[Patient-Related Factors Affecting Bowel Preparation Prior to Colonoscopy.] / Factores relacionados al paciente que afectan la limpieza del colon previo a la colonoscopia.

INTRODUCTION: Colorectal cancer is a major health problem worldwide because it is the third most common cancer and the third leading cause of cancer mortality in western countries. Screening for colorectal cancer in asymptomatic patients is crucialfor reducing the incidence and colonoscopy is one of the methods of choice. The ability of colonoscopy in detecting small lesions is clearly influenced by the quality of the colonic preparation. OBJECTIVES: To know which are the variablesrelating to the patient and the type ofpreparation that affect the quality of colonic cleansing. MATERIALS AND METHODS: It was designed a cross-sectional study. It was administered a questionnaire for the enrolled subjects to assess the presence offactors that could affect the quality of colonic cleansing. Then they underwent a colonoscopy. The different variables between subjects with adequate or inadequate colonic cleansing were compared. RESULTS: We evaluated 277 subjects. In multivariate analysis the only variables that showed significant differences are split dose [OR 0.45 (0.21 to 0.99)] and age [OR 1.02 (1-1.05)]. Obesity showed no significant differences in multivariate analysis [OR 1.84 (0.9-3.78)]. CONCLUSIONS: Age and split-dose were the only variables significantly associated with the quality of bowel preparation prior to colonoscopy. Not so constipation or the presence ofdiverticula, so these patients do not require special preparation regimes.

HELICOBACTER PYLORI PREVALENCE IN PATIENTS WITH CELIAC DISEASE: results from a cross-sectional study.

BACKGROUND: Some previously published studies have suggested an inverse relationship between celiac disease and Helicobacter pylori, raising the possibility of the protective role Helicobacter pylori could have against celiac disease development. Nevertheless, this association is inconclusive. OBJECTIVES: To determine the prevalence of Helicobacter pylori infection in celiac subjects. METHODS: Between January 2013 and June 2014, patients over 18 years old undergoing upper endoscopy who required both gastric and duodenal biopsies were included for analysis. Enrolled subjects were divided in two groups: those with a diagnosis of celiac disease and those without a celiac disease diagnosis. Helicobacter pylori infection prevalence was compared between groups. Among celiac patients, endoscopic markers of villous atrophy as well as histological damage severity were compared between those with and without Helicobacter pylori infection. RESULTS: Overall, 312 patients were enrolled. Seventy two of them had a diagnosis of celiac disease. Helicobacter pylori infection prevalence among celiac disease patients was 12.5%, compared to 30% in non-celiac patients [OR=0.33 (0.15-0.71)]. There was not a significant difference in terms of the severity of villous atrophy in patients with Helicobacter pylori infection compared to those without it. There was a slight increase in the prevalence of endoscopic markers in those Helicobacter pylori-negative celiac subjects. CONCLUSION: Helicobacter pylori infection seems to be less frequent in celiac patients; among those celiac subjects with concomitant Helicobacter pylori infection, histological damage degree and presence of endoscopic markers suggesting villous atrophy seem to be similar to those without Helicobacter pylori infection.

HELICOBACTER PYLORI PREVALENCE IN PATIENTS WITH CELIAC DISEASE: results from a cross-sectional study / Prevalência do Helicobacter pylori em pacientes com doença celíaca: resultados de um estudo transversal

