Eosinofilia duodenal en pacientes Colombianos con dispepsia funcional: un estudio de casos y controles / Duodenal eosinophilia in functional dyspepsia in a Colombian sample: a case-control study

Introducción: La dispepsia funcional (DPF) es una entidad compleja cuya fisiopatología no está claramente definida. Existen alteraciones motoras gastroduodenales y recientemente se ha dado importancia a la eosinofilia duodenal. Objetivo: El objetivo de este estudio fuedeterminar si existe asociación entre eosinofilia duodenal y DPF. Materiales y métodos: Estudio de casos y controles. Pacientes mayores de 18 años con dispepsia según ROMA IV, a quienes se descartó DP orgánica con endoscopia alta (EVDA). Los controles fueron pacientes con anemia ferropénica y diarrea crónica a quienes de rutina se toman biopsias tanto del estómago como del duodeno. Se calcularon 70 pacientes en cada grupo. La información se recolectó en un formulario específico. Resultados: Hubo 243 pacientes elegibles. Se incluyeron 84 pacientes en grupo. El 80% eran mujeres. Edad promedio 53,6 años. Se encontró eosinofilia duodenal con diferencia significativa en los pacientes con saciedad precoz (p=0,01). No hubo diferencia significativa en los pacientes con llenura posprandial (p=0,63), dolor o ardor epigástrico (p=0,26), síntomas de reflujo gastroesofágico (p=0,13), alergia e intolerancia a alimentos (p=0,42) y tabaquismo (p=0,28). Asimismo, no se encontró relación entre mastocitosis duodenal y saciedad precoz (p=0,98), llenura posprandial (p=0,78) y dolor o ardor epigástrico (p=0,82). Conclusiones: La eosinofilia duodenal fue más frecuente en pacientes con DPF que tenían saciedad precoz.

Introduction: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. Objective: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. Material and methods: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. Results: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). Conclusions: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.

Suplementação de ferro e sua associação com a incidência de diabetes mellitus gestacional / Iron supplementation and its association with the incidence of gestational diabetes mellitus

Iron requirements are significantly increased during pregnancy, which makes the daily dietary reference intake difficult to achieve through diet. Because iron deficiency may cause iron-deficiency anemia, which increases perinatal mortality, iron supplementation has been broadly adopted as a standard procedure during pregnancy. However, caution should be exercised as recent evidence suggests that iron excess may hamper fetus development and increase the risk for gestational diabetes mellitus (GDM). Literature is still scarce and it is inconclusive on this matter as the risks and benefits of prophylactic iron supplementation during pregnancy are still a source of controversy. However, it is imperative that a greater attention be given to the iron circulating levels individually. This practice would provide a better evaluation of the necessity and dosage determination of iron supplementation during pregnancy, being, therefore, potentially less likely to trigger the excess of iron-induced deleterious effects.

La demanda nutricional de hierro aumenta significativamente durante el embarazo siendo difícil alcanzar las dosis diarias recomendadas solamente a través de la alimentación. Dado que la deficiencia de hierro puede causar anemia y aumento de la mortalidad perinatal, la suplementación con hierro ha sido ampliamente utilizada como procedimiento estándar en las mujeres embarazadas. Sin embargo esta práctica debe usarse con cautela porque evidencias recientes sugieren efectos adversos de los niveles altos de hierro, que pueden perjudicar el desarrollo fetal y aumentar el riesgo de la diabetes mellitus gestacional (DMG). Aún no existe acuerdo, en la literatura, sobre la mejor manera de abordar el problema. Los riesgos y beneficios de la suplementación con hierro todavía son materia de debate. Sin embargo, es necesario que se preste más atención, de forma individual, a los niveles de hierro circulante Esta práctica permitiría una mejor evaluación de la necesidad de suplementación con hierro y de la determinación de la dosis a ser administrada, siendo de esta manera menos factible que se desencadenen los efectos deletéreos causados por el exceso de hierro.

A demanda nutricional de ferro aumenta significativamente durante a gestação, sendo difícil alcançar a ingestão diária recomendada apenas via alimentação. Como a deficiência de ferro pode ocasionar anemia ferropriva, aumentando a mortalidade perinatal, sua suplementação tem sido amplamente utilizada como procedimento padrão em gestantes. No entanto, tal prática deve ser vista com cautela, pois novas evidências sugerem efeitos adversos dos altos níveis férricos, que podem comprometer o desenvolvimento fetal e aumentar o risco para o diabetes mellitus gestacional (DMG). A literatura não é conclusiva sobre a melhor abordagem ao problema. Os riscos e benefícios da suplementação profilática de ferro ainda são motivo de controvérsia. Entretanto, é imperativo que maior atenção seja dada aos níveis circulantes de ferro de forma individualizada. Essa prática permitiria melhor avaliação da necessidade e da determinação da dosagem da suplementação de ferro durante a gestação, sendo então potencialmente menos passível de desencadear os efeitos deletérios induzidos pelo excesso de ferro.

