The intestinal microenvironment and functional gastrointestinal disorders

For decades, interactions between the enteric neuromuscular apparatus and the central nervous system have served as the primary focus of pathophysiological research in the functional gastrointestinal disorders. The accumulation of patient reports, as well as clinical observations, has belatedly led to an interest in the role of various luminal factors and their interactions with each other and the host in functional gastrointestinal disorders. Most prominent among these factors has been the role of food. As a consequence, while not always evidence-based, dietary interventions are enjoying a renaissance in irritable bowel syndrome management. Not surprisingly, given its exploration in many disease states, the gut microbiota has also been studied in functional gastrointestinal disorders; data remain inconclusive. Likewise, there is also a considerable body of experimental and some clinical data to link functional gastrointestinal disorders pathogenesis to disturbances in epithelial barrier integrity, abnormal entero-endocrine signaling and immune activation. These data provide growing evidence supporting the existence of micro-organic changes, particularly in subgroups of patients with functional dyspepsia and IBS. However, their exact role in the complex pathophysiology and symptom generation of functional gastrointestinal disorders needs to be further studied and elucidated particularly with longitudinal and interventional studies.Giovanni Barbara, Christine Feinle-Bisset, Uday C. Ghoshal, Javier Santos, Stepen J. Vanner, Nathalie Vergnolle, Erwin G. Zoetendal, and Eamonn M. Quigle

Diferentes vias de administração da solução de fosfato monobásico e dibásico de sódio no preparo do cólon para colonoscopia rígida em cães Different routes in administration of sodium phosphate monobasic and dibasic solution in bowel preparation for rigid colonoscopy in dogs

Foram comparadas duas vias de administração, oral e retal, com a solução de fosfato monobásico e dibásico de sódio (NaP), juntamente com bisacodil via oral, no preparo do cólon para colonoscopia rígida em cães, para avaliar parâmetros clínicos, qualidade do preparo e variações dos eletrólitos fósforo, cálcio, potássio (K+) sódio (Na+) e magnésio (Mg+), além da creatinina, albumina e hemograma. Todos os eletrólitos apresentaram alterações, sendo significativa a queda nos níveis de K+ e Mg+. Não houve alterações eletrocardiográficas, e a redução da microbiota bacteriana foi confirmada nos dois grupos de administração da solução. Os resultados foram similares quanto à incidência de efeitos colaterais, porém a via retal apresentou facilidade na administração, menor retenção fecal no cólon, maior rapidez para realização da colonoscopia, com menor desperdício de tempo na lavagem e na aspiração do conteúdo fecal. O preparo intestinal com bisacodil oral e solução de NaP por via retal foi mais eficaz, podendo ser recomendado em cães que serão submetidos à colonoscopia.<br>The efficacy of oral and rectal administration of sodium phosphate monobasic and dibasic solution (NaP) combined with bisacodil per oral, as drugs to prepare the colon for rigid colonoscopy in dogs was compa1ed. Clinical parameters; colonic cleaning, plasma concentration of calcium, potassium (K+), sodium (Na+), magnesium (Mg+), creatinine, and albumin, and complete blood count were evaluated. In both groups, all electrolytes presented alterations, with significant reduction of the levels of K+ and Mg+, but there were no electrocardiographic alterations. No difference in the reduction of bacterial population was observed between the two groups. The results were similar regarding the incidence of side effects; however, the rectal route presented less fecal retention in colon and could get patients ready for the procedure faster. The preparation of bowel with bisacodil and NaP solution by rectal route was more effective and could be recommended for colonoscopy in dogs