Background Some previously published studies have suggested an inverse relationship between celiac disease and Helicobacter pylori, raising the possibility of the protective role Helicobacter pylori could have against celiac disease development. Nevertheless, this association is inconclusive. Objectives To determine the prevalence of Helicobacter pylori infection in celiac subjects. Methods Between January 2013 and June 2014, patients over 18 years old undergoing upper endoscopy who required both gastric and duodenal biopsies were included for analysis. Enrolled subjects were divided in two groups: those with a diagnosis of celiac disease and those without a celiac disease diagnosis. Helicobacter pylori infection prevalence was compared between groups. Among celiac patients, endoscopic markers of villous atrophy as well as histological damage severity were compared between those with and without Helicobacter pylori infection. Results Overall, 312 patients were enrolled. Seventy two of them had a diagnosis of celiac disease. Helicobacter pylori infection prevalence among celiac disease patients was 12.5%, compared to 30% in non-celiac patients [OR=0.33 (0.15-0.71)]. There was not a significant difference in terms of the severity of villous atrophy in patients with Helicobacter pylori infection compared to those without it. There was a slight increase in the prevalence of endoscopic markers in those Helicobacter pylori-negative celiac subjects. Conclusion Helicobacter pylori infection seems to be less frequent in celiac patients; among those celiac subjects with concomitant Helicobacter pylori infection, histological damage degree and presence of endoscopic markers suggesting villous atrophy seem to be similar to those without Helicobacter pylori infection. .

Contexto Alguns estudos publicados anteriormente sugerem uma relação inversa entre a doença celíaca e Helicobacter pylori, levantando a possibilidade do papel protetor que o Helicobacter pylori poderia ter contra o desenvolvimento de doença celíaca. No entanto, esta associação é inconclusiva. Objetivos Determinar a prevalência da infecção por Helicobacter pylori em indivíduos celíacos. Métodos Entre janeiro de 2013 e de 2014 junho, foram incluídos para análise pacientes com mais de 18 anos de idade submetidos a endoscopia para necessárias biópsias gástricas e duodenais. Os pacientes foram divididos em dois grupos: aqueles com diagnóstico de doença celíaca e aqueles sem um diagnóstico de doença celíaca. A prevalência da infecção por Helicobacter pylori foi comparada entre os grupos. Entre os pacientes celíacos, os marcadores endoscópicos de atrofia das vilosidades, bem como a gravidade do dano histológico foram comparados entre aqueles com e sem infecção pelo Helicobacter pylori. Resultados De um total de 312 pacientes, 72 deles tiveram diagnóstico da doença celíaca. A prevalência de infecção pelo Helicobacter pylori entre pacientes com doença celíaca foi de 12,5%, em comparação com 30% em pacientes não-celíacos [OR=0,33 (0,15-0,71)]. Não houve diferença significativa em termos da gravidade da atrofia das vilosidades em pacientes com infecção pelo Helicobacter pylori em comparação com aqueles sem ele. Houve um ligeiro aumento na prevalência de marcadores endoscópicos nos indivíduos celíacos com Helicobacter pylori-negativo. Conclusão A infecção pelo Helicobacter pylori parece ser menos frequente em pacientes celíacos; entre esses indivíduos celíacos com concomitante infecção por Helicobacter pylori, o grau de dano histológico e a presença de marcadores endoscópicos sugerindo atrofia vilosa, parecem ser semelhantes com os sem infecção. .

[Influence of proton pump inhibitors on intestinal fermentative profile: a case-control study]. / Impacto del uso de inhibidores de la bomba de protones sobre el perfil fermentativo intestinal: Un estudio de tipo caso-control.

INTRODUCTION: Proton pump inhibitors could have an impact on the results of breath tests performed in patients with irritable bowel syndrome. This impact could be due to the development of small intestine bacterial overgrowth. OBJECTIVE: To compare the prevalence of fermentative profile alterations of irritable bowel syndrome patients exposed and not-exposed to proton pump inhibitor therapy. MATERIAL AND METHODS: Subjects with irritable bowel syndrome were enrolled. A validated questionnaire assessing symptom severity as well as proton pump inhibitor treatment was delivered. A lactulose breath test was undertaken by each enrolled subject. Fermentative profile (area under the curve of hydrogen excretion/time) was compared between proton pump inhibitors consumers and non-consumers. Furthermore, small intestine bacterial overgrowth prevalence was compared. RESULTS: Two hundred and twenty five patients were enrolled. No significant differences were found on the fermentative profile between groups [AUC mediana 3,776 (rango 2,124-5,571) vs 4,347 (rango 2,038-5,481), P = 0.3]. Small intestine bacterial overgrowth prevalence was similar as well [33% vs 27.5%]. These differences remained non-significant after adjusting for proton pump inhibitor dose and treatment time. Surprisingly, symptom score was significantly higher in those patients under proton pump inhibitor therapy [28.5 (23-26) vs 23 (15-29), P = 0.01]. CONCLUSION: Proton pump inhibitors have no significant influence on lactulose breath tests, regardless of the dosage and time of administration.

