¿Existe en la constipación idiopática severa un trastorno difuso de la motilidad intestinal? / Disturbances of small intestinal motility in patients with chronic constipation

Background: Studies in patients with chronic severe constipation, suggest the presence of a diffuse motor disorder of the gastrointestinal tract. Aim: To investigate small bowel motor activity in a group of patients with severe constipation. Material and Methods: Forty three patients (age range 13 to 70 years, 40 women) with severe constipation referred to our motility laboratory, where studied. Ten had a previous colectomy. Radiological examinations showed a megacolon in 30 and dilatation of small intestinal loops in nine; the remaining X rays studies were normal. Small intestinal motility was studied using perfused catheters and external transducers. Results: Ten patients had normal motor recordings. Eight patients showed a neuropathic disorder characterized by a continuous irregular pattern of contractions of normal amplitude, with absence of phase III of the migrating motor complex (MMC). Sixteen presented a normal MMC associated to a decreased amplitude of contractions (Miopatic disorder). Nine showed both types of motor disorders (Mixed pattern). Normal radiological findings were more commonly associated to normal manometric recordings. By contrast, an altered motor activity, mainly of myopathic and mixed type motor disorder, was observed in all patients with dilated small intestinal and colonic loops. Conclusions: The presence of small intestinal motor disorders was a frequent finding in this selected group of patients with chronic constipation.

Giardiasis: functional immunological and histological study of the small bowel; therapeutic trial with a single dose of tinidazole

Quatorze pacientes com idade entre 9 meses e 5 anos, com diarréia crônica e giardíase, foram estudados. Dez eram eutróficos e quatro eram subnutridos. O diagnóstico parasitológico foi feito pelo exame de fezes, aspirado duodenal e no muco aderente à mucosa de biopsia intestinal. Estudos da funçäo absortiva, determinaçäo de IgA e imunofluorescência foram feitos. Após os testes, foi administrada suspensäo de tinidazol com 60 a 70 mg/Kg em dose única, via oral. Os pacientes foram reavaliados clínica e laboratorialmente após 30 dias. O propósito do trabalho foi o de avaliar alteraçöes laboratoriais e a eficácia da dose única. Nove pacientes tiveram bons resultados clínicos, dois foram regulares e três näo foram avaliados devido à doença celíaca. Todos tiveram exame parasitológico negativo. Näo houve relaçäo entre o número de protozoários e severidade dos sintomas, nem entre gordura fecal e d-xilose antes e após o tratamento. Houve melhora significativa (p < 0,05) na absorçäo de dissacarídeos, após o tratamento. A determinaçäo de IgA secretora foi baixa, antes e após o tratamento (p < 0,01). A imunofluorescência mostrou células produtoras de IgA em todos os casos. A melhora histológica da mucosa foi observada em seis pacientes