ABSTRACT
BACKGROUND AND AIMS: Irritable bowel syndrome (IBS) is one of the most frequent disorders in clinical practice, with a mean 7.6-10.8% worldwide prevalence. A study showed that 6.1% of patients with diarrhea-predominant IBS (IBS-D) had severe exocrine pancreatic insufficiency (EPI). We aimed to identify the prevalence of EPI based on fecal elastase stool testing (Fel-1) in IBS-D and the clinical characteristics that may predict the diagnosis of EPI. METHODS: Patients aged > 18 years presenting to tertiary hospital outpatient clinics with IBS-D completed validated questionnaires and gave a stool sample where Fel-1 concentration was measured. Patients with Fel-1 < 100 µg/g represented EPI and > 100 to < 200 µg/g underwent testing for pancreatic pathology with laboratory and endoscopic ultrasound (EUS) evaluation. RESULTS: One hundred forty patients (mean age 60 years, females 75.7%) were studied. EPI was found in 5% (95% CI 2.2-10.4), and pancreatic steatosis was the main EUS finding (71%). Dyspepsia was an independent factor associated with EPI (OR 34.7; 95% CI 4.95-366.37, p = 0.0007). After pancreatic enzyme replacement therapy (PERT), patients showed a significant improvement in the Bristol stool scale (p < 0.0001), bowel movements per day (p < 0.005), distension score (0.0009), pain score (0.0277) and IBS severity (0.0034). CONCLUSION: EPI is present in 5% of patients who fulfill Rome IV criteria for D-IBS, and dyspepsia was an independent symptom strongly associated with EPI. Pancreatic steatosis was the main endoscopic ultrasound finding. After PERT therapy, patients had significantly improved stool frequency, stool consistency, abdominal pain, distension and IBS severity score.
Subject(s)
Dyspepsia , Exocrine Pancreatic Insufficiency , Irritable Bowel Syndrome , Female , Humans , Middle Aged , Irritable Bowel Syndrome/complications , Irritable Bowel Syndrome/diagnosis , Irritable Bowel Syndrome/epidemiology , Diarrhea/epidemiology , Diarrhea/etiology , Rome , Exocrine Pancreatic Insufficiency/diagnosis , Exocrine Pancreatic Insufficiency/epidemiology , Exocrine Pancreatic Insufficiency/etiologyABSTRACT
BACKGROUND/AIMS: Capsule endoscopy is a diagnostic method for evaluating the small bowel lumen and can detect undiagnosed lesions. The aim of this study was to evaluate the diagnostic yield and clinical impact of capsule endoscopy in patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain. METHODS: This study involved a retrospective analysis of prospectively collected data, maintained in a database. Patients with refractory diarrhea-predominant irritable bowel syndrome and functional abdominal pain within the period of March 2012 to March 2014 were included. Capsule endoscopy was used to detect small bowel pathologies in both groups. RESULTS: Sixty-five patients (53.8% female) fulfilled the inclusion criteria and had a mean (±standard deviation) age of 50.9±15.9 years. Clinically significant lesions were detected via capsule endoscopy in 32.5% of the patients in the abdominal pain group and 54.5% of the patients in the diarrhea group. Overall, 48% of patients had small bowel pathologies detected during the capsule endoscopy study. Inflammatory lesions and villous atrophy were the most frequent lesions identified in 16.9% and 15.3% of patients in the abdominal pain and the diarrhea groups, respectively. CONCLUSION: Routine use of capsule endoscopy in patients with irritable bowel syndrome should not be recommended. However, in patients with refractory conditions, capsule endoscopy may identify abnormalities.
