Prevalencia de síntomas gastrointestinales en trastornos del espectro del autismo: un metaanálisis / Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis

Introducción: Se ha descrito una elevada prevalencia de síntomas gastrointestinales (GI) en los niños y adolescentes con trastornos del espectro del autismo (TEA). Además, se ha relacionado la presencia de dichos síntomas con mayor gravedad de la clínica TEA. Sin embargo, la frecuencia de síntomas GI en niños y adolescentes con TEA es muy variable a lo largo de los estudios y no se conoce su verdadera prevalencia. Por tanto, el objetivo del presente trabajo fue estimar la prevalencia de síntomas GI en niños y adolescentes con TEA. Material y método: Se realizó un metaanálisis siguiendo las directrices PRISMA. Se llevó a cabo una búsqueda sistemática rápida de nuevos estudios clínicos y observacionales desde agosto de 2012 en PubMed. Los análisis estadísticos se realizaron con el software R. Resultados: De 91 artículos potencialmente elegibles, solo 8 cumplieron nuestros criterios de inclusión. La prevalencia de síntomas GI osciló entre el 0 y el 69%, con una prevalencia general estimada del 33% (IC del 95%: 13-57%), cifra superior a la reportada por un metaanálisis previo para la población general pediátrica. Esta diferencia es todavía mayor al comparar específicamente los estudios que emplean la versión pediátrica del cuestionario ROMA III (QPGS-ROME III). Conclusiones: Estos resultados confirman la hipótesis de que existe una prevalencia superior de síntomas GI funcionales en el TEA frente a sus coetáneos neurotípicos. (AU)

Introduction: A high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. Material and method: We conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. Results: Of 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%-57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). Conclusions: The results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers. (AU)

Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis.

INTRODUCTION: A high prevalence of gastrointestinal (GI) symptoms has been described in children and adolescents with autism spectrum disorder (ASD). In addition, there is evidence that presence of GI symptoms is associated to greater severity of ASD. However, the frequency of GI symptoms in children and adolescents with ASD varies widely across studies, and their true prevalence is unknown. Therefore, the objective of this study was to estimate the prevalence of GI symptoms in children and adolescents with ASD. MATERIAL AND METHOD: We conducted a meta-analysis following the PRISMA guidelines. We carried out a rapid systematic search for recent clinical and observational studies published from August 2012 in PubMed. The statistical analyses were performed with the software R. RESULTS: Of 91 potentially eligible articles, only 8 met our inclusion criteria. The prevalence of GI symptoms ranged between 0% and 69%, with an estimated general prevalence of 33% (95% CI, 13%-57%), higher than that reported by a previous meta-analysis for the general paediatric population. This difference is even greater in the specific comparison of studies that applied the paediatric version of the ROME III questionnaire (QPGS-ROME III). CONCLUSIONS: The results confirmed the hypothesis that there is a higher prevalence of functional GI symptoms in paediatric patients with ASD compared to their neurotypical peers.

Indice de calidad de vida percibida en pacientes con trastornos gastrointestinales funcionales en Buenos Aires, Argentina / Perceived Quality of Life Index in Patients with Functional Gastrointestinal Disorders at a Public Hospital in Buenos Aires, Argentina

Resumen Los trastornos gastrointestinales funcionales (TGF) son enfermedades crónicas que configuran un problema relevante en la salud pública, asociados en investigaciones previas a una peor calidad de vida. El objetivo del presente trabajo fue estudiar la calidad de vida en pacientes que acuden a un servicio de neurogastroenterología en un hospital de Argentina y compararlo con población control. Para ello, se realizó un estudio cuantitativo y transversal incluyendo población clínica diagnosticada con algún TGF (n = 35) y una muestra control sin diagnóstico de TGF (n = 37). Se encontraron diferencias significativas entre personas con TGF y sujetos control, X 2 (1, N = 70) = 30.23,p < .001 en todas las subdimensiones de la escala de calidad de vida (MQLI), exceptuando satisfacción espiritual (PE). Similar a investigaciones previas, los resultados de este estudio sugieren que, en Argentina -al igual que en otros países-, los individuos con TGF muestran una peor percepción de calidad de vida que la población general. Estos hallazgos podrían contribuir al diseño de intervenciones que contemplen variables biopsicosociales, con el objetivo de una mejoría integral en la calidad de vida de las personas que padecen estos trastornos.

