Revisión del manejo del síndrome diarreico después de una cirugía bariátrica / Review of the management of diarrhea syndrome after a bariatric surgery

La obesidad es un problema de salud frecuente en nuestra población. La cirugía bariátrica es el tratamiento de elección en los casos graves, es muy efectiva (junto con una adecuada modificación de los hábitos de vida), pero también se asocia a múltiples efectos secundarios. Uno de los más frecuentes y que puede reducir marcadamente la calidad de vida es la diarrea. La diarrea que aparece posterior a una cirugía bariátrica puede ser de distintas causas y mecanismos fisiopatogénicos que van a depender, en parte, del tipo de cirugía realizada. Las causas más frecuentes son el síndrome de dumping, la diarrea por vagotomía, el síndrome de intestino corto, la malabsorción de hidratos de carbono, la malabsorción proteica, las alteraciones de la microbiota, la infección por Clostridium difficile, el sobrecrecimiento bacteriano, la malabsorción de sales biliares, la insuficiencia pancreática, trastornos endocrinológicos, trastornos adictivos y otros trastornos digestivos no necesariamente relacionados con la cirugía

Obesity is a prevalent health problem in our population. Bariatric surgery is the indicated treatment for severe cases. It is very effective (together with an adequate lifestyle modification) but it is also associated with frequent adverse events. One of the most frequent and disturbing adverse event is diarrhea. Diarrhea after bariatric surgery may be secondary to multiple causes and the physiopathogenic mechanisms may depend on the type of surgery performed. The most frequent diarrhea mechanisms are dumping syndrome, vagotomy, short bowel syndrome, carbohydrate malabsorption, protein malabsorption, alterations of the microbiota, Clostridium difficile infection, bacterial overgrowth, bile salt malabsorption, pancreatic insufficiency, endocrinological disorders, addictive disorders, and other digestive disorders not necessarily related to surgery

Review of the management of diarrhea syndrome after a bariatric surgery. / Revisión del manejo del síndrome diarreico después de una cirugía bariátrica.

Obesity is a prevalent health problem in our population. Bariatric surgery is the indicated treatment for severe cases. It is very effective (together with an adequate lifestyle modification) but it is also associated with frequent adverse events. One of the most frequent and disturbing adverse event is diarrhea. Diarrhea after bariatric surgery may be secondary to multiple causes and the physiopathogenic mechanisms may depend on the type of surgery performed. The most frequent diarrhea mechanisms are dumping syndrome, vagotomy, short bowel syndrome, carbohydrate malabsorption, protein malabsorption, alterations of the microbiota, Clostridium difficile infection, bacterial overgrowth, bile salt malabsorption, pancreatic insufficiency, endocrinological disorders, addictive disorders, and other digestive disorders not necessarily related to surgery.

Ischemic colitis in an athlete: running is not always good for you.

Running is popular. Ischemic colitis has been reported in marathon runners. We present a case of an amateur runner who developed ischemic colitis after a relatively short run.

Evaluation of four different fecal tests for determination of cure after Helicobacter pylori treatment.

BACKGROUND: Data evaluating the monoclonal tests for determination of cure after Helicobacter pylori treatment are scarce. GOALS: This study was aimed to evaluate the usefulness of 4 stool tests-2 new RAPID monoclonal immunochromatographic tests (RAPID Hp StAR, DakoCytomation, Cambridge, UK and ImmunoCard STAT! HpSA, Meridian Diagnostics, Cincinnati, OH) a monoclonal EIA test (Amplified IDEIA Hp StAR, DakoCytomation, Cambridge, UK), and a polyclonal EIA test (Premier Platinum HpSA, Meridian Diagnostics, Cincinnati, OH)-to confirm cure of H. pylori infection after eradication treatment. STUDY: Ninety-seven patients who underwent eradication treatment were included. Cure of H. pylori infection was determined using 2 consecutive reference tests. Fecal tests were performed according to the specifications of the manufacturer. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: After H. pylori eradication, the RAPID Hp StAR test has a sensitivity of 73% for detecting persistent infection, a specificity of 96% to 98%, a positive predictive value of 73% to 80% and a negative predictive value of 96%. For ImmunoCard STAT! HpSA the corresponding values were 91%, 97%, 77%, and 99%, for Amplified IDEIA Hp StAR 73%, 97%, 73%, and 97%, and for Premier Platinum HpSA 91%, 79%, 35%, and 98%. CONCLUSIONS: All tests except Premier Platinum HpSA were highly accurate confirming eradication after treatment.