Probióticos y prebióticos: rol en la terapéutica de la enfermedad diarreica aguda infantil / Probiotics and prebiotics: its role in childhood acute diarrheal disease therapy

RESUMEN: La enfermedad diarreica aguda infantil (EDAI), constituye un problema de salud pública, representando la 2ª causa de morbimortalidad infantil en menores de 5 años, en el Ecuador. La hidratación oral y parenteral en los niños hospitalizados bajo normas de administración de conformidad con el grado de deshidratación y pérdida de peso, así como medidas preventivas como la vacunación obligatoria contra el rotavirus, han contribuido a disminuir, pero no a solucionar este problema de salud infantil. Múltiples factores contribuyen para que no se resuelva: socioeconómicos, educacionales, el destete temprano y malas prácticas alimenticias, entre otros. Últimos estudios han propuesto la utilización de probióticos que contribuyan a disminuir el problema sugieriendo el usode Saccharomyces boulardii (SB), asociado a un prebiótico; lo que permitiría acortar el tiempo de tratamiento de una EDAI; por lo que la simbiosis entre SB y un prebiótico denominado fructooligosacárido (FOS), podría ser una alternativa para reducir costos y complicaciones. Una alternativa para medir el curso clínico de una EDAI en infantes es la escala BITTS, de reciente creación y fácil aplicación por clínicos. El objetivo de este manuscrito fue resumir la evidencia existente respecto del rol de losprobióticos y prebióticos en la terapéutica de de la EDAI.

SUMMARY: In Ecuador childhood acute diarrheal disease (CADD) constitutes a serious public health problem, representing the 2nd cause of infant morbidity and mortality in children under 5 years of age. Oral and parenteral hydration in hospitalized children, with standard treatments according to their degree of dehydration and weight loss, as well as preventive measures such as mandatory vaccination against rotavirus, have contributed to a decrease. Nevertheless, this childhood disease has still not been resolved. There are multiple contributing factors involved that prevent complete eradication of the disease Among these are socio-economic problems, education, early weaning and poor feeding practices, all of which continue to affect infants. Recent studies have proposed the use of probiotics that help reduce the problem and it has been suggested that Saccharomyces boulardii (SB), associated with a prebiotic, would reduce the treatment time of an CADD. Therefore, the symbiosis between the SB probiotic and a prebiotic called fructo- oligosaccharide (FOS) could be an alternative to reduce complications and reduce costs. An alternative to measure the clinical course of an CADD in infants is the BITTS scale, which was recently created and can easily be applied by clinicians. The aim of this manuscript was to summarize the existing evidence regarding the role of PROBIOTICS and prebiotics in the treatment of CADD.

[Inter- and intra-observer reliability of BITSS scale in the diagnosis and early follow-up of infectious diarrhea in children under 3 years of age]. / Confiabilidad inter e intra observador de la escala BITSS en el diagnóstico y seguimiento precoz de la diarrea infecciosa en niños menores de 3 años.

INTRODUCTION: The BITSS scale (Brussels Infant and Toddler Stool Scale) is an instrument used in the diagnosis and follow-up of infants and young children with infectious diarrhea. It consists of 7 pictures of diapers with different types of stools. OBJECTIVE: To determine intra and interobserver reliability of the BITSS scale in infants and children using diapers. PATIENTS AND METHOD: Reliability study. Three pediatri cians with experience in treating childhood infectious diarrhea were selected and, after training in applying the BITSS scale, they evaluated 70 pictures of stools obtained from pediatric patients, repre senting the 7 different types of stools categorized by the scale (10 images for each item). Two pediatri cians participated in the interobserver reliability study and performed a blind evaluation of the same pictures, assigning a value to each one, and the third pediatrician participated in the intra-observer analysis, evaluating 70 images on two different occasions, 15 days apart. Interobserver agreement and kappa statistics were determined for the scale and each scale item. RESULTS: 280 measurements were made, 140 for the inter-observer reliability study and 140 for the intra-observer one. The degree of inter-observer agreement for the scale was 85.7%; with a kappa of 0.817 (95% CI 0.72; 0.92), and standard error of 0.05; and the intra-observer kappa for the scale was 0.883 (95% CI 0.80; 0.96), with a standard error of 0.04. CONCLUSIONS: The BITSS scale has good intra- and interobserver reliability.

Prevalencia de desórdenes gastrointestinales funcionales y hábito intestinal en lactantes menores de 12 meses internados en el Hospital Infantil Baca Ortíz de Quito, Ecuador / Prevalence of functional gastrointestinal disorders and intestinal habit hospitalized in infants under 12 months of hospital infantil Baca Ortíz from Quito, Ecuador

