Procedimiento de malone videoasistido en pediatria: primeros dos casos en Uruguay / Laparoscopic malone procedure in pediatrics: first cases in Uruguay / Procedimento de malone videoassistido em pediatria: dois primeiros casos no Uruguai

El procedimiento de apendicostomía continente para la realización de enemas anterógrados ha sido publicado ya hace varios años para el tratamiento de la incontinencia fecal y del estreñimiento de muy difícil manejo. Otra indicación del mismo incluye el estreñimiento severo, en el cual se agotaron las medidas farmacológicas y el único tratamiento efectivo es la realización de enemas. El objetivo principal del procedimiento es ofrecer a los niños y sus familias una alternativa a la hora de realizar los enemas, logrando una mayor adherencia al tratamiento y buscando alcanzar una mejor calidad de vida que permita adecuarse a las actividades con sus pares. Por otra parte permite al niño ir logrando cierta independencia gradual a medida que crezca, preparándolos para el futuro y haciéndolos participes activos de su cuidado. Se describen los primeros casos en donde utilizamos en nuestro medio el abordaje laparoscópico, sus indicaciones, la técnica quirúrgica y los resultados iniciales. Hemos constatado como ventaja principal los beneficios del abordaje mínimamente invasivo, como la exploración completa de la cavidad abdominal, el menor dolor postoperatorio, cicatrices más pequeñas, menor creación de adherencias.

The appendicostomy procedure for performing antegrade enemas has been published several years ago for the treatment of fecal incontinence and constipation that are very difficult to manage. The Malone procedure is performed in our setting, especially in patients with fecal incontinence secondary to neurological disorders such as myelomeningocele using a conventional approach. Other indications of it is severe constipation, in which pharmacological measures have been exhausted and the only effective treatment is enemas. The main objective of the procedure is to offer children and their families an alternative when performing enemas, achieving greater adherence to treatment and seeking to achieve a better quality of life that allows them to adapt to the activities of their peers. On the other hand, it allows the child to achieve a certain gradual independence as they grow, preparing them for the future and making them active participants in their care. The first cases in which we use the laparoscopic approach, its indications, the surgical technique and the initial results are described. We think that its main advantage is the benefits of the minimally invasive approach, such as complete exploration of the abdominal cavity, less postoperative pain, smaller scars, and less creation of adhesions.

O procedimento de apendicostomia continente para a realização de enemas anterógrados foi publicado há vários anos para o tratamento de incontinência fecal e constipação de difícil manejo. Outra indicação inclui constipação grave, na qual as medidas farmacológicas foram esgotadas e o único tratamento eficaz são os enemas. O principal objetivo do procedimento é oferecer às crianças e seus familiares uma alternativa na realização dos enemas, alcançando maior adesão ao tratamento e buscando alcançar uma melhor qualidade de vida que lhes permita adaptar-se às atividades com seus pares. Por outro lado, permite que a criança alcance uma certa independência gradual à medida que cresce, preparando-a para o futuro e tornando-a participante ativa em seus cuidados. São descritos os primeiros casos em que utilizamos a via laparoscópica, suas indicações, a técnica cirúrgica e os resultados iniciais. Confirmamos os benefícios da abordagem minimamente invasiva como principal vantagem, como exploração completa da cavidade abdominal, menos dor pós-operatória, cicatrizes menores e menor formação de aderências.

Trastornos funcionales gastrointestinales. Cómo tratar sin medicar / Functional gastrointestinal disorders. How to manage them without medication

Los trastornos funcionales gastrointestinales (TFGI) se caracterizan por síntomas atribuibles al tracto gastrointestinal que no pueden ser explicados por anormalidades estructurales ni bioquímicas. Durante el primer año de vida, pueden generar mucho malestar en el lactante y preocupación en sus padres. Su diagnóstico se basa en criterios clínicos que expertos han determinado y en una historia clínica y un examen físico completo que descartan causas orgánicas. El objetivo de esta actualización es presentar estrategias para el manejo de los TFGI más frecuentes durante el primer año de vida: cólicos, regurgitaciones, disquecia y estreñimiento, bajo la visión de los nuevos conocimientos fisiopatológicos, que eviten los estudios y medicaciones innecesarias.

Functional gastrointestinal disorders (FGIDs) are characterized by symptoms attributable to the gastrointestinal tract that cannot be explained by the presence of structural or biochemical abnormalities. During the first year of life, FGIDs can cause great discomfort in infants and concern in their parents. The diagnosis of FGIDs is based on clinical criteria determined by experts and on a comprehensive case-taking process and physical exam to rule out organic causes. The objective of this update is to describe strategies for the management of the most frequent FGIDs during the first year of life: colics, regurgitations, dyschezia, and constipation, in light of new pathophysiological insights, to avoid unnecessary tests and medications.

Pediatric Functional Constipation Questionnaire-Parent Report (PedFCQuest-PR): development and validation

Abstract Objective: Developing and validating a disease-specific instrument in the Brazilian Portuguese language to assess the Health-Related Quality of Life of children with functional constipation, applied to parents/caregivers. Methods: The process of developing the questionnaire was carried out in the following steps: items generation concerning functional constipation; elaboration of the preliminary questionnaire; assessment by health professionals; identifying problems or inconsistencies by the researchers; improvement of the questions; obtaining a final questionnaire named Pediatric Functional Constipation Questionnaire-Parent Form (PedFCQuest-PR) with 26 questions divided into four domains. Responses options use a Likert scale based on the events of the last four weeks. The process of validation was an observational, cross-sectional study in a sample of 87 parents/caregivers of children from 5 to 15 years of age diagnosed with Functional constipation according to the Rome IV Criteria. The questionnaire was applied simultaneously to the Pediatric Quality of Life Inventory 4.0 (PedsQL TM 4.0) as a control. Results: The questionnaire validation included 87 parents/caregivers. The children's median age was 8.2 years, with a long time of constipation symptoms associated with fecal incontinence in approximately two-thirds. Internal consistency reliability for the Total Scale Score of PedFC-Quest-PR by Coefficient Alpha of Cronbach score was 0.86. Convergent and divergent validity of PedFCQuest-PR was demonstrated by correlating the domains of both questionnaires. Conclusion: This study provides evidence that PedFCQuest-PR is a reliable instrument. The results showed a high degree of internal consistency and validity of the instrument for future applications.

