Transición en las enfermedades crónicas gastrointestinales. Del cuidado pediátrico al del adulto / Transition in chronic gastrointestinal diseases. From pediatric to adult care

Los avances tecnológicos y del conocimiento hicieron que un mayor número de pacientes con enfermedad crónica gastrointestinal pasen de ser atendidos por el pediatra al control por los médicos de adultos durante una de las etapas más vulnerables de la vida: la adolescencia. El Grupo de Trabajo de Transición del Comité de Gastroenterología de la Sociedad Argentina de Pediatría realizó una búsqueda de literatura exhaustiva y convocó a especialistas referentes del país, con el objeto de unificar los criterios basados en la evidencia y la experiencia. De esta manera, se proponen una serie de recomendaciones para todo el equipo de salud (pediatra, gastroenterólogo infantil, nutricionista, gastroenterólogo de adultos, psicólogo, enfermería), incluso para pacientes y familias, que faciliten el proceso de transición y optimicen el seguimiento, el control, la prevención de complicaciones y la calidad de vida de los pacientes con enfermedades crónicas gastrointestinales

Technological advances and the globalization of knowledge have led to a considerable increase in the number of patients with chronic gastrointestinal disease who transition from pediatric to adult care during one of the most vulnerable life stages: adolescence. The Transition Working Group of the Gastroenterology Committee of the Sociedad Argentina de Pediatría conducted an exhaustive literature search and summoned leading specialists in the most frequent chronic pathologies from all over the country to unify criteria based on evidence and experience. As a result, a series of recommendations are proposed for the whole health team (pediatrician, pediatric gastroenterologist, nutritionist, adult gastroenterologist, psychologist, and nurse) including patients and families, to facilitate the transition process, optimize follow-up, prevent complications, and improve the quality of life of patients with chronic gastrointestinal diseases.

Electroacupuncture for acute exacerbation of chronic obstructive pulmonary disease complicated with gastrointestinal dysfunction: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical effect of electroacupuncture (EA) for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with gastrointestinal dysfunction.@*METHODS@#A total of 100 patients with AECOPD complicated with gastrointestinal dysfunction were randomly divided into an EA group (50 cases, 2 cases dropped off, 1 case excluded) and a medication group (50 cases). Both groups were treated with symptomatic and supportive treatment such as low flow oxygen, nebulized inhalation of short-acting β2 agonist (SABA) or short-acting muscarinic antagonist (SAMA) combined with inhaled corticosteroid (ICS). The EA group was treated with EA at Zusanli (ST 36), Yinlingquan (SP 9), Zhongwan (CV 12), Shuifen (CV 9), Tianshu (ST 25), Chize (LU 5) and Lieque (LU 7), with discontinuous wave, 2 Hz in frequency, 30 min each time, once a day. In the medication group, oral mosapride citrate tablets were given, 3 times a day, 5 mg each time. Both groups were treated for 5 d. Before and after treatment, the gastrointestinal symptom rating scale (GSRS) score was observe, serum procalcitonin (PCT), C-reactive protein (CRP), and plasma oxygenation index (PaO2/FiO2) were detected, and patient satisfaction degree was evaluated in the two groups.@*RESULTS@#Compared with before treatment, except for diarrhea dimension in the medication group, the total scores and each dimension scores of GSRS were decreased (P<0.05), serum PCT and CRP were decreased (P<0.05), plasma PaO2/FiO2 was increased (P<0.05) in the two groups after treatment. After treatment, in the EA group, the total score and abdominal pain, dyspepsia, constipation and diarrhea scores of GSRS were lower than those in the medication group (P<0.05), meanwhile serum PCT and CRP were lower and plasma PaO2/FiO2 was higher than those in the medication group (P<0.05). The improvement of gastrointestinal symptoms, life quality and overall satisfaction degree in the EA group were superior to those in the medication group (P<0.05).@*CONCLUSION@#EA could improve the symptoms of patients with AECOPD complicated with gastrointestinal dysfunction, reduce inflammatory response, improve oxygenation and patient satisfaction degree.

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.