Deficiência de ferro em lactentes brasileiros com doença falciforme / Iron deficiency in Brazilian infants with sickle cell disease

OBJETIVO: Avaliar a deficiência ou sobrecarga de ferro em lactentes com doença falciforme, a fim de embasar a decisão de recomendar (ou não) a suplementação profilática de ferro nessa população. MÉTODOS: Estudo retrospectivo transversal envolvendo 135 lactentes menores de 2 anos (66 meninos e 69 meninas), com genótipos SS e SC (77/58), nascidos entre 2005 e 2006 em Minas Gerais. Os indicadores de uma possível deficiência de ferro foram: volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), saturação da transferrina (ST) e ferritina. Dezessete lactentes [12,6 por cento, intervalo de confiança de 95 por cento (IC95 por cento) 7,0-18,2 por cento] haviam recebido hemotransfusão antes da coleta dos exames. RESULTADOS: ST e ferritina estavam significativamente mais baixas nos lactentes com hemoglobina SC (p < 0,001). Quando dois indicadores foram utilizados para definir a deficiência de ferro (VCM ou HCM baixos mais ST ou ferritina baixas), 17,8 por cento das crianças (IC95 por cento 11,3-24,3 por cento) tinham deficiência de ferro, predominando naquelas com perfil SC (p = 0,003). Análise das crianças que não haviam sido transfundidas (n = 118) mostrou prevalência de ferropenia em 19,5 por cento. Constatou-se aumento de ferritina em 15 lactentes (11,3 por cento; IC95 por cento 5,9-16,7 por cento); a maioria havia sido transfundida. CONCLUSÕES: A maior parte dos lactentes com doença falciforme não desenvolve deficiência de ferro, mas alguns têm déficit significativo. Este estudo indica que lactentes com doença falciforme, principalmente aqueles com hemoglobinopatia SC, talvez possam receber ferro profilático; no entanto, a suplementação deve ser suspensa após a primeira hemotransfusão.

OBJECTIVE: To assess iron deficiency or overload in infants with sickle cell disease in order to support the decision to recommend (or not) iron prophylactic supplementation in this population. METHODS: Cross-sectional and retrospective study with 135 infants below 2 years old (66 boys and 69 girls), 77 with SS and 58 with SC hemoglobin, born between 2005 and 2006 in Minas Gerais, Brazil. Indicators of possible iron deficiency were: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), transferrin saturation (TS), and ferritin. Blood transfusions had been given to 17 infants (12.6 percent, 95 percent confidence interval [95 percentCI] 7.0-18.2 percent) before laboratory tests were done. RESULTS: Ferritin and TS were significantly lower in SC infants (p < 0.001). When two indices were considered for the definition of iron deficiency (low MCV or MCH plus low ferritin or TS), 17.8 percent of children (95 percentCI 11.3-24.3 percent) presented iron deficiency, mainly those with SC hemoglobin (p = 0.003). An analysis of infants who were not given transfusions (n = 118) showed that 19.5 percent presented iron deficiency. Fifteen infants (11.3 percent, 95 percentCI 5.9-16.7 percent) presented increased ferritin; the majority had been transfused. CONCLUSIONS: Most infants with sickle cell disease do not develop iron deficiency, though some have a significant deficit. This study indicates that infants with sickle cell disease, mainly those with SC hemoglobin, may receive prophylactic iron; however, supplementation should be withdrawn after the first blood transfusion.

Factores de riesgo y de protección para la anemia ferropénica en niños menores de 6 años: segundo premio poster: LIII Congreso Nacional de Pediatría 2007 / Risk and protection factor for iron deficiency anemia in children under 6 years of age: second reward poster: LIII National Congress of Pediatrics 2007

La anemia ferropénica es un problema de salud pública a nivel mundial. Los niños pequeños son más vulnerables a esta deficiencia. Determinar los factores de riesgo y protección para la anemia ferropénica en niños menores de 6 años. Estudio descriptivo, transversal. Se evaluaron 100 niños. Edad, género, estratificación social, tipo de lactancia, edad de ablactación, diagnóstico nutricional, características de la dieta (calorías, proteínas y hierro). Hemoglobina (Hb), Hematocrito (HTO), Volumen Corpuscular Medio (VCM), Hemoglobulina Corpuscular Media (HCM), hierro sérico. A las variables se les aplicó un análisis de regresión logística simple. 46 por ciento de los pacientes tenían anemia. Siendo la media para la edad de 19,2 meses, tiempo de lactancia materna exclusiva 5,2 meses, inicio de ablactación de 5,7 meses, hemoglobina de 9,9 g/dl. Se observa que en los niños de menor edad existe un mayor riesgo de presentar anemia. No se demostró una diferencia estadísticamente significativa entre los pacientes anémicos y no anémicos en relación al Gaffar Méndez Castellano y diagnóstico nutricional. Los factores de riesgo para la anemia con valores de Odds Ratio (OR) >1 fueron la edad menor de 24 meses, ausencia de lactancia materna exclusiva en menores de 6 meses, ablactación antes de los 5 meses, dietas hipocalóricas y el hierro sérico < 41 ug/dL. La dieta normoproteica resultó ser factor de protección (OR<1). Se evidenció la importancia de la lactancia materna y de una adecuada alimentación complementaria a partir del 5° mes de la vida como factores de protección para la anemia ferropénica en niños menores de 6 años.

