PREVALENCE OF COMORBIDITIES IN PATIENTS WITH CHAGASIC MEGAESOPHAGUS.

•The study investigated the prevalence of certain comorbidities in patients with Chagas megaoesophagus compared to those without the condition, aiming to determine whether it serves as a protective or risk factor. •In the general group (546 patients), the three most prevalent comorbidities were hypertension (44.3%), dyslipidaemia (17.8%), and heart failure (15.2%). •In the older group (248 patients), similar to that in the general group, the most prevalent comorbidities were hypertension, dyslipidaemia, and heart failure. •The lower prevalence of diabetes mellitus and Alzheimer's disease in the patients with Chagas megaoesophagus suggests the association of enteric nervous system denervation and requires further investigation. Objective - This study aimed to evaluate the prevalence of some epidemiologically important comorbidities in patients with Chagas megaoesophagus in relation to the population without megaoesophagus, and whether this condition would be a protective or a risk factor for the conditions analysed. Methods - This observational descriptive study collected data from the medical records of patients with a previous diagnosis of megaoesophagus (timing: from 2005 to 2020). The patients were divided by age into a general (all ages) and an older group (aged 60 years or more). Associations were searched for four main areas/systems/involvements: cardiovascular, respiratory, endocrine and neurological. Results - The general group included 546 patients and the older group included 248 patients. As for the prevalence of comorbidities in the general group, the three most prevalent diseases were hypertension, with 44.3% (CI95%: 40.21-48.51%); dyslipidaemia, with 17.8% (CI95%: 14.79-21.19%); and heart failure, with 15.2% (CI95%: 12.43-18.45%). Similar to that in the general group, the most prevalent comorbidities in the group of older patients were hypertension, dyslipidaemia, and heart failure. Conclusion - Systemic arterial hypertension, dyslipidaemia, and heart failure were the most prevalent comorbidities in this population. The lower prevalence of diabetes mellitus and Alzheimer's disease suggests the association of enteric nervous system denervation and requires further investigation.

Prevalência de comorbidades em pacientes com megaesôfago chagásico / Prevalence of comorbidities in patients with chagasic megaesophagus

ABSTRACT Objective: This study aimed to evaluate the prevalence of some epidemiologically important comorbidities in patients with Chagas megaoesophagus in relation to the population without megaoesophagus, and whether this condition would be a protective or a risk factor for the conditions analysed. Methods: This observational descriptive study collected data from the medical records of patients with a previous diagnosis of megaoesophagus (timing: from 2005 to 2020). The patients were divided by age into a general (all ages) and an older group (aged 60 years or more). Associations were searched for four main areas/systems/involvements: cardiovascular, respiratory, endocrine and neurological. Results: The general group included 546 patients and the older group included 248 patients. As for the prevalence of comorbidities in the general group, the three most prevalent diseases were hypertension, with 44.3% (CI95%: 40.21-48.51%); dyslipidaemia, with 17.8% (CI95%: 14.79-21.19%); and heart failure, with 15.2% (CI95%: 12.43-18.45%). Similar to that in the general group, the most prevalent comorbidities in the group of older patients were hypertension, dyslipidaemia, and heart failure. Conclusion: Systemic arterial hypertension, dyslipidaemia, and heart failure were the most prevalent comorbidities in this population. The lower prevalence of diabetes mellitus and Alzheimer's disease suggests the association of enteric nervous system denervation and requires further investigation.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a prevalência de algumas comorbidades epidemiologicamente importantes em pacientes com megaesôfago chagásico em relação à população sem o megaesôfago e se essa condição seria um fator protetor ou de risco para as condições analisadas. Métodos: Este estudo descritivo observacional coletou dados de prontuários de pacientes com diagnóstico prévio de megaesôfago (período: de 2005 a 2020). Os pacientes foram divididos por idade em um grupo geral (todas as idades) e um grupo idoso (60 anos ou mais). Foram pesquisadas associações para quatro áreas/sistemas/envolvimentos principais: cardiovascular, respiratório, endócrino e neurológico. Resultados: O grupo geral incluiu 546 pacientes e o grupo idosos incluiu 248 pacientes. Quanto à prevalência de comorbidades no grupo geral, as três doenças mais prevalentes foram hipertensão, com 44,3% (IC95%: 40,21-48,51%); dislipidemia, com 17,8% (IC95%: 14,79-21,19%); e insuficiência cardíaca, com 15,2% (IC95%: 12,43-18,45%). Assim como no grupo geral, as comorbidades mais prevalentes no grupo de idosos foram hipertensão, dislipidemia e insuficiência cardíaca. Conclusão: Hipertensão arterial sistêmica, dislipidemia e insuficiência cardíaca foram as comorbidades mais prevalentes nessa população. A menor prevalência de diabetes mellitus e doença de Alzheimer sugere uma associação de denervação do sistema nervoso entérico e requer mais investigação.

DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE.

BACKGROUND: Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual's well-being. OBJECTIVE: To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. METHODS: A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. RESULTS: The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient's needs. CONCLUSION: CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

Diagnóstico e abordagem terapêutica da constipação idiopática crônica: uma revisão de especialistas brasileiros / Diagnosis and management of chronic idiopathic constipation: a narrative review from a brazilian expert task force

ABSTRACT Background Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual's well-being. Objective To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. Methods A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. Results The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient's needs. Conclusion CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

RESUMO Contexto A constipação idiopática crônica (CIC) é uma condição que afeta amplamente a população global, representa um grande custo econômico, causa substancial utilização de recursos em saúde e impacta o bem-estar do indivíduo. Objetivo Revisar os consensos de Sociedades de especialistas e diretrizes publicados sobre o diagnóstico e tratamento da CIC em adultos, buscando auxiliar o raciocínio e a tomada de decisão para a conduta médica frente ao paciente e oferecer um material prático de referência. Métodos Uma força tarefa médica brasileira realizou uma busca na literatura científica nas bases de dados eletrônicos Medline/PubMed, SciELO, Embase e Cochrane, tendo sido utilizados os seguintes descritores: chronic constipation, diagnosis, management of chronic constipation. Adicionalmente, foi realizada uma revisão de artigos sobre o mecanismo de ação, segurança e eficácia das opções terapêuticas disponíveis no Brasil. Resultados A abordagem diagnóstica e o entendimento da fisiopatologia presente na CIC são itens fundamentais para que seja indicada a terapêutica apropriada e seja compreendido o ecossistema de necessidades do paciente. Conclusão A CIC é uma condição comum em adultos, ocorrendo com maior frequência em idosos e mulheres. O manejo correto é definido pela anamnese e exame físico detalhados, juntamente com a terapêutica apropriada, independentemente de ser farmacológica ou não, conforme o melhor momento de indicação. Desta forma, o impacto na qualidade de vida também é otimizado.

TRANSCUTANEOUS MULTICHANNEL ELECTROGASTROGRAPHY: NORMAL PARAMETERS IN A BRAZILIAN POPULATION.

BACKGROUND: Electrogastrography (EGG) is a noninvasive technique for the assessment of gastric myoelectrical activity using electrodes placed on the abdominal surface. Changes in gastric myoelectrical activity may be associated with diseases such as gastroparesis, functional dyspepsia, nausea, and recurrent vomiting. In Brazil, no studies to date have assessed gastric myoelectrical activity using multichannel EGG in healthy individuals. OBJECTIVE: To establish normal values of transcutaneous multichannel EGG in healthy Brazilian individuals. METHODS: This was a prospective study including 20 healthy individuals who underwent EGG. Recording was performed during two periods: a preprandial recording was performed for 30 minutes, and a postprandial recording was performed for 30 minutes after a soft-solid meal of 400 kcal (20 grams of proteins, 60 grams of carbohydrates, and 9 grams of fat). RESULTS: We assessed dominant frequency (DF) parameters, %DF distribution, the instability coefficient, and the power ratio (PR). A total of 20 individuals (11 women and 9 men) with a mean age of 39.5±7.4 years were included. Mean DF (95%CI) ranged from 2.4 to 3.1 cpm in the resting phase and 2.6 to 3.2 cpm in the postprandial period. The %DF in normogastria range was >70% in all healthy individuals. We identified that only one individual did not present a positive response to the test meal, and the other 19 individuals showed a PR greater than 1. The instability coefficient did not change significantly with meal intake. CONCLUSION: Multichannel EGG may be applied in future studies to evaluate gastric motility disorders in the Brazilian population.

