Factors Predicting Failure in Anorectal Biofeedback

Anorectal biofeedback is a method used by specialists in gastrointestinal motility to treat disorders of defecation. In the case of the anorectal biofeedback, unlike in biofeedback applications in other medical fields, the signal is represented by the pressure in the anorectal canal. The pressure is assessed by anorectal manometry. Patients are trained to become aware of this signal in an attempt to reeducate them for a correct defecation. Following the variation of the signals, patients can learn how to modulate the anal sphincter pressure and to improve their defecation disorders. Anorectal biofeedback is therefore used for fecal incontinence and for chronic terminal constipation. Despite its potential, the method is not intensively used and many patients ignore it. The specialists’ evaluation of the method is controversial: from enthusiastic to deceiving results, different data are available. The aim of this presentation is to analyze factors of success and of failure in the use of anorectal biofeedback in a single center specialized in anorectal manometry and to compare our data with results described by other authors

Diabetes's adherence to treatment: the predictive value of satisfaction with medical care

AbstractProblem Statement: Diabetes mellitus has a significant physical and emotional impact, involving difficult lifestyle adjustments, complex and long term treatment. Purpose of Study: To investigate the predictive value witch can have patient satisfaction, socio-demographics, clinical factors and self-efficacy on diabetes's adherence. ResearchMethods78 outpatients diagnosed with Type 2 diabetes completed Patient Satisfaction Questionnaire III, The Medical Outcomes Study Adherence Questionnaire and The Diabetes Empowerment Scale. Findings: Multivariate regression indicates that residence and self-efficacy were independent predictors for general adherence while self-efficacy was independent predictor for specific adherence.Conclusions. Identifying adherence's factors facilitates the optimization of this health behaviour with high benefits for quality of life of diabetic patients

Inflammation as a Potential Therapeutic Target in IBS

The pathogenesis of irritable bowel syndrome (IBS) has been intensively researched, and despite a long journey for unraveling all the structures and the pathways involved, it still remains partially obscure. Inflammation was the first to be hypothesized as a potential pathway for the pathogenesis of IBS. It remains a keystone in the complex machinery of the pathogenesis that is currently considered multifactorial. Elucidating the pathogenesis of IBS is crucial for a targeted therapy of the disease. In this chapter, we review information regarding gut inflammation in IBS, underlining some of the newest data or the cornerstones. Additionally, our aim was also to review treatment currently available and future perspectives regarding anti‐inflammatory treatments for IBS. Newer techniques allow detection and research of mediators involved in inflammation, as well as their potential role to be targeted by pharmacological agents. Recent data supports not only further research of the newer agents that are currently being developed but also some of the available ones that do not have sufficient evidence. Emerging therapies that target inflammation are under evaluation, in trials. A multidrug or a multidisciplinary approach needs to be considered in some cases that fail to respond to current treatment

The relationship between irritable bowel syndrome and psychiatric disorders: from molecular changes to clinical manifestations

Irritable bowel syndrome (IBS) is a functional syndrome characterized by chronic abdominal pain accompanied by altered bowel habits. Although generally considered a functional disorder, there is now substantial evidence that IBS is associated with a poor quality of life and significant negative impact on work and social domains. Neuroimaging studies documented changes in the prefrontal cortex, ventro-lateral and posterior parietal cortex and thalami, and implicate alteration of brain circuits involved in attention, emotion and pain modulation. Emerging data reveals the interaction between psychiatric disorders including generalized anxiety disorder, panic disorder, major depressive disorder, bipolar disorder, and schizophrenia and IBS, which suggests that this association should not be ignored when developing strategies for screening and treatment. Psychological, social and genetic factors appear to be important in the development of IBS symptomatology through several mechanisms: alteration of HPA axis modulation, enhanced perception of visceral stimuli or psychological vulnerability. Elucidating the molecular mechanisms of IBS with or without psychiatric comorbidities is crucial for elucidating the pathophysiology and for the identification of new therapeutical targets in IBS