Constipation in the period of limited isolation during COVID-19 pandemic

SUMMARY OBJECTIVE: COVID-19 outbreak has become widespread globally and caused a new global chaos. This outbreak that completely affected the lifestyle of individuals resulted in periods of isolation. Here, we evaluated the effects of lifestyle changes with isolation on constipation. METHODS: A survey on constipation was performed during the 12-week isolation period starting in March 2020 in Turkey. Data of 390 individuals who participated in the survey through the social media and who were actively employed prior to isolation were analyzed. Rome IV criteria were used to evaluate constipation. RESULTS: Among the participants in the study, 253 (64.9%) were women with the mean age of 39.5±9.5 years. A statistically significant association was found between the decreased water consumption during the isolation period and constipation after the isolation (p=0.020; p<0.05). A significant association was found between the changes in physical activity and constipation after the isolation (p=0.013; p<0.05). New development of constipation during the isolation or declaration of increased constipation was found to be statistically associated with post-isolation constipation according to Rome criteria (p=0.000; p<0.05). CONCLUSION: The data of this present study demonstrated that isolation period was effective on the newly developed constipation. Decreased physical activity and water consumption are also effective on constipation.

Effect of transcutaneous abdominal electrical stimulation in people with constipation due to spinal cord injuries: a pilot study / Efecto de la electroestimulación abdominal transcutánea sobre el estreñimiento en personas con lesión de la médula espinal: estudio piloto / Efeito da eletroestimulação abdominal transcutânea no quadro de constipação em pessoas com lesão medular: estudo piloto

ABSTRACT Objective: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). Method: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. Results: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Conclusion: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.

RESUMEN Objetivo: Evaluar el efecto de la electroestimulación abdominal (EE) sobre la frecuencia de las evacuaciones, la consistencia y la cantidad de heces en personas con estreñimiento debido a una lesión de la médula espinal (LME). Método: Estudio piloto experimental de tipo crossover-aleatorizado en dos grupos de tratamiento: convencional rehabilitación intestinal y convencional asociado a EE con Functional Electrical Stimulation (FES) de 8 y 20 Hz aplicados a los músculos abdominales. Se realizó un seguimiento de ambos grupos durante dos semanas con 30 minutos de sesión diaria de EE. Los participantes estaban hospitalizados en un instituto de rehabilitación de la ciudad de São Paulo. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: Diez personas con LME participaron en el estudio, la mayoría hombres (70%) con una edad media de 39 años (DE = 16,37). La EE asociada al tratamiento convencional demostró ser más eficaz en el aumento de la frecuencia de evacuación (p = 0,029) y la cantidad de heces (p = 0,031). Conclusión: La EE abdominal asociada al tratamiento convencional ayudó a aumentar la frecuencia de evacuación y la cantidad de heces en el contexto de estreñimiento en personas con LME. Este estudio piloto servirá de base para futuros ensayos clínicos con mayor muestreo y evidencia estadística.

RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.

Fatores de risco associados à constipação intestinal e incontinência fecal em idosos do município de São Paulo - Estudo SABE / Ageing and risk factors for constipation and fecal incontinence

Introdução: Com o envelhecimento populacional, resultado da transição demográfica e epidemiológica vivenciada nas últimas décadas, observa-se maior prevalência de afecções crônicas, em especial entre os idosos, capazes de impactar negativamente no natural declínio fisiológico e funcional que ocorre com o avançar da idade. Nesse estudo, foram analisadas duas condições com significativo impacto na qualidade de vida desse grupo etário: incontinência fecal (IF) e constipação intestinal (CI). A IF é caracterizada pela eliminação involuntária de fezes. Estudos mostram que a incidência de IF pode chegar à 17% e a prevalência, 42,8% em idosos institucionalizados, não sendo encontrados dados de prevalência em idosos na comunidade. Já, a CI é um transtorno crônico do trânsito intestinal onde há dificuldade em evacuar, pode ocorrer, igualmente, sensação de evacuação incompleta ou movimentos intestinais incompletos. A incidência de CI em idosos pode chegar a 23,1%. Tanto a CI quanto a IF têm maior incidência em mulheres idosas. Objetivos: Verificar a incidência e fatores de risco associados à ocorrência de IF e CI em idosos residentes no município de São Paulo. Método: Estudo longitudinal de base populacional que utilizou os dados do Estudo SABE (Saúde, Bem-estar e Envelhecimento), com amostragem probabilística representativa, onde foram avaliados 828 pessoas com idade igual e superior a 60 anos em, dos anos de 2010 e 2015. A identificação de CI e IF foi obtida pelo relato dos idosos em 2015 e, sua ausência em 2010. A regressão logística foi utilizada para avaliar os fatores associados à IF e CI. Resultados: A incidência de IF foi de 7,2% e de CI foi de 15,0%. Os fatores associados à incidência de ambas as condições foram analisados por sexo. Entre as mulheres, a incidência de IF associou-se ao relato de saúde autorreferida como regular (OR=2,89), ruim/muito ruim (OR=5,45); ao número de doenças autorreferidas, considerando uma ou mais doenças (OR=1,67); ao uso de medicamentos antidepressivos (OR=4,18); à dificuldade de locomoção (OR=4,79) e à presença de doença articular (OR=0,12). Entre os homens, foram identificadas associações com doenças cerebrovasculares (OR=15,81), doenças articulares (OR=0,17) e doenças cardíacas (OR=0,09) e ingestão de mais que cinco copos de líquidos por dia (OR=3,81). Para a constipação intestinal (IC), entre as mulheres, os fatores associados foram: anos de estudo, aumentando conforme aumentavam os anos de estudo, 1 a 3 anos (OR=3,77), 4-7 anos (OR=5,56) e 8 anos ou mais (OR=5,85); presença de dor crônica (OR=1,83); uso de laxantes (OR=3,09) e, o número de refeições/dia (OR=0,38) como fator de proteção. Já entre os homens, os fatores associados foram: faixa etária de 70-74 anos (OR=4,24); 4-7 anos de estudo (OR=7,86) e 8 anos ou mais (OR=6,73) e número de doenças referidas (OR=0,59). Conclusão: A incidência de CI é o dobro da encontrada para IF sendo mais acentuada em mulheres (IF=5,09% e IC =10,39%) do que para o sexo masculino (IF=2,11% e CI =4,58%). Os fatores associados encontrados relacionam-se à presença de condições crônicas e seu tratamento mostrando a necessidade de atualização dos profissionais de saúde para essa abordagem.

