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1.
Sci Rep ; 10(1): 2401, 2020 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-32051513

RESUMO

Refractory functional dyspepsia (RFD) is characterized by symptoms persistence in spite of medical treatment or H. pylori eradication. No study has yet investigated the presence of gluten-dependent RFD as a clinical presentation of Non-Celiac Gluten Sensitivity (NCGS). Patients with RFD, in whom celiac disease, wheat allergy and H. pylori infection had been ruled out, followed a six weeks long gluten-free diet (GFD). Symptoms were evaluated by means of visual analogue scales; patients with ≥30% improvement in at least one of the reported symptoms after GFD underwent a double-blind placebo controlled gluten challenge. Subjects were randomly divided in two groups and symptoms were evaluated after the gluten/placebo challenge. GFD responders were further followed on for 3 months to evaluate the relationship between symptoms and gluten consumption. Out of 77 patients with RFD, 50 (65%) did not respond to GFD; 27 (35%) cases showed gastrointestinal symptoms improvement while on GFD; after blind gluten ingestion, symptoms recurred in 5 cases (6.4% of patients with RFD, 18% of GFD responders) suggesting the presence of NCGS. Furthermore, such extra-intestinal symptoms as fatigue and weakness (P = 0.000), musculo-skeletal pain (P = 0.000) and headache (P = 0.002) improved in NCGS patients on GFD. Because of the high prevalence of NCGS among patients with RFD, a diagnostic/therapeutic roadmap evaluating the effect of GFD in patients with RFD seems a reasonable (and simple) approach.


Assuntos
Dieta , Dispepsia/epidemiologia , Glutens , Síndromes de Malabsorção/epidemiologia , Adolescente , Adulto , Comorbidade , Método Duplo-Cego , Feminino , Humanos , Síndromes de Malabsorção/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Escala Visual Analógica , Adulto Jovem
2.
JAAPA ; 33(1): 28-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31880647

RESUMO

Type 2 diabetes is primarily managed with lifestyle modifications, self-monitoring of blood glucose, and medication. The goal is to maintain A1C less than 7% in most patients and prevent damage to other organs such as the kidneys and heart. Patients who are obese and cannot achieve normal blood glucose levels despite diet, exercise, and multiple medications may be considered for bariatric surgery. The Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy have been shown to improve A1C, reduce weight, and reduce the number of medications patients need for diabetes management. Comorbidities such as hyperlipidemia and hypertension also may improve. This article describes types of bariatric surgery, proper selection of surgical candidates, patient education, and the postoperative patient management necessary for long-term success in improving blood glucose control.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/metabolismo , Obesidade/cirurgia , Deficiência de Vitaminas/epidemiologia , Deficiência de Vitaminas/prevenção & controle , Deficiência de Vitaminas/terapia , Diabetes Mellitus Tipo 2/complicações , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemia/epidemiologia , Hipoglicemia/prevenção & controle , Hipoglicemia/terapia , Hipoglicemiantes/uso terapêutico , Estilo de Vida , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/prevenção & controle , Síndromes de Malabsorção/terapia , Obesidade/complicações , Obesidade/metabolismo , Educação de Pacientes como Assunto , Seleção de Pacientes , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Perda de Peso , Programas de Redução de Peso
3.
J Clin Invest ; 130(1): 335-344, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31613795

