RESUMEN

The term food intolerance has been used non-specifically to define a wide range of disorders related to food intake. Recently, the use of the term "non-immunological adverse reactions to foods" (RANIAs) was recommended as a more correct clinical definition. The pathophysiological mechanisms can be diverse, sometimes unknown, and there are no validated diagnostic tests, making it difficult to obtain accurate data. The clinical manifestations of non-immunological adverse reactions to foods affect more than one organ or system; and gastrointestinal symptoms (pain, abdominal distension, flatulence, and diarrhea) are the most common. Non-immunological adverse reactions to foods are divided into independent and dependent on host factors. Foods may contain chemicals with pharmacological activity and be present naturally, such as vasoactive amines (histamine) and salicylates, or added for preservation, to improve appearance or flavor (monosodium glutamate, tartrazine, sulfites, and benzoates). In some cases, these types of reactions may be like to hypersensitivity reactions. Concomitant alcohol consumption may worsen symptoms by inhibiting histamine breakdown and increasing intestinal permeability. In patients diagnosed with non-immunological adverse reactions to foods, it is important to rule out some psychological problems: aversions or eating disorders.

---

El término intolerancia alimentaria se ha utilizado de manera inespecífica para definir una amplia gama de trastornos relacionados con la ingesta de alimentos. Recientemente se recomendó el uso de la expresión "reacciones adversas no inmunológicas a alimentos" (RANIAs) como una definición clínica más correcta. Los mecanismos fisiopatológicos pueden ser diversos, a veces desconocidos, y no existen pruebas diagnósticas validadas, por lo que es difícil obtener datos certeros. Las manifestaciones clínicas de las reacciones adversas no inmunológicas a alimentos afectan a más de un órgano o sistema; y los síntomas gastrointestinales (dolor, distensión abdominal, flatulencias y diarrea) son los más frecuentes. Las reacciones adversas no inmunológicas a alimentos se dividen en independientes y dependientes de factores del huésped. Los alimentos pueden contener productos químicos con actividad farmacológica y estar presentes en forma natural, como las aminas vasoactivas (histamina) y los salicilatos, o añadirse para su conservación, mejorar la apariencia o el sabor (glutamato monosódico, tartrazina, sulfitos y benzoatos). En algunos casos, este tipo de reacciones pueden ser similares, desde el punto de vista clínico, a las reacciones de hipersensibilidad. El consumo de alcohol concomitante puede empeorar los síntomas, al inhibir la degradación de la histamina y aumentar la permeabilidad intestinal. En pacientes con diagnóstico de reacciones adversas no inmunológicas por alimentos es importante descartar algunos problemas de índole psicológica: aversiones o trastornos de la conducta alimentaria.

Asunto(s)

Intolerancia Alimentaria , Histamina , Humanos , Intolerancia Alimentaria/diagnóstico , Intolerancia Alimentaria/etiología , Histamina/efectos adversos , Aminas , Benzoatos , Diarrea

RESUMEN

Several chronic digestive conditions are physiologically based on food intolerance, including celiac disease, nonceliac gluten sensitivity, and eosinophilic esophagitis. Patients are expected to follow medically prescribed diets to eliminate identified food triggers to control symptoms. However, the psychological impacts of these dietary approaches are largely unaddressed in clinical practice. Hypervigilance and anxiety regarding food and symptoms, and disordered eating, may emerge and negatively affect outcomes. Clinicians working with pediatric and adult populations with food intolerances should be aware of these psychological comorbidities, and equally emphasize effective ways to help patients manage the mental and physical aspects of their condition.

Asunto(s)

Enfermedad Celíaca , Esofagitis Eosinofílica , Adulto , Humanos , Niño , Enfermedad Celíaca/diagnóstico , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/etiología , Esofagitis Eosinofílica/terapia , Intolerancia Alimentaria/etiología , Glútenes/efectos adversos

RESUMEN

BACKGROUND: Postoperative early oral nutrition has increasingly been adopted for patients undergoing gastrectomy. However, intolerability to early oral nutrition remains a major concern, especially in older patients. This study aimed to investigate early oral nutrition intolerability in older patients who had undergone gastrectomy. METHODS: We retrospectively reviewed 825 patients who had undergone gastrectomy for gastric carcinoma between 2017 and 2019. All patients received an oral diet on postoperative day 1. Patients were divided into older (≥70 years) and younger (<70 years) adult groups, and short-term outcomes and intolerability to oral nutrition were compared. Intolerability to early oral nutrition was defined as oral diet cessation due to adverse gastrointestinal symptoms. RESULTS: Among the 825 patients (≥70 years, n = 286; <70 years, n = 539), 151 (18.3%) developed intolerability to early oral nutrition, of whom 100 patients were < 70 years old and 51 were ≥70 years old. The most common symptom causing intolerability was abdominal distension. The mean duration of fasting after developing intolerability was 2.8 ± 2.4 days. The incidence of intolerability in the older and younger adult groups was 17.8% and 18.6%, respectively (p = 0.799). In terms of sex, operative approach, gastric resection, lymph node dissection, reconstruction, and tumor stage subgroups, the older adult group did not exhibit a significant increase in intolerability. Postoperatively, the older adult group showed a higher incidence of systemic complications; however, anastomotic complications did not significantly differ between the two groups. CONCLUSIONS: Postoperative early oral nutrition can safely be adopted for older patients undergoing gastrectomy, with acceptable intolerability and surgical outcomes.

