Lactase for infantile colic: A systematic review of randomized clinical trials.

Infantile colic is excessive crying for no apparent reason in an otherwise healthy infant. Although its physiopathology is not completely understood, therapies usually target gastrointestinal symptoms. This systematic review of randomized controlled trials (RCTs) analyzes the efficacy of lactase supplementation in infantile colic. PubMed, Embase, and Cochrane were searched for RCTs evaluating lactase supplementation in infants up to 6 months old with infantile colic. Out of six RCTs including 394 patients, three reported a significantly shorter crying time in the lactase group than in the placebo group, while the other three found no significant difference between groups. Of the two studies that performed the hydrogen breath test, only one reported a significant reduction in exhaled hydrogen levels. The pharmacological approach to infantile colic remains debatable, and new studies with standardized diagnostic criteria and outcomes are required to guide lactase supplementation in clinical practice.

Effects of probiotics on gastrointestinal symptoms, anthropometric measurements, and breastfeeding duration in infants with colic: a randomized control trial.

BACKGROUND: Infantile colic has a multifactorial etiology. Recent studies have suggested that probiotics may be effective in its management. OBJECTIVE: This study was carried out to evaluate the effect of the Actiregularis strain (5×106 cfu\ml) included in maternal nutrition on gastrointestinal problems, growth development, and breastfeeding outcomes in infantile colic. DESIGN AND SETTING: The study was a randomized controlled trial conducted in the neonatal outpatient clinic of a training and research hospital in Turkey. METHODS: A probiotic drink containing the Actiregularis (5×106 cfu\ml) strain was added to the diet of mothers in the probiotics group once daily for 15 consecutive days. Data were collected for each infant's 0th (birth), 1st, 4th, and 6th months. RESULTS: Infants whose mothers were administered Actiregularis for 15 days had decreased crying intensity (P = 0.000). When the difference in breastfeeding rates between the groups was significant at the 4th and 6th months (P = 0.044; P = 0.035). There was no difference in anthropometric values except the babies' weights at the 6th month. (P < 0.001). CONCLUSION: Infants treated with Actiregularis, which was added to their mothers' diet for 15 days, showed a decrease in the frequency of crying, and the difference in breastfeeding rates between the groups was significant at the 4th and 6th months. There was no difference in anthropometric values except the babies' weights at the 6th month. CLINICAL TRIALS REGISTRATION: NCT04374955 (https://clinicaltrials.gov/ct2/show/).

Vólvulo de intestino delgado como forma de presentación inusual de obstrucción intestinal / Small bowel volvulus as an unusual presentation of intestinal obstruction

Introducción: Dentro de las causas poco frecuentes de oclusión intestinal se encuentra el vólvulo de intestino delgado, el cual consiste en una torsión anormal del intestino alrededor del su propio eje de mesenterio, que provoca una obstrucción mecánica del intestino. Objetivo: Describir la semiografía del vólvulo de intestino delgado en un paciente de edad avanzada. Caso clínico: Paciente masculino de 62 años de edad, que ingresa en el cuerpo de guardia de cirugía, por dolor abdominal, tipo cólico intermitente, con una evolución de 72 horas; además, presenta distensión abdominal, náuseas y vómitos. Con el cuadro clínico, más los exámenes complementarios, se constata oclusión intestinal mecánica, causada por un vólvulo del intestino delgado. A los 5 días de ser intervenido quirúrgicamente se complicó por una perforación intestinal debido a necrosis del asa. Conclusiones: Debido a su presentación atípica y sus graves complicaciones, se precisa un diagnóstico certero y tratamiento urgente al paciente con vólvulo del intestino delgado, ya que pone en riesgo la vida(AU)

Introduction: Among the rare causes of intestinal obstruction is small intestine volvulus, which consists of an abnormal twisting of the intestine around its own mesentery axis, which causes a mechanical obstruction of the intestine. Objective: To describe the semiography of small intestine volvulus in an elderly patient. Clinical case: 62-year-old male patient, admitted to the surgery ward, due to abdominal pain, intermittent colic type, with an evolution of 72 hours; In addition, he presents abdominal distention, nausea and vomiting. With the clinical picture, plus complementary examinations, mechanical intestinal occlusion is confirmed, caused by a volvulus of the small intestine. Five days after undergoing surgery, it was complicated by intestinal perforation due to necrosis of the loop. Conclusions: Due to its atypical presentation and serious complications, an accurate diagnosis and urgent treatment are required for patients with small intestine volvulus, since it puts life at risk(AU)

Probiotics for infantile colic: Is there evidence beyond doubt? A meta-analysis and systematic review.

