Localized gastrointestinal amyloidosis presenting with protein-losing enteropathy and massive hemorrhage

Amyloidosis of the gastrointestinal tract is usually a systemic disease. Localized gastrointestinal amyloidosis without evidence of extraintestinal involvement or an associated plasma cell dyscrasia is uncommon and does not usually cause death. We report a case of a patient with localized gastrointestinal amyloidosis who presented with protein-losing enteropathy and a fatal upper gastrointestinal bleed (AU)

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Localized gastrointestinal amyloidosis presenting with protein-losing enteropathy and massive hemorrhage.

Amyloidosis of the gastrointestinal tract is usually a systemic disease. Localized gastrointestinal amyloidosis without evidence of extraintestinal involvement or an associated plasma cell dyscrasia is uncommon and does not usually cause death. We report a case of a patient with localized gastrointestinal amyloidosis who presented with protein-losing enteropathy and a fatal upper gastrointestinal bleed.

Irritable bowel syndrome subtypes: Clinical and psychological features, body mass index and comorbidities.

BACKGROUND: Irritable bowel syndrome (IBS) is classified into subtypes according to bowel habit. OBJECTIVE: To investigate whether there are differences in clinical features, comorbidities, anxiety, depression and body mass index (BMI) among IBS subtypes. METHODS: The study group included 113 consecutive patients (mean age: 48 ± 11 years; females: 94) with the diagnosis of IBS. All of them answered a structured questionnaire for demographic and clinical data and underwent upper endoscopy. Anxiety and depression were assessed by the Hospital Anxiety and Depression scale (HAD). RESULTS: The distribution of subtypes was: IBS-diarrhea (IBS-D), 46%; IBS-constipation (IBS-C), 32%, and mixed IBS (IBS-M), 22%. IBS overlap with gastroesophageal reflux disease (GERD), functional dyspepsia, chronic headache and fibromyalgia occurred in 65.5%, 48.7%, 40.7% and 22.1% of patients, respectively. Anxiety and/or depression were found in 81.5%. Comparisons among subgroups showed that bloating was significantly associated with IBS-M compared to IBS-D (odds ratio-OR-5.6). Straining was more likely to be reported by IBS-M (OR 15.3) and IBS-C (OR 12.0) compared to IBS-D patients, while urgency was associated with both IBS-M (OR 19.7) and IBS-D (OR 14.2) compared to IBS-C. In addition, IBS-M patients were more likely to present GERD than IBS-D (OR 6.7) and higher scores for anxiety than IBS-C patients (OR 1.2). BMI values did not differ between IBS-D and IBS-C. CONCLUSION: IBS-M is characterized by symptoms frequently reported by both IBS-C (straining) and IBS-D (urgency), higher levels of anxiety, and high prevalence of comorbidities. These features should be considered in the clinical management of this subgroup.

Irritable bowel syndrome subtypes: clinical and psychological features, body mass index and comorbidities

Background: Irritable bowel syndrome (IBS) is classified into subtypes according to bowel habit. Objective: To investigate whether there are differences in clinical features, comorbidities, anxiety, depression and body mass index (BMI) among IBS subtypes. Methods: The study group included 113 consecutive patients (mean age: 48 ± 11 years; females: 94) with the diagnosis of IBS. All of them answered a structured questionnaire for demographic and clinical data and underwent upper endoscopy. Anxiety and depression were assessed by the Hospital Anxiety and Depression scale (HAD). Results: The distribution of subtypes was: IBS-diarrhea (IBS-D), 46%; IBS-constipation (IBS-C), 32%, and mixed IBS (IBS-M), 22%. IBS overlap with gastroesophageal reflux disease (GERD), functional dyspepsia, chronic headache and fibromyalgia occurred in 65.5%, 48.7%, 40.7% and 22.1% of patients, respectively. Anxiety and/or depression were found in 81.5%. Comparisons among subgroups showed that bloating was significantly associated with IBS-M compared to IBS-D (odds ratio-OR-5.6). Straining was more likely to be reported by IBS-M (OR 15.3) and IBS-C (OR 12.0) compared to IBS-D patients, while urgency was associated with both IBS-M (OR 19.7) and IBS-D (OR 14.2) compared to IBS-C. In addition, IBS-M patients were more likely to present GERD than IBS-D (OR 6.7) and higher scores for anxiety than IBS-C patients (OR 1.2). BMI values did not differ between IBS-D and IBS-C. Conclusion: IBS-M is characterized by symptoms frequently reported by both IBS-C (straining) and IBS-D (urgency), higher levels of anxiety, and high prevalence of comorbidities. These features should be considered in the clinical management of this subgroup (AU)

