Los desórdenes anorrectales afectan al 20% de la población. Los trastornos comunes inclu-yen la incontinencia fecal, el dolor anorrectal funcional, la defecación disinérgica y otros trastornos de la defecación funcional. La manometría anorrectal, especialmente en la últi-ma década, ha surgido como una herramienta valiosa para la evaluación y el diagnóstico de estas afecciones. En esta revisión describimos nuestro enfoque para realizar un estudio meticuloso y de alta calidad, así como cumplir con los estándares mínimos para el proce-dimiento. Asimismo, describimos: instrucciones de preparación; composición del equipo, que incluye sonda, hardware y software; detalles técnicos del procedimiento, incluyendo varias maniobras; un análisis sistemático de los datos obtenidos mediante manometría anorrectal de alta resolución y, finalmente, functional defecation disorders. Anorectal manometry (ARM), especially over the past decade, has emerged as a valuable tool for the evaluation and diagnosis of these conditions. In this review, we describe our approach for performing a meticulous and high-quality study as well as adhering to minimum standards for the procedure. We describe preparation instructions to the subject; the equipment including probe, hardware, and software; technical details of the procedure including various maneuvers followed by a systematic analysis of the data obtained using high-resolution ARM, and finally, how to interpret and generate a standard report.
{"title":"Performing and analyzing high-resolution anorectal manometry","authors":"E. Tetangco, Y. Yan, S. Rao","doi":"10.24875/NGL.19000016","DOIUrl":"https://doi.org/10.24875/NGL.19000016","url":null,"abstract":"Los desórdenes anorrectales afectan al 20% de la población. Los trastornos comunes inclu-yen la incontinencia fecal, el dolor anorrectal funcional, la defecación disinérgica y otros trastornos de la defecación funcional. La manometría anorrectal, especialmente en la últi-ma década, ha surgido como una herramienta valiosa para la evaluación y el diagnóstico de estas afecciones. En esta revisión describimos nuestro enfoque para realizar un estudio meticuloso y de alta calidad, así como cumplir con los estándares mínimos para el proce-dimiento. Asimismo, describimos: instrucciones de preparación; composición del equipo, que incluye sonda, hardware y software; detalles técnicos del procedimiento, incluyendo varias maniobras; un análisis sistemático de los datos obtenidos mediante manometría anorrectal de alta resolución y, finalmente, functional defecation disorders. Anorectal manometry (ARM), especially over the past decade, has emerged as a valuable tool for the evaluation and diagnosis of these conditions. In this review, we describe our approach for performing a meticulous and high-quality study as well as adhering to minimum standards for the procedure. We describe preparation instructions to the subject; the equipment including probe, hardware, and software; technical details of the procedure including various maneuvers followed by a systematic analysis of the data obtained using high-resolution ARM, and finally, how to interpret and generate a standard report.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125457457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
9 . It suggested that fiber supplements are moderately effective, but can cause bloating. This review did not include studies in children, nor did it include all the fiber types. Therefore, to reduce ABSTRACT Functional constipation (FC) is one of the most common gastrointestinal disorders in children and adults. Physicians commonly recommend dietary interventions for its treatment including increasing water and fiber intake. Greater fiber intake can be achieved through the consumption of foods rich in dietary fiber, or taken in supplemental form. In addition to naturally occurring fibers in food, the Food and Drug Administration has approved over 14 isolated or synthetic fibers for use. This review discusses the evidence for various fiber types for the treatment of FC in children and adults.
