Electrogastrografía de superficie: una nueva técnica para el estudio de la motilidad gástrica en nuestro medio / Cutaneous electrogastrography: a recently incorporated technique for the study of gastric motility

Background: Gastric electrical activity can be accurately recorded and analyzed by cutaneous electrogastrography. Different types of abnormalities have been described in a variety of disorders. Aim: To analyze a group of asymptomatic subjects and assess the prevalence and patterns of dysrrhythmias in patients with type 1 and 2 diabetes and patients with functional dyspepsia. Patients and methods: One hundred subjects were studied (32 male, mean age 45 years old, 10 asymptomatic, 11 type 1 diabetics, 22 type 2 diabetics and 57 subjects with functional gastrointestinal disturbances). Gastric myoelectrical activity was recorded using surface electrogastrography for 1 hour in the fasting state and 1 hour after a test meal (350 kcal). Results: The electrogastrogram was normal in 90 percent of asymptomatic controls. It was abnormal in 64 percent of type 1 diabetic patients, in 55.5 percent of type 2 diabetic patients and in 61 percent of patients with functional dyspepsia. Different types of dysrrhythmias were observed in each group. Conclusions: Electrogastrography might define a subgroup of patients with electrical rhythm disturbances, that may have a different approach to treatment than patients with normal gastric electrical activity

Test de hidrógeno espirado en el estudio de la malabsorción de lactosa y sobrecrecimiento bacteriano en niños / Hydrogen breath test in the study of lactose malabsorption and intestinal bacterial overgrowth in children

La malabsorción de lactosa (ML) y el sobrecrecimiento bacteriano intestinal (SBI) son hallazgos frecuentes en adultos en Chile, pero su incidencia en pacientes pediátricos no ha sido investigada sistemáticamente. El objetivo fue estudiar la incidencia de ML y SBI en pacientes pediátricos que presentan síntomas gastrointestinal posterior a la ingesta de leche. Se analizó además el efecto de una dieta libre de lactosa en los síntomas. Se incluyeron 149 pacientes; edad promedio 9 años (rango 3-15), 88 por ciento de sexo femenino. Se determinó ML y SBI mediante test de hidrógeno en aire espirado. Se registraron síntomas basales y en 43 pacientes después de un mes de dieta libre de lactosa. Resultados: se observó ML en 95 pacientes y SBI en 42 pacientes. Se detectó SBI en 37 por ciento de pacientes con ML y en 15,5 por ciento de los pacientes con digestión a la lactosa. La aparición de ML se relacionó a la edad de las pacientes (3-7 años= 49 años, 8-11= 69 por ciento, 85 por ciento). Casi todos los pacientes experimentaron desaparición de síntomas luego de dieta libre de lactosa. Conclusiones : La ML y SBI deben sospecharse en niños síntomas gastrointestinales. El tratamiento con dieta libre de lactosa se acompañó de una significativa mejoría de los síntomas

Disfagia orofaríngea / Oropharyngeal dysphagia

La disfagia orofaríngea (DOF) es un síntoma inespecífico, causado por un grupo de enfermedades funcionales o estructurales de la orofaringe. El paciente manifiesta una dificultad en la transferencia de los alimentos desde la boca hasta el esófago, al iniciar la fase involuntaria de la deglución mientras protege la vía aérea de la aspiración. Se estima que el 12 por ciento de los pacientes hospitalizados y el 60 por ciento de las personas que se encuentran en hogares de reposo, presentan una dificultad para alimentarse. La DOF está asociada a una significativa morbilidad y mortalidad. Su diagnóstico requiere una cuidadosa evaluación de la historia clínica y un estudio que incluye, una videofluoroscopía, manometría esofágica y eventualmente laringoscopía digestiva alta. El tratamiento de la DOF es dependiente de la etiología, y consiste en modificaciones de la dieta, uso de técnicas de deglución, sondas enterales y en algunos casos, de la realización de una miotomía cricofaríngea

Inmunoglobulina A ¿un predictor de daño hepático crónico por alcohol? / Immunoglobulin A: predictor of alcoholic chronic liver damage?

La relación entre etiología, severidad del daño hepático y niveles aumentados de IgA ha sido motivo de controversia. Nuestros objetivos fueron a) analizar el efecto del alcohol sobre la concentración sérica de IgA en pacientes con cirrosis alcohólica, b) estudiar la relación entre IgA y severidad del daño hepático y c) evaluar el efecto de la suspensión del consumo de alcohol sobre sus niveles. Se estudiaron 48 pacientes cirróticos, 30 alcohólicos y 18 no alcohólicos. En todos se midieron inmunoglobulinas séricas (IgA, IgG, IgM) y se determinó la puntuación de Child-Pugh. En 16 pacientes alcohólicos se realizó una segunda determinación de inmunoglobulinas luego de al menos 7 meses de abstinencia. Los valores de la IgA fueron significativamente mayores en pacientes alcohólicos y cifras más elevadas se observaron en la medida que aumentó el grado de insuficiencia hepática, de acuerdo a los niveles de Child-Pugh. No se observó relación entre los valores de IgA y transaminasas. Estos valores aumentados de IgA se mantienen más allá de los seis meses

