Inflammatory bowel disease in an underdeveloped region of Northeastern Brazil.

AIM: To evaluate the demographic characteristics and clinical phenotypes of inflammatory bowel disease (IBD) in a geographic area in Northeastern Brazil. METHODS: This retrospective study was conducted at the Hospital of the Federal University of Piauí in Northeastern Brazil. Demographic characteristics and clinical phenotypes of IBD were analyzed in relation to the time of diagnostic confirmation, which was defined as the date of disease onset. Data were collected between January 2011 and December 2012 and included all census patients 18 years of age or older during that period for whom there was diagnostic confirmation of Crohn's disease (CD), ulcerative colitis (UC), or unclassified colitis according to the Montreal criteria. We also analyzed the period of time between the onset of clinical manifestations and the diagnosis of IBD (delay in the diagnosis). Statistical analyses included means and standard deviations for numeric variables and the Pearson χ2 adherence test for nominal variables. The annual index occurrence and overall prevalence of IBD at our institution were also calculated, with P values<0.05 indicating statistical significance. This study was approved by the Institutional Ethics and Research Committee. RESULTS: A total of 252 patients with IBD were included, including 152 (60.3%) UC patients and 100 (39.7%) CD patients. The clinical and demographic characteristics of all patients with IBD showed a female to male ratio of 1.3:1.0 and a mean age of 35.2 (SD=14.5) years. In addition, the majority of patients were miscegenated (171, 67.9%), had received higher education (157, 62.4%), lived in urban areas (217, 86.1%), and were under the age of 40 years (97, 62.5%). For patients with CD, according to the Montreal classification, the predominant features present from the onset of disease were an age between 17 and 40 years (A2); colonic disease location (L2); and nonstricturing, nonfistulizing disease behavior (B1). However, approximately one-quarter of all CD patients demonstrated perineal involvement. We also observed considerable delay in the diagnosis of IBD throughout the entire study period (mean=35.5 mo). In addition, the annual index occurrence rose from 0.08 to 1.53 cases/10(5) inhabitants/year during the study period, and the prevalence rate was 12.8 cases/10(5) inhabitants in 2012. Over the last two decades, there was a noted increase in the frequency of IBD in the study area. CONCLUSION: In this study, there was a predominance of patients with UC, young people under 40 years of age, individuals with racial miscegenation, and low annual incomes.

What are the most important factors regarding acceptance to the colonoscopy?: study of related tolerance parameters.

CONTEXT: Colonoscopy plays an indubitable role in the setting of clinical practice, however, it is an invasive exam; complex, lengthy, embarrassing, not devoid of risks and discomfort that yields fear and anxiety in the majority of patients. In a new era of rising competition between health institutions, where the quality of health care and client satisfaction are praised, studies regarding tolerance-related colonoscopy issues yield great potential to be explored. In the present study, tolerance is defined as willingness to repeat the exam. OBJECTIVES: Evaluate information associated to bowel preparation, the exam itself and post-examination period that might interfere with the tolerance to the colonoscopy. METHODS: Analysis of the tolerance to the colonoscopy at three stages (pre, post, and during) through a checklist: patient's questionnaire and a medical assessment form were used. RESULTS: In this present study, 91.2% of 373 patients exhibited positive tolerance to the colonoscopy. Aspects related to a negative level of tolerance were patient gender (12.9% of women versus 3.2% of men would not repeat the exam), age extremes (less than 20 years and greater than 80 years of age), and abdominal pain, both during the bowel preparation and after the procedure. CONCLUSIONS: Gender, age, patient cooperation and abdominal pain were the decisive components regarding tolerance to the colonoscopy. Notably, in two phases of the exam, the abdominal pain was the most important feature associated to a lessened tolerance.

