ABSTRACT
Abstract Introduction: This review article develops the basic principles for the use and action mechanisms of neuromodulators applied in clinical practice and their role in treating different disorders of gutbrain interaction (DGBI), particularly, esophageal disorders in part I. Materials and methods: The working group reviewed the most frequent pathologies and medications used according to the most recent literature and presented those with the best clinical evidence in each case. Results: Due to the diversity of disorders, types of studies, and therapeutic options, we decided to present the evidence with the best results for each case. We determined the doses used, their results, and the side effects of each one. Conclusions: The basic principles of the use and mechanisms of action of the main neuromodulators were reviewed, including their use in this section in the main esophageal gastrointestinal functional disorders. Given that the available evidence is not definitive, more controlled clinical trials are needed for each condition to confirm the effectiveness and safety of neuromodulators.
Resumen Introducción: En este artículo de revisión se desarrollan los principios básicos para el uso y los mecanismos de acción de los neuromoduladores utilizados en la práctica clínica y su papel en el tratamiento de los diferentes trastornos de la interacción cerebro-intestino (TICI), particularmente los esofágicos en la parte I. Materiales y métodos: El grupo de trabajo revisó las patologías más frecuentes y los medicamentos utilizados según la bibliografía más reciente, y presenta a los que tienen la mejor evidencia clínica en cada caso. Resultados: Debido a la diversidad de trastornos, tipos de estudios y opciones terapéuticas, se decide presentar las evidencias con los mejores resultados para cada caso, y en cada uno se determinan las dosis utilizadas, sus resultados y efectos colaterales. Conclusiones: Se revisan los principios básicos del uso y mecanismos de acción de los principales neuromoduladores, así como la utilización de los mismos en esta sección en los principales trastornos funcionales gastrointestinales esofágicos. Dado que la evidencia disponible no resulta definitiva, para cada condición se requieren más experimentos clínicos controlados que puedan confirmar la efectividad y seguridad de los neuromoduladores.
ABSTRACT
Irritable bowel syndrome (IBS) and vitamin D deficiency are common among children in Latin America. Previous studies show that Bifidobacterium longum35624TM improves IBS symptoms in adults. This real-world, single-arm, open-label study conducted in Chile investigated the effects of B. longum 35624 (1 × 109 colony-forming units, 12 weeks) on gastrointestinal symptoms (adapted IBS severity scoring system [IBS-SSS]; adapted Questionnaire on Pediatric Gastrointestinal Symptoms [QPGS], and Bristol Stool Form Scale) in 64 children and adolescents (8-18 years) and explored the relationship with baseline vitamin D status. Improvements in all IBS-SSS domains and composite score were observed at week 6 and 12 (p < 0.0007 versus baseline), with 98.3% of participants experiencing numerical improvements in ≥3 domains. Clinically meaningful improvement was seen in 96.6% of participants. The distribution of IBS-SSS severity categories shifted from moderate/severe at baseline to mild/remission (p < 0.0001). Improvements were not maintained during the two-week washout. Low baseline serum vitamin D levels did not correlate to IBS severity or probiotic response. QPGS significantly decreased from baseline to week 6 (p = 0.0005) and 12 (p = 0.02). B. longum 35624 may improve IBS symptoms in children and adolescents, even those with vitamin D deficiency. A confirmatory randomized controlled trial and further exploration of probiotic response and vitamin D status are needed.
Subject(s)
Bifidobacterium longum , Irritable Bowel Syndrome , Probiotics , Humans , Irritable Bowel Syndrome/microbiology , Adolescent , Child , Probiotics/therapeutic use , Male , Female , Chile , Treatment Outcome , Severity of Illness Index , Vitamin D/blood , Vitamin D Deficiency/blood , Vitamin D Deficiency/drug therapyABSTRACT
BACKGROUND: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. METHODS: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs. KEY RESULTS: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7-44.9) vs. without: 14.5% (12.0-17.0); and in subjects with distension by VDs: 29.4% (25.4-33.3) vs. without: 17.2% (14.9-19.5). Among subjects with bowel disorders, those with IBS reported bloating/distension by pictograms the most (93.8%) and those with functional diarrhea the least (71.4%). CONCLUSIONS & INFERENCES: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research.
Subject(s)
Irritable Bowel Syndrome , Pictorial Works as Topic , Humans , Gases , Intestines/physiology , Intestines/physiopathology , Mexico/epidemiology , Rome , Surveys and QuestionnairesABSTRACT
BACKGROUND: In Latin America, there are scarce data on the epidemiology of DGBI. The Rome Foundation Global Epidemiology Study (RFGES) Internet survey included 26 countries, four from Latin America: Argentina, Brazil, Colombia, and Mexico, with a 40.3% prevalence of Rome IV DGBI. We aimed at comparing the prevalence of DGBI and associated factors among these countries. METHODS: The frequency of DGBI by anatomical region, specific diagnoses, sex, age, diet, healthcare access, anxiety, depression, and HRQOL, were analyzed and compared. RESULTS: Subjects included Argentina n = 2057, Brazil = 2004, Colombia = 2007, and Mexico = 2001. The most common DGBI were bowel (35.5%), gastroduodenal (11.9%), and anorectal (10.0%). Argentina had the highest prevalence of functional diarrhea (p = 0.006) and IBS-D; Brazil, esophageal, gastroduodenal disorders, and functional dyspepsia; Mexico functional heartburn (all <0.001). Overall, DGBI were more common in women vs. men and decreased with age. Bowel disorders were more common in the 18-39 (46%) vs. 40-64-year (39%) groups. Diet was also different between those with DGBI vs. those without with subtle differences between countries. Subjects endorsing criteria for esophageal, gastroduodenal, and anorectal disorders from Mexico, more commonly consulted physicians for bowel symptoms vs. those from Argentina, Brazil, and Colombia. General practitioners were the most frequently consulted, by Mexicans (50.42%) and Colombians (40.80%), followed by gastroenterologists. Anxiety and depression were more common in DGBI individuals in Argentina and Brazil vs. Mexico and Colombia, and they had lower HRQOL. CONCLUSIONS: The prevalence of upper and lower DGBI, as well as the burden of illness, psychological impact and HRQOL, differ between these Latin American countries.