[Forty-four years of advances in pathogenesis, diagnosis and treatment of flatulence syndrome]. / 44 años de avances en etiopatogenia, diagnóstico y tratamiento del síndrome flatulencia.

In the present paper, the author reminds investigations performed, since forty-four years ago, to clarify the etiopathogenesis and to improve the diagnosis and treatment of the flatulence syndrome.

[Evaluation of the effect of nitazoxanide compared with placebo in patients with flatulence at the ambulatory consultation of the Central Clinic of Inppares-Lima]. / Evaluación del efecto de la nitazoxanida comparada con el placebo en pacientes con flatulencia de la consulta ambulatoria de la Clínica Central de Inppares-Lima.

Flatulence is a very common complaint related to functional gastrointestinal disorders. We know functional disorders is the main cause of consultation in gastroenterology offices. We don't know the exact reason of flatulence, but the intestinal fermentative microbiota could be an important etiologic factor. The objective of the study is to evaluate the effectiveness of the Nitazoxanida, on the clinical improvement of the flatulence in a group of patients of ambulatory consultation with respect to another group that receives placebo. The present article, is a controlled randomized clinical study designed to double blind, in whom 120 patients with flatulence criteria participate, of which 60 patients received Nitazoxanida 500mg, every 12 hours by 3 days, and the next 60 patients received placebo every 12 hours by 3 days, after one week were reevaluated, and they were put under a test of perception about clinical improvement (Jerome Frank). The Nitazoxanida group and the placebo group were very similar in age, sex, symptoms to the entrance, presence of anxiety, depression and upheavals of the dream. In the Nitazoxanida group was an average of improvement of 4.02 (75.31%) DS 0.94 and with placebo 2.35 (19.58%) D.S. 0.63. with percentage of 0.001 error. Being the perception of global improvement in the Nitazoxanida group 91.67% and in the placebo group 36.67%. Which is statistically significant. The study conclude that Nitozoxanide group produce a significative improvement in the perception of relief of flatulence in comparison to the placebo group. The study sets out a new therapeutic indication of the active principle Nitazoxanide, in flatulence. We found is a high prevalence of anxiety, depression and of upheavals of the dream in patients with flatulence.

[The high fermentative capacity of colonic bacteria in the origin of flatulence and its sensibility to bismuth subsalicylate]. / Alta capacidad fermentativa de las bacterias colónicas en la génesis de la flatulencia, y su sensibilidad al subsalicilato de bismuto.

Using a previously described technique, "in vitro" determinations were carried out for faecal fermentation (FF): basal faecal fermentation (BFF), i.e, only with faeces, with faeces and lactulose (LFF) and with faeces, lactulose and bismuth subsalicylate (BiLFF) in 34 patients with flatulence. The media+d.s. of the difference between the LFFand BFF levels (LFF-BFF) in patients with flatulence was significant and markedly higher than the respective media +d.s. in 30 normal control patients previously studied (9.1+4.7 vs. 3.9+3.2 ml gas/24 hrs; p<0.000001 respectively). And, although FF was reduced by adding bismuth salicylate in only 24% (70.6%) of the patients with flatulence but not in the remaining 10 (29.4%), in total the media+d.s. of the differences between the levels BiLFF and BFF (BiLFFBFF) was significantly lower that the media+d.s. of the differences between the LFF and BFF levels (LFF-BFF) (6.0+4.2 vs 9.1+4.7 ml gas/24 hrs; p<0.01 respectively). These results confirm that: 1) The fermentative capacity of the colonic bacteriae is most likely to be abnormally intense in peoples with flatulence and 2) Bismuth subsalicylate can be useful in the control of excessive colonic fermentation and flatulence; they raise, furthermore, the interesting possibility that we may have found the way to predict when the use of bismuth subsalicylate could be effective in the treatment of a patient with flatulence.

In vitro and in vivo effects of three bismuth compounds on fermentation by colonic bacteria.

Three bismuth compounds (tripotassium dicitrate bismuthate, bismuth subsalicylate, and bismuth subnitrate) were tested in vitro and in vivo for their effect on fermentation by colonic bacteria. The studies in vitro were done with use of a technique designed to determine the effect of each one of the bismuth compounds on the fermentation of several stool samples that had been mixed with lactose as additional fermentable substrate (fermentation of lactose-enriched stools, FLES). The three bismuth compounds reduced FLES significantly in 47 (81%) of 58 of the stool samples used to test their effect. Bismuth subsalicylate, which reduced FLES in 10 of 10 stool samples, showed the greatest reduction (mean reduction, 74%; P less than .0001). The in vivo studies, done in six flatulent patients, showed significant reduction (P less than .01) of colonic fermentation of ingested raffinose by oral bismuth subnitrate given for 8 days.