Ingestão de fibra alimentar e tempo de trânsito colônico em pacientes com constipação funcional

RACIONAL: Pacientes com constipação funcional que não melhoram com suplementação de fibras dietéticas, representam importante problema clínico. OBJETIVOS: Avaliar as relações entre as quantidades de fibras ingeridas, intensidade da constipação e o tempo de trânsito colônico em pacientes com constipação funcional. MÉTODOS: Foram avaliados 30 pacientes constipados funcionais, sem melhoras após suplementação dietética com fibras e 18 pessoas controle, sadias, sem queixas digestivas, utilizando inquéritos individuais quanto à ingestão de fibras e a intensidade da constipação e, por meio da técnica dos marcadores radiopaco, o tempo de trânsito colônico, total e segmentar. RESULTADOS: Apesar da maior ingestão diária de fibras (26,3 ± 12,9 g, constipados x 9,3 ± 5,2 g, controles), os sintomas da constipação mostraram-se intensos nos constipados (escore médio = 21,3 ± 4,07). O tempo normal para o trânsito colônico foi de 58,8h. O trânsito colônico total, em média, foi mais lento nos constipados (41,0 ± 22,8h, constipados x 21,8 ± 18,5h, controles). Constipados com trânsito lento (>58,8h) apresentaram inércia colônica (oito), obstrução de saída (um) e lentificação no cólon esquerdo (um). Constipados com trânsito normal (<58,8h), apresentaram lentificações isoladas no cólon direito (nove), no cólon esquerdo (três) e no segmento retossigmoideano (oito). Não houve correlação entre a quantidade ingerida de fibra, intensidade da constipação e tempo de trânsito colônico nos constipados funcionais. CONCLUSÕES: em constipados funcionais a gravidade da constipação não depende apenas da ingestão de fibras, que, também não é a única contributiva para as variações no tempo de trânsito colônico. Este diferencia os pacientes normais dos constipados e nestes, aqueles com trânsito alterado que exigem abordagens diferentes da suplementação de fibras.

Constipação intestinal

It was reviewed the definition, mechanisms and classification of functional constipation. The diagnostic resources available were showed and it was underlined the importance to investigate and exclude the multiple causes of secondary constipation. The therapy was divided in general measures, like diet and specialized, involving laxatives and others alternatives. It was commented the different categories of laxatives, their actions and adverse effects. It was concluded that the best approach to functional defecatory disorder is biofeedback. Otherwise, for defecatory disturbance caused by mechanical obstruction and refractory constipation due to slow transit the therapeutical option is surgery.

Hipotireoidismo congênito: recomendações do Departamento de Tireoide da Sociedade Brasileira de Endocrinologia e Metabologia

O hipotireoidismo congênito (HC) é o distúrbio endócrino congênito mais frequente, com incidência variando de 1:2.000 a 1:4.000 crianças nascidas vivas e uma das principais causas de retardo mental que pode ser prevenida. Os Programas de Triagem Neonatal para a doença permitem a identificação precoce dos afetados e seu tratamento de modo a evitar as complicações da falta do hormônio. A maioria dos casos de hipotireoidismo congênito é decorrente de disgenesias tireoidianas (85%), entre elas a ectopia, hipoplasia ou agenesia tireoidianas, e os demais resultam de defeitos de síntese hormonal. As crianças afetadas (> 95%) geralmente não apresentam sintomas sugestivos da doença ao nascimento. Os sintomas e sinais mais comuns são: icterícia neonatal prolongada, choro rouco, letargia, movimentos lentos, constipação, macroglossia, hérnia umbilical, fontanelas amplas, hipotonia e pele seca. Várias estratégias são utilizadas para a triagem do HC. No Brasil, esta é obrigatória por lei e geralmente é feita com a dosagem de TSH em sangue seco coletado do calcanhar. A idade recomendada para sua realização é após as 48 horas de vida até o quarto dia. A confirmação diagnóstica é obrigatória com as dosagens de TSH e T4 livre ou T4 total.

