Comparison of different methods of obtaining the rapid shallow breathing index

Abstract Objective: To compare the Rapid Shallow Breathing Index (RSBI) obtained by the ventilometer and from mechanical ventilation parameters. Methods: Randomized crossover trial, including 33 intubated patients, on mechanical ventilation for at least 24 hours, undergoing spontaneous breathing test. Patients were submitted to the measurement of RSBI by four methods: disconnected from the ventilator through the ventilometer; in Pressure Support Ventilation (PSV) mode at a pressure of 7 cm H2O; in Continuous Positive Airway Pressure (CPAP) mode at a pressure of 5 cmH2O with flow trigger; in CPAP mode at a pressure of 5 cmH2O with pressure trigger. Results: No significant difference was detected between the RSBI obtained by the ventilometer and in the CPAP mode with flow and pressure triggers, however, in the PSV mode, the values were lower than in the other measurements (p < 0.001). By selecting patients from the sample with higher RSBI (≥ 80 cycles.min−1.L−1), the value of the index obtained by the ventilometer was higher than that obtained in the three options of ventilation methods. Conclusion: The RSBI obtained in the CPAP mode at a pressure of 5 cmH2O, in both triggers types, did not differ from that measured by the ventilometer; it is, therefore, an alternative when obtaining it from mechanical ventilation parameters is necessary. However, in the presence of borderline values, the RSBI measured by ventilometer is recommended, as in this method the values are significantly higher than in the three ventilation modalities investigated.

Helicobacter pylori infection and UBT-13C values are associated with changes in body mass index in children and adults / La infección por Helicobacter pylori y los valores de UBT-13C se asocian con el índice de masa corporal en niños y adultos

BACKGROUND: The urea breath test (UBT-13C) is a non-invasive technique that allows the diagnosis and confirmation of eradication of Helicobacter pylori infection. Aim: To evaluate H. pylori positivity and values of UBT-13C among infected Chilean children and adults, and to analyze its variation in relation to sex, nutritional status, and age of the patients. Material and Methods: Retrospective study of 1141 patients aged 6 to 94 years, with an indication for a UBT-13C either for diagnosis or for confirmation of eradication of H. pylori infection. 13C enrichment was measured using an infrared spectrometer calculating the delta 13C values before and after the ingestion of 13C marked urea. The clinical data of the patients were obtained at the time of the examination. Results: We included 241 children and 900 adults. Infected children obtained lower UBT-13C delta values than infected adults (16.1 ± 8.7 and 37 ± 52.9, respectively). The rates of infection were higher in males who were recruited for diagnosis. Significant differences were obtained between positivity for H. pylori in overweight and obese children but not adults. UBT-13C titers were significantly associated with the body mass index (BMI) only in adults. Conclusions: H. pylori infection rates are similar between sexes and are higher in children probably because of selection bias. In children, H. pylori positivity is associated with higher BMI and excess malnutrition although with similar UBT-13C values. In adults, H. pylori infection is not related with BMI, but a higher BMI impacts UBT-13C titers.

ANTECEDENTES: La prueba de aliento con urea (UBT-13C) es una técnica no invasiva que permite el diagnóstico y confirmación de erradicación de la infección por Helicobacter pylori. Objetivo: Evaluar los valores de UBT- 13C en niños y adultos chilenos infectados y analizar su variación en relación al sexo, diagnóstico nutricional y edad de los pacientes. Material y Métodos: Estudio retrospectivo de 1.141 pacientes de 6 a 94 años. El enriquecimiento de13C se midió usando un espectrómetro de infrarrojos, calculando el delta 13C antes y después de la ingesta de urea marcada con 13C. Los datos clínicos de los pacientes se obtuvieron al momento del examen. Resultados: Incluimos 241 niños y 900 adultos con valores delta de UBT-13C de 16,1 ± 8,7 frente a 37 ± 52,9, respectivamente. Las tasas de infección fueron mayores en los hombres reclutados para el diagnóstico. Se obtuvieron diferencias significativas entre la positividad para H. pylori en niños con sobrepeso y obesidad, pero no en adultos. Los títulos de UBT-13C se asociaron significativamente con el índice de masa corporal (IMC) solo en adultos. Conclusiones: Las tasas de infección por H. pylori son similares entre los sexos y aumentan en los niños probablemente debido al sesgo de selección. En niños, la positividad para H. pylori se asocia con un IMC más alto y malnutrición por exceso, aunque con valores similares de UBT-13C. En los adultos, la infección por H. pylori no se relaciona con el IMC ni con la obesidad, pero el aumento del IMC afecta los títulos de UBT-13C.

Evaluación de un test del aliento con carbono 13 para el diagnóstico de Helicobacter pylori / Evaluation of a carbon 13 breath test for the diagnosis of Helicobacter pylori

RESUMEN Objetivo: Evaluar un test del aliento con carbono 13 de fabricación China como método diagnóstico no invasivo para la infección por Hp en población peruana a través de la determinación de sensibilidad, especificidad, valor predictivo positivo y negativo, likelihood ratio positivo y negativo y utilidad diagnóstica. Materiales y métodos: Se realizó un estudio transversal y descriptivo sobre una base de datos secundaria del Servicio de Gastroenterología del Hospital Cayetano Heredia y Clínica Cayetano Heredia de noviembre de 2017 a agosto de 2018. Se incluyó a pacientes mayores de 18 años sometidos a una endoscopía digestiva alta. Resultados: Se halló una sensibilidad de 90,3% (IC 95% 0,81-0,96), especificidad de 82,5% (IC 95% 0,67-0,93), valor predictivo positivo y negativo de 90,3% y 82,5%, y likelihood ratio positivo y negativo de 5,16 y 0,12, respectivamente. El área bajo la curva ROC fue 0,88 (IC 95%: 0,80-0,96). Conclusiones: El test del aliento con carbono 13 es una prueba no invasiva y sencilla que proporciona resultados de forma rápida. Sin embargo, no es posible recomendar el uso rutinario de esta prueba debido a la discrepancia entre los resultados internacionales y locales obtenidos. Se sugiere realizar estudios con mayores tamaños muestrales, protocolos estandarizados y de diferentes fabricantes para evaluar su rendimiento y características.

ABSTRACT Objective: To evaluate a Chinese-made carbon-13 breath test as a non-invasive diagnostic method for Hp infection in the Peruvian population through the determination of sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and diagnostic utility. Materials and methods: A cross-sectional and descriptive study was carried out on a secondary database of the Gastroenterology Service of the Cayetano Heredia Hospital and Cayetano Heredia Clinic from November 2017 to August 2018. Patients over 18 years of age who underwent endoscopy were included upper digestive. Results: A sensitivity of 90.3% (95% CI 0.81-0.96), a specificity of 82.5% (95% CI 0.67-0.93), a positive predictive value was found and negative of 90.3% and 82.5%, and positive and negative likelihood ratio of 5.16 and 0.12, respectively. The area under the ROC curve was 0.88 (95% CI: 0.80-0.96). Conclusions: The carbon 13 breath test is a non-invasive and simple test that provides results quickly. However, it is not possible to recommend the routine use of this test due to the discrepancy between the international and local results obtained. Studies with larger sample sizes, standardized protocols and different manufacturers are suggested to evaluate their performance and characteristics.