Abstract Functional Gastrointestinal Disorders (FGDS) are chronic diseases that constitute a relevant public health problem, associated in previous research with a poorer quality of life. The aim of this study was to study the quality of life in patients attending a Neurogastroenterology Service at an Argentinean public hospital and compare it with a control population. A quantitative and cross-sectional study was carried out including a clinical population diagnosed with some FGD (n = 35) and a control sample without diagnosis of FGD (n = 37). Significant differences were found between people with FGD and control subjects, X 2 (1, N = 70) = 30.23, p < .001 in all sub-dimensions of the Quality of Life Index (MQLI), except Spiritual Fulfillment (SF). Similar to previous research, the results of this study suggest that individuals with FGD show a worse perception of quality of life than the general population. These findings could contribute to the design of interventions that contemplate biopsychosocial variables, with the aim of a comprehensive improvement in the quality of life of people with these disorders.

Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization. / [Artículo traducido] Prevalencia de reacciones adversas a medicamentos asociadas a visitas al servicio de urgencias y factores de riesgo de hospitalización.

OBJECTIVE: Adverse drug reactions increase morbidity and mortality, prolong hospital stay and increase healthcare costs. The primary objective of this study was to determine the prevalence of emergency department visits for adverse drug reactions and to describe their characteristics. The secondary objective was to determine the predictor variables of hospitalization for adverse drug reactions associated with emergency department visits. METHODS: Observational and retrospective study of adverse drug reactions registered in an emergency department, carried out from November 15th to December 15th, 2021. The demographic and clinical characteristics of the patients, the drugs involved and the adverse drug reactions were described. Logistic regression was performed to identify factors related to hospitalization for adverse drug reactions. RESULTS: 10,799 patients visited the ED and 216 (2%) patients with adverse drug reactions were included. The mean age was 70 ± 17.5 (18-98) years and 47.7% of the patients were male. A total of 54.6% of patients required hospitalization and 1.6% died from adverse drug reactions. The total number of drugs involved was 315 with 149 different drugs. The pharmacological group corresponding to the nervous system constituted the most representative group (n = 81). High-risk medications, such as antithrombotic agents (n = 53), were the subgroup of medications that caused the most emergency department visits and hospitalization. Acenocumarol (n = 20) was the main drug involved. Gastrointestinal (n = 62) disorders were the most common. Diarrhea (n = 16) was the most frequent adverse drug reaction, while gastrointestinal bleeding (n = 13) caused the highest number of hospitalizations. Charlson comorbidity index behaved as an independent risk factor for hospitalization (aOR 3.24; 95% CI: 1.47-7.13; p=0.003, in Charlson comorbidity index 4-6, and aOR 20.07; 95% CI: 6.87-58.64; p = 0.000, in Charlson comorbidity index ≥ 10). CONCLUSIONS: The prevalence of emergency department visits for adverse drug reactions continues to be a non-negligible health problem. High-risk drugs such as antithrombotic agents were the main therapeutic subgroup involved. Charlson comorbidity index was an independent factor in hospitalization, while gastrointestinal bleeding was the adverse drug reaction with the highest number of hospital admissions.

Prevalencia de reacciones adversas a medicamentos asociadas a visitas al servicio de urgencias y factores de riesgo de hospitalización / Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization

Objetivos: las reacciones adversas a medicamentos aumentan la morbimortalidad, prolongan la estancia hospitalaria y aumentan los costes sanitarios. El objetivo principal de este estudio fue determinar la prevalencia de visitas por reacciones adversas a medicamentos al servicio de urgencias y describir sus características. El objetivo secundario fue determinar las variables predictoras de hospitalización por reacciones adversas a medicamentos asociadas a visitas al servicio de urgencias.Métodosestudio observacional y retrospectivo de las reacciones adversas a medicamentos registradas en un servicio de urgencias, realizado del 15 de noviembre al 15 de diciembre de 2021. Se describieron las características demográficas y clínicas de los pacientes, los medicamentos involucrados y las reacciones adversas a medicamentos. Se realizó una regresión logística para identificar los factores relacionados con la hospitalización por reacciones adversas a medicamentos.Resultados10.799 pacientes visitaron el servicio de urgencias, de los que 216 (2%) presentaban reacciones adversas a medicamentos. La edad media fue de 70 ± 17,5 (18-98) años y el 47,7% de los pacientes fueron hombres. Un 54,6% de los pacientes requirieron hospitalización y el 1,6% fallecieron a causa de una reacción adversa a medicamentos. El número total de fármacos involucrados fue de 315, con 149 fármacos diferentes. El grupo farmacológico correspondiente al sistema nervioso constituyó el grupo más representativo (n = 81). Medicamentos de alto riesgo, como los antitrombóticos (n = 53), fueron el subgrupo de medicamentos que causó más visitas a urgencias y hospitalizaciones. El acenocumarol (n = 20) fue el principal fármaco implicado. Los trastornos gastrointestinales (n = 62) fueron mayoritarios. (AU)

