Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.805
Filtrar
1.
World J Gastroenterol ; 26(31): 4579-4588, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32884218

RESUMO

The pandemic of coronavirus disease 2019 (COVID-19), caused by a newly identified ß-coronavirus (SARS-CoV-2) has emerged as a dire health problem, causing a massive crisis for global health. Primary method of transmission was firstly thought to be animal to human transmission. However, it has been observed that the virus is transmitted from human to human via respiratory droplets. Interestingly, SARS-CoV-2 ribonucleic acid (RNA) has been isolated from patient stools, suggesting a possible gastrointestinal (GI) involvement. Most commonly reported clinical manifestations are fever, fatigue and dry cough. Interestingly, a small percentage of patients experience GI symptoms with the most common being anorexia, diarrhea, nausea and vomiting. The presence of viral RNA in stools is also common and fecal tests can be positive even after negative respiratory samples. The exact incidence of digestive symptoms is a matter of debate. The distribution of Angiotensin converting enzyme type 2 receptors in multiple organs in the body provides a possible explanation for the digestive symptoms' mechanism. Cases with solely GI symptoms have been reported in both adults and children. Viral RNA has also been detected in stool and blood samples, indicating the possibility of liver damage, which has been reported in COVID-19 patients. The presence of chronic liver disease appears to be a risk factor for severe complications and a poorer prognosis, however data from these cases is lacking. The aim of this review is firstly, to briefly update what is known about the origin and the transmission of SARS-CoV-2, but mainly to focus on the manifestations of the GI tract and their pathophysiological background, so that physicians on the one hand, not to underestimate or disregard digestive symptoms due to the small number of patients exhibiting exclusively this symptomatology and on the other, to have SARS-CoV-2 on their mind when the "gastroenteritis" type symptoms predominate.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Gastroenteropatias/virologia , Hepatopatias/virologia , Pneumonia Viral/fisiopatologia , Adulto , Criança , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Gastroenteropatias/diagnóstico , Gastroenteropatias/fisiopatologia , Saúde Global , Humanos , Hepatopatias/diagnóstico , Hepatopatias/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Fatores de Risco
2.
Am J Gastroenterol ; 115(10): 1575-1583, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32868631

RESUMO

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.


Assuntos
Infecções por Coronavirus/prevenção & controle , Gastroenterologia/normas , Gastroenteropatias/diagnóstico , Controle de Infecções/normas , Laboratórios/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Comitês Consultivos/normas , Betacoronavirus/patogenicidade , Técnicas de Laboratório Clínico/normas , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Gastroenterologia/métodos , Gastroenteropatias/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Seleção de Pacientes , Equipamento de Proteção Individual/normas , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Prevalência , Sociedades Médicas/normas , Triagem/normas , Estados Unidos/epidemiologia
3.
Aging (Albany NY) ; 12(15): 15771-15783, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32805726

RESUMO

During the COVID-19 outbreak, some patients with COVID-19 pneumonia also suffered from acute abdomen requiring surgical treatment; however, there is no consensus for the treatment of such patients. In this study, we retrospectively reviewed 34 patients with acute abdomen who underwent emergency surgery during the COVID-19 outbreak. Among the 34 patients with acute abdomen, a total of six cases were found with COVID-19 pneumonia (clinical classification for COVID-19 pneumonia: all were the common type). On the premise of similar demographics between both groups, patients with COVID-19 pneumonia had worse indicators of liver and coagulation function. Compared with acute abdomen patients without COVID-19, patients with COVID-19 pneumonia had a longer hospital stay, but there were no significant differences in postsurgical complications (P = 0.58) or clinical outcomes (P = 0.56). In addition, an obvious resolution of lung inflammation after surgery was observed in five COVID-19 patients (83.3%). No new COVID-19 cases occurred during the patients' hospital stays. Therefore, for the common type of COVID-19 pneumonia, emergency surgery could not only improve the outcomes of COVID-19 pneumonia patients with acute abdomen, but also benefit the resolution of pulmonary inflammation.