Introduction: With the population aging, a result of the demographic and epidemiological transition experienced in recent decades, there is a greater prevalence of chronic conditions, especially among the elderly, capable of negatively impacting the natural physiological and functional decline that occurs with advancing age. In this study, two conditions with a significant impact on the quality of life of this age group were analyzed: fecal incontinence (FI) and constipation (CI). FI is characterized by involuntary feces elimination. Studies show that the incidence of FI can reach 17% and the prevalence, 42.8% in institutionalized elderly, with no data on prevalence in the elderly in the community. On the other hand, FI is a chronic disorder of the intestinal transit where there is difficulty in evacuating, there may also be a feeling of incomplete evacuation or incomplete bowel movements. The incidence of CI in the elderly can reach 23.1%. Both CI and FI have a higher incidence in elderly women. Objectives: To verify the incidence and risk factors associated with the occurrence of FI and CI in elderly people living in the city of São Paulo. Method: Longitudinal population-based study that used data from the SABE Study (Health, Welfare, and Aging), with representative probabilistic sampling, where 828 people aged 60 years and over were evaluated in 2010 and 2015 The identification of CI and FI was obtained by the report of the elderly in 2015 and their absence in 2010. Logistic regression was used to assess factors associated with FI and CI. Results: The incidence of FI was 7.2% and CI was 15.0%. Factors associated with the incidence of both conditions were analyzed by sex. Among women, the incidence of FI was associated with self-reported health reporting as regular (OR=2.89), bad/very bad (OR=5.45); the number of self-reported diseases, considering one or more diseases (OR=1.67); the use of antidepressant medications (OR=4.18); mobility difficulties (OR=4.79) and the presence of joint disease (OR=0.12). Among men, associations with cerebrovascular disease (OR=15.81); joint disease (OR=0.17); and heart disease (OR=0.09), and intake of more than five glasses of fluid per day (OR) were identified =3.81). For constipation (CI), among women, the associated factors were: education, increasing as the years of schooling increased, 1 to 3 years (OR=3.77), 4-7 years (OR=5.56) and eight years or more (OR=5.85); the presence of chronic pain (OR=1.83); use of laxatives (OR=3.09) and the number of meals/day (OR=0.38) as a protection factor. Among men, the associated factors were: age group 70-74 years (OR=4.24); education, 4-7 years (OR=7.86) and eight years or more (OR=6.73) and the number of reported diseases (OR=0.59). Conclusion: The incidence of CI is twice that found for FI, being more pronounced in females (FI=5.09% and CI =10.39%) than in males (FI=2.11% and CI = 4.58%). The associated factors found are related to chronic conditions and their treatment, showing the need to update health professionals for this approach.

Efficacy comparison among high risk factors questionnaire and Asia-Pacific colorectal screening score and their combinations with fecal immunochemical test in screening advanced colorectal tumor / 中华胃肠外科杂志

Objective: To investigate the effects of high risk factors questionnaire (HRFQ), Asia-Pacific colorectal screening (APCS) score and their combinations with fecal immunochemical test (FIT) in screening advanced colorectal neoplasia, in order to provide an evidence for further optimization of cancer screening program. Methods: A retrospective cohort study method was used to summarize and analyze the results of colorectal tumor screening in Jiashan County, Zhejiang Province from March 2017 to July 2018. Those with severe diseases that were not suitable for colonoscopy and those with mental and behavioral abnormalities who can not cooperate with the screening were excluded. Those who met any one or more of the followings in the HRFQ questionnaire were classified as high-risk people of HRFQ: (1) first-degree relatives with a history of colorectal cancer; (2) subjects with a history of cancer or any other malignant tumor; (3) subjects with a history of intestinal polyps; (4) those with two or more of the followings: chronic constipation (constipation lasted for more than 2 months per year in the past two years), chronic diarrhea (diarrhea lasted for more than 3 months in the past two years, and the duration of each episode was more than one week), mucus and bloody stools, history of adverse life events (occurring within the past 20 years and causing greater trauma or distress to the subject after the event), history of chronic appendicitis or appendectomy, history of chronic biliary disease or cholecystectomy. In this study, those who were assessed as high risk by HRFQ were recorded as "HRFQ (+)", and those who were not at high risk were recorded as "HRFQ (-)". The APCS questionnaire provided risk scores based on 4 risk factors including age, gender, family history and smoking: (1) age: 2 points for 50-69 years old, 3 points for 70 years old and above; (2) gender: 1 point for male, 0 point for women; (3) family history: 2 points for first-degree relatives suffering from colorectal cancer; (4) smoking: 1 point for current or past smoking, 0 point for non-smokers. The population was divided into low-risk (0-1 point), intermediate-risk (2-3 points), and high-risk (4-7 points). Those who were assessed as high risk by APCS were recorded as "APCS (+)", and those with intermediate and low risk were recorded as "APCS (-)". The hemoglobin threshold for a positive FIT was set to 100 μg/L. Those who were assessed as high risk by APCS with positive FIT were recorded as "APCS+FIT (+)". Those who were assessed as high risk by APCS with negative FIT, those who were assessed by APCS as low-middle risk with positive FIT, and those who were assessed by APCS as low-middle with negative FIT were all recorded as "APCS+FIT(-)". Observation indicators in this study were as follows: (1) the screening compliance rate of the cohort and the detection of advanced colorectal tumors; (2) positive predictive value, negative predictive value, sensitivity and specificity of HRFQ and APCS and their combination with FIT for screening advanced colorectal tumors; (3) comparison of the detection rate between HRFQ and APCS questionnaire for different colorectal lesions. Using SPSS 21.0 software, the receiver operating characteristic (ROC) curve was drawn to evaluate the clinical value of HRFQ and APCS combined with FIT in screening advanced colorectal tumors. Results: From 2017 to 2018 in Jiashan County, a total of 53 268 target subjects were screened, and 42 093 people actually completed the questionnaire, with a compliance rate of 79.02%. A total of 8145 cases underwent colonoscopy. A total of 3607 cases among HRFQ positive population (5320 cases) underwent colonoscopy, and the colonoscopy compliance rate was 67. 80%; 8 cases were diagnosed with colorectal cancer and 88 cases were advanced colorectal adenoma. A total of 2977 cases among APCS positive population (11 942 cases) underwent colonoscopy, and the colonoscopy compliance rate was 24.93%; 17 cases were diagnosed with colorectal cancer and 148 cases were advanced colorectal adenoma. The positive rate of HRFQ screening was lower than that of APCS [12.6% (5320/42 093) vs. 28.4% (11 942/42 093), χ2=3195. 547, P<0.001]. In the FIT positive population (6223 cases), a total of 4894 cases underwent colonoscopy, and the colonoscopy compliance rate was 78.64%; 34 cases were diagnosed with colorectal cancer and 224 cases were advanced adenoma. The positive predictive values of HRFQ and APCS and their combination with FIT for screening advanced colorectal tumors were 2.67%, 5.54%, 5.44%, and 8.56%; negative predictive values were 94.89%, 96.85%, 96.11% and 96.99%; sensitivity was 29.27%, 50.30%, 12.20 % and 39.02%; specificity was 55.09%, 64.03%, 91.11% and 82.51%, respectively. The ROC curves constructed by HRFQ, APCS, FIT, HRFQ+FIT and APCS+FIT indicated that APCS+FIT presented the highest efficacy in screening advanced colorectal tumors (AUC: 0.608, 95%CI: 0.574-0.642). The comparison of the detection rates of different colorectal lesions between HRFQ and APCS questionnaires showed that there were no significant differences in detection rate of inflammatory polyps and hyperplastic polyps between the two questionnaires (both P>0.05). However, as compared to HRFQ questionnaire, APCS questionnaire had higher detection rates in non-advanced adenomas [26.10% (777/2977) vs. 19.43% (701/3607), χ2=51.228, P<0.001], advanced adenoma [4.97% (148/2977) vs. 2.44% (88/3607), χ2=30.249, P<0.001] and colorectal cancer [0.57% (17 /2977) vs. 0.22% (8/3607), χ2=5.259, P=0.022]. Conclusions: APCS has a higher detection rate of advanced colorectal tumors than HRFQ. APCS combined with FIT can further improve the effectiveness of advanced colorectal tumor screening.

Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews / 中西医结合学报

BACKGROUND@#Functional constipation (FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews (SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.@*OBJECTIVE@#In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.@*SEARCH STRATEGY@#The search strategy was structured by medical subject headings and search terms such as "acupuncture therapy" and "functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.@*INCLUSION CRITERIA@#SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.@*DATA EXTRACTION AND ANALYSIS@#Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools: (1) A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2); (2) Risk of Bias in Systematic Reviews (ROBIS); (3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A); and (4) the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A κ index was used to score the level of agreement between the 2 reviewers.@*RESULTS@#Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified. Using the AMSTAR 2 tool, we rated 92.3% (12/13) of the SRs as "critically low" confidence and one study as "low" confidence. Using the ROBIS criteria, 38.5% (5/13) of the SRs were considered to have "low risk" of bias. Based on PRISMA-A, 76.9% (10/13) of the SRs had over 70% compliance with reporting standards. The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5% (9/40) of the measured outcomes as "moderate" quality, 57.5% (23/40) as "low" quality, and 20.0% (8/40) as "very low" quality. The inter-rater agreement was moderate when using GRADE. Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements (CSBMs) and for raising the Bristol Stool Form Scale (BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.@*CONCLUSION@#Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.@*SYSTEMATIC REVIEW REGISTRATION@#PROSPERO CRD42020189173.

Efficacy of the herbal formula of Foeniculum vulgare and Rosa damascena on elderly patients with functional constipation: A double-blind randomized controlled trial / 中西医结合学报

BACKGROUND@#Constipation is a common chronic bowel disorder with an incidence of more than 50% in the elderly population. Complementary and alternative medicine is a cost-effective and satisfactory treatment for constipation used widely by the elderly.@*OBJECTIVE@#This study evaluates the efficacy of an herbal formula made from Foeniculum vulgare Mill. and Rosa damascena for the treatment of constipation in an elderly population and consequent changes to their quality of life.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This double-blind randomized active controlled clinical trial, with parallel group allocation ratio of 1:1, was conducted in a referral clinic in Afzalipour Hospital, affiliated to Kerman University of Medical Sciences in Kerman, Southeastern Iran. Individuals over 60 years of age, diagnosed with functional constipation (based on the Rome IV criteria), were included in this study. Participants received a sachet of 10 g F. vulgare and R. damascena (herbal formula group) or polyethylene glycol 4000 (PEG 4000 group) with a glass of warm water two times a day for 4 weeks and were followed up for 4 additional weeks.@*MAIN OUTCOME MEASURES@#Constipation severity, stool consistency, and the quality of life were used as the primary outcomes. Drug side effects were used as a secondary outcome. The outcomes were assessed using the Constipation Assessment Scale, the Bristol Stool Form Scale, and the Patient Assessment of Constipation Quality of Life questionnaire.@*RESULTS@#A total of 25 participants in each group completed the four-week treatment cycle and the eight-week follow-up. At the end of the four-week treatment cycle, all clinical outcomes had significant improvements in both groups (P < 0.05). The analysis of constipation severity (P < 0.001), stool consistency (P < 0.001), and the quality of life (P < 0.001) showed significant improvements with fewer side effects (mild diarrhea) and a longer duration of symptom relief in the herbal formula group compared to the PEG 4000 group.@*CONCLUSION@#Although both interventions significantly improved the treatment outcomes, constipation severity, stool consistency and the quality of life were improved more effectively by the herbal formula than by PEG 4000; however, the mechanism of action is not yet understood.@*TRIAL REGISTRATION@#This trial was registered in the Iranian Registry of Clinical Trials (IRCTID: IRCT20200108046056N1).

Clinical practice guideline on the evaluation and management of chronic constipation for Chinese adults (2022 edition) / 中华胃肠外科杂志

Chinese Society of Colorectal Surgery firstly issued guidelines on the chronic constipation in 2008, which played a positive role in the standardization of chronic constipation surgery in China. In recent years, some progress has been made in the basic and clinical researches on chronic constipation. But in terms of clinical practice, there is still a lack of gold standard and high-level clinical research evidence, and surgeons have no authoritative reference in preoperative evaluation, operation selection and efficacy evaluation. In order to further standardize the diagnostic assessment and surgical treatment of chronic constipation, it is necessary to update the guidelines. Based on the published literatures combined with the clinical experience of experts, the "Clinical practice guideline on the evaluation and management of chronic constipation for Chinese adults (2022 edition)" has been formulated, which aims at the common problems in constipation assessment and treatment, is problem-oriented, and puts forward rationalization suggestions on the basis of evidence. It is expected to contribute to the learning and practice on constipation for Chinese surgeons and other relevant medical practitioners, and improve the overall diagnosis and treatment level of constipation surgery in China.

Clinical efficacy of adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder in the treatment of children with outlet obstruction constipation: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVES@#To study the clinical efficacy, advantages, and disadvantages of adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder in the treatment of children with outlet obstruction constipation (OOC).@*METHODS@#A total of 168 children with OOC were enrolled in this prospective study. All the subjects were randomly divided into a test group and a control group based on the order of visiting time, 84 in each group. The test group was treated with adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder, and the control group was treated with oral administration of compound polyethylene glycol 4000-electrolyte powder alone. Eleven children in the test group and two children in the control group withdrew from the study since they could not finish the whole treatment course. Finally, 73 children in the test group and 82 children in the control group were included in this analysis. As clinical outcomes, the total score of clinical symptoms and overall response rate were compared between the two groups at weeks 4 and 8 of treatment.@*RESULTS@#There was no significant difference in the total score of clinical symptoms between the two groups at beginning of treatment and at week 4 (P>0.05), while the test group had a significantly lower total score of clinical symptoms than the control group at week 8 (P<0.05). At week 4, there was no significant difference in overall response rate between the two groups (P>0.05), while the test group had a significantly higher overall response rate than the control group at week 8 (P<0.05).@*CONCLUSIONS@#Adaptive biofeedback training combined with oral administration of compound polyethylene glycol 4000-electrolyte powder is significantly associated with improvement of clinical outcomes in the treatment of children with OOC.

Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom / 中国骨伤

OBJECTIVE@#To analyze the efficacy of percutaneous vertebroplasty for osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom.@*METHODS@#A retrospective analysis was performed on 37 patients with osteoporotic vertebral compression fractures treated from January 2015 to January 2021, all of whom had spin-derived abdominal pain as the main symptom, and were divided into surgery group(21 cases) and conservative group (16 cases) according to different treatment methods. Patients in the surgery group were treated with percutaneous vertebroplasty, including 7 males and 14 females, with an average age of (75.95±6.84) years old and an average course of disease of (5.26±3.79) days. The conservative group received non-surgical treatment, including 5 males and 11 females, with an average age of (75.50±8.07) years old and an average course of disease of (4.28±3.42) days. Two groups of patients with preoperative mainly characterized by abdominal pain, abdominal distension and constipation, have no obvious chest waist back pain symptoms, the thoracolumbar MRI diagnosed as fresh osteoporotic vertebral compression fractures, record its postoperative abdominal pain visual analogue scale (VAS), medical outcomes study short form-36 (SF-36) score, defecation interval after treatment, etc.@*RESULTS@#Thirty-seven patients were followed up for (14.90±14.11) months in surgery group and( 21.42±17.53) months in conservative group. Compared with before treatment, the VAS of surgery group at each time period after treatment, VAS of conservative group at 1 month after treatment and SF-36 score between two groups at 3 months after treatment were all improved(P<0.05), while VAS of conservative group at 3 days after treatment showed no statistically significant difference(P>0.05). Compared between two groups, there were no significant differences in VAS and SF-36 scores at 1 day before treatment(P>0.05), but VAS at 3 days after treatment in surgery group, life vitality and social function score at 3 months after treatment, and defecation time after treatment in surgery group were better than those in conservative group(P<0.05). There were no significant differences in other indexes(P>0.05). The incision healing of patients in surgery group was good, and no serious complications occurred in both groups.@*CONCLUSION@#Percutaneous vertebroplasty is an effective method for the treatment of osteoporotic vertebral compression fractures with spinal origin abdominal pain as the main symptom. Compared with conservative treatment, percutaneous vertebroplasty has more advantages in early relief of abdominal pain and constipation, recovery of vitality and social function.

Experiencia con el uso de toxina botulínica en niños con vejiga hiperactiva neurogénica: Una serie de casos / Experience with Botulinum Toxin in Children with Neurogenic Overactive Bladder: A Case Series

Objetivo Describir la experiencia con la administración de inyección de toxina botulínica en niños con vejiga hiperactiva neurogénica refractaria a manejo de primera línea. Materiales y Métodos Estudio observacional descriptivo (serie de casos) que incluyó a 14 niños con diagnóstico de vejiga hiperactiva neurogénica refractarios a tratamiento de primera línea sometidos a administración intravesical de toxina botulínica entre 2015 y 2021; se realizó el seguimiento teniendo en cuenta las variables clínicas, con evaluación de la respuesta y de los eventos adversos. Se reportaron frecuencias absolutas y porcentajes para las variables cualitativas; para las variables cuantitativas, se reportaron medidas de tendencia central y dispersión. Resultados Se incluyeron 6 niños y 8 niñas, con una media de edad 10,1 (desviación estándar [DE]: ± 4,4) años. Todos los pacientes fueron tratados previamente con anticolinérgico y cateterismos limpios intermitentes, con una media de uso de 2,8 (DE: ± 1.0) pañales al día; 11 (78,5%) pacientes tenían antecedente de infección urinaria, 13 (92,8%), estreñimiento, y 2 (15,3%), incontinencia fecal. En la ecografía, 7 (50,0%) pacientes presentaban engrosamiento de las paredes vesicales, y 6 (42,8%), hidronefrosis. Tras el procedimiento, 1 paciente presentó infección urinaria como complicación, 6 presentaron una respuesta completa, 7, respuesta parcial, y 1 paciente no obtuvo respuesta con la primera inyección, con un tiempo promedio efectivo de la terapia 8 (DE: ± 6,3) meses. Una segunda inyección fue necesaria en 6 (42.8%) pacientes, y, de estos, 3 (50%) requirieron una tercera inyección. Conclusión La inyección de toxina botulinica intravesical como terapia de segunda línea de manejo para vejiga hiperactiva neurogénica tiene buenos resultados, con bajas tasas de complicaciones.

Objective To describe the experience with the administration of botulinum toxin injection in children with neurogenic overactive bladder who were refractory to the first-line management. Materials and Methods A descriptive observational study (case series) which included 14 children with a diagnosis of neurogenic overactive bladder who were refractory to the first-line treatment and were aubmitted to the intravesical administration of botulinum toxin between 2015 and 2021. Follow-up was performed taking into account the clinical variables, wth an evaluation of the response and the adverse events. Absolute frequencies and percentages were reported for the qualitative variables; for the quantitative variables, measures of central tendency and dispersion were reported. Results We included 6 boys and 8 girls with a mean age of 10.1 (standard deviation [SD]: ± 4.4) years. All patients were previously treated with anticholinergics and clean intermittent catheterizations, with a mean use of 2.8 (SD: ± 1.0) diapers per day; 11 (78.5%) had a history of urinary tract infection, 13 (92.8%), constipation, and 2 (15.3%), fecal incontinence. On ultrasound, 7 (50.0%) patients presented bladder wall thickening, and 6 (42.8%), hydronephrosis. After the procedure, 1 patient presented urinary tract infection as a complication, 6 presented complete response, 7, partial response, and 1 patient did not obtain a response with the first injection, with an effective mean time of therapy of 8 (SD: ± 6.3) months. A second injection was required by 6 (42.8%) patients, and of these, 3 (50%) required a third injection. Conclusion Intravesical botulinum toxin injection as a second-line management therapy for neurogenic overactive bladder yileds good results, with low rates of complications.