A Breakthrough Point in Integrative Medical Research: Challenge of Treating Overlapping Symptoms in Functional Gastrointestinal Disorders / 中国结合医学杂志

Functional gastrointestinal disorders (FGIDs) are common disorders that are characterized by persistent and recurring gastrointestinal symptoms. Many patients with FGIDs have overlapping symptoms, which impaired the quality of life and ability to work of patients, and left a considerable impact on health-care systems and society. Chinese medicines (CMs) are commonly utilized by many patients with FGIDs. This article discusses the current status of diagnosis and treatment of FGIDs, the advantages and characteristics of CM treatment, and how integrated medicine can make a breakthrough in FGIDs diagnosis and treatment.

Professor YANG Ji-guo's experience in treatment of functional gastrointestinal diseases with acupuncture combined with umbilicus moxibustion / 中国针灸

Professor YANG Ji-guo's clinical experience in treatment of functional gastrointestinal diseases was summerized. Professor YANG Ji-guo believes that this disease is caused by the deficiency of six fu organs. Dysfunction of six fu organs in descending transportation is the basic pathogenesis. The principle of acupoint selection includes benefiting gastrointestinal functions, unblocking and purging six fu, soothing liver qi and calming down the mind. In treatment, acupuncture is combined with umbilicus moxibustion. In acupuncture, the deqi promoting technique by rotating and trembling needle is adopted. Focusing on the deficiency of six fu organs, umbilicus moxibustion is adopted to benefit the spleen and stomach and harmonize the functions of six fu organs for both biao (symptoms) and ben (root cause).

Management of non traumatic surgical emergencies during the COVID-19 pandemia / Conduta nas urgências e emergências cirúrgicas não traumáticas durante a pandemia COVID-19

ABSTRACT In December 2019, in Wuhan, China, the first cases of what would be known as COVID-19, a disease caused by an RNA virus called SARS-CoV-2, were described. Its spread was rapid and wide, leading the World Health Organization to declare a pandemic in March 2020. The disease has distinct clinical presentations, from asymptomatic to critical cases, with high lethality. Parallel to this, patients with non-traumatic surgical emergencies, such as acute appendicitis and cholecystitis, continue to be treated at the emergency services. In this regard, there were several doubts on how to approach these cases, among them: how to quickly identify the patient with COVID-19, what is the impact of the abdominal surgical disease and its treatment on the evolution of patients with COVID-19, in addition to the discussion about the role of the non-operative treatment for abdominal disease under these circumstances. In this review, we discuss these problems based on the available evidence.

RESUMO Em dezembro de 2019, em Wuhan na China, foram descritos os primeiros casos do que seria conhecida como a COVID-19, doença causado por um RNA vírus denominado SARS-CoV-2. A disseminação foi rápida e ampla, levando a Organização Mundial de Saúde a decretar pandemia em março de 2020. A doença tem apresentação clínica variada, desde portadores assintomáticos até casos críticos, com alta letalidade. Paralelamente a isto, pacientes com urgências cirúrgicas não traumáticos, como apendicites agudas e colecistites agudas, continuam a ser atendidos nos serviços de emergências. Neste contexto, surgiram várias dúvidas sobre a conduta nestes casos, entre essas: como identificar rapidamente o paciente com COVID-19, qual o impacto da doença cirúrgica abdominal e o tratamento na evolução dos pacientes com COVID-19, além da discussão sobre o emprego de tratamento não operatório para a doença abdominal nestas circunstâncias. Nesta revisão, trazemos a discussão destes problemas sob a luz das evidências disponíveis.

Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: a systematic review / Uroterapia no tratamento de crianças e adolescentes com disfunção vesical e intestinal: revisão sistemática

ABSTRACT Objective: To identify and describe the protocols and clinical outcomes of urotherapy interventions in children and adolescents with bladder bowel dysfunction. Method: Systematic review carried out in June 2018 on Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL),Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library, and PsycInfo databases. Clinical trials and quasi-experimental studies carried out in the last ten years in children and/or adolescents with bladder and bowel symptoms and application of at least one component of urotherapy were included. Results: Thirteen clinical trials and one quasi-experimental study were included, with moderate methodological quality. The heterogeneity of the samples and of the methodological design of the articles prevented the performance of a meta-analysis. The descriptive analysis through simple percentages showed symptom reduction and improvement of uroflowmetry parameters. The identified urotherapy components were: educational guidance, water intake, caffeine reduction, adequate voiding position, pelvic floor training, programmed urination, and constipation control/management. Conclusion: This review indicates positive results in terms of symptom reduction and uroflowmetry parameter improvement with standard urotherapy as the first line of treatment for children and adolescents with bladder bowel dysfunction. It is recommended that future studies bring contributions regarding the frequency, number, and time of urotherapy consultations.