RESUMO

BACKGROUNDProteinuria is considered an unfavorable clinical condition that accelerates renal and cardiovascular disease. However, it is not clear whether all forms of proteinuria are damaging. Mutations in CUBN cause Imerslund-Gräsbeck syndrome (IGS), which is characterized by intestinal malabsorption of vitamin B12 and in some cases proteinuria. CUBN encodes for cubilin, an intestinal and proximal tubular uptake receptor containing 27 CUB domains for ligand binding.METHODSWe used next-generation sequencing for renal disease genes to genotype cohorts of patients with suspected hereditary renal disease and chronic proteinuria. CUBN variants were analyzed using bioinformatics, structural modeling, and epidemiological methods.RESULTSWe identified 39 patients, in whom biallelic pathogenic variants in the CUBN gene were associated with chronic isolated proteinuria and early childhood onset. Since the proteinuria in these patients had a high proportion of albuminuria, glomerular diseases such as steroid-resistant nephrotic syndrome or Alport syndrome were often the primary clinical diagnosis, motivating renal biopsies and the use of proteinuria-lowering treatments. However, renal function was normal in all cases. By contrast, we did not found any biallelic CUBN variants in proteinuric patients with reduced renal function or focal segmental glomerulosclerosis. Unlike the more N-terminal IGS mutations, 37 of the 41 proteinuria-associated CUBN variants led to modifications or truncations after the vitamin B12-binding domain. Finally, we show that 4 C-terminal CUBN variants are associated with albuminuria and slightly increased GFR in meta-analyses of large population-based cohorts.CONCLUSIONCollectively, our data suggest an important role for the C-terminal half of cubilin in renal albumin reabsorption. Albuminuria due to reduced cubilin function could be an unexpectedly common benign condition in humans that may not require any proteinuria-lowering treatment or renal biopsy.FUNDINGATIP-Avenir program, Fondation Bettencourt-Schueller (Liliane Bettencourt Chair of Developmental Biology), Agence Nationale de la Recherche (ANR) Investissements d'avenir program (ANR-10-IAHU-01) and NEPHROFLY (ANR-14-ACHN-0013, to MS), Steno Collaborative Grant 2018 (NNF18OC0052457, to TSA and MS), Heisenberg Professorship of the German Research Foundation (KO 3598/5-1, to AK), Deutsche Forschungsgemeinschaft (DFG) Collaborative Research Centre (SFB) KIDGEM 1140 (project 246781735, to CB), and Federal Ministry of Education and Research (BMB) (01GM1515C, to CB).


Assuntos
Albuminúria , Anemia Megaloblástica , Túbulos Renais Proximais , Síndromes de Malabsorção , Mutação , Proteinúria , Receptores de Superfície Celular , Deficiência de Vitamina B 12 , Albuminúria/epidemiologia , Albuminúria/genética , Albuminúria/metabolismo , Albuminúria/patologia , Anemia Megaloblástica/epidemiologia , Anemia Megaloblástica/genética , Anemia Megaloblástica/metabolismo , Anemia Megaloblástica/patologia , Feminino , Humanos , Túbulos Renais Proximais/metabolismo , Túbulos Renais Proximais/patologia , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/genética , Síndromes de Malabsorção/metabolismo , Síndromes de Malabsorção/patologia , Masculino , Proteinúria/epidemiologia , Proteinúria/genética , Proteinúria/metabolismo , Proteinúria/patologia , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/metabolismo , Deficiência de Vitamina B 12/epidemiologia , Deficiência de Vitamina B 12/genética , Deficiência de Vitamina B 12/metabolismo , Deficiência de Vitamina B 12/patologia
4.
PLoS One ; 14(8): e0221095, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31442248

RESUMO

Environmental Enteric Dysfunction (EED) is an acquired small intestinal inflammatory condition underlying high rates of stunting in children <5 years of age in low- and middle-income countries. Children with EED are known to have repeated exposures to enteropathogens and environmental toxins that leads to malabsorptive syndrome. We aimed to characterize association of linear growth faltering with enteropathogen burden and subsequent changes in EED biomarkers. In a longitudinal birth cohort (n = 272), monthly anthropometric measurements (Length for Age Z score- LAZ) of asymptomatic children were obtained up to 18 months. Biological samples were collected at 6 and 9 months for the assessment of biomarkers. A customized TaqMan array card was used to target 40 enteropathogens in fecal samples. Linear regression was applied to study the effect of specific enteropathogen infection on change in linear growth (ΔLAZ). Presence of any pathogen in fecal sample correlated with serum flagellin IgA (6 mo, r = 0.19, p = 0.002), fecal Reg 1b (6 mo, r = 0.16, p = 0.01; 9mo, r = 0.16, p = 0.008) and serum Reg 1b (6 mo, r = 0.26, p<0.0001; 9 mo, r = 0.15, p = 0.008). At 6 months, presence of Campylobacter [ß (SE) 7751.2 (2608.5), p = 0.003] and ETEC LT [ß (SE) 7089.2 (3015.04), p = 0.019] was associated with increase in MPO. Giardia was associated with increase in Reg1b [ß (SE) 72.189 (26.394), p = 0.006] and anti-flic IgA[ß (SE) 0.054 (0.021), p = 0.0091]. Multiple enteropathogen infections in early life negatively correlated with ΔLAZ, and simultaneous changes in gut inflammatory and permeability markers. A combination vaccine targeting enteropathogens in early life could help in the prevention of future stunting.


