Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease.

Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease.

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47%, for NERD in 48%, and for EE patients in 48% of cases. Esophagitis was present in 42% of patients with IBS and in 45% of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: mucus in feces, abdominal distension, nausea and gastritis; and women more frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95% CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

Endoscopic and symptoms analysis in Mexican patients with irritable Bowel syndrome, dyspepsia, and gastroesophageal reflux disease

The aim of this study was to analyze the data of endoscopy and symptoms in 118 Mexican patients with irritable bowel syndrome (IBS), dyspepsia, non-erosive reflux disease (NERD) and erosive esophagitis (EE). IBS criteria were fulfilling for dyspepsia patients in 47 percent, for NERD in 48 percent, and for EE patients in 48 percent of cases. Esophagitis was present in 42 percent of patients with IBS and in 45 percent of patients with dyspepsia. A higher prevalence of hiatus hernia was found in EE vs. NERD. Heartburn and acid eructation were associated with the presence of esophagitis; acid eructation, regurgitation and nocturnal pain with duodenitis; and heartburn and regurgitation with hiatus hernia. Males more frequently reported: ucus in feces, abdoinal distension, nausea and gastritis; and oen ore frequently reported esophagitis and duodenitis. Patients with NERD (OR 2.54, 95 percent CI 1.08 to 5.99, p=0.04), tenesmus and early satiety, and men had an increase risk for reporting hard or lumpy stools. In conclusion, nearly half of the Mexican patients with NERD, EE and dyspepsia fulfill criteria for IBS. A large number of symptoms were correlated with endoscopy, which can be used to improve the indication of the endoscopy and its implementation in clinical studies.

O objetivo deste estudo foi analisar os dados de endoscopia e sintomas de 118 pacientes mexicanos com síndrome do intestino irritável (IBS), dispepsia, doença do refluxo não-erosiva (NERD) e esofagite erosiva (EE). Os pacientes com IBS preencheram os critérios para dispepsia em 47 por cento, para NERD em 48 por cento, e para pacientes EE em 48 por cento dos casos. Esofagite estava presente em 42 por cento dos pacientes com IBS e em 45 por cento dos pacientes com dispepsia. A maior prevalência de hérnia de hiato foi encontrada na EE em comparação com NERD. Azia e eructação ácida foram associadas à presença de esofagite; eructação ácida, regurgitação e dor noturna, com duodenite; e azia e regurgitação com hérnia de hiato. Os homens relataram mais frequentemente sintomas como muco nas fezes, distensão abdominal, náuseas e gastrite, enquanto que as mulheres mais frequentemente relataram esofagite e duodenite. Os pacientes com NERD (OR 2,54, IC 95 por cento 1,08-5,99, p = 0,04), apresentaram tenesmo e saciedade precoce, e os homens tiveram um risco aumentado relacionado a fezes endurecidas ou fragmentadas. Em conclusão, quase metade dos pacientes mexicanos com NERD, EE e dispepsia preenchem os critérios para a IBS. Um grande número de sintomas foi correlacionado com a endoscopia, esta correlação pode ser utilizada para aumentar a indicação da endoscopia e sua aplicação em estudos clínicos.

Irritable bowel syndrome: an international study of symptoms in eight countries.

OBJECTIVES: This report is a preliminary comparative study of irritable bowel syndrome symptoms in eight countries, USA, Mexico, Canada, England, Italy, Israel, India, and China. We also assessed global symptom patterns and correlations and relationships to several psychosocial variables. METHODS: Two hundred and thirty-nine participants completed a bowel symptom scale composed of four symptoms, abdominal pain or discomfort, bloating, diarrhea, and constipation as well as two psychosocial questionnaires, quality of relationship and attribution of symptoms to physical or emotional factors. RESULTS: Pain score in Italy, with the least urban population, was significantly higher than six of the seven other countries whereas it was lowest in India and England. Bloating was highest in Italy and constipation was highest in Mexico, both significantly higher than five other countries. Diarrhea was higher in China than five other countries. All significance values were P<0.05. Globally, diarrhea was less common than constipation, P<0.001 and bloating significantly correlated with constipation as well with pain, P<0.05. Composite analysis of psychosocial variables and symptoms indicated that family conflict correlated directly, P<0.05, whereas family support correlated indirectly, P<0.01, with pain and bloating. Pain, bloating and diarrhea were significantly attributed to physical etiology, P<0.01, whereas only diarrhea was attributed to emotional cause, P<0.05. CONCLUSION: This study suggests that there are significant variations in irritable bowel syndrome symptoms in different geographic locations around the world. Various hypotheses that may explain our data such as cultural beliefs, gut contamination, urban and rural location, dietary practice, and psychosocial factors should be further investigated.

