Preguntas Frecuentes

SINDROME DEL INTESTINO IRRITABLE.

Enero 11th, 2010 at 05:46pm Under Preguntas Frecuentes

Intestino, segundo cerebro
El Síndrome del Intestino Irritable (SII) define mejor al trastorno que afecta a cualquier segmento del tracto digestivo desde la boca al ano, y  no se centra únicamente en el colon.
Haciendo un poco de historia, encontramos que los egipcios consideraban a los intestinos como la sede de las emociones. Como así lo hacen constar en los papiros Smith y  Ebers.
Para los orientales, el vientre era y es el  centro E vital del organismo, donde se integran mente y cuerpo. Este centro no se refiere concretamente al intestino sino a un punto situado a dos dedos por debajo del ombligo, en el centro de gravedad del cuerpo, donde reside la energía vital. Y para mantener la salud, es necesario conectar con este centro y para ello se recurre a la meditación, el tai chi etc. El resultado es un estado general de bienestar, calma y serenidad.
Por otra parte, podemos decir que después de varias décadas de trabajos, los científicos tienen hoy bases sólidas para afirmar que efectivamente existe un segundo cerebro en el tracto gastrointestinal y que es muy similar al que tenemos en la cabeza.
La vinculación entre el SNC y SNE ha dado origen a un nuevo campo en la medicina la Neurogastroenterología. Se considera el padre de esta nueva especialidad medica, doctor Michael D. Gershon jefe del Departamento de Anatomía y Biología celular de la Universidad de Columbia. Se interesó por el tema  1996 y escribió el libro titulado “El segundo cerebro”. En donde encontramos datos tan interesantes como: “La mayoría de los pacientes con ansiedad y depresión también tendrán alteraciones en las funciones intestinales” o “El estrés sobre estimula nervios del esófago, y causan así las sensaciones de ahogo que experimentan muchas personas en los ataques de pánico”.

Una representación de esta similitud entre el intestino y el cerebro la podemos encontrar en una mujer en cristal, en el Museo alemán de la Higiene de Dresde, podemos apreciar el parecido visual entre nuestros dos cerebros.

¿QUE ES SN ENTERICO  O CEREBRO ABDOMINAL?
Es una unidad anatómica única que abarca desde el esófago hasta el ano y que esta constituido a su vez por:
-plexo mientérico o de Auerbach situado entre las capas musculares longitudinal y circular y que vigila la motilidad gastrointestinal.
-plexo submucoso o de Meissner, más interno, que controla las actividades secretoras del tracto digestivo.

MISIONES DEL SNE
2 fundamentales:
-Supervisar todo el proceso de la digestión, desde los movimientos peristálticos, la secreción de jugos digestivos para digerir los alimentos, la absorción y transporte de nutrientes y la eliminación de los productos de desecho.
-Colabora con el sistema inmune  en la defensa del organismo frente a sustancias y microorganismos hostil.

Dos cerebros: SNC y SNE
son sistemas complejos
-ambos tienen “circunvoluciones”
-SNE tapizado por millones de células nerviosas, casi tantas como las que encontramos en nuestro cerebro
-Utilizan los mismos neurotransmisores aunque este tiene funciones diferentes
• Serotonina en SNC proporciona bienestar, serenidad
• Serotonina en SNE responsable de los movimientos peristálticos
• La comunicación entre los SNC y Entérico es en dos direcciones pero 10 veces más hacia arriba que hacía abajo
• casi todas las sustancias que controlan y hacen funcionar el cerebro se producen en el intestino.
• 90% de la serotonina se encuentra en el intestino

 SII: INTESTINO
• se le considera el mayor órgano del sistema de defensa.
• Contiene más células inmunitarias que todo el resto del cuerpo.
• Vigila a los millones de bacterias alojadas en el intestino
• Controla que se mantengan las condiciones adecuadas para el desarrollo de la flora bacteriana beneficiosa y detecta a los microorganismos perjudiciales para su eliminación.
El intestino normal va a movilizar su contenido mediante contracciones musculares secuenciales, lo que se conoce como propulsión y zonas de detención (segmentación). La combinación de propulsión y segmentación es lo que se conoce como peristaltismo. Este proceso en condiciones normales no nos damos cuenta que ocurre.

