Microbiota intestinal y cólicos infantiles: ¿hay lugar para los prebióticos, probióticos y posbióticos? / Gut Microbiota and Infant Colic: is there a Place for Prebiotics, Probiotics, and Postbiotics?

El consumo de probióticos, prebióticos y posbióticos, o su combinación, puede contribuir a mantener una microbiota intestinal saludable ya que permite la regulación de su disbiosis en el caso de algunas enfermedades o trastornos, principalmente en los trastornos gastrointestinales funcionales (TGIF). El microbioma intestinal es protagonista esencial en la fisiopatología de los TGIF a través de sus funciones metabólicas y nutricionales, el mantenimiento de la integridad de la mucosa intestinal y la regulación de la respuesta inmunitaria. Las investigaciones realizadas hasta la fecha indican que los probióticos, prebióticos y posbióticos pueden tener efectos inmunomoduladores directos y clínicamente relevantes. Existen pruebas del uso de esta familia de bióticos en individuos sanos para mejorar la salud general y aliviar los síntomas en una serie de enfermedades como los cólicos infantiles. La colonización y establecimiento de la microbiota comienza en el momento del nacimiento; los primeros 2-3 años de vida son fundamentales para el desarrollo de una comunidad microbiana abundante y diversa. Diversos estudios científicos realizados mediante técnicas tradicionales dependientes de cultivo y más recientemente por técnicas moleculares han observado diferencias en las poblaciones bacterianas de bebés sanos y aquellos que sufren TGIF, estos últimos caracterizados por un aumento de especies patógenas y una menor población de bifidobacterias y lactobacilos, en comparación con los primeros. En tal contexto, se considera que la microbiota intestinal como protagonista en el desarrollo de esos trastornos, entre ellos los cólicos infantiles, a través de sus funciones metabólicas, nutricionales, de mantenimiento de la integridad de la mucosa intestinal y regulación de la respuesta inmunitaria. Esto ha abierto la puerta al estudio de la utilización de prebióticos, probióticos y posbióticos en el tratamiento y/o prevención de los TGIF infantiles. El parto vaginal y de término así como la lactancia son fundamentales en la constitución de una microbiota saludable. Como herramientas de apoyo, existen estudios de eficacia que sustentan la administración de esta familia de bióticos, principalmente en los casos en que la lactancia no sea posible o esté limitada. (AU)

The consumption of probiotics, prebiotics, and postbiotics, or a combination of them, can contribute to maintaining a healthy intestinal microbiota as it allows the regulation of its dysbiosis in the case of some diseases or disorders, mainly in functional gastrointestinal disorders (FGIDs). The gut microbiome is an essential player in the pathophysiology of FGIDs through its metabolic and nutritional functions, the maintenance of intestinal mucosal integrity, and the regulation of the immune response. Research results thus far indicate that probiotics, prebiotics, and postbiotics may have direct and clinically relevant immunomodulatory effects. There is evidence regarding the prescription of this family of biotics in healthy individuals to improve overall health and alleviate symptoms in many conditions like infantile colic. The colonization and microbiota establishment begins at birth; the first 2-3 years of life are critical for developing an abundant and diverse microbial community. Several scientific studies performed by traditional culture-dependent techniques and more recently by molecular techniques have observed differences in the bacterial populations of healthy infants and those suffering from FGIDs, the latter characterized by an increase in pathogenic species and a lower population of bifidobacteria and lactobacilli, compared to the former. In this context, the intestinal microbiota plays a leading role in the onset of these disorders, including infantile colic, through its metabolic and nutritional functions, maintenance of the integrity of the intestinal mucosa, and regulation of the immune response. That has opened the door to the study of prebiotics, probiotics, and postbiotics usage in the treatment and or prevention of infantile FGIDs. Vaginal and term delivery and breastfeeding are fundamental in the constitution of a healthy microbiota. As supportive tools, there are efficacy studies that support the administration of this family of biotics, mainly in cases where lactation is not possible or is limited.

Does L-carnitine prevent cadmium-induced damage in gastrointestinal contractility and histological changes in prepubertal rat / ¿La L-carnitina previene el daño inducido por cadmio en la contractilidad gastrointestinal y los cambios histológicos en ratas prepúberes?

SUMMARY: Cadmium (Cd) is the industrial and environmental toxic heavy metal which is found in air, water and soil. Cd, adversely affects many organs in humans such as kidney, intestine, liver, testis and lungs. L-carnitine (LC) is an important agent that plays essential role in energy metabolism. In our study, we aimed to work out whether LC application has any protective effect on intestinal contractility and morphologic damage of prepubertal rat duodenum on Cd-induced toxicity. Twenty eight prepubertal female Wistar rats were divided into four groups. The first group is control (C), second group; Cd group; Cadmium chloride was given 2 mg/kg 28 days with a one-day break by i.p. The third group; Cd+LC, which cadmium chloride was given 2 mg/kg i.p. and LC was given orally by gastric lavage. The LC dose was given as 75 mg/kg. The fourth group; LC, which only LC was given orally. The intestinal segments were isolated and suspended in tissue bath. Contractile responses were induced by acetylcholine (ACh) and relaxation was achieved with phenylephrine. Also the segments were examined for histological changes by light microscopy. Ach-induced contractions were higher in Cd+LC, LC, and control group compared to the Cd group in duodenal segments. The phenylephrine-induced relaxations were lower in Cd groups as compared with Control, Cd+LC and LC group in duodenal segments. In Cd group intestinal morphology was observed to be severely damaged whereas in Cd+LC group the damage was noticeably lower. Cd administration caused severe cellular damage and decreased gastrointestinal motility. Treatment with the LC has affected the gastrointestinal contractility and reduced the damage in intestinal morphology, which occured after Cd application.