Objective: Adverse drug reactions increase morbidity and mortality, prolong hospital stay and increase healthcare costs. The primary objective of this study was to determine the prevalence of emergency department visits for adverse drug reactions and to describe their characteristics. The secondary objective was to determine the predictor variables of hospitalization for adverse drug reactions associated with emergency department visits.MethodsObservational and retrospective study of adverse drug reactions registered in an emergency department, carried out from November 15th to December 15th, 2021. The demographic and clinical characteristics of the patients, the drugs involved and the adverse drug reactions were described. Logistic regression was performed to identify factors related to hospitalization for adverse drug reactions.Results10,799 patients visited the ED and 216 (2%) patients with adverse drug reactions were included. The mean age was 70 ± 17.5 (18-98) years and 47.7% of the patients were male. A total of 54.6% of patients required hospitalization and 1.6% died from adverse drug reactions. The total number of drugs involved was 315 with 149 different drugs. The pharmacological group corresponding to the nervous system constituted the most representative group (n = 81). High-risk medications, such as antithrombotic agents (n = 53), were the subgroup of medications that caused the most emergency department visits and hospitalization. Acenocumarol (n = 20) was the main drug involved. Gastrointestinal (n = 62) disorders were the most common. Diarrhea (n = 16) was the most frequent adverse drug reaction, while gastrointestinal bleeding (n = 13) caused the highest number of hospitalizations. Charlson comorbidity index behaved as an independent risk factor for hospitalization (aOR 3.24; 95% CI: 1.47-7.13; p=0.003, in Charlson comorbidity index 4-6, and aOR 20.07; 95% CI: 6.87–58.64; p = 0.000, in Charlson comorbidity index ≥ 10). (AU)

Organic colonic lesions in patients with irritable bowel syndrome: A comparative study.

INTRODUCTION AND AIMS: Any alarm symptoms in patients with irritable bowel syndrome (IBS) should be carefully evaluated. Colonoscopy is a standard diagnostic procedure for evaluating the colonic mucosa and ruling out probable diseases responsible for patient symptoms. We analyzed the colonoscopy findings in patients with and without IBS. MATERIAL AND METHODS: Ninety-six patients with IBS and 101 without IBS were consecutively enrolled in the study. All the patients in the IBS group met the Rome IV criteria, and underwent colonoscopy due to the appearance of red flags. The colonoscopy findings were compared between the 2 groups of patients. RESULTS: The main indications for colonoscopy in the IBS group were progressive abdominal pain (36.7%), rectal bleeding with fresh blood (17.7%), and occult blood in stool (12.5%). In the non-IBS group, the most prevalent indicators were rectal bleeding with fresh blood (37.6%), colorectal cancer surveillance (21.8%), and abdominal pain (13.9%). The most common macroscopic findings in the 2 groups were hemorrhoids, polyps, and anal fissure. There were no statistically significant differences with respect to the microscopic and macroscopic findings between groups. CONCLUSIONS: We concluded that the prevalence of organic lesions in the colon of patients with IBS was the same as that in the patients without IBS. The Rome IV criteria accurately predicted IBS. Additional evaluation through colonoscopy in IBS should be based on the presence of alarm features.

Alterações gastrointestinais causadas pela infecção do Sars-Cov-2 / Gastrointestinal changes caused by infection do Sars-Cov-2 / Cambios gastrointestinales causados por la infección de Sars-Cov-2

A pandemia de COVID-19 se propagou rapidamente pelo mundo, causada pela infecção do novo coronavírus (SARS-CoV-2), que surgiu na China no final de 2019. Apesar da porta de entrada mais comum do agente etiológico ser pelo trato respiratório, evidências demonstram que a doença pode apresentar sintomas extrapulmonares, como os do trato gastrointestinal. Descrever sobre possíveis alterações gastrointestinais ocasionadas em pacientes infectados pelo SARS-CoV-2. Tratou-se de uma revisão bibliográfica, que utilizou artigos científicos disponíveis na íntegra em bases de dados Medical Literature Analysis and Retrieval System Online, Google Acadêmico, Scientific Electronic Library Online, nos meses de abril a outubro de 2021, além de monografias, dissertações, teses e livros. Foram utilizados como descritores as palavras: SARS-CoV-2 e intestino, COVID-19 e intestino, alterações intestinais na COVID-19. Os distúrbios gastrointestinais mais prevalentes são náuseas, vômitos e diarreia e dor abdominal. O papel da microbiota intestinal em influenciar as doenças pulmonares foi bem articulado, devido à existência do eixo intestino-pulmão, a inflamação em um desses órgãos interfere diretamente no perfil inflamatório no outro. Embora ainda não esteja totalmente esclarecido se os sintomas gastrointestinais indicam maior viremia ou um processo fisiopatológico alternativo, observa-se que a presença destes configura um fator de risco para a maior severidade da doença.