Assuntos
Microbioma Gastrointestinal/genética , Transtornos do Crescimento/microbiologia , Inflamação/microbiologia , Síndromes de Malabsorção/microbiologia , Criança , Pré-Escolar , Fezes/microbiologia , Feminino , Flagelina/genética , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/genética , Transtornos do Crescimento/patologia , Humanos , Lactente , Inflamação/epidemiologia , Inflamação/genética , Inflamação/patologia , Intestino Delgado/microbiologia , Intestino Delgado/patologia , Modelos Lineares , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/genética , Síndromes de Malabsorção/patologia , Masculino , Paquistão/epidemiologia , Permeabilidade
5.
Dig Dis Sci ; 64(8): 2280-2285, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30806860

RESUMO

BACKGROUND: Intestinal failure is the most critical complication of Crohn's disease. Intestinal failure requires home parenteral nutrition, which worsens the quality of life of the patients and sometimes causes life-threatening complications. AIMS: The purpose of this study was to investigate the incidence and risk factors for intestinal failure in Crohn's disease. METHODS: We performed a retrospective analysis of Crohn's disease patients (162 cases) at Osaka University Hospital between January 2000 and December 2017. Kaplan-Meier analysis was used to investigate the cumulative incidence of intestinal failure. To identify the risk factors of intestinal failure, patient characteristics were analyzed by multivariate analysis, including disease classification, surgical history, medical treatment other than surgery, and cumulative inflammation was calculated using the average C-reactive protein value and disease duration. RESULTS: The cumulative incidence of intestinal failure 5, 10, and 15 years after Crohn's disease diagnosis was 2.6%, 3.4%, and 8.6%, respectively. Multivariate analysis identified the following as independent risk factors for intestinal failure in Crohn's disease: residual small intestinal length < 200 cm (odds ratio 7.51, 95% confidence interval 2.14-29.96), non-use of anti-tumor necrosis factor-alpha therapy (3.34, 1.22-10.74), and cumulative inflammation (1.01, 1.001-1.038). We created a new predictive nomogram consisting of these risk factors. CONCLUSIONS: Intestinal failure occasionally occurred during long-term treatment of Crohn's disease. Cumulative inflammation for the first time, in addition to short residual small intestinal length and non-use of anti-tumor necrosis factor-alpha therapy, was shown to be potential risk factors for intestinal failure in Crohn's disease.


Assuntos
Doença de Crohn/epidemiologia , Absorção Intestinal , Intestino Delgado/fisiopatologia , Síndromes de Malabsorção/epidemiologia , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Criança , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Duração da Terapia , Feminino , Humanos , Incidência , Japão/epidemiologia , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
6.
Obes Surg ; 29(2): 376-386, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30251095

RESUMO

BACKGROUND: Management of failed laparoscopic gastric plication (LGP), defined as weight regain or inadequate weight loss, is a challenging issue. METHODS: This prospective investigation was conducted in individuals with morbid obesity who had undergone LGP from 2000 to 2016. Patients with weight loss failure, weight regain, and regain-prone cases were indicated for reoperation. Re-plication, laparoscopic one anastomosis gastric bypass (LOAGB), and modified jejunoileal bypass were done as revisional surgery. RESULTS: Revisional surgery was performed in 102 of 124 patients who needed reoperation. Overall, 39 re-plication, 38 LOAGB, and 25 malabsorptive procedures were performed. Re-plication was the shortest surgery and had the shortest length of hospital stay. The percentage of TWL at 6, 12, and 24 months of follow-up was 20.5%, 25%, and 26.8% for re-plication; 20.2%, 27%, and 30.5% for LOAGB; and 22.9%, 28.9%, and 32.6% for the malabsorptive procedure, respectively. In addition, the percentage of EWL at 6, 12, and 24 months of follow-up was 62%, 74.6%, and 79.6% for re-plication; 51.6%, 68.2%, and 75.9% for LOAGB; and 55.4%, 70.1%, and 79.1% for malabsorptive procedure, respectively. In long-term follow-up, according to %TWL, LOAGB and malabsorptive procedure had better outcome compared to re-plication, whereas there was no statistically significant difference in %EWL among the three surgical approaches. CONCLUSIONS: In terms of weight loss, reoperation on failed LGP was completely successful and no treatment failure was reported. All three revisional procedures, including re-plication, LOAGB, and malabsorptive procedure showed promising results and provided substantial weight loss. Since there is little information about the long-term efficacy and safety of revisional surgery on failed LGP, we highly recommend further investigations to confirm our results.


