Instruções em bulas destinadas ao uso de medicamentos para dispepsia e constipação durante a lactação / Instructions in package inserts intended for the use of medicines for dyspepsia and constipation during lactation / Instrucciones en prospectos destinados al uso de medicamentos para la dispepsia y el estreñimiento durante la lactancia

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

Prevalence of irritable bowel syndrome and other functional gastrointestinal disorders in Uruguay.

INTRODUCTION AND AIMS: Irritable bowel syndrome (IBS) is one of the most frequent functional gastrointestinal disorders. Prevalence worldwide is estimated at 11%. There is little information on the prevalence of the other functional bowel disorders (FBDs). Our aim was to establish the prevalence of IBS and other FBDs according to the Rome IV criteria, in Uruguay. MATERIALS AND METHODS: An observational, population-based prevalence study was conducted. Data were collected through an online questionnaire, utilizing the Rome IV criteria. RESULTS: Of the 1,052 participants (79% women, mean patient age 44 years), 47.2% met the Rome IV diagnostic criteria for at least one of the FBDs analyzed. Functional constipation (FC) was the most frequent, at 18.7% (16.4-21.1), followed by IBS at 17.1% (14.9-19.4) and functional diarrhea (FD) at 15.4% (13.3-17.6). IBS with constipation (IBS-C) was the most frequent IBS subtype (35%) and the IBS with diarrhea (IBS-D) subtype predominated in men. All FBDs were more prevalent in women and youths. Of the survey participants with a FBD, 59% stated that they perceived no worsening of their symptoms related to the COVID-19 pandemic. CONCLUSIONS: Ours is the first prevalence study on FBDs conducted on the Uruguayan general population. Half of the participants surveyed presented with a FBD analyzed in the study. FC was the most frequent, followed by IBS and FD. The prevalence rate of IBS was the highest, based on the Rome IV diagnostic criteria, and constipation was the most frequent subtype.

Impacto de la terapia de biorretroalimentación en pacientes con incontinencia fecal o constipación en una unidad de neurofisiología gastrointestinal en Bogotá, D.C / Impact of biofeedback therapy on patients with fecal incontinence or constipation in a gastrointestinal neurophysiology unit in Bogotá, D.C

RESUMEN Introducción: El tratamiento de los trastornos funcionales de la unidad anorrectal debe centrarse en la causa subyacente. La terapia de biorretroalimentación es un reentrenamiento funcional del suelo pélvico que ha demostrado su utilidad en el tratamiento del estreñimiento asociado a la disinergia y en el manejo de la incontinencia fecal. Este estudio describe las primeras experiencias con esta forma de terapia de biorretroalimentación en Colombia. Objetivo: Describir nuestra experiencia con la terapia de biorretroalimentación en la unidad de neurofisiología gastrointestinal. Materiales y métodos: Esta cohorte histórica incluyó pacientes con indicación de terapia de biorretroalimentación por estreñimiento o incontinenciafecalenlaunidaddeneurofisiologíagastrointestinalenelperiododerecolección de datos. Se describe la respuesta a la terapia comparando los hallazgos manométricos antes y después de 10 sesiones de biorretroalimentación. Resultados: Se incluyó a 21 pacientes (71,4% mujeres, el promedio de edad fue de 68, 9 con estreñimiento y 12 con incontinencia fecal. Entre los pacientes con estreñimiento hubo una mejoría significativa en el 71,4% de los que tenían hiposensibilidad rectal y en el 57,1% de los que tenían disinergia. La terapia de biorretroalimentación aumentó significativamente la tasa de expulsión del balón (11,1 frente a 66,7%, p=0,02). En pacientes con incontinencia fecal, hubo mejoría en el 50% de los que tenían hipotonía anal y en el 80% de los que tenían hiposensibilidad anal. Conclusiones: Este estudio demuestra que la terapia de biorretroalimentación tiene un impacto favorable en un alto número de pacientes con estreñimiento e incontinencia fecal, en nuestro centro, la respuesta es similar a la de la literatura mundial.

ABSTRACT Introduction: Treatment of functional disorders of the anorectal unit should focus on the underlying cause. Biofeedback therapy is a functional retraining of the pelvic floor that has proven useful in the treatment of constipation associated with dyssynergia and in the management of fecal incontinence. This study describes the first experiences with this form of biofeedback therapy in Colombia. Objective: Describe our experience with biofeedback therapy in the gastrointestinal neurophysiology unit. Materials and methods: This historical cohort included patients with an indication for biofeedback therapy for constipation or fecal incontinence in the gastrointestinal neurophysiology unit during the data collection period. The response to therapy is described by comparing manometric findings before and after 10 biofeedback sessions. Results: 21 patients were included (71.4% women, the average age was 68, 9 with constipation and 12 with fecal incontinence. Among the patients with constipation there was a significant improvement in 71.4% of those who had rectal hyposensitivity and in 57.1% of those with dyssynergia. Biofeedback therapy significantly increased the balloon expulsion rate (11.1 vs. 66.7%, p=0.02). In patients with fecal incontinence, there was improvement in 50% of those who had anal hypotonia and in 80% of those who had anal hyposensitivity. Conclusions: This study demonstrates that biofeedback therapy has a favorable impact on a high number of patients with constipation and fecal incontinence; in our center, the response is similar to that of the world literature.

Efficacy and safety of lubiprostone for the treatment of chronic idiopathic constipation: A phase 3, randomized, placebo-controlled study.

