A global perspective on irritable bowel syndrome: a consensus statement of the World Gastroenterology Organisation Summit Task Force on irritable bowel syndrome.

Irritable bowel syndrome (IBS) is common in western Europe and North America, and many aspects of its epidemiology, risk factors, and natural history have been described in these regions. Recent data suggest, however, that IBS is also common in the rest of the world and there has been some evidence to suggest some differences in demographics and presenting features between IBS in the west and as it is experienced elsewhere. The World Gastroenterology Organization, therefore, established a Task Force comprising experts on the topic from all parts of the world to examine IBS from a global perspective. IBS does, indeed, seem to be common worldwide though with some significant variations in prevalence rates between regions and countries and there may well be some potentially interesting variations in presenting symptoms and sex distribution. The global map of IBS is far from complete; community-based prevalence data is not available from many areas. Furthermore, while some general trends are evident in terms of IBS impact and demographics, international comparisons are hampered by differences in diagnostic criteria, study location and methodology; several important unanswered questions have been identified that should form the basis for future collaborative research and have the potential to shed light on this challenging disorder.

Doença do refluxo gastroesofágico / Gastroesophageal disease

A doença do refluxo gastroesofágico (DRGE) é uma condição que se desenvolve quando o refluxo do conteúdo procedente do estômago provoca sintomas desagradáveis e/ou complicações. O quadro clínico costuma ser simples, representado por pirose e/ou regurgitação (manifestações típicas). As manifestações atípicas (sintomas crônicos laríngeos, asma), entretanto, podem também se apresentar isoladamente, tornando mais difícil a suspeita diagnóstica. DRGE pode ser erosiva (quando visível ao exame endoscópico) ou não erosiva (endoscopia negativa). O exame endoscópico não apresenta sensibilidade elevada. A endoscopia digestiva alta permite a realização de biópsias nos casos de complicação, como o esôfago de Barrett, estenose e ulceração. A pHmetria de 24 horas é um método sensível e específico, mas apresenta alguns inconvenientes, entre os quais a incapacidade para reconhecer o refluxo duodenogástrico. Nesse sentido, a combinação da pHmetria com a impedância esofágica pode ser bastante útil. O tratamento clínico é dividido em medidas comportamentais/dietéticas e farmacológicas, estas compreendendo o uso de inibidores da bomba protônica (omeprazol, lansoprazol, pantoprazol, rabeprazol e esomeprazol). As complicações da doença e os pacientes que requerem tratamento contínuo de manutenção, principalmente os mais jovens, consistem nas principais indicações cirúrgicas da DRGE. Usualmente os mais responsivos ao tratamento cirúrgico são os que melhor respondem ao tratamento clínico.

Efficacy of a 7-day course of furazolidone, levofloxacin, and lansoprazole after failed Helicobacter pylori eradication.

BACKGROUND: Increasing resistance to clarithromycin and nitroimidazole is the main cause of failure in the Helicobacter pylori eradication. The ideal retreatment regimen remains unclear, especially in developing countries, where the infection presents high prevalence and resistance to antibiotics. The study aimed at determining the efficacy, compliance and adverse effects of a regimen that included furazolidone, levofloxacin and lansoprazole in patients with persistent Helicobacter pylori infection, who had failed to respond to at least one prior eradication treatment regimen. METHODS: This study included 48 patients with peptic ulcer disease. Helicobacter pylori infection was confirmed by a rapid urease test and histological examination of samples obtained from the antrum and corpus during endoscopy. The eradication therapy consisted of a 7-day twice daily oral administration of lansoprazole 30 mg, furazolidone 200 mg and levofloxacin 250 mg. Therapeutic success was confirmed by a negative rapid urease test, histological examination and 14C- urea breath test, performed 12 weeks after treatment completion. The Chi-square method was used for comparisons among eradication rates, previous treatments and previous furazolidone use. RESULTS: Only one of the 48 patients failed to take all medications, which was due to adverse effects (vomiting). Per-protocol and intention-to-treat eradication rates were 89% (95% CI- 89%-99%) and 88% (88-92%), respectively. Mild and moderate adverse effects were reported by 41 patients (85%). For patients with one previous treatment failure, the eradication rate was 100%. Compared to furazolidone-naïve patients, eradication rates were lower in those who had failed prior furazolidone-containing regimen(s) (74% vs. 100%, p = 0.002). CONCLUSION: An empiric salvage-regimen including levofloxacin, furazolidone and lansoprazole is very effective in the eradication of Helicobacter pylori, particularly in patients that have failed one prior eradication therapy.

Helicobacter pylori recurrence in patients with duodenal ulcer: Clinical, endoscopic, histologic, and genotypic aspects. A 10-year Brazilian series.

BACKGROUND: Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. MATERIALS AND METHODS: One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. RESULTS: H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. CONCLUSIONS: The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.