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Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors.

OBJECTIVES: To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. SUBJECTS AND METHODS: A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. RESULTS: Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. CONCLUSIONS: Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients.

Dyspeptic symptoms in patients with type 1 diabetes: endoscopic findings, Helicobacter pylori infection, and associations with metabolic control, mood disorders and nutritional factors

Objectives To evaluate, in a group of patients with long-standing type 1 diabetes (DM1), an association of dyspepsia symptoms with: changes in the gastroduodenal mucosa, infection by Helicobacter pylori, glycemic control, and psychological and nutritional factors. Subjects and methods A total of 32 patient with DM1 were studied (age: 38 ± 9 years; females: 25; diabetes duration: 22 ± 5 years). All patients answered a standardized questionnaire for the evaluation of gastrointestinal symptoms and underwent upper gastrointestinal endoscopy, with gastric biopsies for the evaluation of Helicobacter pylori infection. The presence of anxiety and depression was evaluated by the HAD scale. Nutritional parameters were BMI, arm and waist circumference, skinfold measurement, and body fat percentage. Results Upper endoscopy detected lesions in the gastric mucosa in 34.4% of the patients, with similar frequency in those with (n = 21) and without dyspepsia (n = 11). The patients with dyspepsia complaints showed greater frequency of depression (60% vs. 0%; p = 0.001), higher values for HbA1c (9.6 ± 1.7 vs. 8.2 ± 1.3%; p = 0.01) and lower values for BMI (24.3 ± 4.1 vs. 27.2 ± 2.6 kg/m2; p = 0.02), body fat percentage (26.6 ± 6.2 vs. 30.8 ± 7.7%; p = 0.04), and waist circumference (78.7 ± 8 vs. 85.8 ± 8.1 cm; p = 0.02). No association was found between the symptoms and the presence of Helicobacter pylori. Conclusions Dyspepsia symptoms in patients with long-standing DM1 were associated with glycemic control and depression, and they seem to negatively influence the nutritional status of these patients. .

Gastrointestinal involvement in lipoid proteinosis: a ten-year follow-up of a brazilian female patient.

Lipoid proteinosis is a rare autosomal recessive disease characterized by the deposition of hyaline material in the skin and internal organs. The main clinical features are hoarseness and typical skin lesions. In this report we describe the endoscopic and radiologic findings in a Brazilian female patient presenting extensive gastrointestinal involvement and the evolution of the detected lesions in ten years of follow-up. Initial upper endoscopy and colonoscopy showed a similar pattern of multiple yellowish nodules throughout the esophagus, stomach, duodenum, and colons. Histological analysis confirmed the diagnosis of lipoid proteinosis. In addition, small bowel follow through demonstrated numerous well defined, round, small filling defects throughout the jejunum. Ten years later, the esophageal lesions remained the same, but none of the previous alterations were detected in the stomach, duodenum, and colons. In conclusion, lipoid proteinosis may affect all gastrointestinal organs with the same pattern of macroscopic and microscopic lesions. Some lesions may regress with increasing age.

Performance of the Rockall scoring system in predicting the need for intervention and outcomes in patients with nonvariceal upper gastrointestinal bleeding in a Brazilian setting: a prospective study.