INTRODUCTION: Chronic idiopathic constipation (CIC) negatively impacts quality of life and increases healthcare costs. Lubiprostone stimulates the secretion of intestinal fluid, in turn facilitating the passage of stools and alleviating associated symptoms. Lubiprostone has been available in Mexico since 2018, but its clinical efficacy has not been studied in a Mexican population. AIM: To evaluate the efficacy of lubiprostone, assessed by changes in spontaneous bowel movement (SBM) frequency after one week of treatment with 24 µg oral lubiprostone (b.i.d.), as well as its safety, over four weeks of treatment. STUDY: Randomized, double-blind, placebo-controlled study on 211 adults with CIC in Mexico. RESULTS: The increase in SBM frequency, after one week of treatment, was significantly higher in the lubiprostone group than in the placebo group (mean: 4.9 [SD: 4.45] vs. 3.0 [3.14], p = 0.020). Secondary efficacy endpoints revealed a significantly higher proportion of SBM frequency/week in the lubiprostone group at weeks 2, 3, and 4. There was a better response within 24 h after the first dose with lubiprostone vs. placebo (60.0% vs. 41.5%; OR: 2.08, CI95%: [1.19, 3.62], p = 0.009) and the lubiprostone group also had significant improvement, with respect to straining, stool consistency, abdominal bloating, and Satisfaction Index. The main adverse events were gastrointestinal disorders in 13 (12.4%) lubiprostone-treated subjects and 4 (3.8%) control subjects. CONCLUSIONS: Our data confirm the efficacy and safety of lubiprostone for the treatment of CIC in a Mexican population. Lubiprostone treatment induces relief from the most bothersome symptoms associated with constipation.

Percepciones sobre el manejo nutricional del estreñimiento idiopático en el adulto mayor / Perceptions on the Nutritional Management of Idiopathic Constipation in the Elderly

Introducción: Los adultos mayores son la población más propensa a presentar desórdenes gastrointestinales, específicamente y en mayor proporción el estreñimiento idiopático. La alimentación es un factor clave, pero poco estudiado a la hora de tratar el estreñimiento. Objetivo: Comprender las diferentes percepciones por parte de los profesionales de la salud, los cuidadores y el adulto mayor acerca del manejo del estreñimiento idiopático, desde un enfoque alimentario, teniendo en cuenta las preferencias y gustos en el adulto mayor institucionalizado de Medellín. Métodos: La técnica de generación de la información se realizó a través de grupos focales, efectuando seis grupos: uno conformado por los profesionales del área de la salud, tres por los adultos mayores y dos por los cuidadores. Resultados: Se identificó que una de las recomendaciones que más se repite es el incremento del aporte de fibra y líquidos. En general, los adultos mayores tienen poca adherencia a las estrategias nutricionales para el manejo del estreñimiento, ya que los alimentos que se les ofrecen no se adecuan a sus preferencias. Conclusiones: No existe una percepción unánime en el personal de salud y los cuidadores con respecto a la efectividad del tratamiento nutricional para el manejo del estreñimiento en el adulto mayor; sin embargo, se identificaron testimonios exitosos sobre el uso de algunas frutas, la inclusión de fibra en la dieta y el aumento en el consumo de líquidos(AU)

Introduction: Older adults are the population most likely to present with gastrointestinal disorders specifically and idiopathic constipation to a greater extent. Diet is a key factor, but it has been little studied when it comes to treating constipation. Objective: To understand the different perceptions by health professionals, caregivers and older adults about the management of idiopathic constipation, from a dietary approach, taking into account the preferences and tastes of institutionalized older adults in Medellín. Methods: The information generation technique was carried out through focus groups, establishing six groups: one made up of health professionals, three for older adults and two for caregivers. Results: It was identified that one of the most repeated recommendations is to increase the intake of fiber and fluids. In general, older adults have poor adherence to nutritional strategies for managing constipation, since food offered to them do not suit their preferences. Conclusions: There is no unanimous perception among health personnel and caregivers regarding the effectiveness of nutritional treatment for the management of constipation in older adults; however, successful testimonies were identified regarding the use of some fruits, the inclusion of fiber in the diet and the increase in fluid consumption(AU)

Prolapso rectal completo / Complete Rectal Prolapse

Introducción: El prolapso rectal completo es la invaginación de las capas del recto a través del canal anal y su protrusión fuera de este. Su incidencia es de 2,5 por 100 000 habitantes con predominio en mujeres de edad avanzada. Es una afección de curso crónico y benigno, cuya presentación clínica y endoscópica es tan variable que puede confundirse con otras entidades como con el cáncer colorrectal. Objetivo: Presentar el caso de una paciente femenina, operada de prolapso rectal completo en la provincia de Cienfuegos. Presentación de caso: Se presenta una paciente femenina de 76 años de edad, blanca, de procedencia rural que acude a la consulta y refiere que lleva 12 días sin defecar. Además, presenta dolor, sangramiento rectal no activo y una masa que protruía a través de la región anal sugestiva al examen físico de un prolapso rectal completo. El tacto rectal confirma el diagnóstico. Se realiza reducción quirúrgica del prolapso por técnica de Delorme. Actualmente lleva 6 meses de operada con evolución favorable. Por lo poco frecuente de esta entidad se considera de interés científico su publicación. Conclusión: Esta entidad es poco común en el entorno médico, el gran cambio que causa en el nivel de vida de aquellos que la portan y sus complicaciones hace que requiera un tratamiento rápido y oportuno(AU)

Introduction: Complete rectal prolapse is the invagination of the rectal layers through the anal canal and its protrusion out of it. Its incidence is 2.5 per 100,000 inhabitants, predominantly in elderly women. It is a chronic and benign condition, whose clinical and endoscopic presentation is so variable that it can be confused with other entities, such as colorectal cancer. Objective: To present the case of a female patient who underwent surgery for complete rectal prolapse in the province of Cienfuegos. Case presentation: A 76-year-old female patient, white, from a rural area, came to the clinic and reported that she had not defecated for 12 days. In addition, she presents pain, nonactive rectal bleeding and a mass protruding through the anal region suggestive, on physical examination, of a complete rectal prolapse. Digital rectal examination confirmed the diagnosis. Surgical reduction of the prolapse was performed using the Delorme technique. She has undergone surgery for 6 months now, with favorable evolution. Due to the rarity of this entity, its publication is considered as scientifically interesting. Conclusion: This entity is uncommon in the medical environment. The great change that it causes in the living standards of those who carry it and its complications make it require a quick and timely treatment(AU)

