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Background/Aims@#An increase in postprandial intestinal gas plays a role in bloating symptoms. We aim to study the utility of spot breath hydrogen (H 2 ) level in predicting the response to a low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet. @*Methods@#Patients with functional gastrointestinal disorders diagnosed by Rome IV criteria with bothersome bloating for > 6 months were prospectively enrolled. Patients completed 7-day food diaries and collected a breath sample 2 hours after their usual lunch at baselineand 4 weeks after low FODMAPs dietary advice by a dietitian. The responder was defined as an improvement of ≥ 30% bloatingscores in the fourth week. @*Results@#Thirty-eight patients (32 female, 52.6 ± 13.8 years; 22 irritable bowel syndrome) completed the study. Twenty-one patients (55%) were classified as responders. Baseline global gastrointestinal symptoms, bloating, abdominal pain scores, and numbers of high FODMAPs items were similar between responders and non-responders. Both groups significantly decreased high FODMAPs items intake with similar numbers at the follow-up. The area under the curve for predicting low FODMAPs responsiveness using baseline H2 levels was 0.692 (95%CI, 0.51-0.86; P 8 parts per million vs 17% of non-responders (P < 0.05). The baseline spot hydrogen level in responders was 9.5 (3.3-17.3) vs 4.5 (3.3-6.3) in non-responders (P< 0.05). @*Conclusions@#A higher baseline breath hydrogen level was associated with bloating improvement after low FODMAPs dietary advice. A spot breath test after lunch, a simple point-of-care test, is possibly helpful in managing patients with bloating.
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Background: Currently, there is no standard recommendation of fluid resuscitation in dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). The types of fluid as initial choice for resuscitation are still questionable. It is important to review what type of fluid is used for clinical outcome improvement. Objective: To assess the effectiveness and safety of fluid for initial resuscitation of DSS in children. Methods: Randomized control trials (RCTs) of initial fluid resuscitation in 1-15 years-old DSS children were researched. Characteristics of the study (design, methods of randomization, and withdraws/dropouts), participants (age), intervention (type, dose and duration, and fluid after the ending of intervention), outcomes (types of outcome measures, timing, and adverse events), and results were extracted from three selected RCTs. Results: Moderate DSS had no significant difference between each type of crystalloids and colloids in volume of rescue colloid and pulse pressure recovery time (PPRT). In severe DSS, colloids had significantly less median PPRT than crystalloids. Additionally, no difference was found in the incidence of allergic reaction from all the RCTs in both moderate and severe DSS. Conclusion: In moderate DSS, there is no significant difference between crystalloids (Ringer’s lactate solution/normal saline solution) and colloids (dextran/hydroxyethyl starch/gelatin) in the initial fluid resuscitation. The decision in choosing the appropriate type of fluid depends on the physician’s judgment. Some data suggest colloids as the fluid of choice for the initial resuscitation in severe DSS, but there is no significant evidence to support this data. Moreover, any type of colloid is not significantly different from one another. The decision in choosing fluid also depends on the physician’s judgment.