Influencing Factors on Lactulose Breath Test Results / 대한소화기학회지

BACKGROUND/AIMS: This study aimed to identify the demographic and clinical factors associated with positive breath-test results and to assess the relationship between hydrogen and methane production in patients with suspected irritable bowel syndrome (IBS).METHODS: The demographic and clinical factors of 268 patients with suspected IBS, who had undergone a lactulose breath test, were analyzed.RESULTS: Of 268 patients included in this study, 143 (53.4%) were females. The median age and BMI of the patients was 58.0 years (range, 18.0–80.0 years) and 22.5 kg/m² (range, 14.4–34.3 kg/m²), respectively. A weak positive correlation was observed between the BMI and baseline hydrogen level (rho=0.134, p=0.031). Women were significantly more likely to show a ≥20 ppm increase in hydrogen within 90 min (early hydrogen increase, p=0.049), a ≥10 ppm increase in methane within 90 min (early methane increase, p=0.001), and a ≥10 ppm increase in methane between 90 min and 180 min (late methane increase, p=0.002) compared to men. The baseline hydrogen level was related to the baseline methane level (rho=0.592, p<0.001) and the maximal hydrogen level within 90 min was related to maximal methane level within 90 min (rho=0.721, p<0.001). Patients with an early hydrogen increase (43.8%) were more likely to show a positive result for an early methane increase compared to patients without an early increase in hydrogen (0%, p<0.001).CONCLUSIONS: Women were associated with high rates of positive lactulose breath-test results. In addition, methane production was correlated with hydrogen production.

Análise da Fadiga Relatada e das Forças Musculares Respiratória e Periférica em indivíduos com Câncer em Tratamento / Analysis of Reported Fatigue and of Respiratory and Peripheral Muscle Strength in Individuals with Cancer Undergoing Treatment / Análisis de la Fatiga Reportada e de las Fuerzas Musculares Respiratoria y Periférica en Individuos con Cáncer Sometidos a Tratamiento

Introdução: Nos últimos anos, o tratamento do câncer evoluiu, possibilitando uma maior sobrevida ao paciente, porém os efeitos colaterais, como a diminuição da imunidade e a fadiga, influenciam o sistema respiratório e muscular. Objetivo: Analisar a fadiga e as forças musculares respiratória e periférica em voluntários com câncer em tratamento e em indivíduos saudáveis. Método: Trata-se de um estudo analítico, observacional, transversal e controlado. Os indivíduos foram distribuídos em dois grupos: um grupo de câncer em quimioterapia e/ou em radioterapia (GCA: n=98; homens=35,72%; mulheres=64,28%; idade=58,13±13,26 anos; índice de massa corporal (IMC=26,23±4,04 kg/m2; tempo de diagnóstico de câncer=27,54±9,61 meses) e um grupo controle (GC: n=86; homens=30,23%; mulheres=69,77; idade=59,24±12,87 anos; IMC=26,76±4,04 kg/m2). Para todos os indivíduos, a fadiga relatada foi avaliada, usando-se a subescala de fadiga do questionário The Functional Assessment of Cancer Therapy-Fatigue (FACT-F). A avaliação das pressões respiratórias máximas foi realizada por meio da manovacuometria e da força de preensão palmar por intermédio da dinamometria manual. Resultados: O GCA apresentou maior índice de fadiga relatada (p<0,001; f2=0,382), valores inferiores para as variáveis respiratórias (PImax: p<0,001; f2=0,441; PEmax: p<0,001; f2=0,361), força de preensão palmar esquerda (p=0,024 f2=0,182), se comparado ao GC. Conclusão: Voluntários com câncer em quimioterapia e/ou em radioterapia apresentaram maiores níveis de fadiga relatada, com reduções da força muscular respiratória e da força de preensão palmar.

Introduction: In recent years, cancer treatment has evolved, allowing longer survival for the patient, but, side effects such as a decreased immunity and fatigue influence the respiratory and muscular systems. Objective: Analyze fatigue, the respiratory and peripheral muscle strength in individuals with cancer undergoing treatment and in healthy individuals. Method: Analytical, observational, cross-sectional, and controlled study. The individuals were divided into two groups: a cancer group in chemotherapy and/or radiotherapy (GCA: n = 98; men = 35.72%; women = 64.28%; age = 58.13 ± 13.26 years; body mass index (BMI) = 26.23 ± 4.04 kg/m2; time of cancer diagnosis = 27.54 ± 9.61 months) and a control group (CG: n = 86; men = 30.23%; women = 69.77; age = 59.24 ± 12.87 years; BMI= 26.76 ± 4.04 kg/m2). For all the individuals, the reported fatigue was assessed using the fatigue subscale of The Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire. The evaluation of maximal respiratory pressures was performed by manovacuometry and the palmar grip strength by manual dynamometry. Results: The GCA showed the highest reported fatigue index (p<0.001; f2=0.382), lower values for respiratory variables (PImax: p<0.001; f2=0.441; PEmax: p<0.001; f2=0.361), left palmar grip strength (p=0.024; f2=0.182), when compared to the CG. Conclusion: Volunteers with cancer in chemotherapy and/or radiotherapy presented higher levels of reported fatigue, with reductions in respiratory muscle strength and palmar grip strength.

Introducción: En los últimos años, el tratamiento oncológico ha evolucionado, permitiendo una supervivencia más larga para el paciente, pero los efectos secundarios como la disminución de la inmunidad y la fatiga influyen en los sistemas respiratorios y musculares. Objetivo: Analizar la fatiga e las fuerzas musculares respiratoria y periférica en individuos con cáncer sometidos a tratamiento y en individuos sanos. Método: Se trata de un estudio analítico, observacional, transversal y controlado. Los individuos fueran divididos en dos grupos: un grupo de cáncer bajo quimioterapia y/o radioterapia (GCA: no 98; hombres 35,72%; mujeres 64,28%; edad 58,13±13,26 años; indice de masa corporal (IMC) a 26,23±4,04 kg/m2; diagnóstico de cáncer 27,54±9,61 meses) y un grupo de control (CG: no 86; hombres 30,23%; mujeres 69,77; edad de 59,24±12,87 años; IMC 26,76±4,04 kg/m2). Para todos los voluntarios, la fatiga notificada se evaluó utilizando la subescala de fatiga del cuestionario The Functional Assessment of Cancer Therapy-Fatigue(FACT-F). La evaluación de las presiones respiratorias máximas se realizó mediante manovacuometría y fuerza de agarre palmar mediante dinamometría manual. Resultados:El GCA tuvo el índice de fatiga notificado más alto (p<0,001; f2=0,382), valores más bajos para las variables respiratorias (PImax: p<0,001; f2= 0,441; PEmax: p<0,001; f2=0,361), fuerza de agarre palmar izquierda (p=0,024; f2=0,182), en comparación con el GC. Conclusión: Voluntarios con cáncer en quimioterapia y/o radioterapia presentaron mayores niveles de fatiga reportados, con reducciones en la fuerza muscular respiratoria y fuerza de agarre palmar.

