Proton pump inhibitors could have an impact on the results of breath tests performed in patients ... more Proton pump inhibitors could have an impact on the results of breath tests performed in patients with irritable bowel syndrome. This impact could be due to the development of small intestine bacterial overgrowth. To compare the prevalence of fermentative profile alterations of irritable bowel syndrome patients exposed and not-exposed to proton pump inhibitor therapy. Subjects with irritable bowel syndrome were enrolled. A validated questionnaire assessing symptom severity as well as proton pump inhibitor treatment was delivered. A lactulose breath test was undertaken by each enrolled subject. Fermentative profile (area under the curve of hydrogen excretion/time) was compared between proton pump inhibitors consumers and non-consumers. Furthermore, small intestine bacterial overgrowth prevalence was compared. Two hundred and twenty five patients were enrolled. No significant differences were found on the fermentative profile between groups [AUC mediana 3,776 (rango 2,124-5,571) vs 4,3...
Aim. To perform a measurement of the pH in nose, pharynx and esophagus in patients with combinati... more Aim. To perform a measurement of the pH in nose, pharynx and esophagus in patients with combination of esophagitis and rhinosinusitis compared to control groups. Methods. Diagnosis of rhinosinusitis was carried out on the basis of international criteria (1). Diagnosis of esophagitis was carried out on the basis of the Los Angeles classification (2). 76 patients aged 18 to 62 years were randomized into 3 groups. Group A included 25 individuals with a combination of rhinosinusitis, heartburn and esophagitis; in group B were 29 patients with rhinosinusitis without heartburn and without esophagitis; in group C were 22 persons without rhinosinusitis and without GERD. For all patients were performed a 24-hour pH monitoring of the esophagus, pH-metry of the nose and pharynx. For all patients performed microbiological examination of discharge from the middle nasal passage. Results. The mean time with pH below 4 in the esophagus during 24 hour was equal to 25.4% in Group A, 23.8% in group B, and 5.2% in group C (OR1-3=6,20; CI=4,05-9,48; OR23=5,69; CI= 3,73-8,67). The pH of the nose in patients in groups A, B and C was similar. Middle pH in the pharynx in patients in group A was 4,7 ± 0,4; Group B 6,4 ± 0,6 (p1-2 <0,02); Group C 7,2 ± 0,6 (p1-3 <0,002). Microbiological examination revealed strains of S. Aureus, E. Coli, Candida albicans at 100% of patients in group A, 52% of people in group B (OR1-2=47,71; CI=2,65-857,6) and 23% in group C (OR13=162,27; CI=8,42-3126,21). Conclusion. The patients with a combination of rhinosinusitis and esophagitis observed decrease of pharyngeal pH and recorded more frequent seeding of pathological flora in the nasal mucosa in versus with persons without GERD. References: 1. Fokkens W.J., Lund V.J., Mullol J. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012; 3(23): 1-298. 2. Lundell L.R., Dent J., Bennet J.R. Endoscopic assessment of oesophagitis clinical and functional correlates and further validation of Los Angeles classification. Gut. 1999; 45(2): 172-180.
There is growing evidence that gut flora plays a role in the development of Irritable Bowel Syndr... more There is growing evidence that gut flora plays a role in the development of Irritable Bowel Syndrome (IBS). Abdominal bloating is a common symptom in these patients and the severity of this symptom could be related to the variations in their fermentative profiles, obtained by measuring the levels of breath hydrogen excretion after lactulose ingestion. Our objective was to determine the difference in abdominal bloating severity between IBS patients with high vs low levels of breath hydrogen excretion after lactulose administration. Lactulose breath tests were carried out on IBS patients in our institution between July 2009 and August 2010. Patients were requested to fill out a validated questionnaire to assess the severity of their symptoms. Abdominal bloating severity score was compared among patients with high and low breath hydrogen levels. A total of 234 patients were enrolled. There was a statistically significant difference in the abdominal bloating severity score between group...
Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diag... more Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. [corrected] During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologic acid reflux (HyPAR...
Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber di... more Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant ...
Some patients complain of digestive symptoms related to diary products intake. This intolerance c... more Some patients complain of digestive symptoms related to diary products intake. This intolerance could be associated with an intestinal bacterial overgrowth or an increased fermentative intestinal profile and not due to lactose malabsorption. To estimate the prevalence of bacterial overgrowth in subjects with digestive symptoms related to diary products intolerance. Patients who had performed hydrogen breath test due to chronic functional distension syndrome (Rome III) were analyzed. Thirty of them (22 female, average age 52 years) complained of symptoms related to diary products intake. All subjects completed a nutritional survey that allowed to assess the degree of tolerance to milk products and performed the hydrogen breath test with lactulose as substrate. Bacterial overgrowth was considered when baseline values were over 15 parts per million (ppm), values before 80 minutes were greater than 20 ppm or values of area under the curve were greater than 3,000 ppm/min in the 180 studi...
Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibioti... more Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibiotics. Certain probiotics have proved to be clinically effective in patients with abdominal distension. To compare the short-term clinical efficacy of metronidazol vs. a probiotic in patients with SIBO and functional chronic abdominal distension. Patients and methods. This was a randomized prospective pilot study. The study population consisted of 50 patients with chronic abdominal distension (Rome III criteria) and diagnosis of SIBO made by a lactulose H2 breath test. Patients were consecutively randomized to receive either metronidazol or a probiotic. The metronidazol group consisted of 25 subjects (23 women, median age 49 +/- 19 years old), who received metronidazol (Flagyl), 500 mg bid for 5 days. The probiotic group consisted of 25 subjects (20 women, median age 58 +/- 19 years old). The probiotic administered to the latter group contained Lactobacillus casei (3.3 x 10(7) UFC), Lactoba...
INTRODUCTION. There are three indexes that correlate symptoms and reflux episodes in pHmetry test... more INTRODUCTION. There are three indexes that correlate symptoms and reflux episodes in pHmetry tests. The utility of these indexes have been evaluated in prospective trials but their advantages and disadvantages remain controversial. To assess the clinical utility of the pHmetric symptomatic correlation indexes in patients with pathological acid reflux. A sequential pilot study of pHmetry tests was performed between September 2008 and June 2010. Twenty patients with gastroesophageal reflux and a DeMeester score above 14.5 were included. For the analysis, a distinction was made between strong acid reflux episodes (pH < 4) and weak acid reflux episodes (pH < 7 and > 4). The following indexes were calculated for both groups mentioned before: symptom index (SI), symptom sensitivity index (SSI) and symptom association probability (SAP). The mean age was 54 and 55% of patients were male. There were 116 symptomatic episodes (mean 5.8 per patient), 1,634 strong acid reflux episodes a...
There is evidence suggesting that intestinal microbiota plays a role in the development of irrita... more There is evidence suggesting that intestinal microbiota plays a role in the development of irritable bowel syndrome. Its activity can be indirectly assessed using the lactulose breath test. Antibiotics like rifaximin or probiotics can be used as therapeutic options for patients with irritable bowel syndrome. Our purpose was to evaluate the efficacy of a sequential treatment with rifaximin and probiotics in these patients. We prospectively evaluated patients with diagnosis of irritable bowel syndrome according to Rome III criteria. Included patients had to fill in a questionnaire in order to assess their symptoms severity. A lactulose breath test was also performed in each case and a curve with the results of hydrogen concentration and time was elaborated. Then, the area under the curve was calculated After initial evaluation, patients received a seven-day treatment with rifaximin, followed by a ten-day course of probiotics. Thirty days after completion of treatment a new lactulose b...
There is growing evidence that a disorder in intestinal microbiota would contribute to the develo... more There is growing evidence that a disorder in intestinal microbiota would contribute to the development of symptoms in irritable bowel syndrome (IBS) patients. In a subgroup, a remarkably low hydrogen production in lactulose breath test (LBT) is observed. We presume in these patients a predominance of hydrogen consuming gut flora. [corrected] Describe the clinical presentation of lBS patients with low hydrogen production and to compare their cathartic pattern against those with high hydrogen excretion. A case-control study was designed. IBS outpatients were included. A validated questionnaire was delivered (IBSSS) in order to assess their symptoms and a LBT was performed. The cathartic pattern was compared between those with low and high hydrogen production on LBT. One hundred and ten patients were included and 15 of them (13.6%) had low hydrogen production on LBT, which would be compatible with the presence of hydrogen-consuming gut flora. In this group, 11 patients (73.33%) were co...
Proton pump inhibitors could have an impact on the results of breath tests performed in patients ... more Proton pump inhibitors could have an impact on the results of breath tests performed in patients with irritable bowel syndrome. This impact could be due to the development of small intestine bacterial overgrowth. To compare the prevalence of fermentative profile alterations of irritable bowel syndrome patients exposed and not-exposed to proton pump inhibitor therapy. Subjects with irritable bowel syndrome were enrolled. A validated questionnaire assessing symptom severity as well as proton pump inhibitor treatment was delivered. A lactulose breath test was undertaken by each enrolled subject. Fermentative profile (area under the curve of hydrogen excretion/time) was compared between proton pump inhibitors consumers and non-consumers. Furthermore, small intestine bacterial overgrowth prevalence was compared. Two hundred and twenty five patients were enrolled. No significant differences were found on the fermentative profile between groups [AUC mediana 3,776 (rango 2,124-5,571) vs 4,3...
