Comentarios sobre el síndrome de intestino irritable / Comments on irritable bowel syndrome

Se hace comentarios de lo inadecuado de la terminología orgánico y funcional en la descripción de los problemas digestivos catalogados como Síndrome de Intestino Irritable (SII), igualmente el calificativo de irritable es ambiguo y equivoco, y la definición de los criterios de Roma I, II, y III de considerar el SII a partir de 3 meses de molestias esta sujeto a gran discusión.

The Author comments about the inadequacy of the organic and functional terminology in the description of digestive problems categorized as Irritable Bowel Syndrome (IBS),also the adjective irritable and wrong is ambiguous and equivocal and the consideration in the definition of the Rome I, II , and III criteria for IBS since 3 months of discomfort is subject to great debate.

Gastric emptying rates in idiopathic dyspepsia with and without hunger pain

It has been previously observed that in dyspeptic patients with hunger pain, that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between hunger pain and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without hunger pain were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without hunger pain, and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with hunger pain, and significantly lower in the patients without hunger pain, than in the normal control subjects. In idiopathic dyspepsia with and without hunger pain there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

Gastric emptying rates in idiopathic dyspepsia with and without hunger pain

It has been previously observed that in dyspeptic patients with hunger pain, that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between hunger pain and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without hunger pain were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without hunger pain, and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with hunger pain, and significantly lower in the patients without hunger pain, than in the normal control subjects. In idiopathic dyspepsia with and without hunger pain there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment. (AU)

Gastric emptying rates in idiopathic dyspepsia with and without "hunger pain".

It has been previously observed that in dyspeptic patients with "hunger pain", that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between "hunger pain" and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without "hunger pain" were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without "hunger pain", and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with "hunger pain", and significantly lower in the patients without "hunger pain", than in the normal control subjects. In idiopathic dyspepsia with and without "hunger pain" there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

Gastric emptying rates in idiopathic dyspepsia with and without [quot ]hunger pain[quot ].

It has been previously observed that in dyspeptic patients with [quot ]hunger pain[quot ], that is, with pain suggestive of the presence of peptic ulcer, only 12

had an endoscopically demonstrated ulcer, the remaining 88

showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between [quot ]hunger pain[quot ] and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without [quot ]hunger pain[quot ] were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without [quot ]hunger pain[quot ], and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with [quot ]hunger pain[quot ], and significantly lower in the patients without [quot ]hunger pain[quot ], than in the normal control subjects. In idiopathic dyspepsia with and without [quot ]hunger pain[quot ] there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.

A new questionnaire for the diagnosis of dyspepsia.

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups.

A new questionnaire for the diagnosis of dyspepsia

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups

A new questionnaire for the diagnosis of dyspepsia

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups (AU)

[Microscopic colitis in patients with chronic diarrhea]. / Colitis microscópica en pacientes con diarrea crónica

It has recently been suggested that there is an association between infectious gastroenteritis and irritable bowel syndrome with chronic diarrhea; and a striking similarity between the microscopic lesion observed in this condition and the lesion described in microscopic colitis (MC). As in developed countries MC is found in only 12.6 to 15% of patients with chronic diarrhea, we thought it worthwhile to investigate in Perú, a developing country with high prevalence of infectious gastroenteritis, the prevalence of MC also in patients with chronic diarrhea. One hundred and ten patients with chronic diarrhea underwent biopsies from the right and left colon, and the biopsies were examined histologically to detect MC of lymphocytic or collagenous type.MC was present in 44 (40%) of the 110 patients with chronic diarrhea, being of lymphocytic type in 42, and of collagenous type in. The prevalence of MC observed in Peruvian patients with chronic diarrhea is high when compared to reports from developed countries. This finding supports the idea that infectious gastroenteritis may, under certain conditions, precipitate the appearance of MC, probably by an autoimmune reaction.

A new questionnaire for the diagnosis of dyspepsia.

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95

and 100

. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups.

[Prevalence of Manning's symptoms in a Lima upper socioeconomic level population]. / Prevalencia de los criterios de manning en una población de nivel socioeconómico alto de Lima.

All studies confirm IBS is one of the most common problems in medical practice, and the most common in gastroenterologic practice, underdiagnosed in many cases, misdiagnosed in others. In our country there are no studies published to describe the prevalence of symptoms of IBS. Our objective was to evaluate the prevalence of Manning s Criteria, in an apparently healthy population, of high socioeconomical level, from Lima. We carried-out a cross-sectional study of prevalence in 300 subjects from 5 districts of higher socioeconomical level of Lima. We found 78 persons with lower bowel symptoms (26%). The most frequent symptom-criterion in this population was mucus in stools, meanwhile the least frequent was the increase in frequency. We do not find differences between frequency of symptoms with depression associated, sex, age, nor districts. Our frequency of symptoms is not in accord with traditionally described in this syndrome.