AIM: This study is a systematic review and meta-analysis of randomised controlled trials that employed probiotics and symbiotics for treating infantile colic. METHODS: We performed electronic systematic literature searches in Embase, PubMed and Web of Science, to identify articles published between 1950 and April 2023. Only RCT involving infants with infantile colic under 3 months were included. The treatment plan comprised 15 probiotics, which included Lactobacillus reuteri DSM 17938 and Bifidobacterium animalis lactis BB-12. The probiotics were administered alone or in combination with a prebiotic, vs. no intervention or a placebo. RESULTS: Probiotics resulted in an average reduction of 51 min of crying per day (p = 0.001). Further analysis of subgroups showed that the reduction was -39.30 min for vaginal delivery (p = 0.003), -64.66 min for Lactobacillus reuteri DSM 17938 (p = 0.03), -40.45 min for other strains (p < 0.00001), -74.28 min for exclusively breastfed infants (p = 0.0003) and -48.04 min for mixed feeding (p < 0.00001). CONCLUSION: All probiotic strains seem effective in treating infantile colic. Exclusively breastfed infants have demonstrated more significant reduction in crying time. However, the available evidence on the effectiveness of probiotics in formula-fed and caesarean-born infants is limited.

Microbiota intestinal y cólicos infantiles: ¿hay lugar para los prebióticos, probióticos y posbióticos? / Gut Microbiota and Infant Colic: is there a Place for Prebiotics, Probiotics, and Postbiotics?

El consumo de probióticos, prebióticos y posbióticos, o su combinación, puede contribuir a mantener una microbiota intestinal saludable ya que permite la regulación de su disbiosis en el caso de algunas enfermedades o trastornos, principalmente en los trastornos gastrointestinales funcionales (TGIF). El microbioma intestinal es protagonista esencial en la fisiopatología de los TGIF a través de sus funciones metabólicas y nutricionales, el mantenimiento de la integridad de la mucosa intestinal y la regulación de la respuesta inmunitaria. Las investigaciones realizadas hasta la fecha indican que los probióticos, prebióticos y posbióticos pueden tener efectos inmunomoduladores directos y clínicamente relevantes. Existen pruebas del uso de esta familia de bióticos en individuos sanos para mejorar la salud general y aliviar los síntomas en una serie de enfermedades como los cólicos infantiles. La colonización y establecimiento de la microbiota comienza en el momento del nacimiento; los primeros 2-3 años de vida son fundamentales para el desarrollo de una comunidad microbiana abundante y diversa. Diversos estudios científicos realizados mediante técnicas tradicionales dependientes de cultivo y más recientemente por técnicas moleculares han observado diferencias en las poblaciones bacterianas de bebés sanos y aquellos que sufren TGIF, estos últimos caracterizados por un aumento de especies patógenas y una menor población de bifidobacterias y lactobacilos, en comparación con los primeros. En tal contexto, se considera que la microbiota intestinal como protagonista en el desarrollo de esos trastornos, entre ellos los cólicos infantiles, a través de sus funciones metabólicas, nutricionales, de mantenimiento de la integridad de la mucosa intestinal y regulación de la respuesta inmunitaria. Esto ha abierto la puerta al estudio de la utilización de prebióticos, probióticos y posbióticos en el tratamiento y/o prevención de los TGIF infantiles. El parto vaginal y de término así como la lactancia son fundamentales en la constitución de una microbiota saludable. Como herramientas de apoyo, existen estudios de eficacia que sustentan la administración de esta familia de bióticos, principalmente en los casos en que la lactancia no sea posible o esté limitada. (AU)

The consumption of probiotics, prebiotics, and postbiotics, or a combination of them, can contribute to maintaining a healthy intestinal microbiota as it allows the regulation of its dysbiosis in the case of some diseases or disorders, mainly in functional gastrointestinal disorders (FGIDs). The gut microbiome is an essential player in the pathophysiology of FGIDs through its metabolic and nutritional functions, the maintenance of intestinal mucosal integrity, and the regulation of the immune response. Research results thus far indicate that probiotics, prebiotics, and postbiotics may have direct and clinically relevant immunomodulatory effects. There is evidence regarding the prescription of this family of biotics in healthy individuals to improve overall health and alleviate symptoms in many conditions like infantile colic. The colonization and microbiota establishment begins at birth; the first 2-3 years of life are critical for developing an abundant and diverse microbial community. Several scientific studies performed by traditional culture-dependent techniques and more recently by molecular techniques have observed differences in the bacterial populations of healthy infants and those suffering from FGIDs, the latter characterized by an increase in pathogenic species and a lower population of bifidobacteria and lactobacilli, compared to the former. In this context, the intestinal microbiota plays a leading role in the onset of these disorders, including infantile colic, through its metabolic and nutritional functions, maintenance of the integrity of the intestinal mucosa, and regulation of the immune response. That has opened the door to the study of prebiotics, probiotics, and postbiotics usage in the treatment and or prevention of infantile FGIDs. Vaginal and term delivery and breastfeeding are fundamental in the constitution of a healthy microbiota. As supportive tools, there are efficacy studies that support the administration of this family of biotics, mainly in cases where lactation is not possible or is limited.