WHAT ARE THE MOST IMPORTANT FACTORS REGARDING ACCEPTANCE TO THE COLONOSCOPY?: Study of related tolerance parameters

Context Colonoscopy plays an indubitable role in the setting of clinical practice, however, it is an invasive exam; complex, lengthy, embarrassing, not devoid of risks and discomfort that yields fear and anxiety in the majority of patients. In a new era of rising competition between health institutions, where the quality of health care and client satisfaction are praised, studies regarding tolerance-related colonoscopy issues yield great potential to be explored. In the present study, tolerance is defined as willingness to repeat the exam. Objectives Evaluate information associated to bowel preparation, the exam itself and post-examination period that might interfere with the tolerance to the colonoscopy. Methods Analysis of the tolerance to the colonoscopy at three stages (pre, post, and during) through a checklist: patient's questionnaire and a medical assessment form were used. Results In this present study, 91.2% of 373 patients exhibited positive tolerance to the colonoscopy. Aspects related to a negative level of tolerance were patient gender (12.9% of women versus 3.2% of men would not repeat the exam), age extremes (less than 20 years and greater than 80 years of age), and abdominal pain, both during the bowel preparation and after the procedure. Conclusions Gender, age, patient cooperation and abdominal pain were the decisive components regarding tolerance to the colonoscopy. Notably, in two phases of the exam, the abdominal pain was the most important feature associated to a lessened tolerance. .

Contexto É inquestionável o papel da colonoscopia na prática clínica, entretanto, trata-se de exame invasivo, complexo, demorado, impudico, não isento de riscos e desconforto, que gera receio e ansiedade à maioria dos pacientes. Em uma nova época de elevada competição entre instituições de saúde, na qual se valoriza a qualidade dos serviços prestados e satisfação dos clientes, estudos sobre fatores relacionados a tolerância à colonoscopia oferecem grande potencial a ser explorado. No presente estudo considerou-se tolerância a disposição de repetir o exame. Objetivo Analisar informações relacionados ao preparo, exame e pós exame que interferem na tolerância à colonoscopia. Métodos Análise da tolerância à colonoscopia em três momentos da colonoscopia (pré, pós e durante) através de check list: “formulário do paciente” e “ficha de avaliação médica”. Resultados No presente estudo 91.2% de 373 pacientes apresentaram tolerância positiva à colonoscopia. Os fatores relacionados à tolerância negativa foram o sexo feminino (12.9% mulheres and 3.2% dos homens não repetiriam o exame), extremos de idade (<20 anos e >80 anos) e dor abdominal durante o preparo intestinal e após o procedimento. Conclusões Gênero, idade, cooperação do paciente e dor abdominal foram fatores determinantes da tolerância à colonoscopia. Significativa em duas fases do exame, a dor abdominal foi o fator mais importante relacionado à redução da tolerância. .

Eradication Treatment of Helicobacter pylori Infection: Its Importance and Possible Relationship in Preventing the Development of Gastric Cancer.

Helicobacter pylori is the most important carcinogen for gastric adenocarcinoma. Bacterial virulence factors are essential players in modulating the immune response involved in the initiation of carcinogenesis in the stomach; host genetic factors contribute to the regulation of the inflammatory response and to the aggravation of mucosal damage. In terms of environmental factors, salt intake and smoking contribute to the development of lesions. Various therapeutic schemes are proposed to eradicate H. pylori infection, which could potentially prevent gastric cancer, offering the greatest benefit if performed before premalignant changes of the gastric mucosa have occurred.

Endoscopia digestiva alta na rede pública de saúde do Brasil: análise quantitativa por Estados e regiões do pais / Upper gastrointestinal endoscopy on the national health system of Brazil: quantitative analysis by states and regions of the country