El cadmio (Cd) es el metal pesado tóxico industrial y ambiental que se encuentra en el aire, el agua y el suelo. El Cd afecta negativamente a muchos órganos humanos, como los riñones, los intestinos, el hígado, los testículos y los pulmones. La L-carnitina (LC) es un agente importante que juega un rol esencial en el metabolismo energético. El objetivo de este estudio fue determinar si la aplicación de LC tiene algún efecto protector sobre la contractilidad intestinal y el daño morfológico del duodeno de rata prepuberal sobre la toxicidad inducida por Cd. Veintiocho ratas Wistar hembras prepúberes se dividieron en cuatro grupos. El primer grupo control (C), segundo grupo; grupo cd; Se administró cloruro de cadmio 2 mg/kg durante 28 días con un descanso de un día por vía i.p. El tercer grupo; Cd+LC, al que se administró cloruro de cadmio 2 mg/kg i.p. y LC se administró por vía oral mediante lavado gástrico. La dosis de LC se administró como 75 mg/kg. El cuarto grupo; LC, al cual solo LC se administraba por vía oral. Los segmentos intestinales fueron aislados y suspendieron en baño de tejido. Las respuestas contráctiles fueron inducidas por acetilcolina (ACh) y la relajación se logró con fenilefrina. También se examinaron los segmentos en busca de cambios histológicos mediante microscopía óptica. Las contracciones inducidas por Ach fueron mayores en Cd+LC, LC y el grupo control en comparación con el grupo Cd en los segmentos duodenales. Las relajaciones inducidas por fenilefrina fueron menores en los grupos Cd en comparación con el grupo Control, Cd+LC y LC en los segmentos duodenales. En el grupo Cd se observó que la morfología intestinal estaba severamente dañada mientras que en el grupo Cd+LC el daño fue notablemente menor. La administración de Cd causó daño celular severo y disminución de la motilidad gastrointestinal. El tratamiento con LC afectó la contractilidad gastrointestinal y redujo el daño en la morfología intestinal, que ocurría después de la aplicación de Cd.

Effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants: a Meta analysis / 中国当代儿科杂志

OBJECTIVES@#To systematically evaluate the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical development in preterm infants.@*METHODS@#A computerized search was performed in the databases including China National Knowledge Infrastructure, Wanfang Data, Weipu, PubMed, Embase, and the Cochrane Library to identify randomized controlled trials of the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants. RevMan 5.3 software was used to perform a Meta analysis for the included studies.@*RESULTS@#A total of 7 randomized controlled studies were included. The results of Meta analysis showed that compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula could reduce the risk of neonatal necrotizing enterocolitis (RR=0.40, P=0.04) and feeding intolerance (RR=0.40, P=0.005), and had no significant effect on the growth of weight, length and head circumference (P>0.05).@*CONCLUSIONS@#Compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula in preterm infants may reduce the occurrence of necrotizing enterocolitis and feeding intolerance, and can meet the nutrient requirement of physical development. However, the evidence is limited, and the results of this study cannot support the routine prophylactic use of hydrolyzed protein formula in preterm infants.

Motivo de consulta y manifestaciones gastrointestinales en pacientes pediátricos con sobrepeso y obesidad en Colombia / Reasons for consultation and gastrointestinal manifestations in pediatric patients with overweight and obesity in Colombia

Introducción: Los síntomas gastrointestinales determinan diagnóstico y tratamiento en niños con exceso de peso. Objetivo: Definir motivo de consulta y manifestaciones gastrointestinales en pacientes con exceso de peso. Métodos: Estudio descriptivo retrospectivo realizado en un centro de Gastroenterología y Nutrición Pediátrica de Colombia entre 2009 - 2015. Se revisaron 1 650 historias clínicas de pacientes con exceso de peso que asistieron a consulta. Se analizó con STATA V12, se incluyó Test de Fisher de una cola, significación de p ≤ 0,05. Resultados: Se estudiaron 222 pacientes, edad media de 71 meses (rango intercuartílicol 19-124). Tenían sobrepeso 57,7 por ciento y 42,3 por ciento obesidad y 73,9 por ciento consultó por síntomas gastrointestinales. Se presentó alto porcentaje de cesárea y lactancia materna exclusiva de corta duración. En pacientes con sobrepeso, el principal motivo de consulta fue dolor abdominal; en obesos, el exceso de peso. En ambos grupos, el síntoma más frecuente fue dolor abdominal (41,6 por ciento en sobrepeso; 48,9 por ciento en obesidad). Apetito aumentado fue el único síntoma con diferencia estadísticamente significativa (p= 0,010). Estreñimiento funcional fue el diagnóstico gastrointestinal más frecuente. Al comparar los grupos, se encontraron diferencias entre diagnósticos de estreñimiento funcional (p= 0,004), alergia alimentaria (p= 0,003) y reflujo gastroesofágico (p= 0,011). Conclusiones: Las manifestaciones gastrointestinales son frecuentes y resultan motivo de consulta principal en pacientes con exceso de peso; dentro de ellos se destaca el dolor abdominal, que los incapacita y obliga a consultar al gastroenterólogo pediatra. El exceso de peso no es motivo de consulta principal. El estreñimiento funcional es el diagnóstico gastrointestinal más común(AU)

