RESUMO
Our objective of this study was to describe the clinical course of severe functional constipation in early childhood. Eligible patients were 47 children (60% boys; median age, 3.5 months) who had constipation in their first year of life. Follow-up data were obtained through a standardized questionnaire. Success was defined as a period of at least 4 weeks with > or =3 painless bowel movements per week. Six months after initial evaluation, 69% of the children were recovered. After initial success, a relapse occurred in 15% of the children within 3 years. A duration of symptoms <3 months before referral correlated significantly with better outcome. We conclude that most infants with severe constipation evaluated at a tertiary center are recovered after 6 months. Early therapeutic intervention may beneficially contribute to the resolution of constipation.
Assuntos
Constipação Intestinal/terapia , Catárticos/uso terapêutico , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Lactente , Modelos Logísticos , Masculino , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Estatísticas não ParamétricasRESUMO
OBJECTIVE: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. STUDY DESIGN: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were completed. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 +/- 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 +/- 0.9 years), and 15 control children (8 female, mean age 12.7 +/- 1.2 years) completed the study. RESULTS: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P <.001 vs control patients) and in patients with RAP (P <.05 vs control patients). Children with IBS had lower thresholds than children with RAP (P <.01). In contrast, thresholds for perception were decreased in the stomach of children with RAP (P <.005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P <.001) and depression (P <.02). CONCLUSIONS: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression.
Assuntos
Dor Abdominal/fisiopatologia , Dor Abdominal/psicologia , Doenças Funcionais do Colo/fisiopatologia , Doenças Funcionais do Colo/psicologia , Hiperalgesia/fisiopatologia , Hiperalgesia/psicologia , Vísceras/fisiopatologia , Dor Abdominal/complicações , Adolescente , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Criança , Doenças Funcionais do Colo/complicações , Transtorno Depressivo/complicações , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Hiperalgesia/complicações , Masculino , Medição da Dor , Limiar da Dor/fisiologia , Limiar da Dor/psicologia , Reto/fisiopatologia , Recidiva , Índice de Gravidade de Doença , Estômago/fisiopatologia , Tato/fisiologiaRESUMO
Clofazimine, previously used in the treatment of leprosy, is now used for treatment of Mycobacterium avium complex infection in patients with acquired immune deficiency syndrome, dermatologic disorders, and graft-versus-host disease. An 11-year-old boy developed a severe enteropathy 2 years after initiation of clofazimine treatment for graft-versus-host disease. Clofazimine enteropathy caused by crystal deposition can be life-threatening.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Transplante de Medula Óssea/imunologia , Clofazimina/efeitos adversos , Duodenopatias/induzido quimicamente , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doenças do Íleo/induzido quimicamente , Biópsia , Criança , Duodenopatias/patologia , Duodeno/patologia , Endoscopia Gastrointestinal , Doença Enxerto-Hospedeiro/etiologia , Humanos , Doenças do Íleo/patologia , MasculinoAssuntos
Constipação Intestinal/fisiopatologia , Criança , Doença Crônica , Colo/fisiologia , Doenças do Colo/complicações , Doenças do Colo/fisiopatologia , Constipação Intestinal/etiologia , Constipação Intestinal/prevenção & controle , Constipação Intestinal/psicologia , Constipação Intestinal/terapia , Defecação/fisiologia , Seguimentos , Motilidade Gastrointestinal/fisiologia , Humanos , PrevalênciaRESUMO
OBJECTIVES: To evaluate the clinical presentation and to assess the usefulness of antroduodenal manometry (ADM) and the results of multidisciplinary team management in 12 neurologically normal adolescents (9 girls) with rumination. STUDY DESIGN: All patients had extensive investigations that ruled out other causes of their chronic symptoms. We performed ADM in all patients. A multidisciplinary approach was used for the nutritional and behavioral rehabilitation of these patients. RESULTS: The median age at presentation was 14 years (range, 9-19 years), and the average duration of symptoms was 17 months. All patients complained of postprandial, effortless regurgitation, and the majority had weight loss and abdominal pain. Results of fasting ADM were normal in all. The postprandial ADM showed brief, simultaneous pressure increases at all recording sites, associated with regurgitation in 8 patients. No emesis was observed in the other 4 children during the study. Treatment included nutritional support in combination with antidepressants and anxiolytics (n = 6), cognitive therapy with biofeedback or relaxation techniques (n = 7), and pain management (n = 2). Resolution or improvement of symptoms was seen in 10 of the 12 patients, and successful transition to oral feedings was achieved in all during the follow-up period, which ranged from 5 to 36 months. CONCLUSIONS: Rumination is a distinct functional gastrointestinal disorder of otherwise healthy children and adolescents, which can be diagnosed on the basis of clinical features. The ADM shows a characteristic pattern and rules out motility disorders that are often confused with rumination. A multidisciplinary team approach is associated with satisfactory recovery in most patients.