An international study of irritable bowel syndrome: family relationships and mind-body attributions.

Irritable bowel syndrome (IBS) is a functional gastrointestinal illness, characterized by potentially debilitating symptoms without pathologic findings, often associated with psychological conditions. Little is known about the psychosocial aspects of this condition on an international scale. A total of 239 patients in eight countries were given a series of psychological and medical questionnaires, including IBS activity, relationships with significant others, beliefs regarding the etiology of symptoms, and assessment of quality of life. There were highly significant associations between IBS severity and all other measures. Symptoms were worse if relationship conflict was high and if attributions about illness were physiological rather than psychological. Symptoms were less severe if relationship depth and support were high, and illness was viewed as psychological. Implications for treatment are discussed.

Biofeedback treatment of fecal incontinence incorporating a mental variable without instrumentation: a prospective pilot study in Hispanic population.

UNLABELLED: The long-established approaches utilized to treat fecal incontinence always require instrumentation with some type of electronic equipment. This equipment is not always available in every institutions. In addition, no studied protocol principally used as coordination, sensory, or strength training has reached the level of gold standard. The purpose of this study was to describe a simple biofeedback technique that incorporating a mental variable and not requiring electronic equipment with prior adequate training could be used at any medical institution. METHODS: A particular modality of an operant conditioning technique was given once and a home trainer program was established. Forty-eight patients (mean age 37.1 +/- 3.7 years) were recruited. Patients had suffered from total incontinence for a period of 55 +/- 7.5 months, all used two to three pads per day and suffered 2.4 +/- 0.2 episodes of incontinence per day. Patients underwent clinical history recording, laboratory tests, recto-sigmoidoscopy, and double-contrast barium enema. Manometry and rectal sensitivity were performed in 7 and 27 patients, respectively. For physiologic comparisons, 21 healthy volunteers were used. RESULTS: A total of 79.1% of patients became continent in a median period of 3.9 +/- 0.5 months. An average of 3.85 +/- 0.55 sessions was required. Follow-up continued for 3-11 years. Patients with incontinence showed lower basal mean resting pressure, maximum squeeze pressure and rectal sensitivity (p <0. 01) and spontaneous rectoanal inhibitory reflex was absent in 57%. CONCLUSIONS: This biofeedback approach does not employ any type of electronic equipment and can be easily reproduced in any type of medical center. Additionally, this is the first report in which a methodology for biofeedback therapy successfully incorporates a mental variable in addition to sensory and strength training.

Biofeedback treatment of fecal incontinence incorporating a mental variable without instrumentation: a prospective pilot study in Hispanic population.

The long-established approaches utilized to treat fecal incontinence always require instrumentation with some type of electronic equipment. This equipment is not always available in every institutions. In addition, no studied protocol principally used as coordination, sensory, or strength training has reached the level of gold standard. The purpose of this study was to describe a simple biofeedback technique that incorporating a mental variable and not requiring electronic equipment with prior adequate training could be used at any medical institution. METHODS: A particular modality of an operant conditioning technique was given once and a home trainer program was established. Forty-eight patients (mean age 37.1 +/- 3.7 years) were recruited. Patients had suffered from total incontinence for a period of 55 +/- 7.5 months, all used two to three pads per day and suffered 2.4 +/- 0.2 episodes of incontinence per day. Patients underwent clinical history recording, laboratory tests, recto-sigmoidoscopy, and double-contrast barium enema. Manometry and rectal sensitivity were performed in 7 and 27 patients, respectively. For physiologic comparisons, 21 healthy volunteers were used. RESULTS: A total of 79.1