Asunto(s)

Dieta/métodos , Intolerancia Alimentaria/dietoterapia , Intolerancia Alimentaria/etiología , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/dietoterapia , Complicaciones Posoperatorias/etiología , Neoplasias Gástricas/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estado Nutricional , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

BACKGROUND: Patients with severe acute pancreatitis (SAP) have gastrointestinal dysfunction, and enteral nutrition intolerance is easy to occur during the implementation of enteral nutrition, which leads to the suspension or termination of enteral nutrition. Enteral nutrition cannot tolerate the influence of many factors. At present, there is a lack of analysis on the influencing factors of enteral nutrition intolerance in patients with SAP. Therefore, this study analyzed the factors of enteral nutrition intolerance in patients with SAP by meta-analysis, to provide a basis for the protection of enteral nutrition in patients with SAP. METHODS: Databases (PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) were searched using index words to find relevant studies published before March 2021. Meta-analyses of relative risk were performed for the identification of risk factors. RESULTS: We will disseminate the findings of this systematic review and meta-analysis via publications in peer-reviewed journals. CONCLUSION: This study systematically reviewed the existing evidence and determined the incidence and predictors of enteral nutrition intolerance in patients with SAP.

Asunto(s)

Nutrición Enteral/efectos adversos , Intolerancia Alimentaria/epidemiología , Pancreatitis/terapia , Intolerancia Alimentaria/etiología , Humanos , Metaanálisis como Asunto , Pancreatitis/complicaciones , Pancreatitis/diagnóstico , Factores de Riesgo , Índice de Severidad de la Enfermedad , Revisiones Sistemáticas como Asunto

RESUMEN

Histamine intolerance (HIT) is assumed to be due to a deficiency of the gastrointestinal (GI) enzyme diamine oxidase (DAO) and, therefore, the food component histamine not being degraded and/or absorbed properly within the GI tract. Involvement of the GI mucosa in various disorders and diseases, several with unknown origin, and the effects of some medications seem to reduce gastrointestinal DAO activity. HIT causes variable, functional, nonspecific, non-allergic GI and extra-intestinal complaints. Usually, evaluation for HIT is not included in differential diagnoses of patients with unexplained, functional GI complaints or in the here-listed disorders and diseases. The clinical diagnosis of HIT is challenging, and the thorough anamnesis of all HIT-linked complaints, using a standardized questionnaire, is the mainstay of HIT diagnosis. So far, DAO values in serum have not been established to correlate with DAO activity in the gut, but the diagnosis of HIT may be supported with determination of a low serum DAO value. A targeted dietary intervention, consisting of a histamine-reduced diet and/or supplementation with oral DAO capsules, is helpful to reduce HIT-related symptoms. This manuscript will present why histamine should also be taken into account in the differential diagnoses of patients with various diseases and disorders of unknown origin, but with association to functional gastrointestinal complaints. In this review, we discuss currently increasing evidence that HIT is primarily a gastrointestinal disorder and that it originates in the gut.

Asunto(s)

Amina Oxidasa (conteniendo Cobre)/deficiencia , Suplementos Dietéticos , Intolerancia Alimentaria/diagnóstico , Histamina/metabolismo , Mucosa Intestinal/metabolismo , Amina Oxidasa (conteniendo Cobre)/administración & dosificación , Amina Oxidasa (conteniendo Cobre)/sangre , Diagnóstico Diferencial , Intolerancia Alimentaria/sangre , Intolerancia Alimentaria/dietoterapia , Intolerancia Alimentaria/etiología , Histamina/efectos adversos , Humanos