¿QUE ES SINDROME DE INTESTINO IRRITABLE (SII)?
• Trastorno funcional digestivo, crónico con tendencia  recaídas que se caracteriza por una combinación de síntomas y que se consideran provocados por una pérdida de la coordinación de las contracciones intestinales
• No existe alteración estructura intestinal
• Más frecuente en mujeres jóvenes
• Afecta entre 10 y 20% de la población mundial.
 

ETIOLOGIA DEL SII
No existe una causa única ni clara que produzca el SII:
• Perdida de coordinación de las contracciones intestinales
• Alteración de la flora intestinal
• Enfermedades del tracto digestivo, gastroenteritis aguda..
• Alimentos: lácteos, café, trigo, te, chocolate, alimentos refinados, bebidas con gas. Colorantes, conservantes artificiales
• Pueden darse en pacientes con Fibromialgia,  S. de fatiga crónica, Enf Celiaca

DESENCADENANTES DEL SII
• Acontecimientos estresantes: divorcios, matrimonios, fallecimientos, accidentes, intervenciones quirúrgicas
• Conflictos laborales, problemas económicos y de pareja
• Ciertos medicamentos: laxantes+++

SINTOMAS DEL SII
Se caracteriza por: potencian la absorción
• Dolor/molestia abdominal
• Se puede acompañar o no de episodios diarreicos o de estreñimiento
• Distensión abdominal
• Otros: ansiedad, fatiga, depresión, alteraciones del sueño..
Dolor abdominal es:
– Difuso o bien localizado
– No suele irradiarse
– Generalmente  es de moderada intensidad.
– En general se alivia después de la defecación y suele respetar las horas de sueño.
– Se asocia habitualmente con deseos de defecar, alteraciones en la frecuencia o consistencia de las heces
Como este trastorno puede afectar a cualquier segmento del tubo digestivo desde la boca al ano, pueden aparecer síntomas muy variados.
Esófago:
• Ardor, acidez
• Odinofagia (deglución dolorosa sin detención de los alimentos)
• “Globo” en la garganta entre las comidas
Estomago:

• Dispepsia (se parece a los síntomas de una úlcera gástrica)
• Sensación de saciedad (con poca comida )
• Distensión abdominal dolorosa después de comer
Intestino delgado:

• Borborigmos +++
• Distensión abdominal +++que > de noche
• Dolor abdominal que acompaña a la distensión> de noche
Intestino grueso:
• Dolor abdominal ángulo inf e izq que > con la deposición, pero sensación que la evacuación no es completa
• Dolor  inf dcho  no siempre > con la deposición. Ojo¡¡ no fruta después de media tarde
• Dolor debajo costillas dcha que se puede irradiar a la axila dcha: E Voll (VB)
• Ritmo intestinal variable alternando estreñimiento/diarrea. Heces caprinas.
• Gases intestinales++
Recto: Dolores breves punzantes e intensos “proctalgia fugaz”.
Otros:
• Cefaleas, cansancio, fatiga
• Alteración del sueño y del apetito
• Dolor durante las relaciones sexuales en el ángulo inferior izquierdo
• Ansiedad y estrés +++ Depresión 1/3 de los pacientes
• Se asocia tb a la Fibromialgia, síndrome de fatiga crónica, Enf Celiaca

DDif. No es SII:
Dolor abdominal que despierta al enfermo por la noche.
Distensión abdominal que no mejora por la noche.
Pérdida de peso inexplicable y significativa.
Presencia de sangre en las heces.
Diarrea crónica e indolora
Dificultad para tragar alimentos sólidos.

