Ana María Madrid

Long-term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function

OBJECTIVES:Altered small-bowel motility, lengthening of the orocecal transit time, and small-intestinal bacterial overgrowth have been described in patients with liver cirrhosis. These changes might be related to the progressive course and poor prognosis of the disease. We investigated the effect of a long-term treatment with cisapride and an antibiotic regimen on small-intestinal motor activity, orocecal transit time, bacterial overgrowth, and some parameters of liver function.METHODS:Thirty-four patients with liver cirrhosis of different etiology entered in the study. They were randomly allocated to receive cisapride (12), an alternating regimen of norfloxacin and neomycin (12), or placebo (10) during a period of 6 months. At entry and at 3 and 6 months, a stationary small-intestinal manometry was performed, and orocecal transit time and small-intestinal bacterial overgrowth were also investigated using the H2 breath test. Liver function was estimated with clinical and laboratory measurements (Child-Pugh score).RESULTS:After 6 months, both cisapride and antibiotics significantly improved fasting cyclic activity, reduced the duration of orocecal transit time, and decreased small-intestinal bacterial overgrowth. Cisapride administration was followed also by an increase in the amplitude of contractions. No statistically significant variations in these parameters were observed with placebo. An improvement of liver function was observed at 3 and 6 months with both cisapride and antibiotics.CONCLUSIONS:Long-term treatment with cisapride or antibiotics reversed altered small-intestinal motility and bacterial overgrowth in patients with liver cirrhosis. These findings suggest a possible role for prokinetics and antibiotics as a modality of treatment in selected cases of decompensated cirrhosis.

Altered Small Bowel Motility in Patients with Liver Cirrhosis Depends on Severity of Liver Disease

Abnormal small bowel motility has been describedin patients with liver cirrhosis but the mechanismsinvolved are unknown. The aim was to investigate apossible relationship between the severity of liver failure and the intensity of small intestinalabnormalities. Motility was studied during fasting, bymeans of perfused catheters and external transducers, on33 cirrhotics with different etiologies; 8 were at Child-Pugh stage A, 12 stage B, and 13 stageC. Both abnormalities of MMC and increased clusteredactivity were recorded. Absence of cycling activity wasmost frequently observed in Child-Pugh stage C patients compared to Child-Pugh stage Acirrhotics. A significant increase in clusteredcontractions from 4.7 ± 0.4/hr in stage Apatients to 11.3 ± 1.1 in stage C was recorded.The frequency and amplitude of contractions was also increased fromChild-Pugh stage A to stage C. Our findings might berelated to a delayed transit time observed in thesepatients and a higher prevalence of bacterial overgrowth in cirrhotics with more advanced liverdisease.

Small Intestinal Clustered Contractions and Bacterial Overgrowth: A Frequent Finding in Obese Patients

BackgroundSmall intestinal bacterial overgrowth (SIBO) has been observed in several disorders of the gastrointestinal tract. Studies have shown abnormalities of motor function in obese patients, and there is indirect evidence suggesting that SIBO is present in them.AimsTo study small intestinal motility and the prevalence of SIBO in obese patients and to determine whether there was any relationship between both parameters.MethodsThirty-nine patients scheduled for bariatric surgery were subjected to hydrogen breath test with lactulose and to a stationary small intestinal motility study with perfused catheters.ResultsSIBO was observed in 41% of obese patients and was not related to body mass index. Small intestinal manometry showed a marked increase of clustered contractions in obese patients with SIBO compared to obese subjects without SIBO, whereas all the other parameters of fasting cyclic activity were not different.ConclusionsSIBO was a frequent finding in obese patients and was associated with an increased pattern of clustered contractions, which was not observed in absence of SIBO.

Prevalencia de la resistencia a metrodinazol, claritromicina y tetraciclina en Helicobacter pylori aislado de pacientes de la Región Metropolitana

BACKGROUND Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. At present, therapeutic strategies to eradicate this bacterium depend on our knowledge of its resistance to antimicrobials. AIMS To evaluate the primary resistance of H pylori to metronidazole (Mtz), clarithromycin (Cla), and tetracycline (Tet) in symptomatic out-patients. MATERIAL AND METHODS Fifty independent isolates of H pylori were obtained by endoscopy-assisted gastric biopsy from patients attending the University of Chile Clinical Hospital, that previously had not been treated with an eradication regime against this bacterium. The minimal inhibitory concentration of each antimicrobial was determined by agar dilution method. RESULTS Forty five and 27% of the isolates were found to be resistant to Mtz and Tet, respectively; the majority of these resistant isolates were from patients older than 21 years. Twenty percent of isolates were resistant to Cla; these were distributed evenly among different ages. Thirty two percent of the isolates were resistant to two or more of the antimicrobials. CONCLUSIONS The high frequency of naturally occurring, antimicrobial-resistant strains of H pylori poses a national and world-wide problem for public health.

Sobrecrecimiento bacteriano en trastornos funcionales del intestino

BACKGROUND Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. AIM To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). MATERIAL AND METHODS Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. RESULTS We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating. CONCLUSIONS This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.