RESUMO Objetivo: Identificar e descrever os protocolos e desfechos clínicos das intervenções de uroterapia em crianças e adolescentes com disfunção vesical e intestinal. Método: Revisão sistemática realizada em junho de 2018 nas bases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), Scientific Electronic Library Online (SciELO), Cochrane Library e PsycInfo. Foram incluídos ensaios clínicos e estudos quase-experimentais dos últimos 10 anos, em crianças e/ou adolescentes com sintoma urinário e intestinal e aplicação de no mínimo um componente de uroterapia. Resultados: 13 ensaios clínicos e 1 estudo quase-experimental foram incluídos, sendo a qualidade metodológica moderada. A heterogeneidade da amostra e de delineamento metodológico dos artigos impediu a realização de meta-análise. A análise descritiva por meio de percentual simples demonstrou redução dos sintomas e melhora dos parâmetros de urofluxometria. Os componentes de uroterapia identificados foram: orientação educacional, ingestão hídrica, redução de cafeína, posicionamento adequado para eliminação, treinamento do assoalho pélvico, micção programada e controle/manejo da constipação. Conclusão: Esta revisão sinaliza resultados positivos em termos de redução de sintomas e melhora nos parâmetros de urofluxometria com aplicação de uroterapia padrão como primeira linha de tratamento nos casos de crianças e adolescentes com disfunção vesical e intestinal. Recomenda-se que estudos futuros tragam contribuições no que tange a frequência, número e tempo para as consultas de uroterapia.

Control of sheep gastrointestinal nematodes using the combination of Duddingtonia flagrans and Levamisole Hydrochloride 5% / Controle de nematódeos gastrintestinais de ovinos utilizando a combinação de Duddingtonia flagrans e Cloridrato de Levamisole 5%

Abstract The objective was to evaluate the action of D. flagrans pellets in association with Levamisole Hydrochloride 5% for controlling sheep gastrointestinal nematodes in the northeastern Brazil. Three groups of six sheep each were formed: group 1 received 3 g of the pellets (0.6 g of D. flagrans mycelium) for each 10 kg b.w., twice a week for six months, and deworming with Levamisole Hydrochloride 5% when EPG ≥ 1500; group 2 received a dosage of Levamisole Hydrochloride 5% when EPG ≥ 1500; and group 3 received 3 g of pellets without fungi for each 10 kg b.w., twice a week for six months. EPG counts, larval cultures, packed cell volume (PCV) and weighing were performed every 15 days; monthly, samples of grass from each paddock were collected. The mean EPG of the groups began to statistically differ from day 30 (p < 0.05). Group 1 required less deworming with Levamisole Hydrochloride 5% and showed superiority of PCV values ​​throughout the experiment (p < 0.05). There was a significant reduction (p < 0.05) in L3 recovery in the group 1 paddock from day 30 onwards. The use of D. flagrans pellets in association with Levamisole Hydrochloride 5% was effective for controlling gastrointestinal nematodes.

Resumo O objetivo foi avaliar a ação de péletes de Duddingtonia flagrans em associação ao Cloridrato de Levamisole 5% no controle de nematódeos gastrintestinais de ovinos no Nordeste do Brasil. Foram formados três grupos de seis animais cada: grupo 1 recebeu 3 g de péletes (0,6 g de micélio de D. flagrans) para cada 10 kg p.v., duaz vezes por semana durante seis meses, e vermifugações com Cloridrato de Levamisole 5% quando OPG > 1500; grupo 2 recebeu uma dosagem de Cloridrato de Levamisole 5% quando OPG ≥ 1500; e grupo 3 recebeu 3 g de péletes sem fungos para cada 10 kg de p.v., duas vezes por semana durante seis meses. Contagens de OPG, coproculturas, de volumes globulares (VG) e pesagens foram realizadas a cada 15 dias. Mensalmente, amostras de pasto de cada piquete eram coletadasa. A média de OPG dos grupos começou a diferir estatisticamente a partir do dia 30 (p < 0,05). O grupo 1 necessitou de menos vermifugações com Cloridrato de Levamisole 5% e demonstrou superioridade nos valores de VG durante todo o experimento (p < 0,05). Houve redução significativa (p < 0,05) nas L3 recuperadas no piquete do grupo 1 a partir do dia 30. Em conclusão, a utilização de péletes de D. flagrans em associação ao Cloridrato de Levamisole 5% foi eficaz no controle de nematódeos gastrintestinais de ovinos.

