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RESUMEN Introducción: Los desórdenes gastrointestinales funcionales pediátricos, comprenden un conjunto de síntomas gastrointestinales crónicos o recurrentes, no explicados por anomalías estructurales o bioquímicas, con interferencia importante en la calidad de vida del niño y su familia. Objetivo: Determinar la prevalencia de los desórdenes gastrointestinales funcionales en adolescentes. Métodos: Estudio observacional, descriptivo de corte transversal, prospectivo con 318 adolescentes pertenecientes a los centros de enseñanza del reparto Camilo Cienfuegos del municipio Habana del Este, en el período comprendido entre marzo 2020 y enero del 2021. Las variables utilizadas fueron edad, sexo, antecedentes personales de dengue, antecedentes familiares de desórdenes gastrointestinales familiares, primogénito, padres separados, hijo único, prematuridad y nacimiento por cesárea. Se utilizó el cuestionario para síntomas digestivos pediátricos, basado en los criterios de Roma IV. Resultados: Un total de 93 estudiantes, para 29,2 % cumplieron los criterios diagnósticos de Roma IV para algún desorden gastrointestinal funcional. Se encontró predominio del sexo femenino (34,3 %) y del grupo de 10-12 años (30 %). El estreñimiento funcional se diagnosticó en 22,7 % de los adolescentes, seguido de la dispepsia funcional en 3,5 %. Conclusiones: Los desórdenes gastrointestinales funcionales son comunes en los adolescentes del estudio. El estreñimiento funcional es el trastorno más frecuente. Los desórdenes gastrointestinales funcionales se presentan de forma significativa en adolescentes del sexo femenino.

ABSTRACT Introduction: Pediatric functional gastrointestinal disorders comprise a set of chronic or recurrent gastrointestinal symptoms, not explained by structural or biochemical abnormalities, with significant interference in the quality of life of the child and his/her family. Objective: Determine the prevalence of functional gastrointestinal disorders in adolescents. Methods: Observational, descriptive cross-sectional, prospective study with 318 adolescents belonging to the educational centers of Camilo Cienfuegos neighborhood, Habana del Este municipality, in the period between March 2020 and January 2021. The variables used were age, sex, personal history of dengue, family history of gastrointestinal disorders, firstborn, separated parents, only child, prematurity and birth by cesarean section. The questionnaire for pediatric digestive symptoms, based on the Rome IV criteria, was used. Results: A total of 93 students (29.2%) met the diagnostic criteria of Rome IV for some functional gastrointestinal disorder. A predominance of the female sex (34.3%) and the group of 10-12 years (30%) was found. Functional constipation was diagnosed in 22.7% of adolescents, followed by functional dyspepsia (3.5%). Conclusions: Functional gastrointestinal disorders are common in the studied adolescents. Functional constipation is the most common disorder. Functional gastrointestinal disorders occur significantly in female adolescents.

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ABSTRACT Objective: To determine the prevalence of functional gastrointestinal disorders (FGIDs) in children according to Rome IV criteria. Methods: We included cohorts and observational descriptive studies, including information for the prevalence of FGIDs according to Rome IV criteria in children 4 to 18 years old. We searched the MEDLINE (Ovid), EMBASE, LILACS, and CENTRAL databases from May 2016 to nowadays. Gray literature and other databases were also consulted. The risk of bias was assessed using the STROBE Statement. The results were reported in forest plots of the estimated effects of the included studies with a 95% confidence interval (95%CI). Results: We included 14 studies involving a total of 17427 participants. Three studies were conducted in Europe, two in North America, and nine in Latin America. Most studies were school-based (n=14670, 84.18%), participants were mostly female (55.49%), white (51.73%), 8 to 18 years old (77.64%), and assisted to a public school (81.53%). Thirteen studies used the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS-RIV) to assess FGIDs. We found a global prevalence for FGIDs of 23% (95%CI 21-25%, I2 99%). Main disorders were functional constipation (FC) with 12% (95%CI 11-15%) followed by functional dyspepsia (FD) (5%, 95%CI 11-15%) and irritable bowel syndrome (IBS) (3%, 95%CI 2-4%). The prevalence of FGIDs was higher in the Americas, representing 23.67% (95%CI 21.2-26.2%, I2 91.3%). Conclusion: FGIDs are present in one of four children and adolescents, representing a common condition in this age group the central disorders were FC, FD, and IBS.

