Diffuse Gastrointestinal Motor Compromise in Patients with Scleroderma: Utility of Minimally Invasive Techniques.

BACKGROUND: Scleroderma is a systemic inflammatory disorder that can compromise the gastrointestinal tract in up to 90% of patients. AIM: The purpose of this work is to characterize esophageal, gastric, and intestinal compromise in patients with scleroderma by means of minimally invasive methods and its association with symptoms and severity of their rheumatological condition. METHODS: Patients with systemic sclerosis were recruited according to the criteria of the American College of Rheumatology. The study of digestive involvement was carried out on four consecutive days: esophageal manometry was performed on the first day, intestinal manometry on the second day, surface electrogastrography on the third, and hydrogen breath test on the fourth. The Mann-Whitney test was used for quantitative variables and the chi-squared test for categorical variables (p < 0.05). RESULTS: A total of 30 patients were included, with an average age of 52.7 years and 93% women. Average disease evolution duration was 6.5 years, 70% with limited variety. Rodnan averaged 12 points, being higher in the diffuse variety. The main symptom was heartburn, followed by abdominal distension, with no differences between subtypes except for diffuse nausea; 80% had intestinal manometric compromise, 76% esophageal manometric compromise, and 30% electrogastrographic compromise. Bacterial overgrowth was evidenced in two-thirds (66%) of the patients, and 23% of the patients had simultaneous esophageal, gastric, and intestinal involvement, which correlated with greater skin involvement but not with gastrointestinal symptoms. CONCLUSIONS: Gastrointestinal involvement in patients with scleroderma is frequent and is observed regardless of the symptoms and clinical characteristics of the latter, except for skin involvement.

Chronic Intestinal Pseudo-obstruction: Clinical and Manometric Characteristics in the Chilean Population.

BACKGROUND/AIMS: Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by a failure of the propulsion of intraluminal contents and recurrent symptoms of partial bowel obstruction in the absence of mechanical obstruction. Regional variations of the intestinal compromise have been described. Intestinal manometry can indicate the pathophysiology and prognosis. Our objective is to establish the demographic and clinical characteristics of group Chilean patients and analyze the motility of the small intestine and its prognostic value. METHODS: Patients with symptoms of intestinal pseudo-obstruction with dilated bowel loops were included, in all of whom a manometry of the small intestine was performed using perfused catheters. RESULTS: Of the 64 patients included, 51 women (average age 41.5 ± 17.6 years), 54 primary and 10 secondary CIPO were included. Dilatation of the small intestine was the only finding in 38 patients; in the remaining, the compromise was associated with other segments, primarily the colon. Forty-nine patients underwent 65 surgeries, mainly exploratory laparotomies and colectomies. Intestinal manometry was performed on all patients; 4 "patterns" were observed: neuropathic (n = 26), myopathic (n = 3), mixed (n = 24), and a group without motor activity (n = 11). The most relevant findings were the complex migrating motor disorders and decreased frequency and propagation of contractions. The 9 patients who died had a severe myopathic compromise. CONCLUSIONS: In our series, isolated small bowel compromise was the most common disorder. Neuropathic motor compromise was observed in most of the patients. Mortality was associated with severe myopathic compromise.

Enfermedad de Ménétrier con compromiso gástrico difuso y duodenal: Caso clínico / Ménétrier disease: Report of one case

Background: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.

Lactulose hydrogen breath test and functional symptoms in pediatric patients.

BACKGROUND: The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H(2) breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria. METHODS: Seventy-two patients and 17 controls were enrolled. A questionnaire was administered regarding digestive symptoms (abdominal pain, bloating, vomiting, and bowel-movement disorders). A lactose hydrogen breath test was performed to rule out lactose malabsorption and a LHBT was used to measure the time elapsed between lactulose oral ingestion and an increment of H(2) concentration of 20 ppm over basal. RESULTS: There were no differences of age and gender between patients and controls. Mean time to 20-ppm change was shorter in patients (56.3 ± 3 min) compared to healthy children (74.7 ± 5 min), p\0.05. In 39% of patients, rise of H(2) occurred during the first 40 min after lactulose ingestion, and in almost all controls, an increment was observed between 50 and 90 min (p\0.05). Symptoms were unrelated to time to 20-ppm change. CONCLUSIONS: An abnormal LHBT was found in children with functional symptoms of the digestive tract, but the exact mechanism involved, accelerated intestinal transit or SIBO, needs to be confirmed by an additional method.

