Dyssynergic Defecation Concerning Proctalgia Fugax: An Observational Study

Introduction: There is no clarity about manometric findings in patients with proctalgia fugax; evidence shows different results. This study aims to evaluate dyssynergic defecation through anorectal manometry in Colombian patients in two gastroenterology centers in Bogotá, Colombia. Materials and methods: A cross-sectional descriptive observational study in adult patients with proctalgia fugax undergoing anorectal manometry and treated in two gastroenterology centers in Bogotá between 2018 and 2020. Results: 316 patients were included, predominantly women (65%), with a median age of 45.2 (range: 18-78; standard deviation [SD]: 28.3). Four percent of patients had hypertonicity, 50% were normotonic, and 46% were hypotonic. Regarding manometric parameters, 50% had normal pressure, and 46% had anal sphincter hypotonia; 76% had a normal voluntary contraction test. Dyssynergic defecation was documented in 5% of patients, and the most frequent was type I, followed by type III. A rectoanal inhibitory reflex was identified in all patients, 42% with altered sensory threshold and 70% with abnormal balloon expulsion. There was an agreement between the results of the anorectal manometry and the subjective report of the digital rectal exam by the head nurse who performed the procedure. Conclusions: The data obtained in the present study suggest that proctalgia is not related to the elevated and sustained basal contracture of the sphincter but neither to the alteration in voluntary contraction since most patients have typical values.

Introducción: Actualmente, no hay claridad acerca de los hallazgos manométricos en pacientes con proctalgia fugaz, y la evidencia muestra diferentes resultados. Se plantea como objetivo en el presente estudio evaluar la presencia de disinergia defecatoria con manometría anorrectal en pacientes colombianos en dos centros de gastroenterología en Bogotá, Colombia. Metodología: Estudio observacional descriptivo de corte transversal en pacientes adultos sometidos a manometría anorrectal con proctalgia fugaz y atendidos en dos centros de gastroenterología de la ciudad de Bogotá entre el 2018 y el 2020. Resultados: Se incluyó a 316 pacientes, predominantemente mujeres (65%), con mediana de edad 45,2 (rango: 18-78; desviación estándar [DE]: 28,3). El 4% de los pacientes presentaban hipertonicidad, el 50% eran normotónicos y el 46%, hipotónicos. En cuanto a parámetros manométricos, el 50% tenía presión normal y el 46%, hipotonía de esfínter anal. El 76% tuvo una prueba de contracción voluntaria normal. En 5% pacientes se documentó disinergia defecatoria, y la más frecuente fue el tipo I, seguido del tipo III. En todos los pacientes se identificó reflejo recto anal inhibitorio, 42% con alteración en umbral sensitivo y 70% con expulsión de balón anormal, y hubo concordancia entre los resultados de la manometría anorrectal y el reporte subjetivo del tacto rectal de la jefe de enfermería que realizó el procedimiento. Conclusiones: Los datos obtenidos en el presente estudio sugieren que la proctalgia no está relacionada con la contractura basal elevada y sostenida del esfínter, pero tampoco con la alteración en la contracción voluntaria, ya que la mayoría de los pacientes presentan valores normales.

Gastrointestinal and Hepatic Involvement in Primary Sjögren's Syndrome: Case Report and Literature Review

Sjögren's syndrome is a systemic autoimmune disease characterized by dry eyes and mouth due to the involvement of exocrine glands. However, it can manifest with GI symptoms that cover a broad spectrum from esophageal and intestinal dysmotility, achalasia, hypochlorhydria, and chronic atrophic gastritis to pancreatic enzyme deficiency, biliary dysfunction, and liver cirrhosis, which varies in its clinical manifestations and is often associated with erroneous approaches. This article reviews the GI manifestations of Sjögren's syndrome. It presents the case of a woman in her eighth decade of life with this syndrome. She showed asymptomatic hepatobiliary disease, documented abnormalities in liver profile tests, and a subsequent diagnosis of primary sclerosing cholangitis, for which she received initial treatment with ursodeoxycholic acid. During her condition, the patient has had three episodes of cholangitis, requiring endoscopic retrograde cholangiopancreatography with no findings of stones, with scant biliary sludge and discharge of purulent bile precipitated by her underlying liver disease. The association between Sjögren's syndrome and primary sclerosing cholangitis is rare and calls for special consideration.

El síndrome de Sjögren es una enfermedad autoinmune sistémica que se caracteriza por la sequedad ocular y bucal debido a la afección de glándulas exocrinas; sin embargo, puede manifestarse con síntomas gastrointestinales que abarcan un espectro amplio desde la dismotilidad esofágica e intestinal, acalasia, hipoclorhidria y gastritis crónica atrófica hasta enzimodeficiencia pancreática, disfunción biliar y cirrosis hepática, que tiene variación en sus manifestaciones clínicas y se asocia con abordajes erróneos en muchas ocasiones. En este artículo se hace una revisión acerca de las manifestaciones gastrointestinales de síndrome de Sjögren y se presenta el caso de una mujer en la octava década de la vida con este síndrome, que cursa con enfermedad hepatobiliar asintomática, documentación de alteración en pruebas de perfil hepático y diagnóstico ulterior de colangitis esclerosante primaria, por lo que recibió un tratamiento inicial con ácido ursodesoxicólico. Durante el curso de su enfermedad ha presentado 3 episodios de colangitis, con requerimiento de colangiopancreatografía retrógrada endoscópica sin hallazgos de cálculos, con escaso barro biliar y salida de bilis purulenta, precipitada por su enfermedad hepática de base. La asociación entre el síndrome de Sjögren y la colangitis esclerosante primaria es infrecuente y justifica una consideración especial.