GERD 2003 -- a consensus on the way ahead.

Gastroesophageal reflux disease (GERD) has in recent times become an important public health issue owing to the considerable health care resources utilized in its management, its deleterious effect on quality of life and the increasing prevalence of a relatively rare complication of reflux disease - esophageal adenocarcinoma. We review here the major current challenges in the field of reflux disease and its complications, and provide some approaches that may be useful in management. The issues to be faced include the very limited comprehension of the reasons behind the increasing prevalence of the disease, difficulties in correlating symptoms with objective data of pathological gastroesophageal reflux and the relatively unsophisticated tools we are employing to investigate the underlying pathophysiology. It is certain that the lack of well-defined and characterized methodologies to compare the effects of therapy require the development of more effective questionnaire-type analytic tools. In regard to treatment, there is little doubt that the widely prescribed proton pump inhibitors have dose-equivalent efficacy and are the most highly effective agents capable of suppressing acid, controlling many of the symptoms of GERD and healing erosions. Nevertheless, many patients continue to experience symptoms on withdrawal or at night. Pharmacological agents that can effectively increase lower esophageal sphincter pressure or promote motility are as yet unavailable. Although the introduction of laparoscopic techniques has resulted in a modest revival in surgical intervention using a variety of 'wrap-type' operations, the indications are few and the procedure is associated with a significant morbidity and even mortality especially if the expertise of the surgeon is an issue. Endoscopic techniques of regulating reflux are at this time experimental and not applicable to the general population. Intestinal metaplasia in the lower esophagus is probably very common. Whether and how to, first, screen for, and then, perform surveillance in Barrett's esophagus remains highly problematic and contentious.

Inibidor de bomba de protônica pantoprazol em dose plena no tratamento das doenças ácido-relacionadas. Estudo ambulatorial brasileiro / Proton pump inhibitor - Pantoprazole 40 mg - in the trteatment of acid related diseases

Os inibidores de bomba platônica (IBPs) têm elevado significado significativamente os índices de cicatrizaçäo das doenças ácido-relacionadas com mínimos eventos adversos. Pantoprazol é um IBP com propriedades farmacológicas definidas, intensa açäo anti-secretora e elevada eficácia clínica. O objetivo deste estudo foi avaliar a eficácia e a segurança de pantoprazol, 40 mg, em uma populaçäo näo selecionada, portadora de doenças ácido-relacionadas. Em estudo aberto, prospectivo, näo randomizado, ambulatorial, foram avaliados 2.222 pacientes (média etária de 44,3 anos) divididos em três grupos. Todos os pacientes receberam pantoprazol, 40 mg/dia, durante duas a oito semanas. Os índices de cicatrizaçäo da UG e DU foram 71,6 porcento e 81 porcento, respectivamente. Os índices de cicatrizaçäo das esofagites de refluxo foram de 81,2 porcento, 67,7 porcento, 50 porcento e 36,1 porcento nos graus I, II,III e IV, respectivamente, de acordo com a classificaçäo de Savary-Miller. A maioria dos eventos adversos foram leves e ocorreram em 2,5 porcento dos pacientes. Os mais freqüentemente relatados foram cefaléia, diarréia, prurido, constipaçäo e tontura. A eficácia do pantoprazol no tratamento das doenças ácido-relacionadas foi demonstrada. O bom perfil de tolerabilidade confirma a segurança do produto.(au)

Randomized, double-blind trial comparing indinavir alone, zidovudine alone and indinavir plus zidovudine in antiretroviral therapy-naive hiv-infected individuals with CD4 cell counts between 50 and 250/mm3

Treatment with indinavir has been shown to result in marked decreases in viral load and increases in CD4 cell counts in HIV-infected individuals. A randomized double-blind study to evaluate the efficacy of indinavir alone (800 mg q8h), zidovidine alone (200 mg q8h) or the combination was performed to evaluate progression to AIDS. 996 antiretroviral therapy-naive patients with CD4 cell counts of 50-250/mm3 were allocated to treatment. During the trial the protocol was amended to add lamivudine to the zidovudine-containing arms. The primary endpoint was time to development of an AIDS-defining illness or death. The study was terminated after a protocol-defined interim analysis demonstrated highly significant reductions in progression to a clinical event in the indinavir-containing arms, compared to the zidovudine arm (<0.0001). Over a median follow-up of 52 weeks (up to 99 weeks), percent reductions in hazards for the indinavir plus zidovudine and indinavir groups compared to the zidovudine group were 70 percent and 61 percent, respectively. Significant reductions in HIV RNA and increases in CD4 cell counts were also seen in the indinavir-containing groups compared to the zidovudine group. Improvement in both CD4 cell count and HIV RNA were associated with reduced risk of disease progression. All three regimens were generally well tolerated