RESUMO
OBJECTIVE: Epidemiologic data on constipation in South America are limited. The main objective of this study was to assess the prevalence of self-reported symptoms of constipation in Brazil. METHODS: Telephone and personal surveys were conducted among community-dwelling adults in homes with land-based telephones in São Paulo. Data were weighted by numbers of adults, total residents, and telephones in each household. To account for potential nonresponse and noncoverage bias, results were further adjusted according to Brazilian census data. RESULTS: Among 4570 households contacted, 3050 adults (66.7%) participated. Respondents (mean [SE] age: 42.6 [2.7] years) were primarily women (53.1%). A minority of all respondents reported symptoms consistent with constipation, including a perception of incomplete voiding in 8.0%; expending efforts to defecate in 7.6%; ≤2 stools weekly in 9.0%; and hard stools in 12.7%. Prevalences of these symptoms and efforts to manage them were more frequent in women (P ≤ 0.004), but most were not significantly associated with advancing age. With increasing age, proportions of respondents with ≤2 stools per week declined (P = 0.001), whereas use of bowel enemas (P = 0.026) and digital maneuvers to disimpact stool increased (P < 0.001). Despite frequent constipation symptoms, the vast majority of respondents did not report using prescription medications, but some used natural remedies (29.5%) and/or laxatives (13.4%). CONCLUSIONS: Symptoms of constipation are prevalent in São Paulo, particularly among women. On the other hand, most survey respondents did not use medications or other remedies that manage this condition. These findings may point to an unmet gastrointestinal treatment need. Future research is needed to corroborate our findings in rural settings and to further evaluate potential predictors and consequences of constipation in South America.
Assuntos
Constipação Intestinal/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Constipação Intestinal/tratamento farmacológico , Feminino , Inquéritos Epidemiológicos , Humanos , Laxantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Prevalência , Autorrelato , Fatores Sexuais , Fatores Socioeconômicos , Telefone , Adulto JovemRESUMO
AIM: To determine the prevalences of symptoms consistent with gastroesophageal reflux disease (GERD) and dyspepsia in South America. METHODS: A telephone survey was conducted among adult owners of land-based telephones in São Paulo, Brazil, using previously validated computer-assisted sampling and survey protocols. The Portuguese-language survey included (1) sociodemographic characteristics (e.g., weight, height, smoking) and comorbidities; (2) dietary habits; (3) presence of symptoms consistent with GERD or dyspepsia within the prior 3 mo; and (4) use of medications and other therapies to manage symptoms. Data were stratified post-hoc into three homogeneous geographical regions of São Paulo according to the Social Exclusion Indices of the districts and postal codes. Survey response data from each respondent were weighted by the numbers of adults and landline telephones in each household. The analyses were weighted to account for sampling design and to be representative of the São Paulo population according to city census data. RESULTS: Among 4570 households contacted, an adult from 3050 (66.7%) agreed to participate. The nonresponse rate was 33.3%. The mean (SE) respondent age was 42.6 (16.0) years. More than half of all respondents were women (53.1%), aged 18 through 49 years (66.7%), married or cohabitating (52.5%), and/or above normal-weight standards (i.e., 35.3% overweight and 16.3% obese). A total of 26.5% of women were perimenopausal. More than 20% of respondents reported highly frequent symptoms consistent with GERD (e.g., gastric burning sensation = 20.8%) or dyspepsia (e.g., abdominal swelling/distension = 20.9%) at least once per month. Prevalences of these symptoms were significantly (approximately 1.5- to 2.0-fold) higher among women than men but did not vary significantly as a function of advancing age. For instance, 14.1% of women reported that they experienced stomach burning (symptom of GERD) at least twice per week, compared to 8.4% of men (P = 0.012 by χ(2) test). A total of 15.7% of women reported that they experienced abdominal swelling (symptom of dyspepsia) at least twice per week, compared to 6.4% of men (P < 0.001 by χ(2) test). Despite frequent manifestations of GERD or dyspepsia, most (≥ 90%) respondents reported that they neither received prescription medications from physicians, nor took behavioral measures (e.g., dietary modifications), to manage symptoms. CONCLUSION: Symptoms consistent with dyspepsia and GERD are prevalent in Brazil and represent major public-health and clinical challenges.