RESUMEN

BACKGROUND: Inability to advance to an oral diet, or oral feeding intolerance, is a common complication in patients with acute pancreatitis associated with worse clinical outcomes. The factors related to oral feeding intolerance are not well studied. OBJECTIVE: We aimed to determine the incidence and risk factors of oral feeding intolerance in acute pancreatitis. METHODS: Patients were prospectively enrolled in the Acute Pancreatitis Patient Registry to Examine Novel Therapies in Clinical Experience, an international acute pancreatitis registry, between 2015 and 2018. Oral feeding intolerance was defined as worsening abdominal pain and/or vomiting after resumption of oral diet. The timing of the initial feeding attempt was stratified based on the day of hospitalization. Multivariable logistic regression was performed to assess for independent risk factors/predictors of oral feeding intolerance. RESULTS: Of 1233 acute pancreatitis patients included in the study, 160 (13%) experienced oral feeding intolerance. The incidence of oral feeding intolerance was similar irrespective of the timing of the initial feeding attempt relative to hospital admission day (p = 0.41). Patients with oral feeding intolerance were more likely to be younger (45 vs. 50 years of age), men (61% vs. 49%), and active alcohol users (44% vs. 36%). They also had higher blood urea nitrogen (20 vs. 15 mg/dl; p < 0.001) and hematocrit levels (41.7% vs. 40.5%; p = 0.017) on admission; were more likely to have a nonbiliary acute pancreatitis etiology (69% vs. 51%), systemic inflammatory response syndrome of 2 or greater on admission (49% vs. 35%) and at 48 h (50% vs. 26%), develop pancreatic necrosis (29% vs. 13%), moderate to severe acute pancreatitis (41% vs. 24%), and have a longer hospital stay (10 vs. 6 days; all p < 0.04). The adjusted analysis showed that systemic inflammatory response syndrome of 2 or greater at 48 h (odds ratio 3.10; 95% confidence interval 1.83-5.25) and a nonbiliary acute pancreatitis etiology (odds ratio 1.65; 95% confidence interval 1.01-2.69) were independent risk factors for oral feeding intolerance. CONCLUSION: Oral feeding intolerance occurs in 13% of acute pancreatitis patients and is independently associated with systemic inflammatory response syndrome at 48 h and a nonbiliary etiology.

Asunto(s)

Ingestión de Alimentos , Intolerancia Alimentaria/etiología , Pancreatitis/complicaciones , Dolor Abdominal/etiología , Adulto , Factores de Edad , Consumo de Bebidas Alcohólicas/efectos adversos , Nitrógeno de la Urea Sanguínea , Femenino , Hematócrito , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Fumar/efectos adversos , Vómitos/etiología

RESUMEN

OBJECTIVE: Feeding intolerance (FI) is a common presentation of necrotizing enterocolitis (NEC) and sepsis. NEC and sepsis are associated with hematological changes, but these changes alone are not reliable biomarkers for early diagnosis. This study examined whether the combination of hematological indices and FI can be used as an early diagnostic tool for NEC or sepsis. STUDY DESIGN: This retrospective cohort study included infants born at <1,500 g or <30 weeks who had symptoms of FI. The exclusion criteria were congenital or chromosomal disorders, thrombocytopenia or platelet transfusion before the onset of FI, and history of bowel resection. We compared the hematological indices from infants with pathologic FI (due to NEC or sepsis) to infants with benign FI. RESULTS: During the study period, 211 infants developed FI; 185 met the inclusion criteria. Infants with pathologic FI (n = 90, 37 cases with NEC and 53 with sepsis) had lower birth gestational age and weight compared with 95 infants with benign FI (n = 95). Pathologic FI was associated with lower platelet count (median 152 × 103/µL vs. 285 × 103/µL, p < 0.001) and higher immature-to-total neutrophil (I/T) ratio (median 0.23 vs. 0.04, p < 0.001) at the onset of FI. Pathologic FI was also associated with a decrease in baseline platelets compared with an increase in benign FI. For diagnosis of pathologic FI, a decrease ≥10% in platelets from baseline had a sensitivity and specificity of 0.64 and 0.73, respectively, I/T ratio ≥0.1 had a sensitivity and specificity of 0.71 and 0.78, respectively, and the combination of both parameters had a sensitivity and specificity of 0.50 and 0.97, respectively. CONCLUSION: FI caused by NEC or sepsis was associated with a decrease in platelets from baseline, and a lower platelet level and higher I/T ratio at the onset of FI. These findings can help clinicians in the management of preterm infants with FI. KEY POINTS: · FI is a common presentation of NEC and sepsis in preterm infants.. · FI due to NEC or sepsis is associated with changes in platelets and I/T ratio.. · These changes could be useful as early markers for diagnosis..