DIAGNÓSTICO DEL SII
No hay ningún análisis ni prueba que permita por si sola hacer el diagnostico el SII. En los jóvenes  a veces es suficiente con la historia clínica, exploración física y analítica general. En los mayores se hace el diagnostico por exclusión: análisis de heces (sangrado), gastroscopia, ecografía abdominal y colonoscopia.

DIAGNÓSTICO (Criterios de Roma III ) modificado:
• 3 meses con síntomas activos
• 6 meses antes aparecieron los síntomas
• Dolor/molestia abdominal recurrente al menos 3 días por mes
Al menos 2  los siguiente síntomas en los últimos 3 meses:
-Mejora con la defecación
- El comienzo está asociado con un cambio en la frecuencia de las deposiciones;
-El comienzo está asociado con un cambio en la consistencia de las deposiciones.

TRATAMIENTO DEL SII
– Escuchar al paciente e intentar establecer una buena relación empática con el paciente. Explicarle su enfermedad.
– Proponerle cambios en el estilo de vida y en la alimentación
– Tratamiento médico (homeopático) y psicoterapéutico
Cambios en el estilo de vida:

• Ejercicio físico (andar, bailar..) mejora el estrés y la digestión
• Horario para ir a baño (el intestino aprende igual que el cerebro)
• Técnicas de relajación
• Meditación (doctor Wood aplicar técnicas como la meditación para solucionar disfunciones de este segundo cerebro como SII)
• Tai chi
Cambios en la alimentación:
• Comer despacio, masticar bien, mantener un horario de comidas, beber agua en abundancia
• Dieta rica en fibra (introducirla gradualmente) Se recomienda aumentar la ingesta de hidratos de carbono complejos (cereales integrales, frutas y legumbres) y de fibra hidrosoluble (frutas, verduras, avena ).
•  Evitar comidas o bebidas que empeoren los síntomas, como suelen ser leche, café, chocolate, refinados, trigo (cierta intolerancia al gluten) , colorantes, aditivos..
• Reducir el consumo de alcohol
• LIMPIEZA INTESTINAL: es como una cura de sueño para el SNC.
o El cerebro tiene capacidad para aprender y el intestino también. En SII resulta eficaz mantener un horario para ir al baño.
• RECUPERACIÓN DE LA FLORA INTESTINAL: prebióticos y probióticos.
o Alimentos funcionales por sus propiedades nutricionales y  que modifican la flora intestinal
 

PREBIÓTICOS
• Son oligofructosa e inulina
• Son  hidratos de carbono  no digeribles por los jugos gástricos y llegan  intactos al Intestino  Grueso  donde nutren las bifidobacterias de la flora intestinal. Favorecen el transito intestinal.
• Su consumo disminuye  los dolores abdominales significativamente y mejora el  tránsito intestinal.
• Dosis mín recomendada  2 a 6 gramos
• Se encuentran en alimentos como el ajo, la cebolla, espárragos, remolacha y alcachofas.
PROBIÓTICOS:
• Son Bacterias lácticas
• Son bacterias beneficiosas para el organismo se adhieren a las paredes intestinales.  E inhiben el crecimiento de diversos microorganismos patógenos o dañinos.
• alimentos probioticos  como chucrut, kéfir, yogur , contienen microorganismos vivos  favorecen el desarrollo de bacterias beneficiosas -Lactobacillus acidofilus y Bifidus-.
• “El primer científico que explicó cómo actuaban los probióticos fue el ruso Metchnikoff (premio Nobel en 1907)
“Hoy sabemos que más de 400 especies de bacterias (buenas y malas) habitan nuestro tracto intestinal y trabajan en armonía para el mantenimiento de la salud”

PREBIÓTICOS Y PROBIÓTICOS
• Diarrea. Las bacterias lácticas inhiben el crecimiento de diversos microorganismos patógenos o dañinos, etc. Los FOS afectan al hábitat intestinal e inhiben el crecimiento de patógenos.
• Estreñimiento y exceso de gases. Las bacterias lácticas  y los FOS favorecen el equilibrio de la flora intestinal, mejoran el tránsito y la distensión abdominal asociada a exceso de gases.