BACKGROUND/AIMS: This prospective study investigated the performance of pre-endoscopy and the complete Rockall scores in predicting the occurrence of adverse outcomes and the need for endoscopic or surgical intervention in patients with nonvariceal upper gastrointestinal bleeding. METHODS: All 656 consecutive patients who underwent endoscopy due to nonvariceal upper gastrointestinal bleeding between 2007 and 2011 were included. Receiver operating characteristic (ROC) curves were plotted for the outcomes of therapeutic intervention, rebleeding and death. The discriminative accuracy of the risk scores was assessed by the area under the ROC curve. RESULTS: Endoscopic treatment was performed in 55.2% of the patients. Rebleeding and mortality rates were 7.6 and 3.8%, respectively. The pre-endoscopy Rockall scores showed unsatisfactory accuracy in predicting the need for intervention, rebleeding or death, as shown by the respective area under the ROC curve values of 0.52, 0.52 and 0.65. The accuracy of the complete Rockall score in predicting rebleeding was poor (area under ROC: 0.52), but it was higher for mortality (area under ROC: 0.69). CONCLUSIONS: The pre-endoscopy Rockall score was not useful for predicting the need for therapeutic intervention or adverse outcomes. The complete Rockall score showed an acceptable performance in predicting mortality, but was unable to predict rebleeding.

Immunochemical fecal occult blood test for detection of advanced colonic adenomas and colorectal cancer: comparison with colonoscopy results.

Background. Fecal immunochemical tests (FITs) have been used for colorectal cancer (CRC) screening in several countries. There is lack of information concerning diagnostic performances of this method in Brazil. Methods. Patients scheduled for elective colonoscopy provided one stool sample one week before colonoscopy. The accuracy of a qualitative FIT for detection of CRC and advanced adenomas was determined. Results. Overall 302 patients completed the study. Among them, 53.5% were high risk patients referred for screening or surveillance. Nine (3%) CRCs and 11 (3.6%) advanced adenomas were detected by colonoscopy. Sensitivity and specificity for CRC were, respectively, 88.9% and 87.6%. For advanced adenomas, sensitivity was 63.6% and specificity 87.6%. Conclusion. Our results showed good sensitivity and specificity of the FIT for detecting advanced neoplasias. This method may be a valuable tool for future screening programs in Brazil.

Delayed small intestinal transit in patients with long-standing type 1 diabetes mellitus: investigation of the relationships with clinical features, gastric emptying, psychological distress, and nutritional parameters.

BACKGROUND: Studies on small intestinal transit in type 1 diabetes mellitus have reported contradictory results. This study assessed the orocecal transit time (OCTT) in a group of patients with type 1 diabetes mellitus and its relationships with gastrointestinal symptoms, glycemic control, chronic complications of diabetes, anthropometric indices, gastric emptying, small intestinal bacterial overgrowth (SIBO), and psychological distress. SUBJECTS AND METHODS: Twenty-eight patients with long-standing (>10 years) type 1 diabetes mellitus (22 women, six men; mean age, 39 ± 9 years) participated in the study. The lactulose hydrogen breath test was used to determine OCTT and the occurrence of SIBO. The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Gastric emptying was measured by scintigraphy. Anthropometric indices included body mass index, percentage body fat, midarm circumference, and arm muscle area. RESULTS: There was a statistically significant increase in OCTT values in diabetes patients (79 ± 41 min) in comparison with controls (54 ± 17 min) (P=0.01). Individual analysis showed that OCTT was above the upper limit (mean+2 SD) in 30.8% of patients. All anthropometric parameters were significantly decreased (P<0.05) in patients with prolonged OCTT in comparison with those with normal OCTT. In contrast, there was no statistically significant association between prolonged OCTT and gastrointestinal symptoms, peripheral neuropathy, diabetic retinopathy, glycated hemoglobin, delayed gastric emptying, SIBO, anxiety, or depression. CONCLUSIONS: Small bowel transit may be delayed in about one-third of patients with long-standing type 1 diabetes mellitus. This abnormality seems to have a negative effect on nutritional status in these patients.

Beneficial effects of long-term consumption of a probiotic combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult may persist after suspension of therapy in lactose-intolerant patients.

