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1.
Arq. gastroenterol ; 58(3): 302-307, July-Sept. 2021. tab
Article in English | LILACS | ID: biblio-1345301

ABSTRACT

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.


Subject(s)
Humans , Female , Pregnancy , Pelvic Floor/diagnostic imaging , Defecation , Parity , Retrospective Studies , Ultrasonography , Constipation , Constipation/etiology , Constipation/epidemiology , Delivery, Obstetric
2.
Arq. gastroenterol ; 57(4): 354-360, Oct.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142334

ABSTRACT

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.


RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.


Subject(s)
Humans , Female , Adult , Aged , Outpatients , Gastrointestinal Diseases/etiology , Neoplasms/complications , Neoplasms/drug therapy , Antineoplastic Agents/therapeutic use , Vomiting/etiology , Weight Loss , Nutritional Status , Retrospective Studies , Follow-Up Studies , Longitudinal Studies , Constipation/etiology , Diarrhea/etiology , Dyspepsia/etiology , Middle Aged , Nausea
3.
Arch. argent. pediatr ; 118(5): 350-357, oct 2020. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1122544

ABSTRACT

La enfermedad de Hirschsprung ocurre en 1 de cada 5000 nacimientos. La falla de migración de las células ganglionares desde la cresta neural en dirección cefalocaudal genera su ausencia en parte o todo el colon. Se manifiesta con falta de eliminación de meconio, distensión abdominal y dificultades en la evacuación. Luego del tratamiento quirúrgico, existen complicaciones a corto y largo plazo. El objetivo de esta publicación es describir las principales causas de síntomas persistentes en los pacientes operados por enfermedad de Hirschsprung y presentar un algoritmo diagnóstico-terapéutico factible de ser realizado en nuestro medio


Hirschsprung disease is characterized by the lack of migration of intrinsic parasympathetic ganglia from neural crest and consequently absence of them at varying length of the bowel, resulting in functional obstruction. The incidence is 1 per 5000 births. After surgery, short term and long term comorbidity commonly occurs. The aim of this article is to revise the main causes of ongoing symptoms after surgery in Hirschsprung disease patients and to show a diagnostic and therapeutic algorithm that can be developed in our community


Subject(s)
Humans , Hirschsprung Disease/surgery , Hirschsprung Disease/diagnosis , Hirschsprung Disease/therapy , Pediatrics , Chronic Disease , Constipation/diet therapy , Constipation/etiology , Enterocolitis/diet therapy , Enterocolitis/etiology , Fecal Incontinence/diet therapy , Fecal Incontinence/etiology
4.
ABCD arq. bras. cir. dig ; 33(3): e1545, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152621

ABSTRACT

ABSTRACT Background: Several types of complications including constipation, fecal soiling, perianal excoriation, were reported among different types of surgery for Hirschsprung's disease. Aim: To compare circular and oblique anastomoses following Soave's procedure for the treatment of Hirschsprung's disease. Methods: Children who underwent Saove's pull through procedure with oblique and circular anastomoses were included. Duration of the follow up was two years after surgery. Postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, perianal excoriation, were recorded for each patient. Results: Thirty-eight children underwent oblique anastomoses. Circular ones were done for 32 children. Perianal excoriation was seen in 57.89% and 46.87% of children in oblique and circular group, respectively. Enterocolitis was more frequent in circular (40.62%) than oblique (28.94%) group. Anastomotic stricture was more frequent in circular (15.62%) than oblique (7.89%). Conclusion: Perianal excoriation was the most common complication among patient in both groups. Oblique anastomoses had fewer complications than circular, and may be appropriate option for patient who underwent Soave's procedure.


RESUMO Racional: Vários tipos de complicações, incluindo constipação, secreção fecal, escoriação perianal foram relatadas entre diferentes tipos de operações para a doença de Hirschsprung. Objetivo: Comparar as anastomoses circulares e oblíquas realizadas no procedimento de Soave para o tratamento da doença de Hirschsprung. Métodos: Neste estudo, foram incluídas crianças submetidas ao procedimento pull-through de Saove com anastomoses oblíquas e circulares. A duração do acompanhamento foi de dois anos no pós-operatório. Complicações, como infecção da ferida, deiscência da ferida, peritonite, secreção fecal, escoriação perianal foram registradas para cada paciente. Resultados: Trinta e oito crianças foram submetidas à anastomoses oblíquas. As circulares foram realizadas em 32. Escoriação perianal foi observada em 57,89% e 46,87% das crianças nos grupos oblíquo e circular, respectivamente. Enterocolite foi mais frequente no grupo circular (40,62%) do que oblíquo (28,94%). A estenose anastomótica foi mais frequente na circular (15,62%) do que na oblíqua (7,89%). Conclusão: A escoriação perianal foi a complicação mais comum entre os pacientes nos dois grupos. A anastomose oblíqua teve menos complicações do que a anastomose circular e pode ser a opção adequada para o paciente submetido ao procedimento de Soave.