{"title":"Comparison of the role of fiber in the treatment of functional constipation in children and adults","authors":"C. Axelrod","doi":"10.24875/NGL.19000021","DOIUrl":"https://doi.org/10.24875/NGL.19000021","url":null,"abstract":"9 . It suggested that fiber supplements are moderately effective, but can cause bloating. This review did not include studies in children, nor did it include all the fiber types. Therefore, to reduce ABSTRACT Functional constipation (FC) is one of the most common gastrointestinal disorders in children and adults. Physicians commonly recommend dietary interventions for its treatment including increasing water and fiber intake. Greater fiber intake can be achieved through the consumption of foods rich in dietary fiber, or taken in supplemental form. In addition to naturally occurring fibers in food, the Food and Drug Administration has approved over 14 isolated or synthetic fibers for use. This review discusses the evidence for various fiber types for the treatment of FC in children and adults.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130789093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
El síndrome de intestino irritable (SII) puede aparecer en la infancia y continuar en la edad adulta y factores de riesgo tempranos de la vida han sido asociados con el desarrollo del SII más tarde en la adultez; sin embargo, se conoce poco sobre la transición infancia-edad adulta en este trastorno. Por lo anterior nuestro objetivo fue revisar: (1) Factores de riesgo tempranos de la vida que contribuyen al desarrollo de SII en la adultez; (2) la transición de la atención médica; (3) la historia natural del SII y la estabilidad de los síntomas; (4) la prevalencia del SII en los adultos jóvenes hasta la madurez; (5) el tratamiento en la madu-rez; y (6) medidas preventivas. De acuerdo con lo anterior, múltiples factores tempranos de la vida han sido relacionados con el SII en la edad adulta incluyendo dolor abdominal crónico, aprendizaje social de la conducta de enfermedad, trauma en la infancia y la ABSTRACT Irritable bowel syndrome (IBS) may start in childhood and continues into adulthood and risk factors early in life (EL) have been associated with the development of IBS later in life; however, little is known about the childhood-adulthood transition. Therefore, we aimed at reviewing: (1) EL risk factors that contribute to IBS in adulthood; (2) transition of care; (3) the natural history and IBS-symptom stability; (4) prevalence of IBS from young adults to older age; (5) treatment in older age; and (6) preventive measurements. Accordingly, multiple EL factors have been related to IBS in adulthood including chronic abdominal pain, social learning of illness behavior, infantile and childhood trauma, birth weight < 1500 g, gastric suctioning, and cesarean section (may impair gut-micro-biota colonization and immunoregulation: disappearing microbiome), history of abuse, parental deprivation, and low socioeconomical level. There is a controversy of early enteric infections as these may be protective for post-infectious IBS later in life as well as for pet exposure and higher living density (hygiene factors). As for the transition of care from pediatric to adult care – crucial in managing a chronic disorder –, there is no experience in IBS as with other gastrointestinal diseases. Whether the prevalence of IBS increases or decreases with age, the data are inconsistent; however, at least a third of IBS patients become asymptomatic, a third remain stable, and the remaining turnover to another disorder of gut-brain interaction along time. Furthermore, distress among IBS patients with medical comorbidities varies with age, with higher levels of anxiety and depression among younger adults than older patients. Finally, treatment of IBS at an older age is similar to that in younger patients. In conclusions, EL risk factors need to be identified to establish preventive measurements for IBS later in life. A transition of care guidelines need to be developed for IBS and treatment adjustments are required according to the comorbidities.
肠易激综合征(肠易激综合征)可能出现在儿童时期，并持续到成年，早期生命危险因素与成年后期肠易激综合征的发展有关;然而，人们对这种疾病从童年到成年的转变知之甚少。因此，我们的目的是回顾:(1)导致成人肠易激综合征发展的早期生命危险因素;(2)医疗保健转型;(3)肠易激综合征的自然史和症状的稳定性;(4)青年至成年肠易激综合征的患病率;(5) madu-rez的治疗;(6)预防措施。根据以上所述,多种因素相关早期生活被SII在成人期慢性腹痛、社会学习的行为,在童年创伤和疾病ABSTRACT易怒bowel综合症(局)may start儿童并且into和and risk factors early in life()得到相关with the development of局后面in life;然而，利特尔是众所周知的儿童-成人过渡。因此，我们希望审查:(1)导致成人肠易激综合征的风险因素;(2)护理过渡;(3)自然历史和ibs症状稳定性;(4)青少年至老年人肠易激综合征的患病率;(5)老年治疗;(6)预防措施。故,multiple得到局有关的因素和社会包括腹部chronic pain learning of illness behavior、infantile和儿童创伤,生育重量< 1500克,gastric suctioning, and cesarean section (may impair gut-micro-biota colonization immunoregulation: disappearing microbiome), history of父母虐待、剥夺,and low socioeconomical level。早期肠道感染存在争议，因为它们可能对生命后期感染后的肠易感染以及宠物暴露和较高的生活密度具有保护作用(卫生因素)。至于从儿科护理过渡到成人护理——这对管理慢性疾病至关重要——目前还没有与其他胃肠道疾病相比的肠易感染经验。肠易激综合征的患病率是否随年龄增长而增加或减少，数据是不一致的;然而，至少有三分之一的肠易激综合征患者无症状，三分之一的患者保持稳定，随着时间的推移，剩余的转为另一种肠道大脑互动障碍。此外，患有医学合并症的肠易激综合征患者的痛苦随年龄而变化，年轻人的焦虑和抑郁程度高于老年人。最后，老年肠易激综合征的治疗与年轻患者的治疗相似。在结论中，需要确定风险因素，以便在生命后期制定肠易激综合征的预防措施。需要为肠易激综合征制定过渡护理准则，并需要根据共病进行治疗调整。