BACKGROUND: The efficacy of some probiotic strains for the management of lactose intolerance remains to be established. AIM: To evaluate the effects of a 4-week consumption of a probiotic product containing Lactobacillus casei Shirota and Bifidobacterium breve Yakult (10(7)-10(9) CFU of each strain) on symptoms and breath hydrogen exhalation after a lactose load in lactose-intolerant patients and whether the beneficial results persisted after probiotic discontinuation. METHODS: Twenty-seven patients with lactose maldigestion and intolerance participated in this study, which comprised 4 hydrogen breath tests: baseline condition (20 g lactose), after lactase ingestion (9000 FCC units), at the end of 4-week probiotic supplementation, and a follow-up test performed 3 months after probiotic discontinuation. For each test, the area under the breath hydrogen concentration vs time curve (AUC(180 min)) was calculated, and symptom scores were recorded. RESULTS: The probiotic combination significantly reduced symptom scores (P < .01) and breath hydrogen AUC (P = .04) compared with the baseline condition. The comparison with the lactase test showed that symptom scores were similar (P > .05), despite the significantly higher (P = .01) AUC values after probiotic use. In the follow-up test, symptom scores and breath hydrogen AUC values remained similar to those found at the end of probiotic intervention. CONCLUSION: Four-week consumption of a probiotic combination of L casei Shirota and B breve Yakult seems to improve symptoms and decrease hydrogen production intake in lactose-intolerant patients. These effects may persist for at least 3 months after suspension of probiotic consumption.

Estudo do esvaziamento gástrico por cintilografia em pacientes com insuficiência renal crônica / Gastric emptying study by scintigraphy in patients with chronic renal failure

JUSTIFICATIVA E OBJETIVOS: O presente estudo teve como objetivo o esvaziamento gástrico (EG) nos pacientes com insuficiência renal crônica (IRC). MATERIAL E MÉTODO: Foram estudados 30 pacientes com IRC, 16 em tratamento clínico conservador (TCC) e 14 em hemodiálise (THD) há mais de seis meses. O grupo-controle (CTL) foi constituído por 18 voluntários assintomáticos. O método de estudo do esvaziamento gástrico (EG) foi a cintilografia. A refeição-teste padronizada foi uma omelete de três ovos de galinha preparada com enxofre coloidal marcado com 185 MBq de tecnécio-99 m. Foram estudados as curvas de retenção gástrica e, a partir delas, obtido o T½ do EG. Considerou-se normal o valor de T½ correspondente à média dos valores de T½ do grupo-controle mais duas vezes o desvio-padrão. Os testes estatísticos utilizados foram o de χ² e o de Kruskal Wallis. RESULTADOS: Não houve diferença estatisticamente significativa em relação às curvas de retenção gástrica total e ao T½ de EG, que foi semelhante nos três grupos estudados. Nove pacientes apresentaram T½ de EG elevado, acima de 125 minutos. Estes pacientes estavam igualmente distribuídos entre ambos os sexos e entre os grupos TCC e THD. CONCLUSÕES: Concluiu-se que a taxa de retenção gástrica e o T½ de EG em pacientes com IRC em TCC e THD não difere do grupo de pacientes sadios. A hemodiálise não parece diminuir o risco de retenção gástrica em pacientes com IRC.

BACKGROUND AND OBJECTIVES: This study had the purpose of studying gastric emptying in patients with chronic renal failure. MATERIAL AND METHOD: Thirty patients with chronic renal failure were studied, 16 in conservative clinical treatment and 14 in hemodialysis for over six months. The control group (CTL) was composed of 18 asymptomatic volunteers. The method of gastric emptying study was scintigraphy. The standardized test meal was an omelet of three chicken eggs prepared with colloidal sulfur marked with 185 MBq of 99 m technetium. Gastric retention curves were studied and T½ of gastric emptying was obtained from them. A T½ value corresponding to the average of T½ values of control group plus twice standard deviation was considered nornmal. Statistical tests used were χ2 and Kruskal-Wallis. RESULTS: There was no statistically significant difference with regard to total gastric retention curves and T½ of gastric emptying, which was similar in three studied groups. Nine patients had high T½ of gastric emptying, above 125 minutes. These patients were equally distributed among both genders and conservative clinical treatment and hemodialysis groups. CONCLUSIONS: We concluded that gastric retention rate and T½ of gastric emptying in patients with chronic renal failure in conservative clinical treatment and hemodialysis does not differ from the healthy patients group. Hemodialysis does not seem to reduce the risk of gastric retention in patients with chronic renal failure.