Subject(s)
Humans , Infant , Child , Digestive System Surgical Procedures/methods , Anastomosis, Surgical/methods , Constipation/etiology , Fecal Incontinence/etiology , Hirschsprung Disease/surgery , Postoperative Complications/epidemiology , Digestive System Surgical Procedures/instrumentation , Follow-Up Studies , Treatment Outcome , Proctocolectomy, Restorative/methods , Hirschsprung Disease/diagnosis
5.
Arq. gastroenterol ; 55(4): 352-357, Oct.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-983851

ABSTRACT

ABSTRACT BACKGROUND: Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE: The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS: Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS: The median of height-for-age Z-score (-4.05) was lower (P<0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2±454.8 Kcal vs 1890.3±847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1±294.9 mL vs 992.9±292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0±362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7±320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9±1.7 vs 3.7±1.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2±4.3 g vs 12.3±4.3 g, P=0.031) and fluid (456.5±283.1 mL vs 741.1±379.2 mL, P=0.013) intake. CONCLUSION: Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.


RESUMO CONTEXTO: Paralisia cerebral pode estar associada com comorbidades como desnutrição, déficit de crescimento e sintomas gastrintestinais. Os problemas alimentares na paralisia cerebral podem ser secundários a anormalidades anatômicas e funcionais que interferem no processo de alimentação. OBJETIVO: O objetivo deste estudo foi avaliar a associação entre ingestão alimentar, estado nutricional e sintomas gastrintestinais em crianças com paralisia cerebral. MÉTODOS: Estudo transversal que incluiu 40 crianças com paralisia cerebral (35 com tetraparesia espástica e 5 com coreoatetose não-espástica) com idade entre 4 e 10 anos. Todos os pacientes permaneciam exclusivamente na cama ou dependiam de cadeiras de rodas. Foi utilizado o inquérito dos alimentos consumidos habitualmente em casa que foi respondido pelos pais. Foram mensurados os dados antropométricos. Sintomas gastrintestinais associados com distúrbios da deglutição, refluxo gastroesofágico e constipação intestinal crônica foram obtidos. RESULTADOS: A mediana do escore Z da estatura para idade (-4,05) foi menor (P<0,05) do que a mediana de peso-idade (-3,29) e peso-estatura (-0,94). Não se observou diferença entre os escores Z de peso-idade e peso-estatura. Três pacientes com paralisia cerebral (7,5%) apresentavam anemia leve com valor normal de ferritina. Sintomas de disfagia, refluxo gastroesofágico e constipação intestinal ocorreram, respectivamente, em 82,5% (n=33), 40,0% (n=16) e 60,0% (n=24) dos pacientes estudados. Os pacientes com sintomas de disfagia apresentaram menor ingestão energética diária (1280,2±454,8 Kcal vs 1890,3±847,1 Kcal; P=0,009), de carboidratos (mediana: 170,9 g vs 234,5 g; P=0,023) e de líquidos (483,1±294.9 mL vs 992,9±292,2 mL; P=0,001). Os pacientes com sintomas de refluxo gastroesofágico apresentaram maior ingestão diária de líquidos (720,0±362,9 mL) em relação aos pacientes sem este tipo de manifestação clínica (483,7±320,0 mL; P=0.042) além de maior déficit de estatura-idade (escore Z: -4,9±1,7 vs 3,7±1,5; P=0,033). Os pacientes com sintomas de constipação intestinal apresentaram menor ingestão diária de fibra alimentar (9,2±4,3 g vs 12,3±4,3 g; P=0.031) e líquidos (456,5±283,1 mL vs 741,1± 379,2 mL; P=0,013). CONCLUSÃO: Crianças com paralisia cerebral apresentam uma grande variabilidade na ingestão alimentar que pode, pelo menos em parte, constituir um fator de agravo para o déficit de crescimento. Sintoma de disfagia, refluxo gastroesofágico e constipação intestinal associaram-se com diferentes padrões de ingestão alimentar. Portanto, a intervenção nutricional deve ser individualizada levando em consideração os sintomas gastrintestinais e o estado nutricional.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Child Nutrition Disorders/complications , Deglutition Disorders/etiology , Gastroesophageal Reflux/etiology , Cerebral Palsy/complications , Nutritional Status , Constipation/etiology , Comorbidity , Anthropometry , Cross-Sectional Studies , Eating , Feeding Behavior
6.
Arq. gastroenterol ; 55(supl.1): 2-12, Nov. 2018. tab, graf
Article in English | LILACS | ID: biblio-973914