{"title":"Irritable bowel syndrome: from young to older age","authors":"M. Schmulson-Wasserman, M. Saps","doi":"10.24875/NGL.19000024","DOIUrl":"https://doi.org/10.24875/NGL.19000024","url":null,"abstract":"El síndrome de intestino irritable (SII) puede aparecer en la infancia y continuar en la edad adulta y factores de riesgo tempranos de la vida han sido asociados con el desarrollo del SII más tarde en la adultez; sin embargo, se conoce poco sobre la transición infancia-edad adulta en este trastorno. Por lo anterior nuestro objetivo fue revisar: (1) Factores de riesgo tempranos de la vida que contribuyen al desarrollo de SII en la adultez; (2) la transición de la atención médica; (3) la historia natural del SII y la estabilidad de los síntomas; (4) la prevalencia del SII en los adultos jóvenes hasta la madurez; (5) el tratamiento en la madu-rez; y (6) medidas preventivas. De acuerdo con lo anterior, múltiples factores tempranos de la vida han sido relacionados con el SII en la edad adulta incluyendo dolor abdominal crónico, aprendizaje social de la conducta de enfermedad, trauma en la infancia y la ABSTRACT Irritable bowel syndrome (IBS) may start in childhood and continues into adulthood and risk factors early in life (EL) have been associated with the development of IBS later in life; however, little is known about the childhood-adulthood transition. Therefore, we aimed at reviewing: (1) EL risk factors that contribute to IBS in adulthood; (2) transition of care; (3) the natural history and IBS-symptom stability; (4) prevalence of IBS from young adults to older age; (5) treatment in older age; and (6) preventive measurements. Accordingly, multiple EL factors have been related to IBS in adulthood including chronic abdominal pain, social learning of illness behavior, infantile and childhood trauma, birth weight < 1500 g, gastric suctioning, and cesarean section (may impair gut-micro-biota colonization and immunoregulation: disappearing microbiome), history of abuse, parental deprivation, and low socioeconomical level. There is a controversy of early enteric infections as these may be protective for post-infectious IBS later in life as well as for pet exposure and higher living density (hygiene factors). As for the transition of care from pediatric to adult care – crucial in managing a chronic disorder –, there is no experience in IBS as with other gastrointestinal diseases. Whether the prevalence of IBS increases or decreases with age, the data are inconsistent; however, at least a third of IBS patients become asymptomatic, a third remain stable, and the remaining turnover to another disorder of gut-brain interaction along time. Furthermore, distress among IBS patients with medical comorbidities varies with age, with higher levels of anxiety and depression among younger adults than older patients. Finally, treatment of IBS at an older age is similar to that in younger patients. In conclusions, EL risk factors need to be identified to establish preventive measurements for IBS later in life. A transition of care guidelines need to be developed for IBS and treatment adjustments are required according to the comorbidities.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133754753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The placebo effect is the therapeutic result derived from the use of a drug, device or inert physical treatment, with which an improvement or change in a subjective malaise or illness is achieved. It is believed that the mechanism of the placebo effect is related to changes of the central nervous system and that, consequently, there are changes at the sensory level and in bodily functions. In the process, an expectation of benefit is generated, although there is no specific effect that changes a specific disorder or, at least, a scientific theory that explains its action. In functional gastrointestinal disorders, the placebo effect is sig-nificant, and it is reported to be present in 6-72% of patients with functional dyspepsia and 0-84% with irritable bowel syndrome. Therefore, it is necessary to have a scientific study of the placebo effect and related effects such as nocebo or precebo. It is important to determine if each of these factors are caused by psychological or neurobiological factors, or if this is a methodological variant that affects the outcome of clinical studies, causing biases in the interpretation of them. This review analyzes the literature and evaluates the psychological and neurobiological mechanisms of the placebo-analgesia, the complexity of the interaction and its evaluation, since the term placebo is not limited to the use of inert substances.