The COVID-19 pandemic has spread rapidly around the world, caused by the infection of the new coronavirus (SARS-CoV-2), which emerged in China at the end of 2019. respiratory evidence shows that the disease can present extrapulmonary symptoms, such as those in the gastrointestinal tract. Objective: To describe possible gastrointestinal alterations caused in patients infected by SARS-CoV-2. Methodology: this was a literature review, which used scientific articles available in full in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Academic Google, Scientific Electronic Library Online (SciELO) databases, as well as monographs, dissertations, theses and books. The words used as descriptors were: SARS-CoV-2 and intestine, COVID-19 and intestine, intestinal alterations in COVID-19. Development: The most prevalent gastrointestinal disorders are nausea, vomiting and diarrhea and abdominal pain. The role of the intestinal microbiota in influencing lung diseases was well articulated, due to the existence of the gut- lung axis, inflammation in one of these organs directly interfering with the inflammatory profile in the other. Conclusion: Although it is not yet fully understood whether the gastrointestinal symptoms

La pandemia COVID-19 se ha extendido rápidamente por todo el mundo, causada por la infección del nuevo coronavirus (SARS-CoV-2), que surgió en China a finales de 2019. Las evidencias respiratorias muestran que la enfermedad puede presentar síntomas extrapulmonares, como los del tracto gastrointestinal. Objetivo: Describir las posibles alteraciones gastrointestinales causadas en pacientes infectados por SARS-CoV-2. Metodología: se trató de una revisión bibliográfica, que utilizó artículos científicos disponibles en su totalidad en las bases de datos Medical Literature Analysis and Retrieval System Online (MEDLINE), Academic Google, Scientific Electronic Library Online (SciELO), así como monografías, disertaciones, tesis y libros. Las palabras utilizadas como descriptores fueron: SARS-CoV-2 e intestino, COVID-19 e intestino, alteraciones intestinales en COVID-19. Desarrollo: Las alteraciones gastrointestinales más prevalentes son náuseas, vómitos y diarrea y dolor abdominal. Se articuló bien el papel de la microbiota intestinal en la influencia de las enfermedades pulmonares, debido a la existencia del eje intestino-pulmón, la inflamación en uno de estos órganos interfiere directamente en el perfil inflamatorio del otro. Conclusiones: Aunque aún no se comprenda del todo si los síntomas gastrointestinales indican una mayor viremia o un proceso fisiopatológico alternativo, se observa que su presencia es un factor de riesgo para la mayor gravedad de la enfermedad.

Psychosocial quality-of-life correlates in functional gastrointestinal disorders.

INTRODUCTION AND AIM: Functional gastrointestinal disorders (FGIDs) are complex illnesses characterized by gastrointestinal symptoms, with no underlying organic pathology. They are common, chronic, recurrent, and disabling disorders that significantly impair quality of life (QoL). The aim of the present cross-sectional analytical study was to assess QoL and its correlates in adult patients with FGIDs. MATERIALS AND METHODS: A cross-sectional, observational, hospital-based study was conducted at the gastroenterology outpatient department of a tertiary care teaching hospital. The ROME IV diagnostic criteria were used to identify the FGIDs. Anxiety, depression, coping strategies, social support, and QoL were assessed by the hospital anxiety and depression scale, the coping strategies inventory, the multidimensional scale of perceived social support, and the functional digestive disorders quality-of-life questionnaire, respectively. RESULTS: Of the 52 consecutive patients diagnosed with FGIDs, functional dyspepsia (51.92%) and irritable bowel syndrome (40.38%) were the most common. There were no significant associations between sociodemographic variables (age, sex, marital status, socioeconomic status, educational level, employment, occupation, dietary pattern) and QoL scores (all p values >0.05). Duration and social support were not significantly associated with QoL (all p values >0.05). In contrast, psychological variables, such as disengagement coping (r=-0.344, p=0.012), depression (r=-0.600, p=0.000), and anxiety (r=-0.590, p=0.000), were significantly correlated with QoL. CONCLUSIONS: Despite advances in neurogastroenterology, patients continue to be disabled by FGIDs. Psychological factors, especially depression, significantly contribute to poor QoL in those patients and should be addressed in a holistic, multidisciplinary way. The biopsychosocial framework, as it applies to FGIDs, should lead to the inclusion of psychosocial assessments in the clinical management and research of those disorders.