ABSTRACT

ABSTRACT BACKGROUND: Intestinal secretagogues have been tested for the treatment of chronic constipation and constipation-predominant irritable bowel syndrome. The class-effect of these type of drugs has not been studied. OBJECTIVE: To determine the efficacy and safety of intestinal secretagogues for the treatment of chronic constipation and constipation-predominant irritable bowel syndrome. METHODS: A computer-based search of papers from 1966 to September 2017 was performed. Search strategy consisted of the following MESH terms: intestinal secretagogues OR linaclotide OR lubiprostone OR plecanatide OR tenapanor OR chloride channel AND chronic constipation OR irritable bowel syndrome. Data were extracted as intention-to-treat analyses. A random-effects model was used to give a more conservative estimate of the effect of individual therapies, allowing for any heterogeneity among studies. Outcome measures were described as Relative Risk of achieving an improvement in the symptom under consideration. RESULTS: Database Search yielded 520 bibliographic citations: 16 trials were included for analysis, which enrolled 7658 patients. Twelve trials assessed the efficacy of intestinal secretagogues for chronic constipation. These were better than placebo at achieving an increase in the number of complete spontaneous bowel movements per week [RR 1.87 (1.24-2.83)], at achieving three or more spontaneous bowel movements per week [RR 1.56 (1.31-1.85)] and at inducing spontaneous bowel movement after medication intake [RR 1.49 (1.07-2.06)]. Similar results were observed when assessing the efficacy of intestinal secretagogues on constipation-predominant irritable bowel syndrome based on the results of six trials. CONCLUSION: Intestinal secretagogues are useful and safe therapeutic alternatives for the treatment of constipation-related syndromes.


RESUMO CONTEXTO: Os secretagogos intestinais têm sido testados para o tratamento da constipação crônica e síndrome do intestino irritável com constipação predominante. O efeito classe desses tipos de drogas ainda não foi estudado. OBJETIVO: Determinar a eficácia e a segurança de secretagogos intestinais para o tratamento da constipação crônica e síndrome do intestino irritável de constipação predominante. MÉTODOS: Realizada pesquisa baseada em banco de dados de trabalhos publicados entre 1966 e setembro de 2017. A estratégia de pesquisa consistia dos seguintes termos MeSH: secretagogos intestinais OU linaclotide OU lubiprostona OU plecanatide OU tenapanor OU canal de cloro E constipação crônica OU síndrome do intestino irritável. Os dados foram extraídos como análises de intenção de tratar. Um modelo de efeitos aleatórios foi usado para dar uma estimativa mais conservadora do efeito das terapias individuais, permitindo a qualquer heterogeneidade entre os estudos. Os desfechos foram descritos como risco relativo de alcançar uma melhoria no sintoma em consideração. RESULTADOS: A busca no banco de dados rendeu 520 citações bibliográficas: 16 ensaios foram incluídos para análise, que incluiu 7658 pacientes. Doze trabalhos avaliaram a eficácia de secretagogos intestinais para constipação crônica. Estes foram melhores do que placebo, alcançando um aumento no número de evacuações completas espontâneas por semana [RR 1,87 (1,24-2,83)], para a aquisição de três ou mais evacuações espontâneas por semana [RR 1,56 (1,31-1,85)] e na indução espontânea do movimento intestinal após a ingestão de medicação [RR 1,49 (1,07-2,06)]. Resultados semelhantes foram observados ao avaliar a eficácia de secretagogos intestinais na síndrome do intestino irritável de constipação predominante com base em resultados de seis ensaios. CONCLUSÃO: Os secretagogos intestinais são alternativas terapêuticas úteis e seguras para o tratamento de síndromes relacionadas à constipação.


