Estreñimiento funcional en pediatría, diagnóstico y tratamiento / Functional constipation in pediatrics, diagnosis and treatment

El estreñimiento funcional es un motivo de consulta frecuente en pediatría, con una prevalencia del 3 %. El Grupo de Trabajo de Constipación del Comité de Gastroenterología de la Sociedad Argentina de Pediatría se reunió con el objetivo de actualizar el diagnóstico y tratamiento de la constipación funcional en pediatría.Se realizó una búsqueda de literatura para evaluar la calidad de la evidencia. Ante un paciente constipado, es fundamental una historia y examen clínico completos. Los Criterios de Roma IV establecen pautas que, habitualmente, permiten diagnosticar la constipación funcional y evitar estudios innecesarios. La realización de estudios diagnósticos solo se pondrá en consideración ante la presencia de respuesta refractaria al tratamiento médico o en los casos de signos de alarma (banderas rojas). El primer paso del tratamiento es la desimpactación (por vía oral o enemas), seguida del tratamiento dietético, de hábitos y laxantes (es de primera elección el polietilenglicol).

Functional constipation is a common disease and one of the most frequent reasons of visit in pediatric clinics with a 3 % of prevalence. The Constipation Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría met with the objective of updating the diagnosis and treatment of functional constipation in pediatrics.A literature search was performed to assess the quality of the evidence. In a constipated patient, a complete history and clinical examination is essential. The Rome IV Criteria establish guidelines that usually allow us to diagnose functional constipation, avoiding unnecessary studies. The performance of diagnostic studies will only be considered in the absence of response to medical treatment or in cases of alarm signs (red flags). The first step of treatment is disimpaction (orally or enemas), followed by dietary treatment, habits and laxatives, with polyethylene glycol being the first choice.

Enfermedad diverticular: nuevas perspectivas en el tratamiento dieto-terapéutico / Diverticular disease: new perspectives in diet-therapeutic treatment

La enfermedad diverticular corresponde a una condición habitual en el territorio occidental, siendo el hallazgo más frecuente en población de zonas urbanizadas. Respecto a su origen, se ha planteado la influencia de factores ambientales y genéticos, incluyendo en su etiología una inadecuada ingesta de fibra dietética, disbiosis de la microbiota intestinal y niveles alterados de vitamina D. A su vez, la enfermedad diverticular sintomática no complicada (EDNC) corresponde a un tipo de diverticulosis crónica cuyas características asemejan al síndrome de intestino irritable, lo que resalta la importancia en la comprensión de esta condición. Recientemente, se ha discutido la forma en que se aborda la enfermedad diverticular y en el siguiente escrito se expondrá evidencia sobre la patogénesis y su actual manejo.

Diverticular disease corresponds to a habitual condition in the western territory, being frequently found among the population of urban areas. Regarding its origin, the influence of environmental and genetic factors, including the etiology of dietary fiber intake, intestinal microbiota dysbiosis and altered levels of vitamin D have been recognized. Symptomatic uncomplicated diverticular disease corresponds to a type of chronic diverticulosis whose characteristics resemble irritable bowel syndrome, highlighting the importance of understanding this condition. Recently, the treatment of the disease has been discussed and the following review presents evidence on pathogenesis and its management.

Effect of Acupuncture plus Medication on Serum 5-HT, CGRP and ET in IBS-D / 上海针灸杂志

Objective To observe the efficacy of acupuncture plus medication in treating diarrhea-irritable bowel syndrome (IBS-D) due to liver depression and spleen deficiency, and its effect on serum 5-hydroxytryptamine (5-HT), calcitonin gene-related peptide (CGRP) and endothelin (ET). Method Sixty IBS-D (liver depression and spleen deficiency) were recruited and randomized into an observation group and a control group, 30 cases each. Patients in the observation group were intervened by acupuncture plus modified Bai Zhu Shao Yao powder, while the control group was intervened by acupuncture alone. The total effective rate, change of syndrome score of traditional Chinese medicine (TCM) and diarrhea-irritable bowel syndrome quality of life scale (IBS-QOL), as well as the levels of serum 5-HT, CGRP and ET, were observed. Result The total effective rate was 83.3% in the observation group, significantlyhigher than 63.3% in the control group (P0.05). The global and component TCM symptoms scores and IBS-QOL dropped significantly in both groups after the intervention (P0.05) before the treatment. The levels of 5-HT, CGRP and ET decreased significantly after the treatment in both groups (P<0.05); after the intervention, the levels of 5-HT, CGRP and ET in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Acupuncture plus medication can effectively mitigate the symptoms in IBS-D (liver depression and spleen deficiency) and enhance the quality of life, which is possibly achieved by down-regulating the serum 5-HT, CGRP and ET levels.