Aim. To perform a measurement of the pH in nose, pharynx and esophagus in patients with combinati... more Aim. To perform a measurement of the pH in nose, pharynx and esophagus in patients with combination of esophagitis and rhinosinusitis compared to control groups. Methods. Diagnosis of rhinosinusitis was carried out on the basis of international criteria (1). Diagnosis of esophagitis was carried out on the basis of the Los Angeles classification (2). 76 patients aged 18 to 62 years were randomized into 3 groups. Group A included 25 individuals with a combination of rhinosinusitis, heartburn and esophagitis; in group B were 29 patients with rhinosinusitis without heartburn and without esophagitis; in group C were 22 persons without rhinosinusitis and without GERD. For all patients were performed a 24-hour pH monitoring of the esophagus, pH-metry of the nose and pharynx. For all patients performed microbiological examination of discharge from the middle nasal passage. Results. The mean time with pH below 4 in the esophagus during 24 hour was equal to 25.4% in Group A, 23.8% in group B, and 5.2% in group C (OR1-3=6,20; CI=4,05-9,48; OR23=5,69; CI= 3,73-8,67). The pH of the nose in patients in groups A, B and C was similar. Middle pH in the pharynx in patients in group A was 4,7 ± 0,4; Group B 6,4 ± 0,6 (p1-2 <0,02); Group C 7,2 ± 0,6 (p1-3 <0,002). Microbiological examination revealed strains of S. Aureus, E. Coli, Candida albicans at 100% of patients in group A, 52% of people in group B (OR1-2=47,71; CI=2,65-857,6) and 23% in group C (OR13=162,27; CI=8,42-3126,21). Conclusion. The patients with a combination of rhinosinusitis and esophagitis observed decrease of pharyngeal pH and recorded more frequent seeding of pathological flora in the nasal mucosa in versus with persons without GERD. References: 1. Fokkens W.J., Lund V.J., Mullol J. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Rhinol Suppl. 2012; 3(23): 1-298. 2. Lundell L.R., Dent J., Bennet J.R. Endoscopic assessment of oesophagitis clinical and functional correlates and further validation of Los Angeles classification. Gut. 1999; 45(2): 172-180.
There is growing evidence that gut flora plays a role in the development of Irritable Bowel Syndr... more There is growing evidence that gut flora plays a role in the development of Irritable Bowel Syndrome (IBS). Abdominal bloating is a common symptom in these patients and the severity of this symptom could be related to the variations in their fermentative profiles, obtained by measuring the levels of breath hydrogen excretion after lactulose ingestion. Our objective was to determine the difference in abdominal bloating severity between IBS patients with high vs low levels of breath hydrogen excretion after lactulose administration. Lactulose breath tests were carried out on IBS patients in our institution between July 2009 and August 2010. Patients were requested to fill out a validated questionnaire to assess the severity of their symptoms. Abdominal bloating severity score was compared among patients with high and low breath hydrogen levels. A total of 234 patients were enrolled. There was a statistically significant difference in the abdominal bloating severity score between group...
Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diag... more Ambulatory pH monitoring, that defines acid reflux episodes as a fall in pH below 4, fail to diagnose weakly acidic reflux, which sometimes is related to the occurrence of symptoms. To establish the incidence of clinical-phmetric variables that allow to confirm or discard the presence of gastroesophageal reflux and its symptomatic correlation. [corrected] During a period of 12 months, 100 patients (58 males and 42 females) were consecutively included for 24 hour esophageal ambulatory phmetry. The variables considered were: number of symptomatic episodes during the study, number of episodes with positive symptomatic correlation for pH drop greater than 4, number of episodes with positive symptomatic correlation for pH drop lower than 4 and Demeester score. For operative reasons we divided the patients in six groups: without evidence of acidic reflux (WAR), hypoalgesic pathologic acid reflux (HPAR), normoalgesic pathologic acid reflux (NPAR), hyperalgesic pathologic acid reflux (HyPAR...
Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber di... more Irritable Bowel Syndrome (IBS) is characterized by the worsening of symptoms with a high fiber diet. This intolerance could be related to an increase in colonic bacterial fermentation. The hydrogen breath test (HBT) is a marker of the intestinal micro flora fermentative capacity. To assess if there is an association between hydrogen (H2) levels and clinical changes between diets with and without bran. 10 women with predominantly constipated irritable bowel syndrome (Rome II criteria) received a lowfiber diet during one week. This phase was followed by a second 7 day period with the same diet but supplemented with 12 g of crude dietary fiber. At the end of both periods, patients completed a symptom scale (Lickert type) and performed a HBT. Comparing both periods with a different diet the median difference in the clinical scale score (-2.5) shows a tendency favorable to the diet without bran, p = 0.048. In the fiber period the median increase of 2 ppm in H2 values was not significant ...
