Practical approach to irritable bowel syndrome-diarrhea beyond low-FODMAP diet.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered defecation, usually accompanied by abdominal bloating or distension. The integrated model of bidirectional interaction between the central, autonomic, enteric nervous system, the microbiome, and the gut barrier allows a better understanding of the pathophysiology of IBS, as well as consideration of potential therapeutic strategies. IBS with predominant diarrhea (IBS-D) represents a therapeutic challenge. Dietary changes or restrictions are most commonly used by patients in an attempt at symptom control. Therefore, a number of diets, especially low-FODMAP diet, have increasingly gained interest as a therapy for IBS-D or mixed IBS. However, this kind of diet, while effective, is not exempt of problems. It is therefore necessary that other therapeutic options be considered while bearing pathophysiological mechanisms and general symptom management in mind.

Risk of COVID-19 transmission in esophageal, anorectal manometry and 24-hour impedance-pH monitoring.

BACKGROUND: the impact of the COVID-19 pandemic has led to the interruption of most manometry or impedance-pH monitoring studies. The risk of restarting activities is unknown. OBJECTIVE: assess the risk of SARS-CoV-2 virus infection, both to patients and healthcare workers, in relation to esophageal and anorectal functional tests during the pandemic without protective measures. METHOD: a questionnaire was designed to determine whether patients and healthcare workers had COVID-19, confirmed by either a test or compatible symptoms, after functional studies were performed from January until March 2020. RESULTS: the survey was answered by 263 (92.9 %) patients. Four (1.52 %) patients had confirmed COVID-19 in the two weeks after the functional test (adjusted rate 8.34 cases per 1,000 [95 % CI -0.06-16.74], OR 0.84 [95 % CI: 0.83-0.85], p < 0.001) and no patient after anorectal manometry. Another five had only compatible symptoms, for a total of nine patients (3.42 %) (adjusted rate 27.50 cases/1,000 [95 % CI: 7.27-47.74], OR 2.84 [95 % CI: 2.81-2.87]). In the total study period, 18.25 % had confirmed COVID-19 or compatible symptoms. The average number of days between the procedure and the first day of symptoms was progressively shortened (January: 56 days, February: 33 days, March: 10.5 days). Two of ten healthcare workers (20 %) had confirmed COVID-19. CONCLUSIONS: the risk of COVID-19 infection when performing functional tests is low and more related to the evolution of the pandemic rather than to the procedure itself. The small number of healthcare workers included in the study does not allow a definitive conclusion to be drawn on their risk of infection.

Síndrome de defecación obstructiva. Un reto diagnóstico y terapéutico / No disponible

El síndrome de defecación obstructiva es causa de estreñimiento con sensación de bloqueo anal y defecación incompleta. Puede ser secundario a múltiples causas, tanto anatómicas o estructurales como funcionales. En un número significativo de pacientes pueden coexistir diversos factores etiológicos, por lo que se trata de una entidad compleja y multifactorial. En consecuencia, se requiere una evaluación diagnóstica que incluya estudios para evaluar tanto la anatomía como la función. El acuerdo entre los distintos test diagnósticos es limitado, lo que obliga a su análisis individualizado en cada paciente. A la hora de diseñar una estrategia terapéutica también hay que considerar los aspectos funcionales y las posibles alteraciones anatómicas. Por todo ello, esta entidad supone un reto tanto diagnóstico como terapéutico

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Obstructed defecation syndrome: a diagnostic and therapeutic challenge.

Obstructed defecation syndrome produces constipation with anal blockage and a feeling of incomplete evacuation, due to either anatomic and functional causes. This is a complex and multifactorial entity due to diverse etiological factors that may coexist in many patients. Therefore, a diagnostic approach requires structural and functional assessment. The concordance between findings of diagnostic tests is suboptimal, thus an individualized analysis is mandatory in each patient. Therapeutic strategies require the best understanding of anatomic and functional aspects. Consequently, this entity is a diagnostic and therapeutic challenge.

Estudio comparativo del tratamiento médico frente al quirúrgico en el control ácido del esófago de Barrett / A comparison of medical versus surgical treatment in Barrett's esophagus acid control

