Correlación entre los síntomas digestivos y los resultados de una prueba de hidrógeno en aliento en el diagnóstico de intolerancia a carbohidratos

Antecedentes: Las pruebas de hidrógeno en aliento (PHA) se utilizan para el diagnóstico de intolerancia a carbohidratos y sobrecrecimiento bacteriano intestinal. Objetivo: Determinar si existe una correlación entre la presencia e intensidad de los síntomas experimentados por el paciente tras la carga de carbohidrato y el resultado de la PHA. Materiales y métodos: Estudio observacional, retrospectivo y analítico en el cual se revisaron los expedientes con PHA realizadas en el Hospital San José TEC de Monterrey. Mediante una escala visual análoga se reportaron los síntomas y su intensidad presentados durante la PHA. Se realizó estadística descriptiva y para las pruebas de lactosa se calculó el coeficiente de correlación de Pearson entre la concentración máxima de hidrógeno y la intensidad de los síntomas (r). Resultados: 33 pacientes se sometieron a PHA: 23 de lactosa, 5 de fructosa y 5 de lactulosa. De estas, 10, 2 y 5 pruebas resultaron positivas, respectivamente. En las pruebas de lactosa, el síntoma más sensible fue la flatulencia (80%) con el coeficiente de probabilidad más alto (1,73). La diarrea tuvo la mayor especificidad (84,6%). Se observó una tendencia a positividad cuando los pacientes experimentaron síntomas. Se encontró una correlación moderadamente positiva entre las ppmh y la intensidad de los síntomas (r=0,472, p=0,023). Conclusiones: En los pacientes con intolerancia a la lactosa existe una correlación entre la intensidad de los síntomas y la positividad de la prueba de aliento. La presencia de flatulencia tras la carga de lactosa orienta a una prueba positiva.

Background: Hydrogen breath tests (HBT) are used to confirm the diagnosis of carbohydrate intolerance or small intestinal bacterial overgrowth (SIBO). Objective: Determine the existence of a correlation between the presence and intensity of symptoms experimented by the patient after the ingestion of a carbohydrate load and the test result. Materials and methods: This is an observational, retrospective and analytic study, in which all patients files from year 2008 to 2014 containing a report of a HBT performed at Hospital San José TEC de Monterrey were revised. Using a visual analogue scale (VAS), the patient reported the intensity of gastrointestinal symptoms during the test. Descriptive statistics were obtained, and exclusively for lactose HBTs, Pearsons correlation coefficient (r) between maximum hydrogen concentration in breath and symptom intensity was calculated. Results: A HBT was performed in 33 patients: 23 with lactose, 5 with fructose, and 5 with lactulose as substrate. Of these, 10, 2, and 5 tests were positive, respectively. For lactose HBTs, the symptom with most sensitivity was flatulence (80%), which also had the greatest likelihood ratio for a positive test (1.73). Diarrhea had the greatest specificity (84.6%). A tendency for positivity was observed when patients presented symptoms. A moderately positive correlation between hydrogen ppm and symptom intensity was found (r=0.427, p=0.023). Conclusions: A correlation between symptom intensity and test positivity was found in patients with lactose intolerance. The presence of flatulence after lactose loading may be indicative of a positive test.

Um ensaio randomizado duplo-cego e controlado por placebo com probióticos em casos de supercrescimento bacteriano no intestino delgado em crianças tratadas com omeprazol / A double-blind placebo-controlled randomized trial on probiotics in small bowel bacterial overgrowth in children treated with omeprazole