Transición en las enfermedades crónicas gastrointestinales. Del cuidado pediátrico al del adulto / Transition in chronic gastrointestinal diseases. From pediatric to adult care

Los avances tecnológicos y del conocimiento hicieron que un mayor número de pacientes con enfermedad crónica gastrointestinal pasen de ser atendidos por el pediatra al control por los médicos de adultos durante una de las etapas más vulnerables de la vida: la adolescencia. El Grupo de Trabajo de Transición del Comité de Gastroenterología de la Sociedad Argentina de Pediatría realizó una búsqueda de literatura exhaustiva y convocó a especialistas referentes del país, con el objeto de unificar los criterios basados en la evidencia y la experiencia. De esta manera, se proponen una serie de recomendaciones para todo el equipo de salud (pediatra, gastroenterólogo infantil, nutricionista, gastroenterólogo de adultos, psicólogo, enfermería), incluso para pacientes y familias, que faciliten el proceso de transición y optimicen el seguimiento, el control, la prevención de complicaciones y la calidad de vida de los pacientes con enfermedades crónicas gastrointestinales

Technological advances and the globalization of knowledge have led to a considerable increase in the number of patients with chronic gastrointestinal disease who transition from pediatric to adult care during one of the most vulnerable life stages: adolescence. The Transition Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría conducted an exhaustive literature search and summoned leading specialists in the most frequent chronic pathologies from all over the country to unify criteria based on evidence and experience. As a result, a series of recommendations are proposed for the whole health team (pediatrician, pediatric gastroenterologist, nutritionist, adult gastroenterologist, psychologist, and nurse) including patients and families, to facilitate the transition process, optimize follow-up, prevent complications, and improve the quality of life of patients with chronic gastrointestinal diseases.

Endoscopic Findings in Patients with Moderate to Severe COVID-19: A Cross-sectional Study

Introduction: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection has diverse gastrointestinal manifestations, often requiring endoscopy. Objective: The primary objective is to describe the need for endoscopic procedures from a sample of hospitalized patients with moderate to severe coronavirus disease 2019 (COVID-19). The secondary objective is to describe the characteristics, findings, and interventions. Materials and methods: An observational, descriptive, cross-sectional study was conducted from May 2020 to December 2021 about indications, endoscopic findings, interventions, anesthesia requirements, and adverse events from a sample of patients with moderate to severe COVID-19 in whom gastrointestinal endoscopic procedures were performed for any indication. Results: Of 2,312 hospitalized patients with moderate to severe COVID-19, 2.72% required endoscopic procedures, with a predominance of men (75%), an average age of 65.7 years, and the majority for upper gastrointestinal endoscopy (68%). The most frequent indications were gastrointestinal bleeding (62%) and enteral access (28.3%). An ischemic compromise was documented in three patients. Of those with digestive bleeding, 9.5% required hemostatic therapy, and 65% were on ventilatory support and sedation during the endoscopic procedure. In half of these cases, anesthesiology support was required without periprocedural adverse events, nor was a negative pressure room required in any procedure. Conclusions: In patients with moderate to severe COVID-19 requiring gastrointestinal endoscopy, clinical judgment is necessary to define the relevance of the procedure; in many cases, conservative management may be considered.

Introducción: la infección por coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) tiene manifestaciones gastrointestinales diversas, que en muchas ocasiones requieren de endoscopia. Objetivo: como objetivo primario, describir la necesidad de procedimientos endoscópicos a partir de una muestra de pacientes hospitalizados con enfermedad por coronavirus de 2019 (COVID-19) moderado a grave, y como objetivo secundario, describir en detalle las características, los hallazgos y las intervenciones. Materiales y métodos: estudio observacional descriptivo de corte trasversal desde mayo de 2020 a diciembre de 2021 acerca de las indicaciones, hallazgos endoscópicos, intervenciones, requerimiento de anestesia y eventos adversos a partir de una muestra de pacientes con COVID-19 moderado a grave en quienes se realizaron procedimientos endoscópicos gastrointestinales por cualquier indicación. Resultados: de 2312 pacientes hospitalizados con COVID-19 moderado a grave, 2,72% requirió procedimientos endoscópicos, con predominio de los hombres (75%), edad promedio de 65,7 años y la mayoría para endoscopia digestiva alta (68%). Las indicaciones más frecuentes fueron hemorragia gastrointestinal (62%) y acceso enteral (28,3%). Se documentó compromiso isquémico en tres pacientes. En aquellos con sangrado digestivo, 9,5% requirió terapia hemostática, 65% se encontraba con soporte ventilatorio y sedación al momento del procedimiento endoscópico, y en la mitad de estos casos se requirió el apoyo de anestesiología, sin presentarse eventos adversos periprocedimentales, ni requerimiento de sala de presión negativa en ningún procedimiento. Conclusiones: en el paciente con COVID-19 moderado a grave con requerimiento de endoscopia gastrointestinal es necesario un juicio clínico para definir la pertinencia del procedimiento, y en muchos casos puede plantearse un manejo conservador.