Therapeutic value of endoscopic metal stent implantation for left-sided malignant colorectal obstruction / 中华消化内镜杂志

Objective To investigate the therapeutic value of endoscopic implantation of metal stents for obstruction caused by left-sided malignant colorectal tumor.Methods Data of 29 patients with left-sided malignant colonic obstruction who underwent stenting from May 2007 to May 2011 were retrospectively analyzed.Results Self-expanding metal stents were successfully implanted in 27 patients.Symptoms of abdominal distention and vomiting subsided in these patients.The procedure failed in 2 patients (2/29,6.9％ ),because the guidewire failed to pass the colonic stricture due to edema and the length of the diseased colon.Technical success was achieved in 27 of total 29 patients (27/29,92.6％ ).Out of the 27 patients,stage Ⅰ primary left-sided colonic resection and anastomosis were successfully performed in 24 patients.Colonic perforation was found intraoperatively in 1 patient ( 1/27,3.7％ ) who subsequently recovered after operation.There was no death during the perioperative period with the average hospital stay of 11.7 days.A mean colonic stent patency for 5 months was observed in 3 patients who underwent palliative stenting only.Conclusion Endoscopic implantation of metal stents is effective for left-sided malignant colorectal obstruction.As a bridge to surgery,it facilitates sufficient bowel preparation for elective radical operation.

Immunofecal occult blood test predicts the prognosis of patients with chronic kidney disease / 中华肾脏病杂志

Objective To evaluate the value of immunofecal occult blood test (IFOBT) as a prognostic indicator in CKD patients with colorectal impairment.Methods A total of 176CKD patients and 180 healthy adults as control were enrolled.Serum biochemistry was measured at baseline and gastrointestinal bleeding was determined by IFOBT.All the CKD patients were followed up for 4.5 years.Renal replacement therapy or death was defined as end-point event.The Logistic regression analysis was used for risk factors.Kaplan-Meier analysis and COX regression model were used for survival analysis.Results The positive rate of IFOBT in CKD patients was significantly higher than healthy control (17％ vs 5.3％,χ2=13.236,P＜0.01).When comparing with IFOBT negitive patients,IFOBT positive patients were older [(62.030±15.544) years old vs (48.660±19.018)years old,P＜0.01],had higher ESR [(71.800±31.657) mu/h vs (57.210±32.712) mm/h,P＜0.05],C-reactive protein [6.230 (3.000～14.148) mg/L vs 3.000 (3.000～6.833)mg/L,P＜0.05],serum creatinine [419.100 (103.200～546.625) μmol/L vs 175.100 (68.150～462.950) μmol/L,P＜0.05],and had lower hemoglobin level [(97.970±20.590) g/L vs (107.170±27.988) g/L,P＜0.05] and eGFR [11.400 (8.671～53.544) ml·min1·(1.73 m2)1 vs 35.274(10.961～82.145) ml·min-1·(1.73 m2)-1,P＜0.01].There was a negative correlation between IFOBT value and eGFR in CKD patients (r=-0.20,P＜0.01).Positive correlations of IFOBT value with age (r=0.175,P＜0.05) and serum creatinine (r=0.171,P＜0.05) were found.Logistic regression and COX regression analysis showed that IFOBT value,eGFR and ESR were important factors that influenced the prognosis of CKD patients.Kaplan-Meier analysis revealed that IFOBT value ＞100μg/L predicted progression of renal function.Conclusions The prevalence of gastrointestinal bleeding disorder is high in patients with CKD.Value of IFOBT independently predicts decline in renal function of CKD patients.