Subject(s)
Humans , Gastrointestinal Agents/therapeutic use , Constipation/drug therapy , Irritable Bowel Syndrome/drug therapy , Secretagogues/therapeutic use , Gastrointestinal Agents/adverse effects , Chronic Disease , Constipation/etiology , Irritable Bowel Syndrome/complications , Secretagogues/adverse effects
8.
Arq. gastroenterol ; 54(3): 197-200, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-888204

ABSTRACT

ABSTRACT BACKGROUND Celiac disease is a glutten induced enteropathy. Some authors recommended screening celiac in children with constipation. There are studies to evaluate celiac disease in children with constipation. But most of them included children regardless to treatment failure. OBJECTIVE The aim of this study was to evaluate frequency of elevated anti TTG in children with constipation after failure to improve during 6 week of appropriate treatment of constipation. METHODS In this cross sectional study, 550 children with prolonged constipation were included. Place of study was Pediatric Gastroenterology clinic of Abuzar children's hospital. Prolonged constipation was defined as a constipation which failed to resolved after 6 weeks of appropriate treatment. Constipation was defined according to ROME III criteria. After parental agreement, 5 mL of blood was obtained. Serum anti TTG level was measure using ELISA method by Orientec kit. Anti TTG>10 was considered positive if IgA was normal. SPSS version 16.0 (Chicago, IL, USA) was used for data analysis. Chi square, t-test, and Mann Whitney test used for data analysis. RESULTS In this study 550 children (m=277, f=273) were included. Mean age of the cases was 6.8±2.9 year. Anti TTG antibody level was 5.8±2.8 unit/mL. Of these case, 42 (7.6%) had positive anti-TTG antibody. Celiac disease was confirmed in 40 cases after histopathology examination. CONCLUSION Anti-TTG was positive in 7.6% children with chronic constipation who failed to respond after 6 week of treatment. Another multicenter study with longer follow up period is recommended.


RESUMO CONTEXTO A doença celíaca é uma enteropatia glúten-induzida. Alguns autores recomendam a triagem de doença celíaca em crianças com constipação. Há estudos para avaliar a doença celíaca em crianças com constipação, mas a maioria inclue crianças independentemente do insucesso do tratamento. OBJETIVO O objetivo deste estudo foi avaliar a frequência de anti-TTG elevado em crianças com constipação após 6 semanas de tratamento adequado e sem sucesso. MÉTODOS Através de cruzamento seccional, 550 crianças com constipação prolongada foram incluídas. O local de estudo foi o ambulatório de Gastroenterologia Pediátrica do Hospital Infantil de Abuzar. Constipação prolongada foi definida como uma constipação, cuja resolução falhou após 6 semanas de tratamento adequado. Constipação foi definida de acordo com critérios de Roma III. Após o consentimento informado dos pais, obteve-se 5 mL de sangue. O nível de anti TTG no soro foi medido usando-se o método ELISA pelo Orientec kit. O anti-TTG >10 foi considerado positivo se IgA estivesse normal. Os dados foram analisados através de testes do Chi-quadrado, t-teste e teste de Mann Whitney utilizando-se o SPSS versão 16.0 (Chicago, IL, EUA). RESULTADOS Um total de 550 crianças (m=277, f=273) foi incluído neste estudo. A média de idade dos pacientes foi 6,8±2,9 anos. O nível de anticorpo anti-TTG foi de 5,8±2,8 unidades/mL. Do total, 42 (7,6%) indivíduos tinham anticorpos anti-TTG positivo. A doença celíaca foi confirmada em 40 casos após exame de histopatologia. CONCLUSÃO O Anti-TTG foi positivo em 7,6% crianças com constipação crônica que não conseguiram responder após 6 semanas de tratamento. Outro estudo multicêntrico, com acompanhamento mais longo período é recomendado.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Autoantibodies/blood , Celiac Disease/diagnosis , Transglutaminases/blood , Constipation/diagnosis , GTP-Binding Proteins/blood , Enzyme-Linked Immunosorbent Assay , Celiac Disease/complications , Transglutaminases/immunology , Cross-Sectional Studies , Treatment Failure , Constipation/etiology , Constipation/therapy , GTP-Binding Proteins/immunology
9.
J. pediatr. (Rio J.) ; 92(3,supl.1): 46-56, tab
Article in English | LILACS | ID: lil-787519

