Asociación Española de Neurogastroenterología y Motilidad (ASENEM) updated review on the management of functional abdominal pain. / Documento de puesta al día de la Asociación Española de Neurogastroenterología y Motilidad (ASENEM) sobre el manejo del dolor abdominal funcional.

Functional abdominal pain is a disorder in which central and peripheral sensitization processes converge, leading to hypersensitivity and allodynia. Differential diagnosis is made with organic digestive, renal, gynecological, endocrine, or neurological diseases. Treatment should be individualized for each patient. In cases of debilitating pain, therapy combining drugs with different mechanisms of action can be initiated, while in less severe cases, therapy with a progressive introduction of drugs based on clinical response is advised. The first line includes general lifestyle advice and antispasmodic substances, like peppermint oil, anticholinergic/antimuscarinic, and calcium channels antagonists. In the second line of treatment, neuromodulating agents are added. Finally, when these measures fail, third-line treatments such as gabapentine and atypical antipsychotics are considered. Psychological interventions should be considered if specialized therapists are available to manage these disorders.

Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life.

BACKGROUND: although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. OBJECTIVE: to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. METHODS: a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). RESULTS: the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (ß = 0.29; p < 0.01), severity of symptoms (ß = -0.38; p < 0.001), body mass index (ß = -0.30; p < 0.005), state anxiety (ß = 0.28; p < 0.01), female gender (ß = -0.23; p < 0.05) and dyspepsia (ß = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (ß = -0.39; p < 0.01) and depression (ß = -0.32; p < 0.05). CONCLUSIONS: the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component.

Prevalence and factors associated with faecal impaction in the Spanish old population.

Background: Faecal impaction (FI) is a common problem in old people living in nursing home. Its prevalence and associated factors remain unknown in the general population. Aim: To evaluate FI prevalence in the Spanish population older than 65 years and to assess the factors associated with it. Methods: A telephone survey was carried out of a Spanish population older than 65 years random sample (N = 1000). FI was assessed using a previously validated questionnaire. Results: A total of 28,128 calls were made; 1,431 subjects were eligible and 1,000 subjects were enrollled, mean aged 74.6 ± 7.3 (65­97); 57.5% were women. At least 53 people reported FI within the past year (5.3% (CI 95%: 3.9­6.7%)). Only 0.03% met criteria for chronic constipation and faecal incontinence. FI-associated factors were constipation, female gender, reduced physical activity, and chronic renal failure (CRF). Conclusion: FI is a prevalent problem in old Spanish population. Constipation and female gender are the main associated factors; low physical activity and CRF appear to play also a significant role. Further studies are required to confirm this association.

Fecal impaction: a systematic review of its medical complications.

BACKGROUND: Fecal impaction (FI) is a common problem in the elderly and other at-risk groups, such as patients with a neuro-psychiatric disease. It has been associated with medical problems and high morbi-mortality. A systematic review of this topic might be useful to improve the knowledge in this area and helpful to make an appropriate and early diagnosis. METHODS: A PubMed systematic search was performed using relevant keywords. Case reports published in English, Spanish or French till June 2014 were included if they had a diagnosis of FI and a medical complication secondary to it. Each case was classified based on its principal complication. The main objective is to create a classification of FI complications based on published clinical cases. RESULTS: 188 articles met inclusion criteria, comprising 280 clinical cases. Out of the total, 43,5% were over 65 years old, 49% suffered from chronic constipation, 29% had an underlying neuropsychiatric disease and 15% were hospitalised or institutionalised. A total of 346 medical complications secondary to FI were collected. They were divided according to gastrointestinal tract involvement and then classified based on their anatomical and pathophysiological mechanism into three groups: Complications secondary to fecaloma effect on the intestinal wall (73.4%), on the intestinal lumen (14%) and on adjacent structures (12.6%). CONCLUSIONS: FI causes complications that might be fatal. The elderly, underlying neuropsychiatric disease and hospitalised or institutionalised patients integrate the high-risk group in which FI must be suspected. The first FI complications classification is presented to improve the knowledge about this entity.

Enterohepatic Helicobacter other than Helicobacter pylori.