Trânsito gastrintestinal e digestibilidade aparente de nutrientes em eqüinos alimentados com dietas contendo grãos secos ou silagem de grãos úmidos de triticale

Cinco éguas mestiças (idade e peso corporal médios de seis anos e 480 kg PV) foram distribuídas em delineamento experimental em quadrado latino para se e avaliar a utilização de dietas contendo grãos de triticale (secos ou ensilados) em substituição ao milho na alimentação de eqüinos, por meio do ensaio de avaliação do trânsito gastrintestinal e da digestibilidade. Os tratamentos consistiram de três níveis de grãos de triticale em substituição aos grãos de milho (0, 50 e 100%) e duas formas de conservação dos grãos de triticale (secos ou ensilados). As dietas foram isoprotéicas (12,5% PB), com ingestão diária de MS pelos animais de 2,0% PV (relação volumoso : concentrado de 50:50). Os coeficientes de digestibilidade aparente (CDa) da MS, MO, PB e FDN foram determinados indiretamente. Os parâmetros de trânsito gastrintestinal avaliados foram: k1 (taxa de passagem pelo intestino grosso), k2 (taxa de passagem pelo estômago), TT (tempo de trânsito), TMR (tempo médio de retenção) e TMRT (tempo médio de retenção total). Não houve diferença para os CDa da MS, MO, PB e FDN entre as dietas experimentais, observando-se valores médios de 64,31; 65,14; 74,13 e 57,25%, respectivamente. Considerando-se a cinética das fases sólida e líquida, notou-se efeito somente para k2 na fase sólida da digesta, cujo valor nas rações contendo 100% de triticale (seco ou ensilado) foi de 19,63%/h e na dieta controle (0% de triticale), de 23,72%/h. Observou-se efeito linear crescente para o TT na fase sólida da digesta, com a elevação dos níveis de substituição dos grãos de milho pelos grãos de triticale ensilados. Concluiu-se que os concentrados para eqüinos podem ser formulados com grãos de triticale secos ou ensilados em substituição total ao milho. A inclusão de grãos de triticale na alimentação desta espécie animal promoveu trânsito lento da fase sólida da digesta.

Gastro-intestinal transit time in South American deer

The study of diet and physiological peculiarities of the digestive system of neotropical deer is not well known and the literature shows inconsistencies. To better understand the digestive system of these mammals the difference in the gastro-intestinal transit time of four species of neotropical deer (Mazama americana, Mazama gouazoubira, Mazama nana, Blastocerus dichotomus), kept ill captivity, was evaluated. Four plants (Neonotonia wightii, Morus albans, Medicago sativa, Leucaena leucocephala) were utilized and two variables were measured, mean time of the beginning of the elimination (BE) and mean time of permanence (TP). The results obtained for BE indicated similarity among the deer species, with significant differences between M. gouazoubira (mean = 13.62 hr) and M. Americana (mean = 19.25 hr). For the plants, the BE was faster with N. wightii and L. leucocephala, and slower for M. sativa. The TP results for B. dichotomus showed longer time when compared to the other species, whereas M. gouazoubira had a lower permanence. Overall, N. wightii had the highest retention time in the digestive tract of all the deer species studied. Associated with this observation, N. wightii had the highest quantity of plant fiber of the plants tested. In a similar fashion M. sativa showed the lowest TP in the digestive tract of the deer and had the lowest quantity of acid detergent fiber. The data from this study showed that, within species, the shape of the excretion curve of the plants was similar when the animals consumed N. wightii or M. sativa. Blastocerus dichotomus and M. gouazoubira had the highest and the lowest gastro-intestinal transit time, respectively. This suggests that these species characterize different abilities to digest high fiber food, and consequently, represent the two extremities in the morphophysiological adaptation within the deer species evaluated. This information is vital because it is important to know the digestive physiology to define the diet of captive animals, particularly regarding the quantity and quality of fiber. Zoo Biol 25:47-57, 2006. (C) 2005 Wiley-Liss, Inc.

Alginate-chitosan systems: In vitro controlled release of triamcinolone and in vivo gastrointestinal transit

The aim of this study was to develop multiparticulate therapeutic systems of alginate (AL) and chitosan (CS) containing triamcinolone (TC) to colonic drug delivery. Multiparticulate systems of AL-CS, prepared by a complex coacervation/ionotropic gelation method, were characterized for morphological and size aspects, swelling degree, encapsulation content and efficiency, in vitro release profile in different environments simulating the gastrointestinal tract (GIT) and in vivo gastrointestinal transit. The systems showed suitable morphological characteristics with particle diameters of approximately 1.6 mm. In simulated gastric environment, at pH 1.2, the capsules presented low degree of swelling and in vitro release of drug. A higher swelling degree was observed in simulated enteric environment, pH 7.5, followed by erosion. Practically all the drug was released after 6 h of in vitro assay. The in vivo analysis of gastrointestinal transit, carried out in rats, showed that the systems passed practically intact through the stomach and did not show the same profile of swelling observed in the in vitro tests. It was possible to verify the presence of capsules in the colonic region of GIT. The results indicate that AL-CS multiparticulate systems can be used as an adjuvant for the preparation of therapeutic systems to colonic delivery of drugs. (C) 2010 Elsevier Ltd. All rights reserved.