Comparación de dos tipos de clasificación en dispepsia funcional; distrés postprandial o dolor epigástrico vs. un análisis multidimensional por conglomerados utilizando aprendizaje no supervisado

Los métodos de inteligencia artificial utilizando herramientas de aprendizaje no supervisado pueden apoyar la resolución de problemas al establecer patrones de agrupación o clasificación no identificados, que permiten tipificar subgrupos para manejos más individualizados. Existen pocos estudios que permiten conocer la influencia de síntomas digestivos y extradigestivos en la tipificación dispepsia funcional; esta investigación realizó un análisis de aprendizaje no supervisado por conglomerados basándose en dichos síntomas, para discriminar subtipos de dispepsia y comparar con una de las clasificaciones actualmente más aceptadas. Se realizó un análisis exploratorio de conglomerados en adultos con dispepsia funcional según síntomas digestivos, extradigestivos y emocionales. Se conformaron patrones de agrupación de tal manera que dentro de cada grupo existiera homogeneidad en cuanto a los valores adoptados por cada variable. El método de análisis de conglomerados fue bietápico y los resultados del patrón de clasificación se compararon con una de las clasificaciones más aceptadas de dispepsia funcional. De 184 casos, 157 cumplieron con criterios de inclusión. El análisis de conglomerados excluyó 34 casos no clasificables. Los pacientes con dispepsia de tipo 1 (conglomerado uno), presentaron mejoría al tratamiento en el 100% de los casos, solo una minoría presentaron síntomas depresivos. Los pacientes con dispepsia de tipo 2 (conglomerado dos) presentaron una mayor probabilidad de falla al tratamiento con inhibidor de bomba de protones, padecieron con mayor frecuencia trastornos de sueño, ansiedad, depresión, fibromialgia, limitaciones físicas o dolor crónico de naturaleza no digestiva. Esta clasificación de dispepsia por análisis de clúster establece una visión más holística de la dispepsia en la cual características extradigestivas, síntomas afectivos, presencia o no de trastornos de sueño y de dolor crónico permiten discriminar el comportamiento y respuesta al manejo de primera línea.

Artificial intelligence methods using unsupervised learning tools can support problem solving by establishing unidentified grouping or classification patterns that allow typing subgroups for more individualized management. There are few studies that allow us to know the influence of digestive and extra-digestive symptoms in the classification of functional dyspepsia. This research carried out a cluster unsupervised learning analysis based on these symptoms to discriminate subtypes of dyspepsia and compare with one of the currently most accepted classifications. An exploratory cluster analysis was carried out in adults with functional dyspepsia according to digestive, extra-digestive and emotional symptoms. Grouping patterns were formed in such a way that within each group there was homogeneity in terms of the values adopted by each variable. The cluster analysis method was two-stage and the results of the classification pattern were compared with one of the most accepted classifications of functional dyspepsia. Of 184 cases, 157 met the inclusion criteria. The cluster analysis excluded 34 unclassifiable cases. Patients with type 1 dyspepsia (cluster one) presented improvement after treatment in 100% of cases, only a minority presented depressive symptoms. Patients with type 2 dyspepsia (cluster two) presented a higher probability of failure to treatment with proton pump inhibitor, suffered more frequently from sleep disorders, anxiety, depression, fibromyalgia, physical limitations or chronic pain of a non-digestive nature. This classification of dyspepsia by cluster analysis establishes a more holistic vision of dyspepsia in which extradigestive characteristics, affective symptoms, presence or absence of sleep disorders and chronic pain allow discriminating behavior and response to first-line management.

Advances in clinical diagnosis and treatment of radiation enteritis / 国际肿瘤学杂志

Small bowel capsule endoscopy and double-balloon enteroscopy have become new methods for clinical diagnosis of radiation enteritis (RE) , especially for abnormal intestinal tissue. Targeted biopsy or interventional therapy is expected to achieve precision treatment of RE. The screening of molecular markers in biological samples has also become a new direction for RE diagnosis. Fecal microbiota transplantation has become one of the promising treatments for RE. In addition, mechanism studies based on traditional Chinese medicine, targeted cell death, and omics analysis provide rich strategies for the diagnosis and treatment of RE.

Progress in the pathogenesis of eosinophilic gastrointestinal diseases / 国际儿科学杂志

Eosinophilic gastrointestinal diseases are a group of diseases with repeated or persistent gastrointestinal symptoms and the increase of eosinophils in gastrointestinal mucosa.Pathology shows an increase in the number of eosinophils in gastrointestinal mucosa.Fibrosis can be seen in the lamina propria of esophageal mucosa in patients with eosinophilic esophagitis.A variety of cytokines may be chemotactic to the aggregation of eosinophils, including Th2 cytokines, eotaxin, thymic stromal lymphopoietin, macrophage migration inhibitory factor, sialic acid-binding immunoglobulin-like lectin, integrin and extracellular matrix protein.The intestinal tissue injury of eosinophilic gastrointestinal diseases may be related to eosinophil degranulation and secretion of specific products, inflammatory response, oxidative damage, fibrosis, tissue remodeling and impaired barrier function.

