RESUMO
Although abdominal bloating and distension are frequent symptoms, they are considered a challenge in medical practice. Treatment alternatives with varying efficacy levels, associated to the lack of knowledge about this problem, generate difficulties in the doctorpatient relation, and patient's frustration and anxiety. Advances in understanding their etiopathogenetic factors have lead treatment of these patients towards a personalized approach. The purpose of the article is to provide a brief description about abdominal bloating and distension, and ultimately give a practical approach of this condition.
A pesar de que la hinchazón (bloating) y la distensión abdominal son síntomas altamente frecuentes, son considerados un desafío en el quehacer médico. Alternativas terapéuticas con grados de eficacia variables, asociado a un desconocimiento en el enfrentamiento clínico, generan dificultades en la atención de estos pacientes por parte de los médicos, además de frustración para el paciente. Avances en la comprensión de su etiopatogenia han permitido dirigir el tratamiento de estos pacientes de manera personalizada. Este artículo tiene como objetivo realizar una breve descripción del cuadro, y dar finalmente un enfoque práctico frente a esta condición.
Assuntos
Humanos , Dilatação Gástrica/dietoterapia , Dilatação Gástrica/etiologia , Dilatação Gástrica/tratamento farmacológico , Dilatação Patológica , Dilatação Gástrica/epidemiologia , Fármacos Gastrointestinais/uso terapêutico , Flatulência/fisiopatologia , Abdome/fisiopatologiaRESUMO
Probiotic lactic acid bacteria have been reported to alleviate symptoms in patients with irritable bowel syndrome. However, they have not been tested for use in functional gastric disease. We therefore investigated if strains previously shown to protect from response to colorectal distension (CRD) in rats also modulate response to gastric distension (GD). Healthy, male Sprague-Dawley rats were treated with viable, heat-killed, gamma-irradiated Lactobacillus reuteri or viable Lactobacillus plantarum wild type (WT), L. plantarum Dlt¯mutant, conditioned medium or medium control (9 d), and subjected to GD under anesthesia using an i.g. Teflon catheter. Effects were measured by heart rate (HR) changes during noxious distension (60 mm Hg) compared to baseline HR values. We also investigated the localization of viable, green fluorescent protein-transfected bacteria in the stomach mucosa. Viable L. reuteri decreased the bradycardia induced by noxious GD compared to placebo controls (P < 0.001). Heat-killed or gamma-irradiated L. reuteri and conditioned medium did not have a protective effect in GD. Viable L. plantarum WT and Dlt¯mutant, previously shown to be effective antinociceptive agents in CRD, showed no protective effect in GD. All viable bacteria were associated with the pars glandularis of the rat stomach. Thus, we conclude that the antinociceptive mechanisms of action of probiotic bacteria differ between the stomach and the colon. Symptom alleviation cannot be attributed to the localization of the bacteria in the stomach. Information derived from effects of CRD cannot be extrapolated to effects in the stomach, which are likely to be strain and organ specific.
Assuntos
Dilatação Gástrica/dietoterapia , Limosilactobacillus reuteri , Probióticos/uso terapêutico , Dor Abdominal/prevenção & controle , Analgesia , Animais , Aderência Bacteriana , Bradicardia/etiologia , Bradicardia/prevenção & controle , Raios gama/efeitos adversos , Dilatação Gástrica/patologia , Dilatação Gástrica/fisiopatologia , Mucosa Gástrica/metabolismo , Mucosa Gástrica/microbiologia , Mucosa Gástrica/patologia , Proteínas de Fluorescência Verde/genética , Proteínas de Fluorescência Verde/metabolismo , Temperatura Alta/efeitos adversos , Lactobacillus plantarum/crescimento & desenvolvimento , Limosilactobacillus reuteri/crescimento & desenvolvimento , Limosilactobacillus reuteri/metabolismo , Limosilactobacillus reuteri/efeitos da radiação , Masculino , Viabilidade Microbiana , Mutação , Ratos , Ratos Sprague-Dawley , Proteínas Recombinantes/metabolismoRESUMO
La dilatación gástrica aguda es una rara complicación médica de los trastornos de la conducta alimentaria. Presentamos el caso de un varón de 31 años, diagnosticado de anorexia nerviosa y gravemente malnutrido, que debutó con vómitos incoercibles tras la ingestión de una comida copiosa. La situación se resolvió tras aspiración del contenido gástrico y realimentación del paciente mediante nutrición enteral por sonda nasoyeyunal. Generalmente se acepta que este cuadro puede ser debido al síndrome de la arteria mesentérica superior, tal y como está descrito en otras situaciones de desnutrición extrema. En pacientes con trastornos de la conducta alimentaria, en los que los vómitos autoinducidos son frecuentes, la sospecha clínica de esta posibilidad puede ser crucial para evitar un daño irreversible a la pared gástrica (AU)