The impact of small intestinal bacterial overgrowth on the growth of children and adolescents / Impacto do sobrecrescimento bacteriano no intestino delgado sobre o peso e a estatura de crianças e adolescentes

ABSTRACT Objective: To evaluate the association between small intestinal bacterial overgrowth (SIBO) and weight and height impairment in children and adolescents with gastroenterology diseases. Methods: Observational and retrospective study. All 162 patients aged less than 19 years old who underwent breath test in search of SIBO between 2011 and 2016 were studied. Breath test was collected after the intake of 10 grams of lactulose. The concentration of hydrogen and methane was measured for 180 minutes after the beginning of the test by 12i QuinTronMicroLyzer device. Results: SIBO was identified in 51 (31.5%) patients. There was no difference between the age of those with (mean=8.7y.o; 25th and 75th percentile: 4.6 and 11.3) and without (mean=7.9y.o 25th and 75th percentile: 4.8 and 12.2) SIBO (p=0.910). There was no association between gender and SIBO (male 26.3% vs. female 36.3%, p=1.00). A lower median of height-for-age Z score (mean=-1.32; 25th and 75th percentile: -2.12 and -0.08 vs. mean=-0.59; 25th and 75th percentile: -1.57 and 0.22; p=0.04) was demonstrated in children with SIBO when compared with children without it. There was no difference between the BMI-for-age Z score of patients with (mean=-0.48) and without SIBO (mean=-0.06) (p=0.106). The BMI of patients with SIBO (median=15.39) was lower than of those without it (median=16.06); however, the statistical analysis was not significant (p=0.052). The weight-for-age Z score was lower in patients with SIBO (mean=-0.96) than in those without SIBO (mean=-0.22) (p=0.02) Conclusions: Children and adolescents with SBIO associated with diseases of the gastrointestinal tract have lower weight and height values.

RESUMO Objetivo: Avaliar a existência de associação entre sobrecrescimento bacteriano no intestino delgado (SBID) e comprometimento de peso e estatura em crianças e adolescentes com doenças do aparelho digestivo. Métodos: Estudo observacional e retrospectivo em ambulatório de gastroenterologia pediátrica. Foram incluídos todos os 162 pacientes com idade inferior a 19 anos que realizaram teste respiratório para pesquisa de SBID entre 2011 e 2016. O teste respiratório foi realizado após ingestão de dez gramas de lactulose. Foram determinadas as concentrações de hidrogênio e metano em aparelho 12i QuinTron MicroLyzer até 180 minutos após o início do teste respiratório. Resultados: SBID foi caracterizado em 51 (31,5%) dos 162 pacientes. Não houve diferença na idade das crianças com (mediana=8,7 anos; percentil 25-75: 4,6-11,3) e sem (mediana=7,9 anos; percentil 25-75: 4,8-12,2) SBID (p=0,910). Não se observou associação entre SBID e sexo (masculino 27,4% e feminino 36,6%; p=0,283). O escore Z da estatura-idade nos pacientes com SBID (mediana=-1,32; percentil 25-75: -2,12—0,08) foi menor (p=0,040) do que naqueles sem SBID (mediana=-0,59; percentil 25-75: -1,57-0,22). Na comparação do escore Z de índice de massa corpórea-idade não foi observada diferença entre os grupos com (média=-0,489±1,528) e sem (média=-0,067±1,532) SBID (p=0,106). Nos pacientes com menos de 10 anos de idade, o escore Z de peso-idade foi menor nos pacientes com SBID (média=-0,968±1,359) do que nos sem SBID (média=-0,223±1,584) (p=0,026). Conclusões: Crianças e adolescentes com SBID associado a doenças do trato gastrintestinal apresentam menores valores de peso e estatura.

Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique / Pressões máximas inspiratórias e expiratórias no pré e pós-operatório de pacientes com hérnias incisionais abdominais corrigidas pela técnica de Lázaro da Silva

ABSTRACT Objective: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. Method: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. Results: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Conclusion: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

RESUMO Objetivo: verificar o efeito da herniorrafia incisional abdominal longitudinal na pressão dos músculos da respiração. Método: a técnica de herniorrafia incisional utilizada foi a proposta por Lázaro da Silva. Para aferir a pressão foi utilizado manômetro de água, em 20 pacientes, idade mediana 48,5 anos (mínimo 24, máximo 70). Foram analisadas a pressão máxima inspiratória no nível do volume residual (PIVR) e da capacidade residual funcional (PICRF) e a pressão máxima expiratória da capacidade residual funcional (PECRF) e da capacidade pulmonar total (PECPT), no pré-operatório e pós-operatório tardio (entre 40 e 90 dias), em 13 pacientes com hérnias incisionais grandes e em 7 pacientes com hérnias incisionais médias. Resultados: houve aumento significante da PICRF (p=0.027), da PIVR (p=0.011), da PECPT (p=0.003) nos pacientes com hérnias incisionais grandes. A PECRF aumentou, porém de forma não significante. Nos pacientes com hérnias incisionais médias as alterações não foram significantes. Conclusão: a correção cirúrgica da hérnia incisional grande melhora a função dos músculos da respiração, porém a cirurgia da hérnia incisional média não altera a referida função.

Análise da intolerância à lactose em alunos com sintomas sugestivos da síndrome do intestino irritável / Analysis of lactose intolerance in students with suggestive symptoms of irritable bowel syndrome