[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.

Factores geográficos socioeconómicos en la orientación de patología gastroduodenal asociada a la infección por helicobacter pylori / Geographic and socioeconomic factors in the orientation of Helicobacter pylory-associated gastroduodenal pathology

It is highly probable that nutritionally-related geographic and socioeconomic factors may modulate the conversion of early stages of Helicobacter pylori-associated chronic active gastritis (chronic superficial gastritis [CSG] and chronic deep gastritis [CDG]) to chronic atrophic gastritis (CAG). The factors would be diets low in antioxidant vitamins and other micronutrients. In regions of the world and population groups with high socioeconomic level in which these modulating factors are absent, chronic active gastritis tends to stay in its early stages of CSG or CDG and to predispose to duodenal ulcer. On the contrary, in regions and population groups with low socioeconomic level in which the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and diffuse, hypochlorhydria ensues. Hypochlorhydria decreases the predisposition to duodenal ulcer, while CAG, a precancerous lesion, predisposes to gastric cancer of the intestinal type. The real role of the modulating factors already mentioned could be elucidated doing a multicentric study to determine endoscopically and histologically, in large series of dyspeptic patients from various regions of the world and with different socioeconomic levels, prevalence rates of duodenal ulcer, gastric ulcer, gastric cancer, Helicobacter pylori-associated CAG and intestinal metaplasia of the gastric mucosa, and to correlate these prevalence rates with blood levels of antioxidant capacity and related micronutrients. Latin America, because of its diversity in regions, geographic characteristics and population socioeconomic levels, seems to be the ideal place to conduct a study of that type. If the study could be performed, it would undoubtedly constitute an important contribution to a better understanding of Helicobacter pylori-associated gastroduodenal pathology. (Au)

Factores geográficos socioeconómicos en la orientación de patología gastroduodenal asociada a la infección por helicobacter pylori / Geographic and socioeconomic factors in the orientation of Helicobacter pylory-associated gastroduodenal pathology

It is highly probable that nutritionally-related geographic and socioeconomic factors may modulate the conversion of early stages of Helicobacter pylori-associated chronic active gastritis (chronic superficial gastritis [CSG] and chronic deep gastritis [CDG]) to chronic atrophic gastritis (CAG). The factors would be diets low in antioxidant vitamins and other micronutrients. In regions of the world and population groups with high socioeconomic level in which these modulating factors are absent, chronic active gastritis tends to stay in its early stages of CSG or CDG and to predispose to duodenal ulcer. On the contrary, in regions and population groups with low socioeconomic level in which the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and diffuse, hypochlorhydria ensues. Hypochlorhydria decreases the predisposition to duodenal ulcer, while CAG, a precancerous lesion, predisposes to gastric cancer of the intestinal type. The real role of the modulating factors already mentioned could be elucidated doing a multicentric study to determine endoscopically and histologically, in large series of dyspeptic patients from various regions of the world and with different socioeconomic levels, prevalence rates of duodenal ulcer, gastric ulcer, gastric cancer, Helicobacter pylori-associated CAG and intestinal metaplasia of the gastric mucosa, and to correlate these prevalence rates with blood levels of antioxidant capacity and related micronutrients. Latin America, because of its diversity in regions, geographic characteristics and population socioeconomic levels, seems to be the ideal place to conduct a study of that type. If the study could be performed, it would undoubtedly constitute an important contribution to a better understanding of Helicobacter pylori-associated gastroduodenal pathology.

[Geographic and socioeconomic factors in the orientation of gastroduodenal pathology associated with Helicobacter pylori infection]. / Factores geográficos y socioeconómicos en la orientación de la patología gastroduodenal asociada a la infección por Helicobacter pylori.

It is highly probable that nutritionally-related geographic and socioeconomic factors may modulate the conversion of early stages of Helicobacter pylori-associated chronic active gastritis (chronic superficial gastritis [CSG] and chronic deep gastritis [CDG]) to chronic atrophic gastritis (CAG). The factors would be diets low in antioxidant vitamins and other micronutrients. In regions of the world and population groups with high socioeconomic level in which these modulating factors are absent, chronic active gastritis tends to stay in its early stages of CSG or CDG and to predispose to duodenal ulcer. On the contrary, in regions and population groups with low socioeconomic level in which the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and diffuse, hypochlorhydria ensues. Hypochlorhydria decreases the predisposition to duodenal ulcer, while CAG, a precancerous lesion, predisposes to gastric cancer of the intestinal type. The real role of the modulating factors already mentioned could be elucidated doing a multicentric study to determine endoscopically and histologically, in large series of dyspeptic patients from various regions of the world and with different socioeconomic levels, prevalence rates of duodenal ulcer, gastric ulcer, gastric cancer, Helicobacter pylori-associated CAG and intestinal metaplasia of the gastric mucosa, and to correlate these prevalence rates with blood levels of antioxidant capacity and related micronutrients. Latin America, because of its diversity in regions, geographic characteristics and population socioeconomic levels, seems to be the ideal place to conduct a study of that type. If the study could be performed, it would undoubtedly constitute an important contribution to a better understanding of Helicobacter pylori-associated gastroduodenal pathology.