Asunto(s)

Enterocolitis Necrotizante/diagnóstico , Intolerancia Alimentaria/etiología , Neutrófilos/inmunología , Sepsis/diagnóstico , Biomarcadores/sangre , Plaquetas , Diagnóstico Precoz , Enterocolitis Necrotizante/sangre , Enterocolitis Necrotizante/inmunología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Recuento de Leucocitos , Modelos Logísticos , Masculino , Neutrófilos/metabolismo , Estudios Retrospectivos , Sensibilidad y Especificidad , Sepsis/sangre , Sepsis/inmunología

RESUMEN

INTRODUCTION: Allergy affects approximately one-third of the world's population, and the rates are growing. In Europe, it has been noticed that the risk of asthma and allergy is lower in the rural as opposed to urban population. There is a tendency for several allergic diseases to be present in the same person at the same time. OBJECTIVE: The aim of the study was to verify the co-occurrence of allergic multimorbidity and food allergy and intolerance in a group of children. MATERIAL AND METHODS: The multicentre cross-sectional study enrolled 1,008 children and adolescence aged 6-18 years (51.2% boys, 48.8% girls). The study comprised a questionnaire (respondents' declarations) and an outpatient examination (diagnostic examination followed by a medical diagnosis). The study was conducted as part of the 2016-2020 National Health Programme. RESULTS: In the study group, allergic rhinitis (AR) was present in 46.4%, bronchial asthma (BA) in 11.2% and atopic dermatitis (AD) in 6%. Allergic multimorbidity (simultaneous presence of 2 or more of the allergic diseases AR, BA and AD) was diagnosed in 9.7%. A single allergic disease (of the 3) was diagnosed in 43.4%. A diagnosis of food allergy and food intolerance was reported respectively at 29.6% and 14.3% participants with doctor-diagnosed allergic multimorbidity. Among those without any of the 3 allergic diseases, the percentage were 14.4% and 9.1%, respectively. CONCLUSIONS: Food allergy or food intolerance was more common in subjects with allergic multimorbidity than in subjects diagnosed with one allergic disease or those free of allergic diseases.

Asunto(s)

Hipersensibilidad a los Alimentos/epidemiología , Intolerancia Alimentaria/epidemiología , Multimorbilidad , Adolescente , Niño , Estudios Transversales , Femenino , Hipersensibilidad a los Alimentos/etiología , Intolerancia Alimentaria/etiología , Humanos , Hipersensibilidad/epidemiología , Hipersensibilidad/etiología , Masculino , Polonia/epidemiología , Prevalencia

RESUMEN

BACKGROUND: There is an unmet need for a validated, test-specific symptom questionnaire to evaluate carbohydrate perception during breath tests. Our aim was to develop and validate a questionnaire for the assessment of symptoms after a provocative carbohydrate load. METHODS: After a literature search and initial focus group-style interviews, five relevant complaints were identified. Responses were given on a Likert-type faces scale with a language children use and understand. Reliability, validity and responsiveness to change were established by the implementation of the questionnaire during breath tests in 215 pediatric subjects. Correlation between the questionnaire and a medical interview by a pediatrician who was blinded to the results of the questionnaire (n = 19) was determined. KEY RESULTS: The questionnaire had good face and content validity (Lawshe ratio = 1). Intraclass correlation coefficients for test-retest reliability (n = 116) demonstrated good repeatability (P < .001), and effect sizes were small (Cohen's d < 0.15 for all symptoms). Convergent validity and discriminant validity were supported according to the multitrait-multimethod matrix method. The results obtained by the questionnaire correlated highly with the result of the medical interview (P < .001; Fisher's exact test). Cronbach's alpha was 0.81. Responsiveness was verified for the whole patient group and subgroups with medium to high effect sizes. CONCLUSIONS AND INFERENCES: The paediatric Carbohydrate Perception Questionnaire (pCPQ) is a simple, test-specific questionnaire for a pediatric population. It is a valid instrument with excellent psychometric properties to assess gastrointestinal symptoms after carbohydrate ingestion. The pCPQ can replace non-validated symptom assessment during carbohydrate breath tests and allows a standardized diagnosis of carbohydrate intolerance.

Asunto(s)

Carbohidratos de la Dieta/efectos adversos , Intolerancia Alimentaria/diagnóstico , Enfermedades Gastrointestinales/diagnóstico , Percepción , Vigilancia de la Población , Encuestas y Cuestionarios/normas , Adolescente , Pruebas Respiratorias/métodos , Niño , Estudios de Cohortes , Femenino , Intolerancia Alimentaria/etiología , Enfermedades Gastrointestinales/etiología , Humanos , Masculino , Vigilancia de la Población/métodos , Reproducibilidad de los Resultados

Asunto(s)

Quimioradioterapia/efectos adversos , Intolerancia Alimentaria/patología , Neoplasias de Cabeza y Cuello/terapia , Irritantes/efectos adversos , Especias/efectos adversos , Intolerancia Alimentaria/etiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Pronóstico