Plasma homocysteine and the severity of heart failure in patients with previous myocardial infarction

Background: Homocysteine is considered to be a risk factor, or an indicator of risk, for the development of cardiovascular disease. Little data is available on its significance in patients with previous myocardial infarction. The aim of our study was to assess the plasma level of homocysteine and its relationship with the severity of heart failure in patients with chronic myocardial infarction. Methods: We studied 144 patients with previous myocardial infarction. Patients were divided into two groups according to the presence or absence of heart failure, as certified by clinical evidence of heart failure and by echocardiographic criteria for left ventricular systolic dysfunction. Results: Of the patients with prior myocardial infarction (144; 63.6 ± 9.6 years) included in the study, 65 had heart failure. The mean level of homocysteine was significantly higher in the heart failure group (18.9 mmol/L) than in the non-heart failure group (14.1 mmol/L; p ≤ 0.001). Our study demonstrated that there is a statistically significant correlation between homocysteine plasma levels and the severity of heart failure in patients with prior myocardial infarction. Homocysteine levels have proved to become higher with NYHA class progression. A significant cross-sectional correlation has been assessed between homocysteine and tissue Doppler echocardiography parameters. Conclusions: Increased plasma homocysteine levels independently correlate with the severity of heart failure in patients with chronic myocardial infarction. We suggest that homocysteine can be used in clinical practice as a valuable heart failure risk marker in patients with chronic myocardial infarction. (Cardiol J 2011; 18, 1: 55-62

Acute Cholecystitis as a Complication After Colonoscopy: A Case Report and Literature Review

Acute cholecystitis after colonoscopy is a rare event, with less than 10 cases described in the literature. We report the case of a male patient with silent gallstones who underwent colonoscopy for follow-up of his Crohn’s disease. The colonoscopy revealed erosions in the terminal ileum, from which biopsies were taken. A sessile polyp 4 mm in diameter at the recto-sigmoid junction was also removed. Less than 24 h after the colonoscopy, the patient complained of upper right quadrant pain, nausea and vomiting. Based on the clinical findings, laboratory data and ultrasonography, we diagnosed acute cholecystitis and excluded any complication after the colonoscopy. Laparoscopic cholecystectomy was performed and the patient was discharged

Microbioma intestinal y peso corporal – revisión

The link between gut microbiota and insulin resistance has an important clinical impact, people affected by dysbiosis having a predisposition for developing: obesity, type 2 diabetes mellitus, nonalcoholic fatty liver disease, cancers, cardiovascular, neurodegenerative and psychiatric diseases. Dysbiosis may lead through chronic inflammation to obesity and metabolic syndrome. We carried out a systematic review of the studies dedicated to the role of gut microbiota in weight gain and obesity. A systematic literature search of recent data published in electronic databases, was performed, using as search phrase: "gut microbiome and body weight and obesity". Studies that contained no data about the influence of gut microbiota changes on obesity were excluded. Western diet, antibiotic use in childhood, excessive maternal pre-pregnancy weight, Cesarean delivery, and testosterone deficiency are triggers of the alteration of microbiota and subsequently the appearance of obesity. Predominance of Firmicutes and anaerobic genera, changes in the mycobiome and viral intestinal population are implied in the etiology of obesity. Prebiotics, polyphenols, different herbs, medication (antidiabetics, calcium), physical exercise, rich fibre intake and bariatric surgery are the most important therapeutic options. Personalized dietary treatments, antiviral agents and mycobiome manipulation would represent the new target in treating obesity. Any change of the quantitative and qualitative composition of microbiota has influence on the components of metabolic syndrome, so any management strategy for the treatment or prevention of obesity in children and adulthood should have the microbiome as target.La relación entre la microbioma intestinal y la resistencia a la insulina tiene un impacto clínico importante dado que la gente afectada por disbiosis tiene predisposiciones para desarrollar la obesidad, la diabetes mellitus tipo 2, la enfermedad de hígado graso no alcohólico, cánceres, enfermedades cardiovasculares, neurodegenerativas y psiquiátricas. La disbiosis puede convertirse en una inflamación crónica, obesidad o síndrome metabólico. Hemos hecho una revisión sistemática de los estudios dedicados al papel de la microbioma intestinal para el aumento de peso y la obesidad. Una búsqueda sistemática de datos recientes publicados en las bases de datos electrónicas se ha llevado a cabo usando la frase “gut microbiome and body weight and obesity”. Se ha excluido a los estudios que no contenían informaciones sobre la influencia de los cambios de la microbioma intestinal en la obesidad. La dieta occidental, uso de los antibióticos en la niñez, peso excesivo antes del embarazo, parto por cesárea y deficiencia de testosterona provocan la alteración de la microbioma y por consiguiente la apariencia de la obesidad. El predominio de firmicutes y géneros anaeróbicos, cambios en el microbioma y populación intestinal viral están implícitos en la etiología de la obesidad. Prebióticos, polifenoles, diferentes hierbas, medicamentos (antidiabéticos, calcio), ejercicio físico, consumo de fibras y cirugía bariátrica son las opciones terapéuticas más importantes. Tratamientos dietéticos personalizados, agentes antivirales y manipulación de la microbioma representarían nuevas metas en el tratamiento de la obesidad. Cada cambio en la composición cuantitativa o cualitativa de la microbioma influye en los componentes del síndrome metabólico, así que todas las estrategias para el tratamiento o prevención de la obesidad en niños o adultos deberían tener microbioma como su meta