Assuntos
Dispepsia/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Estudos Transversais , Dispepsia/diagnóstico , Dispepsia/terapia , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Fatores Sexuais , Inquéritos e Questionários , Telefone , Adulto JovemRESUMO
BACKGROUND: The Helicobacter pylori reinfection seems to be higher in developing countries, than in developed ones. The aim of the study was to determine the annual recurrence rate of H. pylori, in Brazilian patients with peptic ulcer disease, in a 5-year follow-up. METHODS: Patients, with peptic ulcer disease diagnosed by upper digestive endoscopy (UDE) and H. pylori infection verified by histological analysis, rapid urease test, polymerase chain reaction, and urea breath test (UBT), were treated for bacterial eradication. The cure of the infection was verified using the same tests, 3 months after. Clinical evaluation and UBT were performed after sixth and ninth month. After 1 year of follow-up, UBT and UDE were repeated. Up to the fifth year, patients were assessed twice a year and an UBT was performed annually. The patients included and all the reinfected were tested for 15 different genes of the H. pylori. RESULTS: One hundred and forty-seven patients were followed: 19 for 1 year, eight for 2 years, four for 3 years, five for 4 years, and 98 for 5 years, totaling 557 patients/years. Recurrence did not occur in the first year. In the second year, two patients were reinfected; in the third, four patients; in the fourth, three patients; and in the fifth, one patient. The total of reinfected patients was 10. The annual reinfection rate was 1.8%. CONCLUSION: Brazil presents a low prevalence of H. pylori reinfection, similar to the developed countries.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/isolamento & purificação , Úlcera Péptica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Adulto JovemRESUMO
INTRODUCTION: Several aspects of gastroesophageal reflux disease (GERD) have been studied, but the frequency of comorbidities is not yet fully understood. OBJECTIVES: To study the prevalence of GERD comorbidities in a tertiary care hospital. METHODS: We prospectively studied 670 consecutive adult patients from the outpatient department of our facility. A diagnosis was established using clinical, endoscopic and/or pHmetry-related findings. Each patient's medical file was reviewed with respect to the presence of other medical conditions and diagnoses. RESULTS: Of the 670 patients, 459 (68.6%) were female, and the mean age was 55.94 (17-80 years). We registered 316 patients (47.1%) with the erosive form of GERD and 354 patients (52.9%) with the non-erosive form. A total of 1,664 instances of comorbidities were recorded in 586 patients (87.5%), with the most common being arterial hypertension (21%), hypercholesterolemia (9%), obesity (9%), type II diabetes mellitus (5%) and depression (4%). Two or more comorbidities were present in 437 individuals (64.8%). The occurrence of comorbidities increased with age and was higher in patients with the non-erosive form of GERD. CONCLUSIONS: In a tertiary referral population, comorbidities were very common, and these may have worsened the already impaired health-related quality of life of these patients. Clinicians caring for GERD patients in this setting must be aware of the likelihood and nature of comorbid disorders and their impact on disease presentation and patient management.
Assuntos
Depressão/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Refluxo Gastroesofágico/classificação , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: Increasing resistance to clarithromycin and nitroimidazole is the main cause of failure in the Helicobacter pylori eradication. The ideal retreatment regimen remains unclear, especially in developing countries, where the infection presents high prevalence and resistance to antibiotics. The study aimed at determining the efficacy, compliance and adverse effects of a regimen that included furazolidone, levofloxacin and lansoprazole in patients with persistent Helicobacter pylori infection, who had failed to respond to at least one prior eradication treatment regimen. METHODS: This study included 48 patients with peptic ulcer disease. Helicobacter pylori infection was confirmed by a rapid urease test and histological examination of samples obtained from the antrum and corpus during endoscopy. The eradication therapy consisted of a 7-day twice daily oral administration of lansoprazole 30 mg, furazolidone 200 mg and levofloxacin 250 mg. Therapeutic success was confirmed by a negative rapid urease test, histological examination and 14C- urea breath test, performed 12 weeks after treatment completion. The Chi-square method was used for comparisons among eradication rates, previous treatments and previous furazolidone use. RESULTS: Only one of the 48 patients failed to take all medications, which was due to adverse effects (vomiting). Per-protocol and intention-to-treat eradication rates were 89% (95% CI- 89%-99%) and 88% (88-92%), respectively. Mild and moderate adverse effects were reported by 41 patients (85%). For patients with one previous treatment failure, the eradication rate was 100%. Compared to furazolidone-naïve patients, eradication rates were lower in those who had failed prior furazolidone-containing regimen(s) (74% vs. 100%, p = 0.002). CONCLUSION: An empiric salvage-regimen including levofloxacin, furazolidone and lansoprazole is very effective in the eradication of Helicobacter pylori, particularly in patients that have failed one prior eradication therapy.
