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PubMed1993

Lactose malabsorption. Optimalization of investigational methods.

Although the prevalence of lactose malabsorption is high and the importance of this diagnosis is established in gastroenterological practice, still a variety of poorly standardized tests is used to investigate the ability of the small bowel to digest lactose. In this report the various most commonly used lactose malabsorption tests are described and compared with each other knowing that a 'gold standard' does not exist. The hydrogen breath test is the test most used in clinical practice. On the basis of recent investigations the recommendation is made to improve the accuracy of this test by prolonging it to 4 hours and by simultaneous measuring of the oro-coecal transit time.

Blood Glucose↗
PubMed1994

[Lactobacilli in the treatment of dyspepsia due to dysmicrobia of various causes].

In 30 patients with dyspepsia caused by dysbacteriosis of the gastrointestinal tract the authors administered the preparation Lactobacillus acidophilus (Rossel Co. Canada)--1. capsule with 2 billion live bacteria, in the morning after breakfast. The patients were divided into four groups: maldigestion, malabsorption, radiation enterocolitis and administration of antibiotics. The patients recorded themselves their subjective symptoms: pain, pressure, bloating, flatulence and appetite, and as to objective symptoms, the number and consistency of bowel movements, changes of body weight. The most rapid effect was achieved in dysbioses after antibiotics--within 3-4 days normalization occurred which persisted even after discontinuation of the drug. In maldigestion after one week bloating, flatulence, abdominal pain and pressure in the epigastrium was milder, and within two weeks the condition improved further. An excellent effect was achieved in radiation enterocolitis. In patients with lactose intolerance the tolerance of dairy products improved. No side-effects were observed, the preparation was very well tolerated; the mean body weight increment was 0.75 kg in three weeks. The preparation proved a new useful probiotic which is highly effective in dyspepsias caused by dysbiosis of the intestinal microflora.

Antibiosis↗
PubMed1993

[Clinical and etiologic study of 90 cases of chronic diarrhea].

90 patients with chronic diarrhoea underwent this prospective study. They were seen in a private hospital of Lima during 1990 and 1991. According to a methodologic plan for determining sources and the diseases that originate chronic diarrhoea. In all patients hematologic, bioquimic, coprocultures, coproparasitologic exams were done, chest and intestinal transit X-rays. All underwent duodenal content culture. Colon X-ray in 25 cases; proctosigmoidoscopy in 14 and upper digestive endoscopy in 19 patients. Abdominal echography in 12 and TAC in 2 cases. The final results showed as determinant diseases for chronic diarrhoea, according to their frequency: enteroparasitosis (23.3%), functional digestive disorders (20.0%), intestinal bacterial overpopulation (15.5%) of unknown origin (8.8%), colon diverticulus (7.7%) proven and probably (5.5%), lactose intolerance (3.3%), diabetes mellitus (2.2%), and in one case (1.1%) the following: intestinal linfoma, pancreas malignancy, AIDS, colonic and deformation and megaloblastic anemia. The causes of chronic diarrhoea are several and multifactorals and in this study we prove the preeminence of the intestinal parasitosis, functional disorders and intestinal bacterial overpopulation and with less frequency other pathologies.

Adolescent↗
PubMed1977

Symptomatic intestinal disaccharidase deficiency in alcoholics.

Lactase and sucrase activities were measured in jejunal biopsies from a group of alcoholic and nonalcoholic men of similar nutritional status, consisting of American blacks, and whites of northern European origin. When measured withing 10 days of alcohol withdrawal, sucrase activity was decreased by 33% in the alcoholics. Lactase activity was less than 1 U per g in 100% of the black and 20% of the white alcholics as compared to 50% of the black and none of the white control subjects. Lactase activity was virtually absent in 45% of the black alcoholics. A second jejunal biopsy after an additional 2-week period of alcohol abstinenece exhibited significant secondary increases in the activities of both disaccharidases. Oral administration of lactose (1 g per kg of body weight) resulted in significantly lower blood glucose concentration and higher incidence of adverse effects in alcoholics, mainly among the blacks. Although data from larger populations are needed to confirm our observations, these findings suggest that chronic alcohol ingestion decreases intestinal disaccharidase activities even in the absence of overt malnutrition. The decrease in enzyme activity produced by alcohol is associated with increased morbidity after lactose administration.

Adult↗
PubMed1993

[Secondary osteopenia in gastrointestinal diseases].

Of 2557 patients with osteopenia examined during the past 17 years 1707 were classified as secondary osteoporosis and 406 as osteomalacia. Diseases of the gastrointestinal tract participate as the cause of osteoporosis in 635 patients (37.19%) and osteomalacia was the cause in 210 patients (51.72%). The highest ratio in osteoporoses are lactose intolerance--256 cases (14.99%); maldigestion was recorded in 305 patients (17.86%). This category comprises gastrectomies of both types, severe affections of the gallbladder and biliary pathways, insufficiency of the external pancreatic secretion, patients with frequent exacerbations of ulcerative colitis. Resections of the small intestine are on the borderline between maldigestion and malabsorption. Malabsorption alone was found in 74 patients (4.33%) and there is also sprue, M. Crohn, diverticulosis of the small intestine, diabetic enteropathy and scleroderma. In secondary osteomalacia the leading cause is hepatic damage recorded in 167 patients (41.13%) and malabsorption in 43 patients (10.59%).