Alteración de la microbiota intestinal y su relación con enfermedades gastrointestinales y hepatobiliares / Disruption of the intestinal microbiota and its relationship with gastrointestinal and hepatobiliary diseases

La interrupción de la simbiosis que existe entre el cuerpo humano y su microbioma puede resultar en una disbiosis, un desequilibrio en la interacción huésped-microbiota, que puede asociarse al desarrollo de diversas enfermedades como el síndrome de intestino irritable, hígado graso no alco-hólico, enfermedad hepática alcohólica y cirrosis, entre otras. En ciertas condiciones patológicas y por múltiples factores de riesgo, la capacidad de autorregulación del intestino se puede alterar, contribuyendo al incremento de la permeabilidad con inflamación intestinal crónica. El diagnóstico y el tratamiento, así como la relación entre la permeabilidad intestinal, la disbiosis y las patologías gastrointestinales y hepatobiliares, todavía no tienen estudios clínicos validados o con el soporte científico adecuado, por lo que se realiza una revisión de la literatura con la finalidad de aportar conceptos que puedan orientar con respecto a la importancia del estudio del microbioma humano en estas enfermedades.

Disruption of the symbiosis that exists between the human body and its microbiome can result in dys-biosis, an imbalance in the host-microbiota interaction, which may be associated with the develop-ment of various diseases such as irritable bowel syndrome, non-alcoholic fatty liver disease, alcoholic liver disease and cirrhosis, among others. In certain pathological conditions and due to multiple risk factors, the self-regulating capacity of the intestine may be lost, contributing to increased permeability with chronic intestinal inflammation. Its diagnosis and treatment as well as the relationship between intestinal permeability, dysbiosis and gastrointestinal and hepatobiliary pathologies have not been validated in clinical studies or have adequate scientific support, so a review of the literature is carried out in order to provide concepts that can guide with respect to the importance of the study of the human microbiome in these diseases

Impacto da ecoendoscopia diagnóstica e terapêutica nas crianças / Impact of diagnostic and interventional endoscopic ultrasonography in children

ABSTRACT Background: Endoscopic ultrasonography is used in the diagnosis and treatment of digestive diseases in adults. In children, its use is limited due to a lack of available expertise. Objective: This study aimed to evaluate the clinical impact of endoscopic ultrasonography on diagnostic and therapeutic strategy changes in pediatric patients. Methods: Over ten years, this study retrospectively and consecutively analyzed children aged ≤18 years who underwent endoscopic ultrasonography because of inconclusive imaging or laboratory tests. The indications, results, occurrence of adverse events, and clinical impact of the procedures were analyzed. The clinical impact was classified as major (when the findings led to changes in diagnosis and management), minor (change in diagnosis but not in management), or none (no change in diagnosis or management). Results: Overall, 107 children [77 (72%) of whom were female; mean age: 11.7 ± 4 years] underwent upper [102 (95.3%)] and lower [5 (4.7%)] endoscopic ultrasonography; 64 (58%) patients underwent diagnostic endoscopic ultrasonography, and 43 (42%) underwent interventional endoscopic ultrasonography. Endoscopic ultrasonography was used to investigate pancreaticobiliary, gastric, rectal, esophageal, duodenal, and mediastinal diseases in 81 (76%), 14 (13%), 5 (4.6%), 3 (2.8%), 2 (1.8%), and 2 (1.8%) patients, respectively. The clinical impact was significant in 81% of the children. Major and no clinical impact on pancreaticobiliary, gastrointestinal diseases, and mediastinal masses occurred in 50 (62%) and 13 (16%), 13 (54%) and 9 (37%), and 2 (100%) and 0 (0%) of the patients, respectively. Conclusion: This study evaluated the impact of diagnostic and interventional endoscopic ultrasonography in pediatric patients. When clinically and appropriately indicated, these procedures are safe and effective diagnostic or therapeutic interventions in pediatric patients with gastrointestinal or pancreaticobiliary disorders.