Resumen Introducción: la prevalencia de desórdenes gastrointestinales funcionales en niños menores ecuatorianos se desconoce y no hay una prueba estándar para evaluar la consistencia de las heces. Objetivo: determinar la prevalencia de desórdenes gastrointestinales funcionales en lactantes menores a 12 meses e identificar el hábito intestinal. Metodología: estudio de prevalencia en lactantes internados del Hospital Infantil Baca Ortíz de Quito, Ecuador, a quienes se les diagnosticó diarrea funcional, cólico, estreñimiento funcional, disquecia, regurgitación, síndrome de vómito cíclico y rumiación. Fueron incluidas variables sociodemográficas, clínicas y preguntas sobre hábitos intestinales, basados en el Cuestionario para Síntomas Digestivos Pediátricos Roma III traducido y validado en español. Se hizo análisis uni y multivariados y el cálculo de los ORs, siendo una p<0,05 significativa. Resultados: fueron incluidos 147 lactantes, de 6,8±3,3 meses de edad, 50,3% niñas. La principal causa de hospitalización fue del sistema respiratorio. Se reportó 36,0% con algún desorden gastrointestinal funcional: cólico (12,2%), estreñimiento funcional (9,5%), disquecia (8,0%) y regurgitación (7,5%). No hubo factores de riesgo asociados. Se reportaron heces duras en 4,1% y 7,4% por Criterios de Roma III y Escala de Bristol, respectivamente. Hubo concordancia aceptable (kappa=0,3989, p=0,0221) entre el reporte de los padres por los Criterios de Roma III y la Escala de Bristol. Conclusión: un tercio de estos niños presentó algún desorden gastrointestinal funcional, siendo los más frecuentes: estreñimiento funcional, regurgitación, cólico y disquecia; sin posibles factores de riesgo; identificándose una concordancia aceptable entre lo reportado por los padres según los Criterios de Roma III y la Escala de Bristol. MÉD.UIS.2019;32(2):13-21

Abstract Introduction: the prevalence of functional gastrointestinal disorders in Ecuadorian younger infant is unknown and there is no gold standard for stool consistency. Objective: to determine the prevalence of functional gastrointestinal disorders in infants younger 12 months and to identify the intestinal habit. Methodology: prevalence study in hospitalized infants at the Hospital Infantil Baca Ortíz in Quito, Ecuador, who were diagnosed with functional diarrhea, colic, functional constipation, dyschezia, regurgitation, cyclic vomiting syndrome and rumination. Socio-demographic, clinical variables and questions about intestinal habits, based on the Questionnaire for Pediatric Digestive Symptoms Roma III translated and validated in Spanish, were included. The statistic included uni and multivariate analyzes and the calculation of the ORs, being a significant p <0.05. Results: a total of 147 infants, 6,8±3,3 months old, 50,3% girls; with the main cause of hospitalization the respiratory system. Were reported 36.0% with some functional gastrointestinal disorders: colic (12.2%), functional constipation (9,5%), dyschezia (8,0%) and regurgitation (7,5%). There were no possible associated risk factors. Hard stools were reported in 4,1% and 7,4% by Criteria of Rome III and Bristol Stool Scale, respectively. There was acceptable agreement (kappa = 0,3989, p = 0.0221) between the parents' report for the Rome Criteria III and the Bristol Stool Scale. Conclusion: one third of these children presented some functional gastrointestinal disorders, being the most frequent functional constipation, regurgitation, colic and dyschezia; without possible risk factors; identifying an acceptable concordance between what was reported by parents according to Rome Criteria III and Bristol Stool Scale. MÉD.UIS.2019;32(2):13-21

The prevalence of functional constipation in children was unchanged after the Rome IV criteria halved the diagnosis period in Rome III.

AIM: The Rome IV criteria for the diagnosis of functional constipation are one month, compared with two months in the Rome III criteria. Our aim was to see whether this altered the prevalence in Ecuador by surveying school children and comparing the results to our previous study. METHODS: A cross-sectional study was conducted in Quito, Ecuador, in 2013 two randomly selected schools: one private and one public. Children aged 8-15 completed the Spanish version of the Questionnaire of Paediatric Gastrointestinal Symptoms based on the Rome IV criteria. We compared our findings with our previous 2013 study based on the Rome III criteria. RESULTS: A total of 951 children (61% male) completed the Rome IV questionnaire from June to July 2017 at a mean age of 11.2 ± 1.8 years, and 417 children (52% male) completed the Rome III questionnaire in June 2013 at a mean age of 12.0 ± 1.8 years. We found that 14.4% met the Rome IV criteria for functional constipation compared with 11.8% for the Rome III criteria (p = 0.11). CONCLUSION: Modifying the time required for a diagnosis functional constipation from two months to one month did not result in a significant difference in the prevalence.

Superposición de desórdenes gastrointestinales funcionales en escolares y adolescentes latinoamericanos / Overlapping of functional gastrointestinal disorders in latinamerican schoolchildren and adolescents