Sintomas urinários e intestinais em crianças da rede pública de ensino fundamental / Urinary and intestinal symptoms in public elementary school children / Síntomas urinarios e intestinales en niños de escuelas primarias públicas

Objetivo:levantar a ocorrência de sintomas urinários e intestinais em crianças da rede pública de ensino fundamental da capital paranaense. Método: estudo quantitativo, exploratório-descritivo e de corte transversal. Amostra de pais/responsáveis que preencheram os seguintes instrumentos: Dysfunctional Voiding Scoring System; critérios de Roma IV; escala de Bristol. Análise realizada pelo IBM SPSS Statistics v.20.0. Os dados foram coletados no período de agosto a outubro de 2019. Os critérios de inclusão eram a criança estar matriculada e frequentando regularmente o ensino fundamental e a entrega do questionário preenchido ou parcialmente preenchido. Resultados: Foram entregues 458 questionários. Dos totalmente preenchidos, 51,9% era de meninas, e a de idade foi de 7,7 anos; 83% das crianças apresentaram algum sintoma urinário e/ou intestinal de baixa gravidade. Sem diferença significativa de sintomas entre sexos, e com acréscimo significativo de gravidade em crianças com 7 anos ou menos. Sintomas mais prevalentes: frequência miccional reduzida, frequência evacuatória reduzida, esforço evacuatório, urgência miccional e manobras de contenção; 39,6% das crianças apresentavam Constipação Intestinal Funcional. Disfunção vesical e intestinal em 35 crianças, a maior prevalência no sexo feminino. Conclusão: alta ocorrência de sintomas urinários e intestinais nas crianças. O sintoma mais prevalente foi constipação.

Objective:survey the occurrence of urinary and intestinal symptoms in children from public elementary schools in the capital of Paraná. Method: quantitative, exploratory-descriptive and cross-sectional study. Sample of parents/guardians who completed the following instruments: Dysfunctional Voiding Scoring System; Rome IV criteria; Bristol scale. Analysis performed by IBM SPSS Statistics v.20.0. Data were collected from August to October 2019. Inclusion criteria were the child being enrolled and regularly attending elementary school and the delivery of the completed or partially completed questionnaire. Results: 458 questionnaires were delivered. Of those fully completed, 51.9% were girls, and the age was 7.7 years; 83% of the children had some urinary and/or intestinal symptoms of low severity. There was no significant difference in symptoms between genders, and with a significant increase in severity in children aged 7 years and under. Most prevalent symptoms: reduced voiding frequency, reduced defecation frequency, defecation effort, voiding urgency and containment maneuvers; 39.6% of the children had Functional Intestinal Constipation. Bladder and bowel dysfunction in 35 children, the highest prevalence in females. Conclusion: high occurrence of urinary and intestinal symptoms in children. The most prevalent symptom was constipation.

Objetivo:relevar la ocurrencia de síntomas urinarios e intestinales en niños de escuelas primarias públicas de la capital paranaense. Método: estudio cuantitativo, exploratorio-descriptivo y de corte transversal. Muestra de padres/responsables que completaron los siguientes instrumentos: Dysfunctional Voiding Scoring System; criterios de Roma IV; escala de Bristol. Análisis realizado por el IBM SPSS Statistics v.20.0. Los datos fueron recopilados en el periodo de agosto a octubre de 2019. Los criterios de inclusión eran de niños matriculados y que frecuenten regularmente la escuela primaria y la entrega del cuestionario completo o parcialmente completo. Resultados: Se entregaron 458 cuestionarios. De los totalmente completos, 51,9 % era de niñas, y la de edad fue de 7,7 años; 83 % de los niños presentaron algún síntoma urinario y/o intestinal de baja gravedad. Sin diferencia significativa de síntomas entre sexos, y con incremento significativo de gravedad en niños de 7 años o menos. Síntomas más prevalentes: frecuencia miccional reducida, frecuencia evacuatoria reducida, esfuerzo evacuatorio, urgencia miccional y maniobras de contención; 39,6 % de los niños presentaban Constipación Intestinal Funcional. Disfunción vesical e intestinal en 35 niños, la mayor prevalencia en el sexo femenino. Conclusión: alta ocurrencia de síntomas urinarios e intestinales en niños. El síntoma más prevalente fue el estreñimiento.

Correlação entre disfunção do assoalho pélvico na ultrassonografia 3D dinâmica e parto vaginal, paridade e idade em mulheres com sintomas de defecação obstruída / Correlation between pelvic floor dysfunction on dynamic 3d ultrasound and vaginal delivery, parity, and age in women with obstructed defecation symptoms

ABSTRACT BACKGROUND: Few studies have investigated the constipation or obstructed defecation symptoms identified by using imaging, as dynamic three-dimensional ultrasound and correlate vaginal delivery, parity, and age. OBJECTIVE: The aim of this study was to assess the prevalence of pelvic floor dysfunctions in female patients with obstructed defection symptoms and to determine whether specific pelvic floor dysfunctions identified by dynamic three-dimensional ultrasonography (echodefecography) are correlated with vaginal delivery, parity, and age. The secondary goal is to report the prevalence of coexisting pelvic floor dysfunctions. METHODS: This is a retrospective cohort study including patients with obstructed defecation symptoms underwent echodefecographyto evaluate pelvic floor dysfunctions in the posterior compartment and correlate with vaginal delivery, parity, and age. RESULTS: Of 889 female: 552 (62%) had had vaginal delivery and 337 (38%) were nulliparous. The prevalence of dysfunctions identified by echodefecography (rectocele, intussusception, enterocele/sigmoidocele, and dyssynergia) was similar between the two groups and was not associated with number of deliveriesor age. However, the prevalence of sphincter defects showed higher rates in women with vaginal delivery and increased with the parity. Up to 33% of patients had coexisting dysfunctions. CONCLUSION: The prevalence of dysfunctions such as rectocele, intussusception, dyssynergia, and enterocele/sigmoidocele assessed by echodefecography in patients with obstructed defecation symptoms are found similar regardless of vaginal delivery, number of deliveries or stratified-age. In vaginal delivery, number of deliveries does impact on detection of sphincter defects and liability to fecal incontinence.

RESUMO CONTEXTO: Poucos estudos investigaram pacientes portadoras de defecação obstruída identificados por exames de imagens, como ultrassonografia tridimensional dinâmica, correlacionando parto vaginal, paridade e idade. OBJETIVO: O objetivo deste estudo foi avaliar a prevalência de disfunções do assoalho pélvico em pacientes do sexo feminino com sintomas de defecação obstruída e determinar se disfunções específicas do assoalho pélvico identificadas por ultrassonografia tridimensional dinâmica (ecodefecografia) estão correlacionadas com parto vaginal, paridade e idade. O objetivo secundário é relatar a prevalência de disfunções do assoalho pélvico coexistentes. MÉTODOS: Este é um estudo de coorte retrospectivo incluindo pacientes com sintomas de obstrução da defecação submetidas à ecodefecografia para avaliar disfunções do assoalho pélvico no compartimento posterior e correlacionar com parto vaginal, paridade e idade. RESULTADOS: De 889 mulheres: 552 (62%) tiveram parto vaginal e 337 (38%) eram nulíparas. A prevalência de disfunções identificadas pela ecodefecografia (retocele, intussuscepção, enterocele/sigmoidocele e dissinergia) foi semelhante entre os dois grupos e não foi associada ao número de partos ou à idade. No entanto, a prevalência de defeitos esfincterianos apresentou taxas mais elevadas em mulheres com parto vaginal e aumentou com a paridade. Até 33% dos pacientes apresentavam disfunções coexistentes. CONCLUSÃO: A prevalência de disfunções como retocele, intussuscepção, dissinergia e enterocele/sigmoidocele avaliada pela ecodefecografia em pacientes com sintomas de defecação obstruída são semelhantes independentemente do parto normal, número de partos ou idade estratificada. No parto vaginal, o número de partos tem impacto na detecção de defeitos esfincterianos e na possibilidade de incontinência fecal.