{"title":"El efecto placebo, nocebo y precebo en los trastornos funcionales digestivos: ¿imaginación o realidad?","authors":"S. Sobrino-Cossio, Ó. Teramoto-Matsubara","doi":"10.24875/ngl.18000014","DOIUrl":"https://doi.org/10.24875/ngl.18000014","url":null,"abstract":"The placebo effect is the therapeutic result derived from the use of a drug, device or inert physical treatment, with which an improvement or change in a subjective malaise or illness is achieved. It is believed that the mechanism of the placebo effect is related to changes of the central nervous system and that, consequently, there are changes at the sensory level and in bodily functions. In the process, an expectation of benefit is generated, although there is no specific effect that changes a specific disorder or, at least, a scientific theory that explains its action. In functional gastrointestinal disorders, the placebo effect is sig-nificant, and it is reported to be present in 6-72% of patients with functional dyspepsia and 0-84% with irritable bowel syndrome. Therefore, it is necessary to have a scientific study of the placebo effect and related effects such as nocebo or precebo. It is important to determine if each of these factors are caused by psychological or neurobiological factors, or if this is a methodological variant that affects the outcome of clinical studies, causing biases in the interpretation of them. This review analyzes the literature and evaluates the psychological and neurobiological mechanisms of the placebo-analgesia, the complexity of the interaction and its evaluation, since the term placebo is not limited to the use of inert substances.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117327394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Los trastornos de la motilidad gastrointestinal (GI) en niños pueden ir desde procesos relativamente benignos, como la enfermedad por reflujo gastroesofágico o el estreñimiento funcional, hasta trastornos más graves como la acalasia, la enfermedad de Hirschsprung y la pseudoobstrucción intestinal. Un enfoque sistemático para niños con posibles trastornos de motilidad debe excluir problemas anatómicos y enfermedades subyacentes, así como mostrar alteraciones en los patrones de tránsito y motilidad. La tecnología para medir la motilidad GI ha evolucionado con el tiempo, y las nuevas técnicas incluyen la manometría de alta resolución que se puede implementar junto con la tecnología de impedancia. Estas nuevas tecnologías han permitido una mejor comprensión de la fisiopatología de los trastornos de la motilidad y la implementación de nuevas terapias. (NeuroGastroLatam
{"title":"Advances in gastrointestinal manometry studies in children","authors":"Alejandro Llanos-Chea, S. Nurko","doi":"10.24875/NGL.18000015","DOIUrl":"https://doi.org/10.24875/NGL.18000015","url":null,"abstract":"Los trastornos de la motilidad gastrointestinal (GI) en niños pueden ir desde procesos relativamente benignos, como la enfermedad por reflujo gastroesofágico o el estreñimiento funcional, hasta trastornos más graves como la acalasia, la enfermedad de Hirschsprung y la pseudoobstrucción intestinal. Un enfoque sistemático para niños con posibles trastornos de motilidad debe excluir problemas anatómicos y enfermedades subyacentes, así como mostrar alteraciones en los patrones de tránsito y motilidad. La tecnología para medir la motilidad GI ha evolucionado con el tiempo, y las nuevas técnicas incluyen la manometría de alta resolución que se puede implementar junto con la tecnología de impedancia. Estas nuevas tecnologías han permitido una mejor comprensión de la fisiopatología de los trastornos de la motilidad y la implementación de nuevas terapias. (NeuroGastroLatam","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"20 22","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120837055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breath tests (BTs) have long been used as a valuable diagnostic tool in medicine. Their longevity in the diagnostic realm is likely due to the following advantages: they are noninvasive, easy to perform, and capable of repetitive testing. BTs have a variety of indications and have been used to explore the pathophysiology of functional gastrointestinal disorders (FGIDs). Hydrogen and methane BTs are often used to evaluate FGIDs but have several caveats to its methodology and interpretation. The recent release of the North American consensus guidelines provides uniformity to these BTs in attempts to provide standardization. This review explores the role of methane/hydrogen and also gastric emptying carbon-13 BTs in FGIDs, specifically irritable bowel syndrome (IBS), IBS-like symptoms, and functional dyspepsia. We review the role of BTs in FGIDs and how they not only provide diagnostic information, but the pathophysiologic mechanisms that drive these disorders. This, ultimately, can provide guided treatment for these disorders that at times can be difficult to manage.