RESUMO Contexto: A ecoendoscopia (EUS) faz parte da prática clínica diária no diagnóstico e tratamento de doenças digestivas em adultos, no entanto, seu uso em crianças é limitado. Objetivo: O objetivo do trabalho foi avaliar o impacto clínico da ecoendoscopia diagnóstica (EUS-D) e ecoendoscopia intervencionista (EUS-I) na população pediátrica. Métodos: Por um período de 10 anos, analisamos retrospectivamente os prontuários de 107 crianças (≤18 anos) submetidas à ecoendoscopia alta [102 (95.3%)] e ecoendoscopia baixa [5 (4.7%)] que tiveram teste de imagem ou laboratorial inconclusivos. O impacto clínico foi classificado como forte (quando mudou o diagnóstico e a terapêutica), fraco (modificou o diagnóstico, mas não o manejo) e ausente (não houve mudança nem do diagnóstico e nem no manejo). Resultados: 107 meninas (72%) e 30 meninos (28%), média de idade 11.7±4 anos (5-18), foram submetidas à ecoendoscopia. 64 (58%) à EUS-D e 43 (42%) à EUS-I [EUS-FNA em 33 (77%) e 10 (33%) a drenagens (pseudocisto (5), walled off necrosis (2), perirectal abscesso (1)) e neurólise do plexo celíaco (2). O sucesso técnico, clínico e a taxa de efeitos adversos para a EUS-I foram de 100%, 90% e 0%, respectivamente. A via biliopancreática foi estudada em 81 (76%), estômago 14 (13%), reto 5 (4.6%), esôfago 3 (2.8%), duodeno 2 (1.8%) e mediastino 2 (1.8%) casos. O impacto clínico total foi de 81%. O impacto clínico foi forte e fraco para a via biliopancreática (81), gastrointestinal (24) e mediastinal (2) em 62% e 16%, 54% e 37% e 100% e 0%, respectivamente. A sensibilidade, especificidade e acurácia da EUS-FNA com microhistologia foi de 76.2%, 100% e 84.8%, respectivamente. Conclusão: Os autores concluem que a EUS-D e a EUS-I são efetivas e seguras quando indicadas corretamente para as doenças digestivas em crianças. A EUS-FNA tem elevada acurácia e pode esclarecer a maioria dos casos duvidosos, determinando o diagnóstico preciso das enfermidades digestivas. O impacto clínico foi grande em relação ao diagnóstico e a mudança do tipo de tratamento na maioria das crianças.

Utilidad de la coloración de Giemsa para diagnosticar Helicobacter pylori en pacientes con lesiones preneoplásicas / The usefulness of Giemsa staining to diagnose Helicobacter pylori in patients with preneoplastic lesions

Resumen Introducción: Helicobacter pylori es una bacteria asociada con enfermedades gastroduodenales inflamatorias y neoplásicas. La histopatología es uno de los métodos diagnósticos empleados para su detección, la cual tiene sensibilidad del 90% al 95% cuando hay alta densidad de H. pylori; sin embargo, la bacteria puede pasar desapercibida en infecciones de baja densidad porque la coloración de rutina de hematoxilina y eosina (H&E) no es una tinción específica para su detección y presenta variabilidad interobservador. El objetivo de este estudio fue determinar la utilidad de la tinción complementaria de Giemsa para el diagnóstico de H. pylori en lesiones preneoplásicas en las que la bacteria se encuentra en baja densidad. Materiales y métodos: se realizó un estudio descriptivo retrospectivo y prospectivo que incluyó a 65 pacientes con diagnóstico de lesiones preneoplásicas. Las biopsias gástricas se tiñeron con H&E y Giemsa, y fueron evaluadas por dos patólogos. Resultados: la coloración de Giemsa diagnosticó 20,3% de casos más de infección por H. pylori que la H&E, la mayoría de ellos con baja densidad de la bacteria. No hubo diferencias estadísticamente significativas en el diagnóstico de H. pylori de acuerdo con el tipo de muestra. Conclusión: este estudio encontró que la tinción de Giemsa mejora el diagnóstico histopatológico de H. pylori en pacientes con lesiones preneoplásicas.

Abstract Introduction: Helicobacter pylori is a bacterium associated with inflammatory and neoplastic gastroduodenal diseases. Histopathology is one of the diagnostic methods used for its detection, which has a sensitivity of 90% to 95% when there is a high density of H. pylori; however, the bacterium may be missed in low-density infections because routine hematoxylin and eosin (H&E) staining is not specific for its detection and has interobserver variability. This study aimed to determine the usefulness of complementary Giemsa staining for diagnosing H. pylori in preneoplastic lesions where the bacterium was found in low density. Materials and methods: A retrospective/prospective descriptive study was carried out that included 65 patients diagnosed with preneoplastic lesions. Gastric biopsies were stained with H&E and Giemsa and evaluated by two pathologists. Results: Giemsa staining analyzed 20.3% more cases of H. pylori than H&E, most with a low density of the bacteria. There were no statistically significant differences in the diagnosis of H. pylori according to the sample type. Conclusion: This study found that Giemsa staining improves the histopathological diagnosis of H. pylori in patients with preneoplastic lesions.

Prematurity and functional gastrointestinal disorders in infancy: a cross-sectional study

ABSTRACT BACKGROUND: Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms that are not explained by structural or biochemical abnormalities. Their relationship with prematurity has been increasingly studied. OBJECTIVE: To compare the frequency of FGIDs in preterm and term infants and to evaluate whether invasive procedures during the neonatal period in preterm infants are associated with greater likelihood of FGIDs in the first two years of life. DESIGN AND SETTING: Controlled nested cross-sectional study conducted in a Brazilian university hospital. METHODS: This was a controlled nested cross-sectional study on a retrospective cohort of infants born preterm who were compared with infants born at term regarding the presence of FGIDs. Medical consultations were conducted by a single pediatric gastroenterologist to obtain information on the gestational and neonatal periods and on clinical manifestations of the digestive tract. The Rome IV criteria for the diagnosis of FGIDs were used. RESULTS: A total of 197 infants (< 24 months), including 99 preterm and 98 term infants, were studied. Infant regurgitation was more prevalent in term infants (35.1% and 15.6%; P < 0.001). The frequencies of other FGIDs (infant colic, functional constipation, functional diarrhea and infant dyschezia) in preterm infants did not differ from those of term infants (P > 0.05). No relationship was found between invasive procedures during the neonatal period and development of FGIDs in preterm infants. CONCLUSION: Infants born preterm did not have higher frequency of FGIDs in the first two years of life.

