The Mexican consensus on fecal incontinence.

Fecal incontinence is the involuntary passage or the incapacity to control the release of fecal matter through the anus. It is a condition that significantly impairs quality of life in those that suffer from it, given that it affects body image, self-esteem, and interferes with everyday activities, in turn, favoring social isolation. There are no guidelines or consensus in Mexico on the topic, and so the Asociación Mexicana de Gastroenterología brought together a multidisciplinary group (gastroenterologists, neurogastroenterologists, and surgeons) to carry out the «Mexican consensus on fecal incontinence¼ and establish useful recommendations for the medical community. The present document presents the formulated recommendations in 35 statements. Fecal incontinence is known to be a frequent entity whose incidence increases as individuals age, but one that is under-recognized. The pathophysiology of incontinence is complex and multifactorial, and in most cases, there is more than one associated risk factor. Even though there is no diagnostic gold standard, the combination of tests that evaluate structure (endoanal ultrasound) and function (anorectal manometry) should be recommended in all cases. Treatment should also be multidisciplinary and general measures and drugs (lidamidine, loperamide) are recommended, as well as non-pharmacologic interventions, such as biofeedback therapy, in selected cases. Likewise, surgical treatment should be offered to selected patients and performed by experts.

Inflammatory bowel disease in Mexico: Epidemiology, burden of disease, and treatment trends. / Epidemiología, carga de la enfermedad y tendencias de tratamiento de la enfermedad inflamatoria intestinal en México.

INTRODUCTION AND AIMS: There is no systematized information for determining/monitoring the burden of inflammatory bowel disease in Mexico. The aim of the present study was to estimate the annual burden of inflammatory bowel disease on the Mexican National Healthcare System, by number of patients seen, hospitalizations, and specific deaths, stratified into age groups. MATERIALS AND METHODS: Utilizing specific databases of the Mexican National Healthcare System registries coded as ICD-10: K50 and K51, we retrieved and analyzed the data corresponding to the patients seen and hospitalized in 2015, stratified by age group, as well as the specific deaths. Treatment trends among physicians were also examined. RESULTS: In 2015, 5,009 women (8.1) and 4,944 men (8.4) with Crohn's disease received medical attention (prevalence of cases seen) and 35.1% of those patients were ≥50years of age. In that same period, 17,177 women (27.7) and 15,883 men (26.9) with ulcerative colitis were seen and 31.6% of those patients were ≥50years of age. The hospitalized cases (prevalence of hospitalized cases) were 1,097 patients (0.91) with Crohn's disease and 43.7% of those patients were ≥50years of age; and 5,345 patients (4.42) with ulcerative colitis and 47.6% of those patients were ≥50years of age. Deaths (specific mortality rate) were: 32 women (0.52) and 36 men (0.50) due to Crohn's disease, and 267 women (4.31) and 186 men (3.15) due to ulcerative colitis. CONCLUSIONS: Inflammatory bowel disease is a burden on the health of Mexican adults and the Mexican National Healthcare System, and it is expected to increase over the next 15years.

The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon. / Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon.

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.

Consenso mexicano sobre el diagnóstico y tratamiento de la enfermedad diverticular del colon / The Mexican consensus on the diagnosis and treatment of diverticular disease of the colon

Desde la publicación en 2008 de las guías de diagnóstico y tratamiento de la enfermedad diverticular del colon de la Asociación Mexicana de Gastroenterología ha habido avances significativos en el conocimiento de esta enfermedad. Se realizó una revisión sistemática de la literatura en PubMed de enero de 2008 a julio de 2018 con el fin de revisar y actualizar las guías 2008 y proporcionar nuevas recomendaciones basadas en la evidencia. Se incluyeron todas las publicaciones en español e inglés, de alta calidad. Se redactaron los enunciados, que fueron votados utilizando el método Delphi. Se estableció la calidad de la evidencia y la fuerza de las recomendaciones según el sistema GRADE para cada enunciado. Cuarenta y tres enunciados fueron finalmente votados y calificados. Se informan nuevos datos sobre definición, clasificación, epidemiología, fisiopatología y factores de riesgo. Se revisó con especial énfasis la utilidad de la tomografía computarizada y de la colonoscopia, así como los métodos endoscópicos para el control de la hemorragia. Se discutió sobre el tratamiento ambulatorio de la diverticulitis no complicada, el papel de la rifaximina y la mesalazina, en el manejo de la diverticulitis aguda complicada tanto en sus alternativas mínimamente invasivas hasta las opciones quirúrgicas con énfasis en sus indicaciones, limitaciones y contraindicaciones. Los nuevos enunciados proporcionan directrices basadas en la evidencia actualizada. Se presentan la discusión, el grado y la fuerza de la recomendación de cada uno de ellos.

