Maria Aparecida Mesquita

Gastric emptying and intragastric distribution of a solid meal in functional dyspepsia: Influence of gender and Anxiety

Background Gastric dysmotility and psychological factors have been implicated in the pathophysiology of functional dyspepsia. Goals To investigate the influence of gender and anxiety on gastric emptying and intragastric food distribution in patients with functional dyspepsia. Methods A standard gastric emptying test was used to study total and compartmental gastric emptying of a solid meal in 22 patients with functional dyspepsia (16 women). Comparisons of the data for dyspeptic men and women were made with 2 respective subgroups of controls (9 men; 9 women). The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Results Delayed gastric emptying was observed in 32% of patients with functional dyspepsia. As a group, dyspeptic women had a significantly longer half-emptying time as compared with dyspeptic men (119 ± 41 min vs. 78 ± 22 min) and to female controls (96 ± 17 min). There was no difference in half-emptying times between male patients and controls. The initial activity in the proximal stomach was significantly lower for both men and women with functional dyspepsia in comparison with their respective controls. In addition, meal retention in the distal stomach of dyspeptic women was significantly greater than that in female controls. Sixteen (72%) functional dyspepsia patients had anxiety when evaluated by the Hospital Anxiety and Depression scale. Those patients who scored for anxiety showed significantly greater antral meal retention than patients without anxiety. Conclusion Our study confirmed that prolonged gastric emptying in patients with functional dyspepsia is related to the female sex, while the abnormalities of the meal intragastric distribution appear to occur in dyspeptic males and females. Anxiety is frequent in functional dyspepsia and seems to be related to abnormal antral retention of food in these patients.

Beneficial Effects of Long-Term Consumption of a Probiotic Combination of Lactobacillus casei Shirota and Bifidobacterium breve Yakult May Persist After Suspension of Therapy in Lactose-Intolerant Patients

BACKGROUND The efficacy of some probiotic strains for the management of lactose intolerance remains to be established. AIM To evaluate the effects of a 4-week consumption of a probiotic product containing Lactobacillus casei Shirota and Bifidobacterium breve Yakult (10(7)-10(9) CFU of each strain) on symptoms and breath hydrogen exhalation after a lactose load in lactose-intolerant patients and whether the beneficial results persisted after probiotic discontinuation. METHODS Twenty-seven patients with lactose maldigestion and intolerance participated in this study, which comprised 4 hydrogen breath tests: baseline condition (20 g lactose), after lactase ingestion (9000 FCC units), at the end of 4-week probiotic supplementation, and a follow-up test performed 3 months after probiotic discontinuation. For each test, the area under the breath hydrogen concentration vs time curve (AUC(180 min)) was calculated, and symptom scores were recorded. RESULTS The probiotic combination significantly reduced symptom scores (P < .01) and breath hydrogen AUC (P = .04) compared with the baseline condition. The comparison with the lactase test showed that symptom scores were similar (P > .05), despite the significantly higher (P = .01) AUC values after probiotic use. In the follow-up test, symptom scores and breath hydrogen AUC values remained similar to those found at the end of probiotic intervention. CONCLUSION Four-week consumption of a probiotic combination of L casei Shirota and B breve Yakult seems to improve symptoms and decrease hydrogen production intake in lactose-intolerant patients. These effects may persist for at least 3 months after suspension of probiotic consumption.

Autonomic function in patients with functional dyspepsia assessed by 24-hour heart rate variability

The function of the autonomic nervous system was assessed in 23 patients with dysmotility-like functional dyspepsia and 12 healthy volunteers by analysis of 24-hr heart rate variability and a battery of five standardized sympathetic and parasympathetic cardiovascular reflex tests. Measures of heart rate variability were obtained by analysis of ambulatory electrocardiographic recordings using both the time and the frequency domain methods. The values of parameters reflecting vagal activity (HF, rMSSD) were significantly lower in patients with functional dyspepsia. Individual analysis of heart rate variability data identified at least one abnormal parameter of vagal function in seven (30.4%) patients, and in five of these the results of parasympathetic cardiovascular reflex tests were also abnormal. Our results suggest impaired efferent vagal function in a subgroup of patients with functional dyspepsia. This abnormality may play a role in the pathogenesis of the disease in these patients.