Atualmente, a endoscopia digestiva alta (EDA) é um dos exames mais indicados para avaliar doenças do trato gastrointestinal. Considerando sua importância no diagnóstico e também na terapêutica de doenças do esôfago, estômago e duodeno, é de relevância a análise dos dados quantitativos desse exame no país, bem como calcular seu custo-benefício. O objetivo do presente estudo é avaliar o número de EDA realizadas pelo Sistema Único de Saúde (SUS) durante o período de janeiro de 2008 a dezembro de 2009 por estados e regiões do Brasil. Métodos: calculou-se o número de exames por 100 mil habitantes por ano, utilizando a população brasileira referente ao período de 2009, de acordo com o Instituto Brasileiro de Geografia e Estatística (IBGE). Para efeito de comparação utilizaram-se dados relativos a países com sistemas de saúde semelhantes ao SUS. Resultados: os estados onde mais se realizaram EDA foram: Piauí, Alagoas, Pernambuco, São Paulo e Paraíba; a região com maior número de EDA foi o Nordeste e a média nacional encontrada foi de 550 exames/100 mil habitantes/ano. Conclusão: quando se comparou a média nacional com países como Inglaterra, Holanda e Irlanda, notou-se que em nosso sistema público de saúde foi realizado a metade dos exames destes países.

Nowadays, Upper Gasrointestinal Endoscopy (UGE) is one of the most used procedures to evaluate disease of the Upper GI tract. Considering its diagnostic and therapeutic importance for esophageal, gastric and duodenal diseases, the analysis of Brazilian quantitative data, as well as the cost-effectiveness ratio, is of great importance. The objective of this report is to evaluate the number of UGE performed in the National Health System in the period from January, 2008 to December, 2009. Methodology: the rate of UGE per 100.000 habitants a year was calculated based on 2009 Brazilian population, according to the Brazilian Institute of Geography and Statistics. As comparison subjects, countries with health systems similar to Brazilian were used. Results: were obtained: more UGE were performed in Piauí, Alagoas, Pernambuco, São Paulo e Paraiba; the geographical region with more performed tests was the Northeastern, and the national overall was 550 UGE/100.000 habitants/ year. Conclusion: correlation of the latter figure to countries such as England, Netherlands or Ireland, shown that, in Brazil, there were performed half of UGE than in those countries.

Osteodistrofia hepática / Hepatic osteodystrophy

Osteodistrofia hepática é distúrbio de mineralização óssea associada à doença hepática crônica, sendo a osteoporose, e mais raramente a osteomalácia, sua forma de apresentação clínica. Apesar de pouco diagnosticada e com prevalência de grande variação na literatura, na maioria das vezes, apresenta-se de forma assintomática e, quando não identificada, aumenta consideravelmente o risco de fratura e sequelas permanentes. Seu diagnóstico, portanto, requer alta suspeição e faz-se, na prática clínica, por meio da avaliação da densitometria óssea. De fisiopatogenia multifatorial, envolve fatores genético, ambiental e do próprio estado clínico-nutricional do paciente. Uma atenção maior deve ser despendida a hepatopatas desnutridos, com cirrose hepática avançada, doença colestática crônica e transplantados pelo maior risco de desmineralização óssea. Nesta revisão, será discorrido sobre o metabolismo fisiológico da síntese óssea e a fisiopatologia do distúrbio de mineralização óssea, desde mecanismos fisiopatogênicos na doença hepática crônica, seu diagnóstico e revisão da terapêutica atual empregada.

Hepatic osteodystrophy is a disorder of bone mineralization associated to liver disease, clinically manifested by osteoporosis and more rarely osteomalacia. Although seldomly diagnosed and varying greatly in literature, most of the time, it presents asymptomatically and, when it is not recognized, it enhances considerably the risk of fracture and permanent sequelae. Indeed it requires a high grade of suspicion and it is confirmed by means of bone densitometry evaluation in clinical practice. Presenting with a multifactorial physiopathology, it involves factors, such as genetical, environmental, and patient clinical-nutritional status. A greater attention must be spent on patients with liver disease, especially those malnourished, with advanced cirrhosis, chronic cholestatic disease, and transplanted, because of a higher risk of bone demineralization. In this data, it will be reviewed the bone synthesis metabolism and the physiopathology of bone mineralization disorder ? since fisiopatogenic mechanisms in chronic liver disease, diagnosis and recent therapeutic review employed.

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.

