RESUMO
Context Celiac disease is an autoimmune disorder of the small intestine associated with several extra-intestinal features, such as reproductive disorders. The relationship between celiac disease and infertility has been previously assessed, with conflicting results. Objectives We seek to determine the relationship between celiac disease and infertility. Methods Data was extracted from case-control or cohort design studies from 1966 to December 2013 using the MEDLINE-Pubmed, EMBASE, LILACS and Cochrane Library databases. We analyzed two kinds of trials: those assessing the risk of infertility in subjects with already diagnosed celiac disease, and those evaluating the prevalence of undiagnosed celiac disease in subjects with a diagnosis of infertility. Results The search yielded 413 potentially relevant studies for revision, 12 of which were finally included for analysis. A significant association was found between women with a diagnosis of infertility and undiagnosed celiac disease [OR 3.09 (95% CI 1.74-5.49)]. When considering those studies assessing the occurrence of infertility in subjects with already-diagnosed celiac disease, no difference was found between celiac disease patients and control subjects [OR 0.99 (0.86-1.13)]. Conclusions Undiagnosed celiac disease is a risk factor for infertility. Women seeking medical advice for this particular condition should be screened for celiac disease. Adoption of a gluten-free diet could have a positive impact on fertility in this group of patients. .
Contexto A doença celíaca é uma doença auto imune do intestino delgado associada a manifestações extra-intestinais, tais como distúrbios reprodutivos. A relação entre a doença celíaca e a infertilidade foi previamente avaliada, com resultados conflitantes. Objetivos Procuramos determinar a relação entre a doença celíaca e a infertilidade. Métodos Utilizou-se dados extraídos de estudos de projeto de caso-controle ou coorte de 1966 à dezembro de 2013 utilizando o MEDLINE-Pubmed, EMBASE, LILACS e Cochrane Library. Foram analisados dois tipos de ensaios: os que avaliam o risco de infertilidade em pacientes com doença celíaca já diagnosticados e, os que avaliam a prevalência da doença celíaca não diagnosticada em indivíduos com diagnóstico de infertilidade. Resultados A busca resultou em 413 estudos potencialmente relevantes para a revisão, 12 dos quais foram finalmente incluídos para análise. Foi encontrada uma associação significativa entre as mulheres com diagnóstico de infertilidade e doença celíaca não diagnosticada [TR 3,09 (IC 95% 1,74-5,49)]. Ao considerar esses estudos avaliando a ocorrência de infertilidade em pacientes com doença celíaca já diagnosticada, não foi encontrada diferença entre os pacientes com doença celíaca e controles [TR 0,99 (0,86-1,13)]. Conclusões A falta de diagnóstico para a doença celíaca é um fator de risco para a infertilidade. As mulheres que procuram o conselho médico para esta condição particular, devem ser examinados para a doença celíaca. A adoção de uma dieta sem glúten pode ter um impacto positivo sobre a fertilidade neste grupo de pacientes. .
Assuntos
Feminino , Humanos , Doença Celíaca/complicações , Infertilidade Feminina/etiologia , Estudos Observacionais como Assunto , Prevalência , Fatores de RiscoRESUMO
BACKGROUND AND AIMS: In a previous uncontrolled experiment, oral vancomycin improved the symptoms (S) of chronic constipation (CC). The aim of this 21 day controlled pilot study was to determine if a low lincomycin dose improved the S of CC patients unresponsive to a high fiber diet. METHODS: On days 0-to-10, patients were randomized to 500 mg oral lincomycin + high fiber (L + F) or to placebo + high fiber (P + F). Participants and patients were blinded. From days 10-to-21, patients were continued solely on the high fiber diet. The primary efficacy endpoint was the difference in S between L + F and P + F from days 0-to-21 using a visual analog scale (VAS) calibrated from 0 = severe S to 10 = asymptomatic. RESULTS: The means of all S were significantly improved by L + F but not by P + F. A significant higher proportion of L + F patients increased the VAS > or = 3 points. CONCLUSIONS: The initial course of L facilitated the effect of F probably by its effect on the colon flora. This sequence of flora-altering biologics + F may serve as model to replace chronic use of drugs.