[Predominance of constipation in subjects with hydrogen-consuming intestinal flora]. / Tendencia al estreñimiento en sujetos que presentan predominio de microorganismos intestinales consumidores de hidrógeno.

INTRODUCTION: There is growing evidence that a disorder in intestinal microbiota would contribute to the development of symptoms in irritable bowel syndrome (IBS) patients. In a subgroup, a remarkably low hydrogen production in lactulose breath test (LBT) is observed. We presume in these patients a predominance of hydrogen consuming gut flora. OBJECTIVE: [corrected] Describe the clinical presentation of lBS patients with low hydrogen production and to compare their cathartic pattern against those with high hydrogen excretion. MATERIALS AND METHODS: A case-control study was designed. IBS outpatients were included. A validated questionnaire was delivered (IBSSS) in order to assess their symptoms and a LBT was performed. The cathartic pattern was compared between those with low and high hydrogen production on LBT. RESULTS: One hundred and ten patients were included and 15 of them (13.6%) had low hydrogen production on LBT, which would be compatible with the presence of hydrogen-consuming gut flora. In this group, 11 patients (73.33%) were constipated In contrast, only 30 patients (31.58%) in the high or normal hydrogen production group were constipated [OR 5.95 (95% confidence interval 1.75-20.25; P = 0.03)]. CONCLUSION: IBS patients with low hydrogen production on lactulose breath test were 6 times more frequently constipated.

[Variation of intestinal fermentative profile after sequential therapy with rifaximin/probiotics]. / Variaciones del perfil fermentativo intestinal frente al uso de un esquema terapéutico secuencial: rifaximina/probiótico.

INTRODUCTION: There is evidence suggesting that intestinal microbiota plays a role in the development of irritable bowel syndrome. Its activity can be indirectly assessed using the lactulose breath test. Antibiotics like rifaximin or probiotics can be used as therapeutic options for patients with irritable bowel syndrome. Our purpose was to evaluate the efficacy of a sequential treatment with rifaximin and probiotics in these patients. MATERIAL AND METHODS: We prospectively evaluated patients with diagnosis of irritable bowel syndrome according to Rome III criteria. Included patients had to fill in a questionnaire in order to assess their symptoms severity. A lactulose breath test was also performed in each case and a curve with the results of hydrogen concentration and time was elaborated. Then, the area under the curve was calculated After initial evaluation, patients received a seven-day treatment with rifaximin, followed by a ten-day course of probiotics. Thirty days after completion of treatment a new lactulose breath test along with a questionnaire were performed. RESULTS: We included 15 patients and 93% experienced a significant improvement of their symptoms as well as a significant reduction of the lactulose breath test values. CONCLUSION: Sequential treatment with rifaximin/probiotics seems to be effective for symptom and fermentative profile improvement in irritable bowel syndrome patients.

[Symptomatic correlation variables in patients with pathological gastroesophageal reflux disease]. / Variables de correlación sintomática en pacientes con reflujo gastroesofágico patológico.