JUSTIFICATIVA Y OBJETIVOS: La literatura indica factores de rutina con un impacto negativo sobre la calidad de vida de los anestesiólogos. Este trabajo pretende comparar la percepción de la calidad de vida de anestesiólogos y médicos no anestesiólogos. MÉTODO: Estudio transversal procedente de tres cuestionarios específicos (epidemiológico, WHOQOL-BREF y SF-12®) aplicados en anestesiólogos (Grupo A) y no anestesiólogos (Grupo NA), de un hospital general universitario y de un tercer grupo de anestesiólogos del interior del Estado (Grupo I). Los análisis de las variables epidemiológicas (programa SPSS) y los relacionadas con los dominios de calidad de vida del WHOQOL, fueron interpretados por medio del análisis multivariado. RESULTADOS: El número de respondedores del WHOQOL-BREF en el Grupo A = 67; Grupo NA = 69; Grupo I = 53. El grupo de anestesiólogos del interior (Grupo I) fue excluido del estudio por falta de un Nº adecuado para los análisis estadísticos. El total de respondedores para comprobar la puntuación SF-12® fue de 61 en el Grupo A y 68 en el NA. Para la herramienta WHOQOL-BREF, las puntuaciones del dominio físico fueron 72,97 ± 11,78 para A y 77,17 ± 10,85 para NA (p < 0,05), en el psicológico 66,44 ± 13,66 para A y 71,79 ± 11,48 para NA (p < 0,05), en el dominio de relacionamiento social 64,67 ± 19,08 para A y 73,36 ± 15,37 para NA (p < 0,01), y en el dominio medio ambiente 68,14 ± 11,56 para A y 72,37 ± 10,07 para NA (p < 0,05). En el SF-12® los componentes físico y mental no mostraron diferencias estadísticas. CONCLUSIONES: La percepción de la calidad de vida de los anestesiólogos fue consistentemente inferior a la de los médicos en general para la muestra estudiada.

Gastric emptying study by scintigraphy in patients with chronic renal failure.

BACKGROUND AND OBJECTIVES: This study had the purpose of studying gastric emptying in patients with chronic renal failure. MATERIAL AND METHOD: Thirty patients with chronic renal failure were studied, 16 in conservative clinical treatment and 14 in hemodialysis for over six months. The control group (CTL) was composed of 18 asymptomatic volunteers. The method of gastric emptying study was scintigraphy. The standardized test meal was an omelet of three chicken eggs prepared with colloidal sulfur marked with 185 MBq of 99m technetium. Gastric retention curves were studied and T½ of gastric emptying was obtained from them. A T½ value corresponding to the average of T½ values of control group plus twice standard deviation was considered nornmal. Statistical tests used were χ(2) and Kruskal-Wallis. RESULTS: There was no statistically significant difference with regard to total gastric retention curves and T½ of gastric emptying, which was similar in three studied groups. Nine patients had high T½ of gastric emptying, above 125 minutes. These patients were equally distributed among both genders and conservative clinical treatment and hemodialysis groups. CONCLUSIONS: We concluded that gastric retention rate and T½ of gastric emptying in patients with chronic renal failure in conservative clinical treatment and hemodialysis does not differ from the healthy patients group. Hemodialysis does not seem to reduce the risk of gastric retention in patients with chronic renal failure.

Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh's A and B patients.

BACKGROUND: The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS. METHODS: Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors. RESULTS: During follow-up evaluations averaging 34.9 +/- 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14-13.1, P = 0.029). CONCLUSIONS: Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence.

Food intolerance, diet composition, and eating patterns in functional dyspepsia patients.

