F. A Quilici

ORAL ADMINISTRATION OF EXOGENOUS LACTASE IN TABLETS FOR PATIENTS DIAGNOSED WITH LACTOSE INTOLERANCE DUE TO PRIMARY HYPOLACTASIA.

Background Primary hypolactasia is a common condition where a reduced lactase activity in the intestinal mucosa is present. The presence of abdominal symptoms due to poor absorption of lactose, which are present in some cases, is a characteristic of lactose intolerance. Objective Evaluate the efficacy of a product containing exogenous lactase in tablet form compared to a reference product with proven effectiveness in patients with lactose intolerance. Methods Multicentre, randomized, parallel group, single-blind, comparative non-inferiority study. One hundred twenty-nine (129) adult lactose intolerance patients with hydrogen breath test results consistent with a diagnosis of hypolactasia were randomly assigned to receive the experimental product (Perlatte(r) - Eurofarma Laboratórios S.A.) or the reference product (Lactaid(r) - McNeilNutritionals, USA) orally (one tablet, three times per day) for 42 consecutive days. Results Data from 128 patients who actually received the studied treatments were analysed (66 were treated with the experimental product and 62 with the reference product). The two groups presented with similar baseline clinical and demographic data. Mean exhaled hydrogen concentration tested at 90 minutes after the last treatment (Day 42) was significantly lower in the experimental product treated group (17±18 ppm versus 34±47 ppm) in the per protocol population. The difference between the means of the two groups was -17 ppm (95% confidence interval [95% CI]: -31.03; -3.17). The upper limit of the 95% CI did not exceed the a priori non-inferiority limit (7.5 ppm). Secondary efficacy analyses confirmed that the treatments were similar (per protocol and intention to treat population). The tolerability was excellent in both groups, and there were no reports of serious adverse events related to the study treatment. Conclusion The experimental product was non-inferior to the reference product, indicating that it was an effective replacement therapy for endogenous lactase in lactose intolerance patients.

MANIPULATION OF THE INTESTINAL MICROBIOTA: THE MEDICINE REVOLUTION OF THE 21ST CENTURY.

Arq Gastroenterol • 2017. v. 54 no 2 Abr/Jun • 83 Bacteria usually co-exists with humans for millennium, and can be found in our bodies in many places, most of them in the gastrointestinal tract. They constitute the human microbiome formed by a great variety and diversity of microorganisms. It is estimated that 70% of these microorganisms are concentrated in the intestine, particularly in the colon, forming the intestinal microbiota, with up to 1011 bacteria per milliliter. It shelties about 3 million microbial genes, corresponding to 150 times the human genome. The set formed by microbial cells and genes added to human cells and genes creates the concept of “superorganism”. Before birth, there are no bacteria present in the digestive tract, but in childbirth, their colonization happens quickly. The intestinal microbiota begins to settle from 2 to 3 years of age and, from there, remains relatively stable. However, this stability can be influenced by diet, diseases, use of medications (mainly antibiotics) and aging. This microbiota is composed of commensal bacteria (native to the host) or temporary bacteria (passing through the body). Both can be beneficial, potentially harmful or pathogenic to humans. The beneficial bacteria interact positively with the human immune system, provoking a competitive inhibition with the pathogens bacteria, keeping the intestinal microbiota in a balance called eubiosis. The genre of bacteria with the greatest health benefit are Bifidobacterium and Lactobacillus. Recent researches suggests that the normal intestinal microbiota is not simply a collection of microorganisms but reflects an interrelationship between different genre of bacteria that possibly work together to benefit the host. It is now believed that the existence of a large diversity of microorganisms in the gastrointestinal tract is important and beneficial for the host. A healthy microbiota plays an important role in digestion and absorption of nutrients, production of vitamins, maintenance of the structural and functional integrity of the intestine, protection against pathogens and modulation of the inflammatory response through the interaction of the microbiota and the immune system (gut associated lymphoid tissue – GALT). Manipulation of the intestinal microbiota: the medicine revolution of the 21st century

Câncer do reto baixo: radioterapia pré-operatória, excisão total perirretal e acesso videolaparoscópico

Twenty-four patients (1993-1997) with cancer of the lower rectum (tumors situated between the pectinate line and four cm above it) underwent abdominoperineal excision by laparoscopic approach and its results were studied and analyzed. Only adenocarcinoma tumors were evaluated regardless of age and gender. All patients were submitted to preoperative radiotherapy (4.000 cGy) and operated on ten days after the end of the irradiation. The anatomic observation of the specimens excised by laparoscopy led to the conclusion that a total mesorrectum excision (total peri-rectal excision) was achieved in 91.3% of the patients. Preoperative radiotherapy did not create intra-operative hazard or change the surgical procedure. None of the patients had intra-operative rupture of the tumor or pelvic spillage of carcinomatous cells. The extension of linfonodal excision was similar to the one obtained by open surgery, with an average of 12 lymphnodes dissected by specimen, with positive perirrectal lymphnodes in 33.3% of the patients, or in 72.7% of the patients with Dukes C tumors and in 100% of the tumors with low grade of cellular differentiation. The proportion of positivity (number of metastatic lymphnodes in relation to the number of extirpated lymphnodes) varied from a minimum of 11.11% to a maximum of 75%. The rate of local recurrence observed after abdominoperineal excision of the rectum by laparoscopic approach with total excision of the perirretum in patients previously irradiated was of 4.2%, patient with Dukes C tumor and low grade of cellular differentiation. There were no portal implantation in the series.