The correlation of fecal calprotectin and lactoferrin with intestinal mucosa lesions in Crohn′s disease patients / 中华消化杂志

Objective To study the correlation of fecal calprotectin and lactoferrin with intestinal mucosa lesions in Crohn′s disease (CD). Methods Eighty-eight cases of diagnosed CD patients were selected as study group and 35 irritable bowel syndrome (IBS) patients were as controls. Fecal samples of CD patients were collected in one week before colonoscopy examination and of IBS patients were collected of CD patients, CD activity index (CDAI) was calculated at same visit, and CD endoscopic index (CDEI) was calculated in the subsequent endoscopic examination. The level of fecal calprotectin and lactoferrin were tested by ELISA method. Results The median levels of facal calprotectin and lactoferrin in CD patients were 277.16 mg/kg (from 96.85 to 693.57 mg/kg) and 59.68 mg/kg (from 10.75 to 100.58 mg/kg) respectively, which were significantly higher than those of IBS patients (7.6mg/kg, from 5.54 to 32.3 mg/kg and 0.65 mg/kg from 0.23 to 4.34 mg/kg), (Z=-8.301 and -7.986, respectively both P =0.000). There were no significant difference of calprotectin and lactoferrin level between CD patients with colon pathological changes and without colon pathological changes (Z=-0.424 and -0.699,P=0.672 and 0.485, respectively). There was no significant difference of calprotectin and lacoferrin level between remission and active periods in CD patients (Z=-1.491 and -1.075, P=0.136 and 0.283, respectively). The median values of calprotectin and lactoferrin of patients in moderate and severe active period judged under endoscopy were 663.11 mg/kg (from 263.45 to 2015.63 mg/kg) and 105.64 mg/kg (from 56.52 to 187.44) mg/kg respectively, in mild active period were 344.54 mg/kg (from 132.03 to 722.67 mg/kg) and 86.68 mg/kg (from 21.07 to 100.55 mg/kg) accordingly, and in remission period were 133.94 mg/kg (from 60.54 to 583.33 mg/kg) and 45.31 mg/kg (from 7.59 to 48.31 mg/kg, respectively). Both calprotectin and lactoferrin levels were significantly higher in active period than in remission period (χ2=10.63 and 8.18, while, P=0.005 and 0.017, respectively). Conclusions The level of fecal calprotectin and lactoferrin can reflect the pathological changes and severity of the intestinal mucosa.

Four Cases of Primary Epiploic Appendagitis

Primary epiploic appendagitis (PEA) occurs due to inflammation of an epiploic appendage, which is a peritoneal pouch that arises from the serosal surface of the colon. PEA is often associated with infarction caused by torsion or spontaneous venous thrombosis. PEA is a self-limited disease with a course of approximately 10 days, and it requires only symptomatic management for pain. But it clinically manifests with localized abdominal pain that is often mistaken for appendicitis, diverticulitis, or cholangitis. Therefore, PEA had been diagnosed at surgery for the past few decades. Making the preoperative diagnosis of PEA through ultrasound and computed tomography (CT) has recently become possible. We report here on four cases of PEA that were diagnosed and treated by symptomatic management.

The impact of auto-mA low-dose colonic CT scanning on image quality and lesion visualization / 中华放射学杂志

Objective To evaluate the effect of low-dose colonic CT scanning in image quality and lesion revealing with different noise idex.Methods Model group:in order to find the optimal scanning parameter range,small simulated polyps in pig colon was prepared and mA was modulated by regulating noise index.Images were reprocessed with CT colonography and Raysum reconstructions.Image quality and the lesion revealing situation were evaluated and scored based on both reconstructive and axial images.The study of patient group was prospective and continuous.All positive cases were comfirmed by biopsy or surgery pathology.Two groups of patients were enrolled.First group(39 cases from January 2007 to June 2007):patients were divided into three sub-groups randomly(15 cages with NI=10,13 cases with NI:13,11 cases with NI=16),while NI was not changed with position.Second group(32 cases from Jury 2007 to January 2008):patients were scanned and NI was changed with different position(NI=10,20).The average X-ray radiation values of two patient groups were compared with standard values.All data were processed with rank sum tesL Results First group:when NI=10,the average scores of axial and constructive images were 4.2 and 2.4 respectively,when NI=13,those were 3.2 and 2.5 respectively,When NI=16.those were 2.9 and 2.7 respectively.and the average CTDlw were 17.51,12.90 and 5.94 mGy respectively.When NI increased,the average scores of axial decreased(H=20.01,P＜0.01),the average scores of constructive images did not changed(H=0.81,P＞0.05).Second group:when NI=10,the average scores of axial and constructive images were respectively 3.6 and 2.3,when NI=20,those were 2.2 and 2.3 respectively,and the average CTDIw was 11.63 mGy.When NI increased from 10 to 20,the average scores of axial decreased(H=20.84,P＜0.01),the average scores of constructive images did not decreased(H=0.29,P＞0.05).In the first group,the average CTDIw wag reduced by 35.0%,52.1%and 77.9%respectively when NI was 10,13 and 16.In the second group,the average CTDIw Was reduced by 56.8%.Conclusions Auto-mA low-dose CT scanning could reduce X-ray radiation obviously,while not affecting image quality.