ABSTRACT

ABSTRACT Objective: To analyze the development and prevalence of gastrointestinal signs and symptoms associated with the development of the digestive tract, and to assess the measures aimed to reduce their negative impacts. Source of data: Considering the scope and comprehensiveness of the subject, a systematic review of the literature was not carried out. The Medline database was used to identify references that would allow the analysis of the study topics. Synthesis of results: Infants frequently show several gastrointestinal signs and symptoms. These clinical manifestations can be part of gastrointestinal functional disorders such as infantile colic, infant regurgitation, and functional constipation. Allergy to cow's milk protein and gastroesophageal reflux disease are also causes of these clinical manifestations and represent an important and difficult differential diagnosis. The diseases that course with gastrointestinal signs and symptoms can have an impact on family dynamics and maternal emotional status, and may be associated with future problems in the child's life. Comprehensive pediatric care is essential for diagnosis and treatment. Maternal breastfeeding should always be maintained. Some special formulas can contribute to the control of clinical manifestations depending on the established diagnosis. Conclusion: During the normal development of the digestive tract, several gastrointestinal signs and symptoms may occur, usually resulting from functional gastrointestinal disorders, gastroesophageal reflux disease, and allergy to cow's milk protein. Breastfeeding should always be maintained.


RESUMO Objetivo: Analisar o desenvolvimento e a prevalência de sinais e sintomas gastrintestinais associados com o desenvolvimento do tubo digestivo e as medidas que visam a diminuir suas repercussões negativas. Fontes dos dados: Considerando a abrangência e amplitude do tema, não foi feita revisão sistemática da literatura. Usou-se a base de dados do Medline para a identificação de referências bibliográficas que permitissem contemplar os temas de estudo. Síntese dos resultados: O lactente apresenta com elevada frequência sinais e sintomas gastrintestinais. Essas manifestações clínicas podem fazer parte de distúrbios funcionais gastrintestinais, como cólica, regurgitação e constipação intestinal funcional. A alergia à proteína do leite de vaca e a doença do refluxo gastroesofágico também são causas dessas manifestações clínicas e representam um importante e difícil diagnóstico diferencial. As doenças que cursam com sintomas e sinais gastrintestinais podem ter consequências na dinâmica familiar e no estado emocional das mães. Podem se associar com problemas na vida futura da criança. A atenção pediátrica completa é fundamental para o diagnóstico e o tratamento. O aleitamento natural deve sempre ser mantido. Algumas fórmulas especiais podem contribuir para o controle das manifestações clínicas na dependência do diagnóstico estabelecido. Conclusão: Durante o desenvolvimento normal do tubo digestivo podem ocorrer sinais e sintomas gastrintestinais em geral decorrentes dos distúrbios gastrintestinais funcionais, da doença do refluxo gastroesofágico e da alergia à proteína do leite de vaca. Aleitamento natural deve sempre ser mantido.


Subject(s)
Humans , Infant, Newborn , Infant , Gastrointestinal Tract/growth & development , Gastrointestinal Tract/physiopathology , Gastrointestinal Diseases/physiopathology , Gastrointestinal Diseases/therapy , Milk Hypersensitivity/complications , Age Factors , Constipation/etiology , Constipation/physiopathology , Constipation/therapy , Crying/physiology , Diarrhea/etiology , Diarrhea/physiopathology , Diarrhea/therapy , Gastrointestinal Microbiome/physiology , Gastrointestinal Diseases/etiology
10.
Article in English | WPRIM | ID: wpr-225573

ABSTRACT

The classical triad of abdominal pain, vomiting, and bloody stool is absent in chronic intussusception for more than 2 weeks. Here, we report a 6-year-old female with recurrent abdominal pain for 2 months. Ultrasonography of the abdomen revealed an ileocolic-type intussusception. The lesion accompanying the tight fibrous adhesion was treated by resection and ileocolic anastomosis. It was diagnosed as intussusception with diffuse large B-cell lymphoma. A high index of suspicion for abdominal pain in children should result in the correct diagnosis and appropriate management.


Subject(s)
Abdominal Pain/etiology , Child , Constipation/etiology , Diagnosis, Differential , Female , Humans , Intussusception/diagnosis , Lymphoma, Large B-Cell, Diffuse/complications , Tomography, X-Ray Computed
11.
Rev. cuba. med ; 54(4): 314-322, oct.-dic. 2015. ilus
Article in Spanish | LILACS, CUMED | ID: lil-771011