Resumen: TRATAMIENTO MEDICO DEL SII
• Homeopatía: Tratamiento individualizado
• Medicina Biológica
• Medicina Ortomolecular:
o prebióticos, probióticos.
o Las vitaminas del complejo B necesarias para un correcto funcionamiento de los músculos del tracto gastrointestinal
o L-Glutamina. Es el combustible metabólico más importante para las células intestinales.
o Calcio/Magnesio. Ayuda a regular el sistema nervioso y a relajar los músculos del  estómago.

PSICOTERAPIA EN SII
-Terapia Breve  (miedos, pánicos y fobias)
-El apoyo psicológico para mejorar la autoestima y la confianza en uno mismo
-Los síntomas intestinales pueden revelar problemas emocionales que la persona no exterioriza. Hay miedo a soltar (puede provocar estreñimiento)…..

CONCLUSION
• Aquello que es bueno para cerebro es por lo general bueno para el intestino
• Aquello que cura el cuerpo puede curar el alma
Tenemos que ser conscientes de  que somos responsables de mucho de lo que nos ocurre y también de nuestra salud.

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Colon Irritable

Noviembre 27th, 2009 at 12:36pm Under Preguntas Frecuentes

¿Qué es el colon irritable?,
El colon irritable o «Síndrome del Intestino Irritable» (SII), es un cuadro crónico con tendencia a las recaídas y que se  caracteriza por presentar dolor abdominal, que se puede acompañar o no de episodios diarreicos o de estreñimiento. Es frecuente la distensión abdominal por el gran acumulo de gases a nivel intestinal. Este cuadro no presenta alteraciones en cuanto a la morfología intestinal, y no se conocen causa infecciosa que justifique la sintomatología. 

Causas
 No existe una causa única que justifique la sintomatología tan variada y crónica. Sin embargo, se habla de una cierta sensibilidad del aparato digestivo que pueden favorecer la aparición de ciertos síntomas y que se ven íntimamente relacionados con factores psicológicos. No olvidemos que el intestino es el segundo cerebro.

Síntomatología
Los síntomas digestivos propios del SII son el dolor, la distensión abdominal y una alteración del hábito intestinal. El dolor abdominal puede ser difuso o estar bien localizado en la parte inferior del abdomen. No suele irradiarse y en general es de moderada intensidad. En general se alivia después de la defecación y suele respetar las horas de sueño.  El dolor abdominal se asocia habitualmente con deseos de defecar, alteraciones en la frecuencia o consistencia de las heces. Y la distensión abdominal y el meteorismo se desarrollan progresivamente a lo largo del día y son referidas como “exceso de gases”. Pueden predominar el estreñimiento o la diarrea o bien se alternan. También puede tener sensación de evacuación incompleta y la presencia de moco en las deposiciones.

Diagnostico
A través de la historia clínica y exploración física completa suelen ser suficiente para sospechar SII. Se completa el diagnóstico con pruebas complementarias como análisis generales de sangre y orina, ecografía abdominal y colonoscopia y en general, todos los resultados son negativos. El diagnóstico se hace por exclusión. 

Tratamiento
Escuchar al paciente y explicarle su enfermedad. Debemos intentar establecer una buena relación con el paciente.

- Medidas higiénico-dietéticas:
• Evite temporalmente aquellos alimentos y bebidas que desencadenen o empeoren sus síntomas como los lácteos, azucares y harinas refinadas, especias, picantes, fritos….
• Evite las bebidas con gas y los alimentos flatulentos como:  col, garbanzos, cebollas, guisantes etc.
• Evite, en lo posible, las situaciones estresantes.
• Aumentar alimentos ricos en fibra si sufre de estreñimiento( frutas, verduras, cereales integrales..), pero si predomina la diarrea se evitarán los derivados lácteos así como café, té y chocolate.
• Aumente el ejercicio y beba abundante agua.

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