Using peritoneal and blood lactate as predictor of condition type, surgical referral and prognosis in equine colic cases / Uso do lactato peritoneal e sanguíneo como preditor do tipo de afecção, encaminhamento cirúrgico e prognóstico em casos de cólica equina

It is important to investigate fast and accurate equine colic syndrome diagnostic forms. Lactate results from anaerobic glycolysis; high levels of it may indicate intestinal disorders with tissue hypoperfusion and hypoxia. The current study aims at investigating whether blood and peritoneal lactate values observed when horses with colic syndrome were hospitalized, were associated with condition type, therapeutic referral, and survival rates. Retrospective analysis was applied to 498 medical records of animals with colic syndrome, at EQUIVET Hospital -SP; 89 cases were herein selected. Based on logistic regression, peritoneal lactate played a more significant part than blood in variables like obstruction type and survival rates. Surgical cases comprised 52.8% of analyzed animals; strangulation changes, 26%; and overall survival, 62.9%. Mean blood and peritoneal lactate level in animals showing strangulation changes reached 5.11 and 7.33mmol/L, whereas non-strangulation cases recorded 3.54 and 3.06mmol/L, respectively. On the other hand, mean blood and peritoneal lactate level recorded for survivors reached 3.43 and 2.42mmol/L, whereas non-survivors recorded 4.84 and 7.13mmol/L, respectively. We concluded that peritoneal lactate measured when horses with colic syndrome were hospitalized was a predictor of condition type, and of animal survival and prognosis. However, blood and peritoneal lactate measurements did not contribute to therapeutic referral.

O estudo de formas diagnósticas rápidas e precisas é importante na síndrome cólica equina. O lactato, produto da glicólise anaeróbica, quando elevado, pode indicar afecções intestinais com hipoperfusão e hipóxia. O objetivo deste estudo foi verificar se os valores de lactato sanguíneo e peritoneal, na admissão de equinos com síndrome cólica, estão relacionados com o tipo de afecção, com o encaminhamento terapêutico e a sobrevida. Uma análise retrospectiva foi realizada em 498 atendimentos em síndrome cólica, no Hospital EQUIVET-SP, quando 89 casos foram selecionados. A regressão logística indicou que o lactato peritoneal obteve maior significância comparado ao sanguíneo, nas variáveis tipo de obstrução e sobrevida. Casos cirúrgicos foram 52,8%; alterações estrangulativas, 26%; e sobrevivência geral, 62,9%. Em alterações estrangulativas, a média do lactato sanguíneo e peritoneal foi de 5,11 e 7,33mmol/L; em não estrangulativos, 3,54 e 3,06mmol/L. Já os sobreviventes obtiveram 3,43 e 2,42mmol/L, e os não sobreviventes 4,84 e 7,13mmol/L, respectivamente. Conclui-se que a mensuração do lactato peritoneal na admissão de cavalos com cólica foi considerada um preditor do tipo de afecção, bem como da sobrevida e do prognóstico. Porém, as mensurações de lactato sanguíneo e peritoneal não auxiliaram no encaminhamento terapêutico.

Colic and sleep outcomes of nonpharmacological intervention in infants with infantile colic: systematic review and metaanalysis.

OBJECTIVE: The aim of this study was to systematically review the colic and sleep outcomes of nonpharmacological intervention in infants with infantile colic and perform a meta-analysis of the available evidence. METHODS: The literature review for this systematic review was conducted between December 2022 and January 2023 using five electronic databases, namely PubMed, CINAHL, Scopus, Web of Science, and ULAKBIM. Published articles were scanned using MeSH-based keywords. Only randomized controlled trials conducted in the past 5 years were included. The data were analyzed using the Review Manager computer program. RESULTS: This meta-analysis included three studies involving a total of 386 infantile colic infants. After nonpharmacological treatment, it was found that infants with infantile colic reduced crying time (standardized mean difference: 0.61; 95%CI 0.29-0.92; Z=3.79; p=0.00002), improved sleep duration (standardized mean difference: 0.22; 95%CI -0.04 to 0.48; Z=1.64; p=0.10), and decreased crying intensity (mean difference: -17.24; 95%CI -20.11 to 14.37; Z=11.77; p<0.000001). CONCLUSION: According to the meta-analysis findings, it was determined that the risk of bias was low in the studies included and that nonpharmacological chiropractic, craniosacral, and acupuncture treatments applied to infantile colic infants in the three included studies reduced crying time and intensity and increased sleep duration.