Tricobezoar gástrico y gastroduodenal en pediatría. Reporte de 2 casos e implicaciones quirúrgicas / Gastric and Gastroduodenal Trichobezoar in Pediatrics. Report of 2 Cases and surgical Implications

Resumen El tricobezoar es una variedad de los bezoarios cuya característica es la presencia de una masa compacta constituida por material no digerible, principalmente cabellos y otros componentes. Presentación de casos: Se presentan 2 casos de pacientes de 4 y 9 años, quienes ingresaron por emergencias, con evolución clínica crónica caracterizada por una masa abdominal palpable, pérdida de peso progresiva asociada a tricofagia-tricotilomania, con presunción diagnóstica de ingreso de bezoar gástrico. La ecografía abdominal en ambos pacientes reportó imagen ecorefringente en su interior que produce sombra acústica, compatible con probable tricobezoar, diagnóstico reforzado por tomografía computarizada con contraste. Dada la imposibilidad de extracción vía endoscópica por el gran tamaño, se optó por realizar laparotomía exploratoria, extrayéndose en los 2 casos la masa en bloque completa a través de una gastrotomía. Las pacientes presentaron una evolución favorable, recibiendo alimentación parenteral por 5 días y luego ingesta oral con buena tolerancia, dando de alta hospitalaria a su 9° y 10° día postoperatorio, con seguimiento interdisciplinario y apoyo psicológico. Debe considerarse como primera posibilidad diagnóstica el tricobezoar ante presencia de tricotilomanía, compromiso afectivo, retraso psicomotor, clínica intestinal. En estos casos el manejo neuropsiquiátrico postquirúrgico es fundamental a fin de reducir el riesgo de recurrencias.

Abstract The trichobezoar is a variety of bezoars whose characteristic is the presence of a compact mass made up of indigestible material, mainly hair and other components. Presentation of cases: We present 2 cases of patients aged 4 and 9 years, who were admitted to an emergency room, with symptoms of chronic evolution characterized by a palpable abdominal mass, progressive weight loss associated with trichophagia-trichotillomania, with presumed diagnosis of gastric bezoar admission. The abdominal ultrasound in both reported an echorefringent image inside that produces an acoustic shadow, compatible with a probable trichobezoar, a diagnosis reinforced by contrast-enhanced computed tomography. Given the impossibility of endoscopic extraction due to the large size, it was decided to perform exploratory laparotomy, extracting the complete en-bloc mass through a gastrotomy in both cases. The patients presented a favorable evolution, receiving parenteral feeding for 5 days and then oral ingestion with good tolerance, being discharged from hospital on their 9th and 10th postoperative day with interdisciplinary follow-up and psychological support. There is a high suspicion of trichobezoar in the presence of trichotillomania, affective compromise, psychomotor retardation, intestinal symptoms and postsurgical neuropsychiatric management is essential in order to reduce the risk of recurrence.

High prevalence of functional dyspepsia in nonalcoholic fatty liver disease: a cross-sectional study

Abstract BACKGROUND: Gastrointestinal (GI) symptoms are frequent complaints from individuals with nonalcoholic fatty liver disease (NAFLD). Dyspepsia is a universal clinical symptom and is among the most common GI complaints observed in the general population, but its prevalence in the population with NAFLD has not been previously investigated. OBJECTIVE: To compare the prevalence of functional dyspepsia (FD) between patients with NAFLD and controls without liver disease. DESIGN AND SETTING: Cross-sectional study at the Outpatient Liver Clinic, University Hospital, Belo Horizonte, Brazil. METHODS: We included 96 NAFLD patients and 105 controls without liver disease. All participants were assessed for GI symptoms in accordance with the Rome III criteria. Evaluation methods included a questionnaire for FD (validated in Brazil), laboratory tests and upper GI endoscopy. RESULTS: Mean age and sex were similar between the groups. The NAFLD group presented higher frequency of proton-pump inhibitor usage (31.3% vs 4.8%; P < 0.001) and prevalence of FD (25.0% versus 12.4%; P = 0.021). The symptom frequencies were as follows: postprandial distress, 22.9% versus 11.4% (P = 0.030); postprandial fullness, 18.8% versus 10.5% (P = 0.095); early satiation, 8.3% versus 5.7% (P = 0.466); and epigastric pain or burning, 18.8% versus 5.7% (P = 0.004), in NAFLD patients and controls, respectively. Multivariate analysis demonstrated that female sex (odds ratio, OR 6.97; 95% confidence interval, CI: 1.51-32.12; P = 0.013) and NAFLD diagnosis (OR 2.45; 95% CI: 1.14-5.27; P = 0.021) were independently associated with FD occurrence. CONCLUSION: FD occurs more frequently in individuals with NAFLD than in controls without hepatic disease.

