Background Scleroderma is a systemic inflammatory disorder that can compromise the gastrointestinal tract in up to 90% of patients. Aim The purpose of this work is to characterize esophageal, gastric, and intestinal compromise in patients with scleroderma by means of minimally invasive methods and its association with symptoms and severity of their rheumatological condition. Methods Patients with systemic sclerosis were recruited according to the criteria of the American College of Rheumatology. The study of digestive involvement was carried out on four consecutive days: esophageal manometry was performed on the first day, intestinal manometry on the second day, surface electrogastrography on the third, and hydrogen breath test on the fourth. The Mann-Whitney test was used for quantitative variables and the chi-squared test for categorical variables (p < 0.05). Results A total of 30 patients were included, with an average age of 52.7 years and 93% women. Average disease evolution duration was 6.5 years, 70% with limited variety. Rodnan averaged 12 points, being higher in the diffuse variety. The main symptom was heartburn, followed by abdominal distension, with no differences between subtypes except for diffuse nausea; 80% had intestinal manometric compromise, 76% esophageal manometric compromise, and 30% electrogastrographic compromise. Bacterial overgrowth was evidenced in two-thirds (66%) of the patients, and 23% of the patients had simultaneous esophageal, gastric, and intestinal involvement, which correlated with greater skin involvement but not with gastrointestinal symptoms. Conclusions Gastrointestinal involvement in patients with scleroderma is frequent and is observed regardless of the symptoms and clinical characteristics of the latter, except for skin involvement.

Background/Aims Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by a failure of the propulsion of intraluminal contents and recurrent symptoms of partial bowel obstruction in the absence of mechanical obstruction. Regional variations of the intestinal compromise have been described. Intestinal manometry can indicate the pathophysiology and prognosis. Our objective is to establish the demographic and clinical characteristics of group Chilean patients and analyze the motility of the small intestine and its prognostic value. Methods Patients with symptoms of intestinal pseudo-obstruction with dilated bowel loops were included, in all of whom a manometry of the small intestine was performed using perfused catheters. Results Of the 64 patients included, 51 women (average age 41.5 ± 17.6 years), 54 primary and 10 secondary CIPO were included. Dilatation of the small intestine was the only finding in 38 patients; in the remaining, the compromise was associated with other segments, primarily the colon. Forty-nine patients underwent 65 surgeries, mainly exploratory laparotomies and colectomies. Intestinal manometry was performed on all patients; 4 “patterns” were observed: neuropathic (n = 26), myopathic (n = 3), mixed (n = 24), and a group without motor activity (n = 11). The most relevant findings were the complex migrating motor disorders and decreased frequency and propagation of contractions. The 9 patients who died had a severe myopathic compromise. Conclusions In our series, isolated small bowel compromise was the most common disorder. Neuropathic motor compromise was observed in most of the patients. Mortality was associated with severe myopathic compromise.

Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.

The role of small intestinal bacterial overgrowth (SIBO) in functional digestive disorders in the pediatric population is a matter of controversy, since methods currently used to establish this diagnosis are difficult to interpret. The aim of this work was to analyze the characteristics of the lactulose H2 breath test (LHBT) in children with functional gastrointestinal symptoms according to more recent criteria.

BACKGROUND:Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.

BACKGROUND:Small intestinal bacterial overgrowth (SIBO) has been observed in several disorders of the gastrointestinal tract. Studies have shown abnormalities of motor function in obese patients, and there is indirect evidence suggesting that SIBO is present in them.AIMS:To study small intestinal motility and the prevalence of SIBO in obese patients and to determine whether there was any relationship between both parameters.METHODS:Thirty-nine patients scheduled for bariatric surgery were subjected to hydrogen breath test with lactulose and to a stationary small intestinal motility study with perfused catheters.RESULTS:SIBO was observed in 41% of obese patients and was not related to body mass index. Small intestinal manometry showed a marked increase of clustered contractions in obese patients with SIBO compared to obese subjects without SIBO, whereas all the other parameters of fasting cyclic activity were not different.CONCLUSIONS:SIBO was a frequent finding in obese patients and was associated with an increased pattern of clustered contractions, which was not observed in absence of SIBO.

The paper describes a feature selection process applied to electrogastrogram (EGG) processing. The data set is formed by 42 EGG records from functional dyspeptic (FD) patients and 22 from healthy controls. A wrapper configuration classifier was implemented to discriminate between both classes. The aim of this work is to compare artificial neural networks (ANN) and support vector machines (SVM) when acting as fitness functions of a genetic algorithm (GA) that performs a feature selection process over some features extracted from the EGG signals. These features correspond to those that literature shows to be the most used in EGG analysis. The results show that the SVM classifier is faster, requires less memory and reached the same performance (86% of exactitude) than the ANN classifier when acting as the fitness function for the GA.