Lactobacillus reuteri como probiótico para cólicos infantiles, diarrea, dolor abdominal funcional y estreñimiento funcional en pediatría / Lactobacillus reuteri as a probiotic for infantile colic, diarrhea, functional abdominal pain and functional constipation in pediatrics

INTRODUCCIÓN: El principio del uso de probióticos proviene de la utilización de productos fermentados, desde tiempos muy antiguos. Se definen como microorganismos vivos que, administrados en cantidades adecuadas, confieren beneficios para la salud.[1] Entre las utilidades atribuidas a los probióticos, las más extensamente estudiadas han sido los efectos en niños con diarrea aguda. Existe abundante bibliografía sobre la utilización de estos productos en el tratamiento y la prevención de diarrea aguda infecciosa, y prevención de diarrea nosocomial y de diarrea asociada al uso de antibióticos. Los estudios son heterogéneos en su metodología y muestran resultados dispares, incluso contradictorios. En la interpretación de éstos es imprescindible tener en cuenta las cepas de probióticos utilizadas, las dosis administradas y las características de los pacientes en quienes fueron probadas.[2] El cólico infantil, o el llanto excesivo de causa desconocida, es una condición de pesada carga que afecta aproximadamente 1 cada 5 bebés menores de 3 meses de edad.[3] El cólico infantil es comúnmente definido por los criterios de Wessel modificados como la presencia de llanto y/o molestias > 3 horas al día durante = 3 días a la semana.[4] El cólico infantil es un problema frecuente en la consulta pediátrica. Su prevalencia mundial es del 15 al 40% en niños menores de cuatro meses, independientemente del tipo de lactancia administrada El dolor abdominal funcional es un dolor de estómago episódico o continuo sin causa orgánica. Esto significa que el dolor no es causado por un cambio físico o fisiológico de algún tejido u órgano. Por lo general, el dolor se localiza alrededor del ombligo, pero el patrón y la localización de este dolor no siempre son predecibles. El dolor puede ocurrir repentinamente o ir incrementando lentamente de intensidad. Puede ser constante o variar en severidad. Este afecta a niños entre 4 y 18 años, con un pico de presentación entre los 5 y los 7 años, justo cuando el niño comienza a ir al colegio, y otro pico entre los 8 y los 12 años. Se estima que entre el 10 y el 20% de los niños en edad escolar padecen trastornos funcionales de dolor. El dolor abdominal funcional es más común en las niñas.[6] El estreñimiento funcional es un problema común en pediatría, con una prevalencia mundial estimada del 3 %. La constipación funcional es originada por la retención voluntaria de materia fecal debido al dolor o miedo evacuatorio. Los desencadenantes pueden ser por un cambio en la dieta, la dificultad en el abandono del pañal, durante el período de escolarización o, simplemente, el antecedente de haber padecido una deposición previa dolorosa, que produce conductas retentivas secundarias al temor. Estas conducen a una mayor absorción colónica de agua, lo que crea heces duras, con el consiguiente círculo vicioso que puede desencadenar escurrimiento fecal. OBJECTIVO: Evaluar rapidamente los parâmetros de eficácia, seguridade, costos y recomendacones disponibles acerca del empleo de L. reuteri para el tratamento de personas con cólicos infnatiles, diarrea, dolor abdominal funional, estreñimiento funcional en niños. METODOLOGIA: Se realizó una búsqueda bibliográfica en las principales bases de datos tales como PUBMED, LILACS, BRISA, COCHRANE, SCIELO, EMBASE, TRIPDATABASE como así también en sociedades científicas, agencias reguladoras, financiadores de salud y agencias de evaluación de tecnologias sanitárias. Se priorizó la inclusión de revisiones sistemáticas, ensayos clínicos controlados aleatorizados, evaluación de tecnología sanitária y guias de práctica clínica. RESULTADOS: Se hicieron recomendaciones para el uso de cepas probióticas específicas para el tratamiento de la gastroenteritis aguda, la prevención de la diarrea asociada a antibióticos, la diarrea nosocomial y la enterocolitis necrotizante, el tratamiento de la infección por Helicobacter pylori y el tratamiento de los trastornos funcionales del dolor abdominal y los cólicos infantiles. CONCLUSIONES: Los probióticos, en general, se consideran seguros para su uso en niños en las indicaciones de cólico del lactante, diarrea aguda, estreñimiento funcional y dolor abdominal funcional pediátrico. Sin embargo, es importante destacar que pueden causar efectos secundarios gastrointestinales leves en algunos casos, como gases, distensión abdominal o molestias estomacales. Estos efectos suelen ser transitorios y desaparecen con el tiempo o al suspender el uso de los probióticos. En raras ocasiones, se han reportado complicaciones más serias, como infecciones sistémicas en pacientes inmunocomprometidos, aunque son extremadamente infrecuentes. En la actualidad, los probióticos se consideran un complemento terapéutico más que un tratamiento definitivo para las diversas indicaciones solicitadas. Aunque existen pruebas limitadas sobre su eficacia en la mejora de estas condiciones, especialmente en el ámbito pediátrico, su inclusión en los listados institucionales es aún limitado. Sin embargo, contar con una gama más amplia de opciones terapéuticas fortalecería el arsenal de herramientas disponibles para los pediatras en la gestión de problemas de la práctica clínica habitual, que con frecuencia resultan en consultas recurrentes por parte de los padres. Por lo tanto, la ampliación del uso de probióticos podría proporcionar beneficios adicionales en el manejo de diversas afecciones pediátricas, ofreciendo opciones terapéuticas complementarias y promoviendo una atención integral y personalizada para los pacientes pediátricos.