Alimentación funcional para corregir desórdenes gastrointestinales asociados a trastornos del espectro autista: una revisión sistemática / Functional feeding to correct gastrointestinal disorders associated with autism spectrum disorders: a systematic review

Antecedentes: los trastornos gastrointestinales (TGI) son comorbilidades comunes en los pacientes con trastornos del espectro autista (TEA); los tratamientos con dietas libres de gluten y caseína (LGLC) o suplementos de prebióticos/probióticos podrían reducir la severidad de los TGI. Objetivo: integrar y discutir la evidencia sobre la efectividad de las terapias con dietas LGLC y suplementos de prebióticos/probióticos sobre los TGI en pacientes con TEA. Metodología: se utilizaron las guías para la publicación de revisiones sistemáticas y metaanálisis (PRISMA). Se analizaron las características de los participantes, las intervenciones dietéticas, la administración de suplementos de prebióticos/prebióticos, los efectos de las intervenciones sobre los TGI, el riesgo de sesgo de los estudios y la seguridad de los tratamientos. Resultados: se analizaron quince investigaciones; la prevalencia de los TGI entre los pacientes con TEA fue alta (58 %; rango, 27-83 %). En más del 20 % de los pacientes intervenidos con dietas LGLC o suplementos disminuyó la severidad de los TGI (principalmente estreñimiento, diarrea y dolor abdominal). Se reportaron aumentos en los conteos de bacterias benéficas y una disminución de la proporción de bacterias patógenas tras el uso de los suplementos. Sin embargo, todas estas investigaciones presentaron sesgos metodológicos importantes. Conclusiones: aunque se han encontrado reducciones en la frecuencia y severidad de algunos TGI, la efectividad de estos tratamientos aún no se ha comprobado. Dadas las diferencias metodológicas de las investigaciones, se justifica el diseño de estudios rigurosos para evaluar los efectos terapéuticos de estos tratamientos sobre la salud gastrointestinal en pacientes con TEA (AU)

Background: gastrointestinal disorders (GIDs) are common comorbidities in patients with autism spectrum disorders (ASD); treatments with gluten- and casein-free (LGLC) diets or prebiotic/probiotic supplements may reduce the severity of GIDs. Objective: to integrate and discuss the evidence on the effectiveness of LGLC diet therapies and prebiotic/probiotic supplements on GIDs in patients with ASD. Methodology: the guidelines for the publication of systematic reviews and meta-analyses (PRISMA) were used. Participant characteristics, dietary interventions, prebiotic/prebiotic supplementation, effects of interventions on GIDs, risk of bias, and safety of treatments were analyzed. Results: fifteen investigations were analyzed; the prevalence of GIDs among patients with ASD was high (58 %; range, 27-83 %). In more than 20 % of the patients managed with LGLC diets or supplements GID severity decreased (mainly constipation, diarrhea, and abdominal pain). Increases in the counts of beneficial bacteria and a decrease in the proportion of pathogenic bacteria were reported after supplement use. However, all these investigations had significant methodological biases. Conclusions: although reductions in the frequency and severity of some GIDs have been found, the effectiveness of these treatments has not been proven yet. Given the methodological differences in the investigations, the design of rigorous studies to evaluate the therapeutic effects of these treatments on gastrointestinal health in patients with ASD is warranted (AU)

[Functional feeding to alleviate gastrointestinal disorders associated with autism spectrum disorders: A systematic review]. / Alimentación funcional para aliviar desórdenes gastrointestinales asociados a trastornos del espectro autista: Una revisión sistemática.

Introduction: Background: gastrointestinal disorders (GIDs) are common comorbidities in patients with autism spectrum disorders (ASD); treatments with gluten- and casein-free (LGLC) diets or prebiotic/probiotic supplements may reduce the severity of GIDs. Objective: to integrate and discuss the evidence on the effectiveness of LGLC diet therapies and prebiotic/probiotic supplements on GIDs in patients with ASD. Methodology: the guidelines for the publication of systematic reviews and meta-analyses (PRISMA) were used. Participant characteristics, dietary interventions, prebiotic/prebiotic supplementation, effects of interventions on GIDs, risk of bias, and safety of treatments were analyzed. Results: fifteen investigations were analyzed; the prevalence of GIDs among patients with ASD was high (58 %; range, 27-83 %). In more than 20 % of the patients managed with LGLC diets or supplements GID severity decreased (mainly constipation, diarrhea, and abdominal pain). Increases in the counts of beneficial bacteria and a decrease in the proportion of pathogenic bacteria were reported after supplement use. However, all these investigations had significant methodological biases. Conclusions: although reductions in the frequency and severity of some GIDs have been found, the effectiveness of these treatments has not been proven yet. Given the methodological differences in the investigations, the design of rigorous studies to evaluate the therapeutic effects of these treatments on gastrointestinal health in patients with ASD is warranted.