UNLABELLED: INTRODUCTION. There are three indexes that correlate symptoms and reflux episodes in pHmetry tests. The utility of these indexes have been evaluated in prospective trials but their advantages and disadvantages remain controversial. OBJECTIVE: To assess the clinical utility of the pHmetric symptomatic correlation indexes in patients with pathological acid reflux. MATERIAL AND METHODS: A sequential pilot study of pHmetry tests was performed between September 2008 and June 2010. Twenty patients with gastroesophageal reflux and a DeMeester score above 14.5 were included. For the analysis, a distinction was made between strong acid reflux episodes (pH < 4) and weak acid reflux episodes (pH < 7 and > 4). The following indexes were calculated for both groups mentioned before: symptom index (SI), symptom sensitivity index (SSI) and symptom association probability (SAP). RESULTS: The mean age was 54 and 55% of patients were male. There were 116 symptomatic episodes (mean 5.8 per patient), 1,634 strong acid reflux episodes and 555 weak acid reflux episodes. Twelve (60%) had positive SI for strong acid reflux. Twelve had positive SSI for strong acid reflux and 91.66% of them had positive SI. Only 4 patients had a positive SAP. Only 2 patients had a positive SI for weak acid reflux and none of them had either a positive SI for strong acid reflux or a positive SAP for weak acid reflux. Finally, 30% of patients had a positive SSI for weak acid reflux. CONCLUSION: Positive correlation was significantly higher in strong acid rather than in weak acid reflux. SAP was the index with the lowest percentage of positivity. On the other hand, there was a high concordance between SI and SSI. Thus, the PAS index does not seem to have enough clinical utility in this cohort of patients.

[Frequency of bacterial overgrowth in patients with clinical lactose intolerance]. / Frecuencia de sobrecrecimiento bacteriano en pacientes con intolerancia clínica a la lactosa.

INTRODUCTION: Some patients complain of digestive symptoms related to diary products intake. This intolerance could be associated with an intestinal bacterial overgrowth or an increased fermentative intestinal profile and not due to lactose malabsorption. OBJECTIVE: To estimate the prevalence of bacterial overgrowth in subjects with digestive symptoms related to diary products intolerance. MATERIAL AND METHODS: Patients who had performed hydrogen breath test due to chronic functional distension syndrome (Rome III) were analyzed. Thirty of them (22 female, average age 52 years) complained of symptoms related to diary products intake. All subjects completed a nutritional survey that allowed to assess the degree of tolerance to milk products and performed the hydrogen breath test with lactulose as substrate. Bacterial overgrowth was considered when baseline values were over 15 parts per million (ppm), values before 80 minutes were greater than 20 ppm or values of area under the curve were greater than 3,000 ppm/min in the 180 studied minutes. RESULTS: Fifty four patients were analyzed. Thirty of them showed moderate, important or severe clinical milk intolerance. Of these patients, 23 (77%), had a positive breath hydrogen test according to used criteria. CONCLUSIONS: The prevalence of small bowel bacterial overgrowth or an increased fermentative intestinal profile among individuals who complain of symptoms related to diary products is high and this fact should be considered in order to avoid empirical restrictive diets.

[Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study]. / Eficacia comparativa de un probiótico vs un antibiótico en la respuesta clínica de pacientes con sobrecrecimiento bacteriano del intestino y distensión abdominal crónica funcional: un estudio piloto.

INTRODUCTION: Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibiotics. Certain probiotics have proved to be clinically effective in patients with abdominal distension. OBJECTIVE: To compare the short-term clinical efficacy of metronidazol vs. a probiotic in patients with SIBO and functional chronic abdominal distension. Patients and methods. This was a randomized prospective pilot study. The study population consisted of 50 patients with chronic abdominal distension (Rome III criteria) and diagnosis of SIBO made by a lactulose H2 breath test. Patients were consecutively randomized to receive either metronidazol or a probiotic. The metronidazol group consisted of 25 subjects (23 women, median age 49 +/- 19 years old), who received metronidazol (Flagyl), 500 mg bid for 5 days. The probiotic group consisted of 25 subjects (20 women, median age 58 +/- 19 years old). The probiotic administered to the latter group contained Lactobacillus casei (3.3 x 10(7) UFC), Lactobacillus plantarum (3.3 x 10(7) UFC), Streptococcus faecalis (3.3 x 10(7) UFC) and Bifidobacterium brevis (1.0 x 10(6) UFC) (Bioflora) and 5 ml bid were administered for 5 days. Both groups went on the same diet, which consisted in reduced consumption of alcohol, legumes, dairy products and leafy green vegetables. Response to treatment was assessed by an independent questioner 15 days post treatment. A five-level overall response questionnaire was used. Responses included much better, better, the same, worse, and much worse. Better and much better were considered positive responses. RESULTS: Thirteen (52%) subjects receiving metronidazol and 20 (82%) receiving the probiotic referred clinical improvement after the treatment. A statistically significant difference favoured the use of the probiotic (P = 0.036). All the study patients completed treatment. No adverse events leading to treatment discontinuation were observed. CONCLUSIONS: Based on this pilot study results, we can suggest that the probiotic herein used has a higher efficacy than metronidazol in the early clinical response of patients with chronic abdominal distension and SIBO.