Restriction fragment length polymorphism of urease C and urease B genes of Helicobacter pylori strains isolated from Brazilian patients with peptic ulcer and chronic gastritis.

The aim of the present work is to identify the presence of Helicobacter pylori bacterium in samples of gastric mucosa fragments, obtained by gastric biopsy, from Brazilian patients with peptic ulcer and chronic gastritis and also to determine differences among the prevalent strains in these two diseases by urease C and urease B genes amplification utilizing nested polymerase chain reaction (PCR) and PCR. We encountered 17 genotyping patterns for urease C and 7 for urease B and, although no significant differences were found among the patterns encountered for both diseases, we found predominant groups for each disease. Typing methods of the products obtained by nested PCR and PCR show a functional scheme and are of great importance for epidemiologic studies and H. pylori strain characterization, in addition to allowing correlation among the several strains and their role in the diseases caused by this microorganism.

Esofagite eosinofílica em adultos: [revisão] / Eosinophilic esophagitis in adults: [review]

Esofagite eosinofílica é uma doença inflamatória primária crônica na qual ocorre infiltração de eosinófilos na mucosa esofágica. Tem patogênese indefinida, porém há importante associação com doenças alérgicas e história familiar. Os sintomas principais são disfagia e impactação de bolo alimentar, mas pode haver também pirose. O diagnóstico é estabelecido através de endoscopia e análise histológica da mucosa esofágica. O tratamento mais eficaz tem sido a corticoterapia tópica, havendo boa resposta clínica e histológica.

Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies.

BACKGROUND: Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM: To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS: One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS: The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5%; adenomatous polyps - 73,6%; fundic gland polyps - 72%). Hyperplastic polyps were the most frequent and accounted for 71.3% of the cases, whereas fundic gland polyps accounted for 16.3% and adenomatous polyps for 12.4%. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9%) and in two adenomatous polyps (10.5%). High grade dysplastic foci were found in four adenomatous polyps (21%). CONCLUSIONS: The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologist's aid, once the conduct to be adopted will depend on the result of the biopsy.

Gastric polyps: a retrospective analysis of 26, 000 digestive endoscopies

BACKGROUND: Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM: To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS: One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS: The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5 percent; adenomatous polyps - 73,6 percent; fundic gland polyps - 72 percent). Hyperplastic polyps were the most frequent and accounted for 71.3 percent of the cases, whereas fundic gland polyps accounted for 16.3 percent and adenomatous polyps for 12.4 percent. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9 percent) and in two adenomatous polyps (10.5 percent). High grade dysplastic foci were found in four adenomatous polyps (21 percent). CONCLUSIONS: The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologist's aid, once the conduct to be adopted will depend on the result of the biopsy.

RACIONAL: Os pólipos gástricos são pequenas lesões gástricas, assintomáticos na maioria dos casos, e são diagnosticados por acaso durante a endoscopia digestiva alta. OBJETIVOS: Avaliar retrospectivamente as características e freqüência dos pólipos gástricos, oriundos da mucosa gástrica em uma casuística extensa de endoscopias digestivas. MÉTODOS: Cento e cinqüenta e três doentes em uma casuística de 26.000 endoscopias digestivas altas realizadas durante 5 anos, sendo que cada doente realizou apenas um exame, foram analisados quanto às características histopatológicas, classificação de Yamada, localização, tamanho e tratamento. Todos os casos tinham pelo menos um pólipo gástrico, confirmado pelo exame histopatológico de biopsia endoscópica. RESULTADOS: Os pólipos foram classificados como hiperplásicos, adenomatosos e de glândulas fúndicas. A maioria deles era menor que 1 cm (pólipos hiperplásicos - 60,5 por cento; pólipos adenomatosos - 73,6 por cento; pólipos de glândulas fúndicas - 72 por cento). Os pólipos hiperplásicos foram os mais freqüentes e diagnosticados em 71,3 por cento dos casos, enquanto os de glândulas fúndicas somaram 16,3 por cento e os adenomatosos foram 12,4 por cento. Os pólipos hiperplásicos e os adenomatosos, na maioria das vezes, foram únicos, enquanto os de glândulas fúndicas tenderam a ser múltiplos. Carcinoma foram detectados em um pólipo hiperplásico (0,9 por cento) e em dois adenomatosos (10,5 por cento). Focos de displasia de alto grau foram encontrados em quatro pólipos adenomatosos (21 por cento). CONCLUSÕES: A endoscopia digestiva é o método mais seguro e eficiente para o diagnóstico dos pólipos gástricos, que na maioria dos doentes não apresenta sintomas característicos. A definição histopatológica não é possível ao olhar endoscópico, necessitando-se do auxílio do patologista, uma vez que do resultado da biopsia dependerá a conduta a ser adotada.