Assuntos
2-Piridinilmetilsulfinilbenzimidazóis/uso terapêutico , Anti-Infecciosos/uso terapêutico , Furazolidona/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Levofloxacino , Ofloxacino/uso terapêutico , 2-Piridinilmetilsulfinilbenzimidazóis/efeitos adversos , Adulto , Idoso , Anti-Infecciosos/efeitos adversos , Relação Dose-Resposta a Droga , Farmacorresistência Bacteriana , Quimioterapia Combinada , Feminino , Furazolidona/efeitos adversos , Humanos , Lansoprazol , Masculino , Pessoa de Meia-Idade , Ofloxacino/efeitos adversos , Estudos Prospectivos , Terapia de Salvação , Resultado do TratamentoRESUMO
INTRODUCTION: Several aspects of gastroesophageal reflux disease (GERD) have been studied, but the frequency of comorbidities is not yet fully understood. OBJECTIVES: To study the prevalence of GERD comorbidities in a tertiary care hospital. METHODS: We prospectively studied 670 consecutive adult patients from the outpatient department of our facility. A diagnosis was established using clinical, endoscopic and/or pHmetry-related findings. Each patient's medical file was reviewed with respect to the presence of other medical conditions and diagnoses. RESULTS: Of the 670 patients, 459 (68.6 percent) were female, and the mean age was 55.94 (17-80 years). We registered 316 patients (47.1 percent) with the erosive form of GERD and 354 patients (52.9 percent) with the non-erosive form. A total of 1,664 instances of comorbidities were recorded in 586 patients (87.5 percent), with the most common being arterial hypertension (21 percent), hypercholesterolemia (9 percent), obesity (9 percent), type II diabetes mellitus (5 percent) and depression (4 percent). Two or more comorbidities were present in 437 individuals (64.8 percent). The occurrence of comorbidities increased with age and was higher in patients with the non-erosive form of GERD. CONCLUSIONS: In a tertiary referral population, comorbidities were very common, and these may have worsened the already impaired health-related quality of life of these patients. Clinicians caring for GERD patients in this setting must be aware of the likelihood and nature of comorbid disorders and their impact on disease presentation and patient management.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Depressão/epidemiologia , /epidemiologia , Refluxo Gastroesofágico/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Comorbidade , Refluxo Gastroesofágico/classificação , Hospitais Universitários , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: The Brazilian consensus recommends a short-term treatment course with clarithromycin, amoxicillin and proton-pump inhibitor for the eradication of Helicobacter pylori (H. pylori). This treatment course has good efficacy, but cannot be afforded by a large part of the population. Azithromycin, amoxicillin and omeprazole are subsidized, for several aims, by the Brazilian federal government. Therefore, a short-term treatment course that uses these drugs is a low-cost one, but its efficacy regarding the bacterium eradication is yet to be demonstrated. The study's purpose was to verify the efficacy of H. pylori eradication in infected patients who presented peptic ulcer disease, using the association of azithromycin, amoxicillin and omeprazole. METHODS: Sixty patients with peptic ulcer diagnosed by upper digestive endoscopy and H. pylori infection documented by rapid urease test, histological analysis and urea breath test were treated for six days with a combination of azithromycin 500 mg and omeprazole 20 mg, in a single daily dose, associated with amoxicillin 500 mg 3 times a day. The eradication control was carried out 12 weeks after the treatment by means of the same diagnostic tests. The eradication rates were calculated with 95% confidence interval. RESULTS: The eradication rate was 38% per intention to treat and 41% per protocol. Few adverse effects were observed and treatment compliance was high. CONCLUSION: Despite its low cost and high compliance, the low eradication rate does not allow the recommendation of the triple therapy with azithromycin as an adequate treatment for H. pylori infection.
