Incidence of 'new-onset' constipation and associated factors during lockdown due to the COVID-19 pandemic.

OBJECTIVE: A minimum of physical activity and low liquid intake are factors that have been associated with constipation. The health emergency brought on by the COVID-19 pandemic has resulted in adopting behaviour, such as sheltering-in-place (less mobility) and dietary changes, creating a scenario we believe to be an adequate model for examining the appearance of symptoms of constipation and its associated factors. DESIGN: A cross-sectional and descriptive study was conducted on an open population, applying an electronic survey (4 weeks after lockdown due to COVID-19 in Mexico) to evaluate demographic characteristics, physical activity, water and fibre intake, appearance of constipation symptoms (including stool consistency), and quality of life. RESULTS: Out of 678 subjects evaluated, 170 (25%, 95% CI: 21.7 to 28.4) developed symptoms of 'new-onset' constipation, with a significant decrease in the number of daily bowel movements (p<0.05) and stool consistency (p<0.05) during lockdown. Furthermore, in the 'new-onset' constipation population there was a higher proportion of subjects (79 (47%) of 170) who stopped exercising during the pandemic compared with the subjects who did not develop constipation symptoms (187 (37%) of 508, p=0.03, OR: 1.49, 95% CI: 1.0 to 2.1). The multivariate analysis (logistic regression) showed that female sex (p=0.001), water intake (p=0.039), and physical activity (p=0.012) were associated with 'new-onset' constipation. CONCLUSIONS: In our study on an open population in Mexico, we found that one-fourth of the population developed 'new-onset' constipation symptoms during the lockdown imposed due to the COVID-19 pandemic. A reduction of physical activity and less water consumption were associated factors.

Lactobacillus acidophilus LB: a useful pharmabiotic for the treatment of digestive disorders.

Dysbiosis, a loss of balance between resident bacterial communities and their host, is associated with multiple diseases, including inflammatory bowel diseases (nonspecific chronic ulcerative colitis and Crohn's disease), and digestive functional disorders. Probiotics, prebiotics, synbiotic organisms and, more recently, pharmabiotics, have been shown to modulate the human microbiota. In this review, we provide an overview of the key concepts relating to probiotics, prebiotics, synbiotic organisms, and pharmabiotics, with a focus on available clinical evidence regarding the specific use of a unique pharmabiotic, the strain Lactobacillus acidophilus LB (Lactobacillus boucardii), for the management of gastrointestinal disorders. Since it does not contain living organisms, the administration of L. acidophilus LB is effective and safe as an adjuvant in the treatment of acute diarrhea, chronic diarrhea, and antibiotic-associated diarrhea, even in the presence of immunosuppression.

[Guidelines for diagnosis and treatment of constipation in Mexico. C) Medical and surgical treatment]. / Guías de diagnóstico y tratamiento del estreñimiento en México. C) Tratamiento médico y quirúrgico.

BACKGROUND: There are multiple therapeutic options for the management of constipation, from lifestyle modifications to the use of laxatives and in extreme cases surgery. OBJECTIVES AND METHODS: To establish the clinical guidelines for diagnosis and treatment of chronic constipation in Mexico we conducted a review of the literature regarding medical and surgical treatments for chronic constipation and have made recommendations based on evidence. RESULTS: Low water consumption, physical inactivity and low intake of fiber are conditions associated with chronic constipation, but the evidence to prove these associations is scarce. Bolus forming agents are useful in the management of constipation with normal colonic transit and defecation without dissynergia. Evidence supports the use of lactulose (IB) and polyethylene glycol (IA) as the most safe and effective agents in the long term in adults. The use of stimulant laxatives (docusate, picosulfate, senna) is recommended only for short periods. Tegaserod is an agonist of 5-HT4 receptors and there are many clinical trials supporting its effectiveness in the management of functional constipation (IA). However "their cardiovascular safety has been questioned recently. Biofeedback therapy is the gold standard in the management of constipation associated with pelvic floor dyssynergia. Surgical treatment is reserved for extreme cases of colonic inertia. CONCLUSIONS: The treatment of constipation should be based on the underlying pathophysiological mechanisms and the selection of drugs must be made according to the scientific evidence.