ABSTRACT

INTRODUCCIÓN: el estreñimiento es un síntoma o afección que puede comprometer la calidad de vida de los pacientes. Su prevalencia global varía entre 2 % y 28 %. OBJETIVO: evaluar la concordancia entre los resultados de los exámenes imagenológicos y la manometría anorrectal, en pacientes con sospecha de estreñimiento funcional. MÉTODOS: la muestra estuvo conformada por 37 pacientes, a los que se les realizó exámenes radiológicos de cecocolografía secuencial (o colon por ingestión), tiempo de tránsito colónico con marcadores radiopacos, defecografía y examen manométrico. Se calculó el índice de Kappa para determinar la concordancia. RESULTADOS: 62,2 % de los enfermos fueron del sexo femenino, la edad predominante estuvo entre 41 y 60 años (43,2 %), predominó el ciego móvil (54,2 %) como causa de estreñimiento. Se hicieron 14 estudios de tiempo de tránsito colónico con marcadores radiopacos, de ellos 28,6 % presentó un tiempo de tránsito lento. Se realizó defecografía a 4 pacientes y 3 presentaron disfunción del suelo pelviano. Se constató que 94,6 % de las pruebas imagenológicas y 78,4 % de las manometrías resultaron positivas (Kappa p= 0,006). CONCLUSIÓN: las técnicas imagenológicas que se investigaron son apropiadas para diagnosticar el estreñimiento funcional y la concordancia de dichas técnicas con la manometría anorrectal es adecuada.


INTRODUCTION: constipation is a symptom or condition that can compromise the quality of patient's life. Its global prevalence varies between 2 % and 28 %. OBJECTIVE: evaluate the correlation between the results of imaging tests and anorectal manometry in patients with suspected functional constipation. METHODS: the sample consisted of 37 patients, who underwent radiological examinations of sequential cecocolografía (colon or swallowed), colonic transit time with radiopaque markers, defecography and manometric examination. Kappa index was calculated to determine the correlation. RESULTS: 62.2 % of patients were female, the predominant age was between 41 and 60 years (43.2 %), mobile blind predominated (54.2 %) as a cause of constipation. 14 studies of colonic transit time with radiopaque markers, were made, 28.6 % of them presented a slow transit time. 4 patients underwent defecography and 3 had pelvic floor dysfunction. It was found that 94.6 % of imaging tests and 78.4 % of manometries were positive (Kappa p= 0.006). CONCLUSIONS: imaging techniques used in this study are suitable for diagnosing functional constipation and consistency of these techniques is suitable anorectal manometry.


Subject(s)
Humans , Colon/diagnostic imaging , Constipation/diagnosis , Constipation/etiology , Manometry/methods
13.
Article in English | WPRIM | ID: wpr-191018

ABSTRACT

Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.


Subject(s)
Adenocarcinoma/diagnosis , Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , CA-19-9 Antigen/analysis , Chorionic Gonadotropin, beta Subunit, Human/blood , Colon, Sigmoid/pathology , Colonic Neoplasms/diagnosis , Colonoscopy , Constipation/etiology , Female , Fluorouracil/therapeutic use , Humans , Leucovorin/therapeutic use , Liver Neoplasms/secondary , Middle Aged , Organoplatinum Compounds/therapeutic use , Prognosis , Tomography, X-Ray Computed
14.
Journal of Gorgan University of Medical Sciences. 2014; 16 (1): 62-65
in Persian | IMEMR | ID: emr-157575

ABSTRACT

Children constipation is one of the common causes of abdominal pain. Cow's milk in children diet is suggested to be one of the main cause of chronic constipation. This study was performed to determine the effect of cow's milk elimination from children diet with chronic constipation. This quasi-experimental study, was performed on 80 children with chronic constipation. Rome-III criteria were considered for disease diagnosis. Cow's milk was eliminated for three weeks from children's diet and the clinical symptoms in children were surveyed, subsequently. Constipation was cured in 33.8% of children as result of cow's milk free diet. The rate of treatment response in affecting children whom their disease in began under 2 years of age [52.6%] was significantly higher than others [16.6%] [P<0.05]. Children treatment was not significantly related to child's gender and amount of milk consumption. Eliminating of cow's milk from the diet improves the chronic constipation in children


Subject(s)
Humans , Milk Hypersensitivity/complications , Milk Proteins/adverse effects , Constipation/etiology , Chronic Disease , Abdominal Pain/etiology , Child
15.
Article in English | WPRIM | ID: wpr-161112

