[Is the diet low in FODMAP really effective and safe for irritable bowel syndrome?: A scoping review]. / La dieta baja en FODMAP, ¿es realmente eficaz y segura en el síndrome del intestino irritable?: una revisión panorámica.

At present, there is no aetiological treatment available for irritable bowel syndrome, and dietary modifications, particularly the low-FODMAP (monosaccharide, disaccharide, oligosaccharides and fermentable polyols) diet is increasingly used to control the symptoms of irritable bowel syndrome, although its actual efficacy and safety are unknown. The objective of this overview is to determine whether the low FODMAP diet is really effective and safe in the long term in the dietary management of irritable bowel syndrome. The review, following an appropriate methodology, was carried out with 25 studies, which were retrieved full text. Of these, 3 were meta-analyses, 2 were systematic reviews, and 3 were both types of studies. The rest of the studies were, in general, of low methodological quality and very heterogeneous, with a low level of evidence and low degree of recommendation. It can be concluded that, in the short term, the low-FODMAP diet is effective in most patients with irritable bowel syndrome, so its use as first-line therapy could be supported. However, of all the studies, only one was prospective for long-term follow-up, between 6 and 18 months, with good results. More follow-up studies, designed for this purpose, are needed to investigate long-term effects. Furthermore, if this type of diet is advised, it should be led by specialised dietitians.

Endoscopic follow-up and management of Barrett's esophagus in relation to its preneoplastic potential.

Barrett's esophagus is an acquired clinical condition in which the squamous epithelium of the distal esophagus is replaced by a columnar epithelium. The diagnosis requires histological confirmation of specialized intestinal metaplasia, in which goblet cells must be present. Barrett's esophagus is a risk factor for the development of esophageal adenocarcinoma, a tumor with an incidence and mortality have increased alarmingly in recent years in the western world. It has been estimated that the annual incidence of cancer in patients with Barrett's esophagus has increased from 0.2-2%. Once diagnosed, Barrett's esophagus is estimated to have an annual neoplastic transformation rate of 0.5% per patient. The highlights of the endoscopic diagnosis and treatment are reviewed here, as well as the screening and monitoring of this process.

Irritable bowel syndrome immune hypothesis. Part one: the role of lymphocytes and mast cells.

OBJECTIVE: To review the available evidence on the role of T-lymphocytes and mast cells in the etiopathogenesis of Irritable Bowel Syndrome. METHODS: Bibliographic retrieval on PubMed including the terms "Irritable Bowel Syndrome, "Immune System", "T-Lymphocytes" and "Mast Cells". RESULTS: Twenty-five case-control studies and one randomized controlled trial were retrieved. Noteworthy in the blood is the increase in activated T cells destined to migrate to the bowel in these patients. A high frequency of T-lymphocytes is described in the intestinal mucosa, although the study findings are, at times, contradictory. An evident increase in mast cells (and in their activity) between the terminal ileum and descending colon is also observed. CONCLUSIONS: The heterogeneity of diagnostic criteria and experimentation methods could account for some of the differences in the results found in the selected research. There are indications that give reason to believe these patients have "low-grade intestinal inflammation", and the increase in T-lymphocytes and mast cells has been associated with disorders found in IBS such as the communication between the intestine and the nervous system, the increase in intestinal permeability and changes in the microbiota.

Irritable bowel syndrome immune hypothesis. Part two: the role of cytokines.

OBJECTIVE: To review the available evidence on the role of interleukins in the etiopathogenesis of Irritable Bowel Syndrome. METHODS: Bibliographic retrieval on PubMed including the MeSH terms "Irritable Bowel Syndrome, "Immune System", "Cytokines" and "Interleukins". RESULTS: Sixteen case-control studies and one randomised controlled trial were retrieved. The blood appears to have a high concentration of pro-inflammatory cytokines (TNF- á , IL-1 â , IL-6, IL-8) and lower concentration of IL-10, an anti-inflammatory cytokine, even though the findings are disparate and heterogeneous. As many as 33 genes were found, each with different expressions, and a diminished expression of cytokines in the colon mucosa of patients with IBS, which have not been previously described in any other pathology. CONCLUSIONS: In patients with IBS, a clear profile of cytokine levels in the blood does not appear to exist, although an imbalance between them can be observed. Moreover, there are indications that give reason to believe that the different subsets of patients with IBS could present cytokine profiles in different blood. On the other hand, in the intestine, high cytokine secretion levels are not detected, contrary to what would be expected. Further studies are required to substantiate these findings.

[Effects of blood volume expansion on atrial natriuretic factor and the renin-aldosterone axis in experimental cirrhosis]. / Efectos de la expansión de la volemia sobre el factor auricular natriurético y el eje renina-aldosterona en la cirrosis experimental.

Serum concentrations of ANF, Renin and Aldosterone were measured in animals with experimental cirrhosis and volume overload. We studied 75 Wistar rats divided in five groups. Group I: rats with hepatic cirrhosis induced by CCl4; Group II: Control rats; Group III: rats with hepatic cirrhosis and continuous infusion of saline serum; Group IV: control rats with continuous infusion and Group V: cirrhotic rats and bolus infusion of saline. There were no statistical differences in serum concentrations of ANF (232 +/- 75 vs 195 +/- 42 pg/ml) and Renin concentration (182 +/- 24 vs 171 +/- 34 ng/ml/hour) between controls and rats with cirrhosis. However, Aldosterone levels were elevated in cirrhotic rats in basal conditions as compared to controls (1197 +/- 287 vs 475 +/- 88 pg/ml; p < 0.001). The volume overload caused a paradoxical decrease of ANF in cirrhotic rats (124 +/- 15 and 122 +/- 17; p < 0.001). On the other hand, no changes were observed in Renin and Aldosterone after volume expansion. These results suggest the existence of a hemodynamic response to compensate the volume overload. Other studies are necessary to confirm this hypothesis.