RESUMEN

Gallbladder agenesis is a rare congenital anomaly occurring in 10-65 per 100,000 populations with the incidence being more common in females with a ratio of 3:1. Although asymptomatic, some patients present with symptoms like biliary colic and often indistinguishable from common conditions leading to unnecessary surgery. A 19-year old woman presented to the hospital with epigastric and right upper quadrant pain, other signs and symptoms consistent with biliary colic. However, on laparoscopy gall bladder was absent. Ultra-sound of the abdomen is the preferred for gallbladder diseases but due to scarcity of reports on gallbladder agenesis, it is often misread due to periportal tissue and sub-phrenic folds often reported as gallbladder or calculi leading to unnecessary surgery. Agenesis, a rare anomaly, poses a diagnostic dilemma to surgeons as it is usually diagnosed during a laparoscopic cholecystectomy. Clinicians should keep in mind this entity when the gallbladder is poorly visualized on ultrasound and think of more detailed investigations such as Magnetic resonance cholangiopancreatography.

Asunto(s)

Anomalías del Sistema Digestivo/diagnóstico , Vesícula Biliar/anomalías , Dolor Abdominal/etiología , Colecistectomía Laparoscópica , Colecistitis/diagnóstico , Colecistitis/cirugía , Enfermedad Crónica , Errores Diagnósticos , Grasas de la Dieta , Anomalías del Sistema Digestivo/complicaciones , Femenino , Intolerancia Alimentaria/etiología , Humanos , Náusea/etiología , Vómitos/etiología , Adulto Joven

RESUMEN

INTRODUCTION: Food intolerance is expected during the postoperative period following gastric bypass and may be associated with inadequate chewing. OBJECTIVE: To evaluate chewing before and after speech therapy intervention in subjects undergoing Roux-en-Y gastric bypass who present with food intolerance. MATERIALS AND METHODS: This was a randomized controlled trial, approved by the Brazilian Ethics and Research Committee under n. 438,600. The study population was allocated into two groups: the study group (SG), who received speech therapy intervention, and the control group (CG), who did not receive any intervention, in six visits at 7, 15, 30, 60, and 90 days (v7, v15, v30, v60, and v90) after the initial visit (v0). During v0 and v90, a chewing evaluation was performed according to the MBGR protocol adapted. The significance level adopted was 5%. RESULTS: A total of 30 females (88%) and 4 males (12%) were analyzed. The SG had 18 subjects, and the CG had 16, with mean ages of 50.17 ± 12.28 years and 45.69 ± 9.78 years, respectively. The postoperative time ranged from 4 to19 months. In the SG, a marked improvement in the number of episodes of food intolerance was observed (p < 0.001), an improvement in the intake of cereals and meats (p = 0.004 and p < 0.001, respectively), and an improvement in chewing capacity and swallowing (p = 0.002 and p = 0.011, respectively). CONCLUSION: Speech therapy intervention in chewing led to a marked improvement of food acceptance and food intolerance resulting from Roux-en-Y gastric bypass.

Asunto(s)

Intolerancia Alimentaria/etiología , Derivación Gástrica/efectos adversos , Masticación/fisiología , Obesidad Mórbida/cirugía , Logopedia/métodos , Adulto , Anciano , Deglución/fisiología , Dieta , Femenino , Intolerancia Alimentaria/diagnóstico , Intolerancia Alimentaria/fisiopatología , Intolerancia Alimentaria/terapia , Derivación Gástrica/métodos , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio

RESUMEN

INTRODUCTION: Gastric emptying (GE) and food tolerance (FT) can be altered after Roux-en-Y gastric bypass (RYGB) has been performed, especially when it involved the use of a restrictive mechanism (such as a silastic ring). AIM: To assess GE and FT in patients who underwent banded (BRYGB) or non-banded Roux-en-Y gastric bypass (RYGB). METHODS: Forty-seven BRYGB patients and 47 RYGB patients underwent gastric emptying scintigraphy (GES) and FT assessment (by means of a questionnaire) between 6 months and 2 years postoperatively. RESULTS: GES was performed on average 11.7 ± 5.0 months (6 to 24) postoperatively. T½ medians (time taken for the gastric radioactivity to decrease to half of the original value in the gastric pouch) in the RYGB and BRYGB groups were 48.7 min (40.6-183.0 min) and 56.3 min (41.1-390.9 min), respectively (p = 0.031). The median of total questionnaire scores was 24 points (18-27) in the RYGB group and 20 points (13-27) in the BRYBG group (p < 0.001). CONCLUSIONS: The band (silastic ring) delays GE time and does not affect patient satisfaction or food tolerance to vegetables, bread, or rice, but does affect tolerance to the intake of meat, salad, and pasta. The best tolerated foods are vegetables, salad, and fish. Banded patients are more likely to regurgitate and vomit. Gastric emptying does not affect FT.