New methodologies for old problems: tridimensional gastrointestinal organoids and guts-on-a-chip / Novas metodologias para velhos problemas: organoides gastrointestinais e guts-on-a-chip tridimensionais

ABSTRACT Objectives: The present review intended to present a critical overview of the methodological and experimental advances concerning tridimensional cell culture models within the scope of gastrointestinal research. Methods: A literature review was performed and some of the main published articles in the area were mentioned. Main results: Classic studies and high impact results were presented, starting from the pioneer works with gastrointestinal organoids, with a small gut organoid, to the achievement of guts-on-a-chip and multi-organ-chips. It was also discussed which implications the construction of such co-cultures bring, as well as future applications arising from these new methodologies. Conclusions: Despite the still discrete number of publications, in quantitative terms, there are qualitative promising and consistent results addressing physiopathological aspects and new therapeutic perspectives of tridimensional in vitro cultures in the gastroenterology field. It is expected, thus, that such new methodological approaches, including organoids and guts-on-a-chip, may contribute decisively to the advance in knowledge on basic aspects, as well as on the translation to new therapeutic approaches in gastrointestinal diseases.

RESUMO Objetivos: A presente revisão visou apresentar uma abordagem crítica dos avanços metodológicos e experimentais referentes a modelos de cultura celular tridimensionais no âmbito do sistema gastrintestinal. Métodos: Foi realizada revisão da literatura com ênfase nos principais artigos publicados na área. Resultados principais: São apresentados trabalhos clássicos e resultados de maior impacto, desde os trabalhos pioneiros com organoides do sistema gastrintestinal, com intestino delgado, até a obtenção de guts-on-a-chip e multi-organ-chips. Discutiu-se, ainda, as implicações decorrentes da elaboração de tais co-culturas, bem como as futuras aplicações decorrentes dessas novas metodologias. Conclusões: Apesar do número ainda discreto de publicações, em termos quantitativos, há, qualitativamente, resultados promissores e consistentes abordando aspectos fisiopatológicos e de novas perspectivas terapêuticas em gastrenterologia decorrentes das culturas tridimensionais in vitro. É esperado, portanto, que essas novas abordagens metodológicas incluindo organoides e guts-on-a-chip possam contribuir decisivamente para o avanço no conhecimento sobre de aspectos básicos, bem como para a translação do conhecimento para novas abordagens terapêuticas em doenças gastrintestinais.

Síndromes linfoproliferativos gastrointestinales / Gastrointestinal lymphoproliferative syndrome

The gastrointestinal lymphoid system plays a relevant role. The daily and continuous interaction between gastrointestinal lymphocytes with food and intestinal microbes requires precise functioning. The pathologic spectrum of lymphocyte malfunction results in lymphomas. MALT lymphoma is the most frequently diagnosed lymphoma, but there are other lymphoproliferative diseases such as diffuse large B cell lymphoma, mantle cell lymphoma and T associated lymphoma. The gastroenterologist and the endoscopist need to know these diseases in detail to achieve early diagnosis and treatment.

El sistema linfoide de defensa abdominal tiene un relevante rol en el buen funcionamiento sistémico. La interacción diaria y continua con patógenos alimentarios y microbios comensales intestinales precisa un estrecho funcionamiento. Las alteraciones linfoides clonales favorecen el desarrollo de linfomas de diversos tipos. Si bien, el linfoma asociado a tejido linfoide de mucosas (MALT) es el más conocido en contexto de su asociación con Helicobacter pylori, el tracto gastrointestinal se puede ver afectado por otros linfomas como el linfoma difuso de células grandes B y linfomas indolentes como el linfoma folicular, el linfoma del manto y el linfoma T asociado a enteropatía. El gastroenterólogo y endoscopista precisan conocer en detalle estas entidades para un oportuno diagnóstico y adecuado tratamiento.