Diferencias en la duración del reflejo rectoanal inhibitorio en pacientes con constipación funcional refractaria y mielomeningocele / Differences in rectoanal inhibitory reflex duration between patients with refractory functional constipation and myelomeningocele

Introducción. Habitualmente, durante la manometría anorrectal, en lo correspondiente al reflejo rectoanal inhibitorio (RRAI) solo se pesquisa su presencia o ausencia. Estudios han reportado que su análisis detallado puede brindar datos de interés. Nuestra hipótesis es que la medición del RRAI puede dar información para reconocer causas orgánicas (médula anclada, lipoma, etc.) en pacientes en los que previamente se consideró como de causa funcional. Objetivos. Comparar la duración del reflejo rectoanal inhibitorio en la manometría anorrectal de pacientes con constipación funcional refractaria (CFR) y mielomeningocele (MMC). Población y métodos. Estudio observacional, transversal, analítico (2004-2019). Pacientes constipados crónicos con incontinencia fecal funcional y orgánica (mielomeningocele). Se les realizó manometría anorrectal con sistema de perfusión de agua y se midió la duración del RRAI con diferentes volúmenes (20, 40 y 60 cc). Grupo 1 (G1): 81 CFR. Grupo 2 (G2): 54 MMC. Se excluyeron pacientes con retraso madurativo, esfínter anal complaciente, agenesia sacra y aquellos no colaboradores. Resultados. Se incluyeron 135 sujetos (62 varones). La mediana de edad fue G1:9,57 años; G2: 9,63 años. Duración promedio G1 vs. G2 con 20 cc: 8,89 vs. 15,21 segundos; con 40 cc: 11.41 vs. 21,12 segundos; con 60 cc: 14,15 vs. 26,02 segundos. La diferencia de duración del RRAI entre ambos grupos con diferentes volúmenes fue estadísticamente significativa (p = 0,0001). Conclusión. La duración del RRAI aumenta a mayor volumen de insuflación del balón en ambas poblaciones. Pacientes con MMC tuvieron mayor duración del RRAI que aquellos con CFR. En los pacientes con RRAI prolongado, debe descartarse lesión medular.

Introduction. Usually, during anorectal manometry, only the presence or absence of rectoanal inhibitory reflex (RAIR) is investigated. Studies have reported that a detailed analysis may provide data of interest. Our hypothesis is that RAIR measurement may provide information to detect organic causes (tethered cord, lipoma, etc.) in patients in whom a functional cause had been previously considered. Objectives. To compare RAIR duration in anorectal manometry between patients with refractory functional constipation (RFC) and myelomeningocele (MMC). Population and methods. Observational, analytical, cross-sectional study (2004­2019). Patients with chronic constipation and functional and organic fecal incontinence (myelomeningocele). The anorectal manometry was performed with a water-perfused system, and the duration of RAIR was measured with different volumes (20, 40, and 60 cc). Group 1 (G1): 81 RFC. Group 2 (G2): 54 MMC. Patients with developmental delay, compliant anal sphincter, sacral agenesis and non-cooperative patients were excluded. Results. A total of 135 individuals were included (62 were male). Their median age was 9.57 years in G1 and 9.63 years in G2. Average duration in G1 versus G2 with 20 cc: 8.89 versus 15.21 seconds; 40 cc: 11.41 versus 21.12 seconds; 60 cc: 14.15 versus 26.02 seconds. The difference in RAIR duration with the varying volumes was statistically significant (p = 0.0001). Conclusion. RAIR duration was longer with increasing balloon inflation volumes in both populations. RAIR duration was longer in patients with MMC than in those with RFC. Spinal injury should be ruled out in patients with prolonged RAIR.

Functional constipation symptoms and complementary feeding methods: A randomized clinical trial.

INTRODUCTION: The aim of the study was to investigate the impact of different complementary feeding methods on the prevalence of functional constipation symptoms in infants at 12 months of age. MATERIAL AND METHODS: Randomized clinical trial in mother-infant dyads that underwent the intervention at 5.5 months post birth, randomly allocated to one of three complementary food introduction methods: PLW (parent-led weaning), Baby-led Introduction to SolidS (BLISS) and a mixed approach. The symptoms of constipation were assessed at 12 months with an online questionnaire based on the Rome IV diagnostic criteria and adapted to our sample. The data were summarised as absolute frequencies and percentages and compared by means of the χ2 test. The project was approved by the ethics committee of the Hospital de Clínicas de Porto Alegre under number 2019-0230. RESULTS: We analysed data corresponding to 135 infants, 45 allocated to PLW, 48 to BLISS and 42 to the mixed approach. The prevalence of constipation symptoms was 49.6% in the overall sample (n = 67), 60% (n = 27) in the PLW group, 47.9% (n = 23) in the BLISS group and 40.5% (n = 17) in the mixed approach group. We found no association between functional constipation symptoms and the method used to introduce complementary foods (P = .183). CONCLUSIONS: The prevalence of functional constipation symptoms was high in the study population. The presence of constipation symptoms was not associated with the complementary feeding approach.

Efficacy, safety, and acceptability of polyethylene glycol 3350 without electrolytes vs magnesium hydroxide in functional constipation in children from six months to eighteen years of age: A controlled clinical trial.