Bone Diseases, Metabolic↗
PubMedDate not supplied

[Stable isotopes in biomedical diagnosis and research].

Atoms that are chemically identical but that differed slightly in weight due to the number of nuclear neutrons are called isotopes stables, meaning that do not degrade spontaneously. Mass spectrometry is the analytical technique to evaluate the enrichment on these isotopes with a variety of applications in the clinical diagnosis of pathological processes and the quantitation of metabolic events such as bacterial growth (Helicobacter pylorii), Phenylketonuria, lactose intolerance, liver and pancreatic function, body composition and energy expenditure, cholesterogenesis, glucose utilization, etc. in an easy, non-invasive and specific way as mass spectrometers develop.

Clinical Laboratory Techniques↗
PubMed1996

Functional diagnostic work-up in patients with irritable bowel syndrome.

The first aim of the study was to find a cause of symptoms in patients suffering from "irritable bowel syndrome" using diagnostic tests aimed at functional disorders of lower gut. A second aim was to test, whether the presence of irritable bowel syndrome (or, synonymously, absence of classic organic disease) can be predicted by specific symptoms. 134 consecutive patients (50 +/- 16 SD years, range 17 to 88, 94 women) presenting in our gastroenterological outpatient department with abdominal pain and altered bowel habits were included. A conventional diagnostic work-up aimed at classic organic diseases and, if negative, a functional diagnostic work-up aimed at gastrointestinal malfunction such as dietary fibre trial, functional proctoscopy, defecography, colonic transit of radiopaque markers, anorectal manometry, and lactose tolerance test were done. A classic organic disease was found in only 15 of 134 patients by conventional diagnostic tests. Functional diagnostic work-up yielded a diagnosis in 70 of the remaining 119 patients that else would have been labeled to suffer from IBS (25 slow transit constipation, 20 disordered defecation, nine low fibre intake, and nine lactose intolerance among them). When symptoms were evaluated with a standardized questionnaire, "constipation" and the "necessity of straining to open bowels" were very specific for functional bowel disorder (92% and 100%), but sensitivity of both symptoms was only about 60%. The so-called "Manning criteria" had a very low prevalence in our sample and so were not discriminatory. Since in more than half of the patients with "irritable bowel syndrome" a specific diagnosis can be reached, functional tests should be considered in such patients. The symptom "constipation" in patients with lower gut complaints predicted a functional disorder rather than a classic organic disease with a high specificity.

Adolescent↗
PubMed1995

The long-term outcome after negative appendix operation.

We evaluated the long-term outcome of "negative appendix" (NA) by analysing the follow-up results of 76 patients identified from a group of 670 appendectomized patients. Randomly selected and histologically proven cases of true acute appendicitis (TA) matched for age and sex were identified to construct case control pairs. Special interest was focused on gender and age, by analysing the results separately in men and women in two age groups (15-39 years and > or = 40 years). The results showed that NA was most common in women aged 15-39 years (21% of appendectomized cases in this age group). At follow-up examination after a mean follow-up of 2.9 years two-thirds of patients were symptomfree. Women aged 15-39 years had significantly more complaints (P < 0.05) and findings (P < 0.05) than patients with TA. In women aged > or = 40 years no significant differences were detected, nor in either age groups in men. Lactose intolerance was the most common finding in symptomatic patients. In conclusion, patients with NA were mostly young women. At long-term follow-up the great majority of patients were symptomfree and appeared not to have developed any serious disease. Routine follow-up for patients with NA does not thus seem necessary.

Adolescent↗
PubMedDate not supplied

[Management of infantile colics].