RESUMO Objetivo: Determinar a prevalência de distúrbios gastrointestinais funcionáis (DGF) em crianças de acordo com os critérios de Roma IV. Métodos: Incluímos coortes e estudos observacionais descritivos, incluindo informações para a prevalência de DGF de acordo com os critérios de Roma IV em crianças de 4 a 18 anos. Pesquisamos nas bases de dados MEDLINE (Ovid), EMBASE, LILACS e CENTRAL de maio de 2016 até os dias atuais. A literatura cinzenta e outras bases de dados também foram consultadas. O risco de viés foi avaliado usando a Declaração STROBE. Os resultados foram relatados em parcelas florestais dos efeitos estimados dos estudos incluídos com um intervalo de confiança de 95% (95%IC). Resultados: Foram incluídos 14 estudos envolvendo um total de 17.427 participantes. Três estudos foram realizados na Europa, dois na América do Norte e nove na América Latina. A maioria dos estudos foi de base escolar (n=14.670, 84,18%), os participantes eram em sua maioria do sexo feminino (55,49%), brancos (51,73%), de 8 a 18 anos (77,64%) e atendidos em escola pública (81,53%). Treze estudos usaram o Questionário de Sintomas Gastrointestinais Pediátricos (QPGS-RIV) para avaliar DGF. Encontramos uma prevalência global de DGF de 23% (95%IC 21-25%, I2 99%). Os principais distúrbios foram constipação funcional (CF) com 12% (95%IC 11-15%) seguido de dispepsia funcional (DF) (5%, 95%IC 11-15%) e síndrome do intestino irritável (SII) (3%, 95%IC 2-4%). A prevalência de DGF foi maior nas Américas, representando 23,67% (95%IC 21, 2-26,2%, I2 91,3%). Conclusão: DGF estão presentes em uma de quatro crianças e adolescentes, representando uma condição comum nessa faixa etária. Os distúrbios centrais foram CF, DF e SII.

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Abstract Background Irritable bowel syndrome (IBS) is a common gastrointestinal disorder; celiac disease is an autoimmune enteropathy that can mimic any functional gastrointestinal disorder. The aim of this study is to estimate the prevalence of celiac disease antibodies (anti Tissue Transglutaminase-tTG) in patients with irritable bowel syndrome. Patients and methods This cross sectional study was conducted on 70 patients with irritable bowel syndrome fulfilling Rome III criteria who visited Azadi Teaching Hospital in Duhok city-Iraq. Patients were classified according to irritable bowel syndrome subtypes into: Diarrhoea Predominant (D-IBS), Constipation Predominant (C-IBS) and Mixed (M-IBS). IgA and IgG anti tTG were used to screen patients for celiac disease. Results A total number of 70 patients (44 females and 26 males) were included; their mean age was 33 years (SD ± 7.64). Five patients (7.1%) were found to have positive both IgA and IgG anti tTG. Three of them have had D-IBS and the other two had C-IBS. No one of the M-IBS patients tested positive. Conclusion The prevalence of anti tTG antibodies in irritable bowel syndrome is high. Patients with D-IBS should be screened for celiac disease.