Assuntos
Transtornos de Alimentação na Infância/diagnóstico , Adolescente , Criança , Terapia Combinada , Duodeno/fisiopatologia , Transtornos de Alimentação na Infância/fisiopatologia , Transtornos de Alimentação na Infância/reabilitação , Feminino , Humanos , Masculino , Manometria/métodos , Equipe de Assistência ao Paciente , Antro Pilórico/fisiopatologia , Estudos RetrospectivosRESUMO
La acreditación veterinaria para el saneamiento de enfermedades bajo programas nacionales, irrumpe en Argentina de la mano del Servicio Nacional de Sanidad y Calidad Agroalimentaria (SENASA) en el año 1994. Esta figura representa, sin lugar a dudas, un gran desafío para la profesión, desarrollada hasta el momento en forma individual y aislada con escasa o nula comunicación con los colegas del sector oficial.
Assuntos
Planos e Programas de Saúde , ComunicaçãoRESUMO
Antibodies to Neospora caninum were measured in bovine foetuses, dairy cows and beef cows in Argentina using the IFAT, the N. caninum agglutination test, and the recombinant NCDG1 and NCDG2 ELISA. Serum antibodies (IFAT titre 1:80) were found in 20 of 82 (24.4%) dairy cow foetuses and one of 22 (4.5%) beef cow foetuses. Microscopic lesions suggestive of neosporosis were seen in brains of seven of eight foetuses with IFAT titres of 1:80. Antibodies (IFAT) were found in 122 of 189 (64.5%) dairy cows that aborted. Serum antibody titres (IFAT) of 189 dairy cows that aborted were: < 1:25 (67 cows), 1:25 (four cows), 1:50 (16 cows), 1:200 (seven cows), 1:> or = 800 (95 cows). Of the 87 sera with IFAT titres of < or = 1:50, 57 had no antibodies in 1:40 dilution and 30 had titres of 1:40 in the N. caninum agglutination test. Thus, sera from at least 56 dairy cows which had aborted were seronegative both in the N. caninum agglutination test and the IFAT. The distribution of positive and negative sera was similar when measured by ELISA, except that, depending on cut-off titre, the ELISA indicated a greater number of seropositive cows that were negative by the IFAT and N. caninum agglutination test. These results suggest that transplacental transmission of N. caninum in dairy cows in Argentina is frequent.
Assuntos
Aborto Animal/epidemiologia , Doenças dos Bovinos/transmissão , Coccidiose/veterinária , Doenças Fetais/veterinária , Transmissão Vertical de Doenças Infecciosas/veterinária , Neospora , Aborto Animal/parasitologia , Animais , Anticorpos Antiprotozoários/sangue , Argentina , Bovinos , Doenças dos Bovinos/epidemiologia , Doenças dos Bovinos/parasitologia , Coccidiose/epidemiologia , Coccidiose/transmissão , Indústria de Laticínios , Feminino , Doenças Fetais/epidemiologia , Neospora/imunologia , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Complicações Parasitárias na Gravidez/veterinária , Testes SorológicosRESUMO
We describe the clinical features and long-term outcome of 11 children who had persistent gastroparesis after an acute viral illness, eight of whom tested positive for rotavirus. Gastric emptying was delayed in the 10 children evaluated with scintigraphy. Antroduodenal manometry confirmed postprandial antral hypomotility in 10 subjects. All children recovered within 6 to 24 months.