ABSTRACT
Structure and floristic composition of three oak forests in the northern region of the Central Cordillera in Colombia. Andean ecosystems harbor a high floristic diversity, which is being threatened by human disturbances such us deforestation and by the expansion of the agricultural frontier. One of these ecosystems are the Andean oak forests dominated by Quercus humboldtii, a threatened species in Colombia. We assessed the floristic composition and structure of three Andean oak forests located in three localities (San Andrés de Cuerquia, Belmira and Guarne) of Antioquia. The main goal was to determine whether these forests showed similarities in their structure and floristic composition. In each site, a permanent plot of 5000 m2 (0.5 ha) was established. All trees with D ≥ 10 cm were sampled and identified to species. The Importance Value Index (IVI) was calculated as the sum of relative density (DeR), dominance (DoR) and frequency (FR) of a species. Trees with 5 ≤ D < 10 cm and 2 ≤ D < 5 cm were registered in sub-plots of 0.05 and 0.0144 ha, respectively. Finally, we used Jaccards Index to quantify the floristic similarity among oak forest. When we considered all trees with D ≥ 10 cm in the three forests, the number of species ranged from 18 to 54, whilst the number of individuals ranged from 326 to 680. The Guarne oak forest showed the highest species richness. In all sites, Q. humboldtii (Fagaceae) was the most important species in relation to the IVI, while Clusia sp. (Clusiaceae) and Myrsine coriaceae (Myrsinaceae) were the most important species in San Andrés de Cuerquia, Clethra fagifolia (Clethraceae) was important only in Belmira and Myrcia popayanensis (Myrtaceae) was important in Guarne. The families with the highest number of species were Fabaceae, Melastomataceae and Rubiaceae. Floristic similarity among places was low. The size distribution of trees had an inverse J- shape curve for all sites with changes in the abundance for size class. The three oak forests differed in their structure and floristic composition probably because of different disturbance degrees. Rev. Biol. Trop. 57 (4): 1165-1182. Epub 2009 December 01.
La alta diversidad florística que albergan los ecosistemas andinos está siendo amenazada por fuertes presiones de origen antrópico. Uno de estos ecosistemas son los robledales, bosques dominados por la especie Quercus humboldtii, que se encuentra seriamente amenazada en Colombia porque su madera es valiosa comercial y dendroenergéticamente. En este estudio, se caracterizó la composición florística y la estructura de tres robledales de los Andes colombianos, con el fin de determinar su similaridad. En cada sitio, se estableció una parcela permanente (5 000 m²) donde se muestrearon todos los árboles con D ≥ 10 cm. En los tres sitios, la especie dominante fue Q. humboldtii, pero la similitud florística entre ellos no fue alta. La estructura por clases de tamaño para los tres sitios fue en forma de J invertida, aunque varió la abundancia de individuos por clase diamétrica. Los resultados indican que los robledales estudiados difieren en su composición florística y estructura a pesar de presentar características biofísicas similares. Las diferencias encontradas se deben posiblemente, a los diferentes factores que interactúan en cada sitio como la historia de uso, intensidad y duración de las perturbaciones antrópicas pasadas, topografía, fauna y clima local, que se ven reflejados en los parámetros estructurales de la vegetación.
Subject(s)
Quercus/classification , Trees/classification , Colombia , Population DensityABSTRACT
Andean ecosystems harbor a high floristic diversity, which is being threatened by human disturbances such us deforestation and by the expansion of the agricultural frontier. One of these ecosystems are the Andean oak forests dominated by Quercus humboldtii, a threatened species in Colombia. We assessed the floristic composition and structure of three Andean oak forests located in three localities (San Andrés de Cuerquia, Belmira and Guarne) of Antioquia. The main goal was to determine whether these forests showed similarities in their structure and floristic composition. In each site, a permanent plot of 5000 m2 (0.5 ha) was established. All trees with D > or = 10 cm were sampled and identified to species. The Importance Value Index (IVI) was calculated as the sum of relative density (DeR), dominance (DoR) and frequency (FR) of a species. Trees with 5 < or = D < 10 cm and 2 < or = D < 5 cm were registered in sub-plots of 0.05 and 0.0144 ha, respectively. Finally, we used Jaccard's Index to quantify the floristic similarity among oak forest. When we considered all trees with D > or = 10 cm in the three forests, the number of species ranged from 18 to 54, whilst the number of individuals ranged from 326 to 680. The Guarne oak forest showed the highest species richness. In all sites, Q. humboldtii (Fagaceae) was the most important species in relation to the IVI, while Clusia sp. (Clusiaceae) and Myrsine coriaceae (Myrsinaceae) were the most important species in San Andrés de Cuerquia, Clethra fagifolia (Clethraceae) was important only in Belmira and Myrcia popayanensis (Myrtaceae) was important in Guarne. The families with the highest number of species were Fabaceae, Melastomataceae and Rubiaceae. Floristic similarity among places was low. The size distribution of trees had an inverse J-shape curve for all sites with changes in the abundance for size class. The three oak forests differed in their structure and floristic composition probably because of different disturbance degrees.
Subject(s)
Quercus/classification , Trees/classification , Colombia , Population DensityABSTRACT
O segmento populacional de idosos cresceu nas últimas décadas. Constatou-se isso em um asilo em Itajaí/SC, despertando assim o desejo de verificar a percepção dos cuidadores de enfermagem sobre a morte dos idosos...