Resumo Introdução A síndrome do intestino irritável (SII) é um distúrbio gastrointestinal comum; a doença celíaca é uma enteropatia autoimune que pode imitar qualquer distúrbio gastrointestinal funcional. O objetivo deste estudo foi estimar a prevalência de anticorpos contra a doença celíaca (antitransglutaminase tecidual - tTG) em pacientes com SII. Pacientes e Métodos Este estudo transversal foi conduzido em 70 pacientes com síndrome do intestino irritável que atendiam aos critérios de Roma III e se apresentaram ao Hospital de Ensino Azadi na cidade de Duhok, no Iraque. Os pacientes foram classificados de acordo com os subtipos de síndrome do intestino irritável em: predominantemente diarreia (D-SII), predominantemente constipação (C-SII) e mista (M-SII). IgA e IgG antitTG foram usados para rastrear pacientes com doença celíaca. Resultados Um total de 70 pacientes (44 mulheres e 26 homens) foram incluídos; a idade média foi de 33 anos (DP ± 7,64). Cinco pacientes (7,1%) apresentaram IgA e IgG antitTG positivos. Três deles tinham D-SII e os outros dois tinham C-SII. Nenhum dos pacientes com M-SII apresentou teste positivo. Conclusão A prevalência de anticorpos antitTG na SII é alta. A presença de doença celíaca deve ser avaliada em pacientes com D-SII.

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Introducción: los trastornos funcionales gastrointestinales son motivo de consulta frecuente en Gastroenterología, y presentan un serio problema social y en la dinámica familiar. El síndrome de intestino irritable en la población pediátrica es poco diagnosticado, y el dolor abdominal crónico es motivo de consulta frecuente en la infancia y adolescencia. Objetivo: analizar los aspectos más actuales en su diagnóstico y tratamiento, y su relación con el dolor abdominal crónico. Métodos: se revisaron las bases documentales de PubMed, Scielo y Latindex y el Registro Especializado del Grupo Cochrane de datos relacionados con el síndrome de intestino irritable hasta diciembre de 2017, así como las guías de tratamiento postuladas por distintas organizaciones médicas, basadas en los criterios de Roma y de la Medicina Basada en la Evidencia. Desarrollo: se realizó una revisión del tema referido a la infancia, y se incluyeron concepto y patogénesis más aceptadas, así como los criterios de Roma establecidos para el diagnóstico. Se hizo énfasis en la etiología, diagnóstico clínico y pruebas diagnósticas. Se analizaron algunos aspectos del tratamiento. Conclusiones: el síndrome de intestino irritable es relativamente frecuente como causa de dolor abdominal crónico funcional, y el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con síndrome de intestino irritable en la infancia deben ser atendidos en la atención primaria(AU)

Introduction: gastrointestinal functional disorders are a frequent reason for consultation in Gastroenterology services, and represent a serious social problem and in family dynamics. Irritable bowel syndrome in the pediatric population is poorly diagnosed, and chronic abdominal pain is a frequent reason for consultation in childhood and adolescence. Objective: to analyze the ultimate aspects in its diagnosis and treatment, and its relation with chronic abdominal pain. Methods: PubMed, Scielo and Latindex documentary databases and the Cochrane Specialized Register of data related to irritable bowel syndrome until December 2017 were revised, as well as the treatment guidelines presented by different medical organizations based on the criteria of Rome and of Evidence-Based Medicine. Development: a review of the subject referring to childhood was carried out, and the most accepted concept and pathogenesis were included, as well as Rome criteria established for the diagnosis. Etiology, clinical diagnosis and diagnostic tests were emphasized. Some aspects of the treatment were analyzed. Conclusions: Irritable bowel syndrome is relatively common as a cause of chronic functional abdominal pain, and questioning conducted according to Rome criteria is useful for diagnosis. The majority of patients with irritable bowel syndrome in childhood should be treated in the primary care level(AU)