UNLABELLED: Infantile colic concerns about 10-30% of all newborns and has been defined as a condition characterized by paroxysmal episodes of unexplained full force crying for at least three days a week and continuing for one week or more in a thriving well-nourished infant. The disorder more likely occurs in the evening, without identifiable causes and resolves spontaneously by the fourth month of life. The several factors involved in the etiopathogenesis (food intolerance or allergy to cow's milk protein, intolerance to lactose, intestinal hyperperistalsis, neuro-hormonal immaturity, maternal anxiety and familial stress), make the management of infants with colics difficult. We propose a scoring system for the evaluation of colics in infants based on: 1) crying intensity and duration; 2) accompanying characteristics of crises (e.g. meteorism, family history for allergic disease, type of feeding, type of stools); 3) evaluation of parents' opinion of their infants' crying. Type of management is based on the score: a) crying that is unrelated to colics: treatments referred to specific diagnosis. b) crying that is related to colics but not severe: first and second step of management; c) crying that is related to colics and is severe: third step of management. MANAGEMENT: first step: pacifier, rocking, dull continuous background noise, hot water bottle on the abdomen, herbal tea, simethicone. Second step: pharmacological treatment and periodic controls. Pharmacological treatment include antispastic drugs (e.g. cimetropium bromide). Third step: dietary modification and/or pharmacological treatment: mothers of breast-fed infants are given a diet with no milk or products containing its proteins, or fish, or eggs. Infants who are not breast-fed receive soy milk and if symptoms continue soy milk is substituted with hydrolyzed casein milk formula. Pharmacological treatment include antispastic drugs (e.g. cimetropium bromide and in non responders dicyclomine hydrochloride). Dietary modifications appear more suitable than pharmacological treatment in resolving symptoms, since side effects of drugs have been described and our recent results indicate appropriate dietary modifications offer better results than pharmacological treatment in resolving crises. However, before interrupting dietary modifications and reintroducing cow's milk proteins, infant's tolerance to such proteins is tested. In any case because of the good prognosis and rapid regression of symptoms, dietary regimens or pharmacological treatment should only be applied if really necessary and for brief periods under medical supervision.

Colic↗
PubMed1977

[Acute gastroenteritis. Clinical evolution without use of antibiotics (author's transl)].

Authors present a prospective study upon 193 cases of acute gastroenteritis in infants 1 to 24 months of age, giving special attention to clinical evolution of the disease without any use of therapy of either antibiotics or other antidiarrheal agents. Data on epidemiology and etiology of this series are similar to those previously reported by other authors. Mean duration of diarrhea was 2,5 days, whereas mean hospital stay was 7,5 days. The number of cases of prolonged diarrhea was 13, from which six were cases of lactose intolerance, six were cases of cow's milk protein intolerance and one was a case of intractable diarrhea. The little use fulness of antibiotics in the treatment of acute diarrhea is commented and also a discussion is made of the different factors involved in the onset of the complications above mentioned.

Acute Disease↗
PubMed1996

[Use of enzyme substitutes in hypolactasia].

The paper presents the results of clinical and laboratory studies of lactrase, a drug containing lactase. This agent is recommended for splitting lactic sugar in subjects with appreciably decreased production of endogenous lactase (hypolactasia). Twenty-eight patients with this condition were examined. Manifest clinical symptoms of the condition were observed after loading with 50 g of lactose in all examinees. Addition of 250 mg of lactrase to lactose led to complete clinical compensation of the deficit of endogenous lactase in 75% examinees, and if 500 mg of lactrase was administered, hypolactasia was compensated in virtually all patients. A single intake of 50 g of lactose with lactrase causes a statistically reliable increase of glycemia in such patients. Moreover, a reliable effect of lactrase was observed when measuring galactose in the urine following the lactose test with 250 and 500 mg of lactrase. Our results indicate a high efficacy of lactrase in the treatment of patients with hypolactasia.

Adolescent↗
PubMed1997

Intestinal calcium absorption from mineral water.

Little is known about the bioavailability of calcium in water and various beverages. Some mineral waters contain large amounts of calcium that could compensate for insufficient consumption of dairy products. The fractional intestinal absorption of calcium (FCA) was measured in 12 healthy adult volunteers, using a trace dose of radiocalcium and 200 mg of calcium carrier, part of which was calcium contained in mineral water. Measurements were performed in fasting subjects consuming a standard breakfast. In all the subjects, three mineral waters with a calcium concentration of 10.4, 78, and 467 mg/l, respectively, were tested. Calcium absorption occurred with the same kinetics for each of the mineral waters tested, and within 2 h of the oral dose, equilibrium was reached between absorbed calcium and calcium remaining in the gastrointestinal tract, which resulted in a constant FCA value. This level comprising between 34.1 and 37.0% was independent of the daily calcium consumption and the chemical content of the mineral water. In conclusion, calcium contained in mineral waters in available for intestinal absorption. In a given normal subject, the only rate-limiting factor for FCA is the amount of total calcium given with foods and drinks. Mineral waters containing calcium are recommended as a supplemental source of calcium to achieve optimal calcium requirements, especially in aged people with lactose intolerance.

Adult↗
PubMed1998

[Recurrent stomach complaints in children].

Next to headache recurrent gastro-intestinal complaints constitute the most common reason for medical consultation among daycare and school children. The use of more sophisticated examination methods has shown that in up to 50 per cent of cases the cause of the gastric complaints is a treatable disease or a functional anomaly of the gastro-intestinal tract. The commonest conditions are lactose intolerance, gluten sensitivity, gastro-oesophageal reflux, and gastritis. In some cases stomach pain is triggered by psychosomatic mechanisms. Depending upon the child's age, aetiological indications can sometimes be derived from history taking. In many cases the investigations can be made in the out-patient clinic. The cornerstones of treatment are various kinds of dietary elimination regimens, prokinetic agents, and antibiotics. Recently, the investigation of neuroendocrinological and neurophysiological processes related to psychosomatic causes of gastric complaints has once again become common.

Abdominal Pain↗