Assuntos
Azitromicina/administração & dosagem , Azitromicina/economia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Cooperação do Paciente/estatística & dados numéricos , Úlcera Péptica/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/administração & dosagem , Brasil , Esquema de Medicação , Custos de Medicamentos , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/microbiologia , Feminino , Infecções por Helicobacter/microbiologia , Helicobacter pylori/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/administração & dosagem , Úlcera Péptica/microbiologia , Resultado do TratamentoRESUMO
BACKGROUND: The prevalence of Helicobacter pylori is higher in developing countries. Sanitary facilities, crowding and ethnic group are some of the factors related to H. pylori infection. The aim of this study was to investigate in blood donors, free of dyspeptic symptoms, the prevalence and factors influencing H. pylori infection. MATERIALS AND METHODS: This study was conducted in São Paulo, a city known to have a mixed population coming from all over the country. A total of 1008 blood donors were initially included in the study. After a final revision of all the questionnaires, 993 were included in the final analysis (746 males). H. pylori status was checked by an ELISA test. The following associations to infection were analyzed: sex, age, ethnic group, previous upper gastrointestinal (GI) endoscopy, smoking, alcoholism, drug addiction, type of drinking water, crowding, sanitary facilities, and family income. RESULTS: Infection was observed in 496 of 746 male (66.5%) and in 156 of 247 female (63.2%) blood donors. Infection prevalence increased according to age group, regardless of sex. Prevalence was lower in White population than in non-White. No relationship was observed between infection and smoking, drug addiction, and alcohol. A positive relation was observed between infection and previous upper GI endoscopy, and type of drinking water, regardless if currently or during childhood. Crowding and lack of toilet in the house during childhood resulted in a higher infection rate. Lower familial income and educational level showed a positive association to infection. CONCLUSIONS: Prevalence of H. pylori is higher in non-White population, independent of gender. A positive association was observed in aging, previous upper GI endoscopy, crowding, type of drinking water, lack of toilet during childhood, lower family income, and lower educational level.
Assuntos
Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adulto , Fatores Etários , Doadores de Sangue , Brasil/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pobreza , Fatores de Risco , Testes Sorológicos , Inquéritos e Questionários , População UrbanaRESUMO
BACKGROUND: Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. MATERIALS AND METHODS: One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. RESULTS: H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. CONCLUSIONS: The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.
Assuntos
Úlcera Duodenal/diagnóstico , Úlcera Duodenal/microbiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Úlcera Duodenal/patologia , Endoscopia do Sistema Digestório , Feminino , Seguimentos , Genótipo , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RecidivaRESUMO
OBJECTIVE: Patients with primary head and neck cancer show a predisposition to develop esophageal cancer. The aim of this study was to investigate in these patients: the prevalence of esophageal cancer comparing the value of chromoendoscopy using Lugol's solution examination to standard endoscopy, in the early diagnosis of esophageal cancer. METHODS: Prospective observational study at a state general university hospital in Sao Paulo, Brazil. 326 consecutive adult patients with primary head and neck cancer were evaluated. A standard endoscopy was performed, followed by a 2% Lugol's dye spray chromoendoscopy and histopathologic study. The prevalence of esophageal cancer was defined. The results of the two endoscopic methods were compared. RESULTS: Twenty-four patients with esophageal cancer and high-grade intraepithelial neoplasia were detected and had a prevalence of 7.36%. Chromoendoscopy and standard endoscopy were equivalent to the diagnosis of advanced and invasive esophageal cancer. However, standard endoscopy diagnosed 55% of high-grade intraepithelial neoplasia, in comparison to chromoendoscopy that detected 100%. CONCLUSIONS: Patients with primary head and neck cancer should be considered as high risks for the presence of esophageal cancer. Lugol's dye chromoendoscopy diagnosed high-grade intraepithelial neoplasia, which went unnoticed with standard endoscopy. It permits a more exact detection of lesion boundaries and facilitates a more precise targeting of biopsy fragments.
