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Max Schmulson

Publications and source records attributed to Max Schmulson.

10 recordsLinked to original sources
PubMed2006

Effect of sex on perception of rectosigmoid stimuli in irritable bowel syndrome.

In irritable bowel syndrome (IBS) patients, the relationship between sex and sensitivity to visceral stimuli is incompletely understood. Our aim was to evaluate the effect of sex on perceptual responses to visceral stimulation in IBS. Fifty-eight IBS patients (mean age 42+/-1 yr; 34 men, 24 women) and 26 healthy controls (mean age 38+/-3 yr; 9 men, 17 women) underwent barostat-assisted distensions of the rectum and sigmoid colon. Rectal discomfort thresholds were measured using a randomized, phasic distension paradigm before and after repeated noxious sigmoid stimulation (SIG, 60-mmHg pulses). Sex had a significant effect on rectal discomfort thresholds. Women with IBS were the most sensitive (lower thresholds [27+/-2.7 mmHg] and higher ratings), with significantly lower rectal discomfort thresholds compared with men with IBS (38+/-2.3 mmHg) and healthy women who were the least sensitive (41.9+/-3.2 mmHg; both P<0.01). There were no significant differences in rectal discomfort thresholds between healthy men (34+/-4.3 mmHg) and men with IBS. Across both IBS and control groups, women demonstrated a significant lowering of discomfort thresholds after noxious sigmoid stimulation (P<0.01), while men did not. Sex significantly influences perceptual sensitivity to rectosigmoid distension. Women show greater perceptual responses to this paradigm.

Adult↗
PubMed2006

Frequency of functional bowel disorders among healthy volunteers in Mexico City.

BACKGROUND: The frequency of functional bowel disorders (FBD) in Mexico using the Rome II criteria is unknown. METHODS: The Rome II Modular Questionnaire (RII-MQ) was translated into Spanish in coordination with the Rome Committee and their Latin American program. Volunteers were recruited by advertisement in Mexico City, and administered the RII-MQ. RESULTS: The study population consisted of 324 healthy volunteers, with a mean age of 35.7; 66% were female. The most prevalent disorders were heartburn 35%, irritable bowel syndrome (IBS) 35%, functional bloating 21%, proctalgia fugax 21%, and functional constipation 19%. Based on gender, IBS-C was 4 times more frequent in females than males (19 vs. 4.6%) and functional bloating 3 times more frequent (10 vs. 3.7%). Differences according to occupation included a higher prevalence of ulcer-like dyspepsia (p = 0.04), IBS-C (p = 0.018) and proctalgia fugax (p = 0.034) among students. CONCLUSIONS: This is the first study to use RII-MQ to determine the prevalence of FBD in urban Mexico. The prevalence of IBS was significant and is related to a number of factors, including the stress of living in an overpopulated city. Selection bias is likely operative. A community-based study is warranted.

Adult↗
PubMed2005

Maximum tolerated volume in drinking tests with water and a nutritional beverage for the diagnosis of functional dyspepsia.

AIM: Recently, drinking load tests with water or nutritional beverages have been proposed as diagnostic tools for functional dyspepsia (FD), therefore we sought to reproduce if these tests can discriminate between FD patients and controls in a Mexican population. METHODS: Twenty FD-Rome II patients were matched by age and gender with 20 healthy controls. All underwent both drinking tests at a 15 mL/min rate, randomly, 7 d apart. Every 5 min within each test, four symptoms were evaluated (satiety, bloating, nausea and pain) by Likert scales. Maximum tolerated volume (MTV) was defined as the ingested volume when a score of 5 was reached for any symptom or when the test had to be stopped because the patients could not tolerate more volume. Sensitivity and specificity were analyzed. RESULTS: FD patients had higher symptom scores for both tests compared to controls (water: t = 4.1, P = 0.001<0.01; Nutren: t = 5.2, P = 0.001<0.01). The MTV for water and Nutren were significantly lower in FD (water: 1 014+/-288 vs 1 749+/-275 mL; t = 7.9, P = 0.001<0.01; Nutren: 652+/-168 vs 1 278+/-286 mL; t = 6.7, P = 0.001<0.01). With the volume tolerated by the controls, the percentile 10 was determined as the lower limit for tolerance. Sensitivity and specificity were 0.90, 0.95 for water and 0.95, 0.95 for Nutren tests. CONCLUSION: A drinking test with water or a nutritional beverage can discriminate between FD patients and healthy subjects in Mexico, with high sensitivity and specificity. These tests could be used as objective, noninvasive, and safe diagnostic approaches for FD patients.

Adult↗
PubMed2005

Intestinal involvement is not sufficient to explain hypertransaminasemia in celiac disease?

Chronic unexplained hypertransaminasemia is an isolated clinical manifestation of celiac disease (CD) and lacks of a clear physiopathological explanation. Since CD and tropical sprue (TS) have similar intestinal functional and histological pattern of injury and that an increased inflammatory response has been reported to occur in patients with irritable bowel syndrome (IBS), liver involvement might be expected to occur either in TS or IBS. However, according to author's prior observations, the frequency of hypertransaminasemia is significantly higher in CD than in TS and IBS-diarrhea predominant patients (IBS-D). Thus, based on current knowledge, intestinal mucosal damage, increased intestinal permeability and/or an active intestinal inflammatory response do not completely explain liver damage in CD. We hypothesize that other factors, unique to CD not present in TS or IBS-D, like gluten toxicity and the presence of tissular transglutaminase (tTG) an auto-antigen with pro-inflammatory and remodeling properties, act in addition to intestinal mucosal injury and account to hypertransaminasemia in CD. Further research focusing on the mechanisms of gluten and tTG hepatic toxicity, and/or the characterization of the expression, secretion and enteral-hepatic transport of certain pro-inflammatory cytokines is needed, to understand the possible links between intestinal and liver disorders seen in CD.