{"title":"Breath tests for functional gastrointestinal disorders: When and for what?","authors":"Nipaporn Pichetshote, A. Rezaie","doi":"10.24875/NGL.18000013","DOIUrl":"https://doi.org/10.24875/NGL.18000013","url":null,"abstract":"Breath tests (BTs) have long been used as a valuable diagnostic tool in medicine. Their longevity in the diagnostic realm is likely due to the following advantages: they are noninvasive, easy to perform, and capable of repetitive testing. BTs have a variety of indications and have been used to explore the pathophysiology of functional gastrointestinal disorders (FGIDs). Hydrogen and methane BTs are often used to evaluate FGIDs but have several caveats to its methodology and interpretation. The recent release of the North American consensus guidelines provides uniformity to these BTs in attempts to provide standardization. This review explores the role of methane/hydrogen and also gastric emptying carbon-13 BTs in FGIDs, specifically irritable bowel syndrome (IBS), IBS-like symptoms, and functional dyspepsia. We review the role of BTs in FGIDs and how they not only provide diagnostic information, but the pathophysiologic mechanisms that drive these disorders. This, ultimately, can provide guided treatment for these disorders that at times can be difficult to manage.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127469769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andres F. Ardila-Hani, Ana María Leguizamo, Valeria Costa, A. Ardila
The motor esophageal disorders are categorized according to the Chicago Classification 3.0 into major and minor disorders of peristalsis; and those with outflow obstruction; divided in achalasia and esophagogastric junction outflow obstruction (EGJOO). The present study has as an objective to revise the types of EGJOO, their etiology, clinical manifestations, pathophysiology, diagnostic tests and different treatment options. EGJOO comprises a heterogeneous group of patients characterized by manometric findings of an alteration in the EGJ, with the presence of intact or weak peristalsis of the esophageal body, in such a way that the criteria for achalasia are not met. It can be caused not only by functional pathology (idiopathic) but structural (secondary) pathology. Dysphagia is the most common symptom, followed by chest pain, regurgitation and heartburn. The finding of EGJOO in the absence of secondary etiology is accompanied by clinical uncertainty. Some seem to have an early stage of achalasia, while others have almost no obstructive symptoms and the finding of a high integrated relaxation pressure may be only an incidental finding without clinical implication or relevance. Differentiating secondary EGJOO is important because these patients will require a different management on many occasions compared to patients with primary or idiopathic EGJOO. Within the diagnostic armamentarium, we count with endoscopy, esophagogram and high-resolution manometry to identify underlying causes of incomplete relaxation of the EGJ. Endoscopic ultrasound and computed tomography can help us exclude infiltrative or inflammatory pathology. Although there are no curative treatments for EGJOO disorders, there are options for medical, endoscopic and surgical management. Individualized management of this condition is recommended, taking into account factors such as the symptoms of the patient and the severity of these symptoms, and the type of EGJOO (functional vs. structural), among others, remembering that in a significant percentage of patients there might be a spontaneous resolution of symptoms during follow-up.