[Breath hydrogen levels do not predict fiber intolerance in irritable bowel syndrome with constipation]. / El incremento del hidrógeno en el aire espirado no predice la intolerancia a la fibra en la dieta en el síndrome del intestino irritable con constipación. Estudio piloto.

BACKGROUND: Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. AIM: To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. PATIENTS AND METHODS: 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. RESULTS: Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant deferent. Neither was possible to establish an association between breath H2 and the clinical response to a fiber diet. CONCLUSIONS: In this pilot study we could not detect ary association between breath H2 levels and the clinical response to dietary fiber.

[Clinical-phmetric variants in gastroesophageal reflux disease]. / Variantes clínico-phmétricas en la enfermedad por reflujo gastroesofágico.

BACKGROUND: Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. AIM: To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. PATIENTS AND METHODS: [corrected] During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologic acid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR). RESULTS: 18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P = 0.0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and probably they should be evaluated and treated in a different way.

Variantes clínico-phmétricas en la enfermedad por reflujo gastroesofágico / Clinical-phmetric variants in gastroesophageal reflux disease

En los estudios ambulatorios de pH esofágico, al considerer solo las caídas de pH por debajo de 4, no se detectan los episodios de reflujo débilmente ácidos que coinciden, a veces, con la ocurrencia de síntomas. Objetivo: Establecer la incidencia de las variantes clínico-phmétricas que permiten confirmar o descartar la presencia de reflujo astroesofágico ácido y su correlación sintomática. Pacientes y método: Durante 12 meses, 100 pacientes (58 hombres y 42 mujeres) fueron incluidos en forma consecutiva para estudio prolongado del pH esofágico. Las variables consideradas fueron: número de episodios sintomáticos durante elestudio, número de episodios con correlación sintomática positiva para caídas de pH mayor de 4, número de episodios con correlación sintomática positiva para episodios con caída de pH menor de 4 y puntaje de Demeester. Los pacientes se clasificaron operativamente en seis grupos: Sin evidencias de reflujo ácido (SRGE), reflujo ácido patológico hipoalgésico (RPHO), reflujo ácido patológico normoalgésico (RPNO), reflujo acido patológico hiperalgésico (RPHP), reflujo acido fisiológico hiperalgésico (RFHP) y reflujo acido fisiológico alodínico (RFAL). Resultados: 18% presentaron SRGE, 7% RPHO, 36% RPNO, 14% RPHP, 18% RFHP y 7% RFAL. Los pacientes con reflujo ácido patológico presentaron mayor número de episodios con correlación sintomática positiva que los pacientes con ausencia de reflujo patológico(P=0,0008). En base a la intensidad del reflujo ácido y a la presencia o ausencia de correlación sintomática, se diferenciaron seis grupos de pacientes con enfermedad por reflujo que posiblemente deban ser tratados y seguidos de modo diferente.

Background: Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. Aim: To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. Patents and methods: During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologicacid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR). Results: 18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P=0,0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and pbably they should be evaluated and treated in a different way.

Variantes clínico-phmétricas en la enfermedad por reflujo gastroesofágico / Clinical-phmetric variants in gastroesophageal reflux disease