ABSTRACT BACKGROUND: Irritable bowel syndrome is a clinical condition presenting pain, distension and abdominal fullness, diarrhea, constipation, and other symptoms. It generates significant impacts on the quality of life of those affected. The pathophysiology is uncertain, but the role of various food types has been established in bowel sensitivity and its clinical manifestations. Carbohydrate intolerance, particularly to lactose, generates similar and sometimes indistinguishable symptoms from irritable bowel syndrome, and in clinical practice is both a frequent and underdiagnosed condition. Carbohydrate intolerance is related to enzymatic deficiencies, alterations of intestinal microbiota and even genetic change. The principal test for a diagnosis of lactose intolerance is the breath test, which measures hydrogen emission (produced only by bacteria), after ingestion of the corresponding substrate. OBJECTIVE: The present work aims to verify the prevalence of lactose intolerance in university students, presenting gastrointestinal symptoms suggestive of irritable bowel syndrome. METHODS: In a transversal study, to screen for those with suggestive symptoms, 124 medicine students participated by responding to a form. Those with abdominal pain were referred for anti-parasite treatment in order to exclude intestinal parasites as a secondary cause. Subsequently, using the hydrogen breath test, bacterial overgrowth was investigated, and if negative, lactose intolerance testing would be performed. Patients presenting high hydrogen concentrations of ≥20 ppm above the basal level were considered lactose intolerant. RESULTS: Of the total of students researched (n=124), 7 were excluded because they did not completing all study phases. From those 117 individuals effectively included in the survey; 8 (6.8%) were diagnosed with lactose intolerance and 2 (1.7%) with bacterial overgrowth. Intolerance was more frequent in; female individuals (75%), age range 18 to 25 years (62.5%), being colored (50%), and in their 5th semester of studies (37.5%). The presence of at least one gastrointestinal symptom among those presenting intolerance (100%), and those not presenting intolerance (42.2%) was found (P=0.002). In addition to abdominal pain (100%) (P<0.001), the most recurrent gastrointestinal symptom in the lactose intolerant students was the distension/flatulence (62.5%) (P=0.026). In relation to life habits and food patterns, there was no statistical difference between lactose tolerant and intolerant individuals, or for symptom frequencies. The more advanced students, completing more periods towards graduation, demonstrated more occurrences of gastrointestinal symptoms, yet without presenting significant statistical discrepancies. CONCLUSION: In view of the test sample quantity (n=21), a high prevalence of lactose intolerance (6.8%) in the academic environment, with epidemiological characteristics compatible to those found the literature is demonstrated, generating knowledge with understanding to prevent, diagnose, alleviate and treat lactose intolerant university students, and generate positive impacts towards well-being, improving the quality of life of these individuals.

RESUMO CONTEXTO: A síndrome do intestino irritável é uma condição clínica que cursa com dor, distensão e plenitude abdominal, diarreia, constipação, entre outros sintomas. Gera impacto significativo na qualidade de vida das pessoas acometidas. Sua fisiopatologia é incerta, mas o papel de vários tipos de alimentos está estabelecido na sensibilização intestinal e nas manifestações clínicas. A intolerância aos carboidratos, particularmente a lactose, gera sintomas similares e por vezes indistinguíveis da síndrome do intestino irritável e é uma condição frequente e subdiagnosticada na prática clínica. Está relacionada a deficiências enzimáticas, alterações da microbiota intestinal e mesmo alterações genéticas. O principal exame para o diagnóstico da intolerância à lactose é o teste respiratório, que mede a emissão de hidrogênio produzido apenas por bactérias, após a ingestão do substrato correspondente. OBJETIVO: O presente trabalho tem como objetivo verificar a prevalência de intolerância à lactose em universitários que apresentem sintomas gastrointestinais sugestivos da síndrome do intestino irritável. MÉTODOS: O estudo, caracterizado como do tipo transversal, teve a participação de 124 discentes de medicina que responderam um formulário, a fim de realizar a triagem daqueles com sintomatologia sugestiva. Aqueles com dor abdominal foram encaminhados para o tratamento antiparasitário, a fim de excluir parasitose intestinal como causa secundária. Posteriormente, através do teste respiratório com hidrogênio expirado, foi feito primeiro a pesquisa de supercrescimento bacteriano e caso fosse negativo seria realizado o da intolerância à lactose. Foram considerados com intolerância aqueles que obtiveram uma elevação na concentração de hidrogênio ≥20 ppm acima do nível basal. RESULTADOS: Do total de alunos pesquisados (n=124), 7 foram excluídos por não cumprirem todas as etapas do estudo. A partir dos 117 indivíduos efetivamente incluídos na pesquisa, verificou-se que 8 (6,8%) foram diagnosticados com intolerância a lactose e 2 (1,7%) com supercrescimento bacteriano. A intolerância foi mais frequente nos indivíduos do sexo feminino (75%), faixa etária de 18 a 25 anos (62,5%), cor parda (50%) e do 5º semestre (37,5%). Verificou-se que a presença de pelo menos um sintoma gastrointestinal entre aqueles que possuem intolerância (100%) e os que não possuem (42,2%) foi estatisticamente significativa (P=0,002). Além da própria dor abdominal (100%) (P<0,001), o sintoma gastrointestinal mais recorrente nos discentes intolerantes foi a distensão/flatulência (62,5%) (P=0,026). Em relação aos hábitos de vida e padrão alimentar, não houve diferença estatística entre os indivíduos intolerantes e tolerantes, bem como na frequência de sintomas. Os discentes dos períodos mais avançados da graduação se destacaram por manifestarem com maior constância os sintomas gastrointestinais, porém sem apresentar discrepâncias estatísticas significativas. CONCLUSÃO: Tendo em vista a quantidade da amostra que realizou o teste (n=21), pode-se provar a alta prevalência da intolerância à lactose (6,8%) no meio acadêmico, com as características epidemiológicas compatíveis com a literatura. Assim, foi possível gerar conhecimento para entender, prevenir, diagnosticar, aliviar e tratar os universitários intolerantes, gerando impactos positivos para o bem-estar, melhorando a qualidade de vida desses indivíduos.

Instant and freshness effect of mouth rinses on type 1 (oral) halitosis / Efecto anti-halitosis instantáneo y efecto de frescura de los enjuagues bucales sobre la halitosis (oral) tipo I

Hygiene deficiency causes type 1 (oral) halitosis. There are short and long-term studies on the anti-halitosis effect of mouth rinses but less knowledge on their instant effects. The aim of this study was to compare instant and freshness effects of 8 mouth rinses on type 1 halitosis. Ninety self-reported halitosis patients (19-58 y.o., median 31) were randomly divided into 9 groups. Cysteine (20 mM) challenge test was applied to obtain maximum halitosis level in the mouth of each patient. Single use of 8 different mouth rinses (R1-R8) and tap water (R0) were tested on each group (n=10). Afterward, patients were requested to score oral freshness effect of the mouth rinse on a 5-point scale (0, bad; 5, fresh). Minimum halitosis level was obtained by rinsing with 20 mMol ZnCL2. In each step, oral gas (organic, NH3, SO2, H2S, H2) concentrations were quantified by using a portable multi-gas detector (MX6, IndSci, US). The ANOVA or Kruskal Wallis tests were used to compare the quantitative measurements. R3 (Halitosil Zn) mouth rinse was found to be have the highest instant anti-halitosis effect while the R2 (Colgate plax) had the lowest. The sensation of freshness was highest in R7 (Oxyfresh power mouth rinse lemon-mint) and lowest in R8 (Signal expert protection). The freshness effect was not associated with the anti-halitosis effect (r= 0.185, p=0.608). Mouth rinses containing ZnCl2 without alcohol are instantly effective on halitosis. Mouth rinses containing ethyl and other alcohols (including glycol, sorbitol, menthol, eucalyptol, thymol, xylitol and eugenol) were found to be less effective on halitosis.