Eletrogastrografia multicanal transcutânea: parâmetros normais em uma população brasileira / Transcutaneous multichannel electrogastrography: normal parameters in a brazilian population

ABSTRACT BACKGROUND: Electrogastrography (EGG) is a noninvasive technique for the assessment of gastric myoelectrical activity using electrodes placed on the abdominal surface. Changes in gastric myoelectrical activity may be associated with diseases such as gastroparesis, functional dyspepsia, nausea, and recurrent vomiting. In Brazil, no studies to date have assessed gastric myoelectrical activity using multichannel EGG in healthy individuals. OBJECTIVE: To establish normal values of transcutaneous multichannel EGG in healthy Brazilian individuals. METHODS: This was a prospective study including 20 healthy individuals who underwent EGG. Recording was performed during two periods: a preprandial recording was performed for 30 minutes, and a postprandial recording was performed for 30 minutes after a soft-solid meal of 400 kcal (20 grams of proteins, 60 grams of carbohydrates, and 9 grams of fat). RESULTS: We assessed dominant frequency (DF) parameters, %DF distribution, the instability coefficient, and the power ratio (PR). A total of 20 individuals (11 women and 9 men) with a mean age of 39.5±7.4 years were included. Mean DF (95%CI) ranged from 2.4 to 3.1 cpm in the resting phase and 2.6 to 3.2 cpm in the postprandial period. The %DF in normogastria range was >70% in all healthy individuals. We identified that only one individual did not present a positive response to the test meal, and the other 19 individuals showed a PR greater than 1. The instability coefficient did not change significantly with meal intake. CONCLUSION: Multichannel EGG may be applied in future studies to evaluate gastric motility disorders in the Brazilian population.

RESUMO CONTEXTO: Eletrogastrografia (EGG) é técnica não invasiva que avalia a atividade miolétrica gástrica utilizando eletrodos localizados na superfície abdominal. Alterações na atividade miolétrica gástrica podem estar associadas a distúrbios como gastroparesia, dispepsia funcional, náuseas e vômitos recorrentes. No Brasil, não há estudos até o momento que tenham avaliado a atividade miolétrica gástrica pela EGG multicanal transcutânea em indivíduos saudáveis. OBJETIVO: Estabelecer valores de normalidade da EGG multicanal transcutânea em indivíduos brasileiros saudáveis. MÉTODOS: Este foi um estudo prospectivo, incluindo 20 indivíduos saudáveis submetidos a EGG. O registro foi realizado em dois períodos: um período pré-prandial foi registrado por 30 minutos, e um período pós-prandial por 30 minutos após a ingesta de uma dieta de prova com consistência sólida e pastosa de 400 kcal (20 gramas de proteínas, 60 gramas de carboidratos e 9 gramas de gordura). RESULTADOS: Foram avaliados os parâmetros de frequência dominante (FD), distribuição da % de FD, coeficiente de instabilidade e "power ratio" (PR). Foram incluídos 20 indivíduos (11 mulheres e 9 homens) com idade média de 39,5 +/- 7,4 anos. A FD média (95%CI) variou de 2,4 a 3,1 cpm no período de basal (pré-prandial) e de 2,6 a 3,2 cpm no período pós-prandial. A % da FD na faixa de normogastria foi >70% em todos os indivíduos saudáveis. Identificamos que apenas um indivíduo não apresentou resposta positiva a refeição de prova, e os outros 19 indivíduos apresentaram PR>1. O coeficiente de instabilidade não mudou significativamente com a ingesta da refeição de prova. CONCLUSÃO: A EGG multicanal transcutânea pode ser aplicada em estudos futuros para a avaliar distúrbios da motilidade gástrica na população brasileira.

Use of Vitamin D With Anti-Tumor Necrosis Factor Therapy for Crohn's Disease.

BACKGROUND: Vitamin D (VD) has an important role in regulating gut mucosal immunity, and seems to be inversely linked to disease activity and more frequent relapses in inflammatory bowel disease. In this study, we evaluated patients with Crohn's disease (CD) treated with anti-tumor necrosis factor (TNF) in association with VD. METHODS: A double-blind, randomized, prospective study was conducted. Thirty patients with a history of moderate to severe CD, in use of anti-TNF, of both sexes, 18 to 70 years, with the dosage of VD < 75 nmol/L (30 ng/mL) were randomized and divided into three groups: group 1 (G1): 10 patients received 2,000 IU VD, per os (PO)/week for 8 weeks; group 2 (G2): 10 patients received 10,000 IU VD, PO/week for 8 weeks; group 3 (G3): 10 patients received 50,000 IU VD, PO/week for 8 weeks. Before and at the end of 8 weeks patients were submitted to VD, fecal calprotectin (FC) and C-reactive protein (CRP) dosage. Follow-up period was 52 weeks, and they are checked for disease activity recurrence (Crohn's disease activity index (CDAI) > 150, FC > 300 and computerized tomography (CT) scan), FC, CRP, and VD levels. RESULTS: Increased VD levels were observed in all groups (P < 0.0001). CRP did not change. There was a significant decrease of FC in G3 (1,014 ± 850 vs. 483 ± 564; P = 0.04), no significant decrease in G2 (76,767 ± 751 vs. 535 ± 823; P = 0.2) and increase in G1 (1,101 ± 744 vs. 1,357 ± 819; P = 0.4). During the 52-week follow-up period, it was showed that recurrent disease activity (CDAI > 150, FC > 200 and CT scan) was predominant in patients with VD < 30 group, and the remission rate was predominant in patients with VD > 30 group (P = 0.0001). A statistically significant difference in VD levels was noted in CD patients after 52 weeks that presented flare or disease remission (P = 0.001). CONCLUSIONS: Use of VD associated with anti-TNF treatment may improve clinical response in CD. VD levels greater than 30 ng/mL have better rates of remission.