[Recommended endoscopic surveillance of patients with Barrett's esophagus (BE) is a cost-effective strategy?]. / La vigilancia endoscópica recomendada en pacientes con esófago de Barrett es una estrategia costo-efectiva?

OBJECTIVE: Evaluate the cost-effectiveness of the American College of Gastroenterology (ACG) guidelines for the surveillance of Barrett's esophagus (BE) in the context of a Mexican cohort of patients with BE and no dysplasia. BACKGROUND: For patients with BE and no dysplasia, the ACG has recommended endoscopic surveillance every three years. The cost-benefit of this strategy has been evaluated in populations with an annual incidence of esophageal adenocarcinoma (EA) of 1%-5%. METHODS: Demographic, clinical, surveillance and disease progression characteristics were analysed in patients with BE and no dysplasia seen at a terciary care center. Four surveillance strategies were considered, namely endoscopy every one, two, three and four years. Direct medical cost of endoscopy was dollar 2,950.00 Mexican pesos (dollar 256.52 USD). Total costs, cost-effectiveness ratios and marginal costs were determined assuming a cohort of 100 BE patients followed for a period of 10 years. RESULTS: A cohort of 185 BE patients was incepted, with a male:female ratio of 1.28:1, mean age of 55.14 years and mean follow-up of 7.1 years. Annual progression rate from no dysplasia to high grade dysplasia and AE was 0.30%. The lowest cost-effectiveness ratio was observed with endoscopic surveillance every five years, with a cost of dollar 202,913.86 Mexican pesos (dollar 17,644.68 USD) per high grade dysplasia and AE diagnosed. CONCLUSIONS: In Mexican patients with BE and no dysplasia, progression to high grade dysplasia and AE is lower than reported. This makes the performance of endoscopy every five years a more cost-effective surveillance strategy in our environment.

[Diagnostic usefulness of the Carlsson-Dent questionnaire in gastroesophageal reflux disease (GERD)]. / Utilidad diagnóstica del cuestionario de Carlsson-Dent en la enfermedad por reflujo gastroesofágico (ERGE).

BACKGROUND: Diagnosis of GERD is based on presence of symptoms (heartburn) associated to abnormal esophageal acid exposure or esophageal erosions determined by 24-hr pH monitoring and/or endoscopy, respectively. Different instruments have been evaluated in order to diagnose GERD without invasive studies. Carlsson-Dent questionnaire (CDQ), validated among European patients, have shown good sensitivity and positive predictive values for detection of GERD. Diagnostic usefulness of the CDQ in Mexican patients is unknown. OBJECTIVE: To evaluate usefulness of CDQ among patients with erosive GERD (EG) and non-erosive GERD (NERD). PATIENTS AND METHODS: Consecutive patients with heartburn at least twice per week during the last three months and previous endoscopy were included. All patients answered a self-administered Spanish version of the CDQ, previously evaluated for its content validity and easy application. A score of > or = 4 was considered as positive for GERD. All patients underwent 24-hr pH esophageal monitoring to determine the presence of pathologic reflux (% time pH < 4, > 4.2), as well as the symptom index (SI). Questionnaire's sensitivity (S), specificity (E), positive and negative predictive values (PPV, NPV) were calculated using 24-hr pH monitoring and endoscopic oesophagitis as gold-standard tests. RESULTS: A total of 125 patients were evaluated, 81 women (65%) and 44 men (35%) with an age of 47.9 (21-83). Eighty-six patients (69%) had NERD and 39 (31%) EG. Among patients with NERD, 28 (32%) had abnormal pH study, 10 (12%) had normal pH study with positive SI (> 50%), and 48 (65%) had normal pH study with negative SI. Most common symptom was a burning feeling rising from the stomach or lower chest up towards the neck (classic definition of heartburn) in 53%, noncardiac chest pain in 14%, and nausea in 5%. In 44 patients (35%) the main discomfort occurred within 2 hours of taking food, and in 77% it worsed with larger meals and food rich in fat, as well as in 77% after taking spicy food. One hundred and seven patients (86%) scored > or = 4 on CDQ and there was no significantly difference between CDQ score among groups. CDQ's sensitivity compared to pH monitoring was 89%, and PPV 55%. When compared to endoscopic findings, sensitivity was 94% and PPV 90. There was strong and significative correlation between esophageal acid exposure and higher CDQ's scores. CONCLUSIONS: CDQ in Spanish is an useful instrument for detection of GERD, and its score correlates with the degree of esophageal acid exposure.