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Abstract Introduction Chronic constipation is the most common digestive complaint at the doctor's office, with high prevalence in the population. However, many patients - and even those physicians not so familiar with pelvic floor disorders-define and consider constipation based on intestinal functionality and stool consistency. But symptoms of incomplete defecation, digital maneuvers, abdominal discomfort, and straining should not be overlooked. Objectives To investigate the correlation between constipation referred and documented through objective criteria in patients admitted on a daytime-nursing ward basis at the Hospital Santa Marcelina, São Paulo. Methodology This is a prospective study of a random sample of patients admitted on a daytime-ward hospitalization basis at Santa Marcelina Hospital to perform minor surgical procedures not related to functional disorders of the gastrointestinal tract in the period from September 2014 to June 2015; the only exclusion criterion was "not agreed to participate in the interview conducted by students of medicine at Santa Marcelina Medical School". Results 102 patients were randomly analyzed in the period considered (51% female) with a mean overall age of 48.6 (19-82) years. Constipation has been reported spontaneously by 17.6% of participants and denied by 82.4%. With the implementation of the Cleveland Clinic's criteria for the diagnosis of constipation, the compliance with the referred symptomatology was 88.9%; the same value was found with the use of the Rome III criteria (Kappa = 0.665). In addition, a higher incidence of constipation was observed in female patients (p = 0.002). Conclusion A higher incidence of constipation was observed in female participants, with no statistical difference with respect to age. Furthermore, a substantial agreement was found between constipation referred and constipation documented through objective criteria.

Resumo Introdução A constipação intestinal crônica representa a queixa digestiva mais comum no consultório com elevada prevalência na população. No entanto, frequentemente, os pacientes e mesmo os médicos, não tão afeitos com os distúrbios do assoalho pélvico, definem e consideram constipação baseados na funcionalidade intestinal e consistência das fezes. Entretanto, os sintomas de defecação incompleta, manobras digitais, desconforto abdominal e esforço evacuatório não devem ser negligenciados. Objetivos Verificar a correlação entre constipação intestinal referida e constatada através de critérios objetivos em pacientes internados em regime de enfermaria dia no Hospital Santa Marcelina, São Paulo. Metodologia Estudo prospectivo de amostra aleatória de pacientes internados em enfermaria dia do Hospital Santa Marcelina para realização de cirurgias de pequeno porte e não relacionadas a distúrbios funcionais de trato gastrintestinal no período entre setembro de 2014 e junho de 2015, cujo único critério de exclusão foi o não consentimento em participar da entrevista realizada pelos alunos do curso de medicina da Faculdade Santa Marcelina. Resultados Foram analisados de forma aleatória 102 pacientes no período sendo 51% do sexo feminino e média de idade global de 48,6 anos (19-82 anos). A constipação foi referida de forma espontânea em 17,6% e negada em 82,4%. Ao se utilizar o critério da Cleveland Clinic para constatar constipação houve uma concordância com o sintoma referido fora de 88,9%, com mesmo valor ao se utilizar os critérios de Roma III (Kappa = 0,665). Além disso, verificou-se maior incidência de constipação intestinal nos pacientes do sexo feminino (p = 0,002). Conclusão Verificou-se maior incidência de constipação no sexo feminino sem diferença estatística baseado na idade. Além disso, constatou-se concordância substancial entre a constipação referida e a documentada através de critérios objetivos.

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OBJECTIVE: the aim of this study was to identify the prevalence of constipation in diabetic patients treated at the endocrinology outpatient clinic at Hospital Universitário Professor Alberto Antunes and PAM Salgadinho, from April to August 2013. METHODS: a descriptive and cross-sectional study, carried out through a questionnaire using the Rome III criteria in 372 patients treated at the outpatient endocrinology clinic. RESULTS: of 372 patients evaluated, the frequency of constipation found was 31.2% among diabetic patients. Females predominated in the sample (72.8%) as well as for the frequency of constipation (80.2%). The incidence of type II diabetes was 97.3% and it was observed that 80.2% of the sample was older than 50 years. One hundred and twelve patients with inadequate glycemic control (HgA1c = 7) had an association with constipation. CONCLUSION: there was an increased frequency of constipation in patients with diabetes mellitus according to the Rome III criteria, in relation to the general population. The inadequate glycemic control in patients with diabetes mellitus increases the frequency of constipation and it is necessary to perform studies that allow the confirmation of this association to demonstrate this hypothesis. (AU)