La deficiencia de higiene causa halitosis tipo 1 (oral). Se han reportado efectos anti-halitosis a corto o largo plazo de los enjuagatorios bucales, pero se desconocen sus efectos instantáneos. El objetivo de este estudio fue comparar el efecto instantáneo y de frescura de 8 enjuagues bucales en la halitosis tipo 1. Noventa pacientes (19-58 años, mediana 31) que reportaron sufrir halitosis se dividieron aleatoriamente en 9 grupos. Se aplicó la prueba de provocación con cisterna (20 mM) para obtener el máximo nivel de halitosis en la boca de cada paciente. El uso individual de 8 enjuagues bucales diferentes (R1-R8) y agua del grifo (R0) se probó en cada grupo (n = 10). Posteriormente, se pidió a los pacientes que puntuaran el efecto de la frescura oral del enjuague bucal en una escala de 5puntos (0, malo; 5, fresco). El nivel mínimo de halitosis se obtuvo con 20 mMol de ZnCL2 enjuague. En cada paso, se cuantificaron las concentraciones de gases orales (orgánicos, NH3, SO2, H2S, H2) mediante el uso de un detector portátil de múltiples gases (MX6, IndSci, EE. UU.)Se encontró que el enjuague bucal R3 (Halitosil Zn) tiene un mayor efecto antihalitosis instantáneo, mientras que el R2 (Colgate plax) fue el más bajo. El sentido de frescura fue mayor en el enjuague bucal R7 (enjuague bucal Oxyfresh power lemon-mint) mientras que fue bajo en R8 (protección experta de Signal). El efecto de frescura no se asoció con el efecto anti-halitosis (r = 0.185, p=0.608). Los enjuagues bucales que contienen ZnCl2 sin alcohol son instantáneamente efectivos en la halitosis. Se encontró que los enjuagues bucales que contenían etil y otros alcoholes (incluidos glicol, sorbitol, mentol, eucaliptol, timol, xilitol y eugenol) son menos efectivos para el control de la halitosis.

Estudo prospectivo para validação de protocolo único para o teste respiratório com ureia marcada com carbono-13 empregando dois dispositivos diferentes, no diagnóstico da infecção por H. pylori / Prospective study for validation of a single protocol for the 13c-urea breath test using two different devices in the diagnosis of h. pylori infection

ABSTRACT BACKGROUND: 13C-urea breath test (UBT) is the gold-standard, noninvasive method for H. pylori diagnosis. However, there is no uniform standardization of the test. This situation can be unpractical for laboratories running with two or more devices. OBJECTIVE: To perform a prospective comparison validation study of UBT employing one validated protocol for two different devices: BreathID Hp Lab System® (Exalenz Bioscience Ltd, Israel), here called device A and IRIS-Doc2® (Wagner Analysen-Technik, Germany, now Mayoly Spindler Group, France), here called device B, in the diagnosis of H. pylori infection. METHODS: A total of 518 consecutive patients (365 females, 153 males, mean age 53 years) referred for UBT were included. All patients received device A protocol as follow: after at least one hour fasting, patients filled two bags prior to the test, then ingested an aqueous solution containing 75 mg of 13C-urea with a 4.0 g citric acid powder and filled another two bags 15 min after ingesting the test solution. One pair of breath sample bags (before and after ingestion) was analyzed by the two different devices. A delta over baseline (DOB) ≥5‰ indicated H. pylori infection. Statistics: Wilcoxon test, kappa coefficient with 95% CI, Wilson's method. RESULTS: Considering the device A protocol as the gold standard, its comparison with device B showed a sensitivity of 99.3% (95% CI: 96.3-99.9) and a specificity of 98.9% (95% CI: 97.3-99.6). Kappa coefficient was 0.976 (95% IC: 0.956-0.997). CONCLUSION: Correlation between the two devices was excellent and supports a uniform standardization of UBT.

RESUMO CONTEXTO: O teste respiratório com ureia-marcada com carbono-13 (TR-13C) é o método padrão-ouro para o diagnóstico não invasivo da infecção por H. pylori. Apesar disto, não existe uma uniformização de protocolos para a sua realização, trazendo dificuldades operacionais para laboratórios ou clínicas que operam com equipamentos de fabricantes diferentes. OBJETIVO: Estudo prospectivo e comparativo para validação do TR-13C para o diagnóstico de infecção por H. pylori, com emprego de protocolo único para dois equipamentos diferentes, a saber: BreathID Hp Lab System® (Exalenz Bioscience Ltd, Israel), aqui denominado equipamento A e IRIS-Doc2® (Wagner Analysen-Technik, Alemanha, agora Mayoly Spindler Group, França), aqui denominado equipamento B. MÉTODOS: Um total de 518 pacientes (365 mulheres e 153 homens, idade média de 53 anos) consecutivamente encaminhados para a realização do TR-13C foram incluídos no estudo. Todos os participantes realizaram TR-13C, que foi processado e analisado simultaneamente pelos dois equipamentos. Embora os dois equipamentos possuam protocolos independentes previamente validados, foi optado, por sua maior praticidade, pela utilização de um único protocolo, conforme recomendado pelo fabricante do equipamento A, e assim resumido: após jejum mínimo de 1h, foram amostras de ar expirado coletadas em dois pequenos sacos coletores (120 mL), correspondendo ao tempo-zero (amostra-1, controle). Em seguida, os pacientes ingeriram, em até 2 min, uma solução aquosa (200 mL) contendo 75 mg de 13C-ureia e 4,0 gramas de ácido cítrico em pó, adicionado com edulcorante. Uma segunda coleta de ar expirado era realizada 15 min após a ingestão do substrato em dois novos pequenos sacos coletores, correspondendo à amostra-2. Foram considerados positivos para a presença da infecção por H. pylori quando apresentavam um delta over baseline (DOB) igual ou maior que 5‰. Análise estatística foi realizada com o teste de Wilcoxon, coeficiente kappa com IC 95% e método de Wilson. RESULTADOS: Considerando o protocolo do equipamento A como o padrão-ouro, sua comparação com o equipamento B mostrou sensibilidade de 99,3% (IC 95%: 96,3-99,9) e especificidade de 98,9% (IC 95%: 97,3-99,6). O coeficiente kappa observado foi de 0,976 (IC 95%: 0,956-0,997). CONCLUSÃO: A correlação entre os dois equipamentos foi excelente e contribui para uma uniformização de protocolos para TR-13C.