Critical Issues on Diverticular Disease

In this session diverse critical issues in diverticular disease were considered, including 'In or outpatient management of uncomplicated diverticulitis?', 'Segmental colitis associated with diverticulosis: what is it?'and 'Diverticular inflammation is a risk factor for colorectal cancer?'. The conclusions drawn are outlined in the statements but in summary, outpatient management is safe in selected patients, as long as correct diagnosis and stage are assured, and this can allow a cost effective treatment. Non-antibiotic management is also safe but should be confined as an outpatient treatment in carefully selected patients. Segmental colitis associated with diverticulosis (SCAD) is a defined pathological entity (only diagnosed on biopsy) characterized by an inflammatory bowel disease-like pathology, occurring principally in the sigmoid colon, with rectal and right colon sparing. The pathogenesis is unclear but may include a genetic predisposition, microbiome alteration and ischaemia. Treatment can last months, and depends on severity, options include antibiotics, 5 ASA and probiotics for mild cases. Severe disease needs systemic steroids or even anti TNFα treatment. Whether diverticular inflammation is a risk factor for colorectal cancer was debated and the conclusion that within the first eighteen months of diagnosis of diverticular disease associations with cancer are found, likely due to similar symptoms and misclassification of disease. After that time, diverticular disease does not increase the risk of colorectal cancer. Therefore, this is recommended to exclude cancer with imaging and colonoscopy after healing of the first episode of diverticulitis

Giant gastric polyp mimicking a duodenal tumor

Inflammatory fibroid polyps are very rare gastrointestinal tumors. We present the case of a 66-year-old woman with severe anemia and a giant gastric polyp which had intermittent duodenal intussusception. Ultrasonography showed increased gastric wall thickness and suspected an ampulloma, as revealed also by endoscopy and computed tomography. Ultrasonography reassessment showed later the intragastric mass, which was confirmed by endosonography: giant pediculated hypervascular polyp suggesting malignancy. Challenging phenomena at different investigation methods were due to intermittent protrusion into the first duodenal segment mimicking an ampulloma, but without gastric outlet syndrome or a malignant component, despite the severe anemia. Abnormal US aspect of the stomach in clinical context of anemic syndrome, requires EUS with biopsies in order to confirm underlying lesions. The particularities of this case are the: discordance between imaging aspects and the protrusion into the first duodenal segments with consecutive cholestasis mimicking an ampulloma and the lack of gastric outlet syndrome