The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25% of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6% sensitivity, 92.9% specificity, and an error of 17.9 +/- 6% (with a 95% confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders.To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID).Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO.We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating.This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.

During continuous intraintestinal infusion of elementary diets, periodic fluctuation of the frequency of contractions has been observed. This study sought to characterize the temporospatial organization of this pattern and the influence of cholinergic input. Studies were performed on unanesthetized dogs with a duodenal cannula. Motor activity was recorded by means of infused catheters and external transducers. Nutrients were infused continuously at the duodenum and jejunal levels. Studies were repeated after administration of atropine. Six to 14 periodic variations of frequency of contractions during 10 basal infusion experiments were observed in random order. During duodenal infusion, atropine significantly increased the number of these events, associated with a synchronous pattern. Frequency and amplitude of contractions during jejunal infusion were significantly lower compared to duodenal infusion. Cyclic pattern elicited by nutrient infusion is related to a cholinergic mechanism; changes depend on the level of infusion.

BACKGROUND:Helicobacter pylori is a pathogenic bacterium that infects a significant number of individuals. At present, therapeutic strategies to eradicate this bacterium depend on our knowledge of its resistance to antimicrobials.AIMS:To evaluate the primary resistance of H pylori to metronidazole (Mtz), clarithromycin (Cla), and tetracycline (Tet) in symptomatic out-patients.MATERIAL AND METHODS:Fifty independent isolates of H pylori were obtained by endoscopy-assisted gastric biopsy from patients attending the University of Chile Clinical Hospital, that previously had not been treated with an eradication regime against this bacterium. The minimal inhibitory concentration of each antimicrobial was determined by agar dilution method.RESULTS:Forty five and 27% of the isolates were found to be resistant to Mtz and Tet, respectively; the majority of these resistant isolates were from patients older than 21 years. Twenty percent of isolates were resistant to Cla; these were distributed evenly among different ages. Thirty two percent of the isolates were resistant to two or more of the antimicrobials.CONCLUSIONS:The high frequency of naturally occurring, antimicrobial-resistant strains of H pylori poses a national and world-wide problem for public health.

BACKGROUND Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. AIM To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). MATERIAL AND METHODS Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. RESULTS We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating. CONCLUSIONS This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients.

Background: Many patients with irritable bowel syndrome (IBS) have lowered sensory thresholds to rectal distention when compared to control subjects, a phenomenon called visceral hypersensitivity. Aim: To investigate the usefulness of a rectal barostat as a diagnostic tool in IBS and if there are differences in visceral hypersensitivity in different groups of IBS patients. Patients and Methods: Ten healthy subjects and 19 IBS patients, defined using Rome II criteria (12 with constipation, three with diarrhea and four alternating between diarrhea and constipation), were studied. Sequential isobaric rectal distentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reported pain, were carried out. Visceral hypersensitivity was defined as a pain threshold tinder 38 mmHg. Results: Only 26% of IBS patients bad visceral hypersensitivity (1696 and 4396 of patients with IBS and constipation and IBS and diarrhea or alternating symptoms, respectively, p = NS). Pain threshold in controls, patients with IBS and constipation and patients with IBS and diarrhea or alternating symptoms was 43.8 +/- 6.6, 45.3 +/- 9.2 and 40.8 +/- 9.2 mmHg, respectively (p = NS). Conclusions: Our results do not support the usefulness of the electronic rectal barostat as a diagnostic method to diagnose IBS.

Background: Studies in patients with chronic severe constipation, suggest the presence of a diffuse motor disorder of the gastrointestinal tract. Aim: To investigate small bowel motor activity in a group of Patients with severe constipation. Material and Methods.- Forty three patients (age range 13 to 70 years, 40 women) with severe Constipation referred to our motility laboratory were studied. Ten bad a previous colectomy. Radiological examinations showed a megacolon in 30 and dilatation of small intestinal loops in nine; the remaining X rays studies were normal. Small intestinal motility was studied using perfused catheters and external transducers. Results: Ten patients bad normal motor recordings. Eight patients showed a neuropathic disorder characterized by a continuous irregular Pattern of contractions of normal amplitude,. with absence of phase III of the migrating motor complex (MMC). Sixteen presented a normal MMC associated to a decreased amplitude of contractions (Miopatic disorder). Nine showed both types of motor disorders (Mixed pattern). Normal radiological findings were more commonly associated to normal manometric recordings. By contrast, an altered motor activity, mainly of myopathic and mixed type motor disorder, was observed in all patients with dilated small intestinal and colonic loops. Conclusions: The presence of small intestinal motor disorders was a frequent finding in this selected group of patients with chronic constipation (Rev Med Chile 2006; 134: 181-6).