Ulcera péptica / peptic ulcer

A úlcera péptica é uma doença muito freqüente em nos- so meio. É causada na maioria das vezes pela bactéria Helícobacter pylorí ou pelo uso de antiinfiamatórios não, esteroídais. Não há quadro clínico característico e muitos doentes podem ter sintomatología pobre. A dor epigástrica é o sintoma mais comum e pode ter relação com a alimentação. O diagnóstico das úlceras gastroduodenais é feito através de endoscopia digestiva alta, que permite ainda verificar a exístêncía ou não da infecção pelo H.pylori. A erradicação da bactéria é o tratamento de escolha nos portadores do microrganismo. A utilização de medicamentos redutores de se- creção ácida gástrica é capaz de cicatrizaras úlceras da grande maioria dos pacientes, independente da etiologia. Os mais eficazes são os inibidores da bomba de prótons. Eles podem ser usados profílaticamente nos usuários crônicos de antiin- flamatórios que tenham risco aumentado de lesões, como nos idosos, nos que utilizam corticosteróides ou anticoagulantes e nos pacientes com doenças sistêmicas graves.

Ursodeoxycholic acid does not interfere with in vivo Helicobacter pylori colonization

A low frequency of Helicobacter pylori in the gastric mucosa of patients with alkaline gastritis has been reported. At the same time, it can be noted that the growth of bacteria can be inhibited by bile acids. We studied 40 patients with chronic gastritis related to Helicobacter pylori in order to determine the effect of ursodeoxycholic acid on this infection. Diagnoses of the infection and the inflammatory process were obtained by histologic study of gastric biopsies collected during endoscopy. Two groups were studied: group I received ursodeoxycholic acid - 300 mg/day, and group II received the placebo, twice a day, both for 28 days. The colonization by Helicobacter pylori and the intensity of the mononuclear and polymorphonuclear inflammatory infiltrate were determined before (time 1) and after (time 2) treatment. Ursodeoxycholic acid had no effect on the Helicobacter pylori infection. A significant reduction in the intensity of the mononuclear inflammatory infiltrate of the gastric antrum mucosa was observed in patients from group I, when we compared not only times 1 and 2 but also groups I and II. However, this was not the case with the body mucosa. We concluded that ursodeoxycholic acid had no action on the colonization by Helicobacter pylori or on the polymorphonuclear inflammatory infiltrate, but it caused a significant reduction in the intensity of the mononuclear inflammatory infiltrate of the gastric antrum

Parasitoses intestinais / Parasitics infections intestinal

As parasitoses intestinais, apesar de sua distribuiçäo universal, adquirem maior importância sanitária nos países em desenvolvimento. Recentemente verificou-se que algumas delas säo responsáveis por quadros clínicos graves na síndrome da imunodeficiência adquirida (Aids). Nesta revisäo procurou-se enfocar as protoozes e helmintoses que habitam o tubo digestivo do homem, com vistas a analisar objetivamente o seu diagnóstico e tratamento. Os dados epidemiológicos e o fornecimento de aspectos clínicos gerais foram introduzidos apenas visando fornecer subsídios para o diagnóstico. Apesar de tentativas de desenvolvimento de métodos imunológicos para o diagnóstico das parasitoses, o exame ainda de maior valor e que deve ser utilizado de início é o parasitológico de fezes, nas suas diversas modificaçöes técnicas. A terapêutica, sempre que possível, será fornecida em dose única, prescrevendo-se medicamentos de eficácia comprovadora e de efeitos adversos mínimos ou inexistentes. Entretanto, isso nem sempre é freqüente em nosso meio e näo há ainda medicamento totalmente eficiente nesses casos