INTRODUCCIÓN: El esófago de Barrett (EB) es una lesión esofágica ocasionada mayoritariamente por reflujo gastroesofágico ácido. El control del reflujo ácido es uno de los principales objetivos del tratamiento de esta patología. OBJETIVO: Evaluar en nuestra área de salud el grado de control del reflujo ácido en los pacientes con EB en función del tratamiento de mantenimiento recibido, médico o quirúrgico. MÉTODOS: Estudio retrospectivo de pacientes con diagnóstico endoscópico e histológico de EB. Un grupo de pacientes recibió tratamiento médico con inhibidores de la bomba de protones (IBP) y otro grupo fue sometido a intervención quirúrgica (funduplicatura de Nissen). Se compararon datos epidemiológicos y resultados de pHmetría (tiempo de pH < 4, reflujos prolongados > 5 min, puntuación de DeMeester) de cada grupo. La pH-metría se realizó con IBP en el grupo de tratamiento médico y en el grupo de cirugía sin consumo de antisecretores ácidos. Se definió fracaso del tratamiento como un pH < 4 total superior al 5%. RESULTADOS: Fueron incluidos 128 pacientes con EB (tratamiento médico 75, tratamiento quirúrgico 53). Ambas cohortes eran homogéneas respecto a sus características demográficas. Las puntuaciones de DeMeester, fracción de tiempo de pH < 4 y cantidad de reflujos prolongados fueron significativamente inferiores en los pacientes con funduplicatura frente a los que recibían IBP (p < 0,001). De forma global se apreció un fracaso de tratamiento en el 29% de los pacientes, que fue significativamente mayor en el grupo de tratamiento médico (40% vs 13%; p < 0,001). CONCLUSIONES: El grado de control del reflujo ácido gastroesofágico es subóptimo en un elevado porcentaje de pacientes con EB. El tratamiento médico ofrece resultados inferiores a la cirugía antirreflujo y se debería intentar optimizar sus resultados

INTRODUCTION: Barrett's oesophagus (BE) is an oesophageal injury caused by gastroesophageal acid reflux. One of the main aims of treatment in BE is to achieve adequate acid reflux control. OBJECTIVE: To assess acid reflux control in patients with BE based on the therapy employed: medical or surgical. METHODS: A retrospective study was performed in patients with an endoscopic and histological diagnosis of BE. Medical therapy with proton pump inhibitors (PPI) was compared with surgical treatment (Nissen fundoplication). Epidemiological data and the results of pH monitoring (pH time < 4, prolonged reflux > 5min, DeMeester score) were evaluated in each group. Treatment failure was defined as a pH lower than 4 for more than 5% of the recording time. RESULTS: A total of 128 patients with BE were included (75 PPI-treated and 53 surgically-treated patients). Patients included in the two comparison groups were homogeneous in terms of demographic characteristics. DeMeester scores, fraction of time pH < 4 and the number of prolonged refluxes were significantly lower in patients with fundoplication versus those receiving PPIs (P < .001). Treatment failure occurred in 29% of patients and was significantly higher in those receiving medical therapy (40% vs 13%; P < .001). CONCLUSIONS: Treatment results were significantly worse with medical treatment than with anti-reflux surgery and should be optimized to improve acid reflux control in BE. Additional evidence is needed to fully elucidate the utility of PPI in this disease

Reactivación de tuberculosis pulmonar durante el tratamiento con triple terapia de la hepatitis C / Reactivation of pulmonary tuberculosis during treatment with triple therapy for hepatitis C

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[A comparison of medical versus surgical treatment in Barrett's esophagus acid control]. / Estudio comparativo del tratamiento médico frente al quirúrgico en el control ácido del esófago de Barrett.

INTRODUCTION: Barrett's oesophagus (BE) is an oesophageal injury caused by gastroesophageal acid reflux. One of the main aims of treatment in BE is to achieve adequate acid reflux control. OBJECTIVE: To assess acid reflux control in patients with BE based on the therapy employed: medical or surgical. METHODS: A retrospective study was performed in patients with an endoscopic and histological diagnosis of BE. Medical therapy with proton pump inhibitors (PPI) was compared with surgical treatment (Nissen fundoplication). Epidemiological data and the results of pH monitoring (pH time <4, prolonged reflux >5min, DeMeester score) were evaluated in each group. Treatment failure was defined as a pH lower than 4 for more than 5% of the recording time. RESULTS: A total of 128 patients with BE were included (75 PPI-treated and 53 surgically-treated patients). Patients included in the two comparison groups were homogeneous in terms of demographic characteristics. DeMeester scores, fraction of time pH<4 and the number of prolonged refluxes were significantly lower in patients with fundoplication versus those receiving PPIs (P<.001). Treatment failure occurred in 29% of patients and was significantly higher in those receiving medical therapy (40% vs 13%; P<.001). CONCLUSIONS: Treatment results were significantly worse with medical treatment than with anti-reflux surgery and should be optimized to improve acid reflux control in BE. Additional evidence is needed to fully elucidate the utility of PPI in this disease.

Hepatitis asociada a acetato de glatirámero / Hepatitis induced by glatiramer acetate

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Hemosuccus pancreático, una causa rara de hemorragia digestiva alta / Pancreatic hemosuccus, a rare cause of upper gastrointestinal bleeding

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