Ana Cristina Fontenele Soares

Breath methane associated with slow colonic transit time in children with chronic constipation.

Objective: This study analyzed the relationship between methane production and colonic transit time in children with chronic constipation. Methodology: Forty children, from 3 to 13 years of age, suffering from chronic constipation were included. Methane production was defined when the breath methane concentration was greater than 3 ppm. The total and segmental colonic transit times were measured with radio-opaque markers. Results: Soiling was present in 34 (85.0%) of 40 patients with constipation. Methane production was present in 25 of 34 (73.5%) patients with constipation and soiling and only in 1 (16.7%) of 6 with constipation but without soiling (P = 0.014). The medians of total colonic transit time were 80.5 and 61.0 hours, respectively (P = 0.04), in methane and nonmethane producers. Segmental colonic transit times were 17.5 and 10.5 hours, respectively (P = 0.580), in right colon, 29.5 and 10.5 hours (P = 0.001), respectively, in left colon, and 31.5 and 27.0 hours (P = 0.202), respectively, in the rectosigmoid. By the sixth week of treatment, the reduction in the total colonic transit time was greater in patients who had become nonmethane producers. Conclusion: The presence of breath methane in children with chronic constipation may suggest the possibility of prolonged colonic transit time.

Breath hydrogen test after a bean meal demonstrates delayed oro-cecal transit time in children with chronic constipation.

Objective: To evaluate oro-cecal transit time in children with chronic constipation. Methods: 34 patients with chronic functional constipation age 3 to 13 years and 15 controls without constipation. Oro-cecal transit time was evaluated using the hydrogen breath test after ingestion of lactulose and after a standard meal of cooked beans. Total and segmental colonic transit times were measured with radiopaque markers. Results: Of 34 patients with chronic constipation 61.8% had increased total colonic transit time (>62 hours). Oro-cecal transit time measured with lactulose as substrate was similar (p = 0.727) in constipated patients with increased colonic transit time (63.8 ± 16.3 minutes), in constipated patients with normal colonic transit time (66.9 ± 22.9 minutes), and in controls (65.3 ± 15.5 minutes). Using a test meal of beans, the hydrogen breath test showed that oro-cecal transit time of constipated patients with increased total colon transit time was higher (252.4 ± 23.2 minutes) than oro-cecal transit time of constipated patients with normal colonic transit time (227.7 ± 39.6 minutes) or controls (205.3 ± 23.3 minutes) (p < .05). Conclusion: Hydrogen excretion in breath after a bean test meal showed delayed oro-cecal transit time in children with chronic constipation with abnormal total colonic transit time.

Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar

OBJECTIVE: To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time. METHODS: A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration. RESULTS: At admission, colonic dysmotility was found in 71.9% (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6% (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014). CONCLUSION: The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.

A manometria anorretal (método do balão) no diagnóstico diferencial da doença de Hirschsprung

OBJECTIVE To evaluate results of anorectal manometry performed with equipment made in Brazil for the screening of Hirschsprungs disease in children with chronic constipation. METHODS Results of 372 anorectal manometries performed consecutively in children with chronic constipation were evaluated. The equipment (Proctosystem Viotti) has two channels for pressure registration by the balloon method and is connected to a computer using specific software. Absence of the inhibitory recto-anal reflex was considered suggestive of Hirschsprungs disease and diagnosis was confirmed by traditional diagnostic methods. RESULTS Absence of the inhibitory recto-anal reflex was found in 14 (3.8%) of the 372 anorectal manometry examinations. Diagnosis of Hirschsprung disease was confirmed in 9 out of 14 patients by characterization of aganglionosis upon rectal biopsy. In the other 5 patients, rectal biopsy was not performed in view of a satisfactory evolution with the clinical treatment for constipation. In 4 out of the 5 patients the inhibitory recto-anal reflex was demonstrated with a second anorectal manometry examination. CONCLUSIONS The equipment used for anorectal manometry presented a satisfactory performance. Diagnosis of Hirschsprung disease was discarded in 86.5% of the patients with chronic constipation because the inhibitory recto-anal reflex was detected. Manometric evaluation also made possible the identification of a small group of patients in which more than half had Hirschsprungs disease.