Animals↗
PubMedDate not supplied

[Differences in the stress symptoms rating scale in Spanish between patients with irritable bowel syndrome (IBS) and healthy controls].

UNLABELLED: Irritable bowel syndrome (IBS) can be explained by the interrelation of cognitive components such as illness behavior, emotional such as depression and anxiety, behavioral such as environmental stressors, and physiologic such as pain modulation alterations. The stress symptom rating (SSR) scale is being used in physiologic studies in IBS, but differences between IBS patients and healthy controls in the basal condition is unknown. AIMS: To determine the basal differences in the SSR-Spanish between IBS patients and controls, and between IBS patients according to bowel-habit predominance. METHODS: Forty consecutive IBS-Roma 1 patients [M: 28 (78%), F:8(22.2%), 42.6 +/- 2.7 years] and 36 healthy volunteers paired by gender and age [M: 28 (78%), F:8 (22.2%); 36.7 +/- 2.1 years] were included. IBS were classified as constipation, diarrhea, or alternating. All completed the SSR prior to the medical visit. Mean group values of the different SSR parameters were compared by ANOVA. A p < 0.05 was considered significant. RESULTS: Compared with controls, IBS patients reported higher anxiety (p = 0.005), attention (p = 0.04) fatigue (p = 0.04), and lower arousal (p = 0.003). There were no differences in stress and anger either in IBS patients according to bowel-habit predominance. CONCLUSIONS: Under basal conditions, there are differences in anxiety, weakness, attention, and arousal between IBS patients and controls that correspond to intrinsic characteristics of IBS independent of bowel-habit predominance. Higher anxiety is in agreement with psychological comorbidity, higher attention with hypervigilance, and fatigue and lower arousal with sleep disturbances known to be present in IBS. Absence of differences in stress and anger under basal conditions suggests that SSR-Spanish is a good instrument to evaluate response to stress during physiologic paradigms.

Adult↗
PubMedDate not supplied

[Impact of gastrointestinal symptoms on health related quality of life in patients with type 2 diabetes mellitus].

INTRODUCTION: A recent study has shown that health related quality of life (HRQOL) in patients with diabetes mellitus (DM) is affected by the presence of gastrointestinal symptoms (GI). It is unknown if this is reproducible among Latin patients with DM. OBJECTIVE: To determine the impact of GI symptoms on HRQOL of Latin patients with type 2 DM. METHODS: Between March and June 2001, consecutive patients with type 2 DM from a referral center were studied, excluding those with a history of DM related chronic complications or using insulin. A Bowel Symptom Questionnaire identified 47 patients with GI symptoms (A) and they were compared with 46 consecutive patients without GI symptoms (B). All patients answered the HRQOL questionnaire, SF-36 Spanish-Mexico. Results of the SF-36 were expressed in means +/- SD and analyzed by ANOVA and Bonferroni. A p < 0.05 was considered significant. RESULTS: The frequency of GI symptoms in A were: 41.6% gastroesophageal reflux, 14.6% dyspepsia, 21.3% IBS, 20.8% fecal incontinence and 2.2% combinations. Compared to A, B showed lower scores in all the SF-36 scales (Physical function: p = 0.001, role limitations-physical: p = 0.003, bodily pain: p = 0.001, general health: p = 0.016, energy/fatigue: p = 0.003, social functioning: p = 0.013, emotional well-being: p = 0.004) except in role limitations-emotional. Also A had lower scores in the physical component summary (p = 0.001) but no difference in the mental component. CONCLUSIONS: In Latin patients with type 2 DM the presence of GI symptoms has a negative impact mainly on the physical components of HRQOL, compared to those without GI symptoms.

Diabetes Mellitus, Type 2↗
PubMedDate not supplied

Gastrointestinal stromal tumors: clinical and pathological analysis of 24 cases.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract. They are positive for the expression of c-Kit protein at immunohistochemistry and their clinical presentation is variable. We conducted a study to identify true GISTs with known pathological and immunohistochemical criteria from other tumors of the gastrointestinal tract. METHODS: The clinical records of patients with the diagnosis of schwannoma, leiomyoma, leiomyosarcoma and tumor of uncertain biological behavior of the gastrointestinal tract were identified and the slides of paraffin obtained for review by two experienced pathologists in the diagnosis of GISTs. The clinical presentation, treatment and outcomes were analyzed. RESULTS: Twenty four GISTs (11 low-risk and 13 high-risk) were identified from 76 cases reviewed. All the confirmed GISTs were positive at immunohistochemistry for c-Kit expression. The two predominant location of the tumors were the stomach and small intestine. The outcome was good for benign and completely resected tumors. CONCLUSIONS: True GISTs can be recognized from other tumors by histological analysis. Immunohistochemistry to identify c-Kit protein expression is useful to confirm the diagnosis. Physicians must consider GISTs in patients with a lesion of the gastrointestinal tract resembling a smooth muscle tumor or/and in association with chronic or acute bleeding.

Adult↗