Assuntos
Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Adulto , Feminino , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Humanos , Derivação Jejunoileal/efeitos adversos , Derivação Jejunoileal/métodos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/etiologia , Síndromes de Malabsorção/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estômago/cirurgia , Falha de Tratamento , Perda de Peso/fisiologia
7.
Eur J Gastroenterol Hepatol ; 31(1): 123-127, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30273226

RESUMO

OBJECTIVE: Intestinal failure (IF) is a complex disease that is gaining significance and attention throughout the world. In Mexico, there are no available data on this condition. The aim of this study was to determine the frequency and characteristics of patients with IF type II and III hospitalized at a tertiary referral center in our country. PATIENTS AND METHODS: A cross-sectional study was carried out from August 2016 to July 2017. Adult patients hospitalized in noncritical areas with a recent diagnosis of IF type II or III according to the European Society for Clinical Nutrition and Metabolism classification were included. Demographic, anthropometric, nutritional therapy, biochemical, and clinical characteristics were registered. Nutritional risk was determined by the Nutritional Risk Score 2002. RESULTS: During the study, 4144 patients were admitted to noncritical areas; 21 (5/1000) of these patients were included. The mean age of the patients was 51±18.8 years, and the mean BMI was 17.6±5.5 kg/m. Fifteen (71.5%) patients were diagnosed with IF type II and six (28.5%) with IF type III. The primary diagnosis was surgical complications in seven (33.3%) of the cases and the principal pathophysiological mechanism was short bowel syndrome in nine (42.8%) patients. The most frequent (37%) clinical classification was D2: more than 20 kcal/kg/day and 1001-2000 ml/day and parenteral nutrition and PN2: 1001-2000 ml/day (52.3%) based on the modified European Society for Clinical Nutrition and Metabolism clinical classification. CONCLUSION: In this study, a high frequency of IF was found; surgical complications and short bowel syndrome were the main mechanisms involved, and D2 was the most frequent clinical category.


Assuntos
Absorção Intestinal , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/fisiopatologia , Estado Nutricional , Síndrome do Intestino Curto/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Centros de Atenção Terciária , Adulto , Idoso , Estudos Transversais , Ingestão de Energia , Feminino , Humanos , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/terapia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Nutrição Parenteral , Síndrome do Intestino Curto/diagnóstico , Síndrome do Intestino Curto/fisiopatologia , Resultado do Tratamento
8.
Korean J Intern Med ; 34(1): 90-98, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29172402

RESUMO

BACKGROUND/AIMS: Olmesartan, a widely used angiotensin II receptor blocker (ARB), has been linked to sprue-like enteropathy. No cases of olmesartan-associated enteropathy have been reported in Northeast Asia. We investigated the associations between olmesartan and other ARBs and the incidence of enteropathy in Korea. METHODS: Our retrospective cohort study used data from the Korean National Health Insurance Service to identify 108,559 patients (58,186 females) who were initiated on angiotensin converting enzyme inhibitors (ACEis), olmesartan, or other ARBs between January 2005 and December 2012. The incidences of enteropathy were compared among drug groups. Changes in body weight were compared after propensity score matching of patients in the ACEis and olmesartan groups. RESULTS: Among 108,559 patients, 31 patients were diagnosed with enteropathy. The incidences were 0.73, 0.24, and 0.37 per 1,000 persons, in the ACEis, olmesartan, and other ARBs groups, respectively. Adjusted rate ratios for enteropathy were: olmesartan, 0.33 (95% confidential interval [CI], 0.10 to 1.09; p = 0.070) and other ARBs, 0.34 (95% CI, 0.14 to 0.83; p = 0.017) compared to the ACEis group after adjustment for age, sex, income level, and various comorbidities. The post hoc analysis with matched cohorts revealed that the proportion of patients with significant weight loss did not differ between the ACEis and olmesartan groups. CONCLUSION: Olmesartan was not associated with intestinal malabsorption or significant body weight loss in the general Korean population. Additional large-scale prospective studies of the relationship between olmesartan and the incidence of enteropathy in the Asian population are needed.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Imidazóis/efeitos adversos , Enteropatias/etiologia , Tetrazóis/efeitos adversos , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Doença Celíaca/epidemiologia , Doença Celíaca/etiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Enteropatias/epidemiologia , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/etiologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
10.
J Pediatr Gastroenterol Nutr ; 66 Suppl 3: S56-S60, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29762380