[Perception of symptoms with minimal reductions of esophageal pH in patients with erosive and non-erosive GERD]. / Percepción de síntomas con descensos mínimos en el pH esofágico en pacientes con ERGE erosiva y no erosiva.

BACKGROUND: Patients with gastrointestinal reflux disease GERD perceive < 5% of acid reflux episodes, independently of GERD type. The role of minimal changes on esophageal pH (1 or 2 units) on development of symptoms is unknown. OBJECTIVE: To evaluate symptom perception and its relationship with minimal changes on esophageal pH in patients with erosive and non-erosive GERD (NERD). PATIENTS AND METHODS: We evaluated consecutive patients with symptomatic GERD. All patients had endoscopy in the previous 8 weeks. All patients underwent 24-h esophageal pH-monitoring. Abnormal pH-metry was defined as % time of pH < 4 > 4.2. Symptom index (SI) was considered positive when > or = 50. We also calculated SI at pH 5 and pH 6. Patients with GERD were classified into three groups: 1) abnormal pH and negative SI. For statistical analysis, we used the test-Student, chi 2, and ANOVA test. P < 0.05 was considered statistically significant. RESULTS: We evaluated 120 patients, 79 (66%) females and 41 (34%) males with mean age of 47.8 years (range 21-83 years). Eighty three (69%) patients had NERD and 37 (31%), erosive esophagitis (EE). Seventy two patients (87%) with NERD and 36 (97%) with erosive GERD developed symptoms during the study. NERD patients had mean of 69 reflux episodes compared with 184 of patients with EE. Perception of reflux symptoms was significantly higher in the group with EE (3.4 vs. 1.02 p < 0.0001). Among patients with NERD, 33% had abnormal pH-metry and 67%, a normal test. Of these patients, nine (16%) had normal pH test and positive SI, and 47 (83%) normal pH test and negative SI. There was no difference in symptom perception among the three groups. Patients with NERD and abnormal pH had similar SI patients with EE; 4% of patients with normal pH and negative SI at pH 4 had positive SI when calculated at pH 5, and 68% when SI was calculated at pH 6. CONCLUSIONS: The majority of acid reflux episodes are not perceived and this phenomenon is independent of erosive or non-erosive GERD. Patients with erosive esophagitis had significantly higher esophageal acid exposure than patients with NERD. Minimal changes in esophageal pH (1 or 2 pH units) increases SI in patients with GERD, especially in those with normal esophageal acid exposure.

[Post-infectious irritable bowel syndrome. A review based on current evidence]. / Síndrome de intestino irritable postinfeccioso. Una revisión basada en evidencias.

INTRODUCTION: Pathophysiology of irritable bowel syndrome (IBS) is multifactorial. Recent investigations have associated episodes of infectious gastroenteritis with development of IBS. This condition is named post-infectious IBS (PI-IBS). The role of inflammation-infection in IBS pathogenesis is not well understood. AIM: To review published scientific evidence on PI-IBS regarding risk factors, causal agents, histopathological changes, and treatment. MATERIALS AND METHODS: An electronic search in MEDLINE and abstracts presented at national and international GI meetings was performed, looking for information published in the past 50 years including animal studies, cohort studies, case-control studies, and series of cases and case reports, using the key words post-infectious enteritis, post-dysenteric or post-infectious irritable bowel syndrome (PI-IBS), and post-infectious colitis. RESULTS: Fifty one papers were included. These studies were classified according to pathophysiologic mechanisms, infectious agents involved, animal or human studies, and treatment. CONCLUSIONS: Current evidence shows a strong association between colonic infection and inflammation with development of IBS. Approximately 25% of patients with IBS have a history of infectious enteritis. Microbial agents related with PI-IBS include bacteria (Campylobacter, Salmonella) and parasites (Trichinella spiralis). Increased number of enteroendocrine cells, CD3 lymphocytes and mast cells within the colonic muscle wall, release of pro-inflammatory substances, and increased number of inflammatory cells with intestinal nervous endings are the most common histopathologic findings. Patients developing PI-IBS have a higher frequency of psychological disorders and stressful events prior to the gastroenteritis episode. Therapeutic interventions with steroids, COX-2 inhibitors, antibiotics and probiotics require further investigation.