Predictive validity and cut-off point of the Turkish version of the Infant Colic Scale in the diagnosis of colic.

OBJECTIVE: To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic. METHODS: This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6-16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard. RESULTS: The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815-0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%. CONCLUSION: The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.

Uso do grupo de WhatsApp® no acompanhamento pós-alta do bebê prematuro: implicações para o cuidado em enfermagem / Uso del grupo WhatsApp® en el seguimiento post-alta del bebé prematuro: implicaciones para el cuidado de enfermería / Use of the WhatsApp® group in the post-discharge follow-up of the premature infant: implications for nursing care

Resumo Objetivo analisar o uso do aplicativo WhatsApp®, enquanto ferramenta tecnológica, para auxiliar as mães no acompanhamento pós-alta do bebê prematuro. Método estudo de abordagem qualitativa realizado com 18 mães de bebês prematuros que haviam sido internados nas unidades neonatais de um hospital universitário no interior de São Paulo. Os dados foram coletados no período de julho a novembro de 2021 por meio de mensagens deixadas em um grupo de WhatsApp® destinado ao acompanhamento pós-alta dos pré-termo. As mensagens foram analisadas a partir da Análise de Conteúdo Temática. Resultados o grupo de WhatsApp® teve boa aceitação e adesão por parte das mães, que puderam compartilhar suas experiências, seus conhecimentos e sentimentos. Os principais temas levantados foram: Aleitamento materno ao bebê prematuro; Manejo da cólica infantil; Cuidados básicos ao prematuro no domicílio; Vivências na internação do prematuro; Desafios enfrentados no domicílio; Percepção das mães sobre o grupo de WhatsApp®. Conclusão e implicações para a prática as mães demonstraram inseguranças e dúvidas sobre os cuidados básicos com o prematuro em domicílio. A estratégia de utilizar o aplicativo WhatsApp® no acompanhamento em saúde do bebê prematuro apresentou resultados satisfatórios, favorecendo a continuidade do cuidado e o apoio às mães.

Resumen Objetivo analizar el uso de la aplicación WhatsApp®, como herramienta tecnológica, para asistir a las madres en el seguimiento post-alta del bebé prematuro. Método estudio de abordaje cualitativo realizado con 18 madres de prematuros internados en las unidades neonatales de un hospital universitario del interior de São Paulo. Los datos fueron recolectados de julio a noviembre de 2021 a través de mensajes dejados en un grupo de WhatsApp® destinado al seguimiento post-alta de prematuros. Los mensajes fueron analizados a partir del Análisis de Contenido Temático. Resultados el grupo de WhatsApp® fue bien aceptado y adherido por las madres, que pudieron compartir sus experiencias, sus conocimientos y sentimientos. Los principales temas abordados fueron: Lactancia materna del prematuro; Manejo del cólico infantil; Cuidados básicos para bebés prematuros en el hogar; Experiencias en la hospitalización de prematuros; Desafíos enfrentados en el hogar; Percepción de las madres sobre el grupo de WhatsApp®. Conclusión e implicaciones para la práctica las madres mostraron inseguridades y dudas sobre los cuidados básicos del prematuro en el hogar. La estrategia de uso de la aplicación WhatsApp® en el seguimiento de la salud de los bebés prematuros mostró resultados satisfactorios, favoreciendo la continuidad de la atención y el apoyo a las madres.

Abstract Objective to analyze the use of the WhatsApp® application, as a technological tool, to help mothers in the post-discharge follow-up of their premature infant. Method a qualitative study conducted with 18 mothers of preterm infants who had been admitted to the neonatal units of a university hospital in the interior of São Paulo. Data were collected from July to November 2021 through messages left in a WhatsApp® group for the post-discharge follow-up of preterm infants. The messages were analyzed using Thematic Content Analysis. Results the WhatsApp® group had good acceptance and adhesion by the mothers, who were able to share their experiences, knowledge, and feelings. The main topics raised were: Breastfeeding the premature baby; Management of infant colic; Basic care of the premature baby at home; Experiences in the hospitalization of the premature baby; Challenges faced at home; Mothers' perception of the WhatsApp® group. Conclusion and implications for the practice the mothers showed insecurities and doubts about the basic care of the premature baby at home. The strategy of using the WhatsApp® application in the health monitoring of premature babies showed satisfactory results, favoring the continuity of care and support to mothers.