RESUMO

OBJECTIVES: The epidemiology and clinical significance of disaccharidase deficiencies have not been thoroughly characterized. Recent work suggests at least genetic sucrase-isomaltase deficiency is more prevalent than previously believed. Because lactase deficiency (LD) is well described, the present study focuses on the clinical characteristics of children with disaccharidase deficiencies determined by esophagogastroduodenoscopy. METHODS: Endoscopic records were reviewed from patients undergoing esophagogastroduodenoscopies with biopsies assayed for disaccharidase activity performed by 13 pediatric gastroenterologists during 5 years (2010-2014). Presenting symptoms, clinical and histological diagnosis, treatment, disaccharidase results, and demographic variables were obtained from medical and endoscopic records of those with maltase and sucrase deficiency (SD). RESULTS: Among 963 patients undergoing intestinal disaccharidase testing, 73 (7.6%) had SD on biopsy (enzyme activity <25 µmol ·â€Šmin ·â€Šg). Thirty-four (34/73; 47%) had normal duodenal histology and are the focus of this report. Four patients had SD without LD. Pan-disaccharidase deficiency was observed in 24 patients when maltase and palatinase assays were obtained (n = 646), and 11 had SD + LD when just those 2 enzymes were analyzed (n = 317). Those with SD without LD were younger 4.6 ±â€Š6.1 versus 14.1 ±â€Š3.6 years and uniformly presented with diarrhea. Patients with pan-disaccharidase deficiency or SD + LD primarily reported abdominal pain (33/35; 94%), diarrhea (16/35; 46%), nausea (14/35; 40%); and poor weight gain/weight loss (10/35; 29%); constipation, flatulence, and bloating were also noted. Maltase deficiency is less common (8/963; 0.8%), presenting with similar symptoms. CONCLUSIONS: Genetic sucrase-isomaltase deficiency often occurs together with lactase or pan-disaccharide deficiency. Disaccharidase deficiency should be considered a potential cause of abdominal pain and/or diarrhea in children and adolescents.


Assuntos
Dissacaridases/deficiência , Duodeno/enzimologia , Síndromes de Malabsorção/diagnóstico , Adolescente , Criança , Pré-Escolar , Dissacaridases/análise , Endoscopia do Sistema Digestório/métodos , Feminino , Humanos , Lactente , Síndromes de Malabsorção/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos
11.
J Pediatr Gastroenterol Nutr ; 66 Suppl 3: S52-S55, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29762379

RESUMO

BACKGROUND: A subset of children with functional gastrointestinal disorders (FGIDs), which includes functional dyspepsia, may have duodenal disaccharidase deficiencies. OBJECTIVES: To determine the frequency, demographics, and clinical characteristics associated with duodenal disaccharidase deficiencies in children with functional dyspepsia. METHODS: Children ages 4 to 18 years undergoing esophagogastroduodenoscopy (EGD) evaluation for dyspepsia were enrolled in either a retrospective (study 1) or prospective (study 2) evaluation. Those with histologic abnormalities were excluded. Duodenal biopsies were obtained for disaccharidase enzyme analysis. In the retrospective study, both demographic and clinical characteristics were obtained via chart review. In the prospective study, parents completed the Rome II Questionnaire on Gastrointestinal Symptoms before the EGD. RESULTS: One hundred and twenty-nine children (n = 101, study 1; n = 28, study 2) were included. Mean age was 11.2 ±â€Š3.8 (SD) years in study 1 and 10.6 ±â€Š3.2 years in study 2. Forty-eight (47.5%) of subjects in study 1 and 13 (46.4%) of subjects in study 2 had at least 1 disaccharidase deficiency identified. All of those with a disaccharidase deficiency in both studies had lactase deficiency with 8 (7.9%) and 5 (17.9%) of those in studies 1 and 2, respectively, having an additional disaccharidase deficiency. The second most common disaccharidase deficiency pattern was that of pan-disaccharidase deficiency (PDD) in both studies. In study 1 (where both race and ethnicity were captured), self-identified Hispanic (vs non-Hispanic, P < 0.05) and non-white (vs white, P < 0.01) children were more likely to have lactase deficiency. Age, sex, and type of gastrointestinal symptom were not associated with presence or absence of a disaccharidase deficiency. CONCLUSIONS: Approximately half of children with functional dyspepsia undergoing EGD were identified as having a disaccharidase deficiency (predominantly lactase deficiency). Race/ethnicity may be associated with the likelihood of identifying a disaccharidase deficiency. Other clinical characteristics were not able to distinguish those with versus without a disaccharidase deficiency.