Detection of Helicobacter pylori resistance to clarithromycin and fluoroquinolones in Brazil: A national survey.

AIM: To evaluate bacterial resistance to clarithromycin and fluoroquinolones in Brazil using molecular methods. METHODS: The primary antibiotic resistance rates of Helicobacter pylori (H. pylori) were determined from November 2012 to March 2015 in the Southern, South-Eastern, Northern, North-Eastern, and Central-Western regions of Brazil. Four hundred ninety H. pylori patients [66% female, mean age 43 years (range: 18-79)] who had never been previously treated for this infection were enrolled. All patients underwent gastroscopy with antrum and corpus biopsies and molecular testing using GenoType HelicoDR (Hain Life Science, Germany). This test was performed to detect the presence of H. pylori and to identify point mutations in the genes responsible for clarithromycin and fluoroquinolone resistance. The molecular procedure was divided into three steps: DNA extraction from the biopsies, multiplex amplification, and reverse hybridization. RESULTS: Clarithromycin resistance was found in 83 (16.9%) patients, and fluoroquinolone resistance was found in 66 (13.5%) patients. There was no statistical difference in resistance to either clarithromycin or fluoroquinolones (P = 0.55 and P = 0.06, respectively) among the different regions of Brazil. Dual resistance to clarithromycin and fluoroquinolones was found in 4.3% (21/490) of patients. The A2147G mutation was present in 90.4% (75/83), A2146G in 16.9% (14/83) and A2146C in 3.6% (3/83) of clarithromycin-resistant patients. In 10.8% (9/83) of clarithromycin-resistant samples, more than 01 mutation in the 23S rRNA gene was noticed. In fluoroquinolone-resistant samples, 37.9% (25/66) showed mutations not specified by the GenoType HelicoDR test. D91N mutation was observed in 34.8% (23/66), D91G in 18.1% (12/66), N87K in 16.6% (11/66) and D91Y in 13.6% (9/66) of cases. Among fluoroquinolone-resistant samples, 37.9% (25/66) showed mutations not specified by the GenoType HelicoDR test. CONCLUSION: The H. pylori clarithromycin resistance rate in Brazil is at the borderline (15%-20%) for applying the standard triple therapy. The fluoroquinolone resistance rate (13.5%) is equally concerning.

Current epidemiological profile of Chagasic megaesophagus in Central Brazil.

INTRODUCTION: Chagasic megaesophagus (CM) is the most common digestive manifestation of Chagas disease in Brazil, and the State of Goiás is one of the most affected regions. In recent decades, the Hospital das Clínicas (HC)/Universidade Federal de Goiás (UFG) has been a reference center for the study and treatment of CM. The objective of this study was to characterize the current epidemiological profile of patients with CM observed at the HC of the UFG from 1998 to 2010. METHODS: In total, 939 patient records were analyzed, and age, gender, place of birth, serology, symptoms and radiological classification according to Rezende et al. were analyzed. RESULTS: The median patient age was 55 years. Male patients were more (54%) prevalent than female patients. The prevalence of younger patients (less than 31 years of age) was 4.2%, but 82.1% of the younger patients were from State of Bahia. Patients older than 40 years were the majority (85.5%). The radiological groups were distributed as follows: Group I (35.9%), Group II (32.9%), Group III (17%) and Group IV (14.2%). CONCLUSIONS: Compared with previous studies by the same group in 1975, 1994 and 1995, the number of younger patients decreased, and the frequency curve has shifted to older patients.