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

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.

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.

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.

CLINICAL AND EPIDEMIOLOGICAL EVALUATION OF COMPLICATIONS ASSOCIATED WITH GALLSTONES IN A TERTIARY HOSPITAL.

BACKGROUND: Gallstones are the presence of bile clay in the gallbladder or bile ducts. The disease can be asymptomatic or symptomatic and can lead to complications and consequently a worse prognosis, such as acute cholecystitis, choledocholithiasis, cholangitis, and acute pancreatitis. The risk of complications increases after the first episode of biliary colic. OBJECTIVE: A clinical-epidemiological evaluation of patients admitted to a gastroenterology ward of a tertiary care hospital with gallstone-related complications. METHODS: We evaluated 158 patients admitted through discharge reports and medical records analysis from January 1, 2013, to February 24, 2021. RESULTS: The female sex was predominant (76.6%), and the mean age of patients was 51.6 years. Men were significantly older than women (P=0.005). Most (57.6%) had some comorbidity, the most frequent being systemic arterial hypertension, diabetes mellitus, and obesity. The mean hospitalization time was 24 days, significantly longer in men (P=0.046) but without a direct relationship with age (P=0.414). The most frequent complication was choledocholithiasis, and 55.7% of patients without previous cholecystectomy had a report of biliary colic before admission, on average 1.5 years previously. A history of a prior cholecystectomy was present in 17.1% of those evaluated. Abdominal ultrasonography followed by magnetic resonance cholangiography was the most frequently performed exam for diagnostic definition. Regarding therapeutic measures, endoscopic retrograde cholangiopancreatography was necessary for 47.3% of patients without previous cholecystectomy and 81.4% of patients who have already had a cholecystectomy. Among patients not yet cholecystectomized, 84% underwent the procedure before discharge. CONCLUSION: The female patients were predominant. Men were significantly older than women and had more extended hospital stays. The most frequent complication was choledocholithiasis, and around half of the patients reported previous biliary colic. endoscopic retrograde cholangiopancreatography has been necessary for the majority of the patients.

Prevalence of Functional Gastrointestinal Disorders in Brazilian Infants Seen in Private Pediatric Practices and Their Associated Factors.

OBJECTIVES: To assess the prevalence of the most frequent functional gastrointestinal disorders (FGIDs) in Brazilian infants seen in private pediatric clinics and their relationship with cesarean delivery, breastfeeding, and history of prematurity. METHODS: This cross-sectional study enrolled 5080 infants under 12 months old with routine visits in private pediatric clinics in Brazil. The mothers answered questions about the type of delivery, type of feeding (breast milk, infant formula, cow milk, mixed feeding), history of prematurity, and gastrointestinal symptoms. Rome IV criteria were used to diagnose FGIDs. RESULTS: The prevalence of infant regurgitation was 10.7% (487/4560); infant colic, 6.1% (131/2162); infant dyschezia, 4.0% (157/3895); functional constipation, 7.6% (341/4506); and functional diarrhea, 0.09% (2/2186). Prematurity was associated ( P < 0.05) with infant regurgitation (odds ratio [OR] = 1.41; 95% confidence interval [CI]: 1.05, 1.90), infant colic (OR = 1.97; 95% CI: 1.19, 3.24), infant dyschezia (OR = 1.64, 95% CI: 1.02, 2.64), and functional constipation (OR = 1.44; 95% CI: 1.02, 2.02). Prematurity was associated ( P < 0.001) with two or more FGIDs between 21 days and 150 days of age (OR = 3.06; 95% CI: 1.74, 5.37). CONCLUSION: FGIDs are common in infants seen in the private pediatric practice in Brazil. History of prematurity was associated with infant regurgitation, infant colic, functional dyschezia, and functional constipation.

Changes in the gut microbiome and colic in horses: Are they causes or consequences?

The gut microbiome is a compound for millions of microorganisms that coexist in an organized way and contribute to the fermentation of different types of indigestible fibers by the small intestine. Some techniques, such as the massive sequencing of the 16S ribosomal RNA gene, have made it possible to obtain information about the abundance and functionality of the microorganisms that compose the equine gut microbiome and the interaction with their environment. Recent studies have identified the change in the composition of the intestinal microbiome during and after a colic episode, although is not clear if it is a cause or a consequence. The objective of this review was to elucidate whether there is a direct relationship between the changes that occur in the gut microbiome and colic in the equine. A systematized search in Embase, Web of Science, and PubMed was realized. Although there is good evidence that horses with colic have a change in their gut microbiome, it is not fully understood whether these changes are causes or effects. It is necessary to delve into this topic, considering studying larger population sizes. In addition, it would be of great value to previously know the normal intestinal microbiome of a group of healthy horses, which in the future could develop an episode of colic, to compare the before and after in the same individual.