INTRODUCTION AND AIMS: There are few studies that compare polyethylene glycol (PEG) 3350 and magnesium hydroxide (MH), as long-term treatment of functional constipation (FC) in children, and they do not include infants as young as 6 months of age. Our aim was to determine the efficacy, safety, and acceptability of PEG vs MH in FC, in the long term, in pediatric patients. METHODS: An open-label, parallel, controlled clinical trial was conducted on patients from 6 months to 18 years of age, diagnosed with FC, that were randomly assigned to receive PEG 3350 or MH for 12 months. Success was defined as: ≥ 3 bowel movements/week, with no fecal incontinence, fecal impaction, abdominal pain, or the need for another laxative. We compared adverse events and acceptability, measured as rejected doses of the laxative during the study, in each group and subgroup. RESULTS: Eighty-three patients with FC were included. There were no differences in success between groups (40/41 PEG vs 40/42 MH, p = 0.616). There were no differences in acceptability between groups, but a statistically significant higher number of patients rejected MH in the subgroups > 4 to 12 years and > 12 to 18 years of age (P = .037 and P = .020, respectively). There were no differences regarding adverse events between the two groups and no severe clinical or biochemical adverse events were registered. CONCLUSIONS: The two laxatives were equally effective and safe for treating FC in children from 0.5 to 18 years of age. Acceptance was better for PEG 3350 than for MH in patients above 4 years of age. MH can be considered first-line treatment for FC in children under 4 years of age.

El consumo de dos kiwis diarios podría mejorar el hábito intestinal en personas con estreñimiento crónico / Daily consumption of two kiwifruits could improve bowel habits in people with chronic constipation

A partir del caso de una paciente con síndrome de intestino irritable a predominio de estreñimiento cuyos síntomas mejoraron con el consumo regular de kiwi, el médico de familia se planteó la pregunta de si el kiwi podría mejorar los síntomas asociados a constipación crónica en comparación con el tratamiento habitual. Tras realizar una búsqueda de estudios que analizaran los efectos del consumo de kiwi sobre el hábito intestinal, fueron seleccionados tres artículos que permiten concluir que el consumo de esta fruta tiene una eficacia superior al placebo y comparable al psyllium y las pasas de ciruela para mejorar los síntomas de personas con estreñimiento crónico. (AU)

Based on the case of a patient with constipation-predominant irritable bowel syndrome whose symptoms improved with regular consumption of kiwi, the family doctor wondered if kiwi could improve symptoms associated with chronic constipation compared to usual treatment. After conducting a search for studies that analyzed the effects of kiwi consumption on intestinal habit, three articles were selected that allow us to conclude that the consumption of this fruit has an efficacy superior to placebo and comparable to psyllium and plum raisins to improve the symptoms of people with chronic constipation. (AU)

Avaliação de constipação intestinal em estudantes de nível superior em uma universidade do extremo sul catarinense / Evaluation of intestinal constipation in higher level students at a university in the extreme south of catarina / Evaluación del estreñimiento intestinal en estudiantes de nivel superior de una universidad del extremo sur de catarina

Objetivo: Avaliar a presença de CI em estudantes das fases iniciais e finais dos cursos de Medicina, Nutrição e Engenharia Civil de uma Universidade no Extremo Sul Catarinense -Criciúma, através da ingestão alimentar e hídrica, dos tipos de fezes, se fazem uso, ou não, de alternativas de evacuação, comparando os hábitos alimentares com influência na constipação nos estudantes das três diferentes áreas. Método:Tal estudo foi realizado através de um questionário adaptado com questões sobre os hábitos de vida do indivíduo, juntamente com os critérios de Roma III, Roma IV e Escala de Bristol. Resultados:Caracterizou-se por 158 estudantes, sendo 71,5% (n=113) representam o sexo feminino e apenas 28,5% (n=45), o sexo masculino. A ingestão de líquidos demonstrou-se ser baixa, sendo 33,5% (n=53) ingerem mais que 1600ml/dia. Através da Escala de Bristol, 15,8% (n=25) revelaram evacuar o Tipo 1 e 2, caracterizando CI. Sobre os laxantes, apenas 3,2% (n=5) confirmaram a utilização. Foi verificada CI em 18,6% (n=21) das mulheres e 8,9% (n=4) dos homens. Conclusão:a alimentação destacou ser pobre em fibras. É notório que os estudantes sofrem com sintomas de CI. Através do auxílio de um profissional de nutrição, é necessário que equilibrem sua alimentação com fibras, consumem mais água diariamente e, consequentemente, auxiliem no bom funcionamento intestinal e na melhora da qualidade de vida.

Objective: To evaluate the presence of IC in students in the initial and final stages of Medicine, Nutrition and Civil Engineering courses at a University in the extreme south of Santa Catarina -Criciúma, through food and water intake, types of feces, whether they use, or no, of evacuation alternatives, comparing eating habits with influence on constipation in students from three different areas. Method: This study was carried out through a questionnaire answered with questions about the individual's life habits, together with the criteria of Rome III, Rome IV and Bristol Scale. Results: Characterized by 158 students, 71.5% (n=113) female and only 28.5% (n=45) male. Liquid intake was low, with 33.5% (n=53) ingesting more than 1600ml/day. Through the Bristol Scale, 15.8% (n=25) revealed to evacuate Type 1 and 2, characterizing CI. Regarding laxatives, only 3.2% (n=5) confirmed their use. CI was found in 18.6% (n=21) of women and 8.9% (n=4) of men. Conclusion:the highlighted diet is low in fiber. It is notorious that students suffer from HF symptoms. Through the help of a nutrition professional, it is necessary that they balance their diet with fiber, consume more water daily and, consequently, help in the good intestinal functioning and in the improvement of the qualityof life.

Objetivo:Evaluar la presencia de CI en estudiantes de las etapas inicial y final de las carreras de Medicina, Nutrición e Ingeniería Civil de una Universidad del extremo sur de Santa Catarina -Criciúma, a través de la ingesta de alimentos y agua, tipos de heces, si utilizan , o no, de alternativas de evacuación, comparando los hábitos alimentarios con influencia sobre el estreñimiento en estudiantes de las tres diferentes áreas. Método:Este estudio se realizó mediante un cuestionario adaptado con preguntas sobre el estilo de vida del individuo, junto con los criterios de Roma III, Roma IV y la Escala de Bristol. Resultados:Se caracterizó por 158 estudiantes, 71,5% (n=113) mujeres y sólo 28,5% (n=45) hombres. La ingesta de líquidos resultó ser baja, con un 33,5% (n=53) ingiriendo más de 1.600 ml/día. A través de la Escala de Bristol, el 15,8% (n=25) reveló evacuar Tipo 1 y 2, caracterizando CI. Respecto a los laxantes, sólo el 3,2% (n=5)confirmó su uso. La CI se verificó en el 18,6% (n=21) de las mujeres y en el 8,9% (n=4) de los hombres. Conclusión:la dieta era baja en fibra. Es notorio que los estudiantes padecen síntomas de CI. Con la ayuda de un profesional de la nutrición, es necesario que equilibren su dieta con fibra, consuman más agua diariamente y, en consecuencia, ayuden en el buen funcionamiento intestinal y en la mejora de la calidad de vida.

