ABSTRACT
El eructo es un síntoma frecuente en Pediatría que socialmente está mal considerado y puede tener consecuencias negativas en la calidad de vida del paciente. No obstante, no son muchas las publicaciones pediátricas al respecto. Según su origen, se pueden clasificar como eructos supragástricos o gástricos, con una fisiología distinta y que pueden ser síntomas de patologías subyacentes tanto físicas como psicológicas. Se revisa la fisiología del eructo y el diagnóstico diferencial a propósito de dos casos diagnosticados de eructos supragástricos.Caso clínico 1: varón de 14 años con cuadro de 15 días de eructos hasta 20-30 por minuto, sensación de imputación esofágica y dolor abdominal. El dolor mejora con omeprazol, pero los eructos persisten; se realiza endoscopia y tránsito esofágico superior que resultan normales. Mejora tras logopedia e inicio de técnicas de relajación.Caso clínico 2: varón de 10 años con cuadro de 19 días de eructos de más de 15 por minuto, sin otros síntomas digestivos, pero con sintomatología ansiosa. Mejoría tras tratamiento psicológico.Ambos tipos de eructo presentan una fisiología distinta, de manera que en el eructo supragástrico el aire no proviene del estómago. El esfínter esofágico inferior permanece cerrado. Los dos tipos son distinguibles mediante pH-impedanciometría. Conclusión: una cuidadosa anamnesis puede establecer el diagnóstico de sospecha del origen del eructo antes de recurrir a pruebas complementarias y permite orientar el tratamiento más adecuado para cada paciente. (AU)
Belching is a frequent symptom in paediatrics that is negatively perceived in our society and can have a negative impact on the quality of life of patients. However, there is a dearth of data on the subject for the paediatric population. Depending on the origin, belching can be classified as supragastric or gastric, has a different physiology and may be a manifestation of underlying physical or psychological disorders. We review the physiology of belching and the differential diagnosis of 2 cases of supragastric belching.Clinical case 1: male patient aged 14 years presenting with belching of 15 days duration at a rate of 20 to 30 burps per minute, sensation of oesophageal impaction and abdominal pain. The pain improved with omeprazole but the belching persisted, the findings of endoscopy and upper oesophageal transit were normal. The patient improved with speech therapy and initiation of relaxation techniques.Clinical case 2: male patient aged 10 years-old male presenting with belching of 19 days duration at a rate of more than 15 burps per minute, with no other digestive symptoms but with anxiety symptoms. The patient improved with psychological treatment.The underlying physiology of belching was different in each patient, as in supragastric belching the air does not come from the stomach and the lower oesophageal sphincter remains closed. These 2 types can be differentiated by pH-impedance. Conclusion: A careful anamnesis can establish the suspected diagnosis of the origin of the belching before resorting to diagnostic tests, and can guide the most appropriate treatment for each patient. (AU)
Subject(s)
Humans , Male , Child , Adolescent , Eructation/diagnosis , Eructation/psychology , Diagnosis, Differential , Endoscopy , Psychotherapy , Follow-Up StudiesABSTRACT
Introducción: Existen recomendaciones para la toma de decisiones ante padres que no vacunan a sus hijos, pero son escasas las publicaciones que analizan este problema. En noviembre de 2014, se inaugura una consulta pionera en España, sobre asesoramiento en vacunas. El objetivo principal es dedicar tiempo y exclusividad a los padres, aplicar las recomendaciones de la AAP y la AEP, y analizar el éxito de las mismas, según el número de padres que aceptan la vacunación. Pacientes y métodos: Estudio descriptivo, transversal, prospectivo y unicéntrico llevado a cabo en el periodo del 1 de noviembre de 2014 al 1 de marzo de 2016. Se incluyen menores de 16 años no correctamente vacunados según el calendario de la comunidad autónoma donde se realiza el estudio, tras la firma del consentimiento informado. Resultados: Veinte familias acudieron a la consulta. La edad mediana de los niños fue de 2 años. El 80% no tenía ninguna vacuna administrada. El 45% de los padres mostró rechazo absoluto a la vacunación. Los principales motivos para no vacunar fueron: 100% presencia de mercurio, 90% riesgo de desarrollar autismo, 85% presencia de aluminio, 70% presencia de estabilizantes y conservantes, y 65% riesgo de desarrollar anafilaxia. Al 90% de los padres les pareció útil la consulta. Un 90% aceptaron la vacunación (45% completa). Conclusiones: El convencimiento de la filosofía antivacunas es firme y difícil de cambiar. También es complicado que los pediatras no rechacen a los padres que ponen en riesgo la vida de sus hijos. El encuentro es posible y la sociedad lo necesita. Tiempo para escuchar, empatía y trasmisión de buena información han constituido las claves de nuestros resultados (AU)
Introduction: There are recommendations for decision-making as regards parents who do not vaccinate their children, but there are few publications analysing this problem. In November 2014, a pioneer medical clinic opened in Spain, for counselling on immunisation practices. The aim of this study is to determine the success of the recommendations of the American and Spanish Paediatrics Associations according to the number of parents who finally accept vaccination. Patients and methods: A descriptive, cross-sectional, prospective and single-centre study was conducted from November 2014 to March 2016. Children under the age of 16 not properly vaccinated, according to the immunisation schedule of the region where the study was conducted, were included after signing informed consent. Results: A total of 20 families were counselled. The median age of the children was 2 years, and 80% of them received no vaccine. Absolute non-acceptance of vaccination was practiced by 45% of parents. The main reasons for not vaccinating were: 100% thimerosal-containing, 90% risk of autism, 85% aluminium-containing, 70% presence of other stabilisers and preservatives, and 65% risk of anaphylaxis. The immunisation advice was said to be helpful by 90% of parents. Vaccination was accepted by 90% of parents (45% completely). Conclusions: Anti-vaccination ideologies are strong and hard to change. Paediatricians not denying medical care to parents who endanger the lives of their own children are also hard to find. The meeting point is possible, and society needs it. Active listening, empathy, and good quality information were the keys to our results (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Treatment Refusal/statistics & numerical data , Mass Vaccination/statistics & numerical data , Immunization Programs/statistics & numerical data , Parental Notification , Health Education/methods , Persuasive CommunicationABSTRACT
INTRODUCTION: There are recommendations for decision-making as regards parents who do not vaccinate their children, but there are few publications analysing this problem. In November 2014, a pioneer medical clinic opened in Spain, for counselling on immunisation practices. The aim of this study is to determine the success of the recommendations of the American and Spanish Paediatrics Associations according to the number of parents who finally accept vaccination. PATIENTS AND METHODS: A descriptive, cross-sectional, prospective and single-centre study was conducted from November 2014 to March 2016. Children under the age of 16 not properly vaccinated, according to the immunisation schedule of the region where the study was conducted, were included after signing informed consent. RESULTS: A total of 20 families were counselled. The median age of the children was 2 years, and 80% of them received no vaccine. Absolute non-acceptance of vaccination was practiced by 45% of parents. The main reasons for not vaccinating were: 100% thimerosal-containing, 90% risk of autism, 85% aluminium-containing, 70% presence of other stabilisers and preservatives, and 65% risk of anaphylaxis. The immunisation advice was said to be helpful by 90% of parents. Vaccination was accepted by 90% of parents (45% completely). CONCLUSIONS: Anti-vaccination ideologies are strong and hard to change. Paediatricians not denying medical care to parents who endanger the lives of their own children are also hard to find. The meeting point is possible, and society needs it. Active listening, empathy, and good quality information were the keys to our results.