Factores de riesgo prequirúrgicos para una colecistectomía laparoscópica difícil / Preoperative risk factors for difficult laparoscopic cholecystectomy

RESUMEN Antecedentes: varios estudios observacionales han identificado factores de riesgo (FR) para una colecistectomía laparoscópica difícil (CLD). Objetivo: identificar los FR preoperatorios para CLD en un hospital público de mediana complejidad. Material y métodos: estudio prospectivo de cohorte transversal. Se analizaron 80 pacientes mayores de 18 años sometidos a colecistectomía laparoscópica, entre enero y diciembre de 2019. Se analizaron las variables: edad, sexo, IMC (índice de masa corporal), litiasis vesicular, pancreatitis aguda, colecistitis aguda o crónica, síndrome de Mirizzi, CPRE dentro del mes, numero de cólicos en el último mes, si presentó al menos un cólico en la última semana, leucocitos, enzimas hepáticas mayores, bilirrubina total, hallazgos de ecografía prequirúrgicos, antecedentes de cirugías abdominales previas. Resultados: la incidencia de CLD fue de 47,5%. La tasa de conversión a cirugía convencional fue del 11,25%, el 100% fueron CLD. Los FR para CLD incluyeron sexo masculino (OR: 4,50, IC 95%:1,60-12,62, p: 0,004), cólico en la semana previa a la cirugía (OR:7,17, IC 95%:1,89-27,23, p: 0,004), paredes engrosadas de la vesícula (OR: 4.90, IC 95%:1,90-12,70, p: 0,001), edema perivesicular (OR: 7,14 IC 95%:1,45-35,13 p: 0,016), la vesícula hidrópica (OR: 4,94, IC 95%:1,44-16,88, p: 0,011) y las cirugías previas (OR: 4.38 IC 95%:1,27-15,10 p: 0,001). En el análisis multivariado vemos que los pacientes de sexo masculino y pacientes con cirugías previas presentaban un riesgo elevado para CLD (OR: 6,63 IC 95%:1,75-25,08 p: 0.005; OR: 11.70 IC 95%:1,48-92,37 p: 0,020). Conclusión: se deben centrar los esfuerzos en identificar los pacientes con sospecha de CLD, pudiendo planificar la cirugía y un equipo quirúrgico experimentado.

ABSTRACT Background: The risk factors (RF) for difficult laparoscopic cholecystectomy (DLC) have been identified in many observational studies. Objective: The aim of this study is to identify the preoperative RF for DLC in a secondary care public hospital. Material and methods: We conducted a prospective cross-sectional cohort study of patients > 18 years undergoing laparoscopic cholecystectomy between January and December 2019. The following variables were analyzed: age, sex, body mass index (BMI), cholelithiasis, acute pancreatitis, acute or chronic cholecystitis, Mirizzi syndrome, ERCP within the previous month, episodes of biliary colic in the last month, presence of at least one colic within one week before surgery, white blood cell count, liver enzymes, total bilirubin, preoperative ultrasound and history of upper abdomen surgery. Results: The rate of DLC was 47.5%. Conversion rate to conventional surgery was 11.25% and 100% were categorized as DLC. The RF for DLC included male sex (OR, 4.50; 95% CI,1.60-12.62; p = 0.004), colic within 1 week before surgery (OR, 7.17; 95% CI,1.89-27.23; p = 0.004), gallbladder wall thickening (OR, 4.90; 95% CI,1.90-12.70; p = 0.001), edema around the gallbladder (OR, 7.14; 95% CI, 1.45-35.13; p = 0.016), hidrops gallbladder (OR, 4.94; 95% CI,1.44-16.88; p = 0.011) and previous surgeries (OR, 4.38; 95% CI, 1.27-15.10; p = 0.001). On multivariate analysis, male sex and previous surgery were associated with higher risk of DLC (OR, 6.63; 95% CI,1.75-25.08; p = 0.005; and OR, 11.70, 95% CI,1.48-92.37; p = 0.020, respectively). Conclusion: Efforts should focus on identifying patients with suspicion of DLC to plan surgery with an experienced surgical team.

Síndrome cólica em equinos induzida por ingestão de cana de açúcar / Equine colic syndrome induced by the ingestion of sugarcane

Background: Equine colic syndrome comprises numerous conditions associated with abdominal pain in horses. Impaction, a common cause of this manifestation, is strongly related to these animals' diet. Highly fibrous diets such as sugarcane can predispose horses to colic. The clinical condition can be worsened by fermentative processes, which lead to dysbiosis, circulatory disorders and even endotoxemia. The aim of this study was to report 4 cases of colic syndrome among 8 horses that underwent an experiment to adapt them to a sugarcane-based diet, and to correlate the animals' clinical conditions to the forage they ingested. Cases: Eight male castrated Mangalarga Marchador horses, between 5.5 and 7 years old, were subjected to an experiment to test the feasibility of sugarcane as forage. Four of these horses were taken to the Large Animal Veterinary Hospital (HVGA) of the Federal Rural University of Rio de Janeiro for treatment of abdominal signs of discomfort a few days after the exclusive consumption of sugarcane, in a proportion of 1.75% of live weight in dry matter. The animals' symptoms ranged from behavioral signs indicative of pain to changes in vital parameters and structure of the feces, as well as changes revealed by transrectal palpation. Three of the 4 cases presented impaction in the small colon, and 1 of the horses also presented impaction in the right dorsal colon and rostral displacement of the pelvic flexure, with accumulation of contents in the right ventral colon and sternal flexure. Two of the cases were treated medically, while the other 2 required surgical intervention. The clinical condition of all the patients evolved favorably and they were discharged between 2 and 18 days. Discussion: Colic originating in the digestive system is a syndrome strongly associated with management, especially with respect to confinement, nutrition, and parasite control. During the experiment, 4 of the 8 horses fed with sugarcane presented with colic syndrome. The low quality of sugarcane fiber is due to the high degree of lignification of the plant cell wall, which favors accumulation of ingesta. The poor digestibility and sweet taste of this roughage favor increased consumption. Furthermore, its high sucrose content, associated with an increased rate of passage in the small intestine, alters the intestinal microbiome, and hence, the fermentation byproducts and pH of the ingesta. High intestinal content, allied to longer retention times in the colon and activation of the renin-angiotensin-aldosterone system, promote greater dryness of the ingesta, predisposing the occurrence of impactions in the most distal portion of the large intestine. Intestinal distension and mesenteric traction caused by the accumulation of contents and gases trigger pain, which can worsen due to displacement of the large colon. Small colon impaction, which is easily identified by transrectal palpation, evolves gradually and its treatment, both clinical and surgical, tends to have a favorable prognosis. The need for alternative food sources for horses is a growing demand; however, sugarcane as an exclusive roughage has been shown to be unsafe for horses. The low quality of the fiber and the high sucrose content of this forage can alter the digestive physiology of horses through changes in the passage rate, microbiome and motility of digesta, predisposing them to intestinal dysfunction, ingesta compaction and displacement of the large colon.

Heavy metal contamination in Peru: implications on children's health.

Cerro de Pasco, Peru, has been excessively contaminated with heavy metals due to high mining activities in the region. We investigated the presence of chronic exposure to heavy metals in children living in Cerro de Pasco and its effect on health. Heavy metal concentrations were determined in hair samples collected from 78 children living in a region exposed to an open-pit mine (Paragsha region) and from other 16 children unexposed to mine activities (Carhuamayo region). Children exposed to the mine showed statistically significant higher concentration of aluminum, antimony, arsenic, cadmium, chromium, iron, lead, tin and thallium (p < 0.05) than control children. Hair samples collected from the same children in two occasions (2016 and 2018) showed that the exposure is chronic with higher levels of heavy metals observed in 2018. The concentration of heavy metals was higher in hair tip than in hair root samples. Heavy metals are associated with substantial higher risk of nosebleed (odds ratio, OR = 15.40), chronic colic (OR = 7.30), dermatologic alterations (OR = 6.16), mood alterations (OR = 7.07), presence of white lines on nails (OR = 12.10), reduced visual camp (OR = 3.97) and other symptoms (OR = 5.12). Chronic heavy metal exposure implies various negative consequences on children's health. Preventive measures are crucial to protect children's health.

Evidence of Lactobacillus reuteri to reduce colic in breastfed babies: Systematic review and meta-analysis.

OBJECTIVE: To investigate evidence for the treatment of childhood colic by supplementing Lactobacillus reuteri in infants breastfed with breast milk. METHODS: The study was conducted according to the PRISMA protocol. The databases used for acquiring data were PubMed and Web of Science, applying MeSH terms and free terms. Meta-analysis was conducted using Stata ™ 12.0. The risk of bias was evaluated by the Review Manager (RevMan) 5.3 tool, and the strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten clinical trials were included in the review. The administration of L. reuteri (DSM 17938 or ATCC55730) was tested in infants (n = 248) versus the control/placebo group (n = 229). Eight articles were included in the meta-analysis. There was a significant response in reducing crying time (minutes/day) and treatment effectiveness (reduction ≥ 50% in average daily crying time) in the first week (p = 0.001 and p = 0.003, respectively). These results were similar in the second, third weeks (p < 0.001 for both outcomes) and fourth weeks (p<0.001 and p = 0.002, respectively). The risk of bias was low for the majority of the studies. Confidence in evidence was considered very low for crying time and low for effectiveness treatment. CONCLUSIONS: The evidence shows that the administration of Lactobacillus reuteri to babies fed with breast milk reduces the crying time in babies diagnosed with colic. But our confidence in the effect estimate is limited.