Assuntos
Abdome Agudo , Infecções por Coronavirus , Tratamento de Emergência , Gastroenteropatias , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Operatórios , Abdome Agudo/diagnóstico , Abdome Agudo/epidemiologia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Idoso , Betacoronavirus/isolamento & purificação , Testes de Coagulação Sanguínea/métodos , China/epidemiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/tendências
4.
Am J Gastroenterol ; 115(9): 1534-1538, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732620

RESUMO

INTRODUCTION: To determine whether pretreatment vagal efficiency (VE), respiratory sinus arrhythmia, and heart period can predict pain improvement with auricular neurostimulation in pediatric functional abdominal pain disorders. METHODS: A total of 92 adolescents with functional abdominal pain disorders underwent a 4-week randomized, double-blinded, sham-controlled auricular neurostimulation trial. Electrocardiogram-derived variables at baseline were used to predict pain using mixed effects modeling. RESULTS: A 3-way interaction (95% confidence intervals: 0.004-0.494) showed that the treatment group subjects with low baseline VE had lower pain scores at week 3. There was no substantial change in the placebo or high VE treatment group subjects. This effect was supported by a significant correlation between baseline VE and degree of pain reduction only in the treatment group. DISCUSSION: Impaired cardiac vagal regulation measured by VE predicts pain improvement with auricular neurostimulation.


Assuntos
Dor Abdominal/terapia , Terapia por Estimulação Elétrica/métodos , Gastroenteropatias/terapia , Nervo Vago/fisiopatologia , Dor Abdominal/fisiopatologia , Adolescente , Criança , Método Duplo-Cego , Feminino , Gastroenteropatias/fisiopatologia , Humanos , Masculino , Manejo da Dor , Medição da Dor , Resultado do Tratamento
5.
J Physiol Pharmacol ; 71(2)2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32633236

RESUMO

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2) outbreak is the most dramatic event since World War II. Originating as a cluster of unexplained cases of pneumonia, it turned out that this viral disease termed COVID-19 is not only a respiratory infection, but a systemic disease associated with a number of extrapulmonary complications. One of the medical disciplines that is strongly affected by this viral infection is gastroenterology. COVID-19 causes in some patients typical symptoms of enteritis such as diarrhea or abdominal pain. There is also evidence that this infection may lead to liver and pancreatic injury. Since the SARS-CoV2 virus was detected in stool, a fecal-oral route of transmission is possible. Moreover, viral receptor angiotensin converting enzyme 2 (ACE2) is highly expressed in the gastrointestinal tract and enables the invasion of the gastrointestinal epithelium as demonstrated in vitro and in vivo. COVID-19 pandemic has an impact on the daily practice and the workflows in endoscopy leading to a dramatic decrease of screening and surveillance procedures. COVID-19 impacts the therapy of patients with inflammatory bowel disease (IBD), particularly those using high doses of corticosteroids, immunosuppressive agents and biologics. Patients with preexisting liver disease, especially metabolic associated liver fatty disease (MALFD) with fibrosis or liver cirrhosis, are at high risk for severe COVID-19. As long as no active vaccine against SARS-CoV2 is available, gastroenterologists have to be aware of these problems that affect their daily routine practice.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Gastroenteropatias/virologia , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Animais , Infecções por Coronavirus/terapia , Surtos de Doenças , Gastroenterologistas , Gastroenteropatias/fisiopatologia , Gastroenteropatias/terapia , Humanos , Pandemias , Pneumonia Viral/terapia , Fatores de Risco
6.
Am J Physiol Gastrointest Liver Physiol ; 319(2): G245-G252, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32639848

RESUMO

In addition to the typical respiratory response, new coronavirus disease 2019 (COVID-19) is also associated with very common gastrointestinal symptoms. Cases with gastrointestinal symptoms are more likely to be complicated by liver injury and acute respiratory distress syndrome (ARDS). If not treated in time, coma and circulatory failure may ensue. As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the human body through the combination of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract, the mechanism underlying the gastrointestinal symptoms may involve damage to the intestinal mucosal barrier and promotion of the production of inflammatory factors. Indeed, after cells in the lungs become infected by SARS-CoV-2, effector CD4+ T cells reach the small intestine through the gut-lung axis, causing intestinal immune damage and diarrhea; early extensive use of antibacterial and antiviral drugs can also lead to diarrhea in patients. Thus, treatment options for COVID-19 patients should be promptly adjusted when they have gastrointestinal symptoms. As SARS-CoV-2 has been detected in the feces of COVID-19 patients, future prevention and control efforts must consider the possibility of fecal-oral transmission of the virus.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus , Gastroenteropatias , Trato Gastrointestinal , Pandemias , Pneumonia Viral , Antivirais/farmacologia , Infecções por Coronavirus/metabolismo , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Gastroenteropatias/terapia , Gastroenteropatias/virologia , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal/fisiopatologia , Trato Gastrointestinal/virologia , Humanos , Incidência , Controle de Infecções/métodos , Pandemias/prevenção & controle , Seleção de Pacientes , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/metabolismo , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
9.
Eur J Clin Invest ; 50(9): e13276, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32406522