Introduction: Gastrointestinal symptoms determine diagnosis and treatment in children with excess weight. Objective: To define reason of consultation and gastrointestinal manifestations in patients with overweight or obesity.exeso Methods: A retrospective descriptive study was carried out in a Pediatric Gastroenterology and Nutrition Center of Colombia from 2009 to 2015. 1 650 clinical records of patients with excess weight who attended the consultation were reviewed. Data was analyzed with STATA V12, one-tailed Fisher's test was included, significance of p ≤ 0.05. Results: 222 patients were studied with a mean age of 71 months (Interquartile range 19-124). 57.7 percent of them presented overweight and 42.3 percent obesity and 73.9 percent were consulted due to gastrointestinal symptoms. A high percentage of cesarean sections and exclusive breastfeeding of short duration were presented. In overweight patients, the main reason for consultation was abdominal pain and in obese ones it was excess weight. In both groups, the most frequent symptom was abdominal pain (41.6 percent in overweight, 48.9 percent in obesity). Increased appetite was the only symptom with a statistically significant difference (p= 0.010). Functional constipation was the most frequent gastrointestinal diagnosis. When comparing the groups, differences were found among diagnoses of functional constipation (p= 0.004), food allergy (p= 0.003) and gastroesophageal reflux (p= 0.011). Conclusions: Gatrointestinal manifestations are frequent and are the main reason of consultation in patients with excess weight. Abdominal pain is a frequent symptom in those patients incapacitating them and compelling to consult a pediatric gastroenterologist. Excess weight is not the main consultation reason. Functional constipation is the most common gastrointestinal diagnosis. Lifestyle changes are required to prevent or treat excess weight and associated symptoms(AU)

Probiotics: an update / Probióticos: informações atualizadas

OBJECTIVE: Triggered by the growing knowledge on the link between the intestinal microbiome and human health, the interest in probiotics is ever increasing. The authors aimed to review the recent literature on probiotics, from definitions to clinical benefits, with emphasis on children. SOURCES: Relevant literature from searches of PubMed, CINAHL, and recent consensus statements were reviewed. SUMMARY OF THE FINDINGS: While a balanced microbiome is related to health, an imbalanced microbiome or dysbiosis is related to many health problems both within the gastro-intestinal tract, such as diarrhea and inflammatory bowel disease, and outside the gastro-intestinal tract such as obesity and allergy. In this context, a strict regulation of probiotics with health claims is urgent, because the vast majority of these products are commercialized as food (supplements), claiming health benefits that are often not substantiated with clinically relevant evidence. The major indications of probiotics are in the area of the prevention and treatment of gastro-intestinal related disorders, but more data has become available on extra-intestinal indications. At least two published randomized controlled trials with the commercialized probiotic product in the claimed indication are a minimal condition before a claim can be sustained. Today, Lactobacillus rhamnosus GG and Saccharomyces boulardii are the best-studied strains. Although adverse effects have sporadically been reported, these probiotics can be considered as safe. CONCLUSIONS: Although regulation is improving, more stringent definitions are still required. Evidence of clinical benefit is accumulating, although still missing in many areas. Misuse and use of products that have not been validated constitute potential drawbacks. .

OBJETIVO: Motivado pelo conhecimento cada vez maior da associação entre o microbioma intestinal e a saúde humana, o interesse nos probióticos vem crescendo cada vez mais. Os autores visaram analisar a última literatura a respeito dos probióticos, de definições a benefícios clínicos com ênfase nas crianças. FONTES DOS DADOS: Foi analisada a literatura relevante de pesquisas do PubMed, do CINAHL e dos últimos consensos. SÍNTESE DOS DADOS: Apesar de um equilíbrio no microbioma estar relacionado à saúde, um desequilíbrio no microbioma ou disbiose está relacionado a vários problemas de saúde no trato gastrointestinal, como diarreia e doença inflamatória intestinal, e fora do trato gastrointestinal, como obesidade e alergia. Nesse contexto, a regulamentação rigorosa dos probióticos a alegações de saúde é urgente, pois a grande maioria desses produtos é comercializada como alimentação (suplementos), alegando benefícios à saúde que frequentemente não são comprovados com evidências clinicamente relevantes. As principais indicações de probióticos são feitas na área da prevenção e tratamento de doenças gastrointestinais, porém mais dados têm sido disponibilizados a respeito de indicações extraintestinais. Pelo menos dois ensaios clínicos controlados e randomizados publicados com o probiótico comercializado na indicação declarada são a condição mínima antes de uma afirmação poder ser mantida. Atualmente, o Lactobacillus rhamnosus GG e Saccharomyces boulardii são as melhores cepas estudadas. Apesar de efeitos adversos terem sido esporadicamente relatados, os probióticos podem ser considerados seguros. CONCLUSÕES: Apesar de a regulamentação estar aumentando, ainda são necessárias definições mais rigorosas. As evidências de benefícios clínicos estão aumentando, apesar de ainda ausentes em várias áreas. O uso inadequado e a utilização de produtos não validados constituem possíveis desvantagens. .