En los estudios ambulatorios de pH esofágico, al considerer solo las caídas de pH por debajo de 4, no se detectan los episodios de reflujo débilmente ácidos que coinciden, a veces, con la ocurrencia de síntomas. Objetivo: Establecer la incidencia de las variantes clínico-phmétricas que permiten confirmar o descartar la presencia de reflujo astroesofágico ácido y su correlación sintomática. Pacientes y método: Durante 12 meses, 100 pacientes (58 hombres y 42 mujeres) fueron incluidos en forma consecutiva para estudio prolongado del pH esofágico. Las variables consideradas fueron: número de episodios sintomáticos durante elestudio, número de episodios con correlación sintomática positiva para caídas de pH mayor de 4, número de episodios con correlación sintomática positiva para episodios con caída de pH menor de 4 y puntaje de Demeester. Los pacientes se clasificaron operativamente en seis grupos: Sin evidencias de reflujo ácido (SRGE), reflujo ácido patológico hipoalgésico (RPHO), reflujo ácido patológico normoalgésico (RPNO), reflujo acido patológico hiperalgésico (RPHP), reflujo acido fisiológico hiperalgésico (RFHP) y reflujo acido fisiológico alodínico (RFAL). Resultados: 18% presentaron SRGE, 7% RPHO, 36% RPNO, 14% RPHP, 18% RFHP y 7% RFAL. Los pacientes con reflujo ácido patológico presentaron mayor número de episodios con correlación sintomática positiva que los pacientes con ausencia de reflujo patológico(P=0,0008). En base a la intensidad del reflujo ácido y a la presencia o ausencia de correlación sintomática, se diferenciaron seis grupos de pacientes con enfermedad por reflujo que posiblemente deban ser tratados y seguidos de modo diferente.(AU)

Background: Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. Aim: To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. Patents and methods: During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologicacid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR). Results: 18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P=0,0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and pbably they should be evaluated and treated in a different way. (AU)

Variantes clínico-phmétricas en la enfermedad por reflujo gastroesofágico / Clinical-phmetric variants in gastroesophageal reflux disease

En los estudios ambulatorios de pH esofágico, al considerer solo las caídas de pH por debajo de 4, no se detectan los episodios de reflujo débilmente ácidos que coinciden, a veces, con la ocurrencia de síntomas. Objetivo: Establecer la incidencia de las variantes clínico-phmétricas que permiten confirmar o descartar la presencia de reflujo astroesofágico ácido y su correlación sintomática. Pacientes y método: Durante 12 meses, 100 pacientes (58 hombres y 42 mujeres) fueron incluidos en forma consecutiva para estudio prolongado del pH esofágico. Las variables consideradas fueron: número de episodios sintomáticos durante elestudio, número de episodios con correlación sintomática positiva para caídas de pH mayor de 4, número de episodios con correlación sintomática positiva para episodios con caída de pH menor de 4 y puntaje de Demeester. Los pacientes se clasificaron operativamente en seis grupos: Sin evidencias de reflujo ácido (SRGE), reflujo ácido patológico hipoalgésico (RPHO), reflujo ácido patológico normoalgésico (RPNO), reflujo acido patológico hiperalgésico (RPHP), reflujo acido fisiológico hiperalgésico (RFHP) y reflujo acido fisiológico alodínico (RFAL). Resultados: 18% presentaron SRGE, 7% RPHO, 36% RPNO, 14% RPHP, 18% RFHP y 7% RFAL. Los pacientes con reflujo ácido patológico presentaron mayor número de episodios con correlación sintomática positiva que los pacientes con ausencia de reflujo patológico(P=0,0008). En base a la intensidad del reflujo ácido y a la presencia o ausencia de correlación sintomática, se diferenciaron seis grupos de pacientes con enfermedad por reflujo que posiblemente deban ser tratados y seguidos de modo diferente.(AU)

Background: Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. Aim: To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. Patents and methods: During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologicacid reflux (HyPAR), allodinic pathologic reflux (APR), hyperalgesic physiologic acid reflux (HyPhAR) and allodynic physiologic acid reflux (APhAR). Results: 18% presented WAR, 7% HPAR, 36% NPAR, 14% HyPAR, 18% HyPhAR and 7% APhAR. The patients with pathologic acid reflux presented more episodes with positive symptomatic correlation than patients without pathologic reflux (P=0,0008). Based on acid reflux intensity and presence or absence of symptomatic correlation, six groups of patients with gastroesophageal reflux disease were differentiated, and pbably they should be evaluated and treated in a different way. (AU)