Introducción: Antecedentes: los trastornos gastrointestinales (TGI) son comorbilidades comunes en los pacientes con trastornos del espectro autista (TEA); los tratamientos con dietas libres de gluten y caseína (LGLC) o suplementos de prebióticos/probióticos podrían reducir la severidad de los TGI. Objetivo: integrar y discutir la evidencia sobre la efectividad de las terapias con dietas LGLC y suplementos de prebióticos/probióticos sobre los TGI en pacientes con TEA. Metodología: se utilizaron las guías para la publicación de revisiones sistemáticas y metaanálisis (PRISMA). Se analizaron las características de los participantes, las intervenciones dietéticas, la administración de suplementos de prebióticos/prebióticos, los efectos de las intervenciones sobre los TGI, el riesgo de sesgo de los estudios y la seguridad de los tratamientos. Resultados: se analizaron quince investigaciones; la prevalencia de los TGI entre los pacientes con TEA fue alta (58 %; rango, 27-83 %). En más del 20 % de los pacientes intervenidos con dietas LGLC o suplementos disminuyó la severidad de los TGI (principalmente estreñimiento, diarrea y dolor abdominal). Se reportaron aumentos en los conteos de bacterias benéficas y una disminución de la proporción de bacterias patógenas tras el uso de los suplementos. Sin embargo, todas estas investigaciones presentaron sesgos metodológicos importantes. Conclusiones: aunque se han encontrado reducciones en la frecuencia y severidad de algunos TGI, la efectividad de estos tratamientos aún no se ha comprobado. Dadas las diferencias metodológicas de las investigaciones, se justifica el diseño de estudios rigurosos para evaluar los efectos terapéuticos de estos tratamientos sobre la salud gastrointestinal en pacientes con TEA.

Blood and faecal lead levels in children with various functional gastrointestinal disorders.

INTRODUCTION: To investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. PATIENTS AND METHODS: One hundred and two children with FGIDs defined by the Rome IV criteria, aged 4-18 years, and one hundred and two sex matched healthy children were enrolled in the study. Children with FGIDs were divided into three subgroups as functional constipation (FC) (n = 36), functional abdominal pain (FAP) (n = 36) and functional nausea (FN) (n = 30). The lead levels were measured using atomic absorption spectrometer. RESULTS: The median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77 µg/dL, respectively). The BLLs were above 5 µg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (p = 0.003, p < 0.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01 µg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (p = 0.992, p = 0.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (p = 0.123). CONCLUSION: This study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5 µg/dL which is considered as toxic level. These results might revive the question of whether or not clinicians need to evaluate routine BLLs in children with FGIDs.

Niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales / Blood and faecal lead levels in children with various functional gastrointestinal disorders

Introducción: El objetivo del estudio fue determinar los niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales (TDF) en comparación con controles sanos. Pacientes y métodos: La muestra incluyó a 102 niños de 4-18 años con TDF definidos mediante los criterios de Roma IV y a 102 controles sanos emparejados por edad y sexo. Los niños con TDF se dividieron en 3 subgrupos: estreñimiento funcional (EF) (n=36), dolor abdominal funcional (DAF) (n=36) y náuseas funcionales (NF) (n=30). Los niveles de plomo se midieron mediante espectrometría de absorción atómica. Resultados: El nivel de plomo en sangre (NPS) mediano fue significativamente mayor en niños con TDF en comparación con controles (5,12 vs. 1,77μg/dl). Los NPS superaron los 5μg/dl en el 51,9% del grupo TDF. Se observó una diferencia estadísticamente significativa en los NPS entre el subgrupo con EF y los otros 2subgrupos (DAF y NF) (p=0,003 y p<0,001, respectivamente). Los niveles de plomo en heces (NPH) fueron significativamente mayores en niños con TDF en comparación con controles (28,08 vs. 0,01μg/g). No hubo diferencias significativas en los NPH entre el subgrupo de EF y los otros subgrupos (p=0,992 y p=0,989). No se encontró una correlación significativa entre los NPS y los NPH en niños con TDF (p=0,123). Conclusión: El presente estudio demostró que los niveles séricos y fecales de plomo eran superiores en niños con TDF en comparación con controles y que más de la mitad de los niños con TDF tenían NPS ≥ 5μg/dl, que se consideran tóxicos. A la vista de estos resultados, cabe replantearse si los clínicos han de determinar los NPS de manera rutinaria en niños con TDF.(AU)