AC Biosusceptometry as a Tool for Monitoring the Gastrointestinal Transit of Multiparticulate Drug Delivery System

Drug delivery systems based on natural polysaccharides, such as chitosan (CS) and pectin (PC), rather than on synthetic polymers, have been widely studied. Some reasons for that are low toxicity and costs and high biodegradability of the formers. A multiparticulate system based on CS and PC was developed in our laboratories, including the addition of an enteric polymer, cellulose acetate phtalate (CAP). Such improvement promoted stronger gastric and enteric resistances, as assessed in vitro, making the systems more selective to enzymatic degradation in the colon. Although in vitro dissolution tests can simulate some properties concerning the gastrointestinal transit (GT), collaborating to characterize the systems behavior in the biological fluids, frequently they do not result in satisfactory in vitro/in vivo correlations. The objective of this work was to follow in vivo the GT of the particles developed by means of AC biosusceptometry (ACB), a non-invasive and of low cost methodology. The particles containing ferrite in powder form were prepared by complex coacervation using an ideal 3:1:1 mass ratio for PC:CS:CAP. The magnetic particles were administered to healthy volunteers by oral route. The GT was monitored by using multi-sensor ACB system and the signal acquisition was performed every IS min until the colonic region was reached. By means of ACB technique, it was possible to acquiring images generated by the magnetic particles within the whole gastrointestinal tract including the colonic region. Variable particles transit times were observed among the volunteers, but without interference on the mapping of the particles until the colonic region. The particles were able to produce magnetic field strong enough to generate signals adequate for mapping the particles. The results suggest that integral particles reached the colon, after they resisted against gastric and enteric media. Studies associating transit time and in vivo drug release are in development in order to confirm the efficiency of the systems.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of a muscarinic type-2 antagonist on cardiorespiratory function and intestinal transit in horses anesthetized with halothane and xylazine

Objective-To evaluate the cardiorespiratory and intestinal effects of the muscarinic type-2 (M-2) antagonist, methoctramine, in anesthetized horses.Animals-6 horses.Procedure-Horses were allocated to 2 treatments in a randomized complete block design. Anesthesia was maintained with halothane (1% end-tidal concentration) combined with a constant-rate infusion of xylazine hydrochloride (1 mg/kg/h, IV) and mechanical ventilation. Hemodynamic variables were monitored after induction of anesthesia and for 120 minutes after administration of methoctramine or saline (0.9% NaCl) solution (control treatment). Methoctramine was given at 10-minute intervals (10 mug/kg, IV) until heart rate (HR) increased at least 30% above baseline values or until a maximum cumulative dose of 30 mug/kg had been administered. Recovery characteristics, intestinal auscultation scores, and intestinal transit determined by use of chromium oxide were assessed during the postanesthetic period.Results-Methoctramine was given at a total cumulative dose of 30 mug/kg to 4 horses, whereas 2 horses received 10 mug/kg. Administration of methoctramine resulted in increases in HR, cardiac output, arterial blood pressure, and tissue oxygen delivery. Intestinal auscultation scores and intestinal transit time (interval to first and last detection of chromium oxide in the feces) did not differ between treatment groups.Conclusions and Clinical Relevance-Methoctramine improved hemodynamic function in horses anesthetized by use of halothane and xylazine without causing a clinically detectable delay in the return to normal intestinal motility during the postanesthetic period. Because of their selective positive chronotropic effects, M-2 antagonists may represent a safe alternative for treatment of horses with intraoperative bracycardia.

Gastrointestinal transit and disintegration of enteric coated magnetic tablets assessed by ac biosusceptometry

The oral administration is a common route in the drug therapy and the solid pharmaceutical forms are widely used. Although much about the performance of these formulations can be learned from in vitro studies using conventional methods, evaluation in vivo is essential in product development. The knowledge of the gastrointestinal transit and how the physiological variables can interfere with the disintegration and drug absorption is a prerequisite for development of dosage forms. The aim of this work was to employing the ac biosusceptometry (ACB) to monitoring magnetic tablets in the human gastrointestinal tract and to obtain the magnetic images of the disintegration process in the colonic region. The ac biosusceptometry showed accuracy in the quantification of the gastric residence time, the intestinal transit time and the disintegration time (DT) of the magnetic formulations in the human gastrointestinal tract. Moreover, ac biosusceptometry is a non-invasive technique, radiation-free and harmless to the volunteers, as well as an important research tool in the pharmaceutical, pharmacological and physiological investigations. (c) 2005 Elsevier B.V. All rights reserved.