The aims of this study are to investigate dietary factors, food intolerance, and the body mass index data, as an indicator of nutritional status, in functional dyspepsia patients. Forty-one functional dyspepsia patients and 30 healthy volunteers answered a standardized questionnaire to identify eating habits and food intolerance, and then completed a 7-day alimentary diary. There was no significant difference in daily total caloric intake between patients and controls. Patients associated their symptoms with the ingestion of several foods, but in general maintained their regular intake, with the exception of a small reduction in the proportion of fat in comparison with controls (median 28 vs. 34%; P = 0.001). No patient was underweight. In conclusion, our results suggest that food intolerance has no remarkable influence on food pattern and nutritional status in most functional dyspepsia patients. Further studies are necessary to clarify the role of fat in the generation of dyspeptic symptoms.

Investigation of autonomic function and orocecal transit time in patients with nonalcoholic cirrhosis and the potential influence of these factors on disease outcome.

BACKGROUND: The presence of autonomic dysfunction in nonalcoholic cirrhosis and its influence on intestinal transit and disease outcome still need clarification. GOALS: To investigate the function of the autonomic nervous system in patients with nonalcoholic cirrhosis and the possible associations among autonomic dysfunction, severity of liver disease, disturbed intestinal transit, and the development of complications during follow-up. STUDY: Measurements of heart rate variability obtained by analysis of 24-hour ambulatory electrocardiographic recordings to assess autonomic function and lactulose breath hydrogen test to determine orocecal transit time were performed in 32 patients with nonalcoholic cirrhosis divided into Child A and B. RESULTS: Child B patients showed significantly lower values (P<0.05) of those parameters reflecting parasympathetic (high frequency, log-transformed high frequency, pNN50) and sympathetic function (low frequency, log-transformed low frequency) in comparison with controls and Child A patients. Orocecal transit time values were significantly (P=0.02) higher in Child B patients than in controls, but no relationship was found between delayed orocecal transit time and autonomic dysfunction. During follow-up, 42% of Child B patients developed encephalopathy. This complication was significantly associated with autonomic dysfunction. In addition, in the 4 patients who died the parameters reflecting parasympathetic function were significantly reduced in comparison with those of survivors. CONCLUSIONS: Autonomic dysfunction and delayed intestinal transit are related to the severity of disease in nonalcoholic cirrhosis. Autonomic dysfunction seems to predispose cirrhotic patients to the development of encephalopathy and may be associated with a poor prognosis of these patients.

Esvaziamento gástrico nos pacientes com insuficiência renal crônica submetidos à hemodiálise / Gastric emptying study in patients with chronic renal failure on hemodialysis

RACIONAL: Queixas dispépticas são comuns em pacientes com insuficiência renal crônica. As mais frequentemente relatadas são anorexia, náusea, vômito, sensação de plenitude gástrica e dor epigástrica. A possibilidade destes sinais e sintomas estarem associadas ao retardo no esvaziamento gástrico é atraente. OBJETIVO: Estudar o esvaziamento gástrico de uma refeição sólida padronizada, em pacientes com insuficiência renal crônica em tratamento dialítico. MÉTODO: Foram estudados 31 pessoas de ambos os sexos com idade variável de 18 à 60 anos, sendo 14 com insuficiência renal crônica em hemodiálise há mais de 6 meses e 17 sadios. Foram excluídos pacientes com diabetes mellitus, amiloidose, doenças do colágeno, doenças dispépticas e/ou submetidos à operação gástrica, pacientes em uso de drogas pró-cinéticas gástricas e grávidas. O método do esvaziamento gástrico foi a cintilografia, através de câmara de cintilação de dois cabeçotes. A refeição teste padronizada consistiu de omelete de três ovos de galinha preparado com mistura de enxofre coloidal marcado com 185 MBq de tecnécio-99m. Foram estudados a curva de retenção gástrica total e o T½ do esvaziamento gástrico. Os testes estatísticos utilizados foram o de c2 e o de Kruskal Wallis. RESULTADOS: Os resultados confirmaram a homogeneidade dos grupos quanto à idade e o sexo. Não houve diferença estatisticamente significativa em relação às curvas de retenção gástrica total e o T½, semelhantes nos dois grupos. CONCLUSÃO: O esvaziamento gástrico de pacientes urêmicos em tratamento hemodialítico há mais de seis meses é igual ao de indivíduos sadios.