O uso de clebopride na doença funcional do aparelho digestivo: estudo duplo-cego / The use of clebopride in functional disease of digestive system: double-blind study

Quarenta pacientes com queixas dispépticas, sem patologia orgânica demonstrada aos exames laboratoriais e complementares, foram avaliados durante um mês. Os pacientes foram divididos aleatoriamente em dois grupos de vinte: um grupo recebeu clebopride como droga única e outro placebo, ambos na posologia de um comprimido três vezes ao dia. Os pacientes que tomaram clebopride obtiveram melhora da plenitude gástrica pós-prandial e da regurgitaçäo ácida; a incidência de efeitos colaterais mostrou-se pouco significativa. Observou-se ainda efeito do palcebo sobre a dor epigástrica e a sensaçäo de boca amarga, cuja interpretaçäo näo está definida. O presente trabalho demonstra que o emprego de clebopride tem seu lugar no tratamento dos quadros dispépticos de natureza funcional do tubo digestivo alto

Constipaçäo intestinal no idoso / Intestinal constipation in the elderly

A constipaçäo intestinal no idoso geralmente é de fácil diagnóstico e de conduta terapêutica simples. Eventualmente ocasiona quadros clínicos complexos e de difícil tratamento. O exame clínico detalhado quase sempre fornece subsídios adequados para o diagnóstico correto, porém no idoso é fundamental afastar as causas orgânicas de constipaçäo intestinal. Na grande maioria das vezes näo há necessidade de submeter o paciente a exames complementares mais sofisticados como medida de trânsito intestinal, defecografia e manometria anorretal. A complicaçäo mais temida de constipaçäo intestinal é o fecaloma, que é definido pelo quadro clínico e simples toque retal e, as vezes, pela radiografia simples de abdome. Essa complicaçäo pode ser acompanhada por incontinência fecal. O tratamento da constipaçäo no idoso, de início, deve incluir: dieta de fibras, farelo de trigo, ingestäo de líquido em abundância, massagem abdominal e reeducaçäo intestinal. Quando näo se obtém sucesso desejável, pode-se lançar mäo de laxantes, tais como a lactulose isolada ou associada a derivados de sene. Esses medicamentos devem ser usados com critério, mas no idoso as reaçöes adversas säo de pequena monta e seus efeitos indesejáveis a longo prazo provavelmente näo surgiräo, considerando a limitada expectativa de vida do paciente. O fecaloma deve ser tratado com enemas, sendo as vezes necessária a desimpactaçäo manual. O desaparecimento do fecaloma melhora a continência fecal e deveräo ser utilizadas medidas preventivas para a recorrência

Influência dos bloqueadores H2 na indicaçäo da cirurgia para úlcera péptica / Effect of H2 blockers on the surgical indication for peptic ulcer

Analisa-se o total de pacientes operados de úlcera péptica no Hospital das Clínicas da Faculdade de Medicina da USP entre 1966 e 1985, para verficar variaçöes com a introduçäo da cimetidine a partir de 1978. foi observada reduçäo na freqüência das cirurgias, que se tornou mais nítida a partir de 1978. Para estudo mais pormenorizado das mesmas variaçöes tomou-se amostra aleatória de 10% das cirurgias entre 1973 e 1985. Neste caso verificou-se reduçäo na feqüência de cirurgias para úlcera péptica estenosante e hemorrágica e diminuiçäo nas úlceras pépticas perfuradas. Näo ocorreu diferença significante em relaçäo ao sexo e a idade dos pacientes, exceto nas úlceras pépticas perfuradas onde ocorreu aumento do número de mulheres