Relação entre níveis de chumbo e cádmio no sangue e a prisão de ventre crônica refratária entre crianças iranianas / Relationship between lead and cadmium levels in blood and refractory chronic constipation among iranian children

ABSTRACT BACKGROUND: There is limited research examining reasons causing refractory chronic constipation (RCC) in children. The effects of lead (Pb) and cadmium (Cd) exposures on this condition have been even less clear. However, some related factors may contribute to evaluation of blood lead levels (BLLs) and blood cadmium levels (BCLs). OBJECTIVE: The present study aimed to examine the relationship between Pb and Cd exposures and RCC in children living in the city of Ahvaz, Khuzestan Province, in Southwestern Iran. METHODS: This study was performed on a total number of 48 children aged 2-13 years, including 36 medically-diagnosed RCC cases and 12 controls referring to a pediatric clinic in the city of Ahvaz. Their BLLs and BCLs were then determined using a graphite furnace atomic absorption spectrophotometer. The data from the researcher-designed questionnaire were also recoded and the related risk factors were analyzed through Spearman's correlation and logistic regression analysis. RESULTS: The findings revealed that the geometric means of Pb and Cd in blood samples in the control group were 58.95 µg/dL and 0.45 µg/dL; respectively. These values in the case group were equally 45.26 µg/dL and 0.26 µg/dL; respectively. A significant difference was additionally observed between BCLs in the case and control groups (P<0.01). All children in both groups also had BLLs greater than the permissible limit endorsed by the World Health Organization (WHO) (≤10 µg/dL). On the other hand, 8.3% of the individuals in the case group and 33.3% of those in the control group had BCLs higher than the acceptable range mentioned by WHO (≤0.5 µg/dL). CONCLUSION: Pb and Cd exposures due to environmental pollution and susceptibility to heavy metals may not be associated with RCC in children living in the city of Ahvaz. Although this research was the first one providing data on BLLs and BCLs in children with RCC, the findings could be useful for designing future epidemiologic studies.

RESUMO CONTEXTO: Há limitadas pesquisas que procuram razões que causem constipação crônica refratária (CCR) em crianças. Os efeitos das exposições de chumbo (Pb) e cádmio (Cd) nesta condição têm sido ainda menos claros. No entanto, alguns fatores relacionados podem contribuir para a avaliação dos níveis de Pb no sangue (NPbSs) e dos níveis de Cd no sangue (NCdSs). OBJETIVO: O presente estudo teve como objetivo examinar a relação entre as exposições de Pb e Cd e a CCR em crianças residentes na cidade de Ahvaz, província de Khuzestan, no Sudoeste do Irã. MÉTODOS: Este estudo foi realizado em um número total de 48 crianças de 2 a 13 anos, incluindo 36 casos de CCR diagnosticados clinicamente, e 12 controles encaminhados a uma clínica pediátrica na cidade de Ahvaz. Seus NPbSs e NCdSs foram então determinados usando um espectrógrafo de absorção atômica do forno de grafite. Os dados do questionário projetado pelo pesquisador também foram recodificados, e os fatores de risco relacionados foram analisados por meio da análise de correlação e regressão logística de Spearman. RESULTADOS: Os achados revelaram que as médias geométricas de Pb e Cd em amostras de sangue no grupo controle foram de 58,95 μg/dL e 0,45 μg/dL; respectivamente. Esses valores no grupo constipação foram igualmente 45,26 μg/dL e 0,26 μg/dL; respectivamente. Observou-se diferença significativa entre os NCdSs nos grupos de caso e controle (P<0,01). Todas as crianças de ambos os grupos também apresentaram NPbSs maiores do que o limite permitido endossado pela Organização Mundial da Saúde (OMS) (≤10 μg/dL). Por outro lado, 8,3% dos indivíduos no grupo de casos e 33,3% dos do grupo controle apresentaram NCdSs superiores à faixa aceitável mencionada pela OMS (≤0,5 μg/dL). CONCLUSÃO: As exposições de Pb e Cd por poluição ambiental e suscetibilidade a metais pesados podem não estar associadas à CCR em crianças residentes na cidade de Ahvaz. Embora esta pesquisa tenha sido a primeira a fornecer dados sobre NPbSs e NCdSs em crianças com CCR, os achados poderiam ser úteis para a concepção de futuros estudos epidemiológicos.

Função Intestinal e qualidade de vida de pacientes operados por anomalias anorretais e doença de Hirschsprung / Intestinal function and quality of life in patients operated for anorectal anomalies and Hirschsprung's disease

RESUMO Introdução: As Anomalias Anorretais (AAR) e a Doença de Hirschsprung (DH) são doenças congênitas que necessitam de tratamento cirúrgico. O qual está associado a complicações na função intestinal. Objetivo: Avaliar a função intestinal e a qualidade de vida de pacientes operados por AAR e DH. Métodos: Um estudo transversal e descritivo foi realizado com crianças operadas por AAR e DH em dois hospitais terciários entre 2008 e 2018. Foram entrevistados apenas pacientes com idade superior a 3 anos. A população final foi de 12 pacientes. A função intestinal foi avaliada por meio da Classificação Internacional de Krickenbeck para resultados pós- -operatórios. Foi aplicado também um questionário para avaliação da qualidade de vida. Resultados: A média de idade dos pacientes no momento da entrevista foi de 7,08 anos ± 2,28. Dentre os 12 pacientes entrevistados, 66,7% tinham o diagnóstico de AAR e 33,3% de DH. 91,7% dos pacientes apresentavam escapes fecais após a cirurgia. 33,3% da amostra tinham constipação. Apenas um paciente tinha história prévia de enterocolite, e este apresentou o pior escore de qualidade de vida. Os resultados do questionário de qualidade de vida mostraram que o único paciente sem escapes fecais tinha o melhore escore. Além disso, observou-se que os pacientes com malformações altas possuíam piores escores de qualidade de vida. Conclusão: A função intestinal, após o tratamento cirúrgico, estava prejudicada. A maioria dos pacientes apresentou escapes fecais. Esse desfecho parece afetar os escores de qualidade de vida. O que enfatiza a necessidade de seguimento clínico e manejo intestinal após o tratamento cirúrgico. PALAVRA-CHAVE: Malformações anorretais, doença de Hirschsprung, anormalidades congênitas, incontinência fecal, constipação intestinal