Analysis of a Blog for Gastrointestinal Disease in the View Point of the Big Data: A Single Institutional Study / 대한소화기학회지

BACKGROUND/AIMS: With the enormous increase in the amount of data, the concept of big data has emerged and this allows us to gain new insights and appreciate its value. However, analysis related to gastrointestinal diseases in the viewpoint of the big data has not been performed yet in Korea. This study analyzed the data of the blog's visitors as a set of big data to investigate questions they did not mention in the clinical situation. METHODS: We analyzed the blog of a professor whose subspecialty is gastroenterology at Gangnam Severance Hospital. We assessed the changes in the number of visitors, access path of visitors, and the queries from January 2011 to December 2013. RESULTS: A total of 50,084 visitors gained accessed to the blog. An average of 1,535.3 people visited the blog per month and 49.5 people per day. The number of visitors and the cumulative number of registered posts showed a positive correlation. The most utilized access path of visitors to the website was blog.iseverance.com (42.2%), followed by Google (32.8%) and Daum (6.6%). The most searched term by the visitors in the blog was intestinal metaplasia (16.6%), followed by dizziness (8.3%) and gastric submucosal tumor (7.0%). CONCLUSIONS: Personal blog can function as a communication route for patients with digestive diseases. The most frequently searched word necessitating explanation and education was 'intestinal metaplasia'. Identifying and analyzing even unstructured data as a set of big data is expected to provide meaningful information.

Analysis of a Blog for Gastrointestinal Disease in the View Point of the Big Data: A Single Institutional Study / 대한소화기학회지

BACKGROUND/AIMS: With the enormous increase in the amount of data, the concept of big data has emerged and this allows us to gain new insights and appreciate its value. However, analysis related to gastrointestinal diseases in the viewpoint of the big data has not been performed yet in Korea. This study analyzed the data of the blog's visitors as a set of big data to investigate questions they did not mention in the clinical situation. METHODS: We analyzed the blog of a professor whose subspecialty is gastroenterology at Gangnam Severance Hospital. We assessed the changes in the number of visitors, access path of visitors, and the queries from January 2011 to December 2013. RESULTS: A total of 50,084 visitors gained accessed to the blog. An average of 1,535.3 people visited the blog per month and 49.5 people per day. The number of visitors and the cumulative number of registered posts showed a positive correlation. The most utilized access path of visitors to the website was blog.iseverance.com (42.2%), followed by Google (32.8%) and Daum (6.6%). The most searched term by the visitors in the blog was intestinal metaplasia (16.6%), followed by dizziness (8.3%) and gastric submucosal tumor (7.0%). CONCLUSIONS: Personal blog can function as a communication route for patients with digestive diseases. The most frequently searched word necessitating explanation and education was 'intestinal metaplasia'. Identifying and analyzing even unstructured data as a set of big data is expected to provide meaningful information.

Um ensaio randomizado duplo-cego e controlado por placebo com probióticos em casos de supercrescimento bacteriano no intestino delgado em crianças tratadas com omeprazol / A double-blind placebo-controlled randomized trial on probiotics in small bowel bacterial overgrowth in children treated with omeprazole

OBJETIVO: Avaliar a incidência de SBID em crianças tratadas com omeprazol e testar se os probióticos influenciam essa incidência. MÉTODOS: Um ensaio duplo-cego controlado por placebo foi realizado em 70 crianças tratadas oralmente, durante 4 semanas, com 20 mg de omeprazol por dia. Desses, 36 indivíduos receberam diária e simultaneamente Lactobacillus rhamnosus R0011 (1,9 x 10(9) cfu) e Lactobacillus acidophillus R0052 (0,1 x 10(9) cfu) (grupo probiótico), enquanto 34 receberam placebo (grupo placebo). O diagnóstico de SBID teve como base o desenvolvimento de sintomas sugestivos em combinação com um teste respiratório com glicose positivo. RESULTADOS: Após um mês de tratamento com IBP, 30% (21/70) apresentaram um teste respiratório positivo sugerindo SBID; desses, 62% foram sintomáticos. Cinco crianças desenvolveram sintomas parecidos com os de SBID, mas apresentaram um teste respiratório negativo; 44 (63%) não apresentavam sintomas e tiveram teste respiratório negativo. Não houve diferença na incidência de testes respiratórios positivos no grupo probiótico em comparação ao grupo placebo (33% em comparação a 26,5%; p: 0,13). CONCLUSÕES: Como houve sintomas sugestivos de SBID em 26% das crianças tratadas com IBP e o teste respiratório com glicose deu resultados anormais em 72% delas, esse efeito colateral deve ser levado em consideração com mais frequência. O probiótico testado não reduziu o risco de desenvolver SBID.