[Obesity and gastroesophageal reflux disease]. / Obesidad y enfermedad por reflujo gastroesofágico.

INTRODUCTION: Obesity is a condition that has been associated with gastroesophageal reflux disease (GERD), however, a cause-effect relationship has not been established. AIM: To analyze current evidence evaluating the relationship between obesity and GERD, as well as the impact of hypocaloric diets and bariatric surgery in gastroesophageal reflux symptoms. MATERIAL AND METHODS: An electronic search in the MEDLINE was performed, looking for information published during the past 15 years: Cohort studies, case-control studies, case series and case reports, including the following key words: "heartburn", "reflux", "gerd", "reflux esophagitis", "obesity", "overweight", "diet", "bariatric surgery" were analized. RESULTS: Thirty-one articles were included. These studies were classified according to the diagnostic method of GERD (i.e., manometry, 24-hour pH monitoring, esophageal transit, endoscopy) and type of bariatric surgery: Adjustable gastric banding (AGB), vertical banded gastroplasty (VBG), and Roux-en-Y gastric bypass (RYGB), or anti-reflux procedure. CONCLUSIONS: Most studies suggest that obesity is a condition predisposing to the development of GERD. However, there are no studies that correlate the degree of obesity with the symptoms of reflux. Hypotonic lower esophageal sphincter, ineffective esophageal motility and presence of hiatal hernia are the pathophysiological mechanisms proposed as inductors of gastroesophageal reflux among obese patients. AGB and VBG seem to induce postoperative esophagitis in some patients, but RYGB has shown to be effective to control GERD symptoms. Overweight and obesity do not seem to affect the results of antireflux surgery. The impact of body weight loss on GERD following hypocaloric diets requires further investigation.

Enfermedad recurrente después del trasplante de higado [simposio] / Recurrences after liver transplantation [symposium]

Objetivo. Antes de la disponibilidad el trasplante hepático, el tratamiento de la enfermedad hepática terminal estuvo limitada a los esfuerzos para corregir y controlar las complicaciones asociadas con la cirrosis así como medidas para paliar, cuando ya las otras medidas habían sido empleadas. En la última década, el trasplante hepático ha sido aceptado como tratamiento efectivo para pacientes con enfermedad terminal hepática. Sin embargo, la recurrencia de la enfermedad post trasplante es común por virus B y C. No así otras enfermedades colestásicas como cirrosis biliar primaria (CBP), colangitis esclerosante primaria (CEP) y hepatitis autoinmune (HA). El carcinoma hepatocellular tiene alta recurrencia. Objetivo. Revisión de los resultados del trasplante hepático en hepatitis por virus B y C, así como de la incidencia de recurrencia en esta enfermedad, en CBP, CEP, cirrosis por alcohol y carcinoma hepatocelular. Pacientes y métodos. Se analizan los resultados de enfermedad recurrente post-trasplante hepático en diferentes centro de trasplante. Resultados. La hepatitis B recurre en el 80-90 por ciento de pacientes con trasplante hepático. Hepatitis C se encuentra del 0-30 por ciento de pacientes en varios centros y la infección del injerto se presenta en 40-45 por ciento de los pacientes un año después del trasplante. Estos datos llevan a la exclusión de pacientes con hepatitis B para trasplante en muchos centros. En los pacientes con hepatitis C debe hacerse una cuidadosa selección para trasplante. La recurrencia de CBP tiene tasa menos al 5 por ciento. Los cambios en la colangiografía en CEP pueden ocurrir después de trasplante y habitualmente son debidos a isquemia por estenosis o trombosis de la arteria hepática. Si no ha etiología isquémica, la CEP debe ser considerada como indicación de trasplante. En carcinoma hepatocelular el trasplante es controvertido en vista de la escasez de órganos. Los resultados de sobrevida del injerto libre de tumor a tres años. En cirrosis por alcohol, la sobrevida postrasplante no es diferente a la de pacientes trasplantados por otras razones. El problema incluye aspectos éticos y el dilema de trasplantar alcohólicos es difícil...