Association Between Symptoms, Quality of Life, and Gastric Emptying in Dyspeptic Patients

BACKGROUND/AIMS: Association between symptoms, quality of life and gastric emptying in dyspepsia is inconsistent in the literature. The aim of our study is to investigate if gastric emptying is associated with specific symptoms and quality of life in dyspeptic patients. METHODS: We reviewed retrospectively gastric emptying measured by ¹³C-labelled octanoate breath testing for more than 6 hours in 198 consecutive patients with dyspepsia complaints. Gastrointestinal symptoms were assessed using a 5-points Likert scale and by a symptomatic composite score, whereas quality of life was measured by the GIQLI. RESULTS: In our cohort, 90 patients (45%) had a delayed gastric emptying (half emptying time above 166 minutes when assessed over 6–8 hours). There was no difference in symptoms or quality of life between patients with or without delayed gastric emptying. However, patients with severely delayed gastric emptying (half emptying time above 200 minutes) had increased postprandial fullness (P = 0.012), abdominal pain (P = 0.026), bloating (P = 0.044), early satiety (P = 0.018), symptomatic composite score (P = 0.005), and a lower quality of life (P = 0.018). This association was no longer observed if the calculation of gastric emptying was limited to the first 4-hour samples. CONCLUSIONS: There is no association between symptoms, quality of life and gastric emptying in an overall dyspeptic population. However, there is an association between symptoms, quality of life of delayed gastric emptying in the subgroup of patients with severely delayed gastric emptying. An 8-hour measurement of gastric emptying should be recommended.

The value of three diaphragm ultrasound indices for ventilator weaning / 中国医师杂志

Objective This study sought to assess the value of the diaphragmatic thickening frac-tion ( DTF) , diaphragmatic-rapid shallow breathing index ( D-RSBI) and diaphragm thickening-rapid shal-low breathing index ( DT-RSBI) in predicting the outcomes of ventilator weaning. Methods A total of 59 patients receiving mechanical ventilation with indications for ventilator withdrawal were included in this stud-y. One hour within the spontaneous breath test ( SBT) began,diaphragmatic displacement ( DD) and DTF were measured with bedside ultrasonography to instead the tidal volume ( VT) in conventional rapid shallow breathing index ( RSBT) to calculate D-RSBI and DT-RSBI. Patients were divided into success group and failure group according to the weaning results. Multivariate logistic regression analysis was used to find inde-pendent risk factors of weaning failure and receiver operating characteristic ( ROC) curve was used to evalu-ate the efficacy of predicting the outcome of weaning. Results The multivariate logistic regression analysis showed that DTF was an independent factor affecting the success or failure after the correction of other fac-tors (P<0. 05), the threshold value is 35％, area under roc curve (AUC) 0. 972. Conclusions The DTF can be effectively used to predict the result of weaning from mechanical ventilation, the value of D-RS-BI and DT-RSBI in SBT needs to be confirmed by more research.

Ion mobility spectrometry: the diagnostic tool of third millennium medicine

SUMMARY Ion mobility spectrometry (IMS) is a fast, low cost, portable, and sensitive technique that separates ions in a drift tube under the influence of an electric field according to their size and shape. IMS represents a non-invasive and reliable instrumental alternative for the diagnosis of different diseases through the analysis of volatile metabolites in biological samples. IMS has applications in medicine in the study of volatile compounds for the non-invasive diagnose of bronchial carcinoma, chronic obstructive pulmonary disease, and other diseases analysing breath, urine, blood, faeces, and other biological samples. This technique has been used to study complex mixtures such as proteomes, metabolomes, complete organisms like bacteria and viruses, monitor anaesthetic agents, determine drugs, pharmaceuticals, and volatile compounds in human body fluids, and others. Pharmaceutical applications include analysis of over-the-counter-drugs, quality assessment, and cleaning verification. Medical practice needs non-invasive, robust, secure, fast, real-time, and low-cost methods with high sensitivity and compact size instruments to diagnose different diseases and IMS is the diagnostic tool that meets all these requirements of the Medicine of the future.

RESUMO A espectrometria de mobilidade iônica (IMS) é uma técnica rápida, de baixo custo, portátil e sensível que separa íons em um tubo de deriva sob a influência de um campo elétrico de acordo com seu tamanho e forma. A IMS representa uma alternativa instrumental não invasiva e confiável para o diagnóstico de diferentes doenças por meio da análise de metabólitos voláteis em amostras biológicas. A IMS possui aplicações em medicina no estudo de compostos voláteis para o diagnóstico não invasivo de carcinoma brônquico, doença pulmonar obstrutiva crônica e outras doenças que analisam respiração, urina, sangue, fezes e outras amostras biológicas. A IMS tem sido usada para estudar misturas complexas, como proteomas, metabólitos, organismos completos como bactérias e vírus, monitorar agentes anestésicos, determinar drogas, produtos farmacêuticos e compostos voláteis em fluidos corporais e outros fluidos. As aplicações farmacêuticas incluem análises de medicamentos sem receita, avaliação de qualidade e verificação de limpeza. A prática médica precisa de métodos não invasivos, robustos, seguros, rápidos, em tempo real e de baixo custo com instrumentos de alta sensibilidade e tamanho compacto para diagnosticar diferentes doenças e a IMS é a ferramenta de diagnóstico que atende a todos esses requisitos da medicina do futuro.

Validación de una prueba de amonio en aliento para el diagnóstico de la infección por Helicobacter pylori en pacientes del Hospital Cayetano Heredia / Validation of an ammonia breath test for the diagnosis of Helicobacter pylori infection in patients with dyspepsia at Hospital Cayetano Heredia

Objetivo: Determinar la validez diagnóstica de una prueba de amonio en aire espirado para la infección por Helicobacter pylori en pacientes a los que se le realiza una endoscopía digestiva alta en el Hospital Cayetano Heredia. Material y métodos: De abril a diciembre del 2014 se evaluó a 155 pacientes con una prueba de amonio en aliento y la evaluación histopatológica de las biopsias de estómago (considerada como el patrón de oro) tomadas durante la endoscopía. Los datos fueron analizados en Microsoft Excel y STATA 14 para construir una curva ROC. Resultados: Los pacientes fueron predominantemente mujeres (71%), con una edad media de 53 años (18-84) y una prevalencia de Helicobacter pylori de 51,6%. Al comparar la prueba de amonio en aire espirado con la prueba histológica se obtiene una sensibilidad de 70%, especificidad de 36%, valor predictivo positivo de 53,8%, valor predictivo negativo de 36%, índice de probabilidad positivo de 1,15 e índice de probabilidad negativo de 0,75. De acuerdo a la curva ROC, no se encontró un punto de corte óptimo con adecuados valores de sensibilidad y especificidad y el área bajo la curva es de 0,5517. Conclusiones: Esta prueba de amonio en aliento (aire espirado) no presenta poder diagnóstico y no se recomienda como una herramienta para el diagnóstico de la infección por Helicobacter pylori.