of patients became continent in a median period of 3.9 +/- 0.5 months. An average of 3.85 +/- 0.55 sessions was required. Follow-up continued for 3-11 years. Patients with incontinence showed lower basal mean resting pressure, maximum squeeze pressure and rectal sensitivity (p <0. 01) and spontaneous rectoanal inhibitory reflex was absent in 57

. CONCLUSIONS: This biofeedback approach does not employ any type of electronic equipment and can be easily reproduced in any type of medical center. Additionally, this is the first report in which a methodology for biofeedback therapy successfully incorporates a mental variable in addition to sensory and strength training.

Reference values for stationary and 24-hour ambulatory esophageal manometry and pH data in Hispanic population.

BACKGROUND: It has not yet been determined whether values obtained with stationary esophageal motility test are similar to those obtained with the 24-h procedure. Furthermore, there are no normal values established for esophageal pH and motility parameters in a Hispanic population. METHODS: Reflux symptoms, endoscopy, Helicobacter pylori, stationary esophageal manometry, and combined 24-h pH-manometry were evaluated in 12 healthy volunteers. Three subjects also underwent 24-h esophageal bilirubin monitoring. RESULTS: Mean lower esophageal sphincter pressure measured stationary was lower (p<0.05) compared with 24-h ambulatory procedure. Mean duration of contraction waves was greater with stationary method (p<0.05). Esophageal contraction mean amplitude was not different between both procedures. Total percent of time with pH<4 was 0.16+/-0.21. Total 24-h acid reflux episodes were 5.5+/-6.6, with no episodes >5 min. No high bilirubin reflux episodes were recorded. CONCLUSIONS: These results suggested that physiologic motility parameters differed depending on the method employed for its evaluation. Values obtained with stationary and 24-h ambulatory esophageal manometry are identical when evaluating amplitude of contractions but differ in duration of contractions and lower esophageal sphincter pressure. In addition, these results provide for the first time reference values for stationary and 24-h ambulatory esophageal manometry and pH data in a Hispanic population.

Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux.

BACKGROUND: The association of H. pylori and hiatal hernia in patients with gastroesophageal reflux disease, in terms of acidity and esophageal motility, is not well defined. The purpose of this work was to assess whether, in patients with gastroesophageal reflux, the presence of H. pylori and hiatal hernia affects the severity of esophagitis. METHODS: Reflux symptoms, endoscopy, H. pylori, esophageal manometry, and 24-h pH monitoring were evaluated in 37 patients with esophageal reflux and 14 healthy volunteers. RESULTS: A total of 75.6% of patients with esophageal reflux was positive for H. pylori; 81% had hiatal hernia, and only 43.2% showed an acid score by 24-h pHmetry. Esophageal reflux patients with H. pylori, hiatal hernia, and an acid score demonstrated higher acid parameters compared with those in healthy volunteers. Patients with an acid score who were negative for H. pylori tended toward more acid reflux events than patients with an acid score who were positive for H. pylori, a difference that did not reach significance. The same situation existed with patients with an acid score and hiatal hernia who were negative for H. pylori, but the tendency did not achieve significance. Independent analysis of patients with Savary-Miller stage II and III esophagitis showed results that were not different from the combined analysis of stage II and III patients. Amplitude and contraction-duration parameters of the esophageal wave, and the number of high-pressure and prolonged contractions were not different among the reflux groups. Wave amplitude in the lower third of the esophagus was significantly lower in esophagitis stage III patients with hiatal hernia and in esophagitis stage II and III patients, combined, with H. pylori, compared with findings in the healthy volunteers. CONCLUSIONS: These results suggest that H. pylori and hiatal hernia in patients with esophageal reflux do not constitute risk factors that affect the severity of esophagitis.