Assuntos
Dissacaridases/deficiência , Duodeno/enzimologia , Dispepsia/etiologia , Mucosa Intestinal/enzimologia , Síndromes de Malabsorção/epidemiologia , Adolescente , Criança , Pré-Escolar , Duodeno/patologia , Endoscopia do Sistema Digestório , Feminino , Humanos , Mucosa Intestinal/patologia , Síndromes de Malabsorção/complicações , Síndromes de Malabsorção/diagnóstico , Masculino , Estudos Prospectivos , Estudos Retrospectivos
12.
Curr Gastroenterol Rep ; 20(3): 10, 2018 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-29582208

RESUMO

PURPOSE OF REVIEW: To provide an update on the prevalence, pathophysiology, disease associations, and treatment options for bile acid malabsorption (BAM). RECENT FINDINGS: •Molecular mechanisms-BAs prevent water reabsorption and increase water secretion by intracellular mediators, increasing aquaporin channels and intracellular permeability. •Inflammatory bowel disease-new molecular mechanisms of BAM are identified in patients without ileal disease, including changes in expression of ileal BA transporter and nuclear receptors involved in BA homeostasis. •Microscopic colitis-BAM is one of the mechanisms leading to microscopic colitis. •Diagnostic testing-new diagnostic tests have been launched in the USA (serum C4 and fecal 48-h BA excretion); stimulated FGF19 has higher detection of BAM compared to fasting sample alone. •Treatment-investigational FXR agonists may provide a daily, oral option for treatment of BAM instead of BA sequestrants. There is a greater appreciation of the biological role of bile acids across multiple fields of medicine, including gastrointestinal indications.


Assuntos
Ácidos e Sais Biliares/metabolismo , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/terapia , Ácidos e Sais Biliares/fisiologia , Biomarcadores/sangue , Colecistectomia/efeitos adversos , Diarreia/etiologia , Diarreia/fisiopatologia , Fezes/química , Humanos , Doenças Inflamatórias Intestinais/complicações , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/fisiopatologia , Lesões por Radiação/etiologia , Receptores Citoplasmáticos e Nucleares/agonistas , Sequestrantes/uso terapêutico , Esteatorreia/etiologia , Esteatorreia/fisiopatologia , Ácido Taurocólico/análogos & derivados
13.
Pharmacoepidemiol Drug Saf ; 27(6): 581-586, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29457309

RESUMO

PURPOSE: The angiotensin II receptor blocker (ARB) olmesartan has been recently associated with sprue-like enteropathy (SLE), a gastrointestinal condition characterized by intestinal malabsorption (IM) and severe diarrhea. Whether the increased risk of SLE is substance-specific or a class effect involving all ARBs is uncertain. The aim of this study is to assess the risk of enteropathy associated with ARBs and angiotensin converting enzyme inhibitors (ACE-i) by using data from large administrative and claim databases. METHODS: We obtained data from Italian local health-care units and a large German claim database and included patients treated with olmesartan, other ARBs, and ACE-i. In the absence of a specific diagnosis code for SLE, International Classification of Diseases codes for IM were used. Analysis implemented a Poisson regression with robust error variance procedure, which allowed accounting for different clusters (local health-care units and countries) and correctly estimating the standard error for the relative risk of rare event occurrence. RESULTS: Patients were divided into 3 groups: olmesartan (25.591, 5.5%), other ARBs (104.901, 22.5%), and ACE-i patients (334.951, 72.0%). Baseline characteristics were similar overall. The incidence of unspecified IM in ACE-i patients was not different compared with that of olmesartan, whereas a higher rate ratio was observed when comparing ARB patients with the olmesartan group (RR: 2.50, 95% CI 1.21 to 5.19, P .01). When International Classification of Diseases codes for coeliac disease were included, no differences were observed. CONCLUSIONS: We could not confirm previous findings of a higher risk of malabsorption in olmesartan-only patients, and drug-induced enteropathy should be considered the result of exposure to the class of ARBs rather than a specific drug-related effect.


Assuntos
Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Hipertensão/tratamento farmacológico , Síndromes de Malabsorção/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Itália/epidemiologia , Síndromes de Malabsorção/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Obes Surg ; 28(6): 1504-1510, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29159553