OBJECTIVE:To evaluate the incidence of small bowel bacterial overgrowth (SBBO) in children treated with omeprazole, and to test whether probiotics influence the incidence. METHODS: A double-blinded, placebo-controlled trial was performed in 70 children treated orally during four weeks with 20 mg omeprazole per day. Lactobacillus rhamnosus R0011 (1.9 x 10(9) cfu) and Lactobacillus acidophillus R0052 (0.1 x 10(9) cfu) were simultaneously given daily to 36 subjects (probiotic group), while 34 subjects received placebo (placebo group). The diagnosis of SBBO was based on the development of suggestive symptoms, in combination with a positive glucose breath test. RESULTS: After one month of proton pump inhibitor (PPI) treatment, 30% (21/70) had a positive breath test suggesting SBBO; of these 62% were symptomatic. Five children developed SBBO-like symptoms, but had a negative breath test; and 44 (63%) were symptom free and had a negative breath test. There was no difference in the incidence of positive breath tests in the probiotic versus the placebo group (33% vs 26.5%; p = 0.13). CONCLUSIONS: Since symptoms suggesting SBBO developed in 26% of PPI-treated children, and since the glucose breath test was abnormal in 72% of these, this side-effect should be more frequently considered. The probiotic tested did not decrease the risk to develop SBBO.

Efeito protetor da lactoferrina humana no trato gastrintestinal / Protective effect of human lactoferrin in the gastrointestinal tract / Efecto protector de la lactoferrina humana en el sistema gastrointestinal

OBJETIVO: Descrever os mecanismos de ação da lactoferrina humana na proteção de morbidades gastrintestinais. FONTES DE DADOS: Revisão não sistemática da literatura utilizando como estratégia de busca pesquisa bibliográfica em bases de dados, as quais incluíram SciELO, Lilacs e MedLine entre 1990 e 2011. Os descritores utilizados foram: lactoferrina, leite materno/humano, gastrintestinal e imunidade, nos idiomas português e inglês. SÍNTESE DOS DADOS: A lactoferrina é a segunda proteína predominante no leite humano, com concentrações mais elevadas no colostro (5,0 a 6,7mg/mL) em relação ao leite maduro (0,2 a 2,6mg/mL). Em contraste, o leite de vaca contém teores inferiores, 0,83mg/mL no colostro e 0,09mg/mL no leite maduro. A lactoferrina desempenha diversas funções fisiológicas na proteção do trato gastrintestinal. A atividade antimicrobiana está relacionada à capacidade de sequestrar ferro dos fluidos biológicos e/ou de desestruturar a membrana de micro-organismos. A lactoferrina possui também a capacidade de estimular a proliferação celular. A ação anti-inflamatória desempenhada pela lactoferrina está associada à capacidade de penetrar no núcleo do leucócito e bloquear a transcrição do fator nuclear Kappa B. Diante da importância da lactoferrina na prevenção de doenças infecciosas em crianças aleitadas ao peito, a indústria vem, por meio da engenharia genética, desenvolvendo tecnologias para expressar esta proteína recombinante humana em plantas e animais, na tentativa de adequar a composição das fórmulas infantis àquela do leite humano. CONCLUSÕES: A lactoferrina humana é um peptídeo com potencial para prevenir morbidades, especialmente às gastrintestinais. Evidências científicas dos efeitos protetores da lactoferrina humana fortalecem ainda mais a recomendação para prática do aleitamento materno.

OBJECTIVE: To describe mechanisms of action of human lactoferrin to protect gastrointestinal morbidities. DATA SOURCES: Nonsystematic literature review using the following databases: SciELO, Lilacs and Medline from 1990 to 2011. The key-words used were lactoferrin, human milk/breastfeeding, gastrointestinal, and immunity, in Portuguese and English. DATA SYNTHESIS: Lactoferrin is the second predominant protein in the human milk, with higher concentrations in the colostrum (5.0 to 6.7mg/mL) if compared to mature milk (0.2 to 2.6mg/mL.) In contrast, cow's milk has lower levels, with 0.83mg/mL in the colostrum and 0.09mg/mL in the mature milk. Lactoferrin has several physiological functions to protect the gastrointestinal tract. The antimicrobial activity is related to the ability to sequester iron from biological fluids and/or to destruct the membrane of microorganisms. Lactoferrin also has the ability to stimulate cell proliferation. The anti-inflammatory action exercised by lactoferrin is associated with its ability to penetrate the core of the leukocyte and to block the Kappa B nuclear factor transcription. Given the importance of lactoferrin to prevent infectious diseases for breastfed children, the industry is using genetic engineering techniques to develop the expression of recombinant human lactoferrin in animals and plants, attempting to adjust the composition of infant formulas to that of human milk. CONCLUSIONS: Human lactoferrin is a peptide with great potential for preventing morbidity, especially in the gastrointestinal tract. Scientific evidence of the protective effects of human lactoferrin strengthens even more the recommendation for breastfeeding.