OBJETIVO: Avaliar a incidência de SBID em crianças tratadas com omeprazol e testar se os probióticos influenciam essa incidência. MÉTODOS: Um ensaio duplo-cego controlado por placebo foi realizado em 70 crianças tratadas oralmente, durante 4 semanas, com 20 mg de omeprazol por dia. Desses, 36 indivíduos receberam diária e simultaneamente Lactobacillus rhamnosus R0011 (1,9 x 10(9) cfu) e Lactobacillus acidophillus R0052 (0,1 x 10(9) cfu) (grupo probiótico), enquanto 34 receberam placebo (grupo placebo). O diagnóstico de SBID teve como base o desenvolvimento de sintomas sugestivos em combinação com um teste respiratório com glicose positivo. RESULTADOS: Após um mês de tratamento com IBP, 30% (21/70) apresentaram um teste respiratório positivo sugerindo SBID; desses, 62% foram sintomáticos. Cinco crianças desenvolveram sintomas parecidos com os de SBID, mas apresentaram um teste respiratório negativo; 44 (63%) não apresentavam sintomas e tiveram teste respiratório negativo. Não houve diferença na incidência de testes respiratórios positivos no grupo probiótico em comparação ao grupo placebo (33% em comparação a 26,5%; p: 0,13). CONCLUSÕES: Como houve sintomas sugestivos de SBID em 26% das crianças tratadas com IBP e o teste respiratório com glicose deu resultados anormais em 72% delas, esse efeito colateral deve ser levado em consideração com mais frequência. O probiótico testado não reduziu o risco de desenvolver SBID.

OBJECTIVE:To evaluate the incidence of small bowel bacterial overgrowth (SBBO) in children treated with omeprazole, and to test whether probiotics influence the incidence. METHODS: A double-blinded, placebo-controlled trial was performed in 70 children treated orally during four weeks with 20 mg omeprazole per day. Lactobacillus rhamnosus R0011 (1.9 x 10(9) cfu) and Lactobacillus acidophillus R0052 (0.1 x 10(9) cfu) were simultaneously given daily to 36 subjects (probiotic group), while 34 subjects received placebo (placebo group). The diagnosis of SBBO was based on the development of suggestive symptoms, in combination with a positive glucose breath test. RESULTS: After one month of proton pump inhibitor (PPI) treatment, 30% (21/70) had a positive breath test suggesting SBBO; of these 62% were symptomatic. Five children developed SBBO-like symptoms, but had a negative breath test; and 44 (63%) were symptom free and had a negative breath test. There was no difference in the incidence of positive breath tests in the probiotic versus the placebo group (33% vs 26.5%; p = 0.13). CONCLUSIONS: Since symptoms suggesting SBBO developed in 26% of PPI-treated children, and since the glucose breath test was abnormal in 72% of these, this side-effect should be more frequently considered. The probiotic tested did not decrease the risk to develop SBBO.

Síndrome do intestino irritável - diagnóstico e tratamento / Irritable bowel syndrome - diagnosis and treatment

Síndrome do Intestino Irritável (SII) é um transtorno funcional crônico do tubo digestivo, caracterizado pela presença de dor e/ou desconforto abdominal associados à alteração do hábito intestinal ou à modificação das características das evacuações. A sua etiologia permanece desconhecida, mas provavelmente é multifatorial. A prevalência estimada da SII na população geral é de 10 a 20%, acometendo predominantemente mulheres entre 20 e 40 anos. O diagnóstico é feito baseado na sintomatologia predominante, adotando-se critérios clínicos bem estabelecidos (Roma III). O tratamento visa aliviar o sintoma predominante. Os antiespasmódicos representam as drogas de primeira escolha para o alívio da dor e do desconforto abdominal. Os antidepressivos tricíclicos têm se mostrado superiores ao placebo para os pacientes com SII e predomínio de diarreia, e a loperamida é eficaz em reduzir a frequência das evacuações nestes casos. Para os pacientes com SII e predomínio de constipação ou forma mista, as fibras solúveis representam a primeira opção. Probióticos e novos serotoninérgicos representam outras opções terapêuticas promissoras. Relatamos o caso de uma paciente do sexo feminino portadora de SII com diarreia predominante.