{"title":"Obstrucción del tracto de salida de la unión esofagogástrica: ¿Qué es y cómo manejarla?","authors":"Andres F. Ardila-Hani, Ana María Leguizamo, Valeria Costa, A. Ardila","doi":"10.24875/ngl.18000009","DOIUrl":"https://doi.org/10.24875/ngl.18000009","url":null,"abstract":"The motor esophageal disorders are categorized according to the Chicago Classification 3.0 into major and minor disorders of peristalsis; and those with outflow obstruction; divided in achalasia and esophagogastric junction outflow obstruction (EGJOO). The present study has as an objective to revise the types of EGJOO, their etiology, clinical manifestations, pathophysiology, diagnostic tests and different treatment options. EGJOO comprises a heterogeneous group of patients characterized by manometric findings of an alteration in the EGJ, with the presence of intact or weak peristalsis of the esophageal body, in such a way that the criteria for achalasia are not met. It can be caused not only by functional pathology (idiopathic) but structural (secondary) pathology. Dysphagia is the most common symptom, followed by chest pain, regurgitation and heartburn. The finding of EGJOO in the absence of secondary etiology is accompanied by clinical uncertainty. Some seem to have an early stage of achalasia, while others have almost no obstructive symptoms and the finding of a high integrated relaxation pressure may be only an incidental finding without clinical implication or relevance. Differentiating secondary EGJOO is important because these patients will require a different management on many occasions compared to patients with primary or idiopathic EGJOO. Within the diagnostic armamentarium, we count with endoscopy, esophagogram and high-resolution manometry to identify underlying causes of incomplete relaxation of the EGJ. Endoscopic ultrasound and computed tomography can help us exclude infiltrative or inflammatory pathology. Although there are no curative treatments for EGJOO disorders, there are options for medical, endoscopic and surgical management. Individualized management of this condition is recommended, taking into account factors such as the symptoms of the patient and the severity of these symptoms, and the type of EGJOO (functional vs. structural), among others, remembering that in a significant percentage of patients there might be a spontaneous resolution of symptoms during follow-up.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126983038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
El síndrome del intestino irritable (IBS) es un trastorno gastrointestinal multifactorial. Un episodio agudo de enteritis infecciosa es uno de los factores de riesgo más relevantes para el desarrollo de IBS, el denominado IBS post-infección IBS (PIIBS). En este artículo pretendemos revisar las publicaciones relevantes sobre la relación entre la gastroenteritis infecciosa y el consiguiente desarrollo de IBS, los factores de riesgo relacionados para el desarrollo de PIIBS, los principales patógenos involucrados, el papel de la microbiota y las terapias. Hemos tomado en consideración los últimos estudios indexados en Pubmed utilizando los siguientes ítems de búsqueda: «IBS», «PIIBS», «therapy of PIIBS». Los resultados de nuestra revisión mostraron que la incidencia de PIIBS oscila entre el 3 y el 30% después de la gastroenteritis infecciosa. Aunque la gastroenteritis por protozoos y parásitos se asoció con el desarrollo de PIIBS en hasta un 41.9% de los casos en comparación con solo un 13.8% después de infecciones bacterianas; se necesitan más estudios para confirmar estas cifras. No hay un tratamiento específico de PIIBS y los enfoques principales reflejan los utilizados para el IBS. En conclusión, la gastroenteritis por infección aguda es un factor de riesgo para el desarrollo de IBS de nueva aparición. Los estudios futuros deberían centrarse en los mecanismos implicados en esta conexión con el fin de desarrollar estrategias terapéuticas que prevengan la aparición de nuevos IBS.