AC Biosusceptometry Technique to Evaluate the Gastrointestinal Transit of Pellets under Influence of Prandial State

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Recalled and recorded bowel habits confirm early onset and high frequency of constipation in day-care nursery children

CONTEXTO: Mães relatam início precoce de constipação em crianças atendidas em clínicas de gastroenterologia. OBJETIVOS: Estudar o hábito intestinal em crianças de baixa idade na comunidade, para avaliar se início precoce da constipação é confirmado neste contexto e se há concordância entre o hábito intestinal relatado e o registrado prospectivamente. MÉTODOS: Obtiveram-se dados sobre evacuações de 57 crianças com idade 6.0-40.7 meses, mediante relato materno (questionário sobre características fecais predominantes) e, a seguir, foram registradas 1.934 evacuações em casa e na creche. O hábito intestinal foi classificado como adequado, constipação, diarréia funcional, outro hábito intestinal, conforme frequência evacuatória e proporção das características fecais (macias, duras e/ou que escorrem). Usaram-se dois critérios para classificar o hábito intestinal registrado, devido indefinição no ponto de corte para fezes duras na identificação de constipação em crianças: critério predominante e critério adulto, respectivamente com >50% e >25% de evacuações com consistência alterada. Usou-se estatística não-paramétrica e, para concordância entre hábito intestinal relatado e registrado, o índice Kappa. RESULTADOS: Constipação ocorreu em 17.5%, 10.5%, 19.3% das crianças, respectivamente pelo relato e pelo registro segundo critérios predominante e adulto. Constipação foi o hábito intestinal mais frequentemente relatado, versus 12.3% outro hábito intestinal. Só uma criança se classificou como tendo diarréia funcional (pelo critério adulto). Concordância entre o hábito intestinal relatado e o registrado foi razoável (fair) para constipação, pelos critérios predominante e adulto (K=0.28 e 0.24, respectivamente), mas apenas leve (slight) para os demais hábito intestinal (K <0.16). Entretanto, dados individuais indicaram melhor relação entre relato de constipação com o critério adulto do que com o critério predominante. CONCLUSÕES: Confirmou-se que constipação é frequente e de início precoce. Concordância razoável entre o hábito intestinal relatado e o registrado segundo os dois critérios indica que o relato materno é razoavelmente confiável para detectar constipação.

Glutamate-induced obesity leads to decreased sperm reserves and acceleration of transit time in the epididymis of adult male rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Prospective Evaluation of Dietary Treatment in Childhood Constipation: High Dietary Fiber and Wheat Bran Intake Are Associated With Constipation Amelioration

Objectives: The aim of the study was to evaluate, over 24 months, the intake of dietary fiber (DF) and the bowel habit (BH) of constipated children advised a DF-rich diet containing wheat bran.Patients and Methods: BH and dietary data of 28 children with functional constipation defined by the Boston criteria were obtained at visit 1 (V1, n = 28) and at 4 follow-up visits (V2-V5, n = 80). At each visit the BH was rated BAD (worse/unaltered; improved but still complications) or RECOVERY (REC) (improved, no complications; asymptomatic), and a food intake questionnaire was applied. DF intake was calculated according to age (year)+5 to 10 g/day and bran intake according to international tables. Nonparametric statistics were used.Results: Median age (range) was 7.25 years (0.25-15.6 years); 21 children underwent bowel washout (most before V1/V2), and 14 had the last visit at V3/V4. DF intake, bran intake, and the BH rate significantly increased at V2 and remained higher than at V1 through V2 to V5. At V1, median DF intake was 29.9% below the minimum recommended and at the last visit 49.9% above it. Twenty-four children accepted bran at 60 visits, at which median bran intake was 20 g/day and median proportion of DF due to bran 26.9%. Children had significantly higher DF and higher bran intake at V2 to V5 at which they had REC than at those at which they presented BAD BH. DF intake > age+10 g/day was associated with bran acceptance and REC. At the last visit 21 children presented REC (75%); 20 of them were asymptomatic and 18 were off washout/laxatives.Conclusions: High DF and bran intake are feasible in constipated children and contribute to amelioration of constipation.