ABSTRACT
Lactose intolerance is a condition with an elevated prevalence worldwide, especially in Latin American, Asian, and African countries. The aim of the present narrative review was to highlight the importance of accurately diagnosing lactose intolerance to prevent self-diagnosis that results in the unnecessary elimination of milk and dairy products from the diet and the consequent deprivation of nutrients that could be essential at certain stages of life. The pathophysiologic mechanism of deficient lactose absorption in the intestine can be primary, secondary to other enteropathies, or coexistent with other intestinal diseases with similar symptoms, such as irritable bowel syndrome, bacterial overgrowth syndrome, or celiac disease, causing confusion in relation to diagnosis and treatment. Lactose intolerance consists of a set of symptoms attributed to the consumption of milk and dairy products that are assumed to be due to deficient digestion of that disaccharide. A wide range of tests have been validated to detect deficient digestion that include blood tests, genetic mutation analyses, breath tests, and recently, a urine test, all of which are described in the present article. Nevertheless, there are few validated questionnaires for symptom evaluation and measurement, partly due to the heterogeneity of concepts and the subjectivity of each of the symptoms.
Subject(s)
Lactose Intolerance/diagnosis , Algorithms , Humans , Symptom AssessmentABSTRACT
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.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Gastrointestinal Diseases/chemically induced , Age Factors , Endoscopy, Gastrointestinal , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/therapy , Humans , Mexico , Risk FactorsABSTRACT
Milk is a liquid food that possesses an important quantity of highly bioavailable macronutrients. In addition, it is readily accessible, as well as relatively inexpensive. Given that the knowledge of physicians about nutrition and food composition is deficient, in general, many of the dietary interventions recommended in diverse clinical settings lack a scientific basis. The aim of the present review was to produce a technical opinion that serves as a frame of reference to best sustain recommendations for consuming milk and dairy products as daily nutrition in the adult and older adult. The effects of milk and dairy products during the pediatric stage are not addressed in the present work. The Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría jointly discussed and analyzed topics dealing with the legal designation of milk, the classification and nutritional profile of cow's milk, its nutritional characteristics, its consumption in the adult, intolerance to cow's milk, and associations of milk consumption with digestive tract alterations and other conditions. Finally, certain aspects of milk consumption in the older adult and its relation to overall health are briefly discussed.
Subject(s)
Dairy Products , Milk , Age Factors , Aged , Aged, 80 and over , Animals , Cattle , Consensus , Digestive System Physiological Phenomena , Health , Humans , Mexico , Milk Hypersensitivity , Nutritional StatusABSTRACT
BACKGROUND: Since the publication in 2009 of the Guidelines on the Diagnosis and Treatment of Irritable Bowel Syndrome of the Asociación Mexicana de Gastroenterología (2009 Guidelines), there have been significant advances in our knowledge of the epidemiology, pathophysiology, diagnosis, and treatment of this disease. AIMS: To present a consensus review of the most current knowledge of IBS, updating the 2009 Guidelines by incorporating new internationally published scientific evidence, with a special interest in Mexican studies. METHODS: The PubMed literature from January 2009 to March 2015 was reviewed and complemented through a manual search. Articles in English and Spanish were included and preference was given to consensuses, guidelines, systematic reviews, and meta-analyses. Statements referring to the different aspects of the disease were formulated and voted upon by 24 gastroenterologists employing the Delphi method. Once a consensus on each statement was reached, the quality of evidence and strength of recommendation were determined through the GRADE system. RESULTS: Forty-eight statements were formulated, updating the information on IBS and adding the complementary data that did not appear in the 2009 Guidelines regarding the importance of exercise and diet, diagnostic strategies, and current therapy alternatives that were analyzed with more stringent scientific vigor or that emerged within the last 5 years. CONCLUSIONS: We present herein a consensus review of the most relevant advances in the study of IBS, updating and complementing the 2009 Guidelines. Several studies conducted in Mexico were included.
Subject(s)
Irritable Bowel Syndrome/therapy , Consensus , Delphi Technique , Evidence-Based Medicine , Guidelines as Topic , Humans , MexicoABSTRACT
INTRODUCTION: The goal of a comprehensive treatment in irritable bowel syndrome (IBS) patients should be the improvement of symptoms and improve the quality of life. AIM: To review the drugs recommended in IBS, their mechanisms of action, side effects, risks and benefits, contraindications, availability in our country and the evidence supporting their use. MATERIAL AND METHODS: A technical and narrative review which evaluated the articles published in national and world literature regarding the pharmacological treatment of IBS was performed. PubMed and IMBIOMED electronic databases were searched (until September 2009) using all descriptors regarding IBS and drug therapy. RESULTS: There is enough clinical evidence to recommend the use of antispasmodics (alone orin combination) and tricyclic antidepressants for pain treatment in IBS. Laxatives are useful in the management of chronic constipation, but there is little evidence in the management of IBS. Although, antiflatulents and antidiarrheals are widely used there is little information supporting its use. The use of a nonabsorbable antibiotic (rifaximin) is effective in a subgroup of IBS patients. Serotoninergics drugs have proven effective in relieving symptoms of IBS; however, these drugs require caution in their use. There are studies have shown that probiotics improve some symptoms of IBS. CONCLUSIONS: There are many effective treatment options in the symptomatic management of IBS. The choice of treatment should be based on the predominant symptoms of each patient.
Subject(s)
Irritable Bowel Syndrome/drug therapy , Alprostadil/analogs & derivatives , Alprostadil/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antidiarrheals/therapeutic use , Antifoaming Agents/therapeutic use , Humans , Laxatives/therapeutic use , Lubiprostone , Parasympatholytics/therapeutic use , Probiotics/therapeutic use , Psychotropic Drugs/therapeutic use , Serotonin Agents/therapeutic useABSTRACT
Multicenter and single centre clinical trials share methodological problems. Advantages and difficulties have to be learn in order to improve the quality of clinical investigation. In this review, the author analyze some of the domestic experience in the field, and focuss the discution in some issues that may offer particular advantage and difficulties in multicentre clinical trials.
Subject(s)
Clinical Trials as Topic/methods , Multicenter Studies as Topic , Cooperative Behavior , Gastroenterology/organization & administration , Humans , Mexico , Patient Selection , Research DesignABSTRACT
Eighty-seven records of patients with a radiologic diagnosis of benign ulcer, cancer or non-specific gastric changes and with a final diagnosis confirmed by biopsy, surgery or follow-up were analyzed to find out whether gastroscopy was useful. In patients with radiologic diagnosis of benign ulcer, gastroscopy was useful in 87% of the cases. When radiology suspected gastric cancer, gastroscopy established the diagnosis in two thirds of the cases. When the radiologist considered a diagnosis as certain his accuracy and specificity were comparable with those of the endoscopist. In such cases endoscopy is only confirmatory. In 7 patients with a radiologic diagnosis of non-specific gastric changes gastroscopy established diagnosis in 6. We concluded that gastroscopy is useful for the patient with a diagnosis of benign ulcer, non-specific gastric changes, or suspicion of gastric cancer. When diagnosis of gastric cancer is established by radiology, gastroscopy is not useful.