Compromiso gastrointestinal por Triypanosoma cruzi: ¿cuándo buscar y cuándo tratar? / Digestive involvement by Trypanosoma cruzi: when to look for it and when to treat

Chagas disease is an endemic zoonosis that can cause chronic medical complications in a third of those infected, usually decades after infection. It mainly affects the peripheral nervous system of heart, esophagus and colon. At digestive level, motor dysfunction leads to the development of megaesophagus and megacolon whose predominant symptoms are dysphagia and constipation. It should be suspected in patients with epidemiological history and compatible symptoms. In the chronic phase it is confirmed with the detection of specific antibodies. The etiological treatment is effective in early stages after infection. In the chronic stage the management is symptomatic, medical and/or surgical.

La enfermedad de Chagas es una zoonosis endémica que puede producir complicaciones médicas crónicas en un tercio de los infectados, habitualmente décadas luego de la infección. Afecta principalmente el sistema nervioso periférico de corazón, esófago y colon. A nivel digestivo la disfunción motora lleva a la formación de megaesófago y megacolon cuyos síntomas predominantes son disfagia y constipación. Debe sospecharse en pacientes con antecedentes epidemiológicos y síntomas compatibles. En la fase crónica se confirma con la detección de anticuerpos específicos. El tratamiento etiológico es efectivo en las fases tempranas post-contagio. En la etapa crónica el manejo es sintomático, médico y/o quirúrgico.

Signs and symptoms associated with digestive tract development / Sinais e sintomas associados com o desenvolvimento do trato digestivo

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.

El empacho: revisión de una enfermedad popular infantil chilena (1674-2014) / Empacho: an historical review of popular Chilean childhood disease (1674-2014)

El empacho, el mal de ojo, los aires, el susto o espanto, son las principales y más reconocidas enfermedades populares latinoamericanas. Sobre el empacho la información médica, histórica y etnográfica es extensa y profunda, pues existen documentos que la registran desde el siglo XVI hasta tiempos recientes (2014), y para el caso chileno lo encontramos desde 1674. Para esta revisión fueron consultadas 109 fuentes documentales procedentes de las principales bibliotecas del país e incluso foráneas. Se encontró que la enfermedad es conocida en todo el territorio. Se trata de un trastorno de vías digestivas ocasionado por excesos alimentarios y la ingesta de productos poco o nada digeribles que provocan alteraciones del tránsito gastrointestinal. Los datos clínicos sobresalientes son gastralgia, diarrea o estreñimiento, vómitos, fiebre y otros malestares. La enfermedad es tratada a nivel doméstico, y en caso necesario se emplean especialistas populares, con excepcional visita al médico académico. Los tratamientos son múltiples, complejos y combinados; abarcan desde productos herbolarios hasta elementos rituales, sin faltar la denominada «quebradura del empacho¼. Esta somera revisión del empacho en Chile permitirá al médico pediatra adentrarse al mundo de los saberes y prácticas populares con la finalidad de mejorar su atención a los pacientes infantes y sus acompañantes familiares, pero también inducir al estudio serio y sistemático sobre esta entidad nosológica que seguirá existiendo a través del tiempo.

«Empacho¼ (abdominal pain and bloating), «mal de ojo¼ (evil eye), «los aires¼ (illnesses said to be caught by catching draughts), «el susto¼ or «espanto¼ (fright or panic), are the principal and most well-known popular Latin American illnesses. As regards empacho, the medical, historical and ethnographic information is extensive and detailed, since there documents recording it from the 16th century until recent times (2014), and in the case of Chile since 1674. For this review, 109 source documents from libraries in Chile, including some foreign ones, were consulted. It was found that the illness is known all over the country. It is a digestive system disorder caused by over-eating and the ingestion of products difficult to digest or indigestible, which cause problems in gastrointestinal transit. The most significant clinical data are gastralgia, diarrhoea or constipation, vomiting, fever, and other discomforts. The illness is treated at home, and if necessary, popular specialists are employed, with a visit to a qualified doctor being exceptional. There are many complex and combined treatments, which go from herbal products to ritual elements, not forgetting the so-called «quebradura del empacho¼. This review summary of empacho in Chile should enable the paediatrician to enter the world of popular knowledge and practices with the aim of improving the care of child patients and their families. It should also lead to the serious and systematic study of this nosological condition that will continue to exist in the future.

Probiotics: an update / Probióticos: informações atualizadas

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

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