3 research outputs found
Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test
CONTEXT: Functional dyspepsia is a condition in which symptoms are not related to organic underlying disease; its pathogenesis is not well known. The small intestinal bacterial overgrowth (SIBO) is characterized by the increase in the number and/or type of colonic bacteria in the upper gastrointestinal tract. The hypothesis of SIBO being associated to functional dyspepsia must be considered, since the impaired motility of the gastrointestinal tract is one of the main etiologic factors involved on both pathologies. OBJECTIVE: To determine if there is SIBO in patients with functional dyspepsia. METHODS: Case-control study, evaluating 34 patients: 23 functional dyspeptic and 11 non-dyspeptic (control group). Questionnaire applied based on Rome III criteria. The patients underwent H2-lactulose breath test, considered positive when: H2 peak exceeding 20 ppm, in relation to fasting, or two peaks exceeding 10 ppm sustained until 60 minutes. RESULTS: Of the 23 dyspeptic patients, 13 (56.5%) obtained positive results for SIBO trough the H2-lactulose breath test. On control group, SIBO was not observed. The association between the dyspeptic group and the control group regarding SIBO was statistically significant, with P = 0.0052. In the group of dyspeptic patients, 12 (52.2%) were using proton pump inhibitor; of these 9 (75%) were positive for SIBO. In the control group, none of the 11 patients used proton pump inhibitors and SIBO was not observed. The association of the dyspeptic group using proton pump inhibitor that were positive for SIBO and the control group was statistically significant, with P = 0.0011. CONCLUSION: It was found that, patients with functional dyspepsia presented SIBO, when they underwent to H2-lactulose breath test, compared to the non-dyspeptic. In addition, it was observed a higher prevalence of SIBO in dyspeptic patients that were using proton pump inhibitors, compared to control group
Evaluation of small intestine bacterial overgrowth in patients with functional dyspepsia through H2 breath test Avaliação de supercrescimento bacteriano no intestino delgado em pacientes com dispepsia funcional, utilizando o teste de H2 no ar expirado
CONTEXT: Functional dyspepsia is a condition in which symptoms are not related to organic underlying disease; its pathogenesis is not well known. The small intestinal bacterial overgrowth (SIBO) is characterized by the increase in the number and/or type of colonic bacteria in the upper gastrointestinal tract. The hypothesis of SIBO being associated to functional dyspepsia must be considered, since the impaired motility of the gastrointestinal tract is one of the main etiologic factors involved on both pathologies. OBJECTIVE: To determine if there is SIBO in patients with functional dyspepsia. METHODS: Case-control study, evaluating 34 patients: 23 functional dyspeptic and 11 non-dyspeptic (control group). Questionnaire applied based on Rome III criteria. The patients underwent H2-lactulose breath test, considered positive when: H2 peak exceeding 20 ppm, in relation to fasting, or two peaks exceeding 10 ppm sustained until 60 minutes. RESULTS: Of the 23 dyspeptic patients, 13 (56.5%) obtained positive results for SIBO trough the H2-lactulose breath test. On control group, SIBO was not observed. The association between the dyspeptic group and the control group regarding SIBO was statistically significant, with P = 0.0052. In the group of dyspeptic patients, 12 (52.2%) were using proton pump inhibitor; of these 9 (75%) were positive for SIBO. In the control group, none of the 11 patients used proton pump inhibitors and SIBO was not observed. The association of the dyspeptic group using proton pump inhibitor that were positive for SIBO and the control group was statistically significant, with P = 0.0011. CONCLUSION: It was found that, patients with functional dyspepsia presented SIBO, when they underwent to H2-lactulose breath test, compared to the non-dyspeptic. In addition, it was observed a higher prevalence of SIBO in dyspeptic patients that were using proton pump inhibitors, compared to control group.