Asunto(s)

Intolerancia Alimentaria/etiología , Derivación Gástrica/efectos adversos , Vaciamiento Gástrico , Obesidad/cirugía , Adulto , Femenino , Derivación Gástrica/métodos , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Satisfacción del Paciente , Implantación de Prótesis/efectos adversos , Implantación de Prótesis/métodos , Estómago/fisiopatología , Estómago/cirugía , Pérdida de Peso

Asunto(s)

Intolerancia Alimentaria/etiología , Hiperamonemia/etiología , Hipercalcemia/etiología , Errores Innatos del Metabolismo/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Hiperamonemia/sangre , Hipercalcemia/sangre , Lactante , Errores Innatos del Metabolismo/sangre , Errores Innatos del Metabolismo/complicaciones

Asunto(s)

Acidosis Tubular Renal/diagnóstico , Intolerancia Alimentaria/etiología , Hiperamonemia/etiología , Hipercalcemia/etiología , ATPasas de Translocación de Protón Vacuolares/genética , Acidosis Tubular Renal/complicaciones , Acidosis Tubular Renal/genética , Acidosis Tubular Renal/terapia , Administración Oral , Amoníaco/sangre , Diagnóstico Diferencial , Femenino , Fluidoterapia , Intolerancia Alimentaria/terapia , Humanos , Hiperamonemia/sangre , Hiperamonemia/terapia , Hipercalcemia/sangre , Hipercalcemia/terapia , Lactante , Errores Innatos del Metabolismo/sangre , Errores Innatos del Metabolismo/complicaciones , Errores Innatos del Metabolismo/diagnóstico , Citrato de Potasio/administración & dosificación , Bicarbonato de Sodio/administración & dosificación , Resultado del Tratamiento , Aumento de Peso/efectos de los fármacos , Secuenciación del Exoma

RESUMEN

The purpose of this study is to evaluate the food intolerance after banded Roux-en-Y gastric bypass (RYGB), correlating the data of food ingestion. METHODS: This is an observational prospective study, which evaluated the individuals before and 3, 6, and 12 months after banded RYGB. We performed an anthropometric evaluation and an assessment of the habitual food ingestion and applied a food tolerance questionnaire. RESULTS: The study group was comprised of 75 individuals, 89% of them female, with a percentual weight loss of 29.73 ± 6.79%. The observed results were that food intolerance increased over time and 1 year after surgery, only 2.7% reported to ingest any type of food, while the greatest difficulty was related to red meat (80%). Regarding vomits, after surgery, this proportion significantly increased after 3, 6, and 12 months. Preoperatively, the mean protein ingestion was 98 g, which decreased to 50 g after 3 and 6 months and to 51 g after 12 months. As a conclusion, food intolerance significantly increased following banded RYGB, leading to a crescent dissatisfaction regarding food and an increase in the vomits frequency.

Asunto(s)

Intolerancia Alimentaria , Derivación Gástrica , Complicaciones Posoperatorias/epidemiología , Proteínas en la Dieta , Femenino , Intolerancia Alimentaria/epidemiología , Intolerancia Alimentaria/etiología , Derivación Gástrica/efectos adversos , Derivación Gástrica/estadística & datos numéricos , Humanos , Masculino , Obesidad Mórbida/cirugía , Estudios Prospectivos , Pérdida de Peso

RESUMEN

BACKGROUND: We evaluated tolerance of hydrolyzed liquid protein (LP) supplement added to fortified human milk (HM) to optimize protein intake in preterm infants. METHODS: A prospective observational study of 31 subjects compared with 31 historic controls, receiving mothers own milk (MOM) and/or donor milk (DM) to assess LP tolerance, growth, and risk for morbidities was conducted. Milk was analyzed for nutrient content. Feeding intolerance, defined as cessation of feedings for ≥48 hours, abdominal distension and/or residuals, necrotizing enterocolitis (NEC), and metabolic acidosis were used to assess safety, while weight and head circumference (HC) were used to evaluate growth. RESULTS: LP added to powder-fortified HM had no impact on feeding intolerance and NEC. Biochemical parameters showed no metabolic acidosis: blood urea nitrogen levels (first week: median, 13 mg/dL; interquartile range [IQR], 9-16; last week: median, 13 mg/dL; IQR, 10.3-14; P = .94), bicarbonate levels (first week: median, 26.3 mEq/L; IQR, 24-28; last week: median, 28 mEq/L; IQR, 26.3-29.8; P = .10), and pH levels (first week: median, 7.4; IQR, 7.3-7.4; last week: median, 7.4; IQR, 7.37-7.40; P = .5). Weight and HC were not statistically significant. HM analysis showed lower protein and caloric content, respectively (MOM: 0.88 vs DM: 0.77 g/100 mL; P < .0001 and MOM: 18.68 vs DM: 17.96 kcal/oz; P = .02). CONCLUSIONS: Hydrolyzed LP is well tolerated in preterm infants with no difference in growth rates. Clinicians should focus on the need to maximize both protein and energy to optimize growth.

