Efficacy and safety of lubiprostone for the treatment of chronic idiopathic constipation: A phase 3, randomized, placebo-controlled study.

INTRODUCTION: Chronic idiopathic constipation (CIC) negatively impacts quality of life and increases healthcare costs. Lubiprostone stimulates the secretion of intestinal fluid, in turn facilitating the passage of stools and alleviating associated symptoms. Lubiprostone has been available in Mexico since 2018, but its clinical efficacy has not been studied in a Mexican population. AIM: To evaluate the efficacy of lubiprostone, assessed by changes in spontaneous bowel movement (SBM) frequency after one week of treatment with 24 µg oral lubiprostone (b.i.d.), as well as its safety, over four weeks of treatment. STUDY: Randomized, double-blind, placebo-controlled study on 211 adults with CIC in Mexico. RESULTS: The increase in SBM frequency, after one week of treatment, was significantly higher in the lubiprostone group than in the placebo group (mean: 4.9 [SD: 4.45] vs. 3.0 [3.14], p = 0.020). Secondary efficacy endpoints revealed a significantly higher proportion of SBM frequency/week in the lubiprostone group at weeks 2, 3, and 4. There was a better response within 24 h after the first dose with lubiprostone vs. placebo (60.0% vs. 41.5%; OR: 2.08, CI95%: [1.19, 3.62], p = 0.009) and the lubiprostone group also had significant improvement, with respect to straining, stool consistency, abdominal bloating, and Satisfaction Index. The main adverse events were gastrointestinal disorders in 13 (12.4%) lubiprostone-treated subjects and 4 (3.8%) control subjects. CONCLUSIONS: Our data confirm the efficacy and safety of lubiprostone for the treatment of CIC in a Mexican population. Lubiprostone treatment induces relief from the most bothersome symptoms associated with constipation.

The Mexican consensus on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy. / Consenso mexicano sobre diagnóstico, prevención y tratamiento de la gastropatía y enteropatía por antiinflamatorios no esteroideos.

More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy.

The Mexican consensus on chronic constipation. / Consenso mexicano sobre estreñimiento crónico.

INTRODUCTION: Significant advances have been made in the knowledge and understanding of the epidemiology, pathophysiology, diagnosis, and treatment of chronic constipation, since the publication of the 2011 guidelines on chronic constipation diagnosis and treatment in Mexico from the Asociación Mexicana de Gastroenterología. AIMS: To present a consensus review of the current state of knowledge about chronic constipation, providing updated information and integrating the new scientific evidence. METHODS: Three general coordinators reviewed the literature published within the time frame of January 2011 and January 2017. From that information, 62 initial statements were formulated and then sent to 12 national experts for their revision. The statements were voted upon, using the Delphi system in 3 voting rounds (2 electronic and one face-to-face). The statements were classified through the GRADE system and those that reached agreement >75% were included in the consensus. RESULTS AND CONCLUSIONS: The present consensus is made up of 42 final statements that provide updated knowledge, supplementing the information that had not been included in the previous guidelines. The strength of recommendation and quality (level) of evidence were established for each statement. The current definitions of chronic constipation, functional constipation, and opioid-induced constipation are given, and diagnostic strategies based on the available diagnostic methods are described. The consensus treatment recommendations were established from evidence on the roles of diet and exercise, fiber, laxatives, new drugs (such as prucalopride, lubiprostone, linaclotide, plecanatide), biofeedback therapy, and surgery.

Risk factors for colorectal polyps in a Mexican population [Corrected and republished].

BACKGROUND: The prevalence of colorectal polyps and adenomas in the general population of Mexico is unknown. AIM: To determine the prevalence and risk factors for colorectal polyps detected during flexible sigmoidoscopy (FSIG) in asymptomatic patients. MATERIAL AND METHODS: From 1995 to 2008, FSIG was performed as part of a complete check-up in patients who had lived in northeast Mexico for over 5 years. RESULTS: 946 (794 males/152 females) were included in the study. The mean age was 48.8 years (range 21-91). A family history of colorectal cancer (FHCRC) was present in 2.2 % of the cases. The adenoma prevalence found in patients with a BMI < 25, 26-30 or > 30 was 7.3%, 6.2% and 10.2% respectively. Independent risk factor for colorectal polyps and adenomas included a positive family history of colorectal cancer (OR 12.4, 95% CI 19.1-230, and OR 12.4, 95% CI 4.1-37.3, respectively) and a body mass index > 25 (OR 4.2, 95% CI 4.2-14.2 and OR 4.2, 95% CI 1.8-9.7, respectively). Seventy two patients had polyps (7.6%) and 29 patients had adenomas (3%). The prevalence of polyps and adenomas on FSIG in patients younger than 50 years was 5.8% and 1.9% respectively, and among those older than 50 years, it was 8.9% and 4.8% respectively. CONCLUSION: A positive family history of colorectal cancer and a body mass index > 25 are independent risk factors for colorectal polyps and adenomas. The adenoma prevalence found in our population was lower than the reported in developed countries.

Risk factors for colorrectal polyps in a Mexican population.

BACKGROUND: The prevalence of colorectal polyps and adenomas in the general population of Mexico is unknown. AIM: To determine the prevalence and risk factors for colorectal polyps detected during flexible sigmoidoscopy (FSIG) in asymptomatic patients. MATERIAL AND METHODS: From 1995 to 2008, FSIG was performed as part of a complete check-up in patients who had lived in northeast Mexico for over 5 years. RESULTS: 946 (794 males/152 females) were included in the study. The mean age was 48.8 years (range 21-91). A family history of colorectal cancer (FHCRC) was present in 2.2 % of the cases. The adenoma prevalence found in patients with a BMI < 25, 26-30 or > 30 was 7.3%, 6.2% and 10.2% respectively. Independent risk factor for colorrectal polyps and adenomas included a positive family history of colorrectal cancer (OR 12.4, 95% CI 19.1-230, and OR 12.4, 95% CI 4.1-37.3, respectively) and a body mass index < 25 (OR 4.2, 95% CI 4.2-14.2 and OR 4.2, 95% CI 1.8-9.7, respectively). Seventy two patients had polyps (7.6%) and 29 patients had adenomas (3%). The prevalence of polyps and adenomas on FSIG in patients younger than 50 years was 5.8% and 1.9% respectively, and among those older than 50 years, it was 8.9% and 4.8% respectively. CONCLUSION: A positive family history of colorectal cancer and a body mass index < 25 are independent risk factors for colorectal polyps and adenomas. The adenoma prevalence found in our population was lower than the reported in developed countries.