Assuntos
Corantes , Neoplasias Esofágicas/diagnóstico , Esofagoscopia , Iodetos , Neoplasias Primárias Múltiplas , Neoplasias Otorrinolaringológicas , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Coloração e RotulagemRESUMO
Os inibidores de bomba platônica (IBPs) têm elevado significado significativamente os índices de cicatrizaçäo das doenças ácido-relacionadas com mínimos eventos adversos. Pantoprazol é um IBP com propriedades farmacológicas definidas, intensa açäo anti-secretora e elevada eficácia clínica. O objetivo deste estudo foi avaliar a eficácia e a segurança de pantoprazol, 40 mg, em uma populaçäo näo selecionada, portadora de doenças ácido-relacionadas. Em estudo aberto, prospectivo, näo randomizado, ambulatorial, foram avaliados 2.222 pacientes (média etária de 44,3 anos) divididos em três grupos. Todos os pacientes receberam pantoprazol, 40 mg/dia, durante duas a oito semanas. Os índices de cicatrizaçäo da UG e DU foram 71,6 porcento e 81 porcento, respectivamente. Os índices de cicatrizaçäo das esofagites de refluxo foram de 81,2 porcento, 67,7 porcento, 50 porcento e 36,1 porcento nos graus I, II,III e IV, respectivamente, de acordo com a classificaçäo de Savary-Miller. A maioria dos eventos adversos foram leves e ocorreram em 2,5 porcento dos pacientes. Os mais freqüentemente relatados foram cefaléia, diarréia, prurido, constipaçäo e tontura. A eficácia do pantoprazol no tratamento das doenças ácido-relacionadas foi demonstrada. O bom perfil de tolerabilidade confirma a segurança do produto.(au)
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Adolescente , Antiulcerosos , Gastroenterite , Gastroenteropatias , Úlcera Duodenal , Refluxo Gastroesofágico , Úlcera GástricaRESUMO
Se efectúo la comparación entre Famotidina y Ranitidina en estudio terapéutico a corto plazo en el tratamiento de úlcera duodenal. Famotidina, 20 mg b.i.d., 40 mg b.i.d. y 40 mg nocturna cura la úlcera como la Ranitidina ((90.9%), 91.7%, 83.3% y 100% respectivamente). Una dosis simple nocturna se mostró efectiva en la prevención de la recidiva de la úlcera por un período de 48 semanas; el grado de recidiva de 38% observado con Famotidina fue estadísticamente diferente del 78% observado con placebo. Diarrea fue la molestia más común observada durante el tratamiento a corto plazo, seguido por somnolencia y cefalea. Las pocas y pequeñas alteraciones bioquimicas observadas durante el tratamiento a largo plazo (aumento de las transaminasas, fosfatasa alcalinas, glucosa, B.U.N.) no podría relacionarse directamente con el uso de la sustencia
Assuntos
Humanos , Masculino , Feminino , Antiulcerosos/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Ranitidina/uso terapêutico , Tiazóis/uso terapêutico , Ensaios Clínicos como Assunto , Distribuição Aleatória , Ranitidina/administração & dosagem , Tiazóis/administração & dosagemRESUMO
Se efectúo la comparación entre Famotidina y Ranitidina en estudio terapéutico a corto plazo en el tratamiento de úlcera duodenal. Famotidina, 20 mg b.i.d., 40 mg b.i.d. y 40 mg nocturna cura la úlcera como la Ranitidina ((90.9%), 91.7%, 83.3% y 100% respectivamente). Una dosis simple nocturna se mostró efectiva en la prevención de la recidiva de la úlcera por un período de 48 semanas; el grado de recidiva de 38% observado con Famotidina fue estadísticamente diferente del 78% observado con placebo. Diarrea fue la molestia más común observada durante el tratamiento a corto plazo, seguido por somnolencia y cefalea. Las pocas y pequeñas alteraciones bioquimicas observadas durante el tratamiento a largo plazo (aumento de las transaminasas, fosfatasa alcalinas, glucosa, B.U.N.) no podría relacionarse directamente con el uso de la sustencia (AU)