The Helicobacter genus includes Gram negative bacteria which were originally considered to belong to the Campylobacter genus. They have been classified in a separate genus since 1989 because they have different biochemical characteristics, with more than 24 species having been identified and more still being studied.H. pylori is the best known. It has an important etiopathogenic role in peptic ulcer disease and gastric cancer. Enterohepatic Helicobacters (EHH) other than H. pylori colonize the bowel, biliary tree and liver of animals and human beings with pathogenic potential. The difficulties existing to correctly isolate these microorganisms limit the description of their true prevalence and of the diseases they cause. Many studies have tried to discover the different clinical implications of EHH. Diseases like chronic liver disease, autoimmune hepatitis, hepatocarcinoma, autoimmune hepatobiliary disease, biliary lithiasis, cholangiocarcinoma and gallbladder cancer, Meckel´s diverticulum, acute appendicitis and inflammatory bowel disease have been related with different EHH species with different results, although their prevalence is greater than in healthy subjects. However, these data are currently not sufficient to draw definitive conclusions. Finally, the best known role of EHH in bowel disease is production of acute and chronic diarrhea pictures initially referred to as Campylobacter. H. pullorum has been identified in patients with acute gastroenteritis. The correct identification of EHH as producers of infectious gastroenteritis is found in its antibiotic susceptibility. It is generally macrolide-susceptible and quinolone-resistant.

Clinical response to linaclotide at week 4 predicts sustained response in irritable bowel syndrome with constipation and improvements in digestive and extra-digestive symptoms.

BACKGROUND: Linaclotide is approved for the treatment of moderate-to-severe irritable bowel syndrome (IBS) with constipation (IBS-C) in adults. This study aimed to assess factors predictive of a clinical response and improvements in non-IBS symptoms with linaclotide treatment in a Spanish patient population. METHODS: In this open-label phase IIIb study, patients with moderate-to-severe IBS-C received linaclotide 290 µg once daily for 12 weeks. The primary endpoint was clinical response at week 12, defined as >30% reduction in IBS symptom severity score (IBS-SSS) or IBS-SSS <75 plus self-reported response of feeling 'better' or 'much better' versus the baseline. Digestive nonintestinal and extra-digestive symptom scores were assessed. Baseline characteristics and week 4 clinical response were assessed as predictors of week 12 clinical response. RESULTS: A total of 96 patients were eligible; 91 were female and the mean age was 47.4 years. Mean (SD) baseline IBS-SSS was 371 (72.5). In the intention-to-treat and per-protocol populations, 22.9% and 31.7% were clinical responders at week 4, respectively, and 25.0% and 36.7% were clinical responders at week 12. Digestive nonintestinal and extra-digestive symptom scores were significantly improved at weeks 4 and 12. Baseline characteristic was not associated with week 12 clinical response; however, clinical response at week 4 was predictive of response at week 12 (OR: 6.5; 95%IC: 2.1-19.8). The most common adverse event was diarrhea inclusive of loose or watery stools (35.4%). CONCLUSIONS: Linaclotide improves IBS-C symptoms, including digestive nonintestinal and extra-digestive symptoms. A clinical response at week 4 may predict response at week 12.

The safety of available treatments for chronic constipation.

INTRODUCTION: Chronic constipation is a frequent syndrome which, not only causes an appreciable deterioration in quality of life, but also entails a high economic cost due, among other things, to its treatment. This is because of the widespread use of laxatives, even by subjects who have not sought medical care, as well as little patient satisfaction with the treatment. Although this generally involves the use of drugs regarded as safe, there is no clear evidence about their short- and long-term effects, something that complicates appropriate prescription and follow-up by health professionals and hinders therapeutic compliance. OBJECTIVE: To review the adverse effects which have been associated with laxatives based on scientific evidence, and ascertain the safety profile of the treatments used for constipation. Expert opinion: While all the drugs currently available for treatment of constipation are generally safe when used at established doses under medical supervision, more rigorous data on their long-term safety are nonetheless required, in view of the fact that constipation is a chronic condition. Their long-term use should be monitored by health professionals to optimize treatment on an individualized basis, with the aim of enhancing efficacy and minimizing adverse effects.

Factores independientes asociados con el impacto de la enfermedad por reflujo gastroesofágico en la calidad de vida relacionada con la salud / Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life

