Two types of irritable bowel syndrome: pathophysiologic and pharmacological considerations / Dos tipos del síndrome de intestino irritable: consideraciones patofisiológicas and farmacológicas

The investigation performed in 18 diarrheid and 24 spastic patients showed adrenal glands hyperactivity in the former and hypoactivity in the latter. The central noradrenergic system was unresponsive to glucose in both groups: probably due to glucose-insulin failure to rise in diarrheics, whereas a hyperactive parasympathetic system may have been resposible in spactics. Diarrheics had the lowest sigmoidal tone with rectal hyperactivity and the highest plasma catecholamines + cortisol + glucose + insulin values. Spastic patients, in turn, had the highest sigmoidal tone and the lowest catecholamine values. Plasma glucose, insulin, platelet serotocin and sigmoidal tone rose in spactics, after glucose ingestion, but failed to do so in diarrheics. Further, in spactic patients, sigmoidal tone correlated positively with platelet serotonin and negatively with noradrenaline. The clonidine test showed hyperresponsivenes of growth hormone, cortisol and diastolic blood pressure in diarrheics, compared to a normal response in spastics, alpha-adrenergic antagonists suppressed diarrhea and renal hiperactivity. Alpha adrenergic agonists (wich also deplete plattelet-and myentericplexa serotonin) reduced signoidal tone to zero, increased rectal activity and provoked diarrhea. These findings suggest that peripheral sympathetic activity (prevalent in diarrheics) and hyperparasympathetic activity (prevalent in spactics) trigger these physiological disorders by respectively suppressing and reinforcing the serotonin-plexa level functioning

Clonidine treatment of acute pancreatitis: report of five cases

Reportamos cinco casos consecutivos de pacientes con pancreatitis aguda, resistente a la terapia convencional, quienes mejoraron dramáticamente con clonidina. Todos los pacientes presentaban niveles plasmáticos muy elevados de noradrenalina, adrenalina y cortisol (indicadores biológicos de estrés, los cuales cayeron bruscamente en cuanto se inició tratamiento con clonidina. Cuando se les practicó el test de clonidina, todos los pacientes tuvieron una hiper-respuesta, lo cual es compatible con situaciones de desadaptación al estrés