<br>CONTEXTO: A dispepsia funcional é uma afecção cujos sintomas não estão relacionados à doença de base orgânica; sua etiopatogenia não é bem definida. O supercrescimento bacteriano no intestino delgado (SBID) é caracterizado pelo aumento do número e/ou tipo de bactérias colônicas no trato gastrointestinal superior. A hipótese de SBID associado à dispepsia funcional deve ser considerada, uma vez que o distúrbio de motilidade do trato gastrointestinal é um dos principais fatores etiológicos envolvidos nas duas patologias. OBJETIVO: Determinar se há presença de SBID em pacientes com dispepsia funcional. MÉTODO: Estudo caso-controle, avaliando 34 pacientes: 23 dispépticos funcionais e 11 não dispépticos (grupo controle). Questionário baseado nos critérios de Roma III foi aplicado. Os pacientes se submeteram ao teste de H2 no ar expirado com lactulose, considerado positivo: pico de H2 superior a 20 ppm, em relação ao jejum ou dois picos superiores a 10 ppm sustentados até 60 minutos. RESULTADOS: Dos 23 pacientes dispépticos, 13 (56.5%) obtiveram resultado positivo para SBID através do teste de H2 no ar expirado. No grupo controle, não foi evidenciado SBID. A associação entre o grupo dispéptico e o grupo controle em relação ao SBID, mostrou-se estatisticamente significante, com P = 0.0052. Do grupo dispéptico, 12 (52.2%) pacientes faziam uso de inibidor de bomba de prótons; destes, 9 (75%) apresentaram resultado positivo para SBID. No grupo controle, os 11 pacientes não usavam inibidor de bomba de prótons e não foi evidenciado SBID. Mostrou-se estatisticamente significante a associação do grupo de dispépticos em uso de inibidor de bomba de prótons que tiveram SBID e grupo controle, com P = 0.0011. CONCLUSÃO: Concluiu-se que, pacientes com dispepsia funcional apresentaram SBID, quando submetidos ao teste de H2 no ar expirado, em relação aos não-dispépticos. Além disso, observou-se maior prevalência de SBID em pacientes dispépticos que faziam uso de inibidor de bomba de prótons, em relação ao grupo controle
Tratamento da sÃndrome do intestino irritável tipo diarreia-predominante com mesalazina e/ou Saccharomyces boulardii
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Previous issue date: 2013-12A sÃndrome do intestino irritável (SII) é uma doença funcional do intestino, caracterizada por dor abdominal e alterações do
hábito intestinal, cuja fisiopatologia permanece desconhecida. Estudos recentes sustentam a hipótese de que algumas formas de SII, especialmente a
sÃndrome do intestino irritável tipo diarreia (SII-D), apresentam sinais de uma inflamação de baixo grau persistente da mucosa intestinal e alterações
da microflora intestinal. A mesalazina é conhecida por suas propriedades anti-inflamatórias intestinais. O Saccharomyces boulardii é um probiótico
largamente utilizado para o tratamento da diarreia relacionada à causa infecciosa. Objetivo – Avaliar os efeitos da mesalazina, da terapia com me-
salazina combinada ao Saccharomyces boulardii e do Saccharomyces boulardii, em pacientes com SII-D. Método – Com base nos critérios de Roma
III, 53 pacientes com SII-D (maiores de 18 anos) foram incluÃdos. Para excluir as doenças orgânicas, todos os pacientes realizaram colonoscopia,
coprocultura, anticorpo anti-endomÃsio, teste de tolerância à lactose e exame parasitológico de fezes. Os pacientes foram divididos em três grupos:
grupo mesalazina (GM) – 20 pacientes foram medicados com mesalazina via oral 800 mg t.i.d. por 30 dias; grupo mesalazina e Saccharomyces
boulardii (GMSb) – 21 pacientes foram medicados com mesalazina 800mg t.i.d. e Saccharomyces boulardii 200 mg via oral t.i.d. por 30 dias; grupo
Saccharomyces boulardii (GSb) – 12 pacientes foram medicados com Saccharomyces boulardii 200 mg t.i.d. por 30 dias. Não foram permitidas drogas