[Ménétrier disease. Report of one case]. / Enfermedad de Ménétrier con compromiso gástrico difuso y duodenal: Caso clínico.

BACKGROUND: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.

Small intestinal clustered contractions and bacterial overgrowth: a frequent finding in obese patients.

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) has been observed in several disorders of the gastrointestinal tract. Studies have shown abnormalities of motor function in obese patients, and there is indirect evidence suggesting that SIBO is present in them. AIMS: To study small intestinal motility and the prevalence of SIBO in obese patients and to determine whether there was any relationship between both parameters. METHODS: Thirty-nine patients scheduled for bariatric surgery were subjected to hydrogen breath test with lactulose and to a stationary small intestinal motility study with perfused catheters. RESULTS: SIBO was observed in 41% of obese patients and was not related to body mass index. Small intestinal manometry showed a marked increase of clustered contractions in obese patients with SIBO compared to obese subjects without SIBO, whereas all the other parameters of fasting cyclic activity were not different. CONCLUSIONS: SIBO was a frequent finding in obese patients and was associated with an increased pattern of clustered contractions, which was not observed in absence of SIBO.

Comparison of artificial neural networks an support vector machines for feature selection in electrogastrography signal processing.

The paper describes a feature selection process applied to electrogastrogram (EGG) processing. The data set is formed by 42 EGG records from functional dyspeptic (FD) patients and 22 from healthy controls. A wrapper configuration classifier was implemented to discriminate between both classes. The aim of this work is to compare artificial neural networks (ANN) and support vector machines (SVM) when acting as fitness functions of a genetic algorithm (GA) that performs a feature selection process over some features extracted from the EGG signals. These features correspond to those that literature shows to be the most used in EGG analysis. The results show that the SVM classifier is faster, requires less memory and reached the same performance (86% of exactitude) than the ANN classifier when acting as the fitness function for the GA.

[Prevalence of metronidazole, clarithromycin and tetracycline resistance in Helicobacter pylori isolated from Chilean patients]. / Prevalencia de la resistencia a metrodinazol, claritromicina y tetraciclina en Helicobacter pylori aislado de pacientes de la Región Metropolitana.

BACKGROUND: Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. At present, therapeutic strategies to eradicate this bacterium depend on our knowledge of its resistance to antimicrobials. AIMS: To evaluate the primary resistance of H pylori to metronidazole (Mtz), clarithromycin (Cla), and tetracycline (Tet) in symptomatic out-patients. MATERIAL AND METHODS: Fifty independent isolates of H pylori were obtained by endoscopy-assisted gastric biopsy from patients attending the University of Chile Clinical Hospital, that previously had not been treated with an eradication regime against this bacterium. The minimal inhibitory concentration of each antimicrobial was determined by agar dilution method. RESULTS: Forty five and 27% of the isolates were found to be resistant to Mtz and Tet, respectively; the majority of these resistant isolates were from patients older than 21 years. Twenty percent of isolates were resistant to Cla; these were distributed evenly among different ages. Thirty two percent of the isolates were resistant to two or more of the antimicrobials. CONCLUSIONS: The high frequency of naturally occurring, antimicrobial-resistant strains of H pylori poses a national and world-wide problem for public health.

Patterns of small intestinal motor activity during intraluminal infusion of elementary diets in dogs.