Delayed Small Intestinal Transit in Patients with Long-Standing Type 1 Diabetes Mellitus: Investigation of the Relationships with Clinical Features, Gastric Emptying, Psychological Distress, and Nutritional Parameters

BACKGROUND Studies on small intestinal transit in type 1 diabetes mellitus have reported contradictory results. This study assessed the orocecal transit time (OCTT) in a group of patients with type 1 diabetes mellitus and its relationships with gastrointestinal symptoms, glycemic control, chronic complications of diabetes, anthropometric indices, gastric emptying, small intestinal bacterial overgrowth (SIBO), and psychological distress. SUBJECTS AND METHODS Twenty-eight patients with long-standing (>10 years) type 1 diabetes mellitus (22 women, six men; mean age, 39 ± 9 years) participated in the study. The lactulose hydrogen breath test was used to determine OCTT and the occurrence of SIBO. The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression scale. Gastric emptying was measured by scintigraphy. Anthropometric indices included body mass index, percentage body fat, midarm circumference, and arm muscle area. RESULTS There was a statistically significant increase in OCTT values in diabetes patients (79 ± 41 min) in comparison with controls (54 ± 17 min) (P=0.01). Individual analysis showed that OCTT was above the upper limit (mean+2 SD) in 30.8% of patients. All anthropometric parameters were significantly decreased (P<0.05) in patients with prolonged OCTT in comparison with those with normal OCTT. In contrast, there was no statistically significant association between prolonged OCTT and gastrointestinal symptoms, peripheral neuropathy, diabetic retinopathy, glycated hemoglobin, delayed gastric emptying, SIBO, anxiety, or depression. CONCLUSIONS Small bowel transit may be delayed in about one-third of patients with long-standing type 1 diabetes mellitus. This abnormality seems to have a negative effect on nutritional status in these patients.

Bleeding Duodenal Varices Successfully Treated with TIPS

Upper gastrointestinal hemorrhage is a life-threatening complication of liver cirrhosis and portal hypertension. It is well recognized that, despite adequate pharmacologic and endoscopic therapy, there is a 20–35% mortality ratio in the first occurrence of gastrointestinal bleeding [1, 2]. Ruptured esophageal varices, peptic ulcer disease, portal hypertensive gastropathy, and ruptured gastric varices are most commonly associated with bleeding events, and the severity seems to be associated with the degree of liver dysfunction. The most common site of variceal bleeding is the lower esophagus, followed by gastric varices. These can be detected in up to 25% of portal hypertensive, cirrhotic patients [3–5]. Duodenal varices are uncommon among cirrhotic patients [6], and bleeding duodenal varices represent a major challenge for management, as both pharmacological and endoscopic therapy may not fully control hemorrhage. We report a case of a patient diagnosed with liver cirrhosis and portal hypertension on a waiting list for liver transplantation who developed upper gastrointestinal bleeding secondary to duodenal varices, managed with transjugular intrahepatic portosystemic shunt (TIPS). Endoscopic features preand post-TIPS are reviewed.

Orocecal transit time in patients with functional dyspepsia.

Background The importance of intestinal dysmotility in functional dyspepsia is a controversial issue. Goals To investigate the orocecal transit time in patients with functional dyspepsia, as well as a possible association between intestinal transit and the presence of anxiety or Helicobacter pylori infection in these patients. Study The participants in this study were 23 patients with dysmotility-like functional dyspepsia and 24 control subjects. Orocecal transit time was measured by the lactulose hydrogen breath test. The presence of anxiety was assessed by the Hospital Anxiety and Depression (HAD) scale. Results No significant difference in orocecal transit times was found between patients (median, 55 minutes; 95% confidence interval [CI], 40–60 minutes) and control subjects (median, 50 minutes; 95% CI, 40–60 minutes;p = 1). In the assessment, 15 patients (73%) scored for anxiety on the HAD scale, and 15 patients (65%) had positive test results for H. pylori. There was no significant difference in orocecal transit times between the patients with (median, 55 minutes; 95% CI, 40–63 minutes) and those without H. pylori infection (50 minutes; 95% CI, 40–68 minutes;p = 0.85), or between the patients with (median, 45 minutes; 95% CI, 40–68 minutes) and those without (60 minutes; 95% CI, 40–63 minutes;p = 0.77) anxiety. Conclusions Orocecal transit time is within the normal range in patients with functional dyspepsia. Anxiety and H. pylori infection do not seem to influence orocecal transit time in these patients.

Investigation of Autonomic Function and Orocecal Transit Time in Patients With Nonalcoholic Cirrhosis and the Potential Influence of These Factors on Disease Outcome

