Lactase and placebo in the management of the irritable bowel syndrome: a double-blind, cross-over study.

A double-blind, cross-over, therapeutic, clinical trial of the efficacy of exogenous, microbial beta-D-galactosidase to reduce the symptoms of the irritable bowel syndrome (IBS) was conducted in 12 patients whose customary diets regularly included milk. Eight of the 12 subjects (67%) proved to be lactase-nonpersistent, lactose-maldigesters when challenged with a aqueous dose of 12.5 g. The study lasted 4 months, with the first month a non-intervention, control period and the latter 3 months alternating in the sequence, treatment/placebo/treatment, or placebo/treatment/placebo. When symptoms during trial months were analyzed by the cumulative sum procedure, gastrointestinal symptoms were found to be independent of lactase treatment. We found a positive temporal association of the severity of both gastrointestinal and non-gastrointestinal symptomatology. In populations with a high prevalence of lactose deficiency, IBS symptoms appear to be independent of lactose maldigestion.

Deficiencia de lactasa y el sindrome de colon irritable. / Lactase deficiency and irritable colon syndrome

Se ivestigo la posible relacion entre el sindrome de colon iritable y la deficiencia de lactasa intestinal.Cincuenta y cinco (66%) de 83 pacientes con colon irritable tuvieron hipolactasia, proporcion similar a la de otros pacientes sin colon irritable en nuestra Institucion. Por otro lado, cuando menos el 56% de los sujetos deficientes que se sometieron a una dieta sin lactosa, mostraron clara mejoria clinica. Este estudio piloto plantea la necesidad de realizar una investigacion doble ciego para esclarecer el papel de la hipolactasia en el sindrome de colon irritabl

Manometria del esofago en pacientes con manifestaciones digestivas altas. / Esophageal manometry in patients with upper digestive manifestations

Se valoran en el presente estudio 40 pacientes con diagnostico de trastornos funcionales digestivos altos que tenian 3 de los siguientes sintomas: regurgitaciones, sensacion de plenitud postprandial, imposibilidad de terminar las comidas, distension abdominal, agruras o pirosis, ardor epigastrico, eructos, nausea y vomito. A todos ellos se les practico estudio clinico completo, radiologia de las vias digestivas superiores, endoscopia y manometria esofagica por medios convencionales.Se demostro que la mitad de los pacientes tenian insuficiencia de presion en el esfinter esofagico ademas de que algunos de ellos presentan aumento de las contraciones en el cuerpo del esofago o disminucion en las mismas.El presente estudio parece mostrar que en los enfermos con supuestos trastornos funcionales digestivos altos, pueden haber combios importantes en las presiones del esfinter esofagico inferior, lo que podria tener relacion a su fisiopatologia. Se discute ademas la conveniencia de emplear medicamentos adecuados en estos pacientes al haberse descernido su funcion motora de manera mas correcta por metodos manometricos

Enteropatia por gluten. / Gluten enteropathy

Se describen los hallazgos clinicos, de laboratorio, radiologicos y de biopsia de instestino delgado, en 43 pacientes con enteropatia por gluten que provenian fundamentalmente del Distrito Federal. La mayor frecuencia del padecimiento lo observamos en la 2a. y 7a. decadas de la vida. El principal sintoma fue diarrea y el signo predominante fue perdida de peso. Otros datos importantes fueron dolor abdominal, meteorismo, anemia y ataque al estado general. Los signos carenciales se presentaron en 44.2% de los enfermos. Otros datos que ocurrieron con frecuencia menor fueron distension abdominal, edema, borborigmos y retardo en el desarrollo. Se observo asi mismo que predomino el grado minimo de desnutricion. Las pruebas especificas fueron en orden de utilidad, absorcion de la d-xilosa, determinacion de carotenos sericos, determinacion de trioleina I 131 en heces y cuantificacion de grasa en materia fecal. Predominaron los cambios microscopicos moderados. La respuesta al tratamiento medico fue excelente en el 41.9%, buena en un 25.6%, regular en 16.3%, mala en 4.6% de los casos, y no se valoro en el resto

[Esophageal manometry in patients with sliding hiatal hernia]. / Manometría esofágica en pacientes con hernia hiatal por deslizamiento.

This presents the method to be followed for the valuation of the gastro-esophagic function in patients with sliding hiatal hernia, twenty-one patients with this diagnosis were studied through X-Rays. Besides gastric and esophagic endoscopy, a complete clinical examinations was made to compare the information obtained from the studies, with the direct measurement of the contractions of the esophagus and the lower sphincter through conventional manometric methods. The relationship between the simptoms and the clinical procedures done in the patients were observed as was the usefulness of esophagic manometry to detect not only the direct pressure of the gastro-esophagic sphincter, but also to determine the concurrent motor changes that can occur in patients which show hiatal hernia. The benefit of this studies to decide the therapeutic handling, specially surgical, is discussed.

[Evaluation of antacids "in vitro"]. / Evaluación de antiácidos "in vitro".

Five different antacids were compared "in vitro" through titration with NaOH 0.5 N to observe their neutralising power towards HCl 1.0 N. Eight pH measurements were done for each antacid. The neutralising capacity of the antacid was calculated with a specific formula for each pH measure reading, with this information statistical calculation were made to compare the antacids among themselves, with suggest that the method can be useful in the valuation of newly produced antacid before their clinical application.

[Surgical treatment of achalasia. Analysis of 27 cases]. / Tratamiento quirúrgico de la acalasia. Análisis de 27 casos.

1. Esophageal achalasia is a rare disease of unknown origin that occurs with the same frequency in both sexes. 2. During the preoperative workup as well as the postoperative time the following studies should be performed: upper GI series, esophageal manometry and endoscopy with biopsy. 3. In most instances conservative treatment with dilations only provides temporal relief of the symptoms and moreover, is not exempt from complications; it should be employed only in incipient achalasia, in patients who refuse to be operated upon and in those whose general conditions make surgery inadvisable. 4. Surgery can provide a permanent cure for the symptomatology in the majority of the patients, with a very low mortality and morbidity; an operation should be performed early in those who retain more than 10 mls. in the esophagus with persistence of the symptomatology as well as in those patients in whom cancer is suspected. 5. A modified Heller type operation, with abdominal approach with gastrostomy, diaphragmatic hernioplasty and an anti-reflux procedure and when necessary a piloroplasty is the treatment of choice for esophageal achalasia yielding good results in 88.8% of the cases. It should be noted that the degree of postoperative gastroesophageal regurgitation is directly related to the extent to which the gastric incisons is extended below the esophageal-gastric junction.

Stimulatory effect of metoclopramide on the esophagus and lower esophageal sphincter of patients of patients with PSS.

Metoclopramide has been shown to stimulate motility of the gastrointestinal tract, including the esophagus. The authors therefore tested the effect of intravenous injections of metoclopramide on the sphincteric pressure and esophageal motility in 14 patients with esophageal dysfunction due to progressive systemic sclerosis (PSS). Isotonic saline similarly injected in a control period in 7 of the patients showed no effect. None of the 14 patients had a detectable pressure zone at the sphincteric area in basal conditions, but following the injection of metoclopramide, one appeared in 7 patients. Metoclopramide also caused the appearance of pressure waves in 5 of 11 patients who had aperistalsis, and caused up to a three fold increase in the amplitude of the pressure waves in the 3 patients who had hypomotility of the esophagus.