Tradução e adaptação cultural para o português do instrumento "The Bowel Disease Questionnaire", utilizado para a avaliação de doenças gastrointestinais funcionais / Portuguese-language cultural adaptation and translation of The Bowel Disease Questionnaire used to assess functional bowel disorders

RACIONAL: As doenças gastrointestinais funcionais são reconhecidas como um problema de saúde pública e sua prevalência é pouco estudada no nosso meio. Em 1989, pesquisadores da Mayo Clinic elaboraram e validaram um questionário para a avaliação das doenças gastrointestinais funcionais denominado "The Bowel Disease Questionnaire". Apesar de ter sido utilizado em diferentes populações, sua aplicação em um contexto sociocultural diferente daquele para o qual foi desenvolvido, necessita de prévia adaptação para garantir a qualidade das informações a serem captadas. OBJETIVO: Realizar a tradução e a adaptação cultural do "The Bowel Disease Questionnaire" para o português com a finalidade de aplicação a uma população de adolescentes do Rio de Janeiro. MÉTODOS: Foram avaliadas as equivalências conceitual e de itens através de revisão bibliográfica e de reuniões com especialistas. A avaliação da igualdade semântica constou de julgamento acerca das equivalências de significado referencial e geral entre a retradução e o original e entre esta e a edição em português, respectivamente. A equivalência de mensuração foi avaliada através da confiabilidade e da consistência interna. RESULTADOS: Os conceitos abarcados pelo questionário original foram considerados pertinentes no nosso meio. O significado geral e referencial das palavras/termos se manteve na maioria das questões. A confiabilidade variou de razoável a quase perfeita, enquanto os grupos de questões referentes às doenças gastrointestinais funcionais mostraram consistência interna variando de 0,66 a 0,74. CONCLUSÃO: A versão em português do "The Bowel Disease Questionnaire" parece ser semântica e de conceito equivalente ao original e avaliar adequadamente as doenças gastrointestinais funcionais. O instrumento resultante da adaptação pode ser útil para avaliar as doenças gastrointestinais funcionais em populações de adolescentes no contexto brasileiro.

BACKGROUND: Functional bowel disorders are considered a public health problem, but there are a few prevalence studies in Brazil. In 1999, researchers from the Mayo Clinic developed The Bowel Disease Questionnaire with the purpose to evaluate functional bowel disorders. Although this has been used in different studies and population, it is often necessary to perform a cultural adaptation of a questionnaire developed for use in another culture, in order to improve the quality of the information obtained. OBJECTIVE: To translate and adapt the Bowel Disease Questionnaire to Portuguese for its use in adolescents. METHODS: Assessment of conceptual and item equivalence involved evaluation of the pertinence of the concepts in the Brazilian context; translation was evaluated through semantic equivalence between the original instrument and the Portuguese version; measurement equivalence between the original and the Portuguese version was assessed by the intra-observer reliability and internal consistency. RESULTS: The Bowel Disease Questionnaire's concepts were considered pertinent in the Brazilian context; the semantic equivalence between the original and the Portuguese version were high; reliability ranged from moderate to almost perfect; internal consistency of the scales ranged from 0,66 to 0,74. CONCLUSION: The Portuguese version of the Bowel Disease Questionnaire seems to be semantically and culturally equivalent to the original version and might be useful for measuring functional bowel disorders among Brazilian adolescents.