Compromiso digestivo en niños con infección por el virus SARS-CoV-2

Introducción: Los niños con infección por SARS-CoV-2 representan el 8,5 % del total de casos notificados, con fiebre y tos como los síntomas más frecuentes, aunque también se han descrito manifestaciones digestivas. Objetivo: Actualizar los conocimientos sobre el compromiso digestivo en niños con COVID-19. Métodos: Se realizó una búsqueda bibliográfica en las bases de datos Medline y Web of Science, incluyendo revisiones sistemáticas, ensayos clínicos, estudios de casos y controles, estudios de cohortes, series y reportes de casos, así como sus referencias bibliográficas en caso que fueron relevantes. Análisis y síntesis de la información: Se encontraron 196 artículos y luego de una cuidadosa revisión se incluyeron finalmente 57. La prevalencia de manifestaciones digestivas varía entre 0 y 88 %, los síntomas más frecuentes: dolor abdominal, náuseas o vómitos y diarrea. Así mismo, se producen lesiones orales y alteración de la función hepática y pancreática, aunque con diferencias notables en comparación con la población adulta. En los casos de síndrome inflamatorio multisistémico, las manifestaciones digestivas son más frecuentes y pueden cursar con dolor abdominal intenso simulando un abdomen agudo quirúrgico. El aislamiento social tuvo un impacto psicológico negativo importante, principalmente en adolescentes con el aumento en la prevalencia de trastornos digestivos funcionales. Conclusiones: Las manifestaciones digestivas de COVID-19 se presentan más frecuentemente en niños en comparación a los adultos, usualmente tienen un mejor pronóstico y pueden ser causadas por efecto directo del virus, respuesta del huésped o asociadas al aislamiento social por la pandemia.

Introduction: Children with SARS-CoV-2 infection represent 8.5% of the total reported cases, with fever and cough as the most frequent symptoms, although digestive manifestations have also been described. Objective: To update knowledge about digestive compromise in children with COVID-19. Methods: A bibliographic search was carried out in Medline and Web of Science databases, including systematic reviews, clinical trials, case-control studies, cohort studies, series and case reports, as well as their bibliographic references if they were relevant. Analysis and synthesis of information: 196 articles were found and after careful review 57 were finally included. The prevalence of digestive manifestations varies between 0 and 88 %; the most frequent symptoms were: abdominal pain, nausea or vomiting and diarrhea. Likewise, oral lesions and alteration of liver and pancreatic function occur, although with notable differences compared to the adult population. In cases of multisystem inflammatory syndrome, digestive manifestations are more frequent and can occur with severe abdominal pain simulating an acute surgical abdomen. Social isolation had a significant negative psychological impact, mainly in adolescents with the increase in the prevalence of functional digestive disorders. Conclusions: The digestive manifestations of COVID-19 occur more frequently in children in comparisson to adults, usually have a better prognosis and can be caused by direct effect of the virus, host response or associated with social isolation due to the pandemic.

Professor YANG Ji-guo's experience in treatment of functional gastrointestinal diseases with acupuncture combined with umbilicus moxibustion / 中国针灸

Professor YANG Ji-guo's clinical experience in treatment of functional gastrointestinal diseases was summerized. Professor YANG Ji-guo believes that this disease is caused by the deficiency of six fu organs. Dysfunction of six fu organs in descending transportation is the basic pathogenesis. The principle of acupoint selection includes benefiting gastrointestinal functions, unblocking and purging six fu, soothing liver qi and calming down the mind. In treatment, acupuncture is combined with umbilicus moxibustion. In acupuncture, the deqi promoting technique by rotating and trembling needle is adopted. Focusing on the deficiency of six fu organs, umbilicus moxibustion is adopted to benefit the spleen and stomach and harmonize the functions of six fu organs for both biao (symptoms) and ben (root cause).

Effect of umbilical vein catheterization on portal vein blood flow and its relationship with gastrointestinal complications in neonates / 中华围产医学杂志