Background The presence of autonomic dysfunction in nonalcoholic cirrhosis and its influence on intestinal transit and disease outcome still need clarification. Goals To investigate the function of the autonomic nervous system in patients with nonalcoholic cirrhosis and the possible associations among autonomic dysfunction, severity of liver disease, disturbed intestinal transit, and the development of complications during follow-up. Study Measurements of heart rate variability obtained by analysis of 24-hour ambulatory electrocardiographic recordings to assess autonomic function and lactulose breath hydrogen test to determine orocecal transit time were performed in 32 patients with nonalcoholic cirrhosis divided into Child A and B. Results Child B patients showed significantly lower values (P<0.05) of those parameters reflecting parasympathetic (high frequency, log-transformed high frequency, pNN50) and sympathetic function (low frequency, log-transformed low frequency) in comparison with controls and Child A patients. Orocecal transit time values were significantly (P=0.02) higher in Child B patients than in controls, but no relationship was found between delayed orocecal transit time and autonomic dysfunction. During follow-up, 42% of Child B patients developed encephalopathy. This complication was significantly associated with autonomic dysfunction. In addition, in the 4 patients who died the parameters reflecting parasympathetic function were significantly reduced in comparison with those of survivors. Conclusions Autonomic dysfunction and delayed intestinal transit are related to the severity of disease in nonalcoholic cirrhosis. Autonomic dysfunction seems to predispose cirrhotic patients to the development of encephalopathy and may be associated with a poor prognosis of these patients.

Estudo do esvaziamento gástrico e da distribuição intragástrica de uma dieta sólida através da cintilografia: diferenças entre os sexos

Gender-related differences in gastric emptying are still controversial. The aims of this study were: to confirm the sex-related difference in gastric emptying of a solid meal and to investigate its association with different patterns of meal distribution between the proximal and distal gastric compartments. Eighteen healthy volunteers (nine males, mean age 35 +/- 9 years; nine females, mean age: 41 +/- 11 years) were studied in the morning, after ingestion of the solid test-meal (an omelette labeled with 185MBq of 99mTc-sulfur colloid). Simultaneous anterior and posterior images of the stomach were acquired immediately after ingestion of the meal and every 10 minutes for 120 minutes. Time versus activity curves were obtained for the whole, proximal and distal stomach. Gastric T1/2 was longer in women (96.1 +/- 17.2 min) than in men (79.9 +/- 17.8 min; P = 0.02). The analysis of the meal distribution inside the stomach showed no differences between males and females in proximal gastric emptying, but the meal retention in the distal compartment was significantly increased among women (P = 0.04). In conclusion, gastric emptying of a solid meal is slower in pre-menopausal women than in age-matched men, probably due to an increased retention of the meal in the distal compartment. This should be taken into consideration to avoid misleading diagnosis of gastroparesis for female patients.

Performance of the Rockall scoring system in predicting the need for intervention and outcomes in patients with nonvariceal upper gastrointestinal bleeding in a Brazilian setting: a prospective study.

Background/Aims: This prospective study investigated the performance of pre-endoscopy and the complete Rockall scores in predicting the occurrence of adverse outcomes and the need for endoscopic or surgical intervention in patients with nonvariceal upper gastrointestinal bleeding. Methods: All 656 consecutive patients who underwent endoscopy due to nonvariceal upper gastrointestinal bleeding between 2007 and 2011 were included. Receiver operating characteristic (ROC) curves were plotted for the outcomes of therapeutic intervention, rebleeding and death. The discriminative accuracy of the risk scores was assessed by the area under the ROC curve. Results: Endoscopic treatment was performed in 55.2% of the patients. Rebleeding and mortality rates were 7.6 and 3.8%, respectively. The pre-endoscopy Rockall scores showed unsatisfactory accuracy in predicting the need for intervention, rebleeding or death, as shown by the respective area under the ROC curve values of 0.52, 0.52 and 0.65. The accuracy of the complete Rockall score in predicting rebleeding was poor (area under ROC: 0.52), but it was higher for mortality (area under ROC: 0.69). Conclusions: The pre-endoscopy Rockall score was not useful for predicting the need for therapeutic intervention or adverse outcomes. The complete Rockall score showed an acceptable performance in predicting mortality, but was unable to predict rebleeding.

Immunochemical Fecal Occult Blood Test for Detection of Advanced Colonic Adenomas and Colorectal Cancer: Comparison with Colonoscopy Results

Background. Fecal immunochemical tests (FITs) have been used for colorectal cancer (CRC) screening in several countries. There is lack of information concerning diagnostic performances of this method in Brazil. Methods. Patients scheduled for elective colonoscopy provided one stool sample one week before colonoscopy. The accuracy of a qualitative FIT for detection of CRC and advanced adenomas was determined. Results. Overall 302 patients completed the study. Among them, 53.5% were high risk patients referred for screening or surveillance. Nine (3%) CRCs and 11 (3.6%) advanced adenomas were detected by colonoscopy. Sensitivity and specificity for CRC were, respectively, 88.9% and 87.6%. For advanced adenomas, sensitivity was 63.6% and specificity 87.6%. Conclusion. Our results showed good sensitivity and specificity of the FIT for detecting advanced neoplasias. This method may be a valuable tool for future screening programs in Brazil.