Objetive: To determine the diagnostic validity of an ammonia breath test for Helicobacter pylori infection in patients who undergo an upper gastrointestinal endoscopy at Hospital Cayetano Heredia. Material and methods: From April to December 2014, 155 patients were evaluated with the ammonia breath test and compared with a histological evaluation of the gastric biopsies as the gold standard. Data were evaluated using Microsoft Excel and STATA 14 to build a ROC curve. Results: The patients were predominantly female (71%), with a median age of 53 years (18-84) and a Helicobacter pylori prevalence of 51.6%. The ammonia breath test, when compared to the gastric biopsy has a 70% sensitivity, 36% specificity, 53.8% positive predictive value, 36% negative predictive value, 1.15 positive likelihood ratio and 0.75 negative likelihood ratio. According to the ROC curve, there is not an optimal cut off value and the area under the curve was 0.5517. Conclusions: The ammonia breath test evaluated on this study does not have diagnostic accuracy and is not recommended as a diagnostic tool for Helicobacter pylori infection.

Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After Excluding Small Intestinal Bacterial Overgrowth

BACKGROUND/AIMS: Fructose malabsorption (FM) mimics symptoms of irritable bowel syndrome (IBS), and its prevalence has increased. Diagnosing FM in IBS is challenging because of its overlap with small intestinal bacterial overgrowth (SIBO). We assessed the prevalence of FM by comparing patients with IBS with asymptomatic control individuals after excluding SIBO using the glucose hydrogen breath test (HBT). METHODS: Patients diagnosed with IBS and asymptomatic control individuals were enrolled prospectively. Dietary habits were assessed with the Food Frequency Questionnaire. After excluding SIBO, participants underwent HBTs with both 15 g and 25 g of fructose. RESULTS: Thirty-five patients with IBS and 35 age- and sex-matched asymptomatic control individuals were enrolled. The 15-g fructose HBT yielded positive results in 7 of the 35 (20.0%) patients with IBS and in 2 of 35 (5.7%) controls (P = 0.070). The 25-g fructose HBT was positive in 16 of the 35 (45.7%) patients with IBS and in 8 of the 35 (22.9%) controls (P = 0.040). Analysis of the Food Frequency Questionnaire responses showed no significant differences between the 2 groups in dietary intake, although patients with IBS showed a significantly higher mean fiber intake than controls (21.24 ± 11.35 g vs 15.87 ± 7.07 g, respectively, P = 0.040). CONCLUSIONS: The 25-g fructose HBT identified FM in a significantly higher percentage of SIBO-negative patients with IBS than in asymptomatic control individuals, suggesting that FM may correlate with IBS. Education regarding dietary control of foods containing fructose may be useful for the management of patients with IBS.

Prevalence of small intestine bacterial overgrowth in patients with gastrointestinal symptoms / Prevalência de supercrescimento bacteriano do intestino delgado em pacientes com sintomas intestinais funcionais

ABSTRACT BACKGROUND Small intestine bacterial overgrowth is a heterogeneous syndrome characterized by an increase in the number and/or the presence of atypical microbiota in the small intestine. The symptoms of small intestine bacterial overgrowth are unspecific, encompassing abdominal pain/distension, diarrhea and flatulence. Due to the increased cost and complexity for carrying out the jejunal aspirate, the gold standard for diagnosis of the syndrome, routinely the hydrogen (H 2 ) breath test has been used, utilizing glucose or lactulose as substrate, which is able to determine, in the exhaled air, the H 2 concentration produced from the intestinal bacterial metabolism. However, due to a number of individuals presenting a methanogenic microbiota, which does not produce H 2 , the testing on devices capable of detecting, concurrently, the concentration of exhaled H 2 and methane (CH 4 ) is justified. OBJECTIVE This study aimed to determine the prevalence of small intestine bacterial overgrowth in patients with digestive symptoms, through a comparative analysis of breath tests of H 2 or H 2 and CH 4 associated, using glucose as substrate . METHODS A total of 200 patients of both sexes without age limitation were evaluated, being directed to a Breath Test Laboratory for performing the H 2 test (100 patients) and of exhaled H 2 and CH 4 (100 patients) due to gastrointestinal complaints, most of them patients with gastrointestinal functional disorders. RESULTS The results indicated a significant prevalence of small intestine bacterial overgrowth in the H 2 test and in the test of exhaled H 2 and CH 4 (56% and 64% respectively) in patients with gastrointestinal symptoms, and higher prevalence in females. It found further that methane gas was alone responsible for positivity in 18% of patients. CONCLUSION The data found in this study is consistent with the findings of the current literature and underscores the need for using devices capable of capturing the two gases (exhaled H 2 and CH 4 ) to improve the sensitivity and hence the accuracy of small intestine bacterial overgrowth diagnosis in daily medical practice.

RESUMO CONTEXTO O supercrescimento bacteriano do intestino delgado é uma síndrome heterogênea, caracterizada pelo aumento no número e/ou presença de uma microbiota atípica no intestino delgado. Os sintomas do supercrescimento bacteriano do intestino delgado são inespecíficos englobando quadro de dor/distensão abdominal, diarreia e flatulência. Devido ao maior custo e complexidade para a realização do aspirado jejunal, padrão ouro para o diagnóstico da síndrome, tem sido utilizado rotineiramente o teste do hidrogênio (H 2 ) expirado, utilizando glicose ou lactulose como substrato, que é capaz de determinar, no ar expirado, a concentração de H 2 produzida a partir do metabolismo bacteriano intestinal. Entretanto, em decorrência de uma parcela de indivíduos apresentar uma microbiota metanogênica, não produtora de H 2 , justifica-se a realização do teste em aparelhos capazes de detectar, concomitantemente, a concentração de H 2 e metano (CH 4 ) expirados. OBJETIVO O presente estudo teve como objetivo determinar a prevalência de supercrescimento bacteriano do intestino delgado em pacientes com sintomas digestivos, através de uma análise comparativa dos testes respiratórios empregando H 2 ou H 2 e CH 4 associados, utilizando a glicose como substrato. MÉTODOS Foram avaliados 200 pacientes de ambos os sexos, sem limitação de idade, encaminhados a um Laboratório de Teste Respiratório para realização do teste de H 2 (100 pacientes) e de H 2 e CH 4 expirados (100 pacientes) devido a queixas gastrointestinais, a maioria deles portadores de distúrbios funcionais gastrointestinais. RESULTADOS Os resultados obtidos indicaram uma significativa prevalência do supercrescimento bacteriano do intestino delgado no teste do H 2 e no teste do H 2 e CH 4 expirados (56% e 64%, respectivamente) em pacientes com sintomas gastrointestinais, além de maior predominância no sexo feminino. Constatou-se ainda, que o gás metano foi isoladamente responsável pela positividade em 18% do total de pacientes. CONCLUSÃO Os dados encontrados no presente estudo demonstram condizentes com os achados da literatura atual e reforçam a necessidade da utilização de aparelhos capazes de captar os dois gases (H 2 e CH 4 expirados) para melhorar a sensibilidade e, consequentemente, a acurácia do diagnóstico de supercrescimento bacteriano do intestino delgado na prática médica diária.