La cisaprida no altera el intervalo Q-T prolongado en pacientes con cirrosis hepática / Cisapride does not modify prolonged Q-T interval in patients with liver cirrhosis

Background: Abnormal small bowel motility, observed in liver cirrhosis, can be reversed with cisapride. Since both cisapride and liver disease are associated with prolonged QT interval, the possibility of adverse cardiovascular effects might be expected with cisapride treatment in these patients. Aim: To evaluate QT interval and other electrocardiographic changes during long term treatment with cisapride in cirrhotic patients. Patients and methods: Forty seven cirrhotic patients were studied. Electrocardiogram was recorded and the QT interval corrected according to Bazzett's formula was determined (normal value <0.44 s). Seventeen patients were treated with cisapride, 10 mg tid for seven months and electrocardiographic controls were performed at the end of the treatment. Results: The mean corrected QT interval was 0.46 ñ 0.03 s (range 0.4-0.53). 34 patients (64 percent) had QTc prolongation (0.47 ñ 0,02 s). Statistically significant higher values of QTc were observed in patients at Child Pugh stage B and C compared to stage A. No statistically significant difference according to the etiology of liver disease, were observed. No changes in mean QTc duration were observed during cisapride treatment. Conclusions: In spite that a prolonged QTc was a frequent finding in our serie of selected patients, no cardiovascular adverse effects were observed with long term cisapride treatment

Valor de la manometría intestinal en la patología gastrointestinal / Value of intestinal manometry in gastrointestinal disorders

Background: Small intestinal manometry is a relatively simple technique. However, its use is usually limited to very few centers and mainly related to research studies. Aim: To report our experience with small intestinal motility studies in a group of normal controls and patients with symptoms suggesting a gastrointestinal motor disorder. Patients and methods: Seventy three studies were performed in 71 subjects: 18 asymptomatic controls and 55 patients presenting with symptoms characterized by abdominal pain, vomiting, bloating, constipation and diarrhea. In 33 patients the same symptoms remained without diagnosis, in spite of extensive laboratory studies. In 10 of these, dilated small intestinal loops were observed and intestinal pseudoobstruction was suspected. Twenty two additional patients with systemic disorders such as scleroderma, diabetes and previous vagotomies, were studied. Motility was assessed by means of perfused catheters connected to external transducers for a mean lapse of 280 min. Results: An abnormal pattern of small intestinal motility suggesting neuropathic, myopathic or a mixed disorder was observed in 76 percent of all studied patients, with the exception of patients with scleroderma, in whom only myopathic and mixed alterations were observed. In 82 percent of patients, the results of manometry were useful for the management of the clinical condition. Conclusions: small intestinal manometry is a relatively simple technique that, when used in selected groups of patients, provides useful information for clinical management

Efecto de fracciones pépticas derivadas de la caseína en la absorción de D-xilosa y motilidad intestinal en el perro: estudio preliminar / Effect of casein derived peptides on D-xylose absorption and small intestinal motility

Background: The presence of food in the intestinal lumen increases absorption from an isolated intestinal loop, the mechanisms involved are unknown. Casein, and its respective hydrolysate, increased D-xylose absorption in both normal volunteers and experimental animals; this effect was associated with prolonged small intestinal transit time and a decrease of motor activity. Aims: To separate from casein hydrolysate, groups of peptides and to investigate their effects on both D-xylose absorption and small intestinal motility. Material and methods: Studies were performed on five dogs with a surgically implanted duodenal cannula. Three groups of peptides were separated by means of a Silica Gel 60 column and were continously infused through the duodenal cannula. After 15 min, 5 g of D-xylose were injected in the duodenum, plasma levels were measured, and the area under the curve was estimated. Motility was recorded by means of infused catheters and external transducers. Results: Plasma levels of D-xylose were significantly increased during the infusion of one group of peptides compared to the others. In addition, the area under the curve: 3366 ñ 885 mg x min-1 observed with this group was significantly greater than the other two groups: 1432 ñ 183 mg x min-1 and 1137 ñ 280 mg x min-1 respectively. No statistically significant differences in motor activity were observed between the different groups of peptides. Conclusions: A group of peptides derived from casein was characterized by increasing D-xylose absorption. The presence of beta casomorphines might be the possible mechanism involved

Manometría endoscópica del esfínter de Oddi / Endoscopic manometry of sphincter of Oddi