Assuntos
Fármacos Gastrointestinais/uso terapêutico , Gastroparesia/tratamento farmacológico , Gastroparesia/virologia , Piperidinas/uso terapêutico , Infecções por Rotavirus/complicações , Doença Aguda , Adolescente , Criança , Pré-Escolar , Cisaprida , Feminino , Motilidade Gastrointestinal , Gastroparesia/diagnóstico , Humanos , Lactente , Masculino , Manometria , Período Pós-PrandialRESUMO
To assess age-related changes, we analyzed 32 colon manometry studies of children referred for motility studies and found not to have colonic disease. Colon motility was recorded by endoscopically placed water-perfused catheters. There was an inverse correlation between the number of high-amplitude propagated contractions and age, before and after administration of a meal; colonic contractions different from the high-amplitude propagated contractions increased with age.
Assuntos
Envelhecimento , Colo/fisiopatologia , Constipação Intestinal/fisiopatologia , Adolescente , Criança , Pré-Escolar , Constipação Intestinal/diagnóstico , Jejum , Feminino , Humanos , Lactente , Masculino , Manometria , Síndrome de Munchausen Causada por Terceiro/fisiopatologia , Fatores de TempoRESUMO
We evaluated colon manometry as a means of differentiating causes of intractable constipation in children. We studied pressure changes in the transverse, descending, and rectosigmoid colons of 23 children with intractable constipation. All patients had a history of less than one bowel movement per week for longer than 2 years without resolution after conventional medical management. The possibility of Hirschsprung disease was excluded in all. On the basis of pathologic and manometric studies of the upper gastrointestinal tract, 10 patients had a diagnosis of gastrointestinal neuropathy and two had a diagnosis of myopathy. The other 11 patients had functional fecal retention; this diagnosis was based on history and outcome of therapy. On the day of study we used endoscopy to place a manometry catheter into the transverse colon and recorded intraluminal pressure for longer than 4 hours. After obtaining a baseline recording, we gave the patient a meal to assess gastrocolonic response. Colonic contractions were recorded in 21 of 23 children. Children with functional fecal retention could be differentiated from those with neuropathy by examination of the postprandial record. After a meal children with functional fecal retention had (1) an increase in motility index (3.4 +/- 0.5 while fasting vs 9.1 +/- 1.3 postprandially; p less than 0.001), and (2) at least one high-amplitude propagated contraction (in 10 of 11 children). The patients with neuropathy had no high-amplitude propagated contractions (p less than 0.001 vs group with functional fecal retention) and motility index in these children did not increase significantly after a meal (2.7 +/- 1.0 while fasting vs 2.9 +/- 1.3 postprandially). The two children with hollow visceral myopathy had no contractions. We conclude that in children with severe chronic constipation the colonic results of manometry differentiate patients with functional fecal retention from those with neuropathy or myopathy of the colon.
Assuntos
Colo/fisiopatologia , Doenças do Colo/complicações , Constipação Intestinal/etiologia , Doenças do Sistema Nervoso/complicações , Criança , Pré-Escolar , Doenças do Colo/diagnóstico , Constipação Intestinal/psicologia , Feminino , Alimentos , Motilidade Gastrointestinal/fisiologia , Humanos , Masculino , Manometria , Doenças do Sistema Nervoso/diagnósticoRESUMO
Esophageal motility was studied in 26 children with gastroesophageal reflux. In 11 patients (group A), esophagitis was severe; in the remaining 15 (group B), either mild or no microscopic changes were found. Lower esophageal sphincter pressure and amplitude, as well as velocity and duration of esophageal pressure waves, were manometrically measured. All patients underwent a 12-week intensive antacid course. Manometric tracings, blindly read, were compared with those of 16 age-matched children with emesis without proven reflux (group C). Among the variables analyzed, amplitude of the motor waves was significantly lower in patients with severe esophagitis than in group B and C patients (P less than 0.01). Nonspecific motor defects (simultaneous, broad-based, double-peaked waves) were more commonly present in group A. At the end of therapy, symptoms had either disappeared or significantly improved. Endoscopic and histologic studies showed disappearance of the severe inflammatory changes. Manometry, repeated in patients with cured severe esophagitis, showed normalization of the amplitude and significant decrease of the nonspecific motility abnormalities. We conclude that severe gastroesophageal reflux disease in children causes esophageal motor dysfunction, resulting from esophageal inflammation. The occurrence of esophageal motility disorders only in patients with severe esophagitis and its disappearance after therapy may account for the favorable course of reflux disease in infancy.