{"title":"Postinfection irritable bowel syndrome","authors":"M. Marcellini, M. Barbaro, C. Cremon, G. Barbara","doi":"10.24875/ngl.18000012","DOIUrl":"https://doi.org/10.24875/ngl.18000012","url":null,"abstract":"El síndrome del intestino irritable (IBS) es un trastorno gastrointestinal multifactorial. Un episodio agudo de enteritis infecciosa es uno de los factores de riesgo más relevantes para el desarrollo de IBS, el denominado IBS post-infección IBS (PIIBS). En este artículo pretendemos revisar las publicaciones relevantes sobre la relación entre la gastroenteritis infecciosa y el consiguiente desarrollo de IBS, los factores de riesgo relacionados para el desarrollo de PIIBS, los principales patógenos involucrados, el papel de la microbiota y las terapias. Hemos tomado en consideración los últimos estudios indexados en Pubmed utilizando los siguientes ítems de búsqueda: «IBS», «PIIBS», «therapy of PIIBS». Los resultados de nuestra revisión mostraron que la incidencia de PIIBS oscila entre el 3 y el 30% después de la gastroenteritis infecciosa. Aunque la gastroenteritis por protozoos y parásitos se asoció con el desarrollo de PIIBS en hasta un 41.9% de los casos en comparación con solo un 13.8% después de infecciones bacterianas; se necesitan más estudios para confirmar estas cifras. No hay un tratamiento específico de PIIBS y los enfoques principales reflejan los utilizados para el IBS. En conclusión, la gastroenteritis por infección aguda es un factor de riesgo para el desarrollo de IBS de nueva aparición. Los estudios futuros deberían centrarse en los mecanismos implicados en esta conexión con el fin de desarrollar estrategias terapéuticas que prevengan la aparición de nuevos IBS.","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130499272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
La hipersensibilidad al reflujo, que Roma IV introdujo recientemente como un nuevo trastorno funcional del esófago, se define por la presencia de síntomas típicos de acidez estomacal en presencia de biopsias y endoscopia superior normales, exposición normal al ácido esofágico y una correlación positiva entre los síntomas del paciente y eventos de reflujo. La hipersensibilidad al reflujo es muy común y generalmente se superpone con otros trastornos gastrointestinales funcionales y a menudo se asocia con algún tipo de comorbilidad psicológica. La hipersensibilidad esofágica debida a la sensibilización periférica y/o central se ha considerado como el principal mecanismo subyacente para la aparición de síntomas en pacientes con hipersensibilidad al reflujo. Además, los factores centrales como el estrés, los trastornos psicológicos por hipervigilancia y la falta de sueño, desempeñan un papel importante en la mejora de la percepción de los estímulos intraesofágicos. El diagnóstico se realiza mediante el uso de una combinación de endoscopia con biopsias, pruebas de pH inalámbricas o pruebas de impedancia de pH y manometría esofágica de alta resolución. La hipersensibilidad al reflujo se trata con neuromoduladores, como los antidepresivos tricíclicos (ATC), los inhibidores selectivos de la recaptación de serotonina (ISRS). Sin embargo, en algunos casos, se debe considerar un mejor control del reflujo gastroesofágico ya sea médicamente, endoscópicamente o incluso quirúrgicamente. La intervención psicológica y la medicina alternativa/complementaria también deben ser asimismo consideradas. GastroLatam Rev. 2018;2:5-17)
{"title":"Reflux hypersensitivity - what is in the name?","authors":"Takahisa Yamasaki, R. Fass","doi":"10.24875/ngl.18000006","DOIUrl":"https://doi.org/10.24875/ngl.18000006","url":null,"abstract":"La hipersensibilidad al reflujo, que Roma IV introdujo recientemente como un nuevo trastorno funcional del esófago, se define por la presencia de síntomas típicos de acidez estomacal en presencia de biopsias y endoscopia superior normales, exposición normal al ácido esofágico y una correlación positiva entre los síntomas del paciente y eventos de reflujo. La hipersensibilidad al reflujo es muy común y generalmente se superpone con otros trastornos gastrointestinales funcionales y a menudo se asocia con algún tipo de comorbilidad psicológica. La hipersensibilidad esofágica debida a la sensibilización periférica y/o central se ha considerado como el principal mecanismo subyacente para la aparición de síntomas en pacientes con hipersensibilidad al reflujo. Además, los factores centrales como el estrés, los trastornos psicológicos por hipervigilancia y la falta de sueño, desempeñan un papel importante en la mejora de la percepción de los estímulos intraesofágicos. El diagnóstico se realiza mediante el uso de una combinación de endoscopia con biopsias, pruebas de pH inalámbricas o pruebas de impedancia de pH y manometría esofágica de alta resolución. La hipersensibilidad al reflujo se trata con neuromoduladores, como los antidepresivos tricíclicos (ATC), los inhibidores selectivos de la recaptación de serotonina (ISRS). Sin embargo, en algunos casos, se debe considerar un mejor control del reflujo gastroesofágico ya sea médicamente, endoscópicamente o incluso quirúrgicamente. La intervención psicológica y la medicina alternativa/complementaria también deben ser asimismo consideradas. GastroLatam Rev. 2018;2:5-17)","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122669627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