Significantes na fala de crianças e pais acerca da constipação intestinal funcional / Significantes en el habla de niños y padres sobre el estreñimiento intestinal funcional / Signifiers in children's and parents' speech surrounding functional intestinalconstipation / Significations du discours des enfants et des parents sur la constipation fonctionnelle

Objetivo: analisar, em 140 entrevistas, os significantes nas falas de crianças e pais acerca do sintoma da constipação intestinal funcional (CIF). Como a constipação na criança revela a subjetividade da mãe, do pai e/ou da crise do casal (ex-casal) parental? Estudo prospectivo-qualitativo, com quatorze crianças, utilizando a técnica Psicanalítica. Os pacientes foram encaminhados pelo setor de Gastroenterologia e Hepatologia Pediátricas (UFBA). As narrativas dos pacientes revelaram ideias inconscientes referentes à pulsão anal, à relação da criança com as fezes, denunciaram como a CIF na criança evidencia a subjetividade da mãe, relação controle mãe-filho, crise do casal (ex-casal) parental, função paterna frágil. O código lúdico-discurso, instrumento fundamental na pesquisa, apareceu 126 vezes. Os pacientes que aderiram ao tratamento (n=10) apresentaram melhora significativa; sete obtiveram a cura do sintoma

Analizar, en 140 entrevistas, los significantes acerca del síntoma de la constipación intestinal funcional (CIF).¿Cómo el estreñimiento en los niños revela la subjetividad de la madre, del padre y/o de la crisis de la pareja parental (ex pareja)? Estudio prospectivo-cualitativo, con catorce niños, utilizando la técnica Psicoanalítica. Los pacientes fueron remitidos por el Servicio de Gastroenterología y Hepatología Pediátrica de la UFBA. Las narraciones de los pacientes revelaron ideas inconscientes sobre la pulsión anal, la relación del niño con las heces, cómo la CIF del niño subraya la subjetividad de la madre, relación de control madre-hijo, crisis de la pareja parental (ex pareja) y frágil función paterna. El código lúdico-habla, herramienta fundamental en la investigación, apareció 126 veces. Diez pacientes adherentes mostraron mejora significativa; siete fueron curados

Analyse the signifiers in 140 interviewees' speeches surrounding the symptom of functional intestinal constipation (FIC). How does children's constipation reveal the subjectivity of the mother, the father and/or the crisis of the parental couple (ex-couple)? Prospective-qualitative study, with fourteen children, using the Psychoanalytic technique. The patients, diagnosed with FIC, were referred by the Pediatric Gastroenterology and Hepatology sector at UFBA.The patients' narratives revealed unconscious ideas about the anal drive, the child's relationship with faeces, how FIC in the child highlights the mother's subjectivity, mother-child control relationship, the crisis of the parental couple (ex-couple) and the fragile paternal function. The ludic-discourse code, a fundamental tool in the research, appeared 126 times. All patients that adhered to the treatment (n=10) presented substantial enhancement, among those seven achieved the symptom's cure

Analyser, dans 140 entretiens, les signifiants à propos du symptôme de la constipation fonctionnelle (CF). Comment la constipation chez l'enfant révèle la subjectivité maternelle, du père et/ou de la crise du couple parental (ex-couple)? Étude prospective-qualitative, avec quatorze enfants, utilisant la technique Psychanalytique. Les patients ont été adressés par le service de Gastro-entérologie et d'Hépatologie Pédiatrique (UFBA). Les récits ont révélé des idées inconscientes concernant la pulsion anale, la relation de l'enfant avec les matières fécales, comment la CIF de l'enfant met en évidence la subjectivité de la mère, relation de contrôle mère-enfant, crise du couple parental (ex-couple) et fonction paternelle fragile. Le code ludic-discours, outil fondamental de la recherche, est apparu 126 fois. Dix patients adhérents ont montré une amélioration significative; sept ont obtenu la guérison du symptôme

Procedimiento de malone videoasistido en pediatria: primeros dos casos en Uruguay / Laparoscopic malone procedure in pediatrics: first cases in Uruguay / Procedimento de malone videoassistido em pediatria: dois primeiros casos no Uruguai

El procedimiento de apendicostomía continente para la realización de enemas anterógrados ha sido publicado ya hace varios años para el tratamiento de la incontinencia fecal y del estreñimiento de muy difícil manejo. Otra indicación del mismo incluye el estreñimiento severo, en el cual se agotaron las medidas farmacológicas y el único tratamiento efectivo es la realización de enemas. El objetivo principal del procedimiento es ofrecer a los niños y sus familias una alternativa a la hora de realizar los enemas, logrando una mayor adherencia al tratamiento y buscando alcanzar una mejor calidad de vida que permita adecuarse a las actividades con sus pares. Por otra parte permite al niño ir logrando cierta independencia gradual a medida que crezca, preparándolos para el futuro y haciéndolos participes activos de su cuidado. Se describen los primeros casos en donde utilizamos en nuestro medio el abordaje laparoscópico, sus indicaciones, la técnica quirúrgica y los resultados iniciales. Hemos constatado como ventaja principal los beneficios del abordaje mínimamente invasivo, como la exploración completa de la cavidad abdominal, el menor dolor postoperatorio, cicatrices más pequeñas, menor creación de adherencias.