Background: Endoscopic manometry is the gold standard for the diagnosis of sphincter of Oddi dysfunction. Aim: To report the result of the first 30 endoscopic manometries of sphincter of Oddi performed in a Gastroenterology Service. Patients and methods: Thirty manometries were performed in 28 patients aged 30 to 70 years old (14 females). The papilla was cannulated with a perfused catherter, measuring pressure with external transducers. Results: Deep cannulation of the papilla was achieved in 88 por ciento. Procedure-related complications were not observed in these cases. Normal values were registered in 11 cases with a basal sphincter pressure 15.6ñ10.7 mm Hg, contractions with an amplitude of 92.3ñ35.7 mm Hg and 6.0ñ2.4/ min frequency. The clinical suspicion suspicion of hypertonic dyskinesis was confirmed in 5 cases with an elevated basal pressure of 43.69ñ13.3 mm Hg, an increased frequency of contractions ("tachyoddia") in one, and large spastic contractions of high pressure in other case. In 3 of 5 cases with common bile duct stones, a predominance of retrograde propagation of the contractions was observed with normal pressure. Variable manometric results were observed after endoscopic papillotomy observing a scale from the complete absence of motor activity to normal aphincter function. Conclusions: Endoscopic manometry is a reasonably safe method, of great importance in the diagnosis of fuctional disorders of the sphincter of Oddi

Efectos de la caseína en la motilidad del intestino delgado en pacientes con cirrosis hepática / Effects of caseina on small bowel motility in cirrhotic patients

Fasting small bowel motor abnormalities have been described in cirrhotic patients. To investigate the effects of orally administered casein in small bowel motor activity in cirrhotic patients. Six healthy subjects and 23 cirrhotic patients were studied. Motility of the upper part of the small bowel was studied by means of perfused manometric catheters, during a basal period and after infusion of 30 g of casein in the stomach. Basal recording showed a cuclical activity in all helathy subjects and in 9 cirrhotics (further considered as group I). In 14 patients, basal cyclical activity was absent and were further considered as group II. Frequency of contractions after casein infusion was higher in group II patients than in group I and healthy controls (2.2ñ0.3, 1.3ñ0.2 and 0.9ñ0.2 cpm respectively). Intestinal motor index after casein infusion was also higher in group II. There was a progressive decline with time in motor activity after casein infusion, being maximal at 45 min, in healthy subjects and group I. This decline was not observed in group II. Patients with cirrhosis have an altered bowel motor response to casen. Since group II of patients had a greater percentage of Child C patients, the abnormalities seem to be related to the degree of liver failure

Efecto de la caseína en la absorción de d-xilosa medida mediante la prueba de H2 espirado / Effect of casein on d-xylose absorption measured by expired H2 test

Different experimental studies suggest that the presence of food in the alimentary tract, promote small intestinal absorption. The mechanism involved are not completely understood and might be related to motility changes or to humoral factors. Since studies have shown a decrease of small bowel motility after casein administration, the aim was to analyze the effect of this protein on small intestinal absorption and orocecal transit time. The hydrogen breath test was used to estimate d-xylose absorption. H2 production is dependent on the amount of this carbohydrate reaching the colon and therefore inversely proportional to d-xylose absorption. Six normal volunteers ingested 25 g d-xylose and 25 g de-xyllose + 30 g casein, and alveolar breath samples were obtained at 15 min intervals. Results: by adding casein to d-xylose solution a statistically significant decrease of maximal H2 concentration was observed from a mean of 40ñ11 ppm to a mean of 26ñ8 ppm. Similarly the area under the curve (which reflects the amount of xylose that was not absorbed) was also significantly decreased from a mean of 3281ñ1399 ppm to mean of 1394ñ700 ppm of H2. The orocecal transit time was significantly prolonged from 85.5ñ40 min to 112ñ38 min. Our results suggest that casein increased d-xylose absorption in normal subjects and that this effect might be related to a slower transit time

Cambios en los marcadores proteicos de repleción nutricional en pacientes desnutridos con nutrición enteral y su relación con los balances energético y nitrogenado / Changes in protein markers of nutritional repletion in undernurished patients with enteral nutrition and its relation with energetic and nitrogenous balance

Aim: to study the relation between tha changes in protein repletion indicators and calorie and nitrogen balance in undernurished patients receiving enteral nutrition. Patients and methods: fourteen patients (11 female, age range 55-85 years old) with an initial serum albumin below 3.5 g/dl or serum transferrin below 200 mg/dl, which receiving enteral nutrition, were studied. On days one and ten of nutritional support, indirect calorimetry, nitrogen balance and serum levels of albumin, transferrin, pre-albumin and total lymphocyte count were measured. Results: initial resting energy expenditure was 25.1ñ5 Kcal/kg/day (115.4ñ20 percent of that predicted by Harris Benedict equations) and urinary urea nitrogen 5.4ñ3.7 g/day. Initial and final nitrogen balances were 66.9ñ71 and 81.4ñ105.9 mg N/kg/day and mean energy balance throughout the study was +9.0ñ7.2 Kcal/kg/day. During the ten days of nutritional support, albumin improved significantly in 0.35ñ0.43 g/dl (15.2ñ19.8 percent). Transferrin, pre-albumin and total lymphocyte count did not change significantly. The changes in these last parameters did not correlate with nitrogen or calorie balance. Conclusions: probably other factors, besides nutritional balances, influence serum protein levels and these may not change despite an adequate nutritional repletion