Some patients complain of digestive symptoms related to diary products intake. This intolerance c... more Some patients complain of digestive symptoms related to diary products intake. This intolerance could be associated with an intestinal bacterial overgrowth or an increased fermentative intestinal profile and not due to lactose malabsorption. To estimate the prevalence of bacterial overgrowth in subjects with digestive symptoms related to diary products intolerance. Patients who had performed hydrogen breath test due to chronic functional distension syndrome (Rome III) were analyzed. Thirty of them (22 female, average age 52 years) complained of symptoms related to diary products intake. All subjects completed a nutritional survey that allowed to assess the degree of tolerance to milk products and performed the hydrogen breath test with lactulose as substrate. Bacterial overgrowth was considered when baseline values were over 15 parts per million (ppm), values before 80 minutes were greater than 20 ppm or values of area under the curve were greater than 3,000 ppm/min in the 180 studi...
Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibioti... more Patients with intestinal bacterial overgrowth (SIBO) are usually treated with different antibiotics. Certain probiotics have proved to be clinically effective in patients with abdominal distension. To compare the short-term clinical efficacy of metronidazol vs. a probiotic in patients with SIBO and functional chronic abdominal distension. Patients and methods. This was a randomized prospective pilot study. The study population consisted of 50 patients with chronic abdominal distension (Rome III criteria) and diagnosis of SIBO made by a lactulose H2 breath test. Patients were consecutively randomized to receive either metronidazol or a probiotic. The metronidazol group consisted of 25 subjects (23 women, median age 49 +/- 19 years old), who received metronidazol (Flagyl), 500 mg bid for 5 days. The probiotic group consisted of 25 subjects (20 women, median age 58 +/- 19 years old). The probiotic administered to the latter group contained Lactobacillus casei (3.3 x 10(7) UFC), Lactoba...
INTRODUCTION. There are three indexes that correlate symptoms and reflux episodes in pHmetry test... more INTRODUCTION. There are three indexes that correlate symptoms and reflux episodes in pHmetry tests. The utility of these indexes have been evaluated in prospective trials but their advantages and disadvantages remain controversial. To assess the clinical utility of the pHmetric symptomatic correlation indexes in patients with pathological acid reflux. A sequential pilot study of pHmetry tests was performed between September 2008 and June 2010. Twenty patients with gastroesophageal reflux and a DeMeester score above 14.5 were included. For the analysis, a distinction was made between strong acid reflux episodes (pH < 4) and weak acid reflux episodes (pH < 7 and > 4). The following indexes were calculated for both groups mentioned before: symptom index (SI), symptom sensitivity index (SSI) and symptom association probability (SAP). The mean age was 54 and 55% of patients were male. There were 116 symptomatic episodes (mean 5.8 per patient), 1,634 strong acid reflux episodes a...
There is evidence suggesting that intestinal microbiota plays a role in the development of irrita... more There is evidence suggesting that intestinal microbiota plays a role in the development of irritable bowel syndrome. Its activity can be indirectly assessed using the lactulose breath test. Antibiotics like rifaximin or probiotics can be used as therapeutic options for patients with irritable bowel syndrome. Our purpose was to evaluate the efficacy of a sequential treatment with rifaximin and probiotics in these patients. We prospectively evaluated patients with diagnosis of irritable bowel syndrome according to Rome III criteria. Included patients had to fill in a questionnaire in order to assess their symptoms severity. A lactulose breath test was also performed in each case and a curve with the results of hydrogen concentration and time was elaborated. Then, the area under the curve was calculated After initial evaluation, patients received a seven-day treatment with rifaximin, followed by a ten-day course of probiotics. Thirty days after completion of treatment a new lactulose b...
There is growing evidence that a disorder in intestinal microbiota would contribute to the develo... more There is growing evidence that a disorder in intestinal microbiota would contribute to the development of symptoms in irritable bowel syndrome (IBS) patients. In a subgroup, a remarkably low hydrogen production in lactulose breath test (LBT) is observed. We presume in these patients a predominance of hydrogen consuming gut flora. [corrected] Describe the clinical presentation of lBS patients with low hydrogen production and to compare their cathartic pattern against those with high hydrogen excretion. A case-control study was designed. IBS outpatients were included. A validated questionnaire was delivered (IBSSS) in order to assess their symptoms and a LBT was performed. The cathartic pattern was compared between those with low and high hydrogen production on LBT. One hundred and ten patients were included and 15 of them (13.6%) had low hydrogen production on LBT, which would be compatible with the presence of hydrogen-consuming gut flora. In this group, 11 patients (73.33%) were co...
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