ABSTRACT Introduction: Anorectal Anomalies (ARA) and Hirschsprung Disease (DH) are congenital diseases that require surgical treatment, which is associated with complications in intestinal function. Objective: To assess intestinal function and quality of life in patients operated on for ARA and DH. Methods: A crosssectional descriptive study was carried out with children operated on for ARA and DH in two tertiary hospitals between 2008 and 2018. Only patients aged over 3 years were interviewed. The final population consisted of 12 patients. Intestinal function was assessed using the Krickenbeck International Classification for postoperative outcomes. A questionnaire to assess quality of life was also applied. Results: The mean age of patients at the time of the interview was 7.08 years ± 2.28. Among the 12 patients interviewed, 66.7% had a diagnosis of ARA and 33.3% of DH. Fecal leakage after surgery affected 91.7% of the patients, and 33.3% of the sample had constipation. Only one patient had a previous history of enterocolitis, and he had the worst quality of life score. The results of the quality of life questionnaire showed that the only patient without fecal leakage had the best score. Furthermore, it was observed that patients with high malformations had worse quality of life scores. Conclusion: Intestinal function, after surgical treatment, was impaired. Most patients had fecal leakage. This outcome appears to affect quality of life scores. This emphasizes the need for clinical follow-up and intestinal management after surgical treatment. KEYWORDS: Anorectal malformations, Hirschsprung disease, congenital abnormalities, fecal incontinence, constipation

Constipação funcional em crianças: alta prevalência em ambulatório especializado, apesar do diagnóstico e manejo simples / Functional constipation in children: high prevalence in a specialized outpatient clinic, despite simple diagnosis and management

RESUMO Introdução: Constipação funcional (CF) é um distúrbio gastrointestinal muito comum, é de fácil diagnóstico e manejo. Este estudo objetiva avaliar a prevalência de CF em crianças atendidas em serviço especializado, o perfil clínico, os tratamentos instituídos e seus desfechos. Método: estudo transversal de pacientes com CF atendidos de outubro/2012 a abril/2018 em ambulatório de gastroenterologia pediátrica. Coletados dados clínico-epidemiológicos, do manejo prévio, número de consultas até o diagnóstico pela equipe, resposta ao tratamento, e desfecho. Resultados: Observou-se prevalência de 15,7%, sendo 50,6% na idade escolar, 60,7% em meninos. Fezes endurecidas ou dor/esforço evacuatório (86,5%) e fezes volumosas (48,3%) foram as manifestações mais observadas; em 77,8% dos pacientes o tempo de sintomas até a primeira consulta foi superior a um ano; 74,2% dos pacientes já haviam recebido algum tipo de tratamento, principalmente laxativos osmóticos (53,9%); mas 25,8% dos pacientes não receberam qualquer tratamento até a consulta especializada. Em 62% foi necessária uma consulta para o diagnóstico de CF. Apenas 7% responderam exclusivamente à mudança dietética, mas 87% necessitaram laxativos osmóticos. A alta ambulatorial foi possível na grande maioria dos pacientes. Conclusões: CF é altamente prevalente no ambulatório estudado. Muitos pacientes com longo tempo de evolução e tratamentos ineficazes, e quase metade referenciados de outros municípios. No entanto, a maioria foi diagnosticada e manejada em até duas consultas pela equipe especializada, e responderam prontamente ao laxante osmótico. Isto demonstra deficiência na abordagem da CF pelos profissionais da atenção primária da nossa região, gerando encaminhamentos desnecessários, apesar do diagnóstico e manejo simples. PALAVRAS-CHAVE: Constipação intestinal, criança, prevalência, gastroenterologia, terapêutica

ABSTRACT Introduction: Functional constipation (FC) is a very common gastrointestinal disorder that is easy to diagnose and manage. This study aims to assess the prevalence of FC in children seen at a specialized service, the clinical profile, the treatments instituted and their outcomes. Method: A cross-sectional study of patients with FC treated from October, 2012 to April, 2018 in a pediatric gastroenterology clinic. Clinical and epidemiological, previous management, number of consultations until diagnosis by the team, response to treatment, and outcome data were collected. Results: There was a prevalence of 15.7%, with 50.6% in school age, 60.7% in boys. Hard stools or pain/defecation effort (86.5%) and bulky stools (48.3%) were the most observed manifestations; in 77.8% of patients, the duration of symptoms until the first consultation was greater than one year; 74.2% of patients had already received some type of treatment, mainly osmotic laxatives (53.9%); but 25.8% of patients did not receive any treatment until the specialist consultation. In 62%, an appointment was necessary for the diagnosis of CF. Only 7% responded exclusively to dietary change, but 87% required osmotic laxatives. Outpatient discharge was possible for the vast majority of patients. Conclusions: FC is highly prevalent in the studied clinic. Many patients with long evolution time and ineffective treatments, and almost half referred from other cities. However, most were diagnosed and managed in up to two consultations by the specialized team, and responded promptly to the osmotic laxative. This demonstrates a deficiency in the approach to FC by primary care professionals in our region, generating unnecessary referrals, despite the simple diagnosis and management. KEYWORDS: Constipation, child, prevalence, gastroenterology, therapeutics

Irritable bowel syndrome in Indonesian adolescents

Abstract Objective: Irritable bowel syndrome is a frequent functional gastrointestinal disorder. The aims of this study were to investigate its epidemiology, focusing on the role of intestinal mucosal integrity and to evaluate the impact on the quality of life. Methods: A community-based survey applying a comparative cross sectional approach was conducted in six high schools in Palembang. Subjects were recruited using multistage random sampling divided in two groups. Rome III criteria were used to establish a diagnosis of IBS in combination with a questionnaire to determine risk factors. Determination of fecal alpha-1-antitrypsin and calprotectin levels was performed to determine impaired intestinal mucosal integrity. A questionnaire was used to evaluate how quality of life was affected by irritable bowel syndrome. Results: The survey was performed in 454 14−18 years old adolescents, of whom 30.2% fulfilled the Rome III criteria for IBS, with the following subtypes: 36.5% diarrhea, 18.9% constipation, 21.9% mixed, and 22.6% unclassified. Major risk factors were female gender, bullying, age 14-16 years, history of constipation and diarrhea, eating nuts, and drinking coffee, tea, and soft drinks. There was a significant association with intestinal inflammation (p = 0.013). A significantly impaired quality of life was found (p = 0.001). Conclusions: The prevalence of irritable bowel syndrome in adolescents was high, with bullying, female gender, age 14-16 years, constipation and diarrhea, and dietary consumption of soft drinks, coffee, and tea as risk factors. A significant association with intestinal inflammation was found.

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

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

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