Estudo da motilidade esofágica após ligadura elástica endoscópica das varizes

OBJETIVOS: Estudar a motilidade esofagica de doentes cirroticos antes e apos a ligadura elastica endoscopica das varizes. METODOS: Vinte e quatro portadores de cirrose hepatica atendidos no Gastrocentro - UNICAMP, no programa de ligadura elastica para tratamento de varizes, foram estudados (media de idade de 49,5 anos, sendo 19 masculinos e 5 femininos). Os criterios de inclusao foram hepatopatia cronica e varizes esofagicas com alto risco de sangramento. Inicialmente foram realizados endoscopia digestiva alta e manometria esofagica em todos os doentes. A seguir, foram submetidos a sessoes de ligadura elastica (o numero medio foi de 3,4±2,1), em regime ambulatorial, com intervalo de duas a quatro semanas. A manometria foi repetida quatro semanas apos a erradicacao das varizes. Os parâmetros estudados foram a amplitude, a duracao, a velocidade de propagacao das ondas contrateis e o peristaltismo. RESULTADOS: A analise do tonus do EIE nao mostrou diferenca entre pre e pos-ligadura elastica. Em dez casos (41,6%), ocorreu alteracao na motilidade, e a amplitude das ondas de degluticao elevou-se no exame pre de 70,7 mmHg (52,3 e 108,4) para 89,7 mmHg (69,9 e 122,8) no pos (p= 0,004 - p 0,05). CONCLUSOES: A analise final mostra que ocorreu alteracao de motilidade esofagica apos ligadura elastica das varizes esofagicas, caracterizada por aumento na amplitude e duracao das ondas contrateis.

Effects of conventional treatment of chronic

OBJECTIVE To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal transit time. METHODS A total of 34 consecutive patients with functional constipation attending a specialized outpatient clinic were included in the study. Total and segmental colonic transit times were assessed using radiopaque markers. Hydrogen breath test was used to evaluate lactulose and bean orocecal transit times. Treatment consisted of disimpaction, general and dietary fiber intake instruction, and mineral oil administration. RESULTS At admission, colonic dysmotility was found in 71.9% (23/32) of patients. All patients who complied with the treatment showed improvement of clinical symptoms after 6 weeks of treatment, when 82.6% (19/23) of those with dysmotility at admission returned to normal or reduced the severity of colonic transit patterns. Transit time decreased (medians) between admission and eighth week of treatment: lactulose orocecal transit (from 70 to 50 minutes, p = 0.002), bean orocecal transit (from 240 to 220 minutes, p = 0.002), and total colonic transit (from 69.5 to 37.0 hours, p = 0.001). The need for mineral oil therapy for constipation after a 12-month treatment was associated with persistence of total colonic transit higher than 62 hours at the eighth week of treatment (p = 0.014). CONCLUSION The conventional therapeutic approach yielded good results regardless of the presence or not of colonic dysmotility at inclusion in the study. Digestive tract motility abnormalities in functionally constipated children may be reversed, and may be secondary to constipation.

Intestinal fructose malabsorption is associated with increased lactulose fermentation in the intestinal lumen

OBJECTIVE To study fructose malabsorption in children and adolescents with abdominal pain associated with functional gastrointestinal disorders. As an additional objective, the association between intestinal fructose malabsorption and food intake, including the estimated fructose consumption, weight, height, and lactulose fermentability were also studied. METHODS The study included 31 patients with abdominal pain (11 with functional dyspepsia, 10 with irritable bowel syndrome, and 10 with functional abdominal pain). The hydrogen breath test was used to investigate fructose malabsorption and lactulose fermentation in the intestinal lumen. Food consumption was assessed by food registry. Weight and height were measured. RESULTS Fructose malabsorption was characterized in 21 (67.7%) patients (nine with irritable bowel syndrome, seven with functional abdominal pain, and five with functional dyspepsia). Intolerance after fructose administration was observed in six (28.6%) of the 21 patients with fructose malabsorption. Fructose malabsorption was associated with higher (p<0.05) hydrogen production after lactulose ingestion, higher (p<0.05) energy and carbohydrate consumption, and higher (p<0.05) body mass index z-score value for age. Median estimates of daily fructose intake by patients with and without fructose malabsorption were, respectively, 16.1 and 10.5g/day (p=0.087). CONCLUSION Fructose malabsorption is associated with increased lactulose fermentability in the intestinal lumen. Body mass index was higher in patients with fructose malabsorption.