From 1978 to 1980, 68 patients with rectal cancer were randomly allocated to either preoperative irradiation plus surgery or surgical treatment without any preoperative measures. The primary aim of the trial was to investigate the 5-year survival rate in both groups; a secondary aim was to analyze the local recurrence rate and finally the anatomopathologic tumoral classification after surgery. All patients were followed at least 8 years. The preoperative irradiation group (Group A) was submitted to 4000 cGy for 4 weeks and surgery was performed 1 week after irradiation. All tumors were classified anatomically and pathologically according to Broders' and Dukes' classifications. The results indicated that there is a significant difference in the five-year survival rates in both groups: group A had a corrected survival rate of 80 percent; group B (nonirradiated) had a corrected survival rate of 80 percent; group B (nonirradiated) had a corrected survival rate of 34.4 percent. The local recurrence rate was 2.9 percent in group A and 23.5 percent in group B. Regarding tumor regression, before radiotherapy 64.6 percent of the tumors were Broders' Grades 3 and 4; after radiotherapy these were reduced to 20.5 percent. As to Dukes' classification, 26.4 percent of the tumors were type C in group A and, in group B, 47 percent were considered as Dukes' C.

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-Background -Primary hypolactasia is a common condition where a reduced lactase activity in the intestinal mucosa is present. The presence of abdominal symptoms due to poor absorption of lactose, which are present in some cases, is a characteristic of lactose intolerance. Objective -Evaluate the efficacy of a product containing exogenous lactase in tablet form compared to a reference product with proven effectiveness in patients with lactose intolerance. Methods -Multicentre, randomized, parallel group, single-blind, comparative non-inferiority study. One hundred twenty-nine (129) adult lactose intolerance patients with hydrogen breath test results consistent with a diagnosis of hypolactasia were randomly assigned to receive the experimental product (Perlatte ® -Eurofarma Laboratórios S.A.) or the reference product (Lactaid ® -McNeilNutritionals, USA) orally (one tablet, three times per day) for 42 consecutive days. Results -Data from 128 patients who actually received the studied treatments were analysed (66 were treated with the experimental product and 62 with the reference product). The two groups presented with similar baseline clinical and demographic data. Mean exhaled hydrogen concentration tested at 90 minutes after the last treatment (Day 42) was significantly lower in the experimental product treated group (17±18 ppm versus 34±47 ppm) in the per protocol population. The difference between the means of the two groups was -17 ppm (95% confidence interval [95% CI]: -31.03; -3.17). The upper limit of the 95% CI did not exceed the a priori non-inferiority limit (7.5 ppm). Secondary efficacy analyses confirmed that the treatments were similar (per protocol and intention to treat population). The tolerability was excellent in both groups, and there were no reports of serious adverse events related to the study treatment. Conclusion -The experimental product was non-inferior to the reference product, indicating that it was an effective replacement therapy for endogenous lactase in lactose intolerance patients. HEADINGS -Lactase. Lactose intolerance. beta-Galactosidase. Clinical trial.

Gastrointestinal symptoms are highly prevalent in Brazilian women and negatively impact different aspects of quality of life (mood, concentration and sexuality). The bowel is an important emotional catalyst that can modulate the psychologic behavior. Better understanding of the interaction between the gut and the brain should help in the management of gastrointestinal symptoms to improve women's quality of life.

Desafios terapêuticos na prática do gastroenterologista INTRODUÇÃO Desde o Egito antigo se atribui grande importância ao funcionamento regular do intestino. A constipação intestinal funcional, em geral, não é uma doença, mas um sintoma que pode estar associado com doenças orgânicas, digestivas ou extradigestivas. É a segunda queixa gastroenterológica mais autorrelatada, mas não há dados epidemiológicos da sua prevalência no Brasil. Segundo várias publicações, ela ocorre em aproximadamente 20% da população ocidental, sendo mais presente em mulheres, crianças, idosos e nos indivíduos de menor poder econômico. A di culdade para se conceituar a constipação intestinal se deve, principalmente, à diferença entre a opinião do paciente e como ela é entendida do ponto de vista médico. Segundo os critérios do ROMA IV, o conceito de constipação intestinal funcional deve incluir dois ou mais dos seguintes itens: Esforço evacuatório durante pelo menos 25% das evacuações. Fezes grumosas ou duras em pelo menos 25% das evacuações. Sensação de evacuação incompleta em pelo menos 25% das evacuações. Sensação de obstrução ou bloqueio anorretal em pelo menos 25% das evacuações. Manobras manuais para facilitar pelo menos 25% das evacuações (p. ex., auxílio digital, compressão do assoalho pélvico). Menos de três evacuações por semana.