Tegaserod inhibits noxious rectal distention induced response and spinal nNOS expression in rats with visceral hypersensitivity / 北京大学学报(医学版)

0.20), but decreased the number of nNOS positive cells in central canal (79% of H saline, P

Colonic Diseases:The Comparative Study on Imaging and Colonoscopy / 实用放射学杂志

Objective To study the value of double contrast barium enema(DCBE),colonoscopy and spiral CT in examination of colonic disease.Methods 325 cases with colonic disease underwent DCBE,colonoscope and CT examinations.The detecting rates and the accurate rates in localizing the lesions were compared among these three examinations.Results The detecting rate of lesions by DCBE,colonoscope and CT were 91.1,89.8 and 64.6,respectively,there was no statistical difference between the former two,but there was difference between the former and CT(P

The effects of valsartan and propranolol on the colonic ultrastructure in rats with portal hypertensive colopathy / 中华消化杂志

Objective To observe the effects of valsartan and propranolol on the colonic mucosal microcirculation and submucosal ultra-structure changes in rats with portal hypertensive colopathy (PHC).Methods Portal hypertension(PHT) with cirrhosis was induced by composite factors after 42 days in rats.Rats were divided into a normal control group,a cirrhotic PHT model group,a treatment group with valsartan 20 mg/kg once daily,a treatment group with propranolol 22.5 mg/kg twice daily and a combination treatment group with propranolol and valsartan.The rats were treated for 15 days. The rats in the normal control group and the cirrhotic PHT model group were given water only.At the end of study,portal venous pressures(PVP) were measured.The submucosal vascular areas and metrical diameters of phlehectasia were measured by light microscope.The ultra-structure was observed by trans mission electron microscope.Results Compared to the cirrhotic PHT model group,PVPs were significantly decreased in the valsartan,propranolol,and combined groups (P

Surgical therapy for colonic slow transit constipation: an analysis of 89 cases / 中国普通外科杂志

Objective To evaluate the result of different surgical modality on colonic slow transit constipation. Methods We retrospectively reviewed clinical data of 89 patients with intractable colonic slow transit constipation undergoing surgical treatment for 94 times from Oct 1990 to Nov 2002. Results Six patients undergoing total colectomy suffered transit diarrhea and one with intractable diarrhea (16. 7% ) but without constipation recurrence. Nineteen out of 73 cases undergoing subtotal colectomy suffered from transit diarrhea (26% ) , and one case suffered from constipation recurrence. Cecorectostomy was performed in 12 cases with a comparable result as subtotal colectomy. Constipation recurred in all 3 cases receiving partial colectomy. There was no operative mortality nor anastomotic fistula occurrenced. Conclusion Total colectomy, subtotal colectomy and cecorectostomy are satisfactory modality for the treatment of STC. Patients with total colectomy suffered from high rate of diarrhea.

Cost-effectiveness Analysis of Three Therapeutic Schemes for Functional Colonic Diseases / 中国药房

OBJECTIVE:To discuss the economical effects of different medications on the treatment of same illness.METH_ODS:148 cases of functional colonic diseases were collected from literature and were randomly divided into three groups;colloidal bismuth artrate was given to the first group,bifidobacterium to the second and cisapride to the last.Data was evaluated using the pharmacoeconomic cost-effectiveness analysis.RESULTS:Colloidal bismuth artrate was the best medicine to treat functional colonic diseases.CONCLUSION:The pharmacoeconomics play an important role in guiding the physician to choose the best therapeutic regimen in making clinical decision,so as to gain the maximal benefit with the minimal cost.

Diagnosis of colonic lesions with OMOM capsule endoscopy:an analysis of 46 cases / 第三军医大学学报

Objective To evaluate the role of OMOM capsule endoscopy in diagnosis of colon diseases.Methods Forty-six patients with suspected colon diseases,aged 18 to 68,voluntarily underwent the examination with the OMOM capsule endoscopy and colon endoscopy after informed the aim of the study.Patients who were suspected with colon stenosis or obstruction were excluded from the study.The outcome were compared with the results of common colonoscopy.The sensitivity,specificity and accuracy of OMOM capsule endoscopy were analyzed.Results OMOM capsule endoscopic examination were completed successfully in 40 of 46(87.0%) patients.For diagnosis of colon diseases with OMOM capsule endoscopy,the sensitivity was 57.7%,the specificity was 85.7%,and the accuracy was 67.5%.While,the positive predictive value was 88.2%,and the negative predictive value was 52.2%.The positive likelihood ratio was 4.04 and the negative likelihood ratio was 0.494.The bowel preparation had direct influence on examine.Polyethylene Glycol 4000 combined with 50% salamarum had better colon clearness.Conclusion OMOM capsule endoscopy is a safe,non-invasive method,and can provide definitive diagnosis in colon diseases.The bowel preparation is important for successful examination.