La enfermedad por reflujo gastroesofágico (ERGE) es un trastorno representativo de las enfermedades relacionadas con la acidez gastrointestinal. Para tratar estos trastornos se usan principalmente agentes antisecretores, como los inhibidores de la bomba de protones (IBP). Además de los IBP convencionales, recientemente se han desarrollado una nueva clase de agentes antiácidos, los bloqueadores de ácido competitivos de potasio (BAC-P), que actúan inhibiendo la H+/K+-ATPasa gástrica compitiendo con el K+. Por otro lado, el reflujo duodenogastroesofágico del ácido biliar es otro promotor de ERGE y sus complicaciones asociadas, como el esófago de Barrett y el adenocarcinoma esofágico inferior. Por lo tanto, los secuestradores de ácidos biliares pueden desempeñar un papel en este tipo de reflujo. En este documento se revisan las funciones de los BAC-P y los secuestradores de ácidos biliares en el tratamiento de la ERGE. Hay tres tipos de BAC-P, uno de los cuales es el vonoprazán, que tiene un potente efecto antisecretor de larga duración sobre la H+/K+-ATPasa debido a su alta acumulación y lenta eliminación en el estómago. El vonoprazán se usa actualmente en Japón para el tratamiento de la esofagitis por reflujo, induciendo un alto índice de cicatrización de la mucosa en pacientes con esofagitis por reflujo refractaria resistente a PPI, y en la protección del epitelio esofágico. Los secuestradores de ácidos biliares, como la colestiramina, se unen a los ácidos biliares y pueden ser fisiológicamente eficaces para reducir la exposición al ácido biliar de la superficie del epitelio esofágico. Mientras que actualmente los tres BAC-P tienen diferentes grados de eficacia en la terapia de la ERGE, la de los secuestradores de ácidos biliares no ha sido plenamente probada. (NeuroGastroLatam Rev. 2018;2:18-27)
{"title":"New pharmacological treatments for gastroesophageal reflux: Potassium-competitive acid blockers and bile acid sequestrants","authors":"Hidekazu Suzuki","doi":"10.24875/ngl.18000007","DOIUrl":"https://doi.org/10.24875/ngl.18000007","url":null,"abstract":"La enfermedad por reflujo gastroesofágico (ERGE) es un trastorno representativo de las enfermedades relacionadas con la acidez gastrointestinal. Para tratar estos trastornos se usan principalmente agentes antisecretores, como los inhibidores de la bomba de protones (IBP). Además de los IBP convencionales, recientemente se han desarrollado una nueva clase de agentes antiácidos, los bloqueadores de ácido competitivos de potasio (BAC-P), que actúan inhibiendo la H+/K+-ATPasa gástrica compitiendo con el K+. Por otro lado, el reflujo duodenogastroesofágico del ácido biliar es otro promotor de ERGE y sus complicaciones asociadas, como el esófago de Barrett y el adenocarcinoma esofágico inferior. Por lo tanto, los secuestradores de ácidos biliares pueden desempeñar un papel en este tipo de reflujo. En este documento se revisan las funciones de los BAC-P y los secuestradores de ácidos biliares en el tratamiento de la ERGE. Hay tres tipos de BAC-P, uno de los cuales es el vonoprazán, que tiene un potente efecto antisecretor de larga duración sobre la H+/K+-ATPasa debido a su alta acumulación y lenta eliminación en el estómago. El vonoprazán se usa actualmente en Japón para el tratamiento de la esofagitis por reflujo, induciendo un alto índice de cicatrización de la mucosa en pacientes con esofagitis por reflujo refractaria resistente a PPI, y en la protección del epitelio esofágico. Los secuestradores de ácidos biliares, como la colestiramina, se unen a los ácidos biliares y pueden ser fisiológicamente eficaces para reducir la exposición al ácido biliar de la superficie del epitelio esofágico. Mientras que actualmente los tres BAC-P tienen diferentes grados de eficacia en la terapia de la ERGE, la de los secuestradores de ácidos biliares no ha sido plenamente probada. (NeuroGastroLatam Rev. 2018;2:18-27)","PeriodicalId":101679,"journal":{"name":"NeuroGastroLATAM Reviews","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124285135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：