ABSTRACT
Se hace comentarios de lo inadecuado de la terminología orgánico y funcional en la descripción de los problemas digestivos catalogados como Síndrome de Intestino Irritable (SII), igualmente el calificativo de irritable es ambiguo y equivoco, y la definición de los criterios de Roma I, II, y III de considerar el SII a partir de 3 meses de molestias esta sujeto a gran discusión.
The Author comments about the inadequacy of the organic and functional terminology in the description of digestive problems categorized as Irritable Bowel Syndrome (IBS),also the adjective irritable and wrong is ambiguous and equivocal and the consideration in the definition of the Rome I, II , and III criteria for IBS since 3 months of discomfort is subject to great debate.
Subject(s)
Humans , Diagnosis , Irritable Bowel SyndromeABSTRACT
It has been previously observed that in dyspeptic patients with hunger pain, that is, with pain suggestive of the presence of peptic ulcer, only 12% had an endoscopically demonstrated ulcer, the remaining 88% showing absence of important macroscopically detectable lesions (idiopathic dyspepsia). In order to investigate the possibility of a relationship between hunger pain and some alteration in gastroduodenal motility, the gastric emptying rates of patients presenting idiopathic dyspepsia with and without hunger pain were compared with those of normal control subjects. The study was conducted in 40 patients presenting idiopathic dyspepsia, 20 with and 20 without hunger pain, and 30 voluntary apparently normal control subjects. The patients and the controls ingested, with a standard breakfast, a gelatine capsule containing 10 radioopaque polyurethane markers, and the gastric emptying of the markers was evaluated taking 3 x-ray films of the abdomen at 1.5, 3.0 and 4.5 hours after the breakfast. The gastric emptying rates of the markers were significantly higher in the patients with hunger pain, and significantly lower in the patients without hunger pain, than in the normal control subjects. In idiopathic dyspepsia with and without hunger pain there are, respectively, abnormally increased and abnormally decreased gastric emptying rates of undigestible solid markers. Our findings could help to better understand the pathogenesis of those different types of dyspepsia and, consequently, to improve their treatment.
Subject(s)
Middle Aged , Humans , Male , Female , Adult , Adolescent , Abdominal Pain , Dyspepsia , Gastric Emptying , Hunger , Abdominal Pain , Case-Control Studies , Contrast Media , DyspepsiaABSTRACT
A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Dyspepsia , Surveys and Questionnaires , Case-Control Studies , Chronic Disease , Sensitivity and SpecificityABSTRACT
It is highly probable that nutritionally-related geographic and socioeconomic factors may modulate the conversion of early stages of Helicobacter pylori-associated chronic active gastritis (chronic superficial gastritis [CSG] and chronic deep gastritis [CDG]) to chronic atrophic gastritis (CAG). The factors would be diets low in antioxidant vitamins and other micronutrients. In regions of the world and population groups with high socioeconomic level in which these modulating factors are absent, chronic active gastritis tends to stay in its early stages of CSG or CDG and to predispose to duodenal ulcer. On the contrary, in regions and population groups with low socioeconomic level in which the modulating factors are present, the frequency of CAG increases markedly. When CAG becomes severe and diffuse, hypochlorhydria ensues. Hypochlorhydria decreases the predisposition to duodenal ulcer, while CAG, a precancerous lesion, predisposes to gastric cancer of the intestinal type. The real role of the modulating factors already mentioned could be elucidated doing a multicentric study to determine endoscopically and histologically, in large series of dyspeptic patients from various regions of the world and with different socioeconomic levels, prevalence rates of duodenal ulcer, gastric ulcer, gastric cancer, Helicobacter pylori-associated CAG and intestinal metaplasia of the gastric mucosa, and to correlate these prevalence rates with blood levels of antioxidant capacity and related micronutrients. Latin America, because of its diversity in regions, geographic characteristics and population socioeconomic levels, seems to be the ideal place to conduct a study of that type. If the study could be performed, it would undoubtedly constitute an important contribution to a better understanding of Helicobacter pylori-associated gastroduodenal pathology.
Subject(s)
Humans , Female , Gastrointestinal Diseases/microbiology , Helicobacter Infections/complications , Helicobacter Infections/epidemiology , Helicobacter pylori , Chronic Disease , Free Radicals , Gastric Mucosa/pathology , Gastritis, Atrophic/microbiology , Gastritis, Atrophic/pathology , Gastritis/microbiology , Gastritis/pathology , Prevalence , Socioeconomic FactorsABSTRACT
En la presente serie, compuesta por 2011 pacientes estudiados, nuestras observaciones coinciden con lo reportado en otros países, en relación al porcentaje de hallazgo del H.pylory en los casos de gastritis crónica activa, úlcera p éptica gástrica, úlcera péptica duodenal y en la mucosa gástrica histológicamente normal. En el Perú, en pacientes con síntomas del tracto gastrointestinal superior, la infección por H. pylori se encuentra en porcentajes más elevados (84%) que lo reportado en naciones industrializadas. No observamos incremento de la infección con la edad, debido a que ésta, en nuestro medio, se adquiere en edades muy tempranas como hemos demostrado por la prueba de ELISA. La distribución ecológica de la bacteria, es igual en las tres regiones del Perú y sólo en as mujeres de nivel socioeconómico alto, la prevalencia de la infección es menor. El porcentaje de recurrencia después de tratamiento es superior al descrito en países industrializados