New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience.

After a century of absence, in late January 1991, Vibrio cholerae invaded the Western Hemisphere by way of Peru. Although a number of theories have been proposed, it is still not understood how that invasion took place. We reviewed the clinical records of persons attending hospital emergency departments in the major coastal cities of Peru from September through January of 1989/1990 and 1990/1991. We identified seven adults suffering from severe, watery diarrhea compatible with a clinical diagnosis of cholera during the four months preceding the cholera outbreak, but none during the previous year. The patients were scattered among five coastal cities along a 1,000 km coastline. We postulate that cholera vibrios, autochthonous to the aquatic environment, were present in multiple coastal locations, and resulted from environmental conditions that existed during an El Nino phenomenon. Once introduced into the coastal communities in concentrations large enough for human infection to occur, cholera spread by the well-known means of contaminated water and food.

Factores geográficos y socioeconómicos en la orientación de la patología gastroduodenal asociada a la infección por Helicobacter pylori. / [Geographic and socioeconomic factors in the orientation of gastroduodenal pathology associated with Helicobacter pylori infection]

It is highly probable that nutritionally-related geographic and socioeconomic factors may modulate the conversion of early stages of Helicobacter pylori-associated chronic active gastritis (chronic superficial gastritis [CSG] and chronic deep gastritis [CDG]) to chronic atrophic gastritis (CAG). The factors would be diets low in antioxidant vitamins and other micronutrients. In regions of the world and population groups with high socioeconomic level in which these modulating factors are absent, chronic active gastritis tends to stay in its early stages of CSG or CDG and to predispose to duodenal ulcer. On the contrary, in regions and population groups with low socioeconomic level in which the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and diffuse, hypochlorhydria ensues. Hypochlorhydria decreases the predisposition to duodenal ulcer, while CAG, a precancerous lesion, predisposes to gastric cancer of the intestinal type. The real role of the modulating factors already mentioned could be elucidated doing a multicentric study to determine endoscopically and histologically, in large series of dyspeptic patients from various regions of the world and with different socioeconomic levels, prevalence rates of duodenal ulcer, gastric ulcer, gastric cancer, Helicobacter pylori-associated CAG and intestinal metaplasia of the gastric mucosa, and to correlate these prevalence rates with blood levels of antioxidant capacity and related micronutrients. Latin America, because of its diversity in regions, geographic characteristics and population socioeconomic levels, seems to be the ideal place to conduct a study of that type. If the study could be performed, it would undoubtedly constitute an important contribution to a better understanding of Helicobacter pylori-associated gastroduodenal pathology.

Helicobacter pylori is not a determinant factor of persistent diarrhoea or malnutrition in Peruvian children.

To investigate the role of Helicobacter pylori in childhood diarrhoea, specific IgG antibodies to H. pylori (determined by an ELISA) were sought in 119 infants aged 3-36 months in Peru. Thirty one of the infants had acute diarrhoea (defined as lasting < 72 h and not present in the previous 3 weeks), 67 had persistent diarrhoea (lasting > or = 14 days with no more than 1 intervening diarrhoea-free day) and the remaining 21 had not had diarrhoea in the previous 3 weeks. The children with diarrhoea had been admitted to hospital in Lima for diarrhoea treatment, and the diarrhoea-free children for investigation of possible tuberculosis. Aspirates of duodenal contents and duplicate stool samples were investigated for the presence of bacterial overgrowth and of pathogenic bacteria, viruses and parasites. Anthropometric measurements were also made. There were no statistically significant differences between the prevalence rates of IgG against H. pylori in the children with acute diarrhoea, persistent diarrhoea and without diarrhoea (32%, 43% and 29%, respectively). In addition, H. pylori infection (as evidenced by specific antibodies) had no apparent influence on the presence of small-bowel overgrowth (in 20% of seropositive children compared with 18% of seronegative children) or of pathogens in the stool (in 53% of seropositive children compared with 49% of seronegative children) or on the occurrence of malnutrition in the groups of children considered as a whole. We conclude that H. pylori infection is not associated with acute or persistent diarrhoeal disease, small-bowel overgrowth, stool pathogens or malnutrition in Peruvian children.