Introduction: To investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. Patients and methods: One hundred and 2children with FGIDs defined by the Rome IV criteria, aged 4 -18 years, and one hundred and 2sex matched healthy children were enrolled in the study. Children with FGIDs were divided into 3subgroups as functional constipation (FC) (n=36), functional abdominal pain (FAP) (n=36) and functional náusea (FN) (n=30). The lead levels were measured using atomic absorption spectrometer. Results: The median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77μg/dL, respectively). The BLLs were above 5μg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (P=.003, P<.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01μg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (P=.992, P=.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (P =.123). Conclusion: This study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5μg/dL which is toxic level. These results might revive the question of whether or not clinician need to evaluate routine BLLs in children with FGIDs.(AU)

[Blood and faecal lead levels in children with various functional gastrointestinal disorders]. / Niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales.

INTRODUCTION: To investigate the blood lead levels (BLLs) and faecal lead levels (FLLs) in children with various functional gastrointestinal disorders (FGIDs) and compare them with controls. PATIENTS AND METHODS: One hundred and 2children with FGIDs defined by the Rome IV criteria, aged 4 -18 years, and one hundred and 2sex matched healthy children were enrolled in the study. Children with FGIDs were divided into 3subgroups as functional constipation (FC) (n=36), functional abdominal pain (FAP) (n=36) and functional náusea (FN) (n=30). The lead levels were measured using atomic absorption spectrometer. RESULTS: The median BLLs in the FGIDs group was significantly higher than in controls (5.12 and 1.77µg/dL, respectively). The BLLs were above 5µg/dL in 51,9% of children with FGIDs. There was statistically significant difference in BLLs between FC subgroup and the other subgroups (FAP and FN) (P=.003, P<.001 respectively). The FLLs in the FGIDs group was significantly higher than in controls (28.08 and 0.01µg/g, respectively). There was no significant difference in FLLs between FC subgroup and the other subgroups (P=.992, P=.989 respectively). No significant relation found between BLLs and FLLs of the FGIDs group (P =.123). CONCLUSION: This study revealed that children with FGIDs had higher BLLs and FLLs than controls and also more than half of children with FGIDs had BLLs ≥5µg/dL which is toxic level. These results might revive the question of whether or not clinician need to evaluate routine BLLs in children with FGIDs.

Autismo y homeopatía / Autism and homeopathy

La Organización Mundial de la Salud define a los trastornos del espectro autista como un grupo de condiciones neurológicas y de desarrollo que ocasionan dificultadesen la comunicación y la interacción social, así como un repertorio restringido y repetitivo de intereses y actividades. Dicho organismo estima que, a nivel mundial,un niño de cada 160 se ve afectado por este problema. En esta conferencia se describe el patrón evolutivo que puede anteceder al diagnóstico del autismo regresivo (en el que el niño pierde el lenguaje y las habilidades sociales que había alcanzado), y en el que se involucran múltiples factores: suspensión de la lactancia, recurrentes enfermedades respiratorias y gastrointestinales, otitis de repetición, manifestaciones alérgicas, uso frecuente de antibióticos, antipiréticos, esteroides, antileucotrienos y broncodilatadores, y aplicación de la vacuna triple viral (SPR o MMR). Por último, se sugieren medidas para la prevención y el tratamiento de esta condición, como el reconocimiento y el seguimiento de los pacientes pediátricos con mayor riesgo de desarrollar autismo regresivo, el fomento de la lactancia materna, el retiro de los alimentos que aportan gluten y la prescripción de medicamentos homeopáticos para favorecer al sistema inmunológico del niño, aún en formación. (AU)

The World Health Organization defines autism spectrum disorders as a group of neurological and developmental conditions that cause difficulties in communicationand social interaction, and restricted and repetitive repertoire of interests and activities. This organization estimates that, globally, one child in 160 is affected by this problem.At this conference the evolutionary pattern that may precede the diagnosis of regressive autism (in which the child loses language and social skills that he had reached), and in which multiple factors are involved are described: cessation of breastfeeding, recurrent illnesses: respiratory and gastrointestinal, recurrent otitis, allergic manifestations, frequent use of antibiotics, antipyretics, steroids, bronchodilators and leukotriene, and application of the MMR vaccine.Finally, measures for the prevention and treatment of this condition, such as recognition and monitoring of pediatric patients with increased risk of regressiveautism, promoting breastfeeding, the withdrawal of foods that provide gluten are suggested and the prescription of homeopathic medicines to favor the child’simmune system, even in early development. (AU)