Current epidemiological profile of Chagasic megaesophagus in Central Brazil

Introduction Chagasic megaesophagus (CM) is the most common digestive manifestation of Chagas disease in Brazil, and the State of Goiás is one of the most affected regions. In recent decades, the Hospital das Clínicas (HC)/Universidade Federal de Goiás (UFG) has been a reference center for the study and treatment of CM. The objective of this study was to characterize the current epidemiological profile of patients with CM observed at the HC of the UFG from 1998 to 2010. Methods In total, 939 patient records were analyzed, and age, gender, place of birth, serology, symptoms and radiological classification according to Rezende et al. were analyzed. Results The median patient age was 55 years. Male patients were more (54%) prevalent than female patients. The prevalence of younger patients (less than 31 years of age) was 4.2%, but 82.1% of the younger patients were from State of Bahia. Patients older than 40 years were the majority (85.5%). The radiological groups were distributed as follows: Group I (35.9%), Group II (32.9%), Group III (17%) and Group IV (14.2%). Conclusions Compared with previous studies by the same group in 1975, 1994 and 1995, the number of younger patients decreased, and the frequency curve has shifted to older patients. .

Dispepsia em pacientes com hipertensão porta submetidos à esclerose endoscópica de varizes esofagianas: relação com aspectos endoscópicos do estômago / Dyspepsia in patients with portal hypertension undergone esophageal scleroteraphy: correlation with gastric endoscopic findings

Objetivo: avaliar a associação entre dispepsia e alterações endoscópicas do estômago em pacientes com hipertensão portal em tratamento endoscópico de varizes esofagianas. Métodos: a partir da demanda espontânea do programa de tratamento endoscópico de varizes esofágicas do Hospital das Clínicas da UFG, 65 pacientes responderam a um questionário validado (PADYQ) sobre sintomas dispépticos e foram submetidos a EDA (Endoscopia Digestiva Alta) por endoscopista que não teve acesso às informações sobre os sintomas. Os achados endoscópicos do estômago foram correlacionados com os escores dos sintomas dispépticos. Resultados: 22 pacientes (33,84%) com sintomas Dispépticos não tiveram alterações endoscópicas. Por outro lado, foram demonstradas alterações na mucosa antral (erosões ou úlcera) em 13 pacientes (20,0%) que não apresentavam sintomas dispépticos. A correlação entre sintomas dispépticos e achados endoscópicos do antro gástrico não demonstrou significância estatística. Conclusão: sintomas dispépticos em pacientes com HP independem da intensidade de alterações endoscópicas na mucosa gástrica, sugerindo que achados endoscópicos em pacientes que se queixam de sintomas dispépticos não devem ser supravalorizados.

Objective: to evaluate the association between dyspepsia and gastric endoscopic alterations in patients with portal hypertension undergone sclerotherapy. Methods: during the normal attendances on the program of esophageal varices treatment in Hospital das Clinica in the Universidade Federal de Goiás, 65 patients answered a validated dyspeptic symptoms questionnaire. The gastric endoscopic findings including portal hypertension gastropathy and antral mucosa alterations were compared with the dyspeptic symptoms score. Results: 22 patients (33.84%) with dyspeptic symptoms didn?t show endoscopic alterations. In the other hand; alterations in the antral mucosa (erosions or ulcers) were demonstrated in 13 patients (20.0%) that didn?t present any symptoms of dyspepsia. There was no correlation between dyspeptic symptoms score and endoscopic findings. Conclusion: dyspeptic symptoms in patients with portal hypertension are not correlated with the intensity of gastric endoscopic abnormalities.

Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine.

CONTEXT: Recent studies support the hypothesis that postinfectious irritable bowel syndrome and some irritable bowel syndrome patients display persistent signs of minor mucosal inflammation. Mesalazine has intestinal anti-inflammatory properties including cyclooxygenase and prostaglandin inhibition. The effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome patients are still unknown. OBJECTIVE: To observe the effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients. METHODS: Based on Rome III criteria, 61 irritable bowel syndrome with diarrhea patients (18 years old or more) were included in the evaluation. Patients were divided into two groups: postinfectious irritable bowel syndrome group, with 18 patients medicated with mesalazine 800 mg 3 times a day for 30 days; noninfective irritable bowel syndrome group, with 43 patients medicated with mesalazine 800 mg 3 times a day for 30 days. Symptom evaluations at baseline and after treatment were performed by means of a four-point Likert scale including stool frequency, stool form and consistency (Bristol Stool Scale), abdominal pain and distension (maximum score: 16; minimum score: 4). RESULTS: Postinfectious irritable bowel syndrome group presented a statistically significant reduction of the total symptom score (P<0.0001). The stool frequency was significantly reduced (P<0.0001), and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distension were significantly reduced (P<0.0001). Noninfective irritable bowel syndrome group presented a statistically significant reduction of total symptom score (P<0.0001). Also, the stool frequency was significantly reduced (P<0.0001) and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distention were significantly reduced (P<0.0001). There was no statistical difference between postinfectious irritable bowel syndrome group and noninfective irritable bowel syndrome group on total symptom score results at 30th day of therapy with mesalazine 800 mg 3 times a day. (P = 0.13). CONCLUSION: Mesalazine reduced key symptoms of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients.

Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine / Tratamento da síndrome do intestino irritável pós-infecciosa e da síndrome do intestino irritável não-infecciosa com mesalazina

CONTEXT: Recent studies support the hypothesis that postinfectious irritable bowel syndrome and some irritable bowel syndrome patients display persistent signs of minor mucosal inflammation. Mesalazine has intestinal anti-inflammatory properties including cyclooxygenase and prostaglandin inhibition. The effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome patients are still unknown. OBJECTIVE: To observe the effects of mesalazine on postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients. METHODS: Based on Rome III criteria, 61 irritable bowel syndrome with diarrhea patients (18 years old or more) were included in the evaluation. Patients were divided into two groups: postinfectious irritable bowel syndrome group, with 18 patients medicated with mesalazine 800 mg 3 times a day for 30 days; noninfective irritable bowel syndrome group, with 43 patients medicated with mesalazine 800 mg 3 times a day for 30 days. Symptom evaluations at baseline and after treatment were performed by means of a four-point Likert scale including stool frequency, stool form and consistency (Bristol Stool Scale), abdominal pain and distension (maximum score: 16; minimum score: 4). RESULTS: Postinfectious irritable bowel syndrome group presented a statistically significant reduction of the total symptom score (P<0.0001). The stool frequency was significantly reduced (P<0.0001), and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distension were significantly reduced (P<0.0001). Noninfective irritable bowel syndrome group presented a statistically significant reduction of total symptom score (P<0.0001). Also, the stool frequency was significantly reduced (P<0.0001) and stool consistency, improved (P<0.0001). Abdominal pain (P<0.0001) and abdominal distention were significantly reduced (P<0.0001). There was no statistical difference between postinfectious irritable bowel syndrome group and noninfective irritable bowel syndrome group on total symptom score results at 30th day of therapy with mesalazine 800 mg 3 times a day. (P = 0.13). CONCLUSION: Mesalazine reduced key symptoms of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with diarrhea patients.

CONTEXTO: Estudos recentes sustentam a hipótese que a síndrome do intestino irritável pós-infecciosa e alguns pacientes com síndrome do intestino irritável mostram sinais menores de inflamação persistente da mucosa. A mesalazina tem propriedades anti-inflamatórias intestinais, incluindo a inibição da ciclooxigenase e das prostaglandinas. Os efeitos da mesalazina na síndrome do intestino irritável pós-infecciosa e em pacientes com síndrome do intestino irritável não-infecciosa ainda são desconhecidos. OBJETIVO- Observar os efeitos da mesalazina em pacientes com síndrome do intestino irritável pós-infecciosa e síndrome do intestino irritável com diarréia não-infecciosa. MÉTODOS: Com base nos critérios de Roma III, 61 pacientes síndrome do intestino irritável acompanhado de diarréia (18 anos ou mais de idade) foram incluídos na avaliação. Os pacientes foram divididos em dois grupos: grupo síndrome do intestino irritável pós-infecciosa, com 18 pacientes medicados com mesalazina 800 mg 3 vezes ao dia por 30 dias; grupo síndrome do intestino irritável não-infecciosa, com 43 pacientes medicados com mesalazina 800 mg 3 vezes ao dia por 30 dias. Avaliações dos sintomas no início e após o tratamento foram realizadas por meio de uma escala Likert de 4 pontos, incluindo a frequência das evacuações, forma e consistência das fezes (Bristol Stool Scale), dor e distensão abdominal (pontuação máxima: 16; pontuação mínima: 4). RESULTADOS: O grupo síndrome do intestino irritável pós-infecciosa apresentou redução estatisticamente significante do escore total de sintomas (P<0,0001). A frequência de evacuações foi significativamente reduzida (P<0,0001) e a consistência das fezes melhoraram (P<0,0001). Dor abdominal (P<0,0001) e distensão abdominal foram significativamente reduzidas (P<0,0001). O grupo síndrome do intestino irritável não-infecciosa apresentou redução estatisticamente significante do escore total de sintomas (P<0,0001). Além disso, a frequência de fezes foi significativamente reduzida (P<0,0001) e a consistência das fezes melhoraram (P<0,0001). Dor abdominal (P<0,0001) e distensão abdominal foram significativamente reduzidas (P<0,0001). Não houve diferença estatística entre o grupo síndrome do intestino irritável pós-infecciosa e o grupo síndrome do intestino irritável não-infecciosa sobre os resultados da pontuação total dos sintomas em 30 dias de terapia com mesalazina 800 mg 3 vezes ao dia (P= 0,13). CONCLUSÃO: O uso de mesalazina reduziu os principais sintomas da síndrome do intestino irritável pós-infecciosa e da síndrome do intestino irritável com diarréia não-infecciosa.