ABSTRACT

We investigated the efficacy and tolerability of various anticholinergics in Korean children with non-neurogenic overactive bladder (OAB). A total of 326 children (males:females= 157:169) aged under 18 yr (mean age 7.3+/-2.6 yr) who were diagnosed with OAB from 2008 to 2011 were retrospectively reviewed. The mean duration of OAB symptoms before anticholinergic treatment was 16.9+/-19.0 months. The mean duration of medication was 5.6+/-7.3 months. Urgency urinary incontinence episodes per week decreased from 1.9+/-3.1 to 0.4+/-1.5 times (P<0.001). The median voiding frequency during daytime was decreased from 9.2+/-5.4 to 6.3+/-4.2 times (P<0.001). According to 3-day voiding diaries, the maximum and average bladder capacity were increased from 145.5+/-66.9 to 196.8+/-80.3 mL and from 80.8+/-39.6 to 121.8+/-56.5 mL, respectively (P<0.001). On uroflowmetry, maximum flow rate was increased from 17.6+/-8.4 to 20.5+/-8.2 mL/sec (P<0.001). Adverse effects were reported in 14 (4.3%) children and six children (1.8%) discontinued medication due to adverse effects. Our results indicate that anticholinergics are effective to improve OAB symptoms and tolerability was acceptable without severe complications in children.


Subject(s)
Child , Child, Preschool , Cholinergic Antagonists/adverse effects , Constipation/etiology , Dizziness/etiology , Female , Humans , Male , Retrospective Studies , Treatment Outcome , Urinary Bladder, Overactive/drug therapy
16.
S. Afr. fam. pract. (2004, Online) ; 55(4): 350-353, 2013.
Article in English | AIM, AIM | ID: biblio-1270039

ABSTRACT

Constipation in children is a universal problem; occurring in 0.7-28 of the population. The exact aetiology is unknown; but the majority of children have a functional; rather than organic; aetiology. Symptoms associated with constipation include abdominal pain; a poor appetite and faecal incontinence; all of which interfere with the quality of life of the child and his or her family. Early intervention with appropriate management is necessary to prevent ongoing sequelae. Once an organic cause has been excluded; a programme of intervention should be implemented; namely evacuation of any faecal mass present; followed by regular maintenance therapy to encourage evacuation of a daily soft stool for at least 2-3 months; prior to gradual withdrawal. Emotional support; exercise and dietary modification are linked to the therapy and will ensure a successful outcome. Failure to implement the protocol may result in ongoing problems in up to 50 of children as they enter adulthood


Subject(s)
Constipation/diagnosis , Constipation/etiology , Constipation/therapy , Infant
17.
Arab Journal of Gastroenterology. 2013; 14 (1): 6-9
in English | IMEMR | ID: emr-130134

ABSTRACT

Chronic functional constipation represents 95% of the cases of paediatric constipation. Epidemiologic data, pathophysiology and anorectal functional abnormalities vary greatly among different reports across different populations. The aim of this study was to evaluate these data in Egyptian children with chronic functional constipation. This study included 150 children with chronic functional constipation [101 males, 49 females; mean age 6 +/- 3.1 years]; a control group of 50 age- and sex-matched healthy children were enrolled for standardisation of the manometry technique. A structured symptom questionnaire and clinical examination including digital rectal examination in addition to anorectal manometry were done for all included children. Defaecation dynamics were assessed in all children 5 years or older using anorectal manometry with integrated electromyogram of the external anal sphincter and the puborectalis muscle. The maximal tolerable volume was significantly higher in the constipated children than in the control group [p = 0.03]. No significant differences existed between constipated and control children regarding other anorectal manometric parameters. Abnormal defaecation dynamics were detected in 35 out of 95 tested patients [36.8%]. Increased maximal tolerable volume is the most striking manometric feature in Egyptian children with chronic functional constipation. Abnormal defaecation dynamics were detected in about one-third of the tested patients. Standardisation of the measurement techniques and obtaining normal ranges for anorectal manometric parameters for each laboratory are recommended


Subject(s)
Humans , Female , Male , Constipation/etiology , Anal Canal , Rectum , Manometry , Chronic Disease , Gastrointestinal Diseases , Defecation , Prospective Studies
18.
Article in Korean | WPRIM | ID: wpr-171345

ABSTRACT

BACKGROUND/AIMS: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. METHODS: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. RESULTS: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. CONCLUSIONS: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability.