Small bowel motility in primary biliary cirrhosis

Objective:Previous studies have shown small bowel motor activity abnormalities in patients with liver cirrhosis of different etiologies, but motility has not been studied in patients with primary biliary cirrhosis. Our aim was to investigate proximal small bowel motility in these patients.Methods:Twenty-five female patients presenting clinical, biochemical, serological, and histological findings compatible with primary biliary cirrhosis, 10 female patients with nonalcoholic liver cirrhosis, and 10 normal female controls were studied. Motility of the upper small bowel was measured in the fasted state by means of perfused manometric catheters, connected to external transducers and positioned in the small bowel under fluoroscopy.Results:The average amplitude of contractions was significantly decreased in patients with primary biliary cirrhosis compared with other liver cirrhosis (20.2 ± 1.0 vs 32 ± 2.9 mm Hg). Also, a significantly increased frequency of cluster of contractions and an increased duration of phase II of the migrating motor complex as seen in liver cirrhosis was observed when compared with normals.Conclusions:We conclude that primary biliary cirrhosis patients present motor abnormalities of the small intestine similar to those of patients with liver cirrhosis of other etiologies. In addition, a decrease in the amplitude of small bowel contractions was also found in these patients, suggesting a myogenic involvement.

Parasitosis y síndrome de intestino irritable

Irritable bowel syndrome (IBS) is a functional disorder of the gastrointestinal tract characterised by multi-factorial aetiology. In IBS physiopathology are involved diverse factors between them biological, psychosocial, and environmental components which affect the immune activation status of gut mucosa. Among these factors is recognized the intestinal parasitosis. Post-infection IBS (PI-IBS) is recognised as a subgroup of functional disorders whose symptoms onset appear after a symptomatic intestinal infection caused by microbial agents. There are few studies regarding of relationship between IBS and intestinal parasitosis in Chile. However, is has been well described a positive association between IBS and Blastocystis hominis infections, one of prevalent parasites in Chile. In other countries, is also described a relationship between IBS and amebiasis and giardiasis. Both, characterized by a common mode of transmission through water as well as contaminated food. Because the high prevalence of parasitosis in our country it is necessary to expand the association studies to clarify the strength of the parasites ethiology in IBS.

A simple feature reduction method for the detection of long biological signals

Recent advances in digital processing of biological signals have made it possible to incorporate more extensive signals, generating a large number of features that must be analyzed to carry out the detection, and thereby acting against the performance of the detection methods. This paper introduces a simple feature reduction method based on correlation that allows the incorporation of very extensive signals to the new biological signal detection algorithms. To test the proposed technique, it was applied to the detection of Functional Dyspepsia (FD) from the EGG signal, which is one of the most extensive signals in clinical medicine. After applying the proposed reduction to the wavelet transform coefficients extracted from the EGG signal, a neuronal network was used as a classifier for the wavelet transform coefficients obtained from the EGG traces. The results of the classifier achieved 78.6% sensitivity, and 92.9% specificity for a universe of 56 patients studied.

Effect of casein-derived peptides on D-xylose absorption assessed by H2 breath test in normal volunteers.

Studies have shown a promoting effect of food on small intestinal absorption. Casein hydrolysate seems be more effective in increasing of D-xylose absorption in dogs than the whole protein and lactulose. The purpose this study was to analyze the effect of groups of peptides derived from casein hydrolysate on the absorption of d-Xylose and intestinal transit time in normal subjects. Seven normal volunteers participated in the study. Three peptide fractions were isolated from casein enzymatic hydrolysate by means of a preparative HPLC silica column. On separate days subjets drank test solutions containing lactulose, d-xylose, and d-xylose with one of three peptide groups. The hydrogen breath test was used to indirectly estimate d-xylose absorption and orocecal transit time. Two peptide fractions when added to d-xylose were followed by an increased absorption characterized by decreased H2 production. A nonstatistically significant increase of orocecal transit time was observed with these peptides.

Chronic Intestinal Pseudo-obstruction: Clinical and Manometric Characteristics in the Chilean Population

Background/Aims Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by a failure of the propulsion of intraluminal contents and recurrent symptoms of partial bowel obstruction in the absence of mechanical obstruction. Regional variations of the intestinal compromise have been described. Intestinal manometry can indicate the pathophysiology and prognosis. Our objective is to establish the demographic and clinical characteristics of group Chilean patients and analyze the motility of the small intestine and its prognostic value. Methods Patients with symptoms of intestinal pseudo-obstruction with dilated bowel loops were included, in all of whom a manometry of the small intestine was performed using perfused catheters. Results Of the 64 patients included, 51 women (average age 41.5 ± 17.6 years), 54 primary and 10 secondary CIPO were included. Dilatation of the small intestine was the only finding in 38 patients; in the remaining, the compromise was associated with other segments, primarily the colon. Forty-nine patients underwent 65 surgeries, mainly exploratory laparotomies and colectomies. Intestinal manometry was performed on all patients; 4 “patterns” were observed: neuropathic (n = 26), myopathic (n = 3), mixed (n = 24), and a group without motor activity (n = 11). The most relevant findings were the complex migrating motor disorders and decreased frequency and propagation of contractions. The 9 patients who died had a severe myopathic compromise. Conclusions In our series, isolated small bowel compromise was the most common disorder. Neuropathic motor compromise was observed in most of the patients. Mortality was associated with severe myopathic compromise.