When symptoms are more than reflux.

45 year-old male patient with history of heartburn and regurgitation of non-acid food in the immediate postprandial period, with no symptomatic improvement after anti-acid treatment. The patient underwent an upper endoscopy that was unremarkable. A high-resolution impedance manometry (HRIM) was performed according to Chicago Protocol 4.0, as well as an additional solid test meal, with findings of rumination syndrome (RS) (figure 1). The study was completed with a 24-hour impedance pH monitoring that showed, in the immediate postprandial period, episodes of reflux that reached the proximal sensor followed by a normal swallow (figure 2). Abdominophrenic biofeedback was started with clinical improvement and anti-acid treatment was maintained at once a day. Discussion: RS is diagnosed by a complete clinical history, using the Rome IV or DSM-5 criteria (figure 3). Due to lack of knowledge of the disease and the fact that regurgitation can be present in other conditions including gastroesophageal reflux disease and achalasia, most patients undergo multiple tests and visit several physicians before reaching the diagnosis1. The gold standard investigation for RS, in cases where there are diagnostic doubts, is HRIM with solid meal administration, that shows a sudden increase in intragastric pressure > 30 mmHg concurrent with a drop in impedance and both simultaneous lower and upper esophageal sphincter relaxation, that may or may not be followed by re-swallowing food2. Rumination episodes can appear spontaneously (type 1) or may be preceded by a reflux episode (type 2) or a supragastric belch (type 3)3. 24-hour impedance pH monitoring cannot confirm de diagnosis, but during rumination, in the majority of episodes, the refluxed material reaches the proximal esophagus2.

Practical approach to irritable bowel syndrome-diarrhea beyond low-FODMAP diet.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered defecation, usually accompanied by abdominal bloating or distension. The integrated model of bidirectional interaction between the central, autonomic, enteric nervous system, the microbiome, and the gut barrier allows a better understanding of the pathophysiology of IBS, as well as consideration of potential therapeutic strategies. IBS with predominant diarrhea (IBS-D) represents a therapeutic challenge. Dietary changes or restrictions are most commonly used by patients in an attempt at symptom control. Therefore, a number of diets, especially low-FODMAP diet, have increasingly gained interest as a therapy for IBS-D or mixed IBS. However, this kind of diet, while effective, is not exempt of problems. It is therefore necessary that other therapeutic options be considered while bearing pathophysiological mechanisms and general symptom management in mind.

Síndrome de defecación obstructiva. Un reto diagnóstico y terapéutico / No disponible

El síndrome de defecación obstructiva es causa de estreñimiento con sensación de bloqueo anal y defecación incompleta. Puede ser secundario a múltiples causas, tanto anatómicas o estructurales como funcionales. En un número significativo de pacientes pueden coexistir diversos factores etiológicos, por lo que se trata de una entidad compleja y multifactorial. En consecuencia, se requiere una evaluación diagnóstica que incluya estudios para evaluar tanto la anatomía como la función. El acuerdo entre los distintos test diagnósticos es limitado, lo que obliga a su análisis individualizado en cada paciente. A la hora de diseñar una estrategia terapéutica también hay que considerar los aspectos funcionales y las posibles alteraciones anatómicas. Por todo ello, esta entidad supone un reto tanto diagnóstico como terapéutico

No disponible

Obstructed defecation syndrome: a diagnostic and therapeutic challenge.

Obstructed defecation syndrome produces constipation with anal blockage and a feeling of incomplete evacuation, due to either anatomic and functional causes. This is a complex and multifactorial entity due to diverse etiological factors that may coexist in many patients. Therefore, a diagnostic approach requires structural and functional assessment. The concordance between findings of diagnostic tests is suboptimal, thus an individualized analysis is mandatory in each patient. Therapeutic strategies require the best understanding of anatomic and functional aspects. Consequently, this entity is a diagnostic and therapeutic challenge.

Factores independientes asociados con el impacto de la enfermedad por reflujo gastroesofágico en la calidad de vida relacionada con la salud / Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life

Introducción: varios factores se han asociado con el deterioro de la calidad de vida en la enfermedad por reflujo gastroesofágico. Sin embargo, se desconoce aquellos que lo condicionan de manera independiente. Objetivo: evaluar los factores independientemente asociados con el impacto de la enfermedad por reflujo gastroesofágico sobre la calidad de vida relacionada con la salud. Material y método: Análisis post hoc de una cohorte prospectiva de pacientes diagnosticados de enfermedad por reflujo gastroesofágico. Se completaron cuestionarios validados para evaluar: calidad de vida (SF36), reflujo gastroesofágico (GERQ) y factores psicológicos (STAI y SCL90R). Resultados: Se incluyeron 98 pacientes. En el análisis univariante, el deterioro en el componente físico del SF36 se encontraba significativamente asociado al sexo femenino, al nivel educativo, a la edad, a la disminución de peso, a la severidad de los síntomas típicos y a los síntomas supraesofágicos e ingresos mensuales; el componente mental se asoció al consumo de alcohol, al dolor epigástrico y a peores puntuaciones en los cuestionarios STAI y SCL90. El análisis multivariante mostró una asociación independiente en el componente físico del SF36 con el nivel educativo (ß = 0,29; p < 0,01), la severidad de los síntomas (ß = -0,38 ; p < 0,001), el índice de masa corporal (ß = -0,30 ; p < 0,005), el estado de ansiedad (ß = 0,28; p < 0,01), el sexo femenino (ß = -0,23; p < 0,05) y la dispepsia (ß = -0,21; p < 0,05); y en la esfera mental, con el estado de ansiedad (ß = -0,39; p < 0,01) y la depresión (ß = -0,32; p < 0,05). Conclusión: los principales factores independientemente asociados con el deterioro de la calidad de vida en pacientes con enfermedad por reflujo gastroesofágico son la severidad de los síntomas típicos y la presencia de dispepsia, con un impacto adicional del índice de masa corporal y el componente psicológico

Background: although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. Objective: to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. Methods: a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). Results: the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (ß = 0.29; p < 0.01), severity of symptoms (ß = -0.38; p < 0.001), body mass index (ß = -0.30; p < 0.005), state anxiety (ß = 0.28; p < 0.01), female gender (ß = -0.23; p < 0.05) and dyspepsia (ß = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (ß = -0.39; p < 0.01) and depression (ß = -0.32; p < 0.05). Conclusions: the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component

Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life.

BACKGROUND: although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. OBJECTIVE: to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. METHODS: a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). RESULTS: the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (ß = 0.29; p < 0.01), severity of symptoms (ß = -0.38; p < 0.001), body mass index (ß = -0.30; p < 0.005), state anxiety (ß = 0.28; p < 0.01), female gender (ß = -0.23; p < 0.05) and dyspepsia (ß = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (ß = -0.39; p < 0.01) and depression (ß = -0.32; p < 0.05). CONCLUSIONS: the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component.