RESUMO

The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared in the last weeks as global pandemic. Currently affecting more than 5 000 000 individuals worldwide, COVID-19 is most commonly associated with symptoms caused by the acute respiratory distress syndrome (ARDS). As the number of infected individuals increases, we are learning that not only lungs, but also other organs can be affected by the virus. The gastrointestinal symptoms, for example diarrhoea, vomiting, nausea or abdominal pain, are frequent in patients with COVID-19. Moreover, alimentary tract symptoms may precede the respiratory presentation of SARS-CoV-2 infection. This can lead to delayed diagnosis and inappropriate management of infected patients. In addition, SARS-CoV-2 nucleic acid can be detected in faeces of infected patients and rectal swabs are even reported to remain positive for a longer period of time than nasopharyngeal swabs. Here, we aim to provide an update on the gastrointestinal involvement of COVID-19 presenting the symptoms that can be encountered in infected patients. We address the role of angiotensin-converting enzyme 2 (ACE2), as a functional receptor for SARS-CoV-2, which also was found in the gastrointestinal tract. Finally, we briefly discuss faecal shedding of SARS-CoV-2 and its potential role in the pathogenesis of the disease.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Pandemias/estatística & dados numéricos , Peptidil Dipeptidase A/sangue , Pneumonia Viral/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Biomarcadores/sangue , Comorbidade , Infecções por Coronavirus/fisiopatologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Gastroenteropatias/fisiopatologia , Humanos , Masculino , Pneumonia Viral/fisiopatologia , Prognóstico , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Medição de Risco
11.
Med Clin North Am ; 104(3): 439-454, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312408

RESUMO

Anorexia and cachexia, nausea and vomiting, and constipation are gastrointestinal symptoms that commonly accompany serious illness. Basic science and clinical research continue to improve the understanding of their pathophysiology. Thorough assessment necessitates history, physical examination, and laboratory and diagnostic testing. Pharmacologic management attempts to counteract or reverse the underlying pathophysiologic mechanisms that accompany each symptom, which may benefit from a multimodal approach to achieve adequate control. Future improvements in management require investments in clinical research to determine the efficacy of novel agents along with comparator studies to better understand which treatments should be used in what sequence or combination.


Assuntos
Anorexia/tratamento farmacológico , Caquexia/tratamento farmacológico , Constipação Intestinal/tratamento farmacológico , Gastroenteropatias/tratamento farmacológico , Náusea/tratamento farmacológico , Vômito/tratamento farmacológico , Analgésicos Opioides/efeitos adversos , Anorexia/epidemiologia , Anorexia/fisiopatologia , Biomarcadores/metabolismo , Caquexia/epidemiologia , Caquexia/fisiopatologia , Terapia Combinada/métodos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/epidemiologia , Constipação Intestinal/fisiopatologia , Estado Terminal , Gastroenteropatias/epidemiologia , Gastroenteropatias/patologia , Gastroenteropatias/fisiopatologia , Humanos , Inflamação/metabolismo , Inflamação/prevenção & controle , Náusea/epidemiologia , Náusea/fisiopatologia , Cuidados Paliativos/métodos , Exame Físico/métodos , Exame Físico/normas , Qualidade de Vida/psicologia , Receptores de Neurotransmissores/efeitos dos fármacos , Vômito/epidemiologia
13.
Einstein (Sao Paulo) ; 18: eAE4799, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32215466

RESUMO

The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.


Assuntos
Conferências de Consenso como Assunto , Doença Enxerto-Hospedeiro/dietoterapia , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Terapia Nutricional/normas , Necessidades Nutricionais , Brasil , Congressos como Assunto , Gastroenteropatias/dietoterapia , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Doença Enxerto-Hospedeiro/fisiopatologia , Humanos , Terapia Nutricional/métodos , Índice de Gravidade de Doença
15.
Dig Dis Sci ; 65(3): 874-884, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32026181

RESUMO

The intestinal microbiome encodes vast metabolic potential, and multidisciplinary approaches are enabling a mechanistic understanding of how bacterial enzymes impact the metabolism of diverse pharmaceutical compounds, including chemotherapeutics. Microbiota alter the activity of many drugs and chemotherapeutics via direct and indirect mechanisms; some of these alterations result in changes to the drug's bioactivity and bioavailability, causing toxic gastrointestinal side effects. Gastrointestinal toxicity is one of the leading complications of systemic chemotherapy, with symptoms including nausea, vomiting, diarrhea, and constipation. Patients undergo dose reductions or drug holidays to manage these adverse events, which can significantly harm prognosis, and can result in mortality. Selective and precise targeting of the gut microbiota may alleviate these toxicities. Understanding the composition and function of the microbiota may serve as a biomarker for prognosis, and predict treatment efficacy and potential adverse effects, thereby facilitating personalized medicine strategies for cancer patients.