Subject(s)
Abdominal Pain/etiology , Adult , Constipation/etiology , Diarrhea/etiology , Double-Blind Method , Drug Administration Schedule , Female , Humans , Irritable Bowel Syndrome/complications , Male , Middle Aged , Parasympatholytics/therapeutic use , Phenothiazines/therapeutic use , Severity of Illness Index , Treatment Outcome , Trimebutine/therapeutic use
19.
J. pediatr. (Rio J.) ; 88(6): 455-464, nov.-dez. 2012. ilus
Article in Portuguese | LILACS | ID: lil-662549

ABSTRACT

OBJETIVOS: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. FONTES DOS DADOS: Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. SÍNTESE DOS DADOS: O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado de humor e capacitação dos cuidadores. Trata-se, portanto, de etiologia multifatorial. As desordens digestórias mais prevalentes são disfagia, doença do refluxo gastroesofágico e constipação intestinal, com consequentes quadros de infecções respiratórias de repetição e repercussão deletéria no estado nutricional. CONCLUSÕES: Indivíduos com paralisia cerebral apresentam alterações neurológicas do controle do sistema digestório, portanto manifestações digestórias são frequentes. As questões abordadas são fundamentais para profissionais das equipes interdisciplinares que atendem indivíduos com paralisia cerebral acerca da importância da anamnese ampla, exame clínico e complementar detalhado que incluam investigação das desordens gastrointestinais associadas e suas consequências. A detecção precoce dessas alterações digestórias pode respaldar medidas de reabilitação mais eficientes no sentido de melhoria da qualidade de vida desses indivíduos.


OBJECTIVES: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment. SOURCES: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. SUMMARY OF THE FINDINGS: The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. CONCLUSIONS: Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.


Subject(s)
Humans , Cerebral Palsy/physiopathology , Gastrointestinal Diseases/physiopathology , Caregivers , Cerebral Palsy/complications , Constipation/etiology , Constipation/physiopathology , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Feeding and Eating Disorders/etiology , Feeding and Eating Disorders/physiopathology , Gastroesophageal Reflux/etiology , Gastroesophageal Reflux/physiopathology , Nutrition Disorders/etiology , Nutrition Disorders/physiopathology , Patient Care Team , Quality of Life
20.
West Indian med. j ; 61(6): 610-614, Sept. 2012. graf, tab
Article in English | LILACS | ID: lil-672966

ABSTRACT

The aim of this report was to determine the outcome of all patients subjected to colonoscopy at an outpatient medical facility in central Jamaica. A copy of the colonoscopy report of each consecutive patient during the period March 2007 to April 2011 was entered into a database and analysed. One thousand two hundred and fifty patients were identified with a mean age of 60 years and 56.5% were female. The most common indication for colonoscopy was bleeding (28%) but constipation (15%) and screening (11%) were also important. Caecal intubation was achieved in 96% of the group. While 30% of the group had normal findings, 32% had diverticulosis and 23% had haemorrhoids; importantly 10% had carcinomas and 11 % had adenomas. Adenomas were detected in 13% of the screened patients. The most important predictor ofan abnormal colonoscopy was a history ofbleeding. The perforation rate was 0.24% with no perforations occurring in the latter 650 cases.


El objetivo de este reporte fue determinar la evolución clínica de todos los pacientes sometidos a colonoscopía en una clínica de consulta externa en Jamaica central. Una copia del reporte de la colonoscopía de cada paciente consecutivo durante el periodo de marzo de 2007 a abril de 2011 fue introducida en la base de datos, y luego analizada. Se identificaron un total de mil doscientos cincuenta pacientes con edad promedio de 60 años, de los cuales 56.5% eran hembras. La indicación más común para la colonoscopía fue el sangramiento (28%) pero el estreñimiento (15%) y el tamizaje (11%) fueron también importantes. La intubación cecal se logró en el 96% del grupo. Mientras que el 30% del grupo tuvo resultados normales, el 32% presentó diverticulosis y el 23% tenia hemorroides. Aún más importante: 10% tenían carcinomas y 11% tenían adenomas. Se detectaron adenomas en 13% de los pacientes tamizados. El predictor más importante de una colonoscopía anormal fue una historia de sangramiento. La tasa de perforación fue 0.24% sin que se presentaran perforaciones en los últimos 650 casos.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Adenoma/diagnosis , Colonoscopy , Carcinoma/diagnosis , Colorectal Neoplasms/diagnosis , Gastrointestinal Hemorrhage/etiology , Adenoma/complications , Carcinoma/complications , Colorectal Neoplasms/complications , Constipation/etiology , Diverticulum/complications , Diverticulum/diagnosis , Early Detection of Cancer , Hemorrhoids/complications , Hemorrhoids/diagnosis , Jamaica , Rectum
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