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract, characterized by abdominal pain and change in bowel habit, with a fluctuating natural history. The exact etiology remains unknown, but it is unlikely there is a single unifying explanation. IBS affects 10-20% of the general population, with women 20-40 years old accounting for the majority of patients. The diagnosis should be made on clinical grounds, using Rome III diagnostic criteria. The clinical approach is based on treatment of the prevalent symptom. When pain predominates, antispasmodics are the first choice. Tricyclic antidepressants are more effective than placebo for patients with diarrhea predominant IBS, and loperamide is useful for reducing bowel frequency in this patients. Soluble fiber represents the first option in subjects with IBS and constipation or mixed IBS. Dietary integrators composed of probiotics and serotonin precursors are a promising therapeutic option. We report a case of a female patient with IBS-diarrhea predominant.

44 años de avances en Etiopatogenia, Diagnóstico y Tratamiento del Síndrome Flatulencia / Forty-four years of advances in pathogenesis, diagnosis and treatment of Flatulence Syndrome

En el presente artículo, el autor recuerda trabajos de investigación realizados, desde hace cuarenticuatro años, para aclarar la etiopatogenia y mejorar el diagnóstico y tratamiento del síndrome flatulencia.

In the present paper, the author reminds investigations performed, since forty-four years ago, to clarify the ethiopathogenesis and to improve the diagnosis and treatment of the flatulence syndrome.

Grandes síndromes gastrointestinales (3): flatulencia (2) / Gastrointestinal syndromes (3): flatulence (2)

Esta segunda parte del artículo sobre flatulencia toca aspectos sobre la etiopatogenia, diagnóstico y tratamiento del síndrome.

The second part of the article on flatulence reviewed aspects of the pathogenesis, diagnosis and treatment of this syndrome.

Phaseolus vulgaris bioprocesada: una nueva alternativa al consumo de leguminosas / Bioprocesed phaseolus vulgaris: a new alternative to legume consumption

Las leguminosas constituyen una importante fuente de proteínas en los países subdesarrollados, sin embargo, suconsumo está limitado entre otras razones, por la flatulencia que se produce después de su ingesta. Los compuestos altamente fermentables en el colón y responsables de este fenómeno, son los a-galactósidos, la fibra soluble y el almidón resistente. El objetivo de este trabajo fue evaluar el efecto de la aplicación de bioprocesos, tales como la hidrólisis enzimática y la fermentación, sobre los compuestos productores de flatulencia en la variedad oscura Tacarigua de Phaseolus vulgaris. Adicionalmente, se midió el efecto de la cocción, sobre la concentración de los factores flatulentos de los granos ya fermentados. Se encontró que la fermentación natural reduce totalmente los a-galactosidos y en un 80 por ciento la fibra soluble presente en los granos. El almidón resistente no es afectado por los bioprocesos; solo disminuye entre 63 por ciento y 70 por ciento por acción de los procesos térmicos. La hidrólisis enzimática resultó ser el método menos efectivo para disminuir los compuestos flatulentos. Se concluyó que la fermentación natural es la metodología más sencilla y efectiva para disminuir los compuestos productores de flatulencia y que el proceso de cocción que se aplica al grano previo a su consumo, no modifica los efectos de la fermentación.

Legumes are an important source of vegetable protein in undeveloped countries; nevertheless, their consumption is limited, for the flatulence they produce among other factors. In the colon the highly fermentable compounds of Phaseolus vulgaris and responsible for the flatulence are the a-galactosides, soluble fiber and resistant starch. The objective of this work was to evaluate the effect of bioprocesses, like enzymatic hydrolysis and fermentation on the flatulent compounds of a black variety Tacarigua of Phaseolus vulgaris . Additionally, the effect of cooking, a necessary process to make beans edible, on the flatulence compounds of the fermented beans was evaluated. It was found that the natural fermentation decrease totally the ¦Á-galactosides and partially (80%) the soluble fiber in beans. Resistant starch was not affected by the bioprocesses; it decreases from 63% to 70% with the thermic process. Enzymatic hydrolysis was the worst method to diminish the flatulent compounds. It was concluded that the natural fermentation is the easiest and most effective method to decrease the flatulence compounds. The cooking required to make beans edible does not affect the fermentation effect on the flatulence factors of beans.