OBJETIVO: Describir los mecanismos de acción de la lactoferrina humana en la protección de morbilidades gastrointestinales. FUENTES DE DATOS: Revisión no sistemática de la literatura utilizando como estrategia de búsqueda investigación bibliográfica en bases de datos, que incluyeron SciELO, Lilacs y MedLine entre 1990 y 2011. Los descriptores utilizados fueron: lactoferrina, leche materna/humana, gastrointestinal e inmunidad, en los idiomas portugués e inglés. SÍNTESIS DE LOS DATOS: La lactoferrina es la segunda proteína predominante en la leche humana, con concentraciones más elevadas en el calostro (5,0 a 6,7mg/mL) respecto a la leche madura (0,2 a 2,6mg/mL). En contraste, la leche de vaca contiene tenores inferiores, 0,83mg/mL en el calostro y 0,09mg/mL en la leche madura. La lactoferrina desempeña diversas funciones fisiológicas en la protección del sistema gastrointestinal. La actividad antimicrobiana está relacionada a la capacidad de secuestrar hierro de los fluidos biológicos y/o de desestructurar la membrana de microorganismos. La lactoferrina posee además la capacidad de estimular la proliferación celular. La acción antiinflamatoria desempeñada por la lactoferrina está asociada a la capacidad de penetrar en el núcleo del leucocito y bloquear la transcripción del nuclear factor Kappa B. Frente a la importancia de la lactoferrina en la prevención de enfermedades infecciosas en niños amamantados al pecho, la industria viene, por medio de ingeniería genética, desarrollando tecnologías para expresar esta proteína recombinante humana en plantas y animales en el intento de adecuar la composición de las fórmulas infantiles a aquella de la leche humana. CONCLUSIONES: La lactoferrina humana es un péptido con potencial para prevenir morbilidades, especialmente las gastrointestinales. Evidencias científicas de los efectos protectores de la lactoferrina humana fortalecen todavía más la recomendación para la práctica de la lactancia materna.

Ostrich (Struthio camelus) gastric diseases in Minas Gerais, Brazil, from 1997 to 2009 / Doenças gástricas de avestruzes em Minas Gerais

Descrevem-se as doenças gástricas de avestruzes diagnosticadas em um Laboratório de Doenças das Aves, Belo Horizonte-MG, entre 1997 e 2009. As afecções gástricas corresponderam a 46,2% de todos os casos de doença, com quadros que incluíram impactação (83,3%), infecções e parasitoses (16,7%). As impactações foram causadas por material não alimentar diversificado e as infecções e parasitoses incluíram o fungo Macrorhabdus ornithogaster (megabacteria) e o nematódeo Libyostrongylus douglassii.

Alergia alimentaria / Food allergies

Las reacciones alérgicas incluyen un amplio espectro de reacciones clínicas. Con una incidencia del 15–30% de las enfermedades alérgicas y afecta a un 8% de los niños y específicamente a la proteína de la leche de vaca entre un 5–15% de los niños. Pueden manifestarse como intolerancia o alergia dando manifestaciones respiratorias, cutáneas o gastrointestinales que pueden ser inducidos por cantidades minimas de la ingesta deproteína y cuyo tratamiento básico es la exclusión de la proteína de leche sobre todo en los primeros años de vida.

Allergic reactions include a wide spectrum of clinical reactions. With a 15-30% incidence of llergicdiseases, affecting 8% of children and specifically to the protein in cow's milk 5-15% of children hey can manifest as intolerance or allergy giving respiratory manifestations, gastrointestinal or skin can be induced by minimal amounts of protein intake and whose basic treatment is the exclusión of milk protein specially inthe early years of life.

Revisión del papel de los oligosacáridos prebióticos en la prevención de infecciones gastrointestinales: [revisión] / Role of prebiotic oligosaccharides in prevention of gastrointestinal infections: [review]

Las enfermedades gastrointestinales siguen siendo un problema de salud pública mundial. El avance de la ciencia muestra que cambios en el balance adecuado de la microflora intestinal (MI) juegan un papel crucial en la patogénesis. La evidencia apunta a que una manera de modular esta MI es a través del uso de oligosacáridos prebióticos, que estimulan el crecimiento de bacterias benéficas y que a la vez aumentan la resistencia a la invasión por patógenos. Estudios con animales indican que el consumo de carbohidratos prebióticos podría estar implicado en la prevención y tratamiento de diarreas. En infantes humanos sanos, los estudios revelan que el consumo de mezclas de prebióticas (galactooligosacáridos/fructooligosacáridos, inulina/galactooligosacáridos) disminuyen la incidencia de fiebre, de infecciones y de patógenos gastrointestinales. Lo anterior representa un gran potencial para los alimentos funcionales que los contienen, principalmente las fórmulas infantiles. Sin embargo, los estudios de prevención de diarreas mediante el suministro de prebióticos en personas con una microflora intestinal alterada no son concluyentes, sobre todo aquellos practicados en ancianos, personas con problemas crónicos de inflamación intestinal y personas con diarreas asociadas a la toma de antibióticos. Lo anterior nos indica la necesidad de estudios bioquímicos y microbiológicos más profundos en humanos de diferentes edades y condiciones de salud intestinal, a fin de determinar en que condiciones, los prebióticos tienen algún efecto sobre las infecciones.

Gastrointestinal disorders are still a main world public health problem. Scientific progress shows that and inadequate balance in intestinal microbiota (IM) plays a crucial role in its pathogenesis. Evidence indicates that one way to modulate the IM is through the use of prebiotics. These oligosaccharides stimulate the growth of benefic bacteria and increase the resistance to invading pathogens. Research using animals show that the consumption of prebiotics could be implicated in prevention and treatment of diarrhea. Studies in healthy infants also indicate that the consumption of prebiotic mixtures (galactooligosaccharides/ fructooligosaccharides, inulin/ galactooligosaccharides) decreases the incidence of fever, infections and pathogens. These results represent a great potential for functional foods that contain prebiotics, mainly the infant formulas. However, results of other clinical studies for prebiotics effects on diarrhea are not conclusive. Specially those studies that include patients with an altered IM (like the elderly), patients with chronic intestinal inflammation and with diarrhea associated to antibiotic treatments. There is a need for more biochemical and microbiological studies in humans at different ages and intestinal health conditions, in order to determine when prebiotics may effectively function on infections.