[Immunological differences between patients with cirrhosis and liver carcinoma]. / Diferencias inmunológicas entre pacientes con cirrosis y hepatocarcinoma.

Fifteen patients with liver cirrhosis and 15 with primary liver cancer were studied. The results of cellular immunity in these two groups and a third control group of 15 healthy subjects were compared. A significant decrease in OKT3 and OKT4 lymphocytes and response to different mytogenic stimuli were found, particularly in the hepatocarcinoma group. No significant differences were observed in OKT8, OKM1 or chemotaxis.

[Endoscopic management of foreign bodies in the digestive tract]. / Manejo endoscópico de los cuerpos extraños del tubo digestivo.

From 1983 to 1989, the Unidad de Endoscopias has attended 424 cases of foreign bodies located in the gastrointestinal tract, most of them in the esophagus. The mean age of the patients was 49 years. The commonest foreign bodies were food particles and the most common symptom was acute dysphagia. The most frequent localization of impaction was the cricopharyngeal sphincter (Killian's mouth). In 89% of the cases the foreign body could be removed endoscopically. The most common underlying pathology was hiatal hernia. There were severe complications related to the presence of the foreign body in 4.5% of the cases; one death was due to aorto-esophageal fistula. Foreign bodies, mainly impacted food particles (p less than 0.001), are most frequent in patients over 65, mainly females (p less than 0.01).

[Role of endoscopy in caustic gastroesophageal lesions]. / Papel de la endoscopia en las lesiones cáusticas gastroesofágicas.

From 1984 to 1989 we have examined endoscopically 191 patients who ingested, for different causes, some type of caustic substance. The mean age was 36.8 +/- 21 years. 57% were female and 43% males. The most common substance was lye (52%). The clinical symptoms consisted mainly of epigastric pain and odynophagia. The most prevalent lesion was oesophagitis, of variable degrees (58%). Complications related to the ingestion of the caustic appeared in 20% of the patients; three of them died. The most common sequela was oesophageal stenosis and secondly gastric stenosis. Males ingested acids more frequently than females (P less than 0.001). In 20% of the cases the ingestion of the caustic was for suicide while in children all the cases were accidents.

[Angiodysplasia of the colon. Experience in 60 cases]. / Angiodisplasias de colon. Experiencia en 60 casos.

A review was made of 60 angiodysplasias of the colon (AD) found retrospectively among 2,750 colonoscopies. The most frequent clinical manifestation was rectal bleeding (65%); mean patient age was 63 years. More than a fourth of the angiodysplasias (26.6%) was located in the left colon, as compared to 66.6% in the cecum and ascending colon. Most of the lesions were multiple and less than 5 mm in diameter. Twenty-two percent of the patients were cirrhotics and 15% had an aortic valvular lesion. The most outstanding aspects of the process are reviewed.

[Colonoscopic approach in the therapy of sigmoid volvulus]. / Abordaje colonscópico en el tratamiento del vólvulo sigmoide.

We present 13 patients with 15 episodes of colonic volvulus, who underwent colonoscopy to decompress and/or devolvulate. Colonoscopic exploration demonstrated a non obstructive dilatation in three cases. In the remaining 10 patients, with 12 episodes of volvulus, decompression was obtained in 83.3% and devoluvulation in 41.6%. There were two failures, due to peritoneal metastases and adhesions which fixed the volvulus. In 40% of the cases there were mild ischemic signs. Forty per cent of the patients were submitted to elective surgery and the two failures (20%) were operated in emergency. The remaining 4 patients declined surgical treatment. At is allows differential diagnosis, we think that, for these patients, colonoscopy should be the first therapeutic approach; it also allows decompression and/or devolvulation and an early diagnosis of the associated ischemia.

[The epidemiological aspects of chronic inflammatory intestinal disease in a catchment area of the Autonomous Community of Madrid]. / Aspectos epidemiológicos de la enfermedad inflamatoria intestinal crónica en un área asistencial de la Comunidad Autónoma de Madrid.

124 cases of chronic inflammatory bowel disease were retrospectively reviewed between 1983 and 1988 (44 affected by Crohn's disease (CD) and 80 by ulcerative colitis (UC)). A median annual incidence of 1.30/100,000 inhabitants/year for CD and 2.37 for UC was found, observing an increase in the incidence of CD and a stabilization of UC.

[Immunologic aspects of chronic diarrhea in relation to inflammatory intestinal disease]. / Aspectos inmunológicos en diarreas crónicas en relación con la enfermedad inflamatoria intestinal.

In a group of patients with chronic diarrhea of unknown origin, a study of cellular and humoral immunity was carried out with in vitro tests and the results are compared to those obtained in a group of patients with ulcerative colitis or Crohn's disease, and to normal controls. In the chronic diarrhea group there was evidence of an immunological deficiency affecting the B and T lymphocytes that had specific characters in relation to IgG, although the IgG deficit was not as important as in intestinal inflammatory disease.