Diagnóstico, manejo y tratamiento de la afectación digestiva en la fase crónica de la enfermedad de Chagas en países no endémicos / Diagnosis, management and treatment of chronic Chagas' gastrointestinal disease in areas where Trypanosoma cruzi infection is not endemic

La infección por Trypanosoma cruzi (T. cruzi), agente responsable de la enfermedad de Chagas, ha estado tradicionalmente ligada a las zonas rurales de América Latina, donde es transmitido por diversas especies de chinches. Esta situación epidemiológica ha ido cambiando en el transcurso de las últimas décadas, de forma que en la actualidad la enfermedad de Chagas es una patología importada diagnosticada a nivel urbano y un problema de salud pública en países no endémicos con gran número de población inmigrante, dónde la transmisión se puede producir durante el embarazo/parto, por transfusión sanguínea o por transplante de órganos. Se estima que hasta un 20% de los pacientes con infección por T. cruzi presentan afectación del aparato digestivo, que causa importante morbilidad y que requiere un manejo y tratamiento adecuado. En el presente documento se aborda el diagnóstico, manejo y tratamiento de las manifestaciones digestivas de pacientes con infección por T. cruzi en nuestro medio (AU)

Trypanosoma cruzi (T. cruzi) infection, causal agent of Chagas’ disease, has been traditionally limited to rural areas of Latinamerica, where it is transmitted by insects belonging to different species of bugs. Due to recent trends in migration, Chagas disease is now a public health problem in urban areas of endemic countries and in non endemic countries as well, where the transmission via blood products, transplantation of infected organs, or vertical transmission is possible. It is estimated that 20% of individuals infected with T. cruzi might develop symptomatic gastrointestinal disease, which causes important morbidity and needs an adequate management and treatment. The aim of this document is to improve patient care by increasing understanding among physicians and other healthcare professionals who may be involved in the management of patients infected by T. cruzi who present with gastrointestinal symptoms (AU)

Electrogastrography in patients with Chagas' disease.

Electrogastrograghy (EGG) was performed in 33 patients with Chagas' disease and in 15 healthy volunteers-control group. The EGG was performed in two different periods: in fasting and postprandial. The EGG was submitted to a continuous spectral analysis. The following parameters were evaluated: % dominant frequency in spectral bands: normogastria (2-4 cpm), bradygastria (1-2 cpm), tachygastria (4-10 cpm) and duod/resp (10-15 cpm). EGG was considered normal if normogastria > 65% in both EGG periods. The chagasic group showed % normogastria significantly lower (basal, P < 0.01), % bradygastria (basal, P = 0.01) and % tachygastria (basal and postprandial, P =.001) significantly higher than the control group. EGG was normal in 14/15 (93%) in control group x 16/33 (53%) in chagasic group (P < 0.05). It was concluded that: 1) the prevalence of gastric dysrhythmias was higher in chagasic patients than in comparison to a control group 2) gastric dysrhythmias may be considered one of the abnormalities presented in the chagasic gastropathy.

Estudo da atividade mioelétrica gástrica por eletrogastrografia cutânea: eletrogastrograma / Myoeletric gastric activity through cutaneous electrogastrography: electrogastrogram