Asunto(s)

Nutrición Enteral/métodos , Alimentos Fortificados , Recien Nacido Prematuro/crecimiento & desarrollo , Leche Humana , Hidrolisados de Proteína/administración & dosificación , Ingestión de Energía , Femenino , Intolerancia Alimentaria/etiología , Edad Gestacional , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Enfermedades del Recién Nacido , Recién Nacido de muy Bajo Peso/crecimiento & desarrollo , Cuidado Intensivo Neonatal , Masculino , Leche Humana/química , Estudios Prospectivos , Hidrolisados de Proteína/efectos adversos

RESUMEN

BACKGROUND: Knowledge of optimal diagnostic workup, etiology, and response to treatment of chronic abdominal pain after Roux-en-Y gastric bypass (RYGB) is limited. OBJECTIVE: To define the etiology of chronic abdominal pain presenting at the 5-year follow-up after RYGB and to evaluate response to treatment. SETTING: Oslo University Hospital (tertiary referral center for obesity surgery). METHODS: Of 234 patients operated during a randomly selected 12-month period, 165 (71%) returned for 5-year follow-up, and 160 responded to study questionnaires. Of these, 54 (34%) reported chronic abdominal pain and were invited to participate in a structured diagnostic and treatment algorithm. These patients were contacted for the evaluation of their response to treatment. RESULTS: Fifty-one of 54 patients (94%) reporting chronic abdominal pain at the 5-year follow-up were included in the study. Of the 45 patients with onset of symptoms post-RYGB, 28 (62%) underwent one or more radiologic evaluations, 10 (22%) underwent endoscopy, and 13 (29%) underwent laparoscopy. Diagnosis and treatment were established for 34 patients (76%), whereas 11 (24%) had abdominal pain of unknown cause. The most common etiology was internal herniation (n = 6), dumping (n = 6), food intolerance (n = 6), gallstones (n = 5), and irritable bowel syndrome (n = 4). After a median follow-up of 13.0 months (standard deviation, 11.5), 37 (82%) patients reported remission or improvement of symptoms, 6 had unchanged symptoms, and 2 patients were lost to follow-up. CONCLUSIONS: The etiology of long-term chronic abdominal pain post-RYGB is diverse. A multidisciplinary team can help most patients with dedicated follow-up, but a subset of patients has symptoms of unknown etiology.

Asunto(s)

Dolor Abdominal/etiología , Derivación Gástrica/efectos adversos , Dolor Abdominal/diagnóstico , Dolor Abdominal/terapia , Dolor Crónico/diagnóstico , Dolor Crónico/etiología , Dolor Crónico/terapia , Síndrome de Vaciamiento Rápido/diagnóstico , Síndrome de Vaciamiento Rápido/etiología , Síndrome de Vaciamiento Rápido/terapia , Femenino , Intolerancia Alimentaria/diagnóstico , Intolerancia Alimentaria/etiología , Intolerancia Alimentaria/terapia , Cálculos Biliares/diagnóstico , Cálculos Biliares/etiología , Cálculos Biliares/terapia , Hernia Abdominal/diagnóstico , Hernia Abdominal/etiología , Hernia Abdominal/terapia , Humanos , Síndrome del Colon Irritable/diagnóstico , Síndrome del Colon Irritable/etiología , Síndrome del Colon Irritable/terapia , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/terapia , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

Ensuring optimal nutrition is vital in critically ill children and enteral feeding is the main route of delivery in intensive care. Feeding intolerance is the most commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition, yet the definition for this remains inconsistent, nebulous, and entirely arbitrary. Not only does this pose problems clinically, but research in this field frequently uses feeding intolerance as an endpoint and the heterogeneity in this definition makes the comparison of studies difficult and meta-analysis impossible. We reviewed the use of, and definitions of, the term feed intolerance in pediatric intensive care research papers in the last 20 years. Gastric residual volume remains the most common factor used to define feed intolerance, despite the lack of evidence for this. Healthcare professionals would benefit from further education to improve their awareness of the limitations of the markers to define feeding intolerance, and the international PICU community needs to agree a consistent definition of this phenomenon to improve consistency in both practice and research.Conclusion: This paper will provide a narrative review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children. What is Known?: • Feeding intolerance is a commonly cited reason amongst pediatric intensive care unit healthcare professionals for stopping or withholding enteral nutrition. • There is no agreed definition for feeding intolerance in critically ill children. What is New?: • This paper provides an up to date review of the definitions of, evidence for, and markers of feeding intolerance in critically ill children. • Despite no evidence, gastric residual volume continues to drive clinical bedside decisions about enteral feeding and feeding tolerance.