OBJETIVO: analisar a prevalência da constipação intestinal em pacientes diabéticos atendidos no ambulatório de endocrinologia do Hospital Universitário Professor Alberto Antunes e no PAM Salgadinho (HUPAA), de abril de 2013 a agosto 2013. MÉTODO: estudo descritivo e transversal, realizado através da aplicação de um questionário com os critérios de Roma III no ambulatório de endocrinologia do HUPAA. RESULTADO: em 372 pacientes, 271 feminino, 101 masculino, 162 de etnia branca, 55 negros e 155 pardos, 297 pacientes estavam acima de 50 anos, houve uma frequência de constipação de 31,2% nos pacientes diabéticos. O gênero feminino prevaleceu na amostra (73%) assim como no índice de frequência da constipação (80,2%). Em nossa amostra a diabetes Tipo II foi verificada em 360 pacientes (97%) e o tipo 1 em 12 pacientes (3%), observou-se que 80% da amostra apresentavam idade superior a 50 anos. Em 112 pacientes com controle glicêmico inadequado (HgA1c =7) havia uma associação com a constipação intestinal. CONCLUSÃO: encontramos maior frequência da constipação intestinal em pacientes com Diabetes Mellitus, segundo os critérios de Roma III, em relação à população geral. Há uma associação entre o controle glicêmico inadequado nos pacientes com Diabetes Mellitus e a frequência da constipação, faz-se necessário a realização de outros estudos que possibilitem confirmar a associação dessa varíavel para comprovação desta hipótese. (AU)

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The sphincter of Oddi dysfunction is a little known entity that typically occurs in post-cholecystectomy patients with abdominal pain with biliary or pancreatic characteristics. It represents an important cause of idiopathic recurrent acute pancreatitis. Most of the patients referred for sphincter of Oddi dysfunction study have another disease which explain the symptoms, so a careful history and appropriate physical examination often can identify the true source of the pain. The most used grading score is the Milwaukee classification, based on clinical, laboratory, imaging and cholangiographic findings. In the last decade, new and more applicable criteria have been developed, such as Rome III criteria, which do not require functional tests considered complex and not available in non-specialized centers. The sphincter of Oddimanometry is considered the gold standard for the diagnosis of this entity, allowing for the determination of which patients will benefit from endoscopic therapy (sphincterotomy). There are some noninvasive diagnostic tests that have failed to show strong correlation to displace the sphincter of Oddi. The treatment of this condition is mainly based on endoscopic sphincterotomy, with variable success rates depending on the type of dysfunction. This article presents a review of the most important aspects related to the sphincter of Oddi and its relationship with idiopathic recurrent pancreatitis.

La disfunción del esfínter de Oddi es una entidad poco conocida, que típicamente se presenta en pacientes post-colecistectomía con dolor abdominal de tipo “biliar” o “pancreático”. Representa unaimportante causa de pancreatitis aguda recurrente idiopática. La mayoría de los pacientes derivados para estudio de disfunción del esfínter de Oddi corresponden a otra causa o enfermedad que explica los síntomas, por lo que una cuidadosa historia clínica y un adecuado examen físico, a menudo permiten identificar el verdadero origen del cuadro doloroso. La clasificación más utilizada es la de Milwaukee basada en parámetros clínicos, de laboratorio, imagenológicos y colangiográficos. En la última década, se han elaborado criterios de mayor aplicabilidad clínica como los criterios de Roma III, que no requieren de test funcionales considerados complejos y poco disponibles en centros no especializados. La manometría del esfínter de Oddi es considerado el gold standard en el diagnóstico de esta entidad, permitiendo además, establecer quiénes se beneficiarán con la terapia endoscópica (esfinterotomía). Se han desarrollado una serie de otros métodos diagnósticos no invasivos, que no han logrado demostrar una correlación suficientemente sólida para desplazar a la manometría. El tratamiento de esta condición se basa principalmente en la esfinterotomía endoscópica, con una tasa de éxito variable dependiendo del tipo de disfunción. En el presente artículo se revisarán los aspectos más importantes relacionados con la disfunción del esfínter de Oddi y su relación con pancreatitis recurrente idiopática.