Assuntos
Antineoplásicos/efeitos adversos , Gastroenteropatias/induzido quimicamente , Microbioma Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/efeitos dos fármacos , Antineoplásicos/administração & dosagem , Gastroenteropatias/microbiologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/microbiologia , Trato Gastrointestinal/fisiopatologia , Humanos , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Probióticos/administração & dosagem
16.
Am J Gastroenterol ; 115(1): 41-48, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31895721

RESUMO

Chronic unexplained gastrointestinal symptoms impact more than 1 in 5 Americans and their families; these disorders include the irritable bowel syndrome (IBS) and functional dyspepsia (FD), currently classified by Rome IV as functional gastrointestinal disorders. By definition, IBS and FD have no established pathology, but emerging evidence suggests this paradigm may need revision. Immune activation and, in subsets, subtle intestinal pathology have been identified in FD (most notably, postprandial distress syndrome) and IBS-diarrhea. A disease model is proposed that accounts for all of the intestinal and extraintestinal symptoms, relationship to food and infection, and the overlap with gastroesophageal reflux disease. It is speculated that antigen presentation to the mucosa (e.g., microbial antigens or food proteins after acute gastroenteritis) induces, in a genetically primed host, immune activation of the intestine with low-grade intestinal inflammation and subsequently neuronal structural and functional alterations, producing regional intestinal hypersensitivity and motor dysfunction. Immune activation may explain the female predominance and fluctuations in immune activity for symptom variability over time. In the future, as further evidence accumulates, the management paradigm may potentially shift to objective pathology-based subtyping based on serological, microbiological, and clinical assessments to identify when targeted therapies should be deployed in subsets. Potential targeted interventions may include therapies to dampen down immune activation or block release of key mediators such as histamine, specific microbial targeted treatments that may reverse disease, and dietary advice to eliminate relevant food antigens after objective in vivo testing. Only by identifying causation can we eventually anticipate cure, and as the true pathology unravels in subsets, this may become a reality.


Assuntos
Gastroenteropatias , Predisposição Genética para Doença , Imunidade Celular , Modelos Biológicos , Animais , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Saúde Global , Humanos , Morbidade , Fatores de Risco
17.
PLoS One ; 15(1): e0227781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978146

RESUMO

BACKGROUND: Memantine, currently available for the treatment of Alzheimer's disease, is an uncompetitive antagonist of the N-methyl-D-aspartate type of glutamate receptors. Under normal physiologic conditions, these unstimulated receptor ion channels are blocked by magnesium ions, which are displaced after agonist-induced depolarization. In humans, memantine administration is associated with different gastrointestinal dysmotility side effects (vomiting, diarrhoea, constipation, motor-mediated abdominal pain), thus limiting its clinical use. Mechanism of these motility disorders has not been clarified yet. Pigs can be used in various preclinical experiments due to their relatively very similar gastrointestinal functions compared to humans. The aim of this study was to evaluate the impact of a single and repeated doses of memantine on porcine gastric myoelectric activity evaluated by means of electrogastrography (EGG). METHODS: Six adult female experimental pigs (Sus scrofa f. domestica, mean weight 41.7±5.0 kg) entered the study for two times. The first EGG was recorded after a single intragastric dose of memantine (20 mg). In the second part, EGG was accomplished after 7-day intragastric administration (20 mg per day). All EGG recordings were performed under general anaesthesia. Basal (15 minutes) and study recordings (120 minutes) were accomplished using an EGG stand (MMS, Enschede, the Netherlands). Running spectral analysis based on Fourier transform was used. Results were expressed as dominant frequency of gastric slow waves (DF) and power analysis (areas of amplitudes). RESULTS: Single dose of memantine significantly increased DF, from basic values (1.65±1.05 cycles per min.) to 2.86 cpm after 30 min. (p = 0.008), lasting till 75 min. (p = 0.014). Basal power (median 452; inter-quartile range 280-1312 µV^2) raised after 15 min. (median 827; IQR 224-2769; p = 0.386; NS), lasting next 30 min. Repetitively administrated memantine caused important gastric arrhythmia. Basal DF after single and repeated administration was not different, however, a DF increase in the second part was more prominent (up to 3.18±2.16 after 15 and 30 min., p<0.001). In comparison with a single dose, basal power was significantly higher after repetitively administrated memantine (median 3940; IQR 695-15023 µV^2; p<0.001). Next dose of 20 mg memantine in the second part induced a prominent drop of power after 15 min. (median 541; IQR 328-2280 µV^2; p<0.001), lasting till 120 min. (p<0.001). CONCLUSIONS: Both single and repeated doses of memantine increased DF. Severe gastric arrhythmia and long-lasting low power after repeated administration might explain possible gastric dysmotility side effects in the chronic use of memantine.


Assuntos
Antagonistas de Aminoácidos Excitatórios/efeitos adversos , Gastroenteropatias/induzido quimicamente , Motilidade Gastrointestinal/efeitos dos fármacos , Memantina/efeitos adversos , Estômago/efeitos dos fármacos , Administração Oral , Doença de Alzheimer/tratamento farmacológico , Animais , Modelos Animais de Doenças , Eletromiografia , Antagonistas de Aminoácidos Excitatórios/administração & dosagem , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Humanos , Memantina/administração & dosagem , Estômago/fisiopatologia , Sus scrofa
18.
Curr Gastroenterol Rep ; 22(1): 1, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31912312

RESUMO

PURPOSE OF REVIEW: Efforts to provide early enteral nutrition in critical illness are thwarted by gastrointestinal dysfunction and feeding intolerance. While many of the signs and symptoms of this dysfunction reflect gastroparesis and intestinal dysmotility, other symptoms which may or may not be related are often included such as diarrhea, bleeding, and intra-abdominal hypertension. This paper discusses the need to monitor tolerance of nutritional therapy in the critical care setting and reviews the results of those clinical trials which have helped establish objective measures, define feeding intolerance, and provide a tool to guide continued delivery of the enteral regimen. RECENT FINDINGS: While definitions vary, the presence of gastrointestinal dysfunction and feeding intolerance correlates with adverse clinical outcomes, including prolonged duration of mechanical ventilation, greater length of stay in the intensive care unit, and increased mortality. Despite their prognostic value, it is not clear to what extent these scoring systems should direct nutritional therapy. The clinician should be astute in the careful selection of monitors, in identifying and addressing signs and symptoms of intolerance, and by responding appropriately with feeding strategies that are effective and safe. Early enteral feeding in critical illness has been shown to be optimized by following protocols which allow monitoring patient tolerance while providing individualized care.


Assuntos
Cuidados Críticos/métodos , Estado Terminal , Nutrição Enteral , Gastroenteropatias/fisiopatologia , Protocolos Clínicos , Estado Terminal/terapia , Gastroenteropatias/terapia , Humanos , Prognóstico , Índice de Gravidade de Doença
19.
J Pediatr ; 218: 114-120.e3, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31955876

RESUMO

OBJECTIVES: To evaluate the prevalence of orthostatic intolerance and joint hypermobility in schoolchildren with and without functional gastrointestinal disorders (FGIDs) and to assess autonomic nervous system dysfunction in children with FGIDs and joint hypermobility. STUDY DESIGN: Schoolchildren (10-18 years) attending public schools from 3 Colombian cities (Cali, Palmira, and Bucaramanga) completed validated questionnaires for FGIDs and underwent testing for hypermobility and autonomic nervous system dysfunction. Heart rate and blood pressure were assessed in recumbency and upright position at regular intervals. The differences in characteristics between schoolchildren with and without FGIDs were compared with a t-test for continuous variables and with a Fisher exact test (2 × 2 contingency tables) for categorical variables. RESULTS: In total, 155 children with FGIDs were matched with 151 healthy controls. Children with FGIDs had historically significant greater frequency of 10 of 12 symptoms of orthostatic intolerance, no significant difference in any symptoms of orthostatic intolerance during recumbency, significantly greater frequency in 6 of 12 symptoms of orthostatic intolerance during orthostasis, trend toward statistical significance for orthostatic intolerance (P = .0509), and no significant difference in prevalence of orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS). There was no significant difference in prevalence of orthostatic intolerance, OH, and POTS between those with joint hypermobility and those without. CONCLUSIONS: Children with FGIDs have a greater prevalence of symptoms of orthostatic intolerance but were not more likely to have OH and POTS as compared with children without FGIDs. Children with joint hypermobility did not have a greater prevalence of orthostatic intolerance, OH, and POTS.


Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Gastroenteropatias/fisiopatologia , Instabilidade Articular/fisiopatologia , Intolerância Ortostática/fisiopatologia , Adolescente , Doenças do Sistema Nervoso Autônomo/complicações , Pressão Sanguínea , Estudos de Casos e Controles , Criança , Colômbia , Feminino , Gastroenteropatias/complicações , Frequência Cardíaca , Humanos , Instabilidade Articular/complicações , Masculino , Intolerância Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/complicações , Síndrome da Taquicardia Postural Ortostática/fisiopatologia , Prevalência , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA