ABSTRACT
Chronic intestinal pseudo-obstruction (CIP) is the most severe intestinal motility disorder. Small intestinal bacterial overgrowth (SIBO) is frequently associated to dysmotility. In spite of this association, there is scare data on the relation between CIP and SIBO. To establish occurrence of CIP in SIBO patients in inter-crisis periods. To compare clinical and manometric characteristics of SIBO and non-SIBO patients. Retrospective analysis of 40 CIP patients (average age: 41 years; range: 18-76 years; 75 percent women). The following elements were registered: symptoms (such as pain, distention, vomit, constipation, diarrhea and weight loss); findings of the intestinal manometry (neuropathic, miopatic and mix pattern; intestinal motility index); and SIBO using lactulose H2 breath test, defined as an increase > 20 ppm in 2 or more figures in the first 60 minutes. Statistical analysis: t-test y and comparison of two ratios. SIBO was observed in 60 percent of the patients with CIP. Three or more symptoms were observed in 70.8 percent of the patients with SIBO 50 percentwithout SIBO (p = NS). In patients with SIBO, the most frequent symptom was abdominal pain (70.8 percent p= 0.032). There were no differences between SIBO patients and the different motility patterns, however, the intestinal motility index was lower for the SIBO group (9.7 +/- 44 12.3 +/-7; p < 0.001). : There is a high prevalence of SIBO in CIP patients. This is associated to a major compromise of intestinal motility assessed by the intestinal motility index...
Introducción: La pseudoobstrucción intestinal crónica (POIC) es el trastorno más grave de la motilidad intestinal. El sobrecrecimiento bacteriano intestinal (SBI) se asocia frecuentemente a estados de dismotilidad. A pesar de esta asociación existen escasos datos sobre la relación entre POIC y SBI. Objetivo: Determinar SBI en pacientes con POIC en período inter-crisis. Comparar características clínicas y manométricas de pacientes con y sin SBI. Material y Método: Análisis retrospectivo de 40 pacientes con POIC (edad promedio: 41 años, rango: 18-76 años; 75 por ciento mujeres). Se registraron síntomas (dolor, distensión, vómitos, constipación, diarrea, baja de peso), hallazgos en manometría intestinal (patrón neuropático, miopático o mixto, índice de motilidad intestinal (IMI)) y SBI con test de H2 con lactulosa, definido como la elevación > 20 ppm en 2 o más cifras en los primeros 60 min. Análisis estadístico: t-test y comparación de 2 proporciones. Resultados: Se observó SBI en 60 por ciento de los pacientes con POIC. Tres o más síntomas se presentaron en 70,8 por ciento de los pacientes con SBI vs 50 por ciento en POIC sin SBI (p = NS). El síntoma dolor abdominal fue más frecuente en pacientes con SBI (70,8 por ciento vs 31,2 por ciento, p = 0,032). No hubo diferencias entre pacientes con SBI y los distintos patrones de motilidad, sin embargo, el IMI fue menor para el grupo con SBI (9,7 +/- 1,44 vs 12,3 +/- 1,7, p < 0,001). Conclusiones: Existe una alta prevalencia de SBI en pacientes con POIC. Esto se relaciona con mayor compromiso de la motilidad intestinal evaluado por el IMI.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Bacteria/growth & development , Intestine, Small/microbiology , Intestinal Pseudo-Obstruction/epidemiology , Chronic Disease , Gastrointestinal Motility , Hydrogen/analysis , Lactulose , Manometry , Breath Tests/methods , Retrospective Studies , Intestinal Pseudo-Obstruction/diagnosis , Intestinal Pseudo-Obstruction/microbiologyABSTRACT
The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25 percent of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6 percent sensitivity, 92.9 percent specificity, and an error of 17.9 ± 6 percent (with a 95 percent confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Dyspepsia/diagnosis , Electrodiagnosis/methods , Case-Control Studies , Dyspepsia/physiopathology , Sensitivity and Specificity , Young AdultABSTRACT
In patients with gastroesophageal reflux disease (GER) and esophageal neuromuscular disorders several routine techniques such as stationary esophageal manometry, cintigraphy, 24 h ambulatory pH metry has been used. These test are considered very important tools in the management of these patients. However in several cases symptoms and their mechanisms remain unexplained by tests previously mentioned. In the last years several new techniques has been introduced in the study of esophageal functions: high-resolution manometry, esophageal impedance, planimetry impedance and high frequency ultrasound. The aim was briefly review these new laboratory techniques, same of which are actually available for clinical purposes, with and increasing role in the study of patients with different esophageal disorders.
En el estudio de pacientes con reflujo gastroesofágico y trastornos neuromusculares del esófago se utilizan en forma habitual varias técnicas, entre otras, la manometría estática, la pH-metría de 24 hrs y la cintigrafía. Estas técnicas se consideran herramientas muy importantes en el manejo de estos enfermos. Sin embargo, en varios pacientes los síntomas y sus mecanismos no pueden ser adecuadamente explicados por estas técnicas. En los últimos años han surgido nuevos métodos de evaluación de la función esofágica como la manometría de alta resolución, la impedanciometría, la impedancia planimétrica y el ultrasonido intraluminal de alta frecuencia. El objetivo de esta revisión es hacer un breve análisis de estas técnicas, alguna de las cuales están disponibles para fines clínicos y en forma creciente han adquirido un rol en el estudio de enfermos con diferentes trastornos esofágicos.
Subject(s)
Humans , Esophagus/physiopathology , Electric Impedance , Manometry/methods , Esophageal pH Monitoring , Ultrasonics , Hydrogen-Ion Concentration , Pain/physiopathology , Electric Stimulation , Physical Stimulation , Esophagus/physiology , Gastroesophageal Reflux/physiopathology , Esophageal Motility Disorders/physiopathologyABSTRACT
Background: Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. Aim: To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). Material and methods: Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. Results: We studied 367 patients with a mean age of 50 years (87 percent females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76 percent of patients with IBS, 73 percent of those with functional constipation, 69 percent of those with functional diarrhea and 68 percent of those with functional bloating. Conclusions: This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Bacteria/growth & development , Constipation/microbiology , Diarrhea/microbiology , Flatulence/microbiology , Irritable Bowel Syndrome/microbiology , Breath Tests/methods , Intestine, Small/microbiology , Prevalence , Prospective Studies , Surveys and QuestionnairesABSTRACT
Background: Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. At present, therapeutic strategies to eradicate this bacterium depend on our knowledge of its resistance to antimicrobials. Aims: To evaluate the primary resistance of H pylori to metronidazole (Mtz), clarithromycin (Cla), and tetracycline (Tet) in symptomatic out-patients. Material and Methods: Fifty independent isolates of H pylori were obtained by endoscopy-assisted gastric biopsy from patients attending the University of Chile Clinical Hospital, that previously had not been treated with an eradication regime against this bacterium. The minimal inhibitory concentration of each antimicrobial was determined by agar dilution method. Results: Forty five and 27 percent of the isolates were found to be resistant to Mtz and Tet, respectively; the majority of these resistant isolates were from patients older than 21 years. Twenty percent of isolates were resistant to Cla; these were distributed evenly among different ages. Thirty two percent of the isolates were resistant to two or more of the antimicrobials. Conclusions: The high frequency of naturally occurring, antimicrobial-resistant strains of H pylori poses a national and world-wide problem for public health.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Clarithromycin/pharmacology , Drug Resistance, Multiple, Bacterial/drug effects , Helicobacter pylori/drug effects , Metronidazole/pharmacology , Tetracycline/pharmacology , Age Distribution , Chile , Helicobacter Infections/drug therapy , Microbial Sensitivity Tests , Tetracycline Resistance/drug effectsABSTRACT
Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. In Chile about 79 percent of the population is colonized. Aims: This study evaluate the prevalence of the H. pylori infection in symptomatic outpatients. Materials and Methods: 276 non selected patients were enrolled from Endoscopic Unit of Clinical Hospital of the University of Chile. The bacterium was detected by urease test. Results: H. pylori infection was found in 44,9 percent patients. Infection was higher in younger patients, 53,8 percent between 21-60 years, and was lower in older patients, 25,6 percent in older than 60 years. The risk of being H. pylori carrier is twofold higher in persons younger than 60 years as compared to those older than 60 years. Conclusion: The age would be modifier factors for H. pylori infection risk.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged, 80 and over , Helicobacter pylori , Helicobacter Infections/diagnosis , Helicobacter Infections/epidemiology , Urease , Chile , PrevalenceABSTRACT
Background: Many patients with irritable bowel syndrome (IBS) have lowered sensory thresholds to rectal distention when compared to control subjects, a phenomenon called visceral hypersensitivity. Aim: To investigate the usefulness of a rectal barostat as a diagnostic tool in IBS and if there are differences in visceral hypersensitivity in different groups of IBS patients. Patients and Methods: Ten healthy subjects and 19 IBS patients, defined using Rome II criteria (12 with constipation, three with diarrhea and four alternating between diarrhea and constipation), were studied. Sequential isobaric rectal distentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reported pain, were carried out. Visceral hypersensitivity was defined as a pain threshold under 38 mmHg. Results: Only 26 percent of IBS patients had visceral hypersensitivity (16 percent and 43 percent of patients with IBS and constipation and IBS and diarrhea or alternating symptoms, respectively, p =NS). Pain threshold in controls, patients with IBS and constipation and patients with IBS and diarrhea or alternating symptoms was 43.8±6.6, 45.3±9.2 and 40.8±9.2 mmHg, respectively (p =NS). Conclusions: Our results do not support the usefulness of the electronic rectal barostat as a diagnostic method to diagnose IBS.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Hyperalgesia/physiopathology , Irritable Bowel Syndrome/physiopathology , Pain Threshold/physiology , Case-Control Studies , Hyperalgesia/etiology , Irritable Bowel Syndrome/complications , Rectum/physiopathology , Reproducibility of Results , Viscera/physiopathologyABSTRACT
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.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Constipation/physiopathology , Gastrointestinal Motility/physiology , Intestinal Diseases/physiopathology , Intestine, Small/physiopathology , Chronic Disease , Constipation , Intestinal Diseases , Intestine, Large/physiopathology , Manometry , Megacolon/physiopathology , MegacolonABSTRACT
Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis. Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated.
Subject(s)
Humans , Male , Female , Middle Aged , Candidiasis/immunology , Esophageal Diseases/microbiology , Immunocompetence/immunology , /immunology , Candidiasis/complications , Esophageal Diseases/immunology , Gastroscopy , Hypersensitivity, Delayed , Prospective StudiesABSTRACT
Serum antibodies against Trypanosoma Cruzi have been observed in 19 percent of the Chilean population. Marked differences in organ involvement have been reported in patients with Chagas disease. Chagas disease is rarely an aetiological factor for achalasia in Chile, which is different from reports in other countries of South America. In contrast, a high incidence of megacolon among these patients have been reported. Aim: To study the incidence of gastric and small intestinal motor disorders among these patients and their relationship to esophageal and colon motility disorders. Patients and Methods: We studied 18 patients, 12 women (mean age 45 years); with positive antibodies against T Cruzi. Seven had radiological evidence of megacolon and no one had radiological or manometric evidence for achalasia. Non specific motor esophageal abnormalities were found in 11 patients. Nine had an abnormal electrocardiogram, suggesting a myocardial disease. A questionnaire for gastrointestinal symptoms, an electrogastrography and a small intestinal motility study, were performed in each patient. Results: All patients had evidences of abnormalities in at least one segment of the digestive tract. Twelve patients had an abnormal electrogastrographic study, with bradygastria as the most common finding. Nine had an abnormal small intestinal manometry with a myophatic pattern evidenced by a decreased amplitude of contractions (18.5±3 mmHg). Also an increased number of clustered contractions was observed. Conclusions: Gastric dysrhythmias and small intestinal motor abnormalities are frequently associated to non specific esophageal motor disorders and megacolon in patients with Chagas disease (Rev Méd Chile 2004; 132: 939-4).
Subject(s)
Adolescent , Adult , Male , Humans , Female , Aged , Chagas Disease/physiopathology , Gastrointestinal Motility/physiology , Esophageal Achalasia/physiopathology , Chile , Incidence , Intestine, Small/physiologyABSTRACT
BACKGROUND: Small intestinal bacterial overgrowth generates endogenous ethanol production both in experimental animals and humans. Patients with cirrhosis have small intestinal bacterial overgrowth, but endogenous ethanol production has not been studied in them. AIM: To investigate endogenous ethanol production in patients with cirrhosis, altered intestinal motility and small intestinal bacterial overgrowth. PATIENTS AND METHODS: Eight patients with cirrhosis of different etiologies and altered gastrointestinal motility, consisting in changes in the migrating motor complex, were studied. All had also small intestinal bacterial overgrowth, measured by means of the H2 breath test with lactulose. Plasma ethanol levels were measured by gas liquid chromatography in fasting conditions and 120 min after a carbohydrate rich meal. RESULTS: In fasting conditions, no patient had endogenous ethanol production. Alter the meal, ethanol in concentrations of 11.3 and 8.2 mg/del were detected in two patients. Negligible amounts of ethanol were detected in 4 patients and two patients had undetectable alcohol levels. CONCLUSIONS: A low endogenous production of ethanol was demonstrated in six of eight patients with cirrhosis.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bacteria/growth & development , Liver Cirrhosis/metabolism , Ethanol/metabolism , Intestine, Small/microbiology , Liver Cirrhosis, Alcoholic/metabolism , Liver Cirrhosis, Alcoholic/microbiology , Liver Cirrhosis, Alcoholic/physiopathology , Liver Cirrhosis/microbiology , Liver Cirrhosis/physiopathology , Ethanol/blood , Intestine, Small/physiopathology , Fasting , Gastrointestinal MotilityABSTRACT
Although abnormalitiew of intestinal motility are usually considered to underly functional gastrointestinal symptoms, objective evidence of such a relation is controversial. We performed manometric studies using perfused catheters in 26 patients with such symptoms. A marked variation in duration of cyclic motor activity (tange 34 to 168 min) was observed, motivity was absent in 5 patients. No clear relation between symptoms and motility pattern was demonstrated. Thus, altered intestinal motility is not clearly related to functional gastrointestinal complaints