The appendicostomy procedure for performing antegrade enemas has been published several years ago for the treatment of fecal incontinence and constipation that are very difficult to manage. The Malone procedure is performed in our setting, especially in patients with fecal incontinence secondary to neurological disorders such as myelomeningocele using a conventional approach. Other indications of it is severe constipation, in which pharmacological measures have been exhausted and the only effective treatment is enemas. The main objective of the procedure is to offer children and their families an alternative when performing enemas, achieving greater adherence to treatment and seeking to achieve a better quality of life that allows them to adapt to the activities of their peers. On the other hand, it allows the child to achieve a certain gradual independence as they grow, preparing them for the future and making them active participants in their care. The first cases in which we use the laparoscopic approach, its indications, the surgical technique and the initial results are described. We think that its main advantage is the benefits of the minimally invasive approach, such as complete exploration of the abdominal cavity, less postoperative pain, smaller scars, and less creation of adhesions.

O procedimento de apendicostomia continente para a realização de enemas anterógrados foi publicado há vários anos para o tratamento de incontinência fecal e constipação de difícil manejo. Outra indicação inclui constipação grave, na qual as medidas farmacológicas foram esgotadas e o único tratamento eficaz são os enemas. O principal objetivo do procedimento é oferecer às crianças e seus familiares uma alternativa na realização dos enemas, alcançando maior adesão ao tratamento e buscando alcançar uma melhor qualidade de vida que lhes permita adaptar-se às atividades com seus pares. Por outro lado, permite que a criança alcance uma certa independência gradual à medida que cresce, preparando-a para o futuro e tornando-a participante ativa em seus cuidados. São descritos os primeiros casos em que utilizamos a via laparoscópica, suas indicações, a técnica cirúrgica e os resultados iniciais. Confirmamos os benefícios da abordagem minimamente invasiva como principal vantagem, como exploração completa da cavidade abdominal, menos dor pós-operatória, cicatrizes menores e menor formação de aderências.

Trastornos funcionales gastrointestinales. Cómo tratar sin medicar / Functional gastrointestinal disorders. How to manage them without medication

Los trastornos funcionales gastrointestinales (TFGI) se caracterizan por síntomas atribuibles al tracto gastrointestinal que no pueden ser explicados por anormalidades estructurales ni bioquímicas. Durante el primer año de vida, pueden generar mucho malestar en el lactante y preocupación en sus padres. Su diagnóstico se basa en criterios clínicos que expertos han determinado y en una historia clínica y un examen físico completo que descartan causas orgánicas. El objetivo de esta actualización es presentar estrategias para el manejo de los TFGI más frecuentes durante el primer año de vida: cólicos, regurgitaciones, disquecia y estreñimiento, bajo la visión de los nuevos conocimientos fisiopatológicos, que eviten los estudios y medicaciones innecesarias.

Functional gastrointestinal disorders (FGIDs) are characterized by symptoms attributable to the gastrointestinal tract that cannot be explained by the presence of structural or biochemical abnormalities. During the first year of life, FGIDs can cause great discomfort in infants and concern in their parents. The diagnosis of FGIDs is based on clinical criteria determined by experts and on a comprehensive case-taking process and physical exam to rule out organic causes. The objective of this update is to describe strategies for the management of the most frequent FGIDs during the first year of life: colics, regurgitations, dyschezia, and constipation, in light of new pathophysiological insights, to avoid unnecessary tests and medications.

Fecal bacterial microbiota in constipated patients before and after eight weeks of daily Bifidobacterium infantis 35624 administration.

INTRODUCTION AND AIM: In recent years, probiotics have been used in functional gastrointestinal disorders, including chronic constipation (CC). The effect of Bifidobacterium infantis strain 35624 on the gut microbiota of CC patients has not been previously studied. Our aim was to analyze the fecal microbiota of constipated patients, before and after consuming a single-strain probiotic (B. infantis strain 35624). MATERIALS AND METHODS: We used 16S rRNA gene high-throughput sequencing to analyze the fecal microbiota of female patients (n=13) with CC. Patients were instructed to ingest one capsule of Alflorex® (containing 1×109 CFUs/g B. infantis strain 35624) daily for eight weeks. Fecal samples were obtained at the baseline and end (final) of probiotic administration. RESULTS: Alpha diversity metrics did not differ between the baseline and final periods. The butyrate producer, Oscillospira, was the taxon most strongly correlated with amplicon sequence variants (R2=0.55, p<0.0001). Except for a few bacterial taxa, there were no significant differences in relative abundance between the baseline and final periods. Beta-diversity measures also showed limited evidence for the differences between the two time periods. CONCLUSIONS: The results suggest that the fecal bacterial microbiota remains stable in constipated women consuming a single-strain probiotic. Those findings may be helpful in better understanding probiotic functioning in patients with digestive disorders.

Effect of transcutaneous abdominal electrical stimulation in people with constipation due to spinal cord injuries: a pilot study / Efecto de la electroestimulación abdominal transcutánea sobre el estreñimiento en personas con lesión de la médula espinal: estudio piloto / Efeito da eletroestimulação abdominal transcutânea no quadro de constipação em pessoas com lesão medular: estudo piloto

ABSTRACT Objective: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). Method: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. Results: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Conclusion: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.

RESUMEN Objetivo: Evaluar el efecto de la electroestimulación abdominal (EE) sobre la frecuencia de las evacuaciones, la consistencia y la cantidad de heces en personas con estreñimiento debido a una lesión de la médula espinal (LME). Método: Estudio piloto experimental de tipo crossover-aleatorizado en dos grupos de tratamiento: convencional rehabilitación intestinal y convencional asociado a EE con Functional Electrical Stimulation (FES) de 8 y 20 Hz aplicados a los músculos abdominales. Se realizó un seguimiento de ambos grupos durante dos semanas con 30 minutos de sesión diaria de EE. Los participantes estaban hospitalizados en un instituto de rehabilitación de la ciudad de São Paulo. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: Diez personas con LME participaron en el estudio, la mayoría hombres (70%) con una edad media de 39 años (DE = 16,37). La EE asociada al tratamiento convencional demostró ser más eficaz en el aumento de la frecuencia de evacuación (p = 0,029) y la cantidad de heces (p = 0,031). Conclusión: La EE abdominal asociada al tratamiento convencional ayudó a aumentar la frecuencia de evacuación y la cantidad de heces en el contexto de estreñimiento en personas con LME. Este estudio piloto servirá de base para futuros ensayos clínicos con mayor muestreo y evidencia estadística.

RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.

Sintomas urinários e intestinais em crianças da rede pública de ensino fundamental / Urinary and intestinal symptoms in public elementary school children / Síntomas urinarios e intestinales en niños de escuelas primarias públicas

Objetivo:levantar a ocorrência de sintomas urinários e intestinais em crianças da rede pública de ensino fundamental da capital paranaense. Método: estudo quantitativo, exploratório-descritivo e de corte transversal. Amostra de pais/responsáveis que preencheram os seguintes instrumentos: Dysfunctional Voiding Scoring System; critérios de Roma IV; escala de Bristol. Análise realizada pelo IBM SPSS Statistics v.20.0. Os dados foram coletados no período de agosto a outubro de 2019. Os critérios de inclusão eram a criança estar matriculada e frequentando regularmente o ensino fundamental e a entrega do questionário preenchido ou parcialmente preenchido. Resultados: Foram entregues 458 questionários. Dos totalmente preenchidos, 51,9% era de meninas, e a de idade foi de 7,7 anos; 83% das crianças apresentaram algum sintoma urinário e/ou intestinal de baixa gravidade. Sem diferença significativa de sintomas entre sexos, e com acréscimo significativo de gravidade em crianças com 7 anos ou menos. Sintomas mais prevalentes: frequência miccional reduzida, frequência evacuatória reduzida, esforço evacuatório, urgência miccional e manobras de contenção; 39,6% das crianças apresentavam Constipação Intestinal Funcional. Disfunção vesical e intestinal em 35 crianças, a maior prevalência no sexo feminino. Conclusão: alta ocorrência de sintomas urinários e intestinais nas crianças. O sintoma mais prevalente foi constipação.

Objective:survey the occurrence of urinary and intestinal symptoms in children from public elementary schools in the capital of Paraná. Method: quantitative, exploratory-descriptive and cross-sectional study. Sample of parents/guardians who completed the following instruments: Dysfunctional Voiding Scoring System; Rome IV criteria; Bristol scale. Analysis performed by IBM SPSS Statistics v.20.0. Data were collected from August to October 2019. Inclusion criteria were the child being enrolled and regularly attending elementary school and the delivery of the completed or partially completed questionnaire. Results: 458 questionnaires were delivered. Of those fully completed, 51.9% were girls, and the age was 7.7 years; 83% of the children had some urinary and/or intestinal symptoms of low severity. There was no significant difference in symptoms between genders, and with a significant increase in severity in children aged 7 years and under. Most prevalent symptoms: reduced voiding frequency, reduced defecation frequency, defecation effort, voiding urgency and containment maneuvers; 39.6% of the children had Functional Intestinal Constipation. Bladder and bowel dysfunction in 35 children, the highest prevalence in females. Conclusion: high occurrence of urinary and intestinal symptoms in children. The most prevalent symptom was constipation.

Objetivo:relevar la ocurrencia de síntomas urinarios e intestinales en niños de escuelas primarias públicas de la capital paranaense. Método: estudio cuantitativo, exploratorio-descriptivo y de corte transversal. Muestra de padres/responsables que completaron los siguientes instrumentos: Dysfunctional Voiding Scoring System; criterios de Roma IV; escala de Bristol. Análisis realizado por el IBM SPSS Statistics v.20.0. Los datos fueron recopilados en el periodo de agosto a octubre de 2019. Los criterios de inclusión eran de niños matriculados y que frecuenten regularmente la escuela primaria y la entrega del cuestionario completo o parcialmente completo. Resultados: Se entregaron 458 cuestionarios. De los totalmente completos, 51,9 % era de niñas, y la de edad fue de 7,7 años; 83 % de los niños presentaron algún síntoma urinario y/o intestinal de baja gravedad. Sin diferencia significativa de síntomas entre sexos, y con incremento significativo de gravedad en niños de 7 años o menos. Síntomas más prevalentes: frecuencia miccional reducida, frecuencia evacuatoria reducida, esfuerzo evacuatorio, urgencia miccional y maniobras de contención; 39,6 % de los niños presentaban Constipación Intestinal Funcional. Disfunción vesical e intestinal en 35 niños, la mayor prevalencia en el sexo femenino. Conclusión: alta ocurrencia de síntomas urinarios e intestinales en niños. El síntoma más prevalente fue el estreñimiento.

Introducción de estudios de manometría anorrectal de alta resolución en Cuba. Primeros resultados / Introduction of high-resolution anorectal manometry in Cuba. First outcomes

Introducción: La manometría anorrectal de alta resolución ha permitido una mayor comprensión de la fisiopatología del daño motor y sensorial, que suelen tener los pacientes con disfunción del suelo pélvico. Objetivo: Ofrecer los resultados de la introducción de la técnica en Cuba, en un primer grupo de pacientes, la caracterización del mismo, los valores obtenidos para los parámetros de estudio y los diagnósticos más frecuentes. Material y Métodos: Se revisaron los registros de manometría anorrectal de alta resolución, realizados en el Laboratorio de Motilidad del CNCMA, entre septiembre de 2017 y junio de 2019. Se analiza el registro de los datos generales de los pacientes y los parámetros específicos de alta resolución. Se estudiaron 159 pacientes que constituyeron el universo de estudio, la mayoría fueron pacientes por encima de los 60 años. Se aplica la Clasificación de Londres para el diagnóstico del tipo de disfunción anorrectal resultante. Resultados: Predominio de sexo femenino. La indicación más frecuente para la prueba fue la incontinencia fecal, seguida en menor medida por el estreñimiento. En las mujeres fue frecuente el antecedente obstétrico o de intervención quirúrgica relacionada. La disinergia defecatoria más frecuente fue el tipo III. El diagnóstico de disfunción anorrectal más frecuente fueron los desórdenes del tono anal y la contractilidad. Conclusiones: La introducción de la técnica fue exitosa. Se introdujeron en Cuba los estudios de manometría anorrectal de alta resolución, lo que permitió mayor conocimiento del daño establecido en los pacientes a quienes se les realiza la prueba, siendo la IF la disfunción que resultó más frecuente en el estudio. Se obtuvieron por primera vez parámetros específicos de alta resolución en pacientes cubanos, lo que permitirá estandarizar la técnica a otros servicios y tendrá como consecuencia mayor calidad en el diagnóstico de estos pacientes(AU)