Trastornos gastrointestinales funcionales en el lactante: Prevalencia en una consulta gastroenterológica / FUNCTIONAL GASTROINTESTINAL DISORDERS IN INFANTS. PREVALENCE IN A GASTROENTEROLOGY OUT CLINIC PATIENTS

Introducción: los trastornos gastrointestinales funcionales son un conjunto de síntomas crónicos o recurrentes sin causa estructural, bioquímica o metabólica explicable. Constituyen un motivo de consulta con una frecuencia variable o descono- cida. Objetivo: determinar la prevalencia de trastornos gastrointestinales funcionales en lactantes en una consulta gas- troenterológica. Pacientes y método: estudio prospectivo y transversal, entre enero 2012 y marzo 2013. Se registró la presencia de los síntomas correspondientes a regurgitación, cólicos y disquecia del lactante, utilizando los criterios de Roma III, a través de un cuestionario a las madres de los lactantes evaluados. Se excluyeron los niños con patologías asociadas. Resultados: 1.197 lactantes, 104 con los trastornos gastrointestinales funcionales investigados, una prevalencia de 8,68% e identificación de 1 por cada 10 lactantes (OR=10,15). Edad promedio: 4,4 meses (rango:1-19), afectación similar en cuanto al sexo, varones 55 (52,88%) y hembras 49 (47,12%). La regurgitación del lactante fue el trastorno más frecuente en 95/104 niños (91,34%), disquecia 31/104 (29,80%) y cólico 9/104 (8,65%). Se encontró la presencia de más de un trastorno en 30 niños, la regurgitación y disquecia presente en 21, regurgitación y cólico en 5, disquecia y cólico en 3. Un paciente presentó todos los trastornos. Conclusiones: Los trastornos gastrointestinales funcionales del lactante son prevalentes en la consulta gastroenterológica, su determinación es de utilidad en la planificación de la atención médica para su diagnóstico y seguimiento.

Introduction: functional gastrointestinal disorders are a set of chronic or recurrent symptoms without structural, biochemi- cal or metabolic cause explicable. They are a matter of consultation with a variable or unknown frequency. Objective: To determine the prevalence of functional gastrointestinal disorders in infants in a gastroenterological consultation. Patients and methods: a prospective crosssectional study between January 2012 and March 2013. The presence of symptoms related to regurgitation, colic and infant dyschezia using the Rome III criteria through a questionnaire to mothers of was recorded, infants evaluated. We excluded children with as- sociated pathologies. Results: 1,197 infants, 104 investiga- ted with functional gastrointestinal disorders, a prevalence of 8.68% and identification of 1 in 10 infants (OR = 10.15). Average age: 4.4 months (range: 1-19), similar in terms of sex affectation, males 55 (52.88%) and 49 females (47.12%). Infant regurgitation was the most common disorder in children 95/104 (91.34%), dyschezia 31/104 (29.80%) and colic 9/104 (8.65%). The presence of more than one disorder was found in 30 children, regurgitation and dyschezia present in 21, regurgitation and colic in 5 dyschezia and colic in 3. One patient had all disorders. Conclusions: Functional gastrointestinal disorders are prevalent in infant gastroenterological consultation, its determination is useful in planning health care for diagnosis and monitoring.

Autismo Infantil: Trastornos digestivos asociados / Infant autism: associate digestive disorders

Se realizó una investigación descriptiva y transversal con el objetivo de conocer la prevalencia de trastornos gastrointestinales, en dos grupos de niños uno autista y otro no autista El universo de trabajo se constituyo por los niños autistas matriculados oficialmente en la Escuela Especial de Autismo Infantil Dora Alonso del Municipio Marianao, y por los niños sanos pertenecientes al Consejo Popular Armada del Municipio Cerro, la muestra se obtuvo mediante un muestreo al azar (edades y sexos homogéneos), en el periodo comprendido de Enero-Diciembre de 2009. Se estudiaron 36 niños y 12 niñas por grupo. El número de niños con presencia de síntomas digestivos, fue significativamente mayor en el grupo de niños autistas que en el de controles(AU)

A transversal and descriptive investigation was carried out with the objective of knowing the prevalence of gastrointestinal disorders in two groups of children ,one with autistic disorder and other without it. The universe of work was constituted by the autistic children which were registerd officially enrolled at Dora Alonso Special Infant School of Autism located in the municipality of Marianao (the sample coincided with the study work) and with healthy children of Armada People´s Council of Cerro municipality (the sampling was done at random with homogeneous ages and sex) from January to December 2009.36 boys were studied and 12 girls per group. The number of boys with presence of digestive sintomes were significantly greater in the group of autistic boy than in the one of controles(AU)