BACKGROUND: Dyspeptic symptoms are frequent in renal patients. They are anorexia, nausea, vomit, pain and epigastric distension. These symptoms can be related to the delay in gastric emptying. AIM: To investigate gastric emptying in patients with chronic renal failure on hemodialysis treatment. METHOD: Thirty one subjects (18-60 y) were studied, 14 on hemodialysis for at least 6 months and 17 healthy subjects). Patients with diabetes, amyloidosis, collagenous disease, pregnant, dyspeptic complaints , gastric surgery and patients taking procinetics drugs were excluded. Gastric emptying was investigated with radionuclide scintigraphy, using a dual-head scintillation camera. The standard test meal consisted of 185 MBq of technetium-99m sulfur colloid mixed with three scrambled eggs. For each study group a time-activity curve of gastric retention was generated and from that the T½ of gastric emptying was obtained. RESULTS: The groups were similar both in gender and age. There was no significant statistical difference in total retention curves between the two studied groups. Also the T½ of gastric emptying was similar in the two groups. CONCLUSION: Gastric emptying of patients on hemodialysis treatment for at least 6 months was not different from the health subjects.

O esvaziamento gástrico e a insuficiência renal crônica / Gastric emptying and chronic renal failure

INTRODUÇÃO E OBJETIVOS: A primeira referência de retardo no esvaziamento gástrico (EG) foi feita por Grodstein em 1979. Outros estudos foram publicados posteriormente, nem sempre confirmando essa observação. A importância do EG em anestesia pode ser resumida em um de seus aspectos principais, o jejum pré-operatório. O retardo no esvaziamento pode causar estase e aumentar o risco de vômito e aspiração pulmonar. A possibilidade de existir retardo do esvaziamento em urêmicos é atraente. Queixas dispépticas são comuns nesses pacientes e poderiam ser explicadas pela dificuldade de esvaziamento gástrico. Apesar das evidências, a literatura é muito controversa nesse aspecto. Não há consenso quanto aos resultados obtidos. Diferenças no método de estudo utilizado poderiam explicar esses resultados, observados em estudos clínicos e experimentais. O objetivo desse estudo foi rever alguns aspectos importantes da síndrome dispéptica em pacientes com insuficiência renal crônica (IRC) terminal, com ênfase no retardo do EG. CONTEUDO: Serão abordados os aspectos básicos relacionados com a fisiologia do EG, os métodos mais empregados para o estudo do EG, a síndrome dispéptica e a uremia e o esvaziamento gástrico na insuficiência renal crônica. CONCLUSÕES: O EG é um processo fisiológico complexo de transferência do alimento do estômago para o duodeno, cujos mecanismos ainda não estão devidamente esclarecidos. A cintilografia, utilizando refeições acrescidas de radiofármacos, é o exame mais utilizado para o estudo do EG. Uma porcentagem expressiva de pacientes com IRC terminal apresenta retardo no EG. Possivelmente outros mecanismos, além da uremia que participa da função motora gástrica, estão envolvidos nesta disfunção.