During continuous intraintestinal infusion of elementary diets, periodic fluctuation of the frequency of contractions has been observed. This study sought to characterize the temporospatial organization of this pattern and the influence of cholinergic input. Studies were performed on unanesthetized dogs with a duodenal cannula. Motor activity was recorded by means of infused catheters and external transducers. Nutrients were infused continuously at the duodenum and jejunal levels. Studies were repeated after administration of atropine. Six to 14 periodic variations of frequency of contractions during 10 basal infusion experiments were observed in random order. During duodenal infusion, atropine significantly increased the number of these events, associated with a synchronous pattern. Frequency and amplitude of contractions during jejunal infusion were significantly lower compared to duodenal infusion. Cyclic pattern elicited by nutrient infusion is related to a cholinergic mechanism; changes depend on the level of infusion.

[Disturbances of small intestinal motility in patients with chronic constipation]. / ¿Existe en la constipación idiopática severa un trastorno difuso de la motilidad intestinal?

BACKGROUND: Studies in patients with chronic severe constipation, suggest the presence of a diffuse motor disorder of the gastrointestinal tract. AIM: To investigate small bowel motor activity in a group of patients with severe constipation. MATERIAL AND METHODS: Forty three patients (age range 13 to 70 years, 40 women) with severe constipation referred to our motility laboratory, where studied. Ten had a previous colectomy. Radiological examinations showed a megacolon in 30 and dilatation of small intestinal loops in nine; the remaining X rays studies were normal. Small intestinal motility was studied using perfused catheters and external transducers. RESULTS: Ten patients had normal motor recordings. Eight patients showed a neuropathic disorder characterized by a continuous irregular pattern of contractions of normal amplitude, with absence of phase III of the migrating motor complex (MMC). Sixteen presented a normal MMC associated to a decreased amplitude of contractions (Miopatic disorder). Nine showed both types of motor disorders (Mixed pattern). Normal radiological findings were more commonly associated to normal manometric recordings. By contrast, an altered motor activity, mainly of myopathic and mixed type motor disorder, was observed in all patients with dilated small intestinal and colonic loops. CONCLUSIONS: The presence of small intestinal motor disorders was a frequent finding in this selected group of patients with chronic constipation.

[Gastrointestinal motility disturbances in Chagas disease]. / Alteraciones motoras gastrointestinales en la enfermedad de Chagas.

UNLABELLED: Serum antibodies against Trypanosoma Cruzi have been observed in 19% of the Chilean population. Marked differences in organ involvement have been reported in patients with Chagas disease. Chagas disease is rarely an aetiological factor for achalasia in Chile, which is different from reports in other countries of South America. In contrast, a high incidence of megacolon among these patients have been reported. AIM: To study the incidence of gastric and small intestinal motor disorders among these patients and their relationship to esophageal and colon motility disorders. PATIENTS AND METHODS: We studied 18 patients, 12 women (mean age 45 years); with positive antibodies against T. Cruzi. Seven had radiological evidence of megacolon and no one had radiological or manometric evidence for achalasia. Non specific motor esophageal abnormalities were found in 11 patients. Nine had an abnormal electrocardiogram, suggesting a myocardial disease. A questionnaire for gastrointestinal symptoms, an electrogastrography and a small intestinal motility study, were performed in each patient. RESULTS: All patients had evidences of abnormalities in at least one segment of the digestive tract. Twelve patients had an abnormal electrogastrographic study, with bradygastria as the most common finding. Nine had an abnormal small intestinal manometry with a myophatic pattern evidenced by a decreased amplitude of contractions (18.5 +/- 3 mmHg). Also an increased number of clustered contractions was observed. CONCLUSIONS: Gastric dysrhythmias and small intestinal motor abnormalities are frequently associated to non specific esophageal motor disorders and megacolon in patients with Chagas disease.

[Clinical and immunological study of 10 immunocompetent patients with esophageal candidiasis]. / Candidiasis esofágica en pacientes inmunocompetentes: estudio clínico e inmunológico.

BACKGROUND: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. AIM: To report the features of 10 immunocompetent patients with esophageal candidiasis. PATIENTS AND METHODS: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, lymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. RESULTS: Six patients had a low CD4 lymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. CONCLUSIONS: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated.

