The motility index averages showed low values for the sigmoid diverticulitis fact that suggests some dysfunction of this segment (hypocontractility). The key factor differentiating the groups was the presence of constipation and no influence was noted regarding the localization of diverticula or previous inflammatory process on intraluminal pressures. The fact that no difference was found in the mean amplitude or % of activity among patients with or without diverticulosis, suggests that the high pressures in a colonic segment, may not be responsible for the diverticular disease, and there must be other factors, besides motility, accounting for the development of the different forms of this disease.

[Esophageal achalasia of chagasic origin: report of a case diagnosed in the pre-symptomatic stage]. / Achalasia esofágica de origen chagásico: a propósito de un caso diagnosticado en etapa pre-sintomática.

A 42 year old male that presented with functional gastrointestinal symptoms is presented. X ray examination showed an esophageal diameter of 3 cm, measured 6 cm above the gastroesophageal junction. This finding, according to previous experiences of the authors, is highly suggestive of Chagasic esophageal involvement. The patient resided in a highly endemic area for Chagas disease; hemagglutination, latex agglutination and ELISA serological tests for Chagas disease were positive. The manometric study of the esophagus confirmed the diagnosis showing an elevated lower esophageal sphincter pressure and hypomotility and poor amplitude contractions of the esophageal body. Barium enema and EKG were normal. Upper gastrointestinal endoscopy disclosed an erosive gastritis that could explain the patients' symptomatology. The antiquity of Chagas infection was estimated in 18 years. This case represents an example of early diagnosis of esophageal involvement in the course of Chagas disease.

Diarreas crónicas / Chronic diarrhea

Se define y precisa el concepto de diarrea y se analiza brevemente su fisiopatología. Se señalan algunas generalidades, enfatizando su frecuencia así como algunas diferencias fundamentales entre las diarreas agudas y las crónicas. Se mencionan y detallan las clasificaciones topográfica, fisiopatológica y clínico evolutiva, destacando el valor diagnóstico de esta última. Entre las diarreas crónicas cuya etiología es difícil de precisar se mencionan la ingestión oculta de purgantes; algunas formas de colon irritable en pacientes de edad; algunas diarreas hipersecretoras endocrinas y la diarrea colorreíca. Se enfatizan las limitaciones del tratamiento sintomático en las diarreas crónicas

Ansiedade na síndrome do cólon irritável / Anxiety in the irritable bowel syndrome

Em nossa cultura, o aparelho digestivo ocupa um lugar de particular importância, sendo comuns em nosso meio as queixas gastrointestinais. Entre estas, a síndrome de cólon irritável ocupa um lugar de destaque, constituindo um dos distúrbios mais freqüentes nesta especialidade. Na maior parte dos pacientes são constatados distúrbios psiquiátricos concomitantes, o que tem levado diversos pesquisadores a investigar a sua interligação. Neste texto é discutida a relação desta síndrome com a ansiedade, sendo apresentados modelos de interação do sistema nervoso central e sistema nervoso periférico. Todavia, para a sua compreensão são necessárias novas pesquisas visando o mecanismo de ação subjacente, diagnóstico e tratamento

Perfuraçäo do ceco complicando a pseudo-obstruçäo do cólon em puérpera após parto normal: revisäo de literatura e apresentaçäo de um caso / Perforation of the cecum complicating colonic pseudo-obstruction after normal delivery: review of the literature and report of a case

Säo comentados os aspectos clínicos da pseudo-obstruçäo de cólon e descrito um caso de perfuraçäo de ceco como complicaçäo deste quadro após parto normal. É salientada a raridade desta associaçäo, visto que na análise da literatura há apenas 55 casos publicados, sendo 11 casos em puérperas (apenas um após parto normal). Säo discutidos os aspectos fisiopatológicos, o quadro clínico, o tratamento e o prognóstico

Síndrome do cólon irritável e diarréia na infância: diagnóstico e evoluçäo / Irritable colon syndrome and diarrhea in infancy: diagnosis and course

A SCI é uma entidade clínica benigna de curso evolutivo prolongado, sendo que nos primeiros anos de vida diarréia crônica é a manifestaçäo mais freqüente. Relatamos 76 crianças com idade média de 18,1 meses portadoras de diarréia crônica, com preservaçäo do estado nutricional e da capacidade digestivo-absortiva e que foram acompanhadas pelo tempo médio de 15,6 meses. Estes pacientes foram submetidos apenas a tratamento dietético com o alto teor de gordura e apresentaram cura em 85% dos casos (12% perderam contato). A SCI pode apresentar múltiplas características clínicas à medida que o paciente se encontra-se nos mais diversos momentos da sua curva de crescimento

Doença instestinal inflamatória e gravidez: uma associaçäo mórbida? / Inflammatory bowel disease and pregnancy: a morbid association?

Apresentamos uma revisäo da literatura sobre a interaçäo da gravidez com a doença intestinal inflamatória, que foi elaborada para tentar esclarecer alguns aspectos controversos dessa associaçäo, que sempre foi temida devido às intercorrências que a doença intestinal inflamatória poderá causar sobre a gestaçäo e vice-versa. Observamos que os riscos materno e fetal, apesar de pequenos, existem e podem ser alterados pela gravidade da doença na concepçäo. O tratamento cirúrgico näo impede a concepçäo nem a evoluçäo da gravidez