Iron deficiency anemia is considered as a worlwide public health problem. Small children are more vulnerable to this deficiency. To determine the risk and protection factors for iron deficiency anemia in children under 6 years of age. This is a descriptive and cross-sectional study. 100 children were evaluated. Age, gender, social stratification, nursing type, complementary feedings, nutritional diagnosis, characteristic of the diet (calories, proteins and iron). Hemoglobin (Hb), hematocrit (HTO), mean corpuscular volume (VCM), mean corpuscular hemoglobin (HCM), total and fractional proteins, serum iron. 46% of patients wer anemic. Average values were: age 19,2 months, duration of exclusive breastfeeding 5.2 months, beginning of complementary feeding 5,7 months, hemoglobin 9.9 g/dl. Younger children had an increased risk of developin ganemia. There was not a statistically significant difference between anemic and non anemic patients in regard to Graffar and nutritional diagnosis. Risk factors for anemia (Odds Ratio-OR-values >1) were age under 24 months, lack of exclusive breastfeeding in children under 6 months, complementary feedings before 5 months of age, hypocaloric diet and serum iron <41 ug/dL. Normoproteic diets proved to be a protection factor (OR<1). Breastfeeding and appropriate complementary feedings after 5 months of age are protection factors for iron deficiency anemia in children under 6 years of age.

Iron deficiency anemia: the utility of upper gastrointestinal endoscopy and histopathohgy

Occult blood loss must be considered as a possible cause in every case of iron deficiency anemia. To evaluate upper gastrointestinal endoscopy in finding a potential cause for iron deficiency anemia among children in Al-Anbar governorate. Twenty five children aged 2-14 years, referred to the gastroenterology unit in Al-Ramadi General Hospital for upper gastrointestinal endoscopy had iron deficiency anemia. Fiberoptic endoscopy was used under general anesthesia and endoscopic tissue biopsies were taken from 22 patients for histopathological examination. The main presenting signs and symptoms were pallor, abdominal pain, and stunting. The upper gastrointestinal endoscopy showed thinning of duodenal folds and serrated mucosa in 8 [32%], duodenal ulcer in 3 [12%], esophageal varices in 1 [4%], nodular gastritis in 1 [4%], and reflux esophagitis in 1 [4%], with a yield rate of 56%. While tissue biopsies revealed histopathological findings suggestive of celiac disease in 12 [48%], Giardia lamblia in 2 [8%], Helicobacter pylori gastritis in 1 [4%], and esophagitis in 1 [4%]. There was a significant association between the endoscopic finding of thinning of duodenal folds and serrated mucosa and the histopathological finding suggestive of celiac disease, P<0.05. Iron deficiency anemia in children 2-14 years of age warrants upper gastrointestinal endoscopy to find potentially treatable causes for the iron deficiency anemia

Morphological and functional alterations of the intestine of rats with iron-deficiency anemia

The present study was designed to assess the intestinal absorption of D-xylose and jejunal morphometry in rats with iron-deficiency anemia. Male Wistar rats were randomly divided into a control group (diet containing 50 mg Fe/kg, N = 12) and an anemic group (diet containing <5 mg Fe/kg, N = 12). The animals were housed in individual metabolic cages and deionized water and diet were provided ad libitum for 6 weeks. Hemoglobin and hematocrit were determined at 0, 2, 4, and 6 weeks. At the end of the study the rats were submitted to a D-xylose absorption test (50 mg/100 g body weight) and sacrificed and a jejunal specimen was obtained for morphometric study. At the end of the study the hemoglobin and hematocrit of the anemic rats (8.7 ± 0.9 g/dl and 34.1 ± 2.9 percent, respectively) were significantly (P < 0.05) lower than those of the controls (13.9 ± 1.4 g/dl and 47.1 ± 1.5 percent, respectively). There was no statistical difference in D-xylose absorption between the anemic (46.5 ± 7.4 percent) and control (43.4 ± 9.0 percent) groups. The anemic animals presented statistically greater villus height (445.3 ± 36.8 µm), mucosal thickness (614.3 ± 56.3 µm) and epithelial surface (5063.0 ± 658.6 µm) than control (371.8 ± 34.3, 526.7 ± 62.3 and 4401.2 ± 704.4 µm, respectively; P < 0.05). The increase in jejunum villus height, mucosal thickness and epithelial surface in rats with iron-deficiency anemia suggests a compensatory intestinal mechanism to increase intestinal iron absorption.

Cytological findings in iron deficiency anemia.

Iron deficiency anemia is a common condition in India. We made an attempt to study the cytological changes in the buccal mucosal cells of iron deficiency anemia, patients. Buccal mucosal cells were scraped from 40 iron deficiency anemia patients and were subjected to morphometric analysis. Results of the study showed there is an increase in the cellular diameter, nuclear diameter, and nuclear:cytoplasmic ratio of iron deficiency anemia patients when compared to the normal values.