Value of lactulose hydrogen breath test combined with radionuclide imaging in the diagnosis of small intestinal bacterial overgrowth / 中华核医学与分子影像杂志

Objective To compare the tracing effects of radionuclide and barium sulfate on lactulose hydrogen breath test (LHBT), and to explore the value of LHBT combined with radionuclide imaging in the diagnosis of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS).Methods From November 2010 to November 2012, 89 patients (47 males, 42 females;mean age (45.7±12.9) years) with IBS and 13 healthy volunteers (9 males, 4 females;mean age (43.3±8.6) years) were enrolled in this prospective study.All the subjects underwent LHBT combined with radionuclide imaging.Recording the time when the increment of H2 value >0.005‰ and the OCTT of the radionuclide.Four healthy volunteers also underwent LHBT combined with barium sulfate 1 week after radionuclide imaging.The location of barium sulfate was recorded when H2 value increment >0.020‰.Patients with SIBO received rifaximin treatment, and the effect was observed.χ2 test, Pearson correlation analysis and Wilcoxon rank sum test were used to analyze the data.Results (1)In LHBT combined with barium sulfate test, barium sulfate was found still stagnating in small intestine by abdominal X-ray when H2 value increment >0.020‰ in 4 healthy volunteers, and barium sulfate didn′t reach the colon in delayed imaging in 1 patient.(2) The rates of SIBO detected by LHBT in IBS patients and healthy volunteers were significantly different (43.8%(39/89) vs 5/13;χ2=0.133, P=0.716), and those detected by LHBT combined with radionuclide imaging were also significantly different (39.3%(35/89) vs 1/13;χ2=4.970, P=0.026).(3)The time of H2 value increased >0.005‰ correlated well with OCTT in 13 healthy volunteers ((73±31) and (50±19) min;r=0.871, P<0.001) and 54 IBS patients without SIBO ((83±34) and (66±28) min;r=0.735, P<0.001), but there was no correlation in 35 IBS patients with SIBO ((36±30) and (75±30) min;r=0.304, P=0.076).(4)A total of 34 SIBO-positive patients received a rifaximin treatment, with a significant improvement in the frequency of abdominal pain and abdominal distension after the treatment according to Rome Ⅲ diagnostic criteria: 5(4, 6) vs 4(3, 5), 4(1, 6) vs 0(0, 4)(z values:-4.842 and-5.388, both P<0.001).Conclusion LHBT alone is not a valid test for SIBO, and LHBT combined with radionuclide imaging is a good candidate for SIBO diagnosis.

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Although the glucose hydrogen breath test is highly specific, its sensitivity is low; in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.

Halitosis: Un asunto del odontólogo / Halitosis: A matter of dentist

La halitosis ha sido definida como un olor ofensivo y fétido en el aliento producido por factores como: mala higiene oral, infecciones dentales u orales y/o la ingestión de ciertos alimentos. El objetivo de esta revisión es evaluar el estado actual del diagnóstico, clasificación y tratamiento de la halitosis, y brindar estrategias y herramientas correctas para abordar una problemática que es tan común en la consulta odontológica. La prevalencia de la halitosis es alta y varía dependiendo de la población estudiada y el método de diagnostico usado (escalas subjetivas, mediciones organolépticas, halimeter, cromatografía de gas, test BANA ). Existen 3 tipos de halitosis: La halitosis genuina (fisiológica y patológica), la pseudohalitosis y la halitofobia. La etiología es multifactorial y existe un acuerdo en que principalmente ocurre por el metabolismo de las bacterias. La producción de compuestos volátiles y no volátiles es común en los humanos y está influenciada por factores genéticos, dieta, estrés, enfermedades y/o desordenes presentes en los individuos. Los dos tratamientos más utilizados y tradicionales para el control de la halitosis son el control mecánico de la lengua saburral y el uso de agentes antimicrobianos. La halitosis afecta una gran parte de la población, puede crear desventajas sociales y sicológicas, y aunque es de origen multifactorial su principal causa se encuentra en la cavidad oral, principalmente por factores como la placa bacteriana, gingivitis y periodontitis. El objetivo de este artículo es revisar las herramientas actuales para el diagnóstico y tratamiento de la halitosis.

Halitosis has been defined as an offensive and fetid breath odor caused by factors such as poor oral hygiene, dental or mouth infections and / or ingestion of certain foods. The aim of this review is to assess the current state of diagnosis, classification and treatment of halitosis, providing the right strategies and tools to address a problem that is so common in dental practice. Halitosis prevalence is high and varies depending on the population studied and the diagnostic method used (subjective scales, organoleptic measurements, halymeter, gas chromatography, BANA test). There are 3 types of halitosis: Genuine halitosis (physiological and pathological), the pseudohalitosis and halitophobia. The etiology is multifactorial and there is an agreement about the cause primarily by bacterial metabolism. The production of volatile and nonvolatile compounds in humans is common and is influenced by genetic factors, diet, stress, diseases and / or disorders present in individuals. The two most used and traditional treatments to control halitosis are the mechanical control of coated tongue and the use of antimicrobial agents. Halitosis affects a large part of the population may create social and psychological disadvantages, and although it is of multifactorial origin its main cause is in the oral cavity, being mostly intraoral factors such as plaque, gingivitis and periodontitis. The aim of this article is to review current tools for diagnosis and treatment of halitosis.

Small Intestinal Bacterial Overgrowth in Patients with Refractory Functional Gastrointestinal Disorders

BACKGROUND/AIMS: Small intestinal bacterial overgrowth (SIBO) is considered to be involved in the pathogenesis of functional gastrointestinal disorders (FGID). However, the prevalence and clinical conditions of SIBO in patients with FGID remain to be fully elucidated. Here, we examined the frequency of SIBO in patients with refractory FGID. METHODS: We prospectively enrolled patients with refractory FGID based on Rome III criteria. A glucose hydrogen breath test (GHBT) was performed using a gas analyzer after an overnight fast, with breath hydrogen concentration measured at baseline and every 15 minutes after administration of glucose for a total of 3 hours. A peak hydrogen value > or = 10 ppm above the basal value between 60 and 120 minutes after administration of glucose was diagnosed as SIBO. RESULTS: A total of 38 FGID patients, including 11 with functional dyspepsia (FD), 10 with irritable bowel syndrome (IBS), and 17 with overlapping with FD and IBS, were enrolled. Of those, 2 (5.3%) were diagnosed with SIBO (one patient diagnosed with FD; the other with overlapping FD and IBS). Their symptoms were clearly improved and breath hydrogen levels decreased to normal following levofloxacin administration for 7 days. CONCLUSIONS: Two patients initially diagnosed with FD and IBS were also diagnosed with SIBO as assessed by GHBT. Although the frequency of SIBO is low among patients with FGID, it may be important to be aware of SIBO as differential diagnosis when examining patients with refractory gastrointestinal symptoms, especially bloating, as a part of routine clinical care.