Canine small bowel motor activity in response to intraduodenal infusion of nutrient mixtures of increasing caloric load in dogs.

The effect of nutrients on small intestinal motility is controversial. Our aim was to analyze the effect of intraduodenal infusion of mixtures of nutrients of increasing caloric load, on intestinal motility. Studies were performed in dogs with a duodenal cannula. Isosmolar infusions of saline, 0.5, 2, and 4 kcal/min were performed and motility recorded by means of infused catheters. Nonstatistically significant differences were observed between frequency of contractions during infusion of 0.5 (4.1 +/- 1.6 cpm) and 2 kcal/min (5.3 +/- 1.5 cpm) compared to control (4.3 +/- 1.9 cpm). With 4 kcal/min a significant decrease of frequency (2.7 +/- 0.9 cpm) was observed. A similar finding was observed for amplitude of contrations. With 0.5 kcal/min fasting cyclic activity was still present, but the numbers of phase III were significantly reduced, associated with an increased duration of phase II. With higher caloric loads cyclic fasting activity was replaced by marked variations of frequency, following a cyclic pattern. A lower threshold for mechanisms switching the fasting to fed state was observed, compared to those controlling frequency and amplitude.

[Endogenous ethanol production in patients with liver cirrhosis, motor alteration and bacterial overgrowth]. / Producción endógena de alcohol en pacientes con cirrosis hepática, alteración motora y sobrecrecimiento bacteriano.

BACKGROUND: Small intestinal bacterial overgrowth generates endogenous ethanol production both in experimental animals and humans. Patients with cirrhosis have small intestinal bacterial overgrowth, but endogenous ethanol production has not been studied in them. AIM: To investigate endogenous ethanol production in patients with cirrhosis, altered intestinal motility and small intestinal bacterial overgrowth. PATIENTS AND METHODS: Eight patients with cirrhosis of different etiologies and altered gastrointestinal motility, consisting in changes in the migrating motor complex, were studied. All had also small intestinal bacterial overgrowth, measured by means of the H2 breath test with lactulose. Plasma ethanol levels were measured by gas liquid chromatography in fasting conditions and 120 min after a carbohydrate rich meal. RESULTS: In fasting conditions, no patient had endogenous ethanol production. Alter the meal, ethanol in concentrations of 11.3 and 8.2 mg/del were detected in two patients. Negligible amounts of ethanol were detected in 4 patients and two patients had undetectable alcohol levels. CONCLUSIONS: A low endogenous production of ethanol was demonstrated in six of eight patients with cirrhosis.

[Cutaneous electrogastrography: a new incorporated technique for the study of gastric motility]. / Electrogastrografía de superficie: una nueva técnica para el estudio de la motilidad gástrica en nuestro medio.

BACKGROUND: Gastric electrical activity can be accurately recorded and analyzed by cutaneous electrogastrography. Different types of abnormalities have been described in a variety of disorders. AIM: To analyze a group of asymptomatic subjects and assess the prevalence and patterns of dysrrhythmias in patients with type 1 and 2 diabetes and patients with functional dyspepsia. PATIENTS AND METHODS: One hundred subjects were studied (32 male, mean age 45 years old, 10 asymptomatic, 11 type 1 diabetics, 22 type 2 diabetics and 57 subjects with functional gastrointestinal disturbances). Gastric myoelectrical activity was recorded using surface electrogastrography for 1 hour in the fasting state and 1 hour after a test meal (350 kcal). RESULTS: The electrogastrogram was normal in 90% of asymptomatic controls. It was abnormal in 64% of type 1 diabetic patients, in 55.5% of type 2 diabetic patients and in 61% of patients with functional dyspepsia. Different types of dysrrhythmias were observed in each group. CONCLUSIONS: Electrogastrography might define a subgroup of patients with electrical rhythm disturbances, that may have a different approach to treatment than patients with normal gastric electrical activity.