Objective:To explore the effect of umbilical vein catheterization (UVC) on portal vein blood flow velocity (PBFVe) and its relationship with gastrointestinal (GI) complications in neonates.Methods:A prospective study was conducted on neonates with indications for UVC and achieving one-time successful catheterization at Gansu Provincial Women and Child-care Hospital from March 2019 to March 2021. Successful UVC was defined as the umbilical catheter reaching the entrance of the inferior vena cava and right atrium through the ductus venosus. PBFVe was measured by bedside ultrasound before and after UVC. All subjects were divided into two groups as those with GI complications anytime from insertion to withdrawal (complication group), and those with no GI complications (no complication group) to compare the PBFVe value before UVC and the percentage of decrease in PBFVe after UVC. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the risk factors of GI complications and the predictive value of the percentage of decrease in PBFVe after UVC.Results:Of 91 subjects included, 59.3% (54/91) had no GI complications, and 40.7% (37/91) had. After UVC, PBFVe was decreased than before in neonates both with and without GI complications [(11.3±1.8) vs (14.7±2.4) cm/s; (12.4±1.7) vs (14.2±1.8) cm/s, t=－16.92 and－17.62, respectively, both P<0.05]. PBFVe before UVC were similar between the two groups. However, the complications group had a lower PBFVe after UVC ( t=－2.98, P=0.004) and a higher percentage of decrease in PBFVe [(22.5±6.0)% vs (12.6±4.9)%, t=8.65, P<0.001] when compared with the no complications group. Multivariate logistic regression analysis showed that the body weight was the protector of GI complications ( OR=0.294, 95% CI:0.089-0.974, P=0.045), and the percentage of decrease in PBFVe was the risk factor ( OR=1.478, 95% CI:1.249-1.749, P<0.001). The area under the curve of the percentage of decrease in PBFVe for predicting GI complications was 0.919 (95% CI:0.843-0.966, P<0.001). The cut-off value was 16.9% with a sensitivity of 89.2% and a specificity of 85.2%. Conclusions:UVC can reduce the PBFVe of neonates. The more the PBFVe decreases, the greater the possibility of GI complications.

The relationships between functional gastrointestinal diseases and psychological factors, diet and lifestyles: a network analysis / 中华内科杂志

Objective:To investigate the relationship between common functional gastrointestinal diseases symptoms with psychological factors, diet and lifestyles by using the network analysis method which has achieved great success in the field of psychology in recent years.Method:A questionnaire survey was conducted in two military units using the cluster sampling method during July 2020, and a total of 1 805 subjects were included. Functional gastrointestinal disease symptoms were evaluated with the Gastrointestinal Symptom Rating Scale (GSRS). The state, trait anxiety scale and stress response scale were used to evaluate the mental and psychological state by self-evaluation. R was used to build the network and calculate statistical parameters.Results:1 486 of the 1 805 subjects (82.3%) had experienced functional gastrointestinal diseases symptoms within 2 weeks, but most of them were mild. Network analysis shows that there was a strong interaction between digestive system symptoms with different clinical manifestations (Spearman coefficient ranges 0.31-0.56). There was a clear relationship between functional gastrointestinal symptoms and mental and psychological factors (Spearman coefficient ranges 0.16-0.27), but there was no clear interaction with diet, age, education level, body mass index, etc. Functional gastrointestinal diseases symptoms were connected with mental and psychological factors through two nodes: stress and indigestion. The stability coefficient of node strength correlation was 0.75, indicating that the network was stable.Conclusions:The current study revealed the network structure and features of functional gastrointestinal diseases symptoms with mental and psychological factors. The key linking nodes provided potential interfering target for controlling functional gastrointestinal symptoms related to mental and psychological factors.

Recommendations for evaluation and diagnosis of extra-glandular manifestations of primary Sjögren syndrome: results of an epidemiologic systematic review/ meta-analysis and a consensus guideline from the Brazilian society of rheumatology (hepatic, gastrointestinal and pancreatic)

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Enterocolitis eosinofílica transmural: a propósito de un caso / Transmural eosinophilic enterocolitis: a case report

RESUMEN Introducción: la enteritis eosinofílica transmural caracterizada por la presencia de infiltrado eosinofílico gastrointestinal, constituye una enfermedad rara de significado incierto y etiología desconocida. Objetivo: describir hallazgos histológicos que caracterizan la enteritis eosinofílica transmural. Presentación de caso: paciente masculino de 40 años, que fue llevado al quirófano con diagnóstico de tumor de intestino delgado al cual se le realizó una hemicolectomía derecha con resección de 12 cm de intestino delgado que incluyó apéndice y válvula íleocecal. Se encontró abundante infiltrado inflamatorio a predominio de eosinófilos desde la lámina propia hasta la serosa. Además de apéndice cecal con infiltrado eosinofílico que se extiende hasta la serosa y grasa adyacente con ocho formaciones ganglionares con hiperplasia linfoide sinusoidal. Conclusiones: a partir de las alteraciones presentes en el examen histológico de la muestra se concluyó que el paciente presentaba enterocolitis eosinofílica transmural. Se confirmó, además, la relevancia de este estudio para el diagnóstico positivo de la enfermedad.

ABSTRACT Introduction: transmural eosinophilic enteritis, is characterized by the presence of gastrointestinal eosinophilic infiltrate, it constitutes a rare entity of uncertain significance and unknown etiology. Objective: to describe the histological findings that characterizes transmural eosinophilic enteritis. Case presentation: a 40-year-old male patient, who was taken to the operating room with a diagnosis of small intestine tumor who underwent a right hemicolectomy with 12 cm resection of the small intestine that included the appendix and ileocecal valvule. Histologically it was found abundant inflammatory infiltrate predominantly of eosinophils from the lamina propria to the serous and adjacent fat with 8 ganglion formations with sinusoidal lymphoid hyperplasia. Conclusions: the alterations present in the histological examination of the sample allowed to conclude that the patient presented transmural eosinophilic enteritis, confirming the relevance of this study for the positive diagnosis of the disease.