Introduction: High-resolution anorectal manometry has allowed a better understanding of the pathophysiology of motor and sensory damage in patients with pelvic floor dysfunction. Objective: To offer the outcomes of the introduction of the technique applied in a first group of patients in Cuba, as well as its characterization, the values obtained for the study parameters and the most frequent diagnoses. Material and Methods: The high-resolution anorectal manometry records, which were performed at the CNCMA Motility Laboratory between September 2017 and June 2019, were reviewed. The record of the patients´ general data and specific discharge parameters were analyzed. The London Classification was applied for the diagnosis of the resulting type of anorectal dysfunction. Results: A total of 159 patients were studied. There was a predominance of females over 60 years of age. The most common indication for the test was fecal incontinence, followed by constipation. Obstetric history or history of surgical intervention were frequent in women. Type III dyssynergia was the most frequent type of dyssynergic defection. The most frequent diagnoses of anorectal dysfunction were disorders of anal tone and contractility. Conclusions: The introduction of the technique was successful. It allowed the identification of the damaged structures, which led to a faster and more timely therapeutic decision-making for the patient. The London Classification was used in the diagnosis of dysfunction(AU)

Características clínico-epidemiológicas y percepción de los padres sobre el estreñimiento funcional en la infancia en una población hospitalaria

RESUMEN Introducción: El estreñimiento funcional (EF) en niños es un problema común, constituyendo un importante problema de salud. Objetivo: Caracterización clínico-epidemiológica y percepción de padres y/o cuidadores de niños de una consulta pediátrica sobre el EF en la infancia. Materiales y Métodos: Estudio observacional descriptivo de corte transverso, utilizando la entrevista con encuesta semiestructurada a cuidadores de niños de 2 a 10 años de una Unidad Pediátrica Ambulatoria. Resultados: sobre 374 encuestados 251(67%) niños estaba al cuidado de sus padres y provenían del departamento central. La frecuencia de EF fue de 4,8% (4.4% en preescolares y 5,1% en escolares). En escolares, predominó en varones. En niños con EF se refirió defecación dolorosa en 66,6 %, antecedente familiar de estreñimiento en 61%, ingesta excesiva de lácteos en 39% y 17% no consumía ninguna fruta o vegetal. El 55,5% de niños inició entrenamiento esfinteriano antes de los 24 meses. Se observó 11% de cuidadores sin escolaridad. Desde la percepción de los encuestados se consideró estreñimiento: esfuerzo defecatorio (27%), ausencia de defecación diaria (19,7%), deposiciones duras y dolorosas (34,4%) y necesidad de uso de laxantes (18,9%). 367/374 (98.1%) conocía los hábitos intestinales de los niños a su cargo en frecuencia, características y síntomas. Refirieron utilización de supositorios, laxantes y enemas en 100% en EF. Conclusiones: La frecuencia del EF fue inferior al promedio mundial reportado de 12%, con predominio en varones en edad escolar. Se constató antecedente familiar de estreñimiento, conceptualización poco clara sobre EF, prácticas inapropiadas sobre prevención y manejo del EF.

ABSTRACT Introduction: Functional constipation (FC) in children is a common problem, constituting an important health problem. Objective: To determine the clinical-epidemiological characteristics and the perception of parents and / or caregivers of children who consulted because of FC in childhood. Materials and Methods: This was a cross-sectional descriptive and observational study, using interviews with a semi-structured survey with caregivers of children aged 2 to 10 years in a Pediatric Outpatient Unit. Results: out of 374 respondents, 251 (67%) children were in the care of their parents and came from the Central Department. The frequency of FC was 4.8% (4.4% in preschool and 5.1% in schoolchildren). In schoolchildren, it predominated in boys. In children with FC, painful defecation was reported in 66.6%, a family history of constipation in 61%, excessive dairy intake in 39%, and 17% did not consume any fruit or vegetable. 55.5% of children began sphincter training before 24 months. 11% of caregivers were without schooling. From the respondents' perspective, constipation was considered: defecation effort (27%), absence of daily defecation (19.7%), hard and painful stools (34.4%) and need to use laxatives (18.9%). 367/374 (98.1%) knew the intestinal habits of the children in their care in terms of frequency, characteristics and symptoms. They reported the use of suppositories, laxatives and enemas in 100% in FC. Conclusions: The frequency of FC was lower than the reported world average of 12%, with a predominance in school-age males. There was a family history of constipation, unclear conceptualization of FC, inappropriate practices in prevention and management of FC.

Meningocele sacro anterior gigante y síndrome de Currarino incompleto en paciente adulta: reporte de un caso

Anterior sacral meningocele is a protrusion of the dural sac through a bone defect in the sacrum anterior wall. It can occur in isolation or be associated with other malformations, such as the Currarino syndrome, which is part of the classic triad together with hemisacrum and anorectal malformation, although it has great variability. This is the case of an adult woman with chronic constipation, recurrent urinary infection and marked abdominal distension, diagnosed with giant anterior sacral meningocele and incomplete Currarino syndrome. The patient underwent a sacral laminectomy and thecal sac ligation at the level of the bone defect. This article describes this rare type of occult spinal dysraphism as well as the surgical technique used.