RESUMEN
BACKGROUND: Abdominal bloating and distension are common symptoms in patients with functional gastrointestinal disorders (FGIDs), however, relatively little is known about their treatment. AIM: To review the treatment trials for abdominal bloating and distension. METHODS: A literature review in Medline for English-language publications through February 2010 of randomised, controlled treatment trials in adults. Study quality was assessed according to Jadad's score. RESULTS: Of the 89 studies reviewed, 18% evaluated patients with functional dyspepsia, 61% with irritable bowel syndrome (IBS), 10% with chronic constipation and 10% with other FGIDs. No studies were conducted in patients diagnosed with functional abdominal bloating. The majority of trials investigated the efficacy of prokinetics or probiotics, although studies are heterogeneous with respect to diagnostic criteria and outcome measures. In general, bloating and/or distension were evaluated as secondary endpoints or as individual symptoms as part of a composite score rather than as primary endpoints. A greater proportion of IBS patients with constipation reported improvement in bloating with tegaserod vs. placebo (51% vs. 40%, P<0.0001) and lubiprostone (P<0.001). A greater proportion of nonconstipating IBS patients reported adequate relief of bloating with rifaximin vs. placebo (40% vs. 30%, P<0.001). Bloating was significantly reduced with the probiotics, Bifidobacterium infantis 35624 (1×10(8) dose vs. placebo: -0.71 vs. -0.44, P<0.05) and B. animalis (live vs. heat-killed: -0.56±1.01 vs. -0.31±0.87, P=0.03). CONCLUSIONS: Prokinetics, lubiprostone, antibiotics and probiotics demonstrate efficacy for the treatment of bloating and/or distension in certain FGIDs, but other agents have either not been studied adequately or have shown conflicting results.
Asunto(s)
Abdomen/fisiopatología , Flatulencia/fisiopatología , Dilatación Gástrica/fisiopatología , Fármacos Gastrointestinales/uso terapéutico , Tránsito Gastrointestinal/fisiología , Probióticos/uso terapéutico , Dilatación Patológica , Flatulencia/terapia , Gases , Dilatación Gástrica/terapia , Tránsito Gastrointestinal/efectos de los fármacos , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
It is presented the case of a 63-year-old female patient, who was admitted to the hospital for the first time, because of clinical picture compatible with acute cholecystitis and choledocholithiasis. She underwent cholecystectomy common bile duct (cbd) exploration, and duodenotomy, with the extraction of two stones located in the distal cbd. During her postoperative course, she had been under a great emotional tension, and ten days after her surgical intervention, she developed symptoms and signs of acute gastric dilatation, requiring a second admission. A barium meal and an upper endoscopy revealed gastric dilation, with marked pyloric spasm. Her complaints improved after conservative therapy was instituted. No surgical intervention was necessary. We concluded that the cause of her gastric retention was due to the emotional stress present during her postoperative course, which produced marked pyloric spasm, and not from an organic cause.