O eletrogastrograma foi realizado em nove voluntários sadios e em 43 pacientes com várias situaçöes clínicas associadas a distúrbios motores gástricos, incluindo: 24 com dispepsia funcional, nove com diabetes mellitus, cinco com náuseas/vômitos, três com gastropatia obstrutiva, um com gastroparesia pós-vagotomia e um com atonia gástrica. O sinal do eletrogastrograma era registrado em dois períodos de uma hora: pré-prandial e após ingestäo de refeiçäo de prova. A freqüência dominante e intensidade do sinal do eletograstrograma foram avaliadas por análise espectral de freqüência. O curso ao longo do tempo da freqüência dominante foi avaliado por gráfico pseudotridimensional. A freqüência dominante foi dividida em quatro faixas: 1) bradigastria (0-2,4 cpm); 2) normal (2,4 a 3,9); 3) taquigastria (4 a 9,9); e 4) duod-rep (10-15) e determinada a percentagem de distribuiçäo da freqüência dominante do eletrogastrograma entre as quatro faixas. O eletrogastrograma foi considerado normal se a freqüência dominante normal estivesse presente em mais de 65 por cento do período. Apresentaram eletrogastrograma normal: 9/9 voluntários sadios, 3/3 gastropatia obstrutiva, 4/5 náusea e vômitos, 3/9 diabetes mellitus, 13/24 dispepsia funcional. Apresentaram disritmia gástrica em mais de 35 por cento do período: 1/5 náusea e vômitos, 6/9 diabetes mellitus, 11/24 dispepsia funcional, uma gastroparesia pós-vagotomia, um atonia gástrica. Apresentaram taquigastria em mais de 10 por cento do eletrogastrograma: 1/5 náusea e vômitos, 1/1 atonia gástrica 1/1 gastroparesia pós-vagotomia 6/9 diabetes mellitus, 6/24 dispepsia funcional. Concluiu-se que o eletrogastrograma é um método näo invasivo capaz de registrar satisfatoriamente a atividade mioelétrica gástrica e as disritimias gástricas. Pacientes com distúrbios motores gástricos, com sintomas dispépticos crônicos ou com náuseas podem apresentar disritmias gástricas transitórias ou prolongadas. O eletrogastrograma pode ser considerado um método näo invasivo útil na avaliaçäo da funçäo motora gástrica

Estudo cintilográfico do esvaziamento da vesícula biliar na doença de Chagas crônica / Scintigraphic study of gallbladder emptying in chronic Chagas' disease

Estudos anteriores sobre a motilidade da vesícula biliar na doença de Chagas têm apresentado resultados conflitantes. Este estudo reavalia esta questäo, determinando o esvaziamento da vesícula de pacientes chagásicos crônicos, em respostaà ceruleína, pelo emprego de um método cintilográfico quantitativo. Pacientes chagásicos (n = 18) e controles (n = 12) foram submetidos a estudo cintilográfico do esvaziamento da vesícula biliar em resposta à injeçäo intra-venosa de ceruleína (60 ng/Kg) feita 90 minutos após a administraçäo de 99mTc-HIDA. Cinco minutos antes e logo antes da injeçäo de ceruleína foram obtidas imagens da vesícula biliar em gamacâmera acoplada a computador, o que foi repetido a cada 5 minutos, até 45 minutos após a aplicaçäo do estímulo. As contagens obtidas em regiöes de interesse correspondentes à vesícula biliar, permitiram calcular a fraçäo de ejeçäo do orgäo, bem como compor curvas individuais do esvaziamento da vesícula biliar. Os valores da fraçäo de ejeçäo obtidos na amostra global de pacientes chagásicos (mediana 67,8%, variaçäo de 4,0 a 99,0%) foram maiores que os verificados no grupo controle (mediana: 34,2%; variaçäo de 13,1 a 88,0%), mas a diferença näo atingiu significância estatística (p > 0,05). Entretanto a análise qualitativa das curvas individuais dos pacientes chagásicos sugeriu a existência de dois subgrupos. Em um deles (n = 9), as curvas foram muito semelhantes as dos controles. No outro subgrupo (n = 9) as curvas indicaram um esvaziamento muito rápido e intenso. Estes resultados sugerem que o comprometimento da vesícula biliar na doença de Chagas pode levar a heterogeneidade dos padröes de alteraçäo da motilidade do órgäo, ressaltando-se um conjunto de pacientes em que há hipersensibilidade a um agente colecistocinético exógeno

Efeito do dinitrato de isosorbitol na pressäo do esfíncter inferior do esôfago de pacientes com doença de Chagas / Effect of isosorbide dinitrate on the lower esophageal sphincter pressure of patients with Chagas' disease

Utilizando o método manométrico, estudamos o efeito do dinitrato de isosorbitol, na dose de 5 mg via sublingual, na pressäo do esfíncter inferior do esôfago de 28 pacientes com doença de Chagas e disfagia há mais de um ano. Dentre estes pacientes, cinco já haviam sido tratado (cardiomiotomia), mas continuavam com disfagia. A pressäo foi medida antes da administraçäo da droga e em intervalos de 5 minutos, após a sua administraçäo, até completar 60 minutos. A pressäo do esfíncter foi reduzida rapidamente pela droga, sendo a reduçäo significativa (p < 0,01) já aos 5 minutos, efeito que permaneceu até 60 minutos. Aos 20 minutos sómente dois paciente näo tiveram a pressäo reduzida a valores inferiores a 50% do valor basal. Os resultados indicam que, com o dinitrato de isosorbitol, existe a possibilidade do tratamento clínico do megaesôfago chagásico ser realizado com sucesso, a exemplo do que ocorre na acalásia idiopática