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.

[Anal intraepithelial neoplasia (NIA) and infection with human papillomavirus (HPV) in anoreceptive patients]. / La neoplasia intraepitelial anal y la infección por virus del papiloma humano en pacientes anorreceptivos.

BACKGROUND: An association between human papilloma virus (HPV) infection and progression to anal intraepithelial neoplasia (AIN) and epidermoid cancer has been established. OBJECTIVE: To know the prevalence of low and high grade AIN, as well as HPV infection in an anoreceptive patients group, infected or not, by human immunodeficiency virus (HIV). MATERIAL AND METHODS: All patients with anoreceptive sexual relations were considered in this study. Patients who accepted anal citology and high definition anoscopy and biopsies with a follow-up not minor of 3 months were included. RESULTS: Forty-four patients were included: 40 male (90.9%) with average age of 31 years. Anal cytology showed inflammatory alterations in 21 patients (28%), low grade intraepithelial lesion in 23 (52%); there were not patients with high grade epithelial lesion. According to the high definition anoscopy, there were low grade intraepithelial lesion in 42 patients (95%) and high grade in 2 (5%). Biopsy showed low grade intraepithelial in 26 patients (59%), high grade in 4 (9%) and inflammatory alterations in 14 (32%). The prevalence of AIN and HPV infection was 68% in both diseases. The HIV infection was associated with the presence of high grade AIN (p=0.002, OR 47.7) CONCLUSIONS: There is a high prevalence of AIN and HPV infection between patients with anoreceptive sexual relations. The HIV infection is a risk factor for the development of high grade AIN.

[Epidemiological characteristics of colorectal cancer in the General Hospital of Mexico. A 20 years analysis: 1988-2007]. / Comportamiento epidemiológico del cáncer de colon y recto en el Hospital General de México. Análisis de 20 años: 1988-2007.

INTRODUCTION: Distribution of colon and rectal tumors has been studied by many authors, which have considered that distal colon and rectum are more affected. However, its frequency and distribution have changed in recent years. OBJECTIVE: A descriptive analysis of colorectal cancer in the General Hospital of Mexico during the last 20 years (1988-2007). MATERIAL AND METHODS: This is a transversal comparative study between decades from the database of the Pathology Service of the General Hospital of Mexico, of cases of cancer diagnosed from January 1988 to December 2007. Variables included age, gender, anatomic site of the tumor,grade of differentiation, stadification and type of surgery. RESULTS: There were 222 cases from 1988 to 1997 and 400 cases from 1998 to 2007. 115 (52%) were female in the firs decade and 210 (53%) in the second. We found a prevalence of 71 cases (32%) for the proximal colon, 24 (11%) for the distal colon and 127 (57%) for the rectum in the first decade; in second decade there were 182 (45%) cases for the proximal colon, 50 (13%) for the distal colon and 168 (42%) for the rectum. CONCLUSIONS: The number of colorectal cancerduring the last decade almost doubled in our hospital (80%); we also found an increase in the number of proximal tumors and a decreasein the number of rectal tumors.

[Infrared photocoagulation in the treatment of hemorrhoids]. / La fotocoagulación por rayos infrarrojos en el tratamiento de la enfermedad hemorroidaria.

PURPOSE: The aim of this study was to determine the efficacy of infrared photocoagulation in the treatment of grades I and II of hemorrhoidal disease. MATERIAL AND METHODS: 60 patients with hemorrhoidal disease grades I and II were included, each one with transanal bleeding as the only symptom, without any other ano-rectal pathology. They were 30 male and 30 female patients, with 39.9 years as median age. Each had 1 to 4 photocoagulation sessions, according to the results obtained in each one. TECHNIC: Each application was 1.5 seconds duration, once every two weeks, in diamond or rainbow shape; 1 to 4 sessions were required. Follow up was 24 months. RESULTS: Good results were obtained in 66.6% since the second application, and in 93.4% at the end of the study; 4 (6.6%) patients were failures and had to be operated on. CONCLUSION: Treatment of hemorrhoidal disease grades I and II with infrared photocoagulation is an excellent alternative; it is painless, suitable as an outpatient procedure and its cost is low.