Resumen: Introducción: Hay pocos estudios sobre Desórdenes Gastrointestinales Funcionales superpuestos (DGFs-s). Objetivo: Describir la prevalencia y posibles factores de riesgo en niños Latinoamericanos (Latam) para presentar DGFs-s. Pacientes y Método: Estudio de prevalencia en niños escolares La tam entre 8-18 años. Se incluyeron variables sociodemográficas; se utilizaron los Criterios de Roma III en español, y se consideró DGFs-s cuando se presentaron 2, 3 o 4 y más DGFs en un mismo niño. El análisis estadístico incluyó t de student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y cálculo de los ORs e IC95%, siendo considerada una p < 0,05 significativa. Resul tados: Fueron analizados 6193 niños Latam (11,8 ± 2,2 años; 62,2% entre 8-12 años; 50,4% niñas; 68,0% colegio público), con diagnóstico de algún DGFs del 23,4%. Hubo superposición de DGFs en un mismo niño, en 8,4% (5,5% con 2 DGFs; 2,1% con 3 DGFs y 0,9% con 4 o más DGFs), siendo las principales superposiciones el Síndrome de intestino irritable (SII) + Dolor abdominal funcio nal (DAF) (2,6%) y el SII + DAF + Estreñimiento funcional (1,1%). Hubo predomino del género femenino. Conclusión: Hay una baja prevalencia de DGFs-s en escolares y adolescentes Latam, con predominio en el sexo femenino y de presentación muy variable.

Abstract: Introduction: There are few studies on overlapping Functional Gastrointestinal Disorders (FGIDs). Objective: To describe the prevalence and possible risk factors in Latin American children (Latam) to present overlapping FGIDs. Patients and Method: Prevalence study in Latam schoolchildren bet ween 8-18 years of age. Sociodemographic variables were included; the Rome III Criteria in Spanish were used, and overlapping FGIDs were considered when two, three or four and more FGIDs were presented in the same child. The statistical analysis included Student's T-test, chi-square test, Fisher's exact test, univariate and multivariate analysis, and calculation of ORs and 95% CI, being considered a significant p < 0.05. Results: 6,193 Latam children were analyzed (11.8 ± 2.2 years, 62.2% between 8-12 years of age, 50.4% girls, 68.0% public school), and 23.4% with a diagnosis of some kind of FGIDs. There was overlap of FGIDs in the same child, in 8.4% (5.5% with 2 FGIDs, 2.1% with 3 FGIDs and 0.9% with 4 or more FGIDs), the main overlaps were irritable bowel syndrome (IBS) + functional abdominal pain (FAP) (2.6%), and IBS + FAP + functional constipation (1.1%). There was predominance of the female gender. Conclusion: There is a low prevalence of overlapping FGIDs in Latam schoolchildren and adolescents, with a predominance in females and of very variable pre sentation.

[Overlapping of functional gastrointestinal disorders in latinamerican schoolchildren and adolescents]. / Superposición de desórdenes gastrointestinales funcionales en escolares y adolescentes latinoamericanos.

INTRODUCTION: There are few studies on overlapping Functional Gastrointestinal Disorders (FGIDs). OBJECTIVE: To describe the prevalence and possible risk factors in Latin American children (Latam) to present overlapping FGIDs. PATIENTS AND METHOD: Prevalence study in Latam schoolchildren bet ween 8-18 years of age. Sociodemographic variables were included; the Rome III Criteria in Spanish were used, and overlapping FGIDs were considered when two, three or four and more FGIDs were presented in the same child. The statistical analysis included Student's T-test, chi-square test, Fisher's exact test, univariate and multivariate analysis, and calculation of ORs and 95% CI, being considered a significant p < 0.05. RESULTS: 6,193 Latam children were analyzed (11.8 ± 2.2 years, 62.2% between 8-12 years of age, 50.4% girls, 68.0% public school), and 23.4% with a diagnosis of some kind of FGIDs. There was overlap of FGIDs in the same child, in 8.4% (5.5% with 2 FGIDs, 2.1% with 3 FGIDs and 0.9% with 4 or more FGIDs), the main overlaps were irritable bowel syndrome (IBS) + functional abdominal pain (FAP) (2.6%), and IBS + FAP + functional constipation (1.1%). There was predominance of the female gender. CONCLUSION: There is a low prevalence of overlapping FGIDs in Latam schoolchildren and adolescents, with a predominance in females and of very variable pre sentation.

High Prevalence of Nausea among School Children in Latin America.

OBJECTIVES: To evaluate the prevalence of nausea and its association with functional gastrointestinal disorders (FGIDs) in a large-scale, population-based study of Latin American school children. STUDY DESIGN: This cross-sectional study collected data from children in 3 Latin American countries. A Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) was administered to school children in Central and South America. Subjects were classified into FGIDs based on Rome criteria (QPGS-III). Students from 4 public and 4 private schools in the countries of El Salvador, Panama, and Ecuador participated in this epidemiologic study. RESULTS: A total of 1137 school children with mean age 11.5 (SD 1.9, range 8-15) years completed the QPGS-III (El Salvador n = 399; Panama n = 321; Ecuador n = 417). Nausea was present in 15.9% of all school children. Two hundred sixty-eight (24%) children met criteria for at least 1 FGID. Nausea was significantly more common in children with FGIDs compared with those without: El Salvador 38% vs 15% (P < .001); Panama 22% vs 7% (P < .001); Ecuador 25% vs 13% (P = .004). Among children with FGIDs, those with functional constipation had a high prevalence of nausea. Nausea was significantly more common in girls and children attending private schools. CONCLUSIONS: Nausea is commonly present in Latin American school children. FGIDs are frequently associated with nausea.