BACKGROUND AND OBJECTIVES: The first reference to delayed gastric emptying (GE) was made by Grodstein in 1979. Other studies have since been published, not always confirming his work. The importance of GE in anesthesia can be resumed by one of its main aspects, preoperative fasting. Delayed gastric emptying can lead to stasis and increase the risk of vomiting and aspiration. The possibility that uremic patients present delayed gastric emptying is fascinating. Gastric complaints are common in this patient population, and could be explained by the difficulty to empty the stomach. Despite the evidence, there is controversy in the literature regarding this subject. There is no consensus regarding the results. Differences in the methods of the studies could explain the results obtained in clinical and experimental trials. The objective of this study was to review a few important aspects of the dyspeptic syndrome in patients with chronic renal failure (CRF), emphasizing the delayed GE. CONTENTS: The basic aspects of the physiology of GE, methods used more often to study GE, dyspeptic syndrome and uremia, and gastric emptying in chronic renal failure will be discussed. CONCLUSIONS: Gastric emptying is a complex physiological process that transfers food from the stomach to the duodenum, whose mechanisms are yet to be fully characterized. Scintigraphy, using meals with radiolabelled drugs, is the exam used more often to study GE. An expressive percentage of the patients with end-stage renal disease also present delayed GE. It is possible that other mechanisms, besides uremia, involved in gastric motor function also play a role in this dysfunction.

INTRODUCCION Y OBJETIVOS: La primera referencia de retardo en el vaciamiento gástrico (EG) fue hecha por Grodstein en 1979. Otros estudios fueron publicados posteriormente, y no siempre confirmando esa observación. La importancia del EG en anestesia puede ser resumida un uno de sus aspectos principales, el ayuno preoperatorio. El retardo en el vaciamiento puede causar estasis y aumentar el riesgo de vómito y aspiración pulmonar. La posibilidad de existir retardo del vaciamiento en urémicos nos atrae. Quejas dispépticas son comunes en estos pacientes y podrían ser explicadas por la dificultad de vaciamiento gástrico. A pesar de las evidencias, la literatura es muy controvertida en este aspecto. No existe un consenso en cuanto a los resultados obtenidos. Diferencias en el método de estudio utilizado podrían explicar esos resultados, observados en estudios clínicos y experimentales. El objetivo de este estudio fue ver nuevamente algunos aspectos importantes del síndrome dispéptico en pacientes con insuficiencia renal crónica (IRC) terminal, con énfasis en el retardo del EG. CONTENIDO: Se abordarán los aspectos básicos relacionados a la fisiología del EG, los métodos más empleados para el estudio del EG, el síndrome dispéptico y la uremia y el vaciamiento gástrico en la insuficiencia renal crónica. CONCLUSIONES: El EG es un proceso fisiológico complejo de transferencia del alimento del estómago para el duodeno, cuyos mecanismos todavía no se conocen bien. La cintilografía, utilizando comidas con radio fármacos, es el examen más utilizado para el estudio del EG. Un porcentaje expresivo de pacientes con IRC terminal presenta retardo en el EG. Posiblemente otros mecanismos, además de la uremia, involucrando la función motora gástrica, están involucrados en esta disfunción.

[Gastric emptying and chronic renal failure]. / O esvaziamento gástrico e a insuficiência renal crônica.

BACKGROUND AND OBJECTIVES: The first reference to delayed gastric emptying (GE) was made by Grodstein in 1979. Other studies have since been published, not always confirming his work. The importance of GE in anesthesia can be resumed by one of its main aspects, preoperative fasting. Delayed gastric emptying can lead to stasis and increase the risk of vomiting and aspiration. The possibility that uremic patients present delayed gastric emptying is fascinating. Gastric complaints are common in this patient population, and could be explained by the difficulty to empty the stomach. Despite the evidence, there is controversy in the literature regarding this subject. There is no consensus regarding the results. Differences in the methods of the studies could explain the results obtained in clinical and experimental trials. The objective of this study was to review a few important aspects of the dyspeptic syndrome in patients with chronic renal failure (CRF), emphasizing the delayed GE. CONTENTS: The basic aspects of the physiology of GE, methods used more often to study GE, dyspeptic syndrome and uremia, and gastric emptying in chronic renal failure will be discussed. CONCLUSIONS: Gastric emptying is a complex physiological process that transfers food from the stomach to the duodenum, whose mechanisms are yet to be fully characterized. Scintigraphy, using meals with radiolabelled drugs, is the exam used more often to study GE. An expressive percentage of the patients with end-stage renal disease also present delayed GE. It is possible that other mechanisms, besides uremia, involved in gastric motor function also play a role in this dysfunction.