concomitantes com algum efeito sobre secreção ou motilidade intestinal. Os sintomas foram avaliados no basal e após tratamento por meio da escala
de Likert de 4 pontos que incluÃa: frequência de evacuações; forma e consistência das fezes (baseado na escala de Bristol); dor abdominal; e distensão
abdominal. A analise estatÃstica foi realizada por meio de teste t pareado e do teste de Kruskal-Wallis. Resultados - Comparados ao basal, observou-se
uma redução estatisticamente significativa da pontuação de sintomas após 30 dias de tratamento no GM (P<0.0001); GMSb (P<0.0001); e GSb
(P<0.003). Diferença estatisticamente significativa da pontuação de sintomas após 30 dias de tratamento entre GM, GMSb e GSb (P = 0.03). Não
foi observada diferença estatisticamente significativa entre GM e GMSb após 30 dias de tratamento (P = 0,9). Conclusão – O uso da mesalazina
isolada, do Saccharomyces boulardii isolado ou do tratamento combinado com ambos, mesalazina e Saccaromyces boulardii, melhoraram os sintomas
da SII-D. A melhora dos sintomas foi maior naqueles que usaram mesalazina seja isolada ou em combinação com Saccharomyces boulardii quando
comparada com o uso de Saccharomyces boulardii isoladamente. Estes resultados sugerem que a mesalazina pode ser útil no tratamento de pacientes
com SII-D e justificam outros estudos com maior número de pacientes.Irritable bowel syndrome (IBS) is a functional bowel disease characterized by abdominal pain and altered in-
testinal habits. The pathophysiology of IBS remains unclear. Recent studies have demonstrated that some IBS patients, especially in
diarrhea-predominant IBS (IBS-D), display persistent signs of minor mucosal inflammation and a modified intestinal microflora.
The mesalazine has known intestinal anti-inflammatory properties. Saccharomyces boulardii is a probiotic used for a long time in
treatment of diarrhea, including infectious diarrhea. Objective - Evaluate the effects of mesalazine alone, combined therapy of me-
salazine with liophylised Saccharomyces boulardii or alone on symptoms of IBS-D patients. Methods - Based on Rome III criteria,
53 IBS-D patients (18 year or more) were included. To exclude organic diseases all patients underwent colonoscopy, stool culture,
serum anti-endomisium antibody, lactose tolerance test and ova and parasite exam. Patients were divided in three groups: mesalazine
group (MG) - 20 patients received mesalazine 800 mg t.i.d. for 30 days; mesalazine and Saccharomyces boulardii group (MSbG) - 21
patients received mesalazine 800 mg t.i.d. and Saccharomyces boulardii 200 mg t.i.d. for 30 days and; Saccharomyces boulardii group
(SbG) – 12 patients received Sb 200 mg t.i.d. for 30 days. Drugs that might have any effect on intestinal motility or secretion were
not allowed. Symptom evaluations at baseline and after treatment were performed by means of a 4-point likert scale including: stool
frequency, stool form and consistency (Bristol scale), abdominal pain and distension. Paired t test and Kruskal-Wallis test were used
for statistical analyses. Results - Compared to baseline, there were statistically significant reduction of symptom score after 30 th day
therapy in all three groups: MG (P<0.0001); MSbG (P<0.0001) and in SbG (P = 0.003). There were statistically significant differ-
ences in the symptom score at 30 th day therapy of the MG, MSbG and SbG groups (P = 0.03). There were no statistical differences
between MSbG and MG symptom score at 30th day therapy (P = 0.9). Conclusions - The use of mesalazine alone, Saccharomyces
boulardii alone or combined treatment with mesalasine and Saccaromyces boulardii improved IBS-D symptoms. The improvement of
the symptom score was greater with mesalazine alone or combined with Sb as compared with Sb treatment alone. These preliminary
results suggest that mezalazine may be useful in treatment of IBS-d patients, and warrant further larger studies