Inmunizaciones: [revisión] / Immunizations: [review]

Los avances en la prevención de la enfermedad diarreica aguda con el uso de vacunas orales están presentes gracias a las investigaciones en el área de los trabajos realizados en cólera, fiebre tifoidea y con más éxito en la prevención de la diarrea por rotavirus. en este consenso desarrollamos los elementos actualizados en la inmunización contra cólera, fiebre tifoidea, indicaciones y futuras vacunas. en especial, se hace referencia a la vacunación contra rotavirus, sus estudios iniciales, evaluación de la investigación en fase III (realizada en Venezuela), las características particulares de cada vacuna desarrollada y en uso hoy en día, su aplicación y seguimiento una vez iniciado el plan nacional de vacunación, finalizando con los estudios de impacto económico y costo-efectividad.

Advances in prevention of acute diarrheal disease with the use of oral vaccines have been accomplished thanks to research in cholera, typhoid fever and, with more success, in the prevention of rotavirus diarrhea. This consensus addresses updates in immunization against cholera, typhoid fever, indications and future vaccines. In particular, we refer to vaccinations against rotavirus, their initial studies, research evaluation in phase III (held in Venezuela), particular characteristics of each vaccine developed and in use today, and the follow up of its implementation once the national vaccination plan is initiated. Final considerations in relation to the economic impact and cost effectiveness studies are stated.

Sangramento durante a anticoagulação oral: alerta sobre um mal maior / Sangrado durante la anticoagulación oral: alerta sobre un mal mayor / Bleeding during oral anticoagulant therapy: warning against a greater hazard

FUNDAMENTO: Sangramento é uma das grandes preocupações em pacientes sob anticoagulação oral. OBJETIVO: Investigar causas determinantes do sangramento em usuários de anticoagulante oral. MÉTODOS: Foram acompanhados prospectivamente, por 48 ± 7,2 meses, 360 pacientes com fibrilação atrial (FA), todos em uso de anticoagulante oral (ACo) com INR-alvo de 2,0-3,5, avaliados em média a cada 30 dias. Os pacientes foram investigados quanto à presença de patologia associada que levasse a sangramento. RESULTADOS: Participaram deste estudo 338 pacientes. Desses, 210 (62,13 por cento) eram do sexo feminino. A estenose mitral estava presente em 218 pacientes (64,4 por cento), a prótese biológica mitral em 64 (18,9 por cento) e a insuficiência da valva mitral em 56 (16,5 por cento). O sangramento ocorreu em 65 pacientes (19,2 por cento) e de forma grave em 7 (10 por cento). Em 38/65 pacientes (58,5 por cento), identificou-se nova doença associada, facilitadora do sangramento. Em 100 por cento dos pacientes com sangramento na faixa terapêutica, foi encontrada doença associada, contra 49,05 por cento de diagnóstico de doenças associadas naqueles com INR > 3,5 (p = 0,001). CONCLUSÃO: O diagnóstico de doença local associada ao sangramento foi frequente entre os medicados com anticoagulante oral (58,5 por cento). Houve associação entre sangramento com INR na faixa terapêutica (INR 2,0-3,5) e diagnóstico de patologia predisponente a sangramento (p < 0,001). Em pacientes em uso de anticoagulante oral que apresentam sangramento, é mandatória a investigação da causa, sobretudo se a INR estiver na faixa terapêutica.

BACKGROUND: Bleeding is one of the main concerns in patients undergoing oral anticoagulation therapy. OBJECTIVE: To investigate the determinant causes of bleeding in patients undergoing oral anticoagulant therapy. METHODS: A total of 360 patients with atrial fibrillation (AF) undergoing oral anticoagulant (ACo) therapy, with a target INR of 2.0-3.5, were followed prospectively for a period of 48 ± 7.2 months. The patients were evaluated on average every 30 days and were investigated regarding the presence of associated pathology that could lead to bleeding. RESULTS: A total of 338 patients participated in the present study. Of these, 210 (62.13 percent) were females. Mitral stenosis was present in 218 patients (64.4 percent), a mitral biological prosthesis in 64 (18.9 percent) and mitral valve failure in 56 (16.5 percent) patients. Bleeding occurred in 65 patients (19.2 percent), being severe in 7 (10 percent) patients. In 38/65 patients, a new associated disease was identified, which facilitated bleeding. An associated disease was identified in 100 percent of the patients with bleeding within the therapeutic range, against 49.05 percent of associated disease diagnosis in those with an INR > 3.5 (p=0.001). CONCLUSION: The diagnosis of a local disease associated to the bleeding was frequent among those patients undergoing oral anticoagulant therapy (58.5 percent). There was an association between bleeding with an INR within the therapeutic range (INR=2.0-3.5) and the diagnosis of a pathology predisposing to bleeding (p<0.001). It is mandatory to investigate the cause of bleeding in patients undergoing oral anticoagulant therapy, especially if the INR is within the therapeutic range.