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La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria(AU)

The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services(AU)

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La diarrea funcional se presenta con frecuencia en la práctica pediátrica, y generalmente no se asocia a alteraciones nutricionales, pero sí a esquemas dietéticos incorrectos. Se actualiza su importancia clínica, se hace énfasis en la patogenia, diagnóstico y en los métodos de tratamiento. Consideramos que es la causa más frecuente de diarrea crónica inespecífica y que el interrogatorio dirigido según los criterios de Roma es útil para su diagnóstico. La mayoría de los pacientes con esta enfermedad en la infancia deben ser tratados en la atención primaria

The functional diarrhea is frequent in the pediatric practice and in general it is not associated with nutritional alterations, but to incorrect dietary schemes. Its clinical significance is updated and its pathogenesis, diagnosis and treatment methods are emphasized. Authors considered that the functional diarrhea is the more frequent cause of unspecific chronic diarrhea and the questioning directed according the Rome criteria is very useful for its diagnosis. Most of patients presenting with this disease during childhood must to be treated in primary care services

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El síndrome de intestino irritable (SII) es una entidad clínica crónica, recurrente y común, de difícil diagnóstico, siendo la base diagnóstica la evaluación sintomática. Se ha descrito el estrés emocional como un factor desencadenante de los síntomas que la identifican, pudiéndose presentar con una alta prevalencia en la población joven y laboralmente activa. Objetivos: Determinar la prevalencia del SII, según los Criterios de Roma III, en una población de médicos de tres centros hospitalarios de Maracay. Mayo 2008 y evidenciar la relación del estrés laboral con esta patología. Métodos: A una muestra de 83 médicos especialistas de consultas, aparentemente sanos, del HCM, ASODIAM y HS, escogidos al azar, se les aplicó una encuesta-cuestionario, previo consentimiento verbal individual, interrogando los criterios de Roma III y la Escala de Maslach para medir el estrés laboral. Resultados: Según Roma III la prevalencia del SII en médicos especialistas fue de 37,3% (77,5% femeninos y 22,5% masculinos), de los cuales el 67,7% presentaron estrés laboral. Conclusión: Según el diagnóstico por criterios de Roma III existe una alta prevalencia de SII en la población de médicos especialistas, donde se describe al estrés como posible factor desencadenante de hechos fisiopatológicos que provocan la sintomatología de este síndrome en el grupo estudiado.

Irritable bowel syndrome (IBS) is a clinical chronic entity, recurrent and common; the diagnosis is based on symptomatic diagnostic evaluation. Emotional stress has been described as a trigger for the symptoms; it can be presented with a high prevalence in young population and labor force. Objectives: To determine the prevalence of IBS according to Rome III Criteria in a population of three doctors of hospitals in Maracay, May 2008 and to demonstrate the relationship of work stress with this condition. Methods: A sample of 83 specialists for consultations, apparently healthy of the HCM, and ASODIAM HS, chosen randomly, were interviewed with a questionnaire survey, previous individual verbal consent, using the Rome III Criteria and the Scale of Maslach to measure work stress. Results: According to the Rome III Criteria, the prevalence of IBS in medical specialists was 37.3% (77.5% female and 22.5% male), of which 67.7% had work-related stress. Conclusion: Accordingwith the Rome III Criteria there is a high prevalence of IBS in the physiciansÊ population, which describes stress as a possible trigger for pathophysiological events that cause the symptoms of this syndrome in this study.