Asunto(s)

Enfermedad Crítica/terapia , Nutrición Enteral/efectos adversos , Intolerancia Alimentaria/diagnóstico , Niño , Nutrición Enteral/métodos , Intolerancia Alimentaria/etiología , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico

RESUMEN

BACKGROUND: Preterm infants are born with low glycogen stores and require higher glucose intake to match fetal accretion rates. In spite of the myriad benefits of breast milk for preterm infants, it may not adequately meet the needs of these rapidly growing infants. Supplementing human milk with carbohydrates may help. However, there is a paucity of data on assessment of benefits or harms of carbohydrate supplementation of human milk to promote growth in preterm infants. This is a 2018 update of a Cochrane Review first published in 1999. OBJECTIVES: To determine whether human milk supplemented with carbohydrate compared with unsupplemented human milk fed to preterm infants improves growth, body composition, and cardio-metabolic and neurodevelopmental outcomes without significant adverse effects. SEARCH METHODS: We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 8), MEDLINE via PubMed (1966 to 21 February 2018), Embase (1980 to 21 February 2018), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 21 February 2018). We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. SELECTION CRITERIA: Published and unpublished controlled trials were eligible if they used random or quasi-random methods to allocate preterm infants in hospital fed human milk to supplementation or no supplementation with additional carbohydrate. DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data and assessed trial quality and the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. We planned to perform meta-analyses using risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, with their respective 95% confidence intervals (CIs). We planned to use a fixed-effect model and to explore potential causes of heterogeneity via sensitivity analyses. We contacted study authors for additional information. MAIN RESULTS: One unblinded, quasi-randomised controlled trial (RCT) assessing effects of carbohydrate supplementation of human milk in the form of a prebiotic in 75 preterm infants was eligible for inclusion in this review. We identified two publications of the same trial, which reported different methods regarding blinding and randomisation. Study authors confirmed that these publications pertain to the same trial, but they have not yet clarified which method is correct. We were unable to reproduce analyses from the data presented. At 30 days of age, the mean weight of preterm infants in the trial was greater in the prebiotic carbohydrate-supplemented group than in the unsupplemented group (MD 160.4 grams, 95% CI 12.4 to 308.4 grams; one RCT, N = 75; very low-quality evidence). We found no evidence of a clear difference in risk of feeding intolerance (RR 0.64, 95% CI 0.36 to 1.15; one RCT, N = 75 infants; very low-quality evidence) or necrotising enterocolitis (NEC) (RR 0.2, 95% CI 0.02 to 1.3; one RCT, N = 75 infants; very low-quality evidence) between the prebiotic-supplemented group and the unsupplemented group. Duration of hospital stay was shorter in the prebiotic group than in the control group at a median (range) of 16 (9 to 45) days (95% CI 15.34 to 24.09) and 25 (11 to 80) days (95% CI 25.52 to 34.39), respectively. No other data were available for assessing effects of carbohydrate supplementation on short- and long-term growth, body mass index, body composition, and neurodevelopmental or cardio-metabolic outcomes. AUTHORS' CONCLUSIONS: We found insufficient evidence on the short- and long-term effects of carbohydrate supplementation of human milk in preterm infants. The only trial included in this review presented very low-quality evidence, and study authors provided uncertain information about study methods and analysis. The evidence may be limited in its applicability because researchers included a small sample of preterm infants from a single centre. However, the outcomes assessed are common to all preterm infants, and this trial demonstrates the feasibility of prebiotic carbohydrate supplementation in upper-middle-income countries. Future trials should assess the safety and efficacy of different types and concentrations of carbohydrate supplementation for preterm infants fed human milk. Although prebiotic carbohydrate supplementation in preterm infants is currently a topic of active research, we do not envisage that further trials of digestible carbohydrates will be conducted, as this is currently done as a component of multi-nutrient human milk fortification. Hence we do not plan to publish any further updates of this review.

Asunto(s)

Carbohidratos de la Dieta/administración & dosificación , Suplementos Dietéticos , Fenómenos Fisiológicos Nutricionales del Lactante , Recien Nacido Prematuro , Leche Humana , Prebióticos/administración & dosificación , Peso Corporal , Enterocolitis Necrotizante/diagnóstico , Intolerancia Alimentaria/etiología , Crecimiento , Humanos , Recién Nacido , Leche Humana/química