FUNDAMENTO: El sangrado es una de las grandes preocupaciones en pacientes bajo anticoagulación oral. OBJETIVO: Investigar causas determinantes del sangrado en usuarios de anticoagulante oral. MÉTODOS: Se realizó el seguimiento, prospectivamente, por 48 ± 7,2 meses, de 360 pacientes con fibrilación atrial (FA), todos en uso de anticoagulante oral (ACo) con INR-objetivo de 2,0-3,5, evaluados en promedio cada 30 días. Los pacientes se investigaron sobre la presencia de patología asociada que llevara al sangrado. RESULTADOS: Participaron en este estudio 338 pacientes. De ellos, 210 (62,13 por ciento) eran del sexo femenino. La estenosis mitral estaba presente en 218 pacientes (64,4 por ciento), la prótesis biológica mitral en 64 (18,9 por ciento) y la insuficiencia de la válvula mitral en 56 (16,5 por ciento). El sangrado ocurrió en 65 pacientes (19,2 por ciento) y de forma grave en 7 (10 por ciento). En 38/65 pacientes (58,5 por ciento), se identificó nueva enfermedad asociada, facilitadora del sangrado. En el 100 por ciento de los pacientes con sangrado en el intervalo terapéutico, se encontró enfermedad asociada, contra el 49,05 por ciento de diagnóstico de enfermedades asociadas en aquellos con INR > 3,5 (p = 0,001). CONCLUSIÓN: El diagnóstico de enfermedad local asociada al sangrado fue frecuente entre los medicados con anticoagulante oral (58,5 por ciento). Hubo asociación entre sangrado con INR en el intervalo terapéutico (INR 2,0-3,5) y diagnóstico de patología predisponente a sangrado (p < 0,001). En pacientes en uso de anticoagulante oral que presentan sangrado, es indispensable la investigación de la causa, sobre todo si la INR está en el intervalo terapéutico.

Probióticos: perspectivas médicas / Probiotics: medical perspectives

Este artigo revisa o tema probióticos com o objetivo de avaliar seus possíveis potenciais como agentes bioterapêuticos na prevenção e/ou tratamento de algumas doenças relacionadas com a via intestinal. Os probióticos representam uma área de pesquisa em extensão. Muitas publicações enfatizam o potencial significado dessa emergente área, entretanto muito ainda necessita ser comprovado e realizado no sentido de definir o real significado do termo probiótico; se for efetivo, quais as cepas que preenchem os critérios de um real microorganismo probiótico e em quais circunstâncias clínicas são indicadas

This article reviews the theme probiotics with the objective to evaluate their potentials as possible biotherapeutic agents for the prevention and/or treatment of some illnesses related tothe intestinal tract. Probiotics represents an expanding research area. Many publications emphasizes the potential significance of this emerging field, meanwhile, much still remains to be proved and to be done in order to standardize the real meaning of the term probiotic and, if they are real, which strains actually fulfill the criteria of true probiotics microorganisms and in which clinical circumstances they are really useful

Hemorragia digestiva asociada a Helicobacter pylori enlactantes menores de 6 meses / Helicobacter pylori and gastrointestinal hemorrhagia

La hemorragia digestiva en niños se puede presentar en diferentes niveles del tubo gastrointestinal, siendo dividida en alta y baja, tomando como referencia al ángulo de Treitz de la unión duodeno yeyunal. Presentamos los casos clínicos de dos lactantes menores, de 5 y 3 meses de edad respectivamente; quienes fueron atendidos en el Hospital del Niño Dr. Ovidio Aliaga Uría por hemorragia digestiva alta asociada a enfermedad ulceropéptica por Helicobacter pylori.

Seroprevalencia de helicobacter pylory en niños de una población de la frontera colombo-venezolana / Seroprevalence of helicobacter pylory children in a population of the colombian-venezuelan border

Con el objetivo de conocer la seroprevalencia de la infección por helicobacter pylori (Hp) en niños de una población de la frontera colombo-venezolana, determinanos en sangre anticuerpos IgG contra Hp. Se incluyeron 98 niños, 51 por ciento del sexo masculino y 49 por ciento del sexo femenino. Encontramos IgG contra Hp en el 47 por ciento contra un 53 por ciento de muestras negativas. No hubo diferencias significativas en cuanto al sexo. La mayor frecuencia se observó en los niños de nueve años. Nuestros resultados demuestran que desde temprana edad existe una alta seroprevalencia de la infección por Hp similar a la reportada en otros países en desarrollo.

Prevención de afecciones gastrointestinales mediante el uso de probióticos en becerros Hostein Lactantes / Gastrointestinal disorder prevention with the use of probiotics in lactating Holstein bovines

El trabajo se realizó en el Rancho "La Palma", ubicado en el municipio de Coacalco, Estado de México. El objetivo fue evaluar el efecto de un probiótico comercial sobre la presentación de diarreas en becerros. Se utilizaron 36 becerras de 36.6 kg de peso vivo en promedio. Los tratamientos fueron cuatro y consistieron en un tratamiento para el grupo testigo y tres diferentes concentraciones de probiótico (tratamiento testigo 1); tratamiento 2 con 0.5 X 10 a la septima de unidades formadoras de colonias (UFC) de lactobacilos; tratamiento 3 con 1 X 10 a la septima UFC; tratamiento 4 con 1.5 X 10 a la septima UFC; cada tratamiento tuvo 9 repeticiones; los parámetros a evaluar fueron: presentación de diarreas y la ganancia de peso durante la etapa de la lactancia. No se encontraron diferencias estadísticas significativas para peso y diarrea, aunque se observó un efecto lineal significativo para diarreas