Introducción: varios factores se han asociado con el deterioro de la calidad de vida en la enfermedad por reflujo gastroesofágico. Sin embargo, se desconoce aquellos que lo condicionan de manera independiente. Objetivo: evaluar los factores independientemente asociados con el impacto de la enfermedad por reflujo gastroesofágico sobre la calidad de vida relacionada con la salud. Material y método: Análisis post hoc de una cohorte prospectiva de pacientes diagnosticados de enfermedad por reflujo gastroesofágico. Se completaron cuestionarios validados para evaluar: calidad de vida (SF36), reflujo gastroesofágico (GERQ) y factores psicológicos (STAI y SCL90R). Resultados: Se incluyeron 98 pacientes. En el análisis univariante, el deterioro en el componente físico del SF36 se encontraba significativamente asociado al sexo femenino, al nivel educativo, a la edad, a la disminución de peso, a la severidad de los síntomas típicos y a los síntomas supraesofágicos e ingresos mensuales; el componente mental se asoció al consumo de alcohol, al dolor epigástrico y a peores puntuaciones en los cuestionarios STAI y SCL90. El análisis multivariante mostró una asociación independiente en el componente físico del SF36 con el nivel educativo (ß = 0,29; p < 0,01), la severidad de los síntomas (ß = -0,38 ; p < 0,001), el índice de masa corporal (ß = -0,30 ; p < 0,005), el estado de ansiedad (ß = 0,28; p < 0,01), el sexo femenino (ß = -0,23; p < 0,05) y la dispepsia (ß = -0,21; p < 0,05); y en la esfera mental, con el estado de ansiedad (ß = -0,39; p < 0,01) y la depresión (ß = -0,32; p < 0,05). Conclusión: los principales factores independientemente asociados con el deterioro de la calidad de vida en pacientes con enfermedad por reflujo gastroesofágico son la severidad de los síntomas típicos y la presencia de dispepsia, con un impacto adicional del índice de masa corporal y el componente psicológico

Background: although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. Objective: to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. Methods: a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). Results: the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (ß = 0.29; p < 0.01), severity of symptoms (ß = -0.38; p < 0.001), body mass index (ß = -0.30; p < 0.005), state anxiety (ß = 0.28; p < 0.01), female gender (ß = -0.23; p < 0.05) and dyspepsia (ß = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (ß = -0.39; p < 0.01) and depression (ß = -0.32; p < 0.05). Conclusions: the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component

Helicobacter enterohepáticos distintos de Helicobacter pylori / Enterohepatic Helicobacter other than Helicobacter pylori

El género Helicobacter engloba bacterias Gram negativas que en un principio se consideraban pertenecientes al género Campylobacter, y desde 1989 se clasificaron en un género separado debido a características bioquímicas diferentes, con más de 24 especies identificadas y otras aún en estudio. H. pylori es el más conocido y tiene un importante papel etiopatogénico en la patología péptica y cáncer gástrico. Otros Helicobacter enterohepáticos (HEH) distintos de H. pylori colonizan el intestino, el árbol biliar y el hígado de animales y seres humanos con potencial patógeno. Las dificultades para el correcto aislamiento de estos microorganismos limitan la descripción de su prevalencia real y de las patologías que provocan. Múltiples estudios intentan desvelar las diferentes implicaciones clínicas de los HEH. Patologías como la hepatopatía crónica, hepatitis autoinmune, hepatocarcinoma, enfermedad hepatobiliar autoinmune, litiasis biliar, colangiocarcinoma y cáncer de vesícula biliar, cáncer de páncreas, diverticulitis de Meckel, apendicitis aguda y enfermedad inflamatoria intestinal se han relacionado con diferentes especies de HEH con diferentes resultados, aunque con una mayor prevalencia que en sujetos sanos. No obstante, estos datos son insuficientes para sacar conclusiones definitivas por el momento. Por último, el papel más conocido de los HEH en la patología intestinal es la producción de cuadros diarreicos agudos y crónicos referidos inicialmente como Campylobacter. H. pullorum se ha identificado en pacientes con gastroenteritis aguda. La correcta identificación de HEH como productores de gastroenteritis infecciosa radica en su sensibilidad antibiótica, generalmente sensible a macrólidos y resistente a quinolonas (AU)

The Helicobacter genus includes Gram negative bacteria which were originally considered to belong to the Campylobacter genus. They have been classified in a separate genus since 1989 because they have different biochemical characteristics, with more than 24 species having been identified and more still being studied. H. pylori is the best known. It has an important etiopathogenic role in peptic ulcer disease and gastric cancer. Enterohepatic Helicobacters (EHH) other than H. pylori colonize the bowel, biliary tree and liver of animals and human beings with pathogenic potential. The difficulties existing to correctly isolate these microorganisms limit the description of their true prevalence and of the diseases they cause. Many studies have tried to discover the different clinical implications of EHH. Diseases like chronic liver disease, autoimmune hepatitis, hepatocarcinoma, autoimmune hepatobiliary disease, biliary lithiasis, cholangiocarcinoma and gallbladder cancer, Meckel´s diverticulum, acute appendicitis and inflammatory bowel disease have been related with different EHH species with different results, although their prevalence is greater than in healthy subjects. However, these data are currently not sufficient to draw definitive conclusions. Finally, the best known role of EHH in bowel disease is production of acute and chronic diarrhea pictures initially referred to as Campylobacter. H. pullorum has been identified in patients with acute gastroenteritis. The correct identification of EHH as producers of infectious gastroenteritis is found in its antibiotic susceptibility. It is generally macrolidesusceptible and quinolone-resistant (AU)