RESUMO

BACKGROUND: This study aimed to evaluate the outcomes of 67 patients who underwent revisional bariatric surgeries over a 29-year period in a Brazilian public hospital. METHODS: The records of all patients who underwent revisional bariatric surgery from January 1987 to December of 2016 at our hospital were analyzed for weight loss and complications. Descriptive statistics and paired t tests were computed. RESULTS: Sixty-seven patients were included in the study. The primary surgeries previously performed on these patients were biliopancreatic diversion with duodenal switch (BPD-DS) (37 cases, 55.2%), jejunoileal bypass (JIB) (24 cases, 35.8%), sleeve gastrectomy (4 cases, 5.9%), Roux-en-Y gastric bypass (RYGB) (1 case, 1.5%), and laparoscopic adjustable gastric band (1 case, 1.5%). The indications for revisional surgery were as follows: malnutrition in 29 cases (43.3%), failure to lose weight in 27 cases (40.3%), weight regain in 5 cases (7.5%), and untreatable diarrhea in 6 cases (9.2%). Most revisional surgeries were performed using JIB or BPD-DS. Operative mortality was higher after the revisional procedures compared with that following the primary bariatric surgeries. CONCLUSIONS: Most patients requiring a revisional surgery had undergone a primary BPD-DS or JIB. Severe and untreatable malnutrition and diarrhea were the main indications for the revisional procedures. RYGB produced significant and sustainable weight loss and exhibited a low risk of malnutrition or requiring revisional surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Síndromes de Malabsorção/cirurgia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Adulto , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Desvio Biliopancreático/efeitos adversos , Desvio Biliopancreático/métodos , Desvio Biliopancreático/estatística & dados numéricos , Brasil/epidemiologia , Comorbidade , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Hospitais Públicos , Humanos , Derivação Jejunoileal/efeitos adversos , Derivação Jejunoileal/métodos , Derivação Jejunoileal/estatística & dados numéricos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/etiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Reoperação/métodos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Perda de Peso
16.
Expert Opin Drug Saf ; 16(11): 1221-1225, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28871813

RESUMO

OBJECTIVE: To investigate the possible relationship between the use of Angiotensin II Receptor Blockers (ARBs) or Angiotensin-Converting-Enzyme Inhibitors (ACE-i) and unspecified intestinal malabsorption (IM) within the Italian and German real-life context. RESEARCH DESIGN AND METHODS: a retrospective cohort of patients with a new unspecified IM diagnosis during the period 1 January 2010-31 December 2013 was extracted from Italian IMS Health Longitudinal Patient Database and German IMS Disease Analyzer. Only patients with at least one prescription of ARB or ACE-i medication during the 6 months preceding the IM diagnosis were included and then followed up for 12 months to assess treatment exposure. RESULTS: After stratification by year and molecule, the proportion of patients experiencing an unspecified IM diagnosis on total patients receiving ARBs or ACE-i ranged from 0% to 0.14%, showing no relevant differences between molecules and no time trends. CONCLUSIONS: this study indicates that ACE-i or ARBs were rarely associated to an unspecified IM diagnosis. No relevant difference between each specific ACE-i and ARB was highlighted.


Assuntos
Antagonistas de Receptores de Angiotensina/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Absorção Intestinal/efeitos dos fármacos , Síndromes de Malabsorção/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Itália/epidemiologia , Síndromes de Malabsorção/epidemiologia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Retrospectivos
17.
Semin Arthritis Rheum ; 47(2): 257-263, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28457529

RESUMO

BACKGROUND: Higher fructose intake has been associated with hyperuricaemia and gout. Some individuals malabsorb fructose in the small intestine. The aims of this study were to determine the rate of fructose malabsorption and the effects of gout and fructose malabsorption on serum urate in people with and without gout. METHODS: A total of 100 people with gout (cases) were age and gender matched with one control without gout. After a low fructose diet, fructose malabsorption was measured using a hydrogen and methane breath test with a 35g fructose load. In a subgroup of 35 cases and 35 controls, serum urate response to the fructose load over 240 minutes was measured. RESULTS: There was no significant difference in the rate of fructose malabsorption between cases and controls (48% vs. 52%; p = 0.67). Cases had a significantly lower mean (SEM) serum urate cumulative incremental concentration from baseline-240 minutes (iAUC0-240) compared to controls 0.97 (0.56) vs. 4.78 (0.55); p < 0.001. Cmax was significantly lower in cases compared to controls [0.38 (0.003) vs. 0.40 (0.003); p < 0.001]. 95% of cases were receiving allopurinol. There was no significant difference between iAUC0-240 or Cmax for malabsorbers compared to normal absorbers irrespective of case-control status. The mean (SEM) increase in serum urate between baseline and 30 minutes was 0.04 (0.004)mmol/l in the controls compared to 0.009 (0.002) in the cases (p < 0.001). CONCLUSION: The rates of fructose malabsorption are similar in people with and without gout. Allopurinol inhibits the increase in serum urate induced by a fructose load suggesting that people with gout receiving allopurinol may not need to restrict dietary intake of fructose.


Assuntos
Frutose/metabolismo , Gota/epidemiologia , Síndromes de Malabsorção/epidemiologia , Idoso , Índice de Massa Corporal , Testes Respiratórios , Estudos de Casos e Controles , Comorbidade , Feminino , Gota/metabolismo , Humanos , Síndromes de Malabsorção/metabolismo , Masculino , Pessoa de Meia-Idade , Prevalência
19.
EBioMedicine ; 17: 57-66, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28122695

RESUMO

BACKGROUND: Environmental enteric dysfunction (EED), a condition characterized by small intestine inflammation and abnormal gut permeability, is widespread in children in developing countries and a major cause of growth failure. The pathophysiology of EED remains poorly understood. METHODS: We measured serum metabolites using liquid chromatography-tandem mass spectrometry in 400 children, aged 12-59months, from rural Malawi. Gut permeability was assessed by the dual-sugar absorption test. FINDINGS: 80.7% of children had EED. Of 677 serum metabolites measured, 21 were negatively associated and 56 were positively associated with gut permeability, using a false discovery rate approach (q<0.05, p<0.0095). Increased gut permeability was associated with elevated acylcarnitines, deoxycarnitine, fatty acid ß-oxidation intermediates, fatty acid ω-oxidation products, odd-chain fatty acids, trimethylamine-N-oxide, cystathionine, and homocitrulline, and with lower citrulline, ornithine, polyphenol metabolites, hippurate, tryptophan, and indolelactate. INTERPRETATION: EED is a syndrome characterized by secondary carnitine deficiency, abnormal fatty acid oxidation, alterations in polyphenol and amino acid metabolites, and metabolic dysregulation of sulfur amino acids, tryptophan, and the urea cycle. Future studies are needed to corroborate the presence of secondary carnitine deficiency among children with EED and to understand how these metabolic derangements may negatively affect the growth and development of young children.


Assuntos
Carnitina/deficiência , Enterite/metabolismo , Ácidos Graxos/sangue , Absorção Intestinal , Síndromes de Malabsorção/metabolismo , Carnitina/sangue , Carnitina/metabolismo , Pré-Escolar , Enterite/sangue , Enterite/epidemiologia , Meio Ambiente , Ácidos Graxos/metabolismo , Feminino , Humanos , Lactente , Intestino Delgado/metabolismo , Intestino Delgado/patologia , Síndromes de Malabsorção/sangue , Síndromes de Malabsorção/epidemiologia , Malaui , Masculino , Oxirredução , Polifenóis/metabolismo
20.
Pediatrics ; 138(6)2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27940670

RESUMO

Approximately 25% of the world's children aged <5 years have stunted growth, which is associated with increased mortality, cognitive dysfunction, and loss of productivity. Reducing by 40% the number of stunted children is a global target for 2030. The pathogenesis of stunting is poorly understood. Prenatal and postnatal nutritional deficits and enteric and systemic infections clearly contribute, but recent findings implicate a central role for environmental enteric dysfunction (EED), a generalized disturbance of small intestinal structure and function found at a high prevalence in children living under unsanitary conditions. Mechanisms contributing to growth failure in EED include intestinal leakiness and heightened permeability, gut inflammation, dysbiosis and bacterial translocation, systemic inflammation, and nutrient malabsorption. Because EED has multiple causal pathways, approaches to manage it need to be multifaceted. Potential interventions to tackle EED include: (1) reduction of exposure to feces and contact with animals through programs such as improved water, sanitation, and hygiene; (2) breastfeeding and enhanced dietary diversity; (3) probiotics and prebiotics; (4) nutrient supplements, including zinc, polyunsaturated fatty acids, and amino acids; (5) antiinflammatory agents such as 5-aminosalicyclic acid; and (6) antibiotics in the context of acute malnutrition and infection. Better understanding of the underlying causes of EED and development of noninvasive, practical, simple, and affordable point-of-care diagnostic tools remain key gaps. "Omics" technologies (genomics, epigenomics, transcriptomics, proteomics, and metabolomics) and stable isotope techniques (eg, 13C breath tests) targeted at children and their intestinal microbiota will enhance our ability to successfully identify, manage, and prevent this disorder.


Assuntos
Insuficiência de Crescimento/epidemiologia , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Enteropatias/diagnóstico , Síndromes de Malabsorção/epidemiologia , Desnutrição/epidemiologia , Criança , Saúde da Criança , Pré-Escolar , Meio Ambiente , Insuficiência de Crescimento/diagnóstico , Feminino , Microbioma Gastrointestinal , Saúde Global , Transtornos do Crescimento/fisiopatologia , Humanos , Lactente , Recém-Nascido , Enteropatias/epidemiologia , Enteropatias/microbiologia , Síndromes de